A New Drug That Stops CHS Vomiting Within an Hour When Nothing Else Works

Case report of 2 adolescents meeting Rome IV criteria for CHS with documented chronic cannabis use. Both failed standard antiemetics (ondansetron, metoclopramide, haloperidol, capsaicin) for 36–45 hours. Aprepitant administered as rescue therapy. Outcomes: time to vomiting cessation, oral fluid tolerance, solid food tolerance, and discharge timing.

CHS is becoming more common as cannabis use increases, particularly among young people (RTHC-00162). Current treatment options are limited and often ineffective for severe episodes. If aprepitant proves effective in larger studies, it could become a critical rescue medication—preventing the prolonged vomiting that can lead to dehydration, electrolyte imbalances, kidney injury, and even brain damage (RTHC-00164).

This is directly relevant to RTHC-00164's case of CHS-induced Wernicke's encephalopathy after 8 weeks of vomiting. If aprepitant had been available as a rescue medication in that case, the prolonged vomiting—and resulting brain damage—might have been prevented. The growing CHS case literature (also reflected in RTHC-00162's review of increasing cannabis-related ER visits) underscores the need for better acute treatment options beyond telling patients to stop using cannabis.

Only 2 cases—far too few to establish efficacy. No blinding or control condition. The timing of symptom resolution could reflect natural episode resolution coinciding with aprepitant administration. Rome IV criteria for CHS are relatively new and may not capture all cases. No long-term follow-up on CHS recurrence. Aprepitant is an expensive medication.