SAEM GRACE: Dopamine antagonists and topical capsaicin for cannabis hyperemesis syndrome in the emergency department: A systematic review of direct evidence.

Publisher: Wiley Country of Publication: United States NLM ID: 9418450 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1553-2712 (Electronic) Linking ISSN: 10696563 NLM ISO Abbreviation: Acad Emerg Med Subsets: MEDLINE

Publication: Hoboken, N.J. : Wiley
Original Publication: Philadelphia, PA : Hanley & Belfus, c1993-

Vomiting*/drug therapy ; Vomiting*/chemically induced ; Emergency Service, Hospital* ; Capsaicin*/therapeutic use ; Capsaicin*/administration & dosage ; Dopamine Antagonists*/therapeutic use; Humans ; Administration, Topical ; Adult ; Antiemetics/therapeutic use ; Syndrome ; Female ; Male ; Cannabinoid Hyperemesis Syndrome

Background: Adults with cannabis hyperemesis syndrome (CHS) are increasingly presenting to the emergency department (ED), and this systematic review will evaluate the direct evidence on the effectiveness of capsaicin and dopamine antagonists in its clinical management.
Methods: A bibliographic search was conducted to address the following population-intervention-control-outcome (PICO) question: (P) adults >18 years old with a diagnosis of acute CHS presenting to the ED; (I) dopamine antagonists (e.g., haloperidol, droperidol) and topical capsaicin; (C) usual care or no active comparator; and (O) symptoms improvement/resolution in ED, ED length of stay, admission rate, ED recidivism, need for rescue medication, and adverse events. This systematic review was conducted in accordance with PRISMA reporting recommendations.
Results: From 53 potentially relevant articles, seven articles were included: five observational studies and two randomized controlled trials, including a total of 492 patients. Five of these studies evaluated the efficacy of capsaicin cream (n = 386), and two examined dopamine antagonists (haloperidol, droperidol; n = 106). There was mixed evidence for the efficacy of capsaicin for reducing nausea and emesis. Both studies evaluating dopamine antagonists detected clinical benefit to usual care or no active comparator.
Conclusions: There is limited direct evidence on the efficacy of dopamine antagonists or capsaicin for treating CHS in the ED. Current evidence is mixed for capsaicin and potentially beneficial for dopamine antagonists. Because of the small number of studies, small number of participants, lack of standardization of treatment administration, and risk of bias of the included studies, methodologically rigorous trials on both types of intervention are needed to directly inform ED management of CHS.
(© 2023 Society for Academic Emergency Medicine.)

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Society for Academic Emergency Medicine (SAEM); Peter Boris Chair in Addictions Research; Tier 1 Canada Research Chair. This paper is written in conjunction with the Society for Academic Emergency Medicine's (SAEM) Guidelines for Reasonable and Appropriate Care in the Emergency Department (GRACE) initiative.; Supported by the Society for Academic Emergency Medicine (SAEM); Peter Boris Chair in Addictions Research; Tier 1 Canada Research Chair. This paper is written in conjunction with the Society for Academic Emergency Medicine's (SAEM) Guidelines for Reasonable and Appropriate Care in the Emergency Department (GRACE) initiative.

Keywords: cannabinoids; cannabis hyperemesis syndrome; capsaicin; droperidol; emergency department; haloperidol; marijuana; treatment

Date Created: 20230630 Date Completed: 20240515 Latest Revision: 20240606

20240607

10.1111/acem.14770

37391387