From the Guidelines
The most effective treatment for cannabinoid hyperemesis syndrome (CHS) is complete cessation of cannabis use for at least 6 months, or at least equal to the total duration of 3 typical vomiting cycles in that patient, as this leads to resolution of symptoms.
Key Treatment Strategies
- Cannabis cessation is the primary treatment for long-term resolution of symptoms, with a recommended abstinence period of at least 6 months, or at least equal to the total duration of 3 typical vomiting cycles in that patient, as supported by the 2024 study published in Gastroenterology 1.
- For acute and short-term care, topical capsaicin, benzodiazepines, haloperidol, promethazine, olanzapine, and ondansetron may be used, with topical capsaicin (0.1%) cream being a potential option for symptom improvement, as noted in the same study 1.
- Opioids should be avoided due to the risk of worsening nausea and high risk of addiction, as cautioned in the study 1.
- For long-term management, counseling to achieve marijuana cessation and tricyclic antidepressants, such as amitriptyline, are the mainstay of therapy, with a minimal effective dose of 75–100 mg at bedtime, starting at 25 mg and titrating the dose with increments each week to reach minimal effective dose, as recommended in the study 1.
Additional Considerations
- The clinical approach in the emergency department (ED) requires immediate evaluation for life-threatening disorders, such as acute abdomen, bowel obstruction, mesenteric ischemia, pancreatitis, and myocardial infarction, among others, as highlighted in the study 1.
- Differential diagnosis in the outpatient setting after exclusion of structural abnormalities includes rumination syndrome, gastroparesis, CVS, pregnancy, migraine, and functional chronic nausea and vomiting syndrome, as noted in the study 1.
From the Research
Treatment Options for Cannabinoid Hyperemesis Syndrome
- The primary treatment for cannabinoid hyperemesis syndrome (CHS) is cessation of cannabis use, as it is the only intervention that provides complete symptom relief 2, 3, 4.
- Pharmacological management of CHS includes the use of analgesics, antiemetics, antipsychotics, beta blockers, and transient receptor potential vanilloid (TRPV) agonists 2.
- Classic antiemetics may be tried initially but often fail to alleviate CHS, while antipsychotics such as haloperidol, benzodiazepines, and/or capsaicin cream appear to be the most efficacious in treating this unique disorder 2, 3, 5.
- Topical capsaicin has been shown to be a promising intervention for CHS, providing dramatic relief within 24 hours in some cases 6, 4, 5.
Symptom Management
- Symptom relief can be achieved through the use of hot showers and baths (hydrothermotherapy) 2, 3, 4.
- Avoidance of opioids is recommended, as they may be harmful and lack evidence for effectiveness in treating CHS 3, 4.
- Conventional antiemetics, including antihistamines, serotonin antagonists, dopamine antagonists, and benzodiazepines, may have limited effectiveness in treating CHS 3, 4.
Diagnosis and Treatment Guidelines
- A novel treatment guideline has been established to unite the emergency department community in the treatment of CHS, focusing on symptom relief, education on cannabis cessation, and avoidance of unnecessary opioids 3.
- Directed questions about cannabis use and the effect of hydrothermotherapy on CHS symptoms can frequently confirm the diagnosis, enabling appropriate pharmacotherapy and referral to addiction treatment 2.
- Clinicians and public health officials should identify and treat CHS patients with strategies that decrease exposure to opioids, minimize use of healthcare resources, and maximize patient safety 3, 4.