There is No Recommended Dosage for "Tropical Pepsi" in Cannabinoid Hyperemesis Syndrome
"Tropical Pepsi" is not a recognized or evidence-based treatment for cannabinoid hyperemesis syndrome (CHS), and no medical literature supports its use. This appears to be either a misunderstanding or confusion with actual therapeutic interventions for CHS.
Evidence-Based Treatments for CHS
Definitive Treatment
- Cannabis cessation is the only definitive cure for CHS and should be the primary therapeutic goal 1, 2.
- Symptoms resolve after abstinence for at least 6 months or duration equal to 3 typical vomiting cycles 1, 2.
Acute Management in the Emergency Department
First-line pharmacological options:
- Haloperidol 5 mg IV has the strongest evidence for acute symptom relief and is superior to conventional antiemetics like ondansetron 3, 4.
- Droperidol (another butyrophenone) is also effective 1.
- Topical capsaicin 0.1% cream applied to the abdomen activates TRPV1 receptors and provides symptom relief 1, 2, 3.
Adjunctive therapies:
- Lorazepam 2 mg IV combined with haloperidol 5 mg IV has shown excellent results in case series 4.
- Benzodiazepines alone may provide relief by decreasing CB1 receptor activation in the frontal cortex and reducing anticipation of nausea 5.
Therapies with limited efficacy:
- Ondansetron and metoclopramide are generally poorly effective in CHS compared to their use in other conditions 1, 3.
- Avoid opioids as they worsen nausea and carry high addiction risk 1, 2, 3.
Long-Term Management
Pharmacological approach:
- Amitriptyline is the mainstay of long-term therapy: Start at 25 mg at bedtime, titrate weekly by 25 mg increments to reach the minimal effective dose of 75-100 mg 1, 2.
- Continue topical capsaicin 0.1% with close monitoring of efficacy and adverse effects 1.
Non-pharmacological essentials:
- Cannabis cessation counseling is mandatory 1, 2.
- Psychological support for comorbid anxiety and depression 2.
- Consider psychiatry co-management for treatment-resistant cases 2.
Common Pitfalls to Avoid
- Do not rely on conventional antiemetics (ondansetron, metoclopramide) as primary therapy—they are largely ineffective in CHS 1, 3.
- Do not prescribe opioids for symptom management as they exacerbate nausea 1, 2, 3.
- Do not miss the diagnosis by failing to ask about cannabis use patterns (>4 times weekly for >1 year) and characteristic hot shower relief 1, 2.
- Rule out life-threatening conditions first including acute abdomen, bowel obstruction, mesenteric ischemia, pancreatitis, and myocardial infarction before attributing symptoms to CHS 1.