Is haloperidol the wonder drug for cannabinoid hyperemesis syndrome?

Inayat, Faisal; Virk, Hafeez Ul Hassan; Ullah, Waqas; Hussain, Qulsoom

doi:10.1136/bcr-2016-218239

Cited by 20 publications

(22 citation statements)

References 14 publications

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“…For these case series, the following CHS pharmacologic treatments were reported as helpful: benzodiazepines (six), topical capsaicin (five), haloperidol (five), and olanzapine (one) . The 44 level‐5 case reports involved 44 patients . For these case reports, the following CHS pharmacologic treatments were reported as effective: benzodiazepines (five), metoclopramide (four), haloperidol (four), ondansetron (two), morphine (two), and topical capsaicin (two) .…”

Section: Resultsmentioning

confidence: 99%

“…A total of 13 metoclopramide treatment failures were noted for CHS based on our review . The butyrophenone haloperidol was reported as effective in several case series and reports that may reflect its unique pharmacology relative to the other more common antiemetics . Haloperidol is primarily an antipsychotic but has been used off‐label as an effective general antiemetic…”

Section: Discussionmentioning

confidence: 99%

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Pharmacologic Treatment of Cannabinoid Hyperemesis Syndrome: A Systematic Review

et al. 2017

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Cannabinoid hyperemesis syndrome (CHS) has become more prevalent with increasing cannabis use. CHS is often resistant to standard antiemetics. The objective of this study is to review the current evidence for pharmacologic treatment of CHS. Medline, PsycINFO, DARE, OpenGrey, Google Scholar, and the Cochrane Library were searched from inception to February 2017. Articles were selected and reviewed independently. Evidence was graded using Oxford Center for Evidence-Based Medicine guidelines. The search resulted in 1262 articles with 63 of them eligible for inclusion (205 human subjects). 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. 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. Effective treatments mentioned only once included fentanyl, diazepam, promethazine, methadone, nabilone, levomepromazine, piritramide, and pantoprazole. Hot showers and baths were cited in all level-4 and -5 articles as universally effective. High-quality evidence for pharmacologic treatment of CHS is limited. Benzodiazepines, followed by haloperidol and capsaicin, were most frequently reported as effective for acute treatment, and TCAs for long-term treatment. As the prevalence of CHS increases, future prospective trials are greatly needed to evaluate and further define optimal pharmacologic treatment of patients with CHS.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Pharmacologic Treatment of Cannabinoid Hyperemesis Syndrome: A Systematic Review

et al. 2017

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“…A summary of these studies appears in Table 2 [6, 7, 10, 19, 22, 54, 94, 97, 99, 101, 105, 111, 113, 114, 116, 117, 121, 126, 127, 132-173]. …”

Section: Clinical Considerationsmentioning

confidence: 99%

“…During his last hospitalization he was given conventional antiemetic therapy but his symptoms persisted for 2 more days. He consented to IV haloperidol 1 mg which relieved his symptoms and produced no adverse effects; he subsequently received two more IV doses of 2 mg before he was discharged [114]. An 18-year-old patient diagnosed with CHS refused to stop using marijuana and was treated in-clinic with haloperidol followed by outpatient 5 mg haloperidol which relieved her symptoms of nausea and vomiting.…”

Section: Treatmentmentioning

confidence: 99%

Cannabinoid Hyperemesis

Pergolizzi Jr.,

LeQuang,

Bisney

2018

Med Cannabis Cannabinoids

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Cannabinoid hyperemesis syndrome (CHS) is a paradoxical condition in which a long-term cannabis user suffers an episode of intractable vomiting that may last days separated by longer asymptomatic periods of weeks or months. Cannabinoids are often utilized for their antiemetic properties, so CHS can be a puzzling condition, and the diagnosis of CHS may be disputed by patients. Unlike other cyclic vomiting syndromes, CHS can be relieved by hot showers or topical capsaicin. Abstinence from cannabinoids causes CHS to resolve, sometimes in a matter of days or hours. Marijuana users as well as many clinicians are not aware of CHS, and patients may undergo unnecessary tests, scans, and other procedures to get an accurate diagnosis. Symptoms may be severe enough to require hospitalization. With liberalization of marijuana laws and favorable public opinion about the healing properties of cannabis, CHS may be more frequently observed in clinical practice.

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“…We would add our anecdotal success with sublingual olanzapine, which can obviate the need for IVaccess and allows for home treatment in some cases. Although case-based literature exists to support the use of anti-dopaminergic agents [2][3][4], there is clearly a need for controlled trials to definitively identify the most time and cost effective treatment approach. We welcome and support future collaboration towards this goal.…”

mentioning

confidence: 99%