Cannabinoid hyperemesis syndrome

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Cannabinoid hyperemesis syndrome

Cannabinoid hyperemesis syndrome is characterized by recurrent nausea, vomiting and crampy abdominal pain. These symptoms have been reported to be improved temporarily by taking a hot shower or bath or more fully by stopping the use of cannabis.

The syndrome was described by Allen and colleagues (2004), and Sontineni and colleagues (2009) who offer simplified clinical diagnostic criteria.[1][2] A subsequent, larger study reported a case series of 98 subjects with cannabinoid hyperemesis syndrome, confirming the earlier reported findings.[3]

Signs and symptoms

Sontineni criteria[2]
Essential Cannabis use for years
Major Severe nausea and vomiting

Vomiting that recurs in a cyclic pattern over months

Resolution of symptoms after stopping cannabis use.

Supportive Compulsive hot baths with symptom relief

Colicky abdominal pain

No evidence of gall bladder or pancreatic inflammation

Modified criteria[3]
Essential Long-term cannabis use
Major Severe cyclic nausea and vomiting

Resolution with cannabis cessation

Relief of symptoms with hot showers or baths

Abdominal pain, epigastric or periumbilical

Weekly use of marijuana.

Supportive Age less than 50 y

Weight loss of >5 kg

Morning predominance of symptoms

Normal bowel habits

Negative laboratory, radiographic, and endoscopic test results

The long-term and short-term effects of cannabis use are associated with behavioural effects leading to a wide variety of effects on the body systems and physiologic states.[2]

Sontineni and colleagues in 2009 discussed the cannabinoid hyperemesis syndrome to offer guidelines for the clinical diagnosis.[2]

Individual attacks can lead to complications, such as acute kidney injury.[4]


Various pathogenic mechanistic theories attempting to explain symptoms have been put forward. These theories fall into two themes: 1) dose dependent buildup of cannabinoids and related effects of cannabinoid toxicity, and 2) the functionality of cannabinoid receptors in the brain and particularly in the hypothalamus (which regulates body temperature and the digestive system). But the mechanisms by which cannabis causes or controls nausea and the adverse consequences of long-term cannabis toxicity remain unknown and organic disease should not be ruled out as a possible cause.[5]

The neurobiology of the compound has led to the discovery of an endogenous cannabinoid system.[6] The therapeutic potential of cannabinoids has been recognized and these compounds are utilized as antiemetics. Several studies have demonstrated the therapeutic effects of cannabinoids for nausea and vomiting in the advanced stages of illnesses such as cancer and AIDS.[7]

Differential diagnosis

Cyclic vomiting syndrome may present similarly.[8]


The number of people affected is unclear as of 2015.[9] Cannabis is by far the most widely cultivated, trafficked and used illicit substance. In the present decade, cannabis use has grown more rapidly than cocaine and opiate use. The most rapid growth in cannabis use since the 1960s has been in developed countries in North America, Western Europe and Australia. Cannabis has become more closely linked to youth culture and the age of initiation is usually lower than for other illicit drugs.[7]


Cannabinoid hyperemesis was first reported in the Adelaide Hills of South Australia in 2004.[1]


Many traditional medications for nausea and vomiting are ineffective. However, treatment with lorazepam or haloperidol has provided relief for some people.[10] Assessing for dehydration due to vomiting and hot showers is important as it can lead to cannabinoid hyperemesis acute renal failure (CHARF), and this is easily treated with IV fluids.[4] Treatment is otherwise supportive and focuses on stopping cannabis use.[11]


Acute episodes of cannabinoid hyperemesis typically last for 24–48 hours and the problem often resolves with long term stopping of cannabis use. Improvement can take one to three months to occur.[12]

Relapses are common, and this is thought to be possibly secondary to a lack of education as many people use or increase their use of cannabis to treat their symptoms of nausea and vomiting.[8]


Template:Research help

  1. ^ a b Allen, J H; De Moore, GM; Heddle, R; Twartz, JC (2004). "Cannabinoid hyperemesis: Cyclical hyperemesis in association with chronic cannabis abuse". Gut. 53 (11): 1566–70. doi:10.1136/gut.2003.036350. PMC 1774264. PMID 15479672.
  2. ^ a b c d Sontineni, Siva-P; Chaudhary, S; Sontineni, V; Lanspa, SJ (2009). "Cannabinoid hyperemesis syndrome: Clinical diagnosis of an underrecognised manifestation of chronic cannabis abuse". World Journal of Gastroenterology. 15 (10): 1264–6. doi:10.3748/wjg.15.1264. PMC 2658859. PMID 19291829.
  3. ^ a b Simonetto, Douglas A.; Oxentenko, Amy S.; Herman, Margot L.; Szostek, Jason H. (2012). "Cannabinoid Hyperemesis: A Case Series of 98 Patients". Mayo Clinic Proceedings. 87 (2): 114–9. doi:10.1016/j.mayocp.2011.10.005. PMC 3538402. PMID 22305024.
  4. ^ a b Habboushe J, Sedor J (June 2014). "Cannabinoid hyperemesis acute renal failure: a common sequela of cannabinoid hyperemesis syndrome". Am J Emerg Med. 32 (6): 690.e1–2. doi:10.1016/j.ajem.2013.12.013. PMID 24418446.
  5. ^ "NCPIC.Cannabinoid hyperemesis syndrome". Retrieved 2016-07-23.
  6. ^ Davis, Mellar; Maida, Vincent; Daeninck, Paul; Pergolizzi, Joseph (2006). "The emerging role of cannabinoid neuromodulators in symptom management". Supportive Care in Cancer. 15 (1): 63–71. doi:10.1007/s00520-006-0180-0. PMID 17139494.
  7. ^ a b World health Organization, Cannabis - epidemiology.
  8. ^ a b Galli, JA; Sawaya, RA; Friedenberg, FK (December 2011). "Cannabinoid hyperemesis syndrome". Current drug abuse reviews. 4 (4): 241–9. doi:10.2174/1874473711104040241. PMC 3576702. PMID 22150623.
  9. ^ Lu, ML; Agito, MD (July 2015). "Cannabinoid hyperemesis syndrome: Marijuana is both antiemetic and proemetic". Cleveland Clinic journal of medicine. 82 (7): 429–34. doi:10.3949/ccjm.82a.14023. PMID 26185942.
  10. ^ King, Chelsey; Holmes, Andrew (2015-03-17). "Cannabinoid hyperemesis syndrome". Canadian Medical Association Journal. 187 (5): 355. doi:10.1503/cmaj.140154. ISSN 1488-2329. PMC 4361109. PMID 25183721.
  11. ^ Wallace, Erik A.; Andrews, Sarah E.; Garmany, Chad L.; Jelley, Martina J. (2011-09-01). "Cannabinoid hyperemesis syndrome: literature review and proposed diagnosis and treatment algorithm". Southern Medical Journal. 104 (9): 659–664. doi:10.1097/SMJ.0b013e3182297d57. ISSN 1541-8243. PMID 21886087.
  12. ^ Sun, S; Zimmermann, AE (September 2013). "Cannabinoid hyperemesis syndrome". Hospital pharmacy. 48 (8): 650–5. doi:10.1310/hpj4808-650. PMC 3847982. PMID 24421535.

Further reading