UMEM Educational Pearls

Category: Toxicology

Title: Use of droperidol for cannabinoid hyperemesis syndrome

Keywords: droperidol, cannabinoid hyperemesis syndrome, recurrent nausea/vomiting (PubMed Search)

Posted: 11/7/2019 by Hong Kim, MD, MPH
Click here to contact Hong Kim, MD, MPH

 

Droperidol has recently become available again in select U.S. institutions. It has been used as an antiemetic and to treat agitation prior to the FDA’s black box warning (for QT prolongation) and national shortage. 

Recently, a retrospective study was conducted (Melbourne, Australia) in the use of droperidol in the management of cannabinoid hyperemesis syndrome (CHS).

Results

689 medical records were identified from January 2006 to December 2016.

76 cases met diagnostic criteria of CHS (below)

  • Long-term cannabis use
  • Symptoms of recurrent vomiting
  • Absence of illness that could otherwise explain symptoms.

Droperidol group (DG) = 37; no droperidol group (NDG)= 39 

Median length of stay: 

  • DG: 6.7 hr vs. NDG: 13.9 hours (p=0.014)

Median time to discharge after final drug administration: 

  • DG: 137 min (IQR: 65, 203) vs. NDG: 185 min (IQR: 149, 403)

Frequency of droperidol (dose) used: 

  1. 0.625 mg (n=25)
  2. 1.25 mg (n=20)
  3. 2.5 mg (n=17)

Metoclopramide and Ondansetron use in non-droperidol group was twice that of droperidol group

Conclusion

  • Droperidol use to treat CHS associated nausea/vomiting resulted in decreased length of stay and lower use of antiemetics.