Objective: Cannabinoid hyperemesis syndrome (CHS) is characterized by cyclic vomiting, abdominal pain, and alleviation of symptoms via hot showers in chronic cannabinoid users. Capsaicin is recommended as a reasonable first-line treatment approach for CHS despite limited clinical evidence regarding its use. The objective of this study is to systematically review the efficacy data for capsaicin in CHS. Data Sources: A literature search using keywords related to cannabinoids, emesis, and capsaicin was performed in MEDLINE, CINAHL, and EMBASE from inception through March 31, 2019. Study Selection and Data Extraction: Studies and published abstracts in which capsaicin was used for CHS and clinical outcomes were reported were eligible for inclusion. Data Synthesis: A total of 241 articles were screened, of which 5 full-text articles and 6 conference abstracts were included. Full-text case reports (n = 3) and case series (n = 2) found capsaicin to be effective in a total of 18 patients. Published abstracts were in the form of case reports (n = 1), case series (n = 3), and retrospective cohort studies (n = 2). Relevance to Patient Care and Clinical Practice: Capsaicin use was described as beneficial in all case series and case reports; however, both retrospective cohort studies were unable to find a significant benefit for capsaicin on primary outcomes (emergency department length of stay). Conclusion: Current data for capsaicin efficacy in CHS is of low methodological quality. However, the limited data on alternative antiemetic therapies and capsaicin’s favorable risk-benefit profile make it a reasonable adjunctive treatment option.

Introduction Creatinine‐based equations used to estimate renal function are inaccurate in certain clinical contexts; however, there are limited resources to guide pharmacists in these situations. Objectives To assess current renal function estimation and subsequent drug dosing practices among American College of Clinical Pharmacy (ACCP) members via an electronic survey. Methods A 21‐item survey was emailed to the listservs of four ACCP Practice‐Research Networks: Adult Medicine, Nephrology, Critical Care, and Infectious Diseases. The survey included pharmacist demographics, practice site information, and case‐based clinical application scenarios requiring the respondent to choose a renal function estimate for overweight, underweight, and elderly patients (≥65 years). Four patient cases captured respondents' enoxaparin dosing decisions in patients with an estimated creatinine clearance of around 30 mL/min. Estimates of renal function were provided based on Cockcroft‐Gault (C‐G), Modification of Diet in Renal Disease, and Chronic Kidney Disease Epidemiology equations. Results There were 299 survey responses. The majority of respondents were pharmacists (98%) who practiced in the hospital setting (96%) as clinical specialists (69%). The C‐G equation was chosen to estimate renal function most commonly (85%). Total and adjusted body weights were used in C‐G estimates most commonly in patients who were underweight (80%) and overweight (75%), respectively. Given an elderly patient with low serum creatinine (Scr), 34% of respondents used actual Scr, 30% rounded Scr to 0.8, and 29% rounded Scr to 1.0 for use in C‐G. Enoxaparin renal dose adjustment differed based on clinical indication. Respondents chose more frequent (every 12 hour) dosing in patients with pulmonary embolism vs atrial fibrillation. Of the 79% of respondents whose practice site utilizes pharmacist‐driven renal dose adjustment policies, 94% indicated they deviated from the policy. Conclusion Large variation exists among clinical pharmacists in the application of renal function estimating equations which may impact dosing strategies and patient care.