From the Guidelines
Olanzapine (Zyprexa) is a viable treatment option for cannabis hyperemesis syndrome (CHS), as evidenced by its inclusion in the management of acute and short-term care in a recent clinical practice update 1. When considering treatment for CHS, it's essential to prioritize cannabis cessation as the primary intervention, with medications providing symptomatic relief.
- Key points to consider:
- Olanzapine may be used for acute episodes, potentially repeated every 12-24 hours as needed, due to its ability to block multiple receptors involved in nausea and vomiting, including dopamine, serotonin, and histamine receptors.
- The dose of olanzapine can vary, but 5-10 mg given orally or as a dissolvable tablet is typically recommended.
- Common side effects of olanzapine include sedation, dizziness, and dry mouth.
- Other treatment options, such as topical capsaicin, benzodiazepines, haloperidol, promethazine, and ondansetron, may also be considered for acute and short-term care.
- Long-term management should focus on counseling to achieve marijuana cessation, with tricyclic antidepressants, such as amitriptyline, being the mainstay of therapy, starting at 25 mg and titrating the dose with increments each week to reach a minimal effective dose of 75–100 mg at bedtime.
- It's crucial to note that opioids should be avoided due to worsening of nausea and high risk of addiction, and the clinical approach in the emergency department (ED) requires immediate evaluation for life-threatening disorders. The most recent evidence suggests that olanzapine can be an effective treatment for CHS, but it should be used in conjunction with other interventions, such as cannabis cessation and topical capsaicin, to provide optimal symptom relief 1.