What is the appropriate dose of Haloperidol (Haldol) in the Emergency Department (ED) for hyperemesis associated with cannabis use?

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Last updated: April 24, 2025 • View editorial policy

From the Research

For hyperemesis associated with cannabis use in the emergency department setting, haloperidol (Haldol) can be administered at a dose of 0.05-0.1 mg/kg IV, as this dose range has been shown to be effective in reducing symptoms of cannabis hyperemesis syndrome 1. The dose of 0.05-0.1 mg/kg IV is based on a randomized, controlled trial that compared haloperidol with ondansetron for the treatment of cannabis hyperemesis syndrome, which found that haloperidol was superior to ondansetron in reducing symptoms of nausea and vomiting 1. Some key points to consider when administering haloperidol for hyperemesis associated with cannabis use include:

  • Prior to administration, baseline QTc should be assessed via ECG as haloperidol can prolong the QT interval.
  • Patients should be monitored for extrapyramidal symptoms (EPS), which can be managed with diphenhydramine 25-50 mg IV if they occur.
  • Haloperidol works by blocking dopamine receptors in the chemoreceptor trigger zone, reducing nausea and vomiting.
  • For cannabis hyperemesis syndrome specifically, hot showers may provide symptomatic relief alongside medication.
  • Patients should be counseled that cessation of cannabis use is the definitive treatment, as symptoms will likely recur with continued use.
  • IV fluids should be administered to address dehydration, and electrolyte abnormalities should be corrected as needed. It's also worth noting that other studies have reported the effectiveness of haloperidol in treating cannabis hyperemesis syndrome, including a review of the clinical literature that found haloperidol to be a potentially effective treatment option 2, and a case report that described the successful use of haloperidol in treating a patient with cannabis hyperemesis syndrome 3. However, the study by 1 provides the most recent and highest-quality evidence for the use of haloperidol in this context.

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