A systematic review of ED treatments for cannabinoid hyperemesis syndrome found mixed evidence for topical capsaicin across 5 studies but potentially beneficial results for dopamine antagonists (haloperidol, droperidol) in both available studies.
Emergency physicians, gastroenterologists, hospital pharmacists
Dopamine antagonists showed benefit in both studies; capsaicin results were mixed
What the researchers found
Of 7 included studies (5 observational, 2 RCTs; 492 total patients), 5 evaluated capsaicin cream (n=386) with mixed results, and 2 evaluated dopamine antagonists (n=106) with both detecting clinical benefit compared to usual care. Evidence for capsaicin was inconsistent for reducing nausea and emesis.
Why it matters
CHS is increasingly common in EDs, but evidence-based treatment guidelines are limited. This review provides the most comprehensive assessment of the two most-discussed ED interventions.
The numbers in context
7 studies; 492 total patients; 5 capsaicin studies (n=386, mixed results); 2 dopamine antagonist studies (n=106, both positive); 2 RCTs included.
How the study worked
Systematic review per PRISMA guidelines addressing a PICO question: adults with acute CHS in the ED, treated with dopamine antagonists or topical capsaicin vs. usual care. 53 articles screened, 7 included.
What this study cannot tell us
Small number of studies. Small patient numbers. Lack of standardized treatment protocols across studies. Risk of bias in observational studies.
How to read the evidence
Systematic review with limited included studies (7), small patient numbers, and mixed study quality.
When this study was published
2024 publication
The bigger picture
Emergency physicians currently manage CHS without strong evidence for any specific treatment. The slightly stronger signal for dopamine antagonists compared to capsaicin may shift clinical practice, though both need larger trials.
Questions still open
- Would a large multicenter RCT comparing capsaicin, dopamine antagonists, and usual care settle the treatment question?
- Are there other pharmacological approaches worth testing for CHS?
Common questions
How is CHS treated in the emergency room?
Does capsaicin cream work for CHS?
Read the original research
SAEM GRACE: Dopamine antagonists and topical capsaicin for cannabis hyperemesis syndrome in the emergency department: A systematic review of direct evidence.
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 31(5), 493-503
Citation
Sabbineni, Monica; Scott, William; Punia, Kiran; Manuja, Kriti; Singh, Angad; Campbell, Kaitryn; MacKillop, James; Balodis, Iris. (2024). SAEM GRACE: Dopamine antagonists and topical capsaicin for cannabis hyperemesis syndrome in the emergency department: A systematic review of direct evidence.. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 31(5), 493-503. https://doi.org/10.1111/acem.14770
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