Table 2

Treatment for refractory nausea and vomiting in cannabinoid hyperemesis syndrome

MedicationRouteSuggested dose
HaloperidolIntramuscular*0.05 mg/kg (maximum 5 mg)
Capsaicin 0.1% creamTopical†5 g of 0.1% cream applied to abdomen
  • *Although the trial used intravenous haloperidol, there is no UK intravenous licence. There is a UK licence for postoperative nausea and vomiting, although doses are lower.

  • †The evidence supports use of 0.1% cream, which does not have a UK license. 0.075% capsaicin (Axsain) is a licensed medication for neuropathic pain and postherpetic neuralgia and may be more easily sourced. However, there is insufficient evidence to make recommendations on the efficacy of this strength.