Capsaicin for Cannaboid Hyperemesis Syndrome

Capsaicin is the stuff in chili peppers that makes your mouth feel hot. But it also has some medical purposes. It’s a key ingredient in creams and patches that has been used for pain relief (e.g. joint, muscle, headaches).

From our recent hospital PNT meeting –information on using Capsaicin for Cannaboid Hyperemesis Syndrome (CHS).

What is cannabinoid hyperemesis syndrome (CHS)?

  • Clinical syndrome in which marijuana users develop nausea, cyclic vomiting, and abdominal pain that improves with a hot water bath or cannabis cessation
  • Often refractory to standard treatment for nausea/vomiting
  • No laboratory or diagnostic tests for CHS

Capsaicin Mechanism for CHS

  • Transient receptor potential vanilloid subtype 1 (TRPV1) receptor is expressed in the brain, along enteric and vagal nerves, and on cutaneous receptors in the skin
  • Chronic cannabis use results in inactivation of TRPV1 receptor leading to  nausea & emesis
  • Nociceptive heat, such as topical capsaicin, acts as a TRPV1 agonist restoring gastric motility
  • Activation of TRPV1 receptor results in potent anti-emetic effects
  • Capsaicin exposure results in subsequent desensitization of the sensory axons and inhibition of pain transmission initiation.

Topical Capsaicin

  • Product: Capsaicin cream 0.025% (Generic)
  • Dosing: Apply thin film to affected area not more than 3 to 4 times/day
  • Benefits:
    • Less adverse effects than unconventional antiemetics (e.g., haloperidol)
    • Cost-effective
  • Adverse effects: “burning sensation” on skin
  • Average wholesale price: $10 per 60 gram tube

Supporting literature

  • Graham J, et al.
    • Case series in which capsaicin was successfully used to treat CHS in two pediatric patients presenting to the emergency department (ED).
    • In a 16 yo & 20 yo, each with two ED visits, on the 2nd visit: due to history of cannabis use, CHS became working diagnosis, patients agreed to try capsaicin cream (0.025%, 1 mm-thick coating) applied to the abdomen. Thirty minutes after capsaicin application, patients pain decreased to a 3 out of 10 and her nausea resolved

References:

  1. Moon AM, Buckley SA, Mark NM. Successful treatment of cannabinoid hyperemesis syndrome with topical capsaicin. ACG Case Rep J. 2018 Jan 3;5:e3.
  2. Graham J, Barberio M, Wang GS. Capsaicin cream for treatment of cannabinoid hyperemesis syndrome in adolescents: A case series. 2017 Dec;140(6): e20163795.

My take: Capsaicin use for CHS is supported by case reports.

Disclaimer: These blog posts are for educational purposes only. Specific dosing of medications/diets (along with potential adverse effects) should be confirmed by prescribing physician/nutritionist.  This content is not a substitute for medical advice, diagnosis or treatment provided by a qualified healthcare provider. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a condition.

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