Table 2.

Management of cannabis hyperemesis syndrome.

Therapy	Mechanism and Advantages	Adverse Effects
Benzodiazepines	Useful for their anti-anxiety and anti-emetic effects and inhibition of the vestibular system	Sedation, altered consciousness
TCA	Reduce cholinergic neurotransmission and modulate alpha-2-adrenoreceptors, thereby decreasing sympathetic nervous system activity and mitigating brain–gut autonomic dysfunction	Arrhythmias
Anti-dopaminergic: Haloperidol Droperidol	Haloperidol is a broad-spectrum antiemetic. May interfere with CB1 signaling. Blockage of dopamine at the chemoreceptor trigger zone.	Arrhythmias, central nervous system side effects Dysrhythmias (Q.T. prolongation), oversedation
Dopaminergic agents: Promethazine Prochlorperazine	Effect CTZ area in the brain stem. Variable success noted	Arrhythmias, extrapyramidal effects, hypotension, and sedation related effects
Serotonergic antagonists: Ondansetron	First-line agents used for emesis. Variable response noted	Arrhythmias
Corticosteroids	Rarely used with limited response	Hyperglycemia and psychosis
Capsaicin	Bind to TRPV1 receptors in proximity to CB1	Skin irritation
Aprepitant:	Blocking NK1 receptors in the dorsal vagal complex of the brainstem inhibits the binding of substance P, thereby preventing receptor activation and reducing nausea sensation
Volume repletion	Prevents dehydration related symptom	Minimal
Cannabis cessation	Required for long-term management	Patient compliance

TRPV1, transient receptor potential cation channel subfamily V member 1; TCA, tricyclic antidepressant; CB, cannabinoid; CTZ, chemoreceptor trigger zone.