Systematic review identified multiple treatments for cannabinoid hyperemesis syndrome | Research

The takeaway

A systematic review of 17 studies found cannabis cessation is the most effective CHS treatment, with hot baths, capsaicin cream, haloperidol, and other medications providing symptom relief.

Emergency physicians, primary care providers, and chronic cannabis users who experience cyclic vomiting.

6 months to 11 years of cannabis use may precipitate CHS

What the researchers found

Cannabis cessation is the most successful management for CHS. Other treatments demonstrating symptom relief include hot water hydrotherapy, topical capsaicin cream, haloperidol, droperidol, benzodiazepines, propranolol, and aprepitant.

Why it matters

CHS is increasingly recognized in emergency departments and clinical settings. This review consolidates the evidence on treatment options, giving clinicians a practical reference for managing this condition.

The numbers in context

225 records retrieved, 17 included. Cannabis use duration of 6 months to 11 years may precipitate CHS. Rome IV criteria require symptoms for at least 6 months. Multiple treatment options identified beyond cessation.

How the study worked

Systematic review searching PubMed, MEDLINE, Cochrane, EMBASE, and Google Scholar for CHS articles from January 2009 to June 2021. Of 225 results, 17 were deemed relevant and reviewed by two independent reviewers.

What this study cannot tell us

Only 17 studies met inclusion criteria, indicating limited evidence overall. Most included studies were case reports or small series. No randomized trials comparing treatments were available.

How to read the evidence

Moderate: systematic review methodology, but limited by small number of included studies and lack of randomized trials.

When this study was published

Published in 2022.

The bigger picture

As cannabis use becomes more common, CHS recognition and management become more important. Having a systematic summary of treatment options helps emergency physicians and primary care providers respond effectively.

Questions still open

Which treatment is most effective for acute CHS episodes in the emergency department? Can any medication prevent CHS in chronic cannabis users? Why does hot water hydrotherapy provide relief?

Common questions

What are the Rome IV criteria for CHS?

They require cannabinoid use and persistence of nausea and vomiting symptoms for at least the past 6 months to diagnose CHS.

Why does capsaicin cream work for CHS?

Capsaicin activates TRPV1 receptors, which are part of the same system that cannabinoids interact with. The exact mechanism is not fully understood, but topical capsaicin applied to the abdomen has provided relief in multiple reports.

Is CHS the same as cyclic vomiting syndrome?

They share similar symptoms, but CHS is specifically linked to chronic cannabinoid use and resolves with cessation. Cyclic vomiting syndrome has different underlying causes.

Read the original research

A Systematic Review on Cannabis Hyperemesis Syndrome and Its Management Options.

Medical principles and practice : international journal of the Kuwait University, Health Science Centre, 31(1), 29-38

View on PubMed ↗Publisher’s paper ↗

Citation

Senderovich, Helen; Patel, Preet; Jimenez Lopez, Briam; Waicus, Sarah. (2022). A Systematic Review on Cannabis Hyperemesis Syndrome and Its Management Options.. Medical principles and practice : international journal of the Kuwait University, Health Science Centre, 31(1), 29-38. https://doi.org/10.1159/000520417