Droperidol Plus Diphenhydramine for Symptom Improvement in Suspected Cannabinoid Hyperemesis Syndrome: A Prospective Cohort Study

Abstract

Quincy Chopra,1 Vincent Peyko,2 Jessica Annie Lee,3 Leo Puhalla,3 David J Gemmel,4 Todd Bolotin5,6 1Department of Emergency Medicine, Palmdale Regional Medical Center, Palmdale, CA, USA; 2Department of Pharmacy, Mercy Health St. Elizabeth Boardman Hospital, Boardman, OH, USA; 3Northeastern Ohio Medical University, College of Medicine, Rootstown, OH, USA; 4Department of Research, Mercy Health St Elizabeth Youngstown Hospital, Youngstown, OH, USA; 5Department of Emergency Medicine, Mercy Health St. Elizabeth Boardman Hospital, Boardman, OH, USA; 6Lake Erie College of Osteopathic Medicine, College of Medicine, Erie, PA, USACorrespondence: Vincent Peyko, Department of Pharmacy, Mercy Health St. Elizabeth Boardman Hospital, 8401 Market St, Boardman, OH, 44512, USA, Email [email protected]: Cannabinoid Hyperemesis Syndrome (CHS) is characterized by recurrent, paroxysmal episodes of nausea, vomiting, and abdominal discomfort in chronic cannabis users. Optimized CHS treatment data remain limited. Recent prospective evidence have demonstrated haloperidol superiority over ondansetron. Retrospective data suggest the utility of droperidol, a dopamine antagonist like haloperidol, for treating acute CHS.Objective: To prospectively assess the utility of droperidol plus diphenhydramine to mitigate common CHS symptoms.Methods: This was a multicenter, prospective interventional study in the emergency department (ED). Participants were administered a study regimen of droperidol and diphenhydramine to treat CHS after enrollment. The primary outcome measure was the change in VAS scores within the droperidol prospective cohort. Symptoms of nausea, vomiting, and abdominal pain were measured using a visual analogue scale (VAS) up to 120 minutes. Secondary measures assessed include repeat visits to the ED within seven days.Results: Amongst 47 droperidol participants, VAS for nausea and vomiting declined from baseline 8.3± 2.0 to 3.1± 3.3 at 30 minutes post treatment (p < 0.05), and 1.4± 2.4 at 120 minutes (p < 0.05). For abdominal pain, VAS mean was 7.8± 2.4 at baseline declining to 3.6± 2.9 at 30 minutes (p < 0.05) and 1.7± 2.9 at 120 minutes (p < 0.05). Return to the ED within 7 days following droperidol was 12.9% (n=47).Conclusion: This trial shows significant improvement in symptoms from baseline, 30 and 120 minutes post-treatment and return to the ED within a week post treatment with the study regimen.Keywords: cannabinoid hyperemesis syndrome, nausea, vomiting, abdominal pain, droperidol

Keywords

• cannabinoid hyperemesis syndrome
• nausea
• vomiting
• abdominal pain
• droperidol