From the Guidelines
The treatment of cannabis hyperemesis syndrome primarily involves cannabis cessation as the definitive solution, with supportive care and pharmacological interventions playing a crucial role in managing symptoms. In the acute phase, supportive care includes intravenous fluids for dehydration and antiemetics, with haloperidol 0.5-2mg IV or droperidol 0.625-1.25mg IV being particularly effective, as reported in a study published in the British Journal of Anaesthesia 1. Hot showers or baths provide temporary symptom relief through thermoreceptor activation, which can be replicated with topical capsaicin cream (0.075%) applied to the abdomen, as suggested by a study in Gastroenterology 1. Benzodiazepines such as lorazepam 1-2mg IV may help with associated anxiety. For nausea control, ondansetron 4-8mg IV is commonly used, though it may have limited effectiveness in this condition. Proton pump inhibitors like pantoprazole 40mg IV daily can reduce gastric acid.
The recovery phase requires complete cannabis cessation, which typically leads to symptom resolution within 1-2 weeks, as stated in a recent study published in Gastroenterology 1. Patients should understand that cannabis is the direct cause of their symptoms through its effect on cannabinoid receptors, particularly CB1 receptors, which regulate nausea and vomiting. The paradoxical hyperemesis occurs with chronic use, and no amount of continued cannabis use will provide long-term relief. Psychological support and addiction counseling are important components of successful long-term management, as emphasized by a study in Gastroenterology 1.
Some key points to consider in the management of cannabis hyperemesis syndrome include:
- Complete cannabis cessation is essential for symptom resolution
- Supportive care, including intravenous fluids and antiemetics, is crucial in the acute phase
- Pharmacological interventions, such as haloperidol, droperidol, and topical capsaicin, can help manage symptoms
- Psychological support and addiction counseling are vital for long-term management
- Patients should be educated about the direct cause of their symptoms and the importance of cannabis cessation.
From the Research
Treatment Options for Cannabis Hyperemesis
- Pharmacologic treatments have been explored for the management of cannabis hyperemesis syndrome (CHS), with varying degrees of success 2.
- Benzodiazepines, haloperidol, and capsaicin have been reported as effective treatments for acute CHS, while tricyclic antidepressants (TCAs) may be useful for long-term management 2.
- A randomized controlled trial found that intravenous haloperidol was superior to ondansetron for the acute treatment of CHS, with significant improvements in abdominal pain and nausea 3.
- A case series of adolescent patients with CHS reported successful treatment with haloperidol, lorazepam, and/or capsaicin, highlighting the potential efficacy of these agents in this population 4.
Non-Pharmacologic Interventions
- Hot water hydrotherapy, including hot showers and baths, has been consistently reported as an effective treatment for CHS, with many patients experiencing significant relief from symptoms 2, 5.
- Topical capsaicin cream has also been shown to be effective in reducing symptoms of CHS, and may be a useful adjunct to pharmacologic treatment 4, 5.
Management and Prevention
- Cannabis cessation is considered the most successful management strategy for CHS, highlighting the importance of addressing the underlying cause of the condition 5.
- Early recognition and diagnosis of CHS are crucial to prevent complications related to severe volume depletion and to reduce the burden on healthcare systems 6.
- Further research is needed to enhance our understanding of CHS, including its pathophysiology, clinical features, and optimal treatment strategies 2, 5, 6.