Capsaicin for Cannabis Hyperemesis – A Randomized Trial

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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1 thought on “Capsaicin for Cannabis Hyperemesis – A Randomized Trial”


    We implemented a capsaicin patch over epigastric abdomen order instead of cream (once in ED or Q8H inpatient). Multiple benefits (and success) in this delivery method most notably patient tolerance, consistent application by nursing, non-messy on clothes, easily removable, limit waste of unused product, reduced use of other adjunct meds such as Ativan/Haldol and OTC availability. We have seen significant improvement in satisfaction of patient and more likely to use patch over cream outpatient. Our toxicology team welcomed the change immediately too.

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