Cannabis Hyperemesis

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We’ve all seen Cannabis hyperemesis and it’s not pretty. The patient showers and feels much better….. and keeps wanting to shower in the ED. We give some Ondansetron and feel better…. although the patient keeps vomiting.

A year ago we presented Cannabis Hyperemesis Syndrome at EMCORE Gold Coast(Watch the Video below and watch to the end for some new approaches), where we spoke about Haloperidol and other treatments.

…Now we have the HaVOC Trial which specifically looked at Haloperidol for this syndrome. 

What they did:

  • n=33: a small study that was halted early
  • Blinded and Randomised
  • Compared haloperidol (randomisation to either 0.05 or 0.1 mg/kg IV) vs ondansetron 8 mg intravenously

Primary Outcome

Reduction in abdominal pain and nausea, measured on a 10-cm visual analog scale at 2 hours following treatment.

The trial although small, secondary to enrolment issues, found Haloperidol to be superior.

Ruberto AJ. Intravenous Haloperidol Versus Ondansetron for Cannabis Hyperemesis Syndrome (HaVOC): A Randomized, Controlled TrialAnn Emerg Med. 2020 Nov. Online ahead of print.

Below is a video on this very topic where Dr Will Davies discussed these methods back at EMCORE Gold Coast 2020

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Dr Peter Kas

Emergency Physician, Educator. Key Interests: Resuscitation, Airway, Emergency Cardiology, Clinical Examination. Creator


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