"The result may lead more doctors to prescribe the drug metoclopramide and women to feel less guilty about using it during their baby's crucial first few months of development, experts said," she reported. Johnson never mentioned the black box for TD in her articles.
The June 10, headline for the same article on the MSNBC Website read: "Morning sickness drug shown safe for babies." On June 11, a Johnson article appeared in the Boston Globe and the same story was in the Durango Herald News as late as June 22.
To begin with, running headlines claiming that Reglan is safe based on the NEJM study was misleading and irresponsible because the majority of women, 2,502 out of 3,458, only took Reglan for 7 days, or less, in the first trimester. The average duration of fetal exposure was about a week. Only 164 took the drug for 22 days or more. Plus, the study only looked at harm at birth with no later follow-up on the babies.
There was no mention in the actual study of the black box for TD, or any other adverse effects, that could harm the mom or the fetus. Yet, the Los Angeles Times ran a June 10, story with claims that the "first study of the anti-nausea drug metoclopramide in pregnant women has found that it is safe for both fetuses and mothers." The Times failed to mention any side effects but included the main talking point that as "many as 80% of pregnant women suffer morning sickness in the first trimester."
Huge Customer Base
Over four million women give birth each year in the US, according to the CDC. The study reported that between 50% and 80% of pregnant women get morning sickness. Those numbers translate into between 2 and 3.2 million new Relgan customers in the US alone, year in and year out.
The women in the NEJM study took three 10mg tablets per day. The current price of Reglan at DrugStore.com is $182 for 100 tablets. Each pregnant woman could buy 2 or 3 months of Reglan for the first trimester, plus the study notes that nausea and vomiting "can continue beyond the first trimester." Two months of the drug at a cost of $364, times 2.5 million women, could potentially ring up $910 million each year.
It sounds like the study's kick-off will definitely boost sales. "I think that women will be comforted by this," Dr Keith Eddleman, director of obstetrics at Mount Sinai Medical Center in New York, told Johnson in an AP article. "Most women are reluctant (to take anti-nausea medicine) just because of the stories they've heard and the perception that taking something in the first trimester can cause harm."
"There are very few drugs approved for use in the first trimester of pregnancy," Dr Jennifer Niebyl, a professor of obstetrics and gynecology at the University of Iowa, told Time Magazine on June 10, 2009.
"But this study could lead to metoclopramide getting approved to treat morning sickness because this is good data with big numbers," she said. "These findings may change practice and help people to be less hesitant to use the drug."
Dr Laura Riley, a Massachusetts General Hospital obstetrician and spokeswoman for the Society for Maternal Fetal Medicine, told Johnson women are far more cautious than doctors about medication. "For some who are on the fence, it'll allow them to take it."
The chairman of obstetrics and gynecology at St John's Health Center in Santa Monica, Dr James Moran, told the LA Times that he thinks the findings should be replicated but that he "wouldn't hesitate to use Reglan at all."
Infants heavily dosed
Reglan is also marketed off-label to nursing mothers to stimulate breast milk even though the medication guide warns women that the drug "can pass into breast milk and may harm your baby."
Reglan is also used to treat GERD in newborns, especially premature babies. Any use with infants is off-label. Yet a study in the June 2006, Pediatrics journal titled, "Reported Medication Use in the Neonatal Intensive Care Unit: Data From a Large National Data Set," found Reglan was one of the 10 drugs reported most commonly for the NICU.