#EMConf: CAT

Clinical Question: Do dopamine antagonist decrease length of stay in cannabinoid hyperemesis syndrome?

Why is this relevant? Marijuana use is growing nationwide with decreased decriminalization and increased legalization of medical marijuana. Some conditions that are typically approved for medical marijuana use include ALS, anxiety, cancer, chronic pain, multiple sclerosis, PTSD, seizures, and terminal illnesses.

Study 1:
Lee, C., Greene, S. L., & Wong, A. (2019). The utility of Droperidol in the treatment of cannabinoid hyperemesis syndrome. 
Clinical Toxicology57(9), 773777. doi: 10.1080/15563650.2018.1564324

  • Ten-year retrospective review of electronic medical records in a single tertiary metropolitan hospital in Melbourne, Australia

  • 76 patients met criteria- 37 received Droperidol and 39 did not

  • Average length of stay in the Droperidol group was 6.7 hours vs 13.9 in the control group (P=.014)


  • There was significantly more doses of Zofran (100 vs 47) and Morphine (43 vs 15) in the control group

  • Only three patients had adverse reactions two of which were drowsiness, one of which was dystonia

  • Limitations:

    There was a wide variation in doses of Droperidol given
    There was no standardization of treatment
    ECGs were not routinely obtained to evaluated for QT prolongation (a known adverse effect of this class of medication)

Study 2:
Wetzel JC, Mycyk MB. Haloperidol, a Novel Treatment for Cannabinoid Hyperemesis Syndrome. American Journal of Therapeutics. 2017;24(1). doi:10.1097/mjt.0000000000000157.
  • One-year retrospective review of electronic medical records of a large urban ED

  • Four cases were reported of patients presenting with intractable nausea and vomiting, all of which had negative GI workups in the past

  •  Limitations:
  1. No standardization of medications given prior to haloperidol 

  2. Very small population

Bottom Line:
  1. Low dose dopamine antagonists appear to be safe and effective in relieving nausea and vomiting in cannabinoid hyperemesis syndrome.


Future Studies:
Haloperidol versus Ondansetron for Cannabis Hyperemesis Syndrome (HaVOC)