First reported cases of capsaicin cream successfully treating cannabinoid hyperemesis in adolescents | Research

The takeaway

Two adolescent patients with cannabinoid hyperemesis syndrome who did not respond to standard anti-nausea treatments improved with topical capsaicin cream in a pediatric ER, marking the first reported use of this treatment in children.

Read this if you're a pediatric provider or parent dealing with CHS in a teenager.

First pediatric cases: capsaicin cream relieved CHS when standard treatments failed

What the researchers found

Two adolescent patients presented to a pediatric emergency department with nausea, vomiting, and abdominal pain in the setting of chronic cannabis use. Standard antiemetic therapies failed to relieve their symptoms.

Both patients responded to topical capsaicin cream administration. The mechanism involves capsaicin's high-specificity binding to TRPV1 receptors, which impairs substance P signaling in brain regions that control vomiting (area postrema and nucleus tractus solitarius).

These are the first reported cases of capsaicin being used to treat CHS in pediatric patients. The treatment is cost-effective and has few serious side effects, making it an attractive alternative to haloperidol, which carries risks of dystonia, extrapyramidal reactions, and neuroleptic malignant syndrome.

Why it matters

CHS is increasingly recognized in adolescents but is often misdiagnosed. Standard treatments frequently fail, and alternatives like haloperidol carry significant risks in young patients. Capsaicin cream offers a safe, inexpensive option that the adult literature has shown to be effective, and this case series extends it to the pediatric population.

The numbers in context

2 adolescent patients. Both had chronic cannabis use, nausea/vomiting/abdominal pain. Both failed standard antiemetics. Both responded to topical capsaicin. First pediatric cases reported.

How the study worked

Case series of two adolescent patients with CHS symptoms refractory to standard antiemetic treatment, treated with topical capsaicin cream in a pediatric emergency department.

What this study cannot tell us

Only two cases. No control group. Case reports cannot establish efficacy or determine optimal dosing. Self-resolving symptoms cannot be excluded. The long-term effectiveness and need for ongoing cannabis cessation were not assessed.

How to read the evidence

Two-case series. Provides proof of concept for pediatric capsaicin use in CHS but very limited evidence.

When this study was published

Published in 2017 in Pediatrics. Capsaicin for CHS has gained wider acceptance in pediatric emergency medicine since.

The bigger picture

CHS in adolescents is an under-recognized diagnosis that can lead to repeated ER visits and unnecessary testing. Establishing capsaicin cream as a safe pediatric treatment option could reduce healthcare costs and complications from more aggressive therapies. The publication in Pediatrics brings this treatment option to the attention of pediatric providers specifically.

Questions still open

What is the optimal capsaicin concentration for pediatric CHS patients? How long does symptom relief last? Would capsaicin be effective for outpatient CHS management in adolescents?

Common questions

Is capsaicin cream safe for teenagers?

Topical capsaicin cream is generally well tolerated with few serious side effects. The main side effect is local skin irritation or burning sensation. In these two cases, it was used safely in adolescents in a supervised emergency department setting.

Why is capsaicin used instead of regular anti-nausea medications?

CHS is often resistant to standard antiemetics. Capsaicin acts through a different mechanism (TRPV1 receptors) that may specifically address the pathophysiology of CHS. It is also cheaper and safer than alternatives like haloperidol, which can cause serious neurological side effects.

Read the original research

Capsaicin Cream for Treatment of Cannabinoid Hyperemesis Syndrome in Adolescents: A Case Series.

Pediatrics, 140(6)

View on PubMed ↗Publisher’s paper ↗

Citation

Graham, Jessica; Barberio, Michael; Wang, George Sam. (2017). Capsaicin Cream for Treatment of Cannabinoid Hyperemesis Syndrome in Adolescents: A Case Series.. Pediatrics, 140(6). https://doi.org/10.1542/peds.2016-3795