From the Guidelines
The most effective treatment for hyperemesis due to cannabis, also known as Cannabinoid Hyperemesis Syndrome (CHS), is complete cessation of cannabis use, which typically resolves symptoms within 24-48 hours. This approach is supported by recent clinical practice updates, such as the one published in Gastroenterology in 2024 1. For immediate symptom relief, hot showers or baths can provide temporary comfort due to the effect of heat on cannabinoid receptors.
Management of Symptoms
Medications that can help manage symptoms include:
- Ondansetron (Zofran) 4-8mg every 8 hours
- Promethazine (Phenergan) 12.5-25mg every 6 hours
- Metoclopramide (Reglan) 10mg every 6 hours for nausea and vomiting Intravenous fluids may be necessary for dehydration. Topical capsaicin cream applied to the abdomen can also help by affecting the same receptors activated during hot showers, as suggested by a recent study in 2024 1.
Additional Therapies
Benzodiazepines like lorazepam (1-2mg) can reduce anxiety and help with symptoms. Proton pump inhibitors such as omeprazole (20-40mg daily) may alleviate associated gastric discomfort. For severe cases, haloperidol (0.5-2mg) has shown effectiveness. It's crucial for patients to understand that symptoms will likely return if cannabis use resumes, as CHS results from chronic cannabis exposure affecting the endocannabinoid system's regulation of nausea and vomiting. Long-term management may involve counseling to achieve marijuana cessation and the use of tricyclic antidepressants, such as amitriptyline, with the minimal effective dose being 75–100 mg at bedtime 1.
From the Research
Treatment Options for Hyperemesis due to Cannabis
- The treatment of hyperemesis due to cannabis, also known as cannabinoid hyperemesis syndrome (CHS), is a complex issue, and various studies have investigated different treatment options 2, 3, 4, 5, 6.
- According to the studies, the following treatment options have been found to be effective:
- Haloperidol: an antipsychotic that has been shown to be more effective than conventional antiemetics for symptom control 4, 5, 6.
- Lorazepam: a benzodiazepine that has been used in combination with haloperidol for acute treatment of CHS 5.
- Capsaicin: a topical cream that has been found to be effective in alleviating symptoms of CHS, with a low adverse-effect profile 3, 5, 6.
- Hydrothermotherapy (hot showers and baths): has been reported to provide relief from symptoms of CHS 2, 3, 6.
Comparison of Treatment Options
- A randomized controlled trial compared haloperidol with ondansetron for the treatment of CHS and found that haloperidol was superior to ondansetron in alleviating acute symptoms 4.
- Another study found that haloperidol, lorazepam, and/or capsaicin were effective in treating adolescent patients with CHS 5.
- A review of the presentation and treatment of CHS found that antipsychotics such as haloperidol or droperidol were more effective than conventional antiemetics for symptom control, and that capsaicin should also be considered due to its positive efficacy and low adverse-effect profile 6.
Limitations and Future Research
- The studies highlight the need for further research to elicit the exact mechanism of CHS and to develop additional therapies for this syndrome 3, 6.
- The current evidence for pharmacologic treatment of CHS is limited, and more prospective trials are needed to evaluate and define optimal pharmacologic treatment of patients with CHS 3.