In this episode, I’ll discuss the comparative effectiveness of ondansetron, haloperidol, and droperidol for the treatment of cannabinoid hyperemesis syndrome in the Emergency Department.
Cannabinoid hyperemesis syndrome involves severe nausea, vomiting and abdominal pain and is becoming a more frequent reason for admission to the Emergency Department. While ondansetron is usually top of mind for such symptoms, haloperidol and droperidol are also good options. A group of authors sought to compare the effectiveness of these 3 medications for cannabinoid hyperemesis syndrome and published a multicenter retrospective cohort study in Academic Emergency Medicine.
The cohort was pulled from over a 10 year period and consisted of over 9000 patients. The primary outcome was a return to the ED within 72 hours of the initial visit. Propensity-score matching was performed for all three pairwise comparisons: haloperidol vs ondansetron, droperidol vs ondansetron, and droperidol vs haloperidol.
When comparing haloperidol vs ondansetron, the rate of return visit to the ED within 72 hours was 8.2% for haloperidol and 15.1% for ondansetron. This was statistically significant and corresponded to an odds ratio of 0.5 in favor of haloperidol.
When comparing droperidol vs ondansetron, the rate of return visit to the ED within 72 hours was 7.4% for droperidol and 14% for ondansetron. This was statistically significant and corresponded to an odds ratio of 0.49 in favor of droperidol.
When haloperidol and droperidol were compared there was no difference found. These results held up when a multivariate model was applied.
The authors concluded:
In this large multicenter cohort, haloperidol and droperidol were associated with lower short-term ED recidivism than ondansetron among adults meeting a suspected CHS phenotype. These findings support prospective studies evaluating haloperidol and droperidol for ED management of CHS, including optimal dosing, route, medication sequencing, discharge treatment, and safety monitoring.
Clinicians should keep in mind haloperidol or droperidol when treating cannabinoid hyperemesis syndrome, as they may prevent readmission to the ED moreso than ondansetron.
To access my free download area with 20 different resources to help you in your practice, go to pharmacyjoe.com/free.
If you like this post, check out my book – A Pharmacist’s Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies.
Leave a Reply