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

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
• marijuana
• capsaicin

Acknowledgements

The authors would like to thank Dr. Kavita Babu and Dr. Andrew Monte for their constructive feedback on the revision of this manuscript.

This manuscript includes data presented as poster abstracts at the 37th International Congress of the European Association of Poisons Centers and Clinical Toxicologists (EAPCCT) 16–19 May 2017, Basel, Switzerland, and at the 21st New England Regional Society for Academic Emergency Medicine Regional Meeting 29 March 2017, Worcester, MA, United States.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.