A nausea drug called aprepitant helped when standard treatments failed for cannabinoid hyperemesis | Research

The takeaway

A case report describes successful use of aprepitant (Emend) to treat cannabinoid hyperemesis syndrome after all other standard anti-emetic medications failed.

People dealing with CHS, emergency physicians, and clinicians looking for treatment alternatives.

Aprepitant succeeded after all standard anti-emetics failed

What the researchers found

A patient with CHS who did not respond to common anti-emetics was successfully treated with aprepitant, an NK1 receptor antagonist typically used for chemotherapy-induced nausea.

Why it matters

CHS can be extremely difficult to treat, and standard anti-emetics often fail. This case suggests aprepitant may be a useful option when other treatments are ineffective.

The numbers in context

1 patient described. Aprepitant succeeded after all other common anti-emetics failed.

How the study worked

Single case report documenting clinical course and treatment response.

What this study cannot tell us

Single case report; effectiveness in one patient does not guarantee it will work for others. No control comparison or dosing optimization was performed.

How to read the evidence

Preliminary: single case report with no comparison group.

When this study was published

Published in 2019.

The bigger picture

As CHS diagnoses increase, having more treatment options is critical. The NK1 receptor pathway represents a different mechanism than traditional anti-emetics, potentially explaining why it works when others don't.

Questions still open

Would aprepitant work in a larger series of CHS patients? What is the optimal dosing regimen? Could it be used as first-line treatment for severe CHS?

Common questions

What is aprepitant?

Aprepitant (brand name Emend) is a drug that blocks NK1 receptors involved in nausea and vomiting. It is primarily used to prevent chemotherapy-induced nausea.

Why don't normal anti-nausea drugs work for CHS?

The mechanism of vomiting in CHS appears to involve different pathways than typical nausea. Standard drugs target serotonin or dopamine receptors, while CHS may involve the endocannabinoid system and NK1 pathways, which is why aprepitant may be more effective.

Read the original research

Emerging Role of Aprepitant in Cannabis Hyperemesis Syndrome.

Cureus, 11(6), e4825

View on PubMed ↗Publisher’s paper ↗

Citation

Parvataneni, Swetha; Varela, Lionel; Vemuri-Reddy, Sireesha M; Maneval, Mandy L. (2019). Emerging Role of Aprepitant in Cannabis Hyperemesis Syndrome.. Cureus, 11(6), e4825. https://doi.org/10.7759/cureus.4825