UMEM Educational Pearls

Category: Toxicology

Title: Capsaicin for cannabinoid hypermesis syndrome?

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

Posted: 9/19/2019 by Hong Kim, MD, MPH
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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).


  • Most frequently administered medications in both groups were:
  1. Anti-emetics
  2. Haloperidol
  3. 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.



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


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]