Updated review finds haloperidol, benzodiazepines, and capsaicin cream most effective for cannabinoid hyperemesis syndrome | Research

The takeaway

Classic antiemetics often fail for cannabinoid hyperemesis syndrome, while haloperidol, benzodiazepines, and topical capsaicin cream appear to be the most effective pharmacological treatments, though complete resolution requires cannabis cessation.

Emergency physicians, gastroenterologists, cannabis users experiencing recurrent vomiting, and clinicians diagnosing CHS.

Standard antiemetics often fail; haloperidol and capsaicin most effective

What the researchers found

CHS does not reliably respond to standard IV antiemetics. Antipsychotics (particularly haloperidol), benzodiazepines, and capsaicin cream (a TRPV1 agonist) appear most effective for acute symptom management. Hot showers provide symptomatic relief. Complete resolution occurs only with cannabis cessation. CHS prevalence is expected to rise with increasing cannabis use and potency.

Why it matters

CHS is frequently unrecognized, leading to extensive unnecessary testing. Knowing which treatments work (and which standard approaches fail) can reduce patient suffering, healthcare costs, and diagnostic delays.

The numbers in context

The review does not provide pooled efficacy data but synthesizes treatment outcomes across the published literature.

How the study worked

Updated clinical literature review covering CHS clinical features, differential diagnosis from cyclic vomiting syndrome, putative etiology, incidence, and treatment options including analgesics, antiemetics, antipsychotics, beta blockers, TRPV agonists, and capsaicin.

What this study cannot tell us

Most treatment evidence comes from case reports and small case series. No randomized controlled trials of CHS treatments. Treatment recommendations are based on clinical experience rather than high-quality evidence. CHS diagnostic criteria still debated.

How to read the evidence

Clinical literature review with treatment recommendations based primarily on case reports and series.

When this study was published

Published in 2022.

The bigger picture

As cannabis potency and use continue increasing globally, CHS is becoming more common. The paradox of cannabis causing severe vomiting, when it is also used medically as an anti-nausea agent, continues to challenge both clinicians and patients.

Questions still open

Why does capsaicin work for CHS? Could lower-potency cannabis products reduce CHS risk? Is there a dose-response relationship between cannabis use intensity and CHS development?

Common questions

Why do standard anti-nausea medications fail for CHS?

CHS appears to involve different mechanisms than typical nausea and vomiting, possibly related to TRPV1 receptor dysregulation from chronic cannabinoid exposure. This is why capsaicin (which activates TRPV1) and haloperidol work better than traditional antiemetics.

Is there a cure for CHS?

Complete resolution occurs only with cessation of cannabis use. Pharmacological treatments like haloperidol, benzodiazepines, and capsaicin cream manage acute episodes but do not prevent recurrence if cannabis use continues.

Read the original research

Pharmacological management of cannabinoid hyperemesis syndrome: an update of the clinical literature.

Expert opinion on pharmacotherapy, 23(6), 693-702

View on PubMed ↗Publisher’s paper ↗

Citation

Burillo-Putze, Guillermo; Richards, John R; Rodríguez-Jiménez, Consuelo; Sanchez-Agüera, Alejandro. (2022). Pharmacological management of cannabinoid hyperemesis syndrome: an update of the clinical literature.. Expert opinion on pharmacotherapy, 23(6), 693-702. https://doi.org/10.1080/14656566.2022.2049237