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

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  • Additional Information
    • Source:
      Publisher: Informa Healthcare Country of Publication: England NLM ID: 101241654 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1556-9519 (Electronic) Linking ISSN: 15563650 NLM ISO Abbreviation: Clin Toxicol (Phila) Subsets: MEDLINE
    • Publication Information:
      Publication: London : Informa Healthcare
      Original Publication: Philadelphia, PA : Taylor & Francis, c2005-
    • Subject Terms:
      Emergency Service, Hospital*/statistics & numerical data; Antiemetics/*therapeutic use ; Cannabinoids/*adverse effects ; Capsaicin/*therapeutic use ; Marijuana Abuse/*drug therapy ; Marijuana Smoking/*adverse effects ; Vomiting/*drug therapy; Abdominal Pain/drug therapy ; Abdominal Pain/etiology ; Administration, Topical ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Antiemetics/administration & dosage ; Antiemetics/adverse effects ; Capsaicin/administration & dosage ; Capsaicin/adverse effects ; Colorado ; Humans ; Length of Stay ; Marijuana Abuse/complications ; Middle Aged ; Nausea/drug therapy ; Nausea/etiology ; Retrospective Studies ; Syndrome ; Vomiting/etiology ; Young Adult
    • Abstract:
      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.
    • Comments:
      Comment in: Clin Toxicol (Phila). 2020 Sep;58(9):938. (PMID: 31913735)
      Comment in: Clin Toxicol (Phila). 2020 Sep;58(9):939. (PMID: 32067516)
    • Contributed Indexing:
      Keywords: Marijuana; cannabis; capsaicin; cyclical vomiting syndrome; nausea; vomiting
    • Accession Number:
      0 (Antiemetics)
      0 (Cannabinoids)
      S07O44R1ZM (Capsaicin)
    • Publication Date:
      Date Created: 20190905 Date Completed: 20201015 Latest Revision: 20201229
    • Publication Date:
      20240829
    • Accession Number:
      10.1080/15563650.2019.1660783
    • Accession Number:
      31482758