What is the recommended dosage of capsaicin for the treatment of Cannabinoid Hyperemesis Syndrome (CHS)?

From the Guidelines

The recommended dosage of capsaicin for the treatment of Cannabinoid Hyperemesis Syndrome (CHS) is a topical application of 0.1% capsaicin cream. This dosage is based on the most recent and highest quality study available, which suggests that topical capsaicin may improve symptoms by activation of transient receptor potential vanilloid type 1 receptors 1. The application of 0.1% capsaicin cream should be done with close monitoring of efficacy and adverse effects.

Key Considerations

• The treatment of CHS should prioritize cannabis cessation, which is the definitive treatment for this condition 1.
• Topical capsaicin is used for acute and short-term care, while counseling to achieve marijuana cessation and tricyclic antidepressants are the mainstay of long-term therapy 1.
• Opioids should be avoided due to worsening of nausea and high risk of addiction 1.

Administration and Monitoring

• The 0.1% capsaicin cream should be applied topically, with the patient washing their hands immediately after application to avoid transferring capsaicin to sensitive areas.
• Patients may experience a burning sensation upon application, which typically diminishes with continued use.
• The treatment should continue until symptoms resolve, with multiple applications possibly needed during an acute episode.

From the Research

Capsaicin Dosage for HCS

• The recommended dosage of capsaicin for the treatment of Cannabinoid Hyperemesis Syndrome (CHS) is not explicitly stated in the provided studies, but the following concentrations and application methods were used:
  • 0.1% capsaicin cream applied to the anterior abdomen 2
  • Topical capsaicin cream applied over the epigastric region 3
  • Topical capsaicin cream for symptom management 4
• The application of topical capsaicin cream was associated with a significant reduction in nausea at 60 minutes but not at 30 minutes, and provided more complete relief of nausea 2
• Capsaicin use was described as beneficial in all case series and case reports, although the methodological quality of the data is low 5
• The use of capsaicin for CHS may decrease emergency department length of stay, reduce the need for additional medications, and decrease opioid usage 6

Key Findings

• Topical capsaicin may be an effective treatment for CHS, with significant reductions in nausea and vomiting reported in several studies 4, 3, 2
• The exact dosage and application method of capsaicin for CHS are not well established, and further research is needed to determine the optimal treatment protocol 5
• Capsaicin may be a useful adjunctive treatment option for CHS, given its favorable risk-benefit profile and the limited data on alternative antiemetic therapies 5