Kelly Geoffrey S, Meeks Gavin, McCoul Bradley, Doshi Vidhi K, Moran Tim P
Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
Emergency Medicine Clinical Pharmacy Specialist, Department of Pharmacy, Emory University, Atlanta, Georgia, USA.
Clin Toxicol (Phila). 2025 Aug;63(8):550-555. doi: 10.1080/15563650.2025.2516128. Epub 2025 Jun 13.
Droperidol is a butyrophenone-class drug with potent antiemetic properties that may be useful for treating the acute symptoms of cannabinoid hyperemesis syndrome. We evaluated the effectiveness of droperidol in emergency department patients with cannabinoid hyperemesis syndrome.
This was a retrospective study of encounters that occurred between March 1, 2024 and August 31, 2024 at two tertiary academic emergency departments in Atlanta, Georgia. We identified cases of cannabinoid hyperemesis syndrome via diagnosis codes and manual review of relevant non-specific diagnoses codes. We stratified patients by use of droperidol in the emergency department. The primary outcome was length of stay and secondary outcomes were total medication use, use of opioids, disposition, and key safety outcomes (medication adverse events, dysrhythmias).
There were 211 encounters among 158 unique patients included in the study. Droperidol was used in 77 (36.5%) of encounters at a median dose of 1.25 mg. The length of stay was significantly reduced in the droperidol group (409 min versus 641 min). After adjustments, droperidol use was associated with a reduced length of stay (mean ratio 0.76; 95% CI: 0.62 0.94; = 0.01), decreased total medication administration (OR 0.34; 95% CI: 0.20-0.58; 0.001) and decreased usage of opioids (OR 0.16; 95% CI: 0.07-0.39; 0.001). Discharge dispositions were non-significant (OR 1.19; 95% CI: 0.57-2.48; = 0.64). There were two mild adverse drug reactions in the droperidol group.
Several drug classes with plausible mechanisms are used to treat the symptoms of cannabinoid hyperemesis syndrome. Droperidol use was associated with several favorable outcomes including decreased length of stay, total medication use, and opioid use.
We believe that droperidol may be considered as a first line treatment in patients with cannabinoid hyperemesis syndrome. Future studies should identify optimal dosing regimens using a randomized controlled trial design.
氟哌利多是一种丁酰苯类药物，具有强大的止吐特性，可能有助于治疗大麻素 hyperemesis 综合征的急性症状。我们评估了氟哌利多在急诊科大麻素 hyperemesis 综合征患者中的有效性。
这是一项对 2024 年 3 月 1 日至 2024 年 8 月 31 日期间在佐治亚州亚特兰大的两个三级学术急诊科发生的就诊情况进行的回顾性研究。我们通过诊断代码和对相关非特异性诊断代码的人工审核来确定大麻素 hyperemesis 综合征病例。我们根据急诊科是否使用氟哌利多对患者进行分层。主要结局是住院时间，次要结局是总用药量、阿片类药物使用情况、出院处置以及关键安全结局（药物不良事件、心律失常）。
该研究纳入了 158 名独特患者的 211 次就诊情况。77 次（36.5%）就诊使用了氟哌利多，中位剂量为 1.25 毫克。氟哌利多组的住院时间显著缩短（409 分钟对 641 分钟）。调整后，使用氟哌利多与住院时间缩短相关（平均比值 0.76；95%可信区间：0.62 - 0.94；P = 0.01），总用药量减少（优势比 0.34；95%可信区间：0.20 - 0.58；P < 0.001）以及阿片类药物使用减少（优势比 0.16；95%可信区间：0.07 - 0.39；P < 0.001）。出院处置无显著差异（优势比 1.19；95%可信区间：0.57 - 2.48；P = 0.64）。氟哌利多组有两例轻度药物不良反应。
有几种具有合理作用机制的药物类别用于治疗大麻素 hyperemesis 综合征的症状。使用氟哌利多与几个有利结局相关，包括住院时间缩短、总用药量减少和阿片类药物使用减少。
我们认为氟哌利多可被视为大麻素 hyperemesis 综合征患者的一线治疗药物。未来的研究应采用随机对照试验设计确定最佳给药方案。
