January 7, 2021

Background/Introduction: Emergency department visits related to cannabis use appear to be increasing nationally secondary to continued trends of legalization, decriminalization, or less restrictive medical cannabis use laws in many states. The number of individuals with daily cannabis use in the United States increased from 5.1 million in 2005 to 8.1 million in 2013 (Bollom 2018). With an increase in the accessibility and consumption of cannabis, there has also been an increase in the utilization of emergency departments for potential adverse effects of cannabis use, particularly gastrointestinal adverse effects. For example, in Colorado, the emergency department visits for cyclic vomiting nearly doubled after liberalization of medical marijuana (Kim 2015). Studies attempting to look at nationwide sampling have noted that the number of persistent vomiting related hospitalization related to cannabis use had a significantly increased trend, with a 286% increase over a 5-year period (Patel 2019). This has led to a renewed interest in the understanding of cannabis hyperemesis syndrome, first well-described in 2004, and recently defined by the Rome IV criteria (Allen 2004). The effective management of cannabis hyperemesis syndrome is still being elucidated as commonly used antiemetics are often ineffective for acute exacerbations. The role of haloperidol as an off-label treatment is being explored but anecdotal evidence suggests it may be an effective adjunct in the treatment of cannabis hyperemesis syndrome.

July 13, 2020

Background Information:

Headache is a common chief complaint that emergency physicians encounter almost every day and sometimes multiple times in each shift. In fact, headache is the fifth leading cause of patients presenting to the emergency department (ED).1 Current first-line treatment consists of a dopamine antagonist such as prochlorperazine or metoclopramide which are given in addition to diphenhydramine to mitigate any potential adverse effects. A recent study has shown that IV haloperidol, another dopamine antagonist, was equivalent to IV metoclopramide in the successful treatment of headaches in the ED.2 Additionally, haloperidol has been shown to be an effective rescue medication in the treatment of refractory migraine-pain.3 Unfortunately, the cardiovascular effects and reported QTc prolongation associated with haloperidol has limited its use in the ED. The authors of the following study sought to determine the effectiveness of low-dose IV haloperidol in the ED treatment of acute benign headache among patients aged 13 to 55 years old

March 30, 2017

Background: Anyone practicing in emergency medicine has taken care of a patient with diabetic gastroparesis.  Although, it is not a sexy topic to discuss, nor a disease process associated with significant mortality, it is associated with decreased quality of life, and increased resource utilization due to frequent hospitalization.  Furthermore, opioid analgesia, can further decrease gastric emptying and therefore worsen symptoms of abdominal pain and nausea/vomiting. Haloperidol possesses antiemetic and analgesic properties, which may be one of the reasons this medication could work in diabetic gastroparesis.  The authors of this paper quite ingeniously entitled their study: Haloperidol Undermining Gastroparesis Symptoms (HUGS).
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