Advance to bland foods (crackers, toast, rice, bananas) when tolerating liquids
Avoid caffeine and alcohol
Hot shower warning
Hot showers may provide temporary relief but are not a treatment
Prolonged hot water exposure can cause serious burns
Do not spend more than 10-15 minutes in a hot shower
Cannabis cessation resources
Contact your family doctor for referral to addiction medicine
Cannabis withdrawal is common — symptoms include irritability, insomnia, anxiety
Withdrawal peaks at 24-72 hours and typically resolves within 2 weeks
Do not attempt cessation without support if you have been a heavy daily user
Return to emergency department immediately if
Unable to keep any fluids down for more than 6 hours
Blood in your vomit
Severe abdominal pain or rigid abdomen
Dizziness or fainting
Decreased urine output or very dark urine for more than 8 hours
Chest pain or difficulty breathing
Confusion or unusual behaviour
References
Guidelines and key sources
SAEM GRACE-4 guidelines — primary ED management reference
Borgundvaag B, Bellolio F, Miles I, et al. Guidelines for Reasonable and Appropriate Care in the Emergency Department (GRACE-4): Alcohol Use Disorder and Cannabinoid Hyperemesis Syndrome Management in the Emergency Department. Academic Emergency Medicine. 2024. doi:10.1111/acem.14911
Recommends haloperidol and droperidol as first-line; endorses topical capsaicin; advises against opioids
AGA Clinical Practice Update 2024
Rubio-Tapia A, McCallum R, Camilleri M. AGA Clinical Practice Update on Diagnosis and Management of Cannabinoid Hyperemesis Syndrome: Commentary. Gastroenterology. 2024. doi:10.1053/j.gastro.2024.01.024
Endorses amitriptyline prophylaxis; emphasizes cannabis cessation as definitive therapy
HaVOC Randomized Controlled Trial
Ruberto AJ, Sivilotti MLA, Forrester S, et al. Intravenous Haloperidol Versus Ondansetron for Cannabis Hyperemesis Syndrome (HaVOC): A Randomized, Controlled Trial. Annals of Emergency Medicine. 2021. PMID 33160719
Haloperidol superior to ondansetron — reduced ED LOS by approximately 2.5 hours
Supporting references
Epidemiology and burden
Swartz JA, Franceschini D. Cannabinoid Hyperemesis Syndrome, 2016 to 2022. JAMA Network Open. 2025. doi:10.1001/jamanetworkopen.2025.45310
Gajendran M, Sifuentes J, Bashashati M, McCallum R. Cannabinoid Hyperemesis Syndrome: Definition, Pathophysiology, Clinical Spectrum, Insights Into Acute and Long-Term Management. Journal of Investigative Medicine. 2020. PMID 33115959
Pediatric references
Sigal A, Padilla G, Carroll T, Mautone SG. Cannabinoid Hyperemesis Syndrome in Adolescents: The Role of Aprepitant as a New Treatment Option for Rapid Symptom Relief. Journal of Adolescent Health. 2025. PMID 40965394
Karrento K, Rosen JM, Tarbell SE, et al. NASPGHAN 2025 Guidelines for Management of Cyclic Vomiting Syndrome in Children. Journal of Pediatric Gastroenterology and Nutrition. 2025
Seabrook JA, Seabrook M, Gilliland JA. Cannabis Hyperemesis Syndrome in Youth: Clinical Insights and Public Health Implications. International Journal of Environmental Research and Public Health. 2025. PMID 40283856
Differential diagnosis and review
Gorelick DA. Cannabis-Related Disorders and Toxic Effects. New England Journal of Medicine. 2023. doi:10.1056/NEJMra2212152
Shah M, Jergel A, George RP, Jenkins E, Bashaw H. Distinguishing Clinical Features of Cannabinoid Hyperemesis Syndrome and Cyclic Vomiting Syndrome: A Retrospective Cohort Study. Journal of Pediatrics. 2024. PMID 38615942
Lapoint J, Meyer S, Yu CK, et al. Cannabinoid Hyperemesis Syndrome: Public Health Implications and a Novel Model Treatment Guideline. Western Journal of Emergency Medicine. 2018. PMID 29560069
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.