Systematic Review Finds Limited Evidence for CHS Treatments, With Dopamine Antagonists Showing More Promise Than Capsaicin
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.
Quick Facts
What This Study 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.
Key Numbers
7 studies; 492 total patients; 5 capsaicin studies (n=386, mixed results); 2 dopamine antagonist studies (n=106, both positive); 2 RCTs included.
How They Did This
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.
Why This Research 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 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.
What This Study Doesn't Tell Us
Small number of studies. Small patient numbers. Lack of standardized treatment protocols across studies. Risk of bias in observational studies.
Questions This Raises
- ?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?
Trust & Context
- Key Stat:
- Dopamine antagonists showed benefit in both studies; capsaicin results were mixed
- Evidence Grade:
- Systematic review with limited included studies (7), small patient numbers, and mixed study quality.
- Study Age:
- 2024 publication
- Original Title:
- SAEM GRACE: Dopamine antagonists and topical capsaicin for cannabis hyperemesis syndrome in the emergency department: A systematic review of direct evidence.
- Published In:
- Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 31(5), 493-503 (2024)
- Authors:
- Sabbineni, Monica, Scott, William, Punia, Kiran, Manuja, Kriti, Singh, Angad, Campbell, Kaitryn, MacKillop, James, Balodis, Iris
- Database ID:
- RTHC-05678
Evidence Hierarchy
Frequently Asked Questions
How is CHS treated in the emergency room?
This systematic review evaluated two common approaches. Topical capsaicin cream had mixed results across 5 studies. Dopamine antagonists (haloperidol, droperidol) showed benefit in both studies that tested them, though the evidence remains limited.
Does capsaicin cream work for CHS?
Evidence is mixed. Of 5 studies evaluating topical capsaicin for CHS in the ED (386 patients total), results were inconsistent. Dopamine antagonists showed more consistent benefit in the 2 studies that tested them, though more research is needed for both treatments.
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Cite This Study
https://rethinkthc.com/research/RTHC-05678APA
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
MLA
Sabbineni, Monica, et al. "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, 2024. https://doi.org/10.1111/acem.14770
RethinkTHC
RethinkTHC Research Database. "SAEM GRACE: Dopamine antagonists and topical capsaicin for c..." RTHC-05678. Retrieved from https://rethinkthc.com/research/sabbineni-2024-saem-grace-dopamine-antagonists
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.