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?
How quickly did symptoms improve?
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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