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Capsaicin for Cannabis Hyperemesis – A Randomized Trial

August 28, 2020

Written by Vivian Lei

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Topical application of capsaicin cream reduced nausea and vomiting in patients with suspected cannabinoid hyperemesis syndrome in this small randomized placebo-controlled trial.

Why does this matter?
The intractable nausea and vomiting of cannabinoid hyperemesis syndrome (CHS) is challenging to manage. Capsaicin cream is an over-the-counter topical analgesic with primarily anecdotal evidence suggesting efficacy in relief of CHS symptoms. This pilot trial evaluated the safety and efficacy of capsaicin in treatment of suspected CHS. 

So you take 10 hot showers a day…
This was a randomized, double-blind, placebo-controlled study which enrolled adult patients with suspected CHS in the ED. Patients were randomized to receive topical 0.1% capsaicin cream versus a placebo moisturizing cream. The researchers enrolled 30 participants, 17 in the capsaicin group and 13 in the placebo group. Patients reported nausea on a validated visual analog scale (VAS) rated from 0 to 10 (most severe) at 30 minutes and 60 minutes. Researchers found that there was a non-statistically significant decrease in nausea at 30 minutes (difference -2.0 cm, 95% CI, 0.2 to -4.2 cm) and a statistically significant difference in nausea at 60 minutes (difference -3.2 cm, 95% CI -0.9 to -5.4 cm). Of the capsaicin group, 29.4% reported complete relief of nausea versus 0% of the placebo group. This study was quite small and underpowered to make major conclusions on several endpoints but suggests a benefit of capsaicin in treatment of refractory nausea in suspected CHS. Larger studies are needed.

A Pilot Trial of Topical Capsaicin Cream for Treatment of Cannabinoid Hyperemesis Syndrome. Acad Emerg Med. 2020 Jun 22. doi: 10.1111/acem.14062. [Epub ahead of print]

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