From the Guidelines
The primary treatment for cannabis hyperemesis syndrome (CHS) is complete cessation of cannabis use, which is the only definitive way to resolve symptoms long-term, with resolution of symptoms after a period of abstinence from cannabis use for at least 6 months, or at least equal to the total duration of 3 typical vomiting cycles in that patient. During acute episodes, treatment focuses on symptom management including rehydration with intravenous fluids to address dehydration from persistent vomiting. Hot showers or baths provide temporary relief for many patients due to the effect of heat on TRPV1 receptors. Medications that can help include conventional antiemetics such as ondansetron (4-8mg every 6 hours), though these often have limited effectiveness in CHS. Haloperidol (0.5-2mg IV) and benzodiazepines like lorazepam (1-2mg) have shown better results for acute symptom control, as supported by the study 1. Topical capsaicin cream (0.1%) applied to the abdomen can also provide relief through similar mechanisms as hot showers. For long-term management, counseling to achieve marijuana cessation and tricyclic antidepressants, such as amitriptyline, are the mainstay of therapy, with the minimal effective dose being 75–100 mg at bedtime, starting at 25 mg and titrating the dose with increments each week to reach minimal effective dose, as recommended by the study 1.
Some key points to consider in the management of CHS include:
- Avoiding opioids due to worsening of nausea and high risk of addiction, as highlighted in the study 1
- Using acetaminophen or NSAIDs as preferred alternatives for pain management
- Recognizing that symptoms will return with resumed cannabis use, as CHS results from chronic cannabinoid effects on the endocannabinoid system in susceptible individuals, particularly affecting gut motility and nausea regulation, as explained in the study 1
- Being aware of the clinical diagnostic criteria for CHS, which include cyclic vomiting, nausea, and abdominal pain, and in some cases, prolonged bathing behavior, as described in the study 1
It is essential to note that the prevalence of CHS is rising, and it is becoming a frequent clinical problem, leading to visits to the emergency department (ED) and gastroenterology clinics, as reported in the study 1. Therefore, healthcare providers should be familiar with the diagnosis and management of CHS to provide optimal care for patients suffering from this condition.
From the Research
Treatment Options for Cannabis Hyperemesis Syndrome (CHS)
- The treatment for CHS is multifaceted and may involve a combination of pharmacological and non-pharmacological therapies 2, 3, 4, 5, 6.
- Benzodiazepines have been proposed as a treatment for CHS, as they decrease the activation of Cannabinoid Type 1 Receptor (CB1) in the frontal cortex and have a sedative and hypnotic effect 2.
- Other treatment options for CHS include:
- Cessation of cannabis use is considered the most effective treatment for CHS, as it can lead to complete resolution of symptoms 3, 4, 5.
- The use of droperidol in the treatment of CHS has been shown to reduce the length of hospital stay and the total number of antiemetic dosages administered 6.
Pharmacological Management of CHS
- The pharmacological management of CHS is complex and may involve the use of multiple medications 3, 4, 5, 6.
- Antipsychotics, benzodiazepines, and capsaicin cream may be effective in the treatment of CHS 3.
- Opioids and benzodiazepines should not be used as first-line therapy for CHS due to the risk of addiction and other adverse effects 4.