Efficacy and safety of topical capsaicin for cannabinoid hyperemesis syndrome in the emergency department

Wagner, Samantha; Hoppe, Jason; Zuckerman, Matthew; Schwarz, Kerry; McLaughlin, Julie

doi:10.1080/15563650.2019.1660783

Cited by 33 publications

(48 citation statements)

References 19 publications

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“…Neurorespiratory depression induced by opioid NPS appears to be reversible with naloxone, although higher doses may be necessary to avoid endotracheal intubation [199]. Topical application of capsaicin has recently been reported to be useful to treat cannabinoid hyperemesis syndrome refractory to the usual antiemetics [202]. Rationale Atropine increases heart rate via its action on muscarinic acetylcholine receptors and reactivates adenylate cyclase (pathway not involving beta-adrenergic receptors).…”

Section: Question 63: When Should An Antidote (When One Exists) Be Amentioning

confidence: 99%

Management of pharmaceutical and recreational drug poisoning

Mégarbane

Oberlin

Alvarez

et al. 2020

Ann. Intensive Care

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Background Poisoning is one of the leading causes of admission to the emergency department and intensive care unit. A large number of epidemiological changes have occurred over the last years such as the exponential growth of new synthetic psychoactive substances. Major progress has also been made in analytical screening and assays, enabling the clinicians to rapidly obtain a definite diagnosis. Methods A committee composed of 30 experts from five scientific societies, the Société de Réanimation de Langue Française (SRLF), the Société Française de Médecine d’Urgence (SFMU), the Société de Toxicologie Clinique (STC), the Société Française de Toxicologie Analytique (SFTA) and the Groupe Francophone de Réanimation et d’Urgences Pédiatriques (GFRUP) evaluated eight fields: (1) severity assessment and initial triage; (2) diagnostic approach and role of toxicological analyses; (3) supportive care; (4) decontamination; (5) elimination enhancement; (6) place of antidotes; (7) specificities related to recreational drug poisoning; and (8) characteristics of cardiotoxicant poisoning. Population, Intervention, Comparison, and Outcome (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Analysis of the literature and formulation of recommendations were then conducted according to the GRADE® methodology. Results The SRLF-SFMU guideline panel provided 41 statements concerning the management of pharmaceutical and recreational drug poisoning. Ethanol and chemical poisoning were excluded from the scope of these recommendations. After two rounds of discussion and various amendments, a strong consensus was reached for all recommendations. Six of these recommendations had a high level of evidence (GRADE 1±) and six had a low level of evidence (GRADE 2±). Twenty-nine recommendations were in the form of expert opinion recommendations due to the low evidences in the literature. Conclusions The experts reached a substantial consensus for several strong recommendations for optimal management of pharmaceutical and recreational drug poisoning, mainly regarding the conditions and effectiveness of naloxone and N-acetylcystein as antidotes to treat opioid and acetaminophen poisoning, respectively.

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Section: Question 63: When Should An Antidote (When One Exists) Be Amentioning

confidence: 99%

Management of pharmaceutical and recreational drug poisoning

Mégarbane

Oberlin

Alvarez

et al. 2020

Ann. Intensive Care

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“…Capsaicin has high specificity to these receptors and inhibits the release of substance P in the nucleus tractus solitarius and the area postrema of the brain stem [ 62 ]. The use of capsaicin was associated with a reduction in opioids and total medical requirement in the treatment of CHS [ 63 ]. Minimal side effects, including skin irritation, have been noted.…”

Section: Managementmentioning

confidence: 99%

Cannabis hyperemesis syndrome: an update on the pathophysiology and management

Perisetti

Gajendran

Dasari

et al. 2020

aog

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Cannabis hyperemesis syndrome (CHS) is a form of functional gut-brain axis disorder characterized by bouts of episodic nausea and vomiting worsened by cannabis intake. It is considered as a variant of cyclical vomiting syndrome seen in cannabis users especially characterized by compulsive hot bathing/showers to relieve the symptoms. CHS was reported for the first time in 2004, and since then, an increasing number of cases have been reported. With cannabis use increasing throughout the world as the threshold for legalization becomes lower, its user numbers are expected to rise over time. Despite this trend, a strict criterion for the diagnosis of CHS is lacking. Early recognition of CHS is essential to prevent complications related to severe volume depletion. The recent body of research recognizes that patients with CHS impose a burden on the healthcare systems. Understanding the pathophysiology of the endocannabinoid system (ECS) remains central in explaining the clinical features and potential drug targets for the treatment of CHS. The frequency and prevalence of CHS change in accordance with the doses of tetrahydrocannabinol and other cannabinoids in various formulations of cannabis. CHS is unique in presentation, because of the cannabis’s biphasic effect as anti-emetic at low doses and pro-emetic at higher doses, and the association with pathological hot water bathing. In this narrative review, we elaborate on the role of the ECS, its management, and the identification of gaps in our current knowledge of CHS to further enhance its understanding in the future.

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“…Topical capsaicin shows promise as abortive therapy and has been described to be effective in case reports and series, although the quality of data is low [56]. A retrospective cohort study of 43 patients reported no significant reduction in the length of stay in the emergency department with topical capsaicin, but the use of topical capsaicin resulted in a fewer additional medication doses (4 vs. 3 doses, p = 0.015) and a numerical reduction in opioid use (166.5 vs. 69 mg oral morphine equivalents) [57]. There may be a role for haloperidol in the acute and chronic management of CHS, possibly through interactions between CB1 and dopamine D2 receptors, although this has not yet been prospectively evaluated [53,58].…”

Section: Cannabinoid Hyperemesis Syndromementioning

confidence: 99%

Cannabis in Gastroenterology: Watch Your Head! A Review of Use in Inflammatory Bowel Disease, Functional Gut Disorders, and Gut-Related Adverse Effects

Nasser

Woo

Andrews

2020

Curr Treat Options Gastro

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Purpose of review To review recent clinical evidence surrounding the use of cannabinoids and cannabis in gastrointestinal diseases, particularly inflammatory bowel disease (IBD) and functional gut disorders. A second aim is to evaluate the current status of gastrointestinal related adverse effects which have been linked to cannabis use, specifically cannabis hyperemesis syndrome (CHS) and acute pancreatitis. Recent findings Observational and prospective studies suggest that cannabinoids improve IBD symptoms. Small prospective clinical trials have not shown any effects on objective inflammatory findings, other than one recent paper in ulcerative colitis, in abstract form only, which suggests endoscopic improvement. Short duration mechanistic studies in functional gut disorders suggest cannabinoids may attenuate gastric emptying and slow colonic motility but appear to have less effect on sensory thresholds in the gut. Summary In general, while mostly uncontrolled data suggests cannabis may improve symptoms in IBD (and to a lesser degree functional gut disorders), this is not likely due to any substantial anti-inflammatory effect. Much remains unknown about CHS etiology and complete abstinence from cannabinoids remains the generally accepted treatment strategy. Population-based studies do not suggest that cannabis use is related to acute pancreatitis. Further research is certainly warranted.

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Efficacy and safety of topical capsaicin for cannabinoid hyperemesis syndrome in the emergency department

Cited by 33 publications

References 19 publications

Management of pharmaceutical and recreational drug poisoning

Management of pharmaceutical and recreational drug poisoning

Cannabis hyperemesis syndrome: an update on the pathophysiology and management

Cannabis in Gastroenterology: Watch Your Head! A Review of Use in Inflammatory Bowel Disease, Functional Gut Disorders, and Gut-Related Adverse Effects

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