The utility of droperidol in the treatment of cannabinoid hyperemesis syndrome

Abstract

Introduction: Cannabinoid hyperemesis syndrome (CHS) can be characterized by recurrent paroxysmal episodes of intractable nausea and vomiting, abdominal pain, and compulsive hot showers/baths with symptom relief, on the background of chronic cannabis use. We reported the use of droperidol in the management of CHS.Methods: We performed a retrospective review of electronic medical records of Emergency Department presentations to a single tertiary level metropolitan hospital between January 2006 and December 2016 using search keywords: “cannabis”, “cannabinoid”, “cannabis”, “hyperemesis”, and “droperidol”. A secondary search of pharmacy droperidol dispensing records was cross matched with electronic medical record data. We reviewed each record to determine if the presentation met previously published diagnostic criteria for CHS. Data were dichotomised into presentations with droperidol administered or not administered. The primary outcome was defined as the total length of hospital stay. Secondary outcomes measures included time until discharge following last drug administration, and the total number of antiemetic dosages administered.Results: Six-hundred and eighty-nine records were identified and 76 met CHS diagnostic criteria. Thirty-seven presentations were treated with droperidol and 39 were not. Droperidol treatment group median length of stay was significantly lower compared to the no droperidol treatment group (6.7 vs. 13.9 hours, p = .014). Median time to discharge after final drug administration in the droperidol treatment group was 137 minutes (IQR 65, 203) vs. the no droperidol treatment group of 185 minutes (IQR 149, 403). The most frequent dosage of droperidol used was 0.625mg intravenously. The frequency of ondansetron (n = 100) and metoclopramide (n = 27) in the no droperidol treatment group was double that of the droperidol group.Conclusions: Use of droperidol to treat CHS associated nausea and vomiting resulted in less overall use of antiemetics and reduced length of stay.