Resolution of cannabis hyperemesis syndrome with topical capsaicin in the emergency department: a case series

Clin Toxicol (Phila). 2017 Sep;55(8):908-913. doi: 10.1080/15563650.2017.1324166. Epub 2017 May 11.

Abstract

Background: Cannabinoid hyperemesis syndrome (CHS) is characterized by symptoms of cyclic abdominal pain, nausea, and vomiting in the setting of prolonged cannabis use. The transient receptor potential vanilloid 1 (TRPV1) receptor may be involved in this syndrome. Topical capsaicin is a proposed treatment for CHS; it binds TRPV1 with high specificity, impairing substance P signaling in the area postrema and nucleus tractus solitarius via overstimulation of TRPV1. This may explain its apparent antiemetic effect in this syndrome.

Purpose: We describe a series of thirteen cases of suspected cannabis hyperemesis syndrome treated with capsaicin in the emergency departments of two academic medical centers.

Methods: A query of the electronic health record at both centers identified thirteen patients with documented daily cannabis use and symptoms consistent with CHS who were administered topical capsaicin cream for symptom management.

Results: All 13 patients experienced symptom relief after administration of capsaicin cream.

Conclusion: Topical capsaicin was associated with improvement in symptoms of CHS after other treatments failed.

Keywords: GI; cannabis; capsaicin; marijuana.

Publication types

  • Multicenter Study

MeSH terms

  • Abdominal Pain / diagnosis
  • Abdominal Pain / drug therapy*
  • Abdominal Pain / etiology
  • Abdominal Pain / metabolism
  • Adult
  • Antiemetics / administration & dosage*
  • Antiemetics / adverse effects
  • Area Postrema / drug effects
  • Area Postrema / metabolism
  • Capsaicin / administration & dosage*
  • Capsaicin / adverse effects
  • Electronic Health Records
  • Emergency Service, Hospital*
  • Female
  • Humans
  • Male
  • Marijuana Abuse / complications*
  • Marijuana Smoking / adverse effects*
  • Massachusetts
  • Middle Aged
  • Missouri
  • Nausea / diagnosis
  • Nausea / drug therapy*
  • Nausea / etiology
  • Nausea / metabolism
  • Retrospective Studies
  • Sensory System Agents / administration & dosage*
  • Sensory System Agents / adverse effects
  • Solitary Nucleus / drug effects
  • Solitary Nucleus / metabolism
  • Syndrome
  • TRPV Cation Channels / antagonists & inhibitors
  • TRPV Cation Channels / metabolism
  • Treatment Outcome
  • Vomiting / diagnosis
  • Vomiting / drug therapy*
  • Vomiting / etiology
  • Vomiting / metabolism
  • Young Adult

Substances

  • Antiemetics
  • Sensory System Agents
  • TRPV Cation Channels
  • TRPV1 protein, human
  • Capsaicin