Journal of Medical Toxicology

, Volume 13, Issue 1, pp 71–87 | Cite as

Cannabinoid Hyperemesis Syndrome: Diagnosis, Pathophysiology, and Treatment—a Systematic Review

  • Cecilia J. Sorensen
  • Kristen DeSanto
  • Laura Borgelt
  • Kristina T. Phillips
  • Andrew A. Monte


Cannabinoid hyperemesis syndrome (CHS) is a syndrome of cyclic vomiting associated with cannabis use. Our objective is to summarize the available evidence on CHS diagnosis, pathophysiology, and treatment. We performed a systematic review using MEDLINE, Ovid MEDLINE, Embase, Web of Science, and the Cochrane Library from January 2000 through September 24, 2015. Articles eligible for inclusion were evaluated using the Grading and Recommendations Assessment, Development, and Evaluation (GRADE) criteria. Data were abstracted from the articles and case reports and were combined in a cumulative synthesis. The frequency of identified diagnostic characteristics was calculated from the cumulative synthesis and evidence for pathophysiologic hypothesis as well as treatment options were evaluated using the GRADE criteria. The systematic search returned 2178 articles. After duplicates were removed, 1253 abstracts were reviewed and 183 were included. Fourteen diagnostic characteristics were identified, and the frequency of major characteristics was as follows: history of regular cannabis for any duration of time (100%), cyclic nausea and vomiting (100%), resolution of symptoms after stopping cannabis (96.8%), compulsive hot baths with symptom relief (92.3%), male predominance (72.9%), abdominal pain (85.1%), and at least weekly cannabis use (97.4%). The pathophysiology of CHS remains unclear with a dearth of research dedicated to investigating its underlying mechanism. Supportive care with intravenous fluids, dopamine antagonists, topical capsaicin cream, and avoidance of narcotic medications has shown some benefit in the acute setting. Cannabis cessation appears to be the best treatment. CHS is a cyclic vomiting syndrome, preceded by daily to weekly cannabis use, usually accompanied by symptom improvement with hot bathing, and resolution with cessation of cannabis. The pathophysiology underlying CHS is unclear. Cannabis cessation appears to be the best treatment


Cannabinoid hyperemesis syndrome Cyclic vomiting syndrome Cannabis Marijuana 



We acknowledge the Colorado Department of Public Health and Environment Retail Marijuana Public Health Advisory Committee.

Compliance with Ethical Standards

Funding and Financial Disclosures

Dr. Sorensen has no conflicts of interest to declare. Kristen DeSanto has no conflicts of interest to declare. Dr. Borgelt receives support from the Colorado Department of Public Health and Environment and the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences. Dr. Phillips receives support from NIH on Drug Abuse R15 DA041656 and R01 DA034957, and Dr. Monte receives support from NIH 1 K23 GM110516 and NIH CTSI UL1 TR001082.


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Copyright information

© American College of Medical Toxicology 2016

Authors and Affiliations

  • Cecilia J. Sorensen
    • 1
  • Kristen DeSanto
    • 2
  • Laura Borgelt
    • 3
  • Kristina T. Phillips
    • 4
  • Andrew A. Monte
    • 1
    • 5
    • 6
  1. 1.Denver Health Residency in Emergency MedicineDenver Health and Hospital AuthorityDenverUSA
  2. 2.Health Sciences LibraryUniversity of Colorado Anschutz Medical CampusAuroraUSA
  3. 3.Skaggs School of Pharmacy and Pharmaceutical SciencesUniversity of Colorado Anschutz Medical CampusAuroraUSA
  4. 4.School of Psychological SciencesUniversity of Northern ColoradoGreeleyUSA
  5. 5.Department of Emergency MedicineUniversity of Colorado School of MedicineAuroraUSA
  6. 6.Rocky Mountain Poison & Drug CenterDenver Health and Hospital AuthorityDenverUSA

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