A pilot trial of topical capsaicin cream for treatment of cannabinoid hyperemesis
Dean DJ, Sabagha N, Rose K, Weiss A, Asmar T, Rammal JA, Beyer M, Bussa R, Smoot T, and Miller J. A pilot trial of topical capsaicin cream for treatment of cannabinoid hyperemesis. Journal of Medical Toxicology 2020; 16(2):145-146.
Journal of Medical Toxicology
Background: Patients with cannabinoid hyperemesis syndrome (CHS) frequently present to the emergency department. Previous case studies suggest dramatic symptomatic improvement with topical capsaicin treatment. Research Question: This exploratory study examines the safety and potential efficacy of topical capsaicin in patients with vomiting due to a suspected CHS exacerbation. Methods: This is a double-blind, randomized placebo-controlled pilot trial. Adults who presented with vomiting suspected to be from CHS were eligible for enrollment. We excluded pregnant females and those with resolution of nausea. Following randomization, topical 0.1% capsaicin or placebo cream was applied to the anterior abdomen in a uniform manner. Primary outcome was the severity of nausea on a visual analog scale (VAS) of 0-10 assessed at 30 minutes. Secondary outcomes were occurrence of post-treatment vomiting, nausea by VAS at 60minutes, and hospital admission. Results: This pilot trial enrolled 30 patients: 17 in the capsaicin arm and 13 in the placebo arm. One patient in the capsaicin arm did not tolerate treatment due to skin irritation. Nausea severity at 30 minutes was 4.1 (95%CI 2.8-5.4) in the capsaicin arm and 6.1 (95% CI 4.1-8.1) in the placebo arm. At 60 minutes, nausea severity was 3.2 (95%CI 1.6-4.8) vs. 6.4 (4.7-8.1). The percent reduction in nausea at 60 minutes from baseline was 46.0% (95% CI 25.5-66.5%) in the capsaicin arm and 24.9% (95% CI 7.8-41.9%) in the placebo arm. Hospital admission was necessary for four patients in the capsaicin arm (23.5%) vs. five (38.5%) in the placebo arm (RR 0.61, 95% CI 0.20-1.84). Conclusion: In this pilot trial of topical capsaicin for CHS, capsaicin was well-tolerated and demonstrated signs of efficacy. Further trials are warranted.