Benzodiazepines resolved cannabinoid hyperemesis syndrome in four patients | Research

The takeaway

Four patients with cannabinoid hyperemesis syndrome who did not respond to standard antiemetics found relief after receiving benzodiazepines.

Emergency physicians, internists, and cannabis users experiencing cyclical vomiting.

4 of 4 responded

What the researchers found

All four patients presented with cyclical nausea, vomiting, and abdominal pain in the context of chronic cannabis use. Standard antiemetics and proton pump inhibitors failed, but benzodiazepines resolved symptoms in each case.

Why it matters

CHS is often misdiagnosed, leading to expensive workups and prolonged suffering. Recognizing the syndrome early and knowing that benzodiazepines may help could shorten hospital stays and reduce unnecessary testing.

The numbers in context

Four patients, all with documented chronic cannabis use, all failed conventional antiemetic therapy, all responded to benzodiazepines.

How the study worked

Case series of four patients admitted to an internal medicine department, all diagnosed with CHS after excluding other gastrointestinal and neurological causes.

What this study cannot tell us

Very small case series (n=4) with no control group. The mechanism by which benzodiazepines help CHS is proposed but not proven. Results may not generalize to all CHS patients.

How to read the evidence

Preliminary: small case series without controls.

When this study was published

Published in 2019.

The bigger picture

As cannabis use increases, CHS is becoming more common in emergency departments. Standard antiemetics do not work for this condition, making targeted treatments like benzodiazepines particularly valuable.

Questions still open

What is the optimal benzodiazepine dosing for CHS? Would this approach work in an outpatient setting to prevent ER visits?

Common questions

Why don't regular anti-nausea medications work for CHS?

CHS appears to involve CB1 receptor dysregulation rather than the pathways targeted by standard antiemetics, which is why conventional treatments often fail.

How might benzodiazepines help with CHS?

They may decrease CB1 receptor activation in the frontal cortex and reduce the anticipation of nausea and vomiting through their sedative effects.

Read the original research

Resolution of Cannabinoid Hyperemesis Syndrome with Benzodiazepines: A Case Series.

The Israel Medical Association journal : IMAJ, 21(6), 404-407

View on PubMed ↗

Citation

Kheifets, Mark; Karniel, Eli; Landa, Daniel; Vons, Shelly Abigail; Meridor, Katya; Charach, Gideon. (2019). Resolution of Cannabinoid Hyperemesis Syndrome with Benzodiazepines: A Case Series.. The Israel Medical Association journal : IMAJ, 21(6), 404-407.