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

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

Publication date: Sep 04, 2019

Introduction: Cannabinoid hyperemesis syndrome (CHS) is a disorder of cyclic and recurrent nausea, vomiting, and abdominal pain associated with high-frequency and extended-duration marijuana use. Standard antiemetic therapy is often ineffective; however, capsaicin, an agonist of transient receptor potential vanilloid 1 (TRPV1), has shown promise in treating CHS. Methods: This retrospective cohort analysis evaluated the safety and efficacy of topical capsaicin for patients presenting with CHS. The primary outcome was to assess if utilization of capsaicin for ED management of CHS decreased ED length of stay (LOS) as compared to a visit without capsaicin. Secondary outcomes included a cost analysis, use of rescue therapies, and adverse events. Results: Forty-three patients met the inclusion criteria within the study period. ED LOS was reduced with capsaicin by a median of 22 minutes (201 vs. 179 min, p = 0.33). Patients received fewer additional medications if capsaicin was utilized (4 vs. 3 doses, p = 0.015), and 67% of visits where capsaicin was utilized required no further treatment prior to discharge. Additionally, opioid usage was less when utilizing capsaicin (166.5 vs. 69 mg OME). Forty-two percent of patients did not have a repeat CHS presentation to the ED after receiving capsaicin for an additional three months after the study period ended. Total medication cost was minimally more expensive (median difference of $3.26) in the capsaicin group. There were no significant adverse events reported with capsaicin. Conclusion: There was no significant difference in ED LOS when capsaicin was utilized for CHS. However, there was a decrease in total medications administered and a reduction in opioid requirements. While medication costs for capsaicin visits were minimally more expensive, the utility of capsaicin as an over-the-counter (OTC) product may empower at home therapy with OTC products, decreasing potentially unnecessary healthcare encounters and costs.

Wagner, S., Hoppe, J., Zuckerman, M., Schwarz, K., and McLaughlin, J. Efficacy and safety of topical capsaicin for cannabinoid hyperemesis syndrome in the emergency department. 03981. 2019 Clin Toxicol (Phila).

Concepts Keywords
Abdominal Pain Unnecessary healthcare encounters
Agonist Capsaicin
Antiemetic Abdominal pain
Capsaicin Cyclic recurrent nausea
Cohort Branches of biology
Department Ion channels
Frequency Vomiting
Healthcare Medicine
Marijuana Clinical medicine
Nausea Capsaicin
Opioid TRPV1
Topical Cannabinoid hyperemesis syndrome
Transient Receptor Potential Vanilloids
TRPV1 Antiemetic
Vomiting CHS
Hyperemesis gravidarum


Type Source Name
disease MESH cyclical vomiting syndrome
drug DRUGBANK Medical Cannabis
drug DRUGBANK Methionine
disease MESH marijuana use
disease DOID CHS
disease MESH emergency
disease DOID syndrome
disease MESH syndrome
drug DRUGBANK Capsaicin


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