A Pilot Trial of Topical Capsaicin Cream for Treatment of Cannabinoid Hyperemesis Syndrome

Abstract

Objectives: Patients with cannabinoid hyperemesis syndrome (CHS) present frequently to the emergency department. Previous case studies suggest dramatic symptomatic improvement with topical capsaicin treatment. This exploratory study examined the potential effectiveness of topical capsaicin in patients with nausea and vomiting due to a suspected CHS exacerbation. Methods: This was a double-blind, randomized placebo-controlled pilot trial. Adults who presented with vomiting suspected to be from CHS were eligible for enrollment. We excluded pregnant women and those with resolution of symptoms. Following randomization, topical 0.1% capsaicin or placebo cream was applied to the anterior abdomen in a uniform manner. The primary outcome was the severity of nausea on a visual analog scale (VAS) of 0 to 10 cm assessed at 30 minutes. Secondary outcomes were adverse events, occurrence of posttreatment vomiting, nausea by VAS at 60 minutes, and hospital admission. Results: This pilot trial enrolled 30 patients, 17 in the capsaicin arm and 13 in the placebo arm. One patient in the capsaicin arm did not tolerate treatment due to skin irritation. Mean AE SD nausea severity at 30 minutes was 4.1 AE 2.3 cm in the capsaicin arm and 6.1 AE 3.3 cm in the placebo arm (difference = À2.0 cm, 95% confidence interval [CI] = 0.2 to À4.2 cm). At 60 minutes, mean AE SD nausea severity was 3.2 AE 3.2 cm versus 6.4 AE 2.8 cm (difference = À3.2 cm, 95% CI = À0.9 to À5.4 cm). The percent reduction in nausea at 60 minutes from baseline was 46.0% in the capsaicin arm and 24.9% in the placebo arm (difference = 21.1%, 95% CI = À5.6% to 47.9%). A higher proportion of capsaicin group patients (29.4% vs. 0%) had complete resolution of nausea (relative risk = 3.4, 95% CI = 1.6 to 7.1). Conclusion: In this pilot trial, the application of topical capsaicin cream was associated with a significant reduction in nausea at 60 minutes but not at 30 minutes and provided more complete relief of nausea. C annabinoid hyperemesis syndrome (CHS), thought to be a variant of cyclic vomiting syndrome (CVS), is characterized by the chronic use of cannabis, intractable nausea, recurrent vomiting episodes, and diffuse abdominal pain. Duration and quantification of cannabis use is variable and minimally involves weekly use. 1-4 One particular unique feature of this syndrome, which differentiates it from

Use of Capsaicin Cream in Cannabinoid Hyperemesis Syndrome in Patients Presenting to the Emergency Department

“…A recent prospective study compared capsaicin with placebo in a double-blind randomized trial. 13 The authors found a reduction of nausea 60 minutes after capsaicin application. However, the authors questioned their findings in light of underpowering and potential selection bias.…”

“…Most patients were younger, long-term daily cannabis users and displayed typical CHS patterns of chronic cannabis consumption, abdominal pain, and relief with hot showers. 1-4,10,11,13,16…”

“…Capsaicin cream has been reported as a novel treatment for CHS. 8-13 Topical capsaicin, similar to nociceptive heat, is a transient receptor potential vanilloid subtype 1 (TRPV1) agonist, and TRPV1 activation leads to decrease in substance P synthesis, further producing an antiemetic effect. 8,14 Capsaicin, a component found in chili peppers, is often applied to the abdomen reportedly relieving CHS symptoms, including nausea, vomiting, and abdominal pain.…”

A focused, longitudinal analysis of cannabinoid hyperemesis syndrome symptomatology

“…As the legalization of cannabis continues to spread in North America, it has become increasingly important for physicians to recognize and treat cannabinoid-related syndromes. In this secondary analysis of a randomized controlled trial that studied the effect of topical capsaicin on patients presenting to the emergency department (ED) with cannabinoid hyperemesis syndrome (CHS), we describe symptomatology and return visits in patients suffering from CHS [1].…”

Hiperemesis por cannabis vs vómitos cíclicos

“…En cuanto al tratamiento del SHC, sólo se han publicado 2 ensayos clínicos hasta la fecha, ambos en 2020, comparando haloperidol frente a ondansetrón (Ruberto et al, 2020) y capsaicina frente a placebo (Dean et al, 2020), con una treintena de pacientes en cada uno. Ambos fármacos han demostrado ser eficaces para el control de las náuseas, aunque son necesarios nuevos ensayos con un número mayor de pacientes y otros fármacos a priori útiles, como es el caso del droperidol (Lee, Greene y Wong, 2019) .…”