# VOMIT Trial: Mirtazapine vs Ondansetron for HG

Page: https://stenobird.com/podcast/dr-chapa-s-obgyn-clinical-pearls-334380/vomit-trial-mirtazapine-vs-ondansetron-for-hg
Text version: https://stenobird.com/podcast/dr-chapa-s-obgyn-clinical-pearls-334380/vomit-trial-mirtazapine-vs-ondansetron-for-hg.md
Podcast: [Dr. Chapa’s OBGYN Clinical Pearls](https://stenobird.com/podcast/dr-chapa-s-obgyn-clinical-pearls-334380)
Published: 2026-05-18T15:07:05+00:00
Episode link: https://podcasters.spotify.com/pod/show/dr-hector-chapa/episodes/VOMIT-Trial-Mirtazapine-vs-Ondansetron-for-HG-e3jhq35
Audio file: https://traffic.megaphone.fm/APO2849676959.mp3
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Duration seconds: 1332

## Resource

Hyperemesis gravidarum (HG) represents the most severe end of the nausea and vomiting of pregnancy spectrum. It has a reported incidence of approximately 0.3–3% of pregnancies and is the most common cause of hospitalization in early pregnancy and the second most common cause of hospitalization in pregnancy overall. In June 2024, the ACOG published a Clinical Expert series summarizing the inpatient management of HG. In that guidance, it describes mirtazapine as an “alternative pharmacologic” option. How effective is this medication compared to ondansetron? A new study (published ahead of print on 12/30/25 and officially out June 2026), out of Denmark, sheds some new light on this medication. This trial is the first double-blind RCT comparing mirtazapine to ondansetron AND placebo. Although a BIG limitation of this study exists (which we will discuss), it does provide some interesting insights. Listen in for details. 1. (ACOG CES) Clark, Shannon M. MD; Zhang, Xue MD; Goncharov, Daphne Arena MD. Inpatient Management of Hyperemesis Gravidarum. Obstetrics & Gynecology 143(6):p 745-758, June 2024. | DOI: 10.1097/AOG.0000000000005518 2. Ostenfeld, AnneDroogh, Marjoes et al.Mirtazapine or ondansetron for hyperemesis gravidarum. A randomized placebo-controlled trial. American Journal of Obstetrics & Gynecology, June 2026

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