Propranolol Treatment of Cannabinoid Hyperemesis Syndrome: A Case Report

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To the Editors
Cannabis is the most commonly used illicit drug in the United States and worldwide, with more than 180 million users.1 Since 2001, past-year adult cannabis use increased from 4.1% to 9.5% of the adult population, and among college students, daily cannabis use has more than tripled.2 In 2011, there were 456,000 emergency department visits related to cannabis use, which represented a 21% increase from 2009.3 After the 2016 election, California, Nevada, Maine, and Massachusetts have legalized recreational cannabis, joining Washington, Oregon, Colorado, and Alaska. From this combination of rising use and availability, cannabinoid hyperemesis syndrome (CHS), a derivative of cyclic vomiting syndrome (CVS) specifically in chronic cannabis users, has become increasingly widespread.4,5 First described in 2004 by Allen and colleagues6 in Australia, CHS is characterized by unpredictable and paroxysmal episodes of nausea and vomiting mitigated by frequent hot showering. Patients experiencing these symptoms often present to the emergency department for intravenous (IV) antiemetics, rehydration, and electrolyte replacement. Complications include acute renal failure, rhabdomyolysis, and pneumomediastinum.7,8 Standard-of-care antiemetics, such as ondansentron and metoclopramide, are often ineffective, necessitating the use of multiple doses of different and unrelated pharmacologic agents until control of hyperemesis is achieved.9 At present, the only proven treatment is hot showering/bathing and cessation of cannabis use.
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