Topical capsaicin for the treatment of cannabinoid hyperemesis syndrome, a systematic review and meta-analysis

Published:January 15, 2021DOI:



      Cannabinoid hyperemesis syndrome (CHS) is a condition that is being recognized and treated more frequently in emergency departments (EDs) across the United States. Currently, ED providers rely on antiemetics, antipsychotics and benzodiazepines to alleviate the symptoms. Topical capsaicin, a transient receptor potential vanilloid 1 (TRPV1) agonist, has been proposed in recent years as a low-cost and effective alternative to the traditional antiemetic regimen when treating CHS. The aim of this systematic review and meta-analysis is to demonstrate the reliability and the gaps of what is known about this treatment modality.


      Articles were extracted from PubMed, SCOPUS, and Google Scholar databases. Publication dates ranged from the inception of the databases to October 2020. Initial searches found 328 studies. After careful review and screening by two investigators, 7 studies met the inclusion criteria and were included for our meta-analysis. Variables that were evaluated included the prevalence of hospital admissions for patients treated with capsaicin, time to relief of symptoms after capsaicin administration, and ED length of stay (LOS). I-square and Q-statistic values were used to assess heterogeneity.


      Among the 7 studies, there was a total of 106 patients. Two studies reported time to resolution of symptoms following capsaicin administration and ED LOS. Means for these outcomes were 325 (95% CI 234–787) and 379 (95% CI 10–747) minutes respectively. I-square was 44%, and Q-statistic was 11 with 6 degrees of freedom, with a p-value of 0.1.


      With acceptable time to resolution of symptoms after topical administration and ED LOS, capsaicin appears to be an effective treatment option for symptomatic relief of CHS. Further randomized controlled trials should be conducted to examine if it is the more efficacious and efficient treatment for CHS across various care settings.


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      1. What is the scope of marijuana use in the United States?.
        (Published online April 8)
        • Hall W.
        • Degenhardt L.
        The adverse health effects of chronic cannabis use.
        Drug Test Anal. 2014; 6: 39-45
        • Kalla A.
        • Krishnamoorthy P.M.
        • Gopalakrishnan A.
        • Figueredo V.M.
        Cannabis use predicts risks of heart failure and cerebrovascular accidents: results from the National Inpatient Sample.
        J Cardiovasc Med. 2018; 19: 480-484
        • Lopez-Quintero C.
        • Cobos J.P.
        de los, Hasin DS, et al. probability and predictors of transition from first use to dependence on nicotine, alcohol, cannabis, and cocaine: results of the National Epidemiologic Survey on alcohol and related conditions (NESARC).
        Drug Alcohol Depend. 2011; 115: 120-130
        • Market Analysis Of Plant-Based Drugs
        United Nations Office on Drugs and Crime.
        • Monte A.A.
        • Shelton S.K.
        • Mills E.
        • et al.
        Acute illness associated with Cannabis use, by route of exposure: an observational study.
        Ann Intern Med. 2019; 170: 531
        • Galli J.A.
        • Sawaya R.A.
        • Friedenberg F.K.
        Cannabinoid hyperemesis syndrome.
        Curr Drug Abuse Rev. 2011; 4: 241-249
        • Habboushe J.
        • Rubin A.
        • Liu H.
        • Hoffman R.S.
        The prevalence of cannabinoid hyperemesis syndrome among regular marijuana smokers in an urban public hospital.
        Basic Clin Pharmacol Toxicol. 2018; 122: 660-662
        • Madireddy S.
        • Patel R.S.
        • Ravat V.
        • et al.
        Burden of comorbidities in hospitalizations for Cannabis use-associated intractable vomiting during post-legalization period.
        Cureus. 2019; 11: e5502
        • Richards J.R.
        Cannabinoid hyperemesis syndrome: pathophysiology and treatment in the emergency department.
        J Emerg Med. 2018; 54: 354-363
        • Richards J.R.
        • Gordon B.K.
        • Danielson A.R.
        • Moulin A.K.
        Pharmacologic treatment of cannabinoid hyperemesis syndrome: a systematic review.
        Pharmacother J Hum Pharmacol Drug Ther. 2017; 37: 725-734
        • Chang Y.H.
        • Windish D.M.
        Cannabinoid hyperemesis relieved by compulsive bathing.
        Mayo Clin Proc. 2009; 84: 76-78
        • Groninger H.
        • Schisler R.E.
        Topical capsaicin for neuropathic pain #255.
        J Palliat Med. 2012; 15: 946-947
        • Rudd J.A.
        • Nalivaiko E.
        • Matsuki N.
        • Wan C.
        • Andrews P.L.
        The involvement of TRPV1 in emesis and anti-emesis.
        Temperature. 2015; 2: 258-276
        • Moon A.M.
        • Buckley S.A.
        • Mark N.M.
        Successful treatment of cannabinoid hyperemesis syndrome with Topical Capsaicin.
        ACG Case Rep J. 2018; 5: e3
        • Dezieck L.
        • Hafez Z.
        • Conicella A.
        • et al.
        Resolution of cannabis hyperemesis syndrome with topical capsaicin in the emergency department: a case series.
        Clin Toxicol. 2017; 55: 908-913
        • McConachie S.M.
        • Caputo R.A.
        • Wilhelm S.M.
        • Kale-Pradhan P.B.
        Efficacy of capsaicin for the treatment of cannabinoid hyperemesis syndrome: a systematic review.
        Ann Pharmacother. 2019; 53: 1145-1152
        • Moher D.
        • Shamseer L.
        • Clarke M.
        • et al.
        Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement.
        Syst Rev. 2015; 4: 1
        • Wells G.A.
        • Shea B.
        • O'Connell D.
        • Peterson J.
        • Welch V.
        • TT Losos M.
        The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in metaanalyses.
        (Available from:)
        • Murad M.H.
        • Sultan S.
        • Haffar S.
        • Bazerbachi F.
        Methodological quality and synthesis of case series and case reports.
        BMJ Evid-Based Med. 2018; 23: 60-63
        • Zeng X.
        • Zhang Y.
        • Kwong J.S.W.
        • et al.
        The methodological quality assessment tools for preclinical and clinical studies, systematic review and meta-analysis, and clinical practice guideline: a systematic review.
        J Evid-Based Med. 2015; 8: 2-10
        • Lapoint J.
        2014 ACMT annual scientific meeting—march 28–30, 2014 Phoenix, AZ, USA.
        J Med Toxicol. 2014; 10: 85
        • Lapoint J.
        2014 annual meeting of the north American congress of clinical toxicology (NACCT).
        Clin Toxicol. 2014; 52: 707
        • Dean D.J.
        • Sabagha N.
        • Rose K.
        • et al.
        A pilot trial of topical capsaicin cream for treatment of cannabinoid hyperemesis syndrome. Kuehl DR, ed.
        Acad Emerg Med. 2020; 27: 1166-1172
        • Wagner S.
        • Hoppe J.
        • Zuckerman M.
        • Schwarz K.
        • McLaughlin J.
        Efficacy and safety of topical capsaicin for cannabinoid hyperemesis syndrome in the emergency department.
        Clin Toxicol. 2020; 58: 471-475
        • McCloskey K.
        • Goldberger D.
        • Rajasimhan S.
        • Mckeever R.
        • Vearrier D.
        North American congress of clinical toxicology (NACCT) abstracts 2017.
        Clin Toxicol. 2017; 55: 141
        • Hayman M.
        • Kam P.C.A.
        Capsaicin: a review of its pharmacology and clinical applications.
        Curr Anaesth Crit Care. 2008; 19: 338-343
        • Fattori V.
        • Hohmann M.
        • Rossaneis A.
        • Pinho-Ribeiro F.
        • Verri W.
        Capsaicin: current understanding of its mechanisms and therapy of pain and other pre-clinical and clinical uses.
        Molecules. 2016; 21: 844
        • Derry S.
        • Moore R.A.
        Topical capsaicin (low concentration) for chronic neuropathic pain in adults. Cochrane Pain, Palliative and Supportive Care Group, ed.
        Cochrane Database Syst Rev. 2012; (Published online September 12)
        • Hafez Z.
        • Liss D.
        • Schwarz D.
        • Mullins M.
        37th international congress of the European Association of Poisons Centres and Clinical Toxicologists (EAPCCT) 16–19 may 2017, Basel, Switzerland.
        Clin Toxicol. 2017; 55: 443