Treatment of cannabinoid hyperemesis syndrome: A systematic review and treatment algorithm for consultation-liaison psychiatrists.
Level 4 - case-series / case-control
Systematic review of individual case reports and case series (Level 4 evidence base)
PubMed 41129865 · doi:10.1016/j.genhosppsych.2025.10.012
What was done
Authors systematically reviewed PubMed, PsycINFO/PsychARTICLES, Embase, and Web of Science from inception through July 2021 according to PRISMA guidelines. The review included literature providing patient-level data on pharmacological treatments for Cannabinoid Hyperemesis Syndrome (CHS). Treatments were evaluated for resolution of nausea, hyperemesis, and hot water bathing behavior to develop a proposed treatment algorithm for consultation-liaison psychiatrists.
What was found
The search identified 34 eligible articles describing 63 individual cases. Across these reports, capsaicin cream, antipsychotics, and benzodiazepines were reported to improve CHS symptoms more effectively than traditional anti-emetics such as promethazine, ondansetron, and metoclopramide. The abstract reports no numerical response rates, effect estimates, or statistical comparisons.
Why it matters
CHS is notoriously resistant to conventional antiemetics, creating management challenges in acute and psychiatric liaison settings. This synthesis organizes published clinical experience into an actionable treatment algorithm.
Limits
The review relies entirely on 63 published case reports, introducing severe publication bias and confounding. No randomized trials or prospective controlled studies were identified, the search concluded in July 2021, and the abstract provides no quantitative outcome measures.
Cited by
- supports Chronic cannabis exposure can lead to cannabinoid hyperemesis syndrome, causing cyclical vomiting despite initial anti-emetic effects.