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Study breakdown

Droperidol plus diphenhydramine rapidly improved CHS symptoms in the emergency department

Prospective CohortModerate evidence
The takeaway

In 47 patients with suspected cannabinoid hyperemesis syndrome, droperidol plus diphenhydramine reduced nausea/vomiting scores from 8.3 to 1.4 and abdominal pain from 7.8 to 1.7 within 120 minutes.

People interested in treatment options for cannabinoid hyperemesis syndrome.

Nausea dropped from 8.3 to 1.4 within 120 minutes

What the researchers found

Nausea/vomiting VAS scores dropped from 8.3 at baseline to 3.1 at 30 minutes and 1.4 at 120 minutes (both p<0.05). Abdominal pain VAS dropped from 7.8 to 3.6 at 30 minutes and 1.7 at 120 minutes (both p<0.05). Return ED visits within 7 days were 12.9%.

Why it matters

CHS is increasingly common and often poorly treated with standard antiemetics. This prospective data supports droperidol as an effective option, with rapid symptom improvement within 30 minutes that continued through 2 hours.

The numbers in context

47 patients. Nausea/vomiting: 8.3 to 3.1 at 30 min, 1.4 at 120 min. Abdominal pain: 7.8 to 3.6 at 30 min, 1.7 at 120 min. 12.9% returned to ED within 7 days. All changes significant at p<0.05.

How the study worked

Multicenter, prospective interventional study in EDs. 47 participants with suspected CHS received droperidol plus diphenhydramine. Nausea, vomiting, and abdominal pain measured on visual analogue scales at baseline, 30, and 120 minutes. 7-day ED return rate tracked.

What this study cannot tell us

No control group or randomization. All participants received the intervention, so natural symptom resolution cannot be excluded. Relatively small sample. Suspected CHS diagnosis may include some misdiagnosed patients. Short follow-up.

How to read the evidence

Prospective multicenter study with consistent results, but limited by lack of control group, small sample, and inability to blind participants to treatment.

When this study was published

Published in 2024 in Open Access Emergency Medicine.

The bigger picture

The GRACE-4 guidelines recently recommended haloperidol/droperidol for CHS. This prospective study adds supporting evidence for droperidol specifically, with real-world data showing rapid, sustained symptom relief in a condition that can be resistant to conventional treatments.

Questions still open

  • How does droperidol compare to haloperidol for CHS in a head-to-head trial? Is the 12.9% ED return rate lower than with standard antiemetics? What is the optimal droperidol dose for CHS?

Common questions

What is the best treatment for cannabinoid hyperemesis syndrome?
This study found droperidol plus diphenhydramine rapidly improved nausea, vomiting, and abdominal pain in CHS patients. Recent guidelines also recommend haloperidol and topical capsaicin. Standard antiemetics like ondansetron are often less effective for CHS.
How quickly did symptoms improve?
Significant improvement occurred within 30 minutes, with nausea/vomiting scores dropping by more than half. By 2 hours, average symptoms had dropped from severe (8/10) to minimal (1-2/10).

Read the original research

Droperidol Plus Diphenhydramine for Symptom Improvement in Suspected Cannabinoid Hyperemesis Syndrome: A Prospective Cohort Study.

Open access emergency medicine : OAEM, 16, 267-273

Citation

Chopra, Quincy; Peyko, Vincent; Lee, Jessica Annie; Puhalla, Leo; Gemmel, David J; Bolotin, Todd. (2024). Droperidol Plus Diphenhydramine for Symptom Improvement in Suspected Cannabinoid Hyperemesis Syndrome: A Prospective Cohort Study.. Open access emergency medicine : OAEM, 16, 267-273. https://doi.org/10.2147/OAEM.S473627

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