A Systematic Review on Cannabis Hyperemesis Syndrome and Its Management Options

Abstract

Introduction: Several forms of cannabinoids are currently being used to manage nausea and vomiting (N/V). Emerging cases of refractory N/V, associated with chronic cannabis use among adults and older patients have been reported named cannabis hyperemesis syndrome (CHS). CHS is a condition that leads to repeated and severe N/V in long-term users of cannabinoids. Objective: To outline current treatments for the management of CHS. Methods: A systematic review was conducted using PubMed, Ovid MEDLINE, Cochrane Central, EMBASE and Google Scholar. Databases were used to search for articles on CHS published from January 2009 to June 2021, yielding 225 results of which 17 were deemed relevant and underwent review by two separate reviewers. Results: The duration of cannabis administration ranged between six months to 11 years may precipitate symptoms of CHS. The Rome IV diagnostic criteria of CHS requires cannabinoid use and persistence if N/V symptoms for at least the past six months. Cannabis cessation is noted to be the most successful management, but other treatments also demonstrated symptom relief and included hot water hydrotherapy, topical capsaicin cream, haloperidol, droperidol, benzodiazepines, propranolol and aprepitant administration. Conclusion: Overall future research on CHS is needed which enhance knowledge translation, education and creates awareness of the medical community about the side effects of cannabinoids and propose the best treatment options.

Patterns of Use and Self-reported Effectiveness of Cannabis for Hyperemesis Gravidarum

“…There is also a potential for misclassification between HG and Cannabis Hyperemesis Syndrome (CHS). However, most of the respondents reported initiating use during pregnancy to treat symptoms already existing prior to use when other antiemetics were self-reportedly ineffective, and CHS is a condition of long-term users 27 . In addition, it is unlikely that respondents with CHS would report weight gain within two weeks of initiating use, so if anything, the inclusion of respondents with CHS would bias results in the opposite direction.…”

Trazodone Prolonged-Release Monotherapy in Cannabis Dependent Patients during Lockdown Due to COVID-19 Pandemic: A Case Series

“…CHS is often refractory to the standard treatment for nausea and vomiting [ 16 ]. Unconventional antiemetics, such as haloperidol, have proved to be successful in alleviating symptoms; however, they can lead to adverse effects, such as dystonia, extrapyramidal reactions, and in rare cases, even to severe clinical pictures, such as neuroleptic malignant syndrome [ 17 ].…”

Cannabis-Related Cyclic/Episodic Hyperemesis Conditions: From Suspected to Definitive Cannabinoid Hyperemesis Syndrome

“…Dear Editor, I read with great interest the systematic review by Senderovich et al [1] on cannabis hyperemesis syndrome (CHS) and its treatment. This systematic review was wellconducted; however, some general concerns on the validity/rigor of diagnoses of CHS should be considered.…”

“…In this regard, the prevalence of CVS in Colorado, USA, has nearly doubled since the liberalization of medical marijuana in 2009, suggesting a broad overlap of CHS and CVS [7]. Vice versa, the samples included in this review were likely to be not representative for CHS populations alone as a “contamination” with a good portion of CVS cases could not be excluded considering the lack of attention given to the duration of symptom-free periods post-cessation [1]. This concern can be extended to most studies and case reports which have dealt with CHS.…”