Managing cannabinoid hyperemesis syndrome in adult patients in the emergency department.

Purpose: This article summarizes pharmacological and nonpharmacological therapies for cannabinoid hyperemesis syndrome (CHS) that may be utilized in the emergency department (ED).

Summary: CHS is an increasingly common condition in the ED characterized by cyclic vomiting and abdominal pain in the setting of excessive consumption of cannabis or cannabinoid use. Symptoms are usually alleviated by hot baths or showers, but when they persist patients often present to the ED. Emergency medicine pharmacists should be able to recognize the common presentation of CHS and assist with treatment of these patients in the ED.

Conclusion: There is a paucity of data regarding the most effective pharmacotherapy for CHS, but cessation of cannabis use is accepted as the quintessential cure. Common therapies for CHS include dopamine antagonists such as haloperidol and droperidol, conventional antiemetics such as ondansetron and metoclopramide, and topical capsaicin. Opioids and benzodiazepines should not be used as first-line therapy for CHS.