A systematic review was conducted using PubMed, Ovid MEDLINE, Cochrane Central, EMBASE, and Google Scholar. Databases were used to search for articles on CHS published from January 2009 to June 2021, yielding 225 results of which 17 were deemed relevant and underwent review by https://ecosoberhouse.com/ 2 separate reviewers. Treatment during the hyperemetic phase includes rehydration with bolus intravenous (IV) crystalloid fluids, IV dextrose-containing fluids (to arrest ketosis), correction of electrolyte abnormalities, and treatment of nausea (Table 2).
How we reviewed this article:
- In older populations, benzodiazepines should be used with caution in the management of CHS due to the potential risk of addiction, cognitive impairment, development of delirium, and falls 45.
- A visit with a pediatric clinician is an ideal time to ensure that a teenager knows the correct information, has the opportunity to make certain contraceptive choices, and instill the knowledge that the pediatric office is a safe place to come for help.
- It’s a condition that can lead to serious health complications if you don’t get treatment for it.
- They are however also encountered in cannabis withdrawal syndrome (CWS), an often debated but officially (ICD and DSM) recognized withdrawal syndrome.
- More research on CHS is needed to enhance knowledge translation, education, and create awareness in the medical community on the side effects of cannabinoids and to propose the best treatment options.
Among level-3 studies (43 subjects), one reported effective treatment with antiepileptics zonisamide and levetiracetam, but not TCAs. Another reported favorable response to morphine, ondansetron, and lorazepam but did not specify the actual number of patients receiving specific treatment. Among the level-4 case series (54 subjects), benzodiazepines, haloperidol, and capsaicin were reported as helpful. For level-5 case reports (44 subjects), benzodiazepines, metoclopramide, haloperidol, ondansetron, morphine, and capsaicin were reported as effective.
Substances
There were 4 prospective level-2, 3 retrospective level-3 studies, 12 level-4 case series, and 44 level-5 case reports. Among level-2 studies (64 subjects), tricyclic antidepressants (TCAs) and lorazepam were discussed as effective long- and short-term treatments, respectively, in two studies. Ondansetron, promethazine, diphenhydramine, and opioids were also mentioned, but the authors did not comment on their efficacy.
Diagnosis and treatment of cannabinoid hyperemesis syndrome
In the CNS, activation of these receptors has a direct role in regulating the sympathetic and hypothalamic-pituitary-adrenal axis, preventing overstimulation. Aprepitant is a Neurokinin 1 (NK1) receptor antagonist and similarly to capsaicin is involved in the regulation of substance P to alleviate N/V in CHS 35. A case report described by Parvataneni et al. 35 revealed a 30-year-old female with intermittent N/V who was unresponsive to conventional emetics such as ondansetron. She was discharged symptom-free 24 h later after the administration of aprepitant 35. A major limitation of this case report is that the dosage of aprepitant was not described. CHS, cannabis hyperemesis syndrome; CB1, cannabinoid receptors 1; cannabinoid hyperemesis syndrome CTZ, chemoreceptor trigger zone; THC, tetrahydrocannabinol.
Capsaicin
In one study, about 84% of people who received treatment for CHS stopped using cannabis, and of those, about 86% reported resolution of symptoms. The only way to stop CHS and its symptoms is to completely quit using cannabis. Most people who quit using cannabis experience no more CHS symptoms within 10 days, but sometimes it may take weeks or months for symptoms to stop. Symptoms of CHS likely won’t return if you’ve completely stopped using cannabis. The only proven way to prevent cannabis hyperemesis syndrome is to avoid cannabis (marijuana).