From the Guidelines
Cannabinoid Hyperemesis Syndrome (CHS) is a condition that requires immediate cessation of cannabis use to resolve symptoms, and the most effective treatment is complete abstinence from all cannabis products, as even occasional use can trigger recurrence of symptoms. The management of CHS involves a combination of pharmacological and non-pharmacological interventions. During acute episodes, hot showers or baths provide temporary relief, as heat activates TRPV1 receptors that can counteract the effects of cannabinoids 1. For symptom management, traditional antiemetics like ondansetron often have limited effectiveness; instead, haloperidol (2.5-5mg IV/IM), droperidol (1.25-2.5mg IV), or olanzapine (5-10mg oral/IM) may provide better relief 1. Topical capsaicin cream (0.1%) applied to the abdomen can also help by activating the same heat receptors 1. IV fluids are important to prevent dehydration from persistent vomiting.
Some key points to consider in the management of CHS include:
- Complete cessation of cannabis use is the most effective treatment for CHS 1
- Hot showers or baths can provide temporary relief during acute episodes 1
- Traditional antiemetics may have limited effectiveness, and alternative medications like haloperidol, droperidol, or olanzapine may be more effective 1
- Topical capsaicin cream can help activate heat receptors and provide relief 1
- IV fluids are important to prevent dehydration from persistent vomiting 1
It is essential to note that CHS is a condition that requires a comprehensive approach, including counseling to achieve marijuana cessation and management of symptoms. The use of tricyclic antidepressants, such as amitriptyline, may also be beneficial in the long-term management of CHS 1. However, the evidence for these interventions is limited, and further research is needed to develop effective treatments for CHS 1.
From the Research
Definition and Diagnosis of Cannabinoid Hyperemesis Syndrome
- Cannabinoid hyperemesis syndrome (CHS) is a disorder characterized by recurrent abdominal pain, intractable nausea, and emesis in patients who regularly smoke cannabis 2.
- The syndrome is often preceded by daily to weekly cannabis use, usually accompanied by symptom improvement with hot bathing, and resolution with cessation of cannabis 3.
- Diagnostic characteristics of CHS include history of regular cannabis use, cyclic nausea and vomiting, resolution of symptoms after stopping cannabis, compulsive hot baths with symptom relief, male predominance, abdominal pain, and at least weekly cannabis use 3.
Treatment Options for Cannabinoid Hyperemesis Syndrome
- Complete resolution of CHS occurs only after cessation of cannabis use 2, 3, 4, 5.
- Hot showers and baths (hydrothermotherapy) have been shown to provide symptom relief 2, 3, 6, 5.
- Pharmacologic treatment options include:
- Benzodiazepines, haloperidol, and capsaicin, which have been reported as effective for acute treatment 6.
- Tricyclic antidepressants (TCAs) such as amitriptyline, which have been reported as effective for long-term treatment 6, 4.
- Antipsychotics, beta blockers, and transient receptor potential vanilloid (TRPV) agonists, which have also been used to treat CHS 2.
- Supportive care with intravenous fluids, dopamine antagonists, and avoidance of narcotic medications has also been shown to be beneficial in the acute setting 3.
Pathophysiology and Prevalence of Cannabinoid Hyperemesis Syndrome
- The pathophysiology of CHS remains unclear, with a dearth of research dedicated to investigating its underlying mechanism 3.
- The prevalence of CHS is expected to continue to rise in parallel with increasing worldwide cannabis use and potency 2, 4.
- CHS is frequently unrecognized by clinicians, leading to extensive and unnecessary testing and treatment 2.