From the Research
Decadron (dexamethasone) is not recommended as a first-line treatment for Cannabinoid Hyperemesis Syndrome (CHS). While dexamethasone is an anti-emetic that can help with nausea and vomiting in other conditions, there is limited evidence supporting its effectiveness specifically for CHS 1. The primary treatment for CHS involves cessation of cannabis use, which is essential for long-term resolution of symptoms. For acute symptom management, hot showers or baths often provide temporary relief due to the effect of heat on TRPV1 receptors. Conventional anti-emetics that may be more effective include ondansetron (Zofran), promethazine, or metoclopramide. Benzodiazepines such as lorazepam may also help reduce symptoms. Topical capsaicin cream applied to the abdomen has shown promise in some cases, with a study demonstrating its safety and efficacy in reducing ED length of stay and opioid usage 2. Intravenous hydration is important as patients are often dehydrated. The underlying mechanism of CHS involves dysregulation of the endocannabinoid system with chronic cannabis use, particularly affecting CB1 receptors and TRPV1 channels, which explains why traditional anti-emetics like dexamethasone may not be as effective for this specific syndrome.
Some key points to consider in the management of CHS include:
- Cessation of cannabis use is essential for long-term resolution of symptoms
- Hot showers or baths can provide temporary relief
- Conventional anti-emetics such as ondansetron, promethazine, or metoclopramide may be effective
- Benzodiazepines such as lorazepam may also help reduce symptoms
- Topical capsaicin cream has shown promise in some cases
- Intravenous hydration is important to prevent dehydration
It's worth noting that the most recent and highest quality study on this topic is from 2022, which suggests that antipsychotics, benzodiazepines, and/or capsaicin cream may be the most efficacious in the treatment of CHS 1. Therefore, dexamethasone is not a recommended treatment option for CHS, and other treatment options should be considered instead.