Capsaicin cream, antipsychotics, and benzodiazepines appeared more effective for cannabinoid hyperemesis syndrome than commonly used anti-nausea medications like ondansetron.
Emergency physicians, psychiatrists, and cannabis users experiencing cyclic vomiting episodes.
Capsaicin, antipsychotics, and benzodiazepines outperformed standard anti-emetics across 63 CHS cases
What the researchers found
Across 34 articles and 63 individual cases of CHS, capsaicin cream, antipsychotics, and benzodiazepines were reported to improve symptoms more effectively than standard anti-emetics such as promethazine, ondansetron, and metoclopramide. The authors proposed a treatment algorithm for consultation-liaison psychiatrists.
Why it matters
CHS is increasingly common and notoriously resistant to standard anti-emetics. Having an evidence-based treatment algorithm could reduce emergency department visits and hospital stays for affected patients.
The numbers in context
34 eligible articles with 63 individual cases reviewed. Capsaicin cream, antipsychotics, and benzodiazepines outperformed standard anti-emetics. The proposed algorithm provides a stepwise treatment approach.
How the study worked
Systematic review following PRISMA guidelines, searching PubMed, PsychINFO, Embase, and Web of Science from inception to July 2021. Included cases where patient-level treatment data was available. Beneficial treatment defined as resolution of nausea, vomiting, and compulsive hot showering.
What this study cannot tell us
Evidence base consists entirely of case reports and case series, the lowest level of clinical evidence. Search only through July 2021 misses recent literature. Publication bias likely favors successful treatments. No randomized controlled trials available.
How to read the evidence
Systematic review methodology is strong, but the underlying evidence consists entirely of case reports and series with no controlled trials.
When this study was published
2025 publication with literature search through July 2021.
The bigger picture
The finding that standard anti-emetics are relatively ineffective for CHS explains why many patients cycle through multiple ER visits before finding relief. The capsaicin mechanism (TRPV1 receptor modulation) directly addresses the hypothesized pathophysiology.
Questions still open
- Would a randomized controlled trial of capsaicin versus ondansetron in CHS be feasible?
- Can the proposed treatment algorithm reduce repeat ER visits for CHS patients?
Read the original research
Treatment of cannabinoid hyperemesis syndrome: A systematic review and treatment algorithm for consultation-liaison psychiatrists.
General hospital psychiatry, 97, 185-191
Citation
Hsu, Jennifer; Kashyap, Saurabh; Hurd, Cheryl; McCormack, Lauren; Herrmann, Zachary; Schwartz, Ann C; Jackson, Joshua; DeMoss, Dustin. (2025). Treatment of cannabinoid hyperemesis syndrome: A systematic review and treatment algorithm for consultation-liaison psychiatrists.. General hospital psychiatry, 97, 185-191. https://doi.org/10.1016/j.genhosppsych.2025.10.012
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