A Randomized Comparative Study of Sharbat Tamarhindi Versus Doxylamine Succinate in Emesis Gravidarum (Qay-al-haml)

Emesis gravidarum also known as nausea and vomiting in pregnancy (NVP) It is a common condition with prevalence rates for nausea of 50–80% and for vomiting and retching of 50%.[1,2] It is a common reason for hospital attendance and admission in the pregnant woman.[3],[4] The beginning of emesis gravidarum is highly variable and is usually between the first and second missed menstrual cycle; it continues to 14 to 16 weeks of pregnancy and usually has the most severity from 7 to 9 weeks of pregnancy. In 50% of women, NVP resolves by the 14 weeks and in 90 percent of women by the 22 weeks.[5] NVP have significant adverse effect on the quality of women’s life.[4,6] NVP and their exact causes are still unknown so that hormonal, social, personal, psychological, racial and geographical factors are believed to be involved in their occurrence.[1,7] Treatment of nausea and vomiting also can be unsatisfactory because the available pharmacotherapy does not correct the fundamental underlying pathophysiological abnormalities.[8] Although there is medication available to treat NVP, some physicians and patients are reluctant to use these drugs due to reports of fetal malformations associated with antiemetic medications.[9] Ondansetron was quickly adopted as a first-line antiemetic for other causes of nausea and vomiting, including NVP.[10]  A possible association between ondansetron use in the first trimester and cleft palate has been reported.[11] Concerns about teratogenicity in the first trimester and more subtle effects on foetal development have dramatically limited the use of orthodox medicine.[12] Pregnant women often use medicinal herbs in an effort to maintain good health and reduce the need for medical intervention.[5,13] The term used for emesis gravidarum in Unani literature is Qay’al-hawamil.[14] And to treat this condition, Unani scholars have been described several safe drugs which have been mentioned for oral administration in a form of single drug as well as compound formations, like some basic single drug are Zanjabeel (Ginger), Amla (Gooseberry), Anar (Pomegranate), Leemu (Lemoon) and Tamarhindi (tamarind).[15] And compounds are sikanjabeen-e-sada, jawarish-e-anarain, jawarish-e-tamarhindi, sharbat-e-anar, sharbat-e-lemu, shikanjabeen-e-tamarhindi and sharbat-e-tamarhindi.[14,16] Among of all Sharbat-e-tamarhindi is an important antiemetic drug used in management of emesis in pregnancy in unani medicine.[14,16,17] Various study shown that tamarhindi ‘Tamarindus Indica’ has antiemetic property which help to treat emesis gravidarum, astringent, anthelmintic, antiseptic, healing, antimicrobial and antiviral properties.[18] Considering this facts it has been decided to conduct the clinical trial to evaluate the safety and efficacy of Sharbat-e-tamarhindi in comparison with doxylamine succinate in patient with nausea and vomiting in pregnancy.