A patient with severe CHS who was unwilling to stop using cannabis achieved complete resolution of nausea and vomiting with the antipsychotic haloperidol, the first reported outpatient CHS treatment success.
Read this if you experience cannabinoid hyperemesis syndrome and are looking for treatment options beyond quitting cannabis.
First outpatient CHS treatment success reported using haloperidol
What the researchers found
Cannabinoid hyperemesis syndrome (CHS) is notoriously resistant to standard anti-nausea medications, and the only reliable long-term treatment is stopping cannabis. But many patients are reluctant to quit.
This case describes a patient with severe, treatment-resistant CHS who achieved complete resolution of nausea and vomiting with haloperidol, an older antipsychotic medication. Notably, this success occurred in the outpatient setting rather than the hospital.
The authors believe this is the first reported case of successful outpatient CHS treatment, suggesting that haloperidol could provide relief for patients who refuse to stop cannabis or who need symptom management while working toward cessation.
Why it matters
The current treatment paradigm for CHS essentially offers patients only one option: stop using cannabis. For patients who are unable or unwilling to quit immediately, having a pharmacological bridge like haloperidol could prevent repeated ER visits and reduce suffering during the transition to abstinence.
The numbers in context
Complete resolution of nausea and vomiting with haloperidol. First reported outpatient treatment success. Standard antiemetics (serotonin and dopamine receptor antagonists) had failed.
How the study worked
Single case report describing outpatient treatment of refractory CHS with haloperidol. The patient had failed standard antiemetic therapies.
What this study cannot tell us
Single case report. No dosing details provided in the abstract. Haloperidol has its own side effect profile including sedation and movement disorders. Long-term use for CHS is not evaluated.
How to read the evidence
Single case report providing a novel treatment observation. No statistical evidence or comparison groups.
When this study was published
Published in 2016. Subsequent studies have further explored haloperidol and other dopamine-acting medications for CHS.
The bigger picture
As CHS becomes more commonly recognized, the need for effective treatments grows. Haloperidol works through a different mechanism than standard antiemetics, which may explain its effectiveness. If confirmed in larger studies, this could change the management approach for CHS.
Questions still open
- What is the mechanism by which haloperidol resolves CHS when standard antiemetics fail? Would other antipsychotics work similarly? What is the optimal dose and duration of haloperidol treatment for CHS?
Common questions
Is there a medication that works for CHS?
Why does haloperidol work when other anti-nausea drugs do not?
Read the original research
Successful Treatment of Suspected Cannabinoid Hyperemesis Syndrome Using Haloperidol in the Outpatient Setting.
Case reports in psychiatry, 2016, 3614053
Citation
Jones, Jennifer L; Abernathy, Karen E. (2016). Successful Treatment of Suspected Cannabinoid Hyperemesis Syndrome Using Haloperidol in the Outpatient Setting.. Case reports in psychiatry, 2016, 3614053. https://doi.org/10.1155/2016/3614053
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