Cannabinoid hyperemesis syndrome: Causes, symptoms, and treatment

Several treatments have been described to relieve N/V in CHS; however, there are limited controlled data to support management decisions. Topical capsaicin and haloperidol are currently the only treatment with efficacy validated in RCTs [22, 32]. Haloperidol showed improvements in N/V and decreased the LOS in the ED; however, caution should be exercised as it has been shown to cause acute dystonia in higher dosages [30, 31, 32, 33]. Other pharmacological interventions, such as droperidol used in the ED for the treatment of CHS, showed accelerated discharge which may help preserve ED resources [27, 28]. Propranolol has also shown relief in N/V for individuals with severe recurrent CHS [34]. Aprepitant was found to rapidly relive N/V in patients resistant to traditional antiemetics [35].

Etiology of CHS

You may have symptoms and side effects of CHS for a few weeks after quitting cannabis. Research is ongoing on the exact way that cannabis triggers this problem. In the meantime, the best way to relieve CHS symptoms is to stop using the drug. While it is possible to return to feeling normal during the recovery phase, research indicates that symptoms recur if cannabis use resumes. Along with the discovery of the CB1 and CB2 receptors has been the identification of endogenous arachidonic acid derivatives that bind to these receptors (Figure 1). These compounds are referred to as endogenous cannabinoids, or endocannabinoids.

The Three Stages of CHS

The prodromal phase4,17 can last for months or years, with patients developing early morning nausea, a fear of vomiting, and abdominal discomfort. Symptoms are most common in early middle-aged adults who have consistently been using cannabis since adolescence. Unlike anorexia nervosa or bulimia, these patients maintain normal eating patterns in this stage. They may increase their use of cannabis due to their belief in its beneficial effects in nausea relief. The mechanism by which cannabis induces hyperemesis is presently unknown.

Signs and symptoms

Although it was considered to be rare, the number of cases has increased with the legalization of marijuana in many places and the opening of retail stores to easily get it. This has increased both the number of people using the drug and the “high” in the available weed. The only proven way to prevent cannabis hyperemesis syndrome is to avoid cannabis (marijuana). Most people with CHS who stop using cannabis have relief from symptoms within 10 days. In one study of frequent cannabis users with potential CHS symptoms, 33% of participants met the definition of CHS.

This factor is a key distinguishing feature from cannabis hyperemesis syndrome, where the toxicokinetics of cannabis itself influence the course of the disease. Furthermore, indications, contraindications, and drug-drug interaction should be kept in mind and risks versus benefits weighed in older adults with multiple comorbidities while considering the management options. In older populations, benzodiazepines should be used with caution in the management of CHS due to the potential risk of addiction, cognitive impairment, development of delirium, and falls [45]. Haloperidol should also be used with caution in patients with dementia and Parkinson’s disease, as dopamine blockade can dramatically worsen symptoms causing extrapyramidal side effects and incapacitation [46].

What are the symptoms?

The majority of reported cases that have provided follow-up included a period of less than one year [6,52,54,56–60,62,68,71]. A greater understanding of the natural course of the syndrome and response to marijuana cessation may be gained with longer lengths of follow-up. Future studies following patients longitudinally for extended periods of time are needed. Two cannabinoid hyperemesis syndrome distinct cannabinoid receptors, CB1 and CB2, have been identified in human and animal models. The CB1 and CB2 receptors function as G-protein coupled receptors that act by inhibiting adenylate cyclase [7]. In the brain, CB1 receptors are localized to the cerebral cortex, hypothalamus, anterior cingulate gyrus, hippocampus, cerebellum, and basal ganglia [8].

• Experts also aren’t clear on what causes CHS, or why some people develop it while others don’t.
• Also, it’s possible there are more cases than have been reported, since not everyone with the illness will seek medical help or tell their doctor they use cannabis, the Cleveland Clinic notes.
• This could result in excessive levels of pro-emetic cannabinoids or emetogenic metabolites.
• A large reservoir of stored THC in fat tissue may produce a “reintoxication effect” secondary to increased lipolysis during times of increased stress or food deprivation [23].
• If symptoms persist and you continue to use cannabis, you may experience more severe problems that require hospitalization for treatment.

A recent review has explored numerous potential explanations regarding various pharmacokinetic and pharmacodynamic factors of the cannabinoids [72]. The cannabis plant contains over four hundred different chemicals, https://ecosoberhouse.com/ with sixty possessing cannabinoid structures [76]. The pro-emetic effects of two of these cannabinoids, CBD and CBG, have been discussed in this review and could conceivably play a role in the development of CHS.

• The syndrome is likely underreported given its recent recognition [74,75].
• And a 2022 Canadian study found that ER visits for CHS-related problems had increased 13-fold between 2014 and 2021.
• Although both conditions share an astonishing similarity, there are several significant differences.

This article may discuss unlabeled or investigational use of certain drugs. Please review the complete prescribing information for specific drugs or drug combinations—including indications, contraindications, warnings, and adverse effects—before administering pharmacologic therapy to patients. The patient’s urine drug screen (UDS) was positive for tetrahydrocannabinol (THC). A computed tomography (CT) scan of his abdomen and pelvis with contrast was unremarkable.