The researchers of a small trial of 33 patients with cannabinoid hyperemesis syndrome compared treatment of abdominal pain and nausea two hours after randomization to either two different doses of haloperidol vs ondansetron. When the results of the 0.05 mg/kg and the 0.1 mg/kg doses of haloperidol were pooled and compared against treatment with 8 mg of ondansetron, which had better treatment success?
At two hours post treatment, there was a 54% treatment success with pooled haloperidol and 29% treatment success with ondansetron. Haloperidol also decreased the use of rescue anti-emetics (31% vs 59%), benzodiazepines (8% vs 41%), any medications (31% vs 76%), and shorter time to discharge (3.1 vs 5.6 hours). Within the haloperidol treatment group, the results were similar regardless of dose.
Ruberto AJ, Sivilotti MLA, Forrester S, Hall AK, Crawford FM, Day AG. Intravenous Haloperidol Versus Ondansetron for Cannabis Hyperemesis Syndrome (HaVOC): A Randomized, Controlled Trial. Ann Emerg Med. 2021 Jun;77(6):613-619. doi: 10.1016/j.annemergmed.2020.08.021. Epub 2020 Nov 5. PMID: 33160719.
Submitted by: Kirk Cumpston, DO, FAACT on behalf of The Medical Toxicology Fellowship, Virginia Commonwealth University