From the Guidelines
The most effective treatment for THC hyperemesis syndrome is complete cessation of cannabis use, which can lead to resolution of symptoms after a period of abstinence for at least 6 months. In the acute phase, management of symptoms is crucial, and this can be achieved through a combination of treatments. For symptom control, patients may receive intravenous fluids for dehydration and antiemetics such as ondansetron, although its effectiveness may be limited 1. Other options like haloperidol and benzodiazepines may provide better relief. Topical capsaicin cream applied to the abdomen can also help by depleting substance P and desensitizing TRPV1 receptors, as suggested by recent clinical practice updates 1.
Key Components of Treatment
- Complete cessation of cannabis use
- Intravenous fluids for dehydration
- Antiemetics for symptom control, considering the potential limited effectiveness of conventional options
- Topical capsaicin cream for symptom management
- Psychological support and substance use counseling for long-term management
Long-term Management
For long-term management, it is essential that patients understand the importance of maintaining cannabis abstinence, as continued use can lead to persistence or recurrence of symptoms due to the accumulation of THC in fat cells and its disruptive effect on the normal endocannabinoid system function 1. Psychological support and substance use counseling are critical components of treatment to help patients achieve and maintain abstinence.
Considerations
- Opioids should be avoided due to the risk of worsening nausea and high risk of addiction 1.
- Hot showers or baths can provide temporary symptom relief, likely due to the effect of heat on the hypothalamus.
- The clinical approach in the emergency department (ED) requires immediate evaluation for life-threatening disorders, and differential diagnosis in the outpatient setting should consider other conditions such as rumination syndrome, gastroparesis, and functional chronic nausea and vomiting syndrome after excluding structural abnormalities 1.
From the Research
Treatment Options for THC Hyperemesis Syndrome
- The primary treatment for THC hyperemesis syndrome is cessation of cannabis use 2, 3.
- Pharmacological therapies that may be utilized in the emergency department include dopamine antagonists such as haloperidol and droperidol, conventional antiemetics such as ondansetron and metoclopramide, and topical capsaicin 4.
- Topical capsaicin has been shown to be effective in relieving symptoms of THC hyperemesis syndrome, with all 13 patients in one study experiencing symptom relief after administration of capsaicin cream 5.
- Other treatments that have been reported as effective include tricyclic antidepressants, lorazepam, benzodiazepines, and antiepileptics such as zonisamide and levetiracetam 6.
- Hot showers and baths have also been cited as universally effective in relieving symptoms of THC hyperemesis syndrome 6.
Non-Pharmacological Therapies
- Hot water bathing is a common non-pharmacological therapy used to relieve symptoms of THC hyperemesis syndrome 2, 3, 6.
- Specialist addiction teams may also be useful in managing THC hyperemesis syndrome, particularly in promoting early recognition and referral to addiction specialists 3.