Haloperidol Successfully Treated Cannabinoid Hyperemesis Syndrome in the Emergency Department | Research

The takeaway

A patient with cannabinoid hyperemesis syndrome, which had not responded to conventional anti-nausea medications, improved significantly after receiving haloperidol in the emergency department.

Read this if you experience cyclical vomiting from cannabis use and hot showers are the only thing that helps.

Haloperidol worked when conventional antiemetics failed for CHS

What the researchers found

A patient with cannabinoid hyperemesis syndrome (CHS), characterized by cyclical vomiting in the setting of chronic cannabis use, was treated with haloperidol in the emergency department. The condition had been unresponsive to conventional antiemetic medications.

Patients with CHS typically report that only compulsive bathing and hot showers provide relief, and the condition frequently requires hospital admission due to intractable vomiting. In this case, haloperidol produced significant improvement, suggesting a potential pharmacological treatment option for a condition with very limited treatment options.

Why it matters

CHS is increasingly recognized as cannabis use grows, and current treatment options are limited. If haloperidol consistently works, it could transform ER management of CHS from prolonged observation and admission to rapid treatment and discharge.

The numbers in context

1 patient with CHS. Unresponsive to conventional antiemetics. Significant improvement with haloperidol. CHS characterized by cyclical vomiting in chronic cannabis users.

How the study worked

Single case report of CHS treated with haloperidol in an emergency department setting.

What this study cannot tell us

Single case report provides the lowest level of clinical evidence. Spontaneous resolution cannot be excluded. The dose and timing of haloperidol were not detailed in the abstract. No comparison to other treatments. Long-term outcome was not reported.

How to read the evidence

Single case report; preliminary evidence but has been supported by subsequent studies.

When this study was published

Published in 2013. Haloperidol has since gained wider recognition as a CHS treatment in emergency settings.

The bigger picture

This case report was among the first to suggest dopamine antagonists as a CHS treatment strategy. Subsequent reports and small studies have supported this approach, with haloperidol and droperidol emerging as effective options. The mechanism may involve dopamine's role in the vomiting reflex and temperature regulation.

Questions still open

What is the optimal haloperidol dose for CHS? Would other dopamine antagonists work equally well? Does haloperidol address the underlying CHS mechanism or just mask symptoms? What is the relapse rate if cannabis use continues?

Common questions

What is cannabinoid hyperemesis syndrome?

CHS is a condition where chronic, heavy cannabis use causes cyclical episodes of severe nausea and vomiting that do not respond to typical anti-nausea medications. Patients often find that only very hot showers or baths provide temporary relief. The only proven long-term treatment is stopping cannabis use.

Why does haloperidol work for CHS?

The exact mechanism is not fully understood. Haloperidol blocks dopamine receptors, and dopamine is involved in both the vomiting reflex and temperature regulation (which may explain why hot showers help). By blocking dopamine, haloperidol may address the same pathway that is disrupted in CHS. This case was one of the first to report this treatment approach.

Read the original research

Haloperidol for treatment of cannabinoid hyperemesis syndrome.

The American journal of emergency medicine, 31(6), 1003.e5-6

View on PubMed ↗Publisher’s paper ↗

Citation

Hickey, Jami L; Witsil, Joanne C; Mycyk, Mark B. (2013). Haloperidol for treatment of cannabinoid hyperemesis syndrome.. The American journal of emergency medicine, 31(6), 1003.e5-6. https://doi.org/10.1016/j.ajem.2013.02.021