UMEM Educational Pearls

Title: Capsaicin for cannabinoid hypermesis syndrome?

Keywords: capsaicin, cannabinoid hyperemesis syndrome, marijuna use. (PubMed Search)

Posted: 9/19/2019 by Hong Kim, MD, MPH
Click here to contact Hong Kim, MD, MPH

Cannabinoid hyperemesis syndrome [CHS] (i.e. cyclic/recurrent nausea, vomiting and abdominal pain) is associated with long-term and frequent use of marijuana. Patients with CHS often report temporary relief of symptoms with hot water/shower exposure. Emergency room providers may encounter a growing number of patients with CHS with increasing legalization of marijuana-containing products.

Topical capsaicin has been gaining interest as a potential adjunct to the conventional management of patients with CHS (e.g. antiemetics, opioids, benzodiazepines and antipsychotics).

A small retrospective study was performed involving 43 patients who had multiple visits, and were treated with and without capsaicin. The primary outcome was the ED length of stay (LOS).

Results

Most frequently administered medications in both groups were:

Anti-emetics
Haloperidol
Diphenhydramine

Median ED LOS: no significant difference
- Capsaicin vs. non-capsaicin: 179 min (IQR: 147, 270) vs. 201 min (IQR: 168, 310) (p=0.33)

Capsaicin group showed
- Decreased opioid used: 69 mg vs. 166.5 mg oral morphine equivalents
- Fewer additional medication administration: 3 vs. 4 doses (p=0.015)
- Shorter median time to discharge after last medication administration: 60 min (IQR: 35, 115) vs. 92 min (IQR: 47, 155) (p=NS)

67% of the visit where capsaicin was used required no additional medication.

Conclusion

Capsaicin use did not decrease ED LOS.
However, there was a decrease in total medications administered and opioid requirement.

References

Wagner S et al. Efficacy and safety of topical capsaicin for cannabinoid hyperemesis syndrome in the emergency department. Clin Toxicol (Phila) 2019. Sep 4:1-5. doi: 10.1080/15563650.2019.1660783. [Epub ahead of print]