Bchap23: /* Cannabis Hyperemesis */

2025-03-24T17:06:07Z

Cannabis Hyperemesis

← Revisión anterior		Revisión del 17:06 24 mar 2025
Línea 13:		Línea 13:
	* Haloperidol 0.05-0.1 mg/kg IV/IM		* Haloperidol 0.05-0.1 mg/kg IV/IM
	* Droperidol 0.625 mg/kg IV/IM		* Droperidol 0.625 mg/kg IV/IM
	* Olanzapine for refractory cases - 5mg IV		* Olanzapine for refractory cases - 5mg IM
	* Capsaicin cream		* Capsaicin cream
	* Consider PPI, diphenhydramine, ondansetron, lorazepam 0.025-0.02 mg/kg/dose		* Consider PPI, diphenhydramine, ondansetron, lorazepam 0.025-0.02 mg/kg/dose

Bchap23 at 17:11, 18 March 2025

2025-03-18T17:11:26Z

← Revisión anterior		Revisión del 17:11 18 mar 2025
Línea 24:		Línea 24:
	*** Potential adjunctive medications: ondansetron, clonidine		*** Potential adjunctive medications: ondansetron, clonidine

	=Limited Evidence=		==Limited Evidence==
	* NAC: Two RCTs have examined NAC for CUD		* NAC: Two RCTs have examined NAC for CUD
	** A RCT in treatment- seeking adolescents with CUD ages 15–21 (N = 116) examined CM plus NAC 2400 mg/day for 8 weeks. Intent-to-treat analyses showed greater than twofold odds of bioverified cannabis abstinence in the NAC group vs. placebo at study end (odds ratio = 2.4, 95%, CI = 1.1–5.2).		** A RCT in treatment- seeking adolescents with CUD ages 15–21 (N = 116) examined CM plus NAC 2400 mg/day for 8 weeks. Intent-to-treat analyses showed greater than twofold odds of bioverified cannabis abstinence in the NAC group vs. placebo at study end (odds ratio = 2.4, 95%, CI = 1.1–5.2).
Línea 41:		Línea 41:
	** Sharaf, R., Venkatesan, T., Shah, R. Management of cyclic vomiting syndrome in adults: evidence review. Neurogastroenterol Motil. 2019; 31, e13605		** Sharaf, R., Venkatesan, T., Shah, R. Management of cyclic vomiting syndrome in adults: evidence review. Neurogastroenterol Motil. 2019; 31, e13605

	=Patient Resources=		==Patient Resources==
	* Hotlines		* Hotlines
	** https://www.samhsa.gov/find-help/national-helpline (#1-800-662-HELP (4357))		** https://www.samhsa.gov/find-help/national-helpline (#1-800-662-HELP (4357))

Bchap23 at 17:09, 18 March 2025

2025-03-18T17:09:11Z

← Revisión anterior		Revisión del 17:09 18 mar 2025
Línea 1:		Línea 1:
	~~Start Here~~		=Treatment Options=
			==Cannabis Use Disorder (CUD)==
			* N-Acetyl Cysteine (NAC)
			** 600 mg PO BID x 3 days, then 1200 mg PO BID x4d, then 1800 mg PO BID for weeks 2-8
			* Gabapentin
			** day 1: one 300 mg capsule in the evening; day 2: one 300 mg capsule in the morning and evening; day 3: one 300 mg capsule in the morning, at midday, and in the evening; day 4: one 300 mg capsule in the morning and at midday and two 300 mg capsules in the evening. Subjects maintained the 1200 mg/day dose until week 11.
			** Can start 300mg TID prn anxiety or standing and titrate to 900mg TID prn anxiety as tolerated if no contraindications like renal insufficiency or falls.
			* Naltrexone: 50 mg PO QD X 12w or 380 mg IM monthly
			** Contraindications: Liver Enzymes 5X normal or greater
			* Amitriptyline: 25 mg PO qhs x 1 week, 50 mg PO qhs X 1 week, 75-100 mg PO QHS

			==Cannabis Hyperemesis==
			* Haloperidol 0.05-0.1 mg/kg IV/IM
			* Droperidol 0.625 mg/kg IV/IM
			* Olanzapine for refractory cases - 5mg IV
			* Capsaicin cream
			* Consider PPI, diphenhydramine, ondansetron, lorazepam 0.025-0.02 mg/kg/dose

			==Cannabis Withdrawal Syndrome==
			* Definition: At least 3 within 1 week of cessation (irritability, nervousness/ anxiety, sleep difficulty, decreased appetite or weight loss, restlessness, depressed mood, somatic sx causing significant discomfort)
			** Gabapentin
			*** day 1: one 300 mg capsule in the evening; day 2: one 300 mg capsule in the morning and evening; day 3: one 300 mg capsule in the morning, at midday, and in the evening; day 4: one 300 mg capsule in the morning and at midday and two 300 mg capsules in the evening. Subjects maintained the 1200 mg/day dose until week 11.
			**Amitriptyline: Dose 25 mg PO qhs x 1 week, 50 mg PO qhs X 1 week, 75-100 mg PO QHS
			*** Potential adjunctive medications: ondansetron, clonidine

			=Limited Evidence=
			* NAC: Two RCTs have examined NAC for CUD
			** A RCT in treatment- seeking adolescents with CUD ages 15–21 (N = 116) examined CM plus NAC 2400 mg/day for 8 weeks. Intent-to-treat analyses showed greater than twofold odds of bioverified cannabis abstinence in the NAC group vs. placebo at study end (odds ratio = 2.4, 95%, CI = 1.1–5.2).
			** A similar RCT by the same team with adults with CUD found that '''NAC 2400 mg/day for 12 weeks did not differ from placebo''' in cannabis craving or use.
			*** Herbst ED, Pennington DL, Borsari B, Manuel J, Yalch M, Alcid E, Martinez Rivas M, Delacruz J, Rossi N, Garcia B, Wong N, Batki SL. N-acetylcysteine for smoking cessation among dual users of tobacco and cannabis: Protocol and rationale for a randomized controlled trial. Contemp Clin Trials. 2023 Aug;131:107250. doi: 10.1016/j.cct.2023.107250. Epub 2023 Jun 2. PMID: 37271412; PMCID: PMC10847050.

			* Gabapentin
			** Mason BJ, Crean R, Goodell V, Light JM, Quello S, Shadan F, et al. A '''proof-of-concept randomized controlled study''' of gabapentin: effects on cannabis use, withdrawal and executive function deficits in cannabis dependent adults. Neuropsychopharmacol Off Publ Am Coll Neuropsy chopharmacol. 2012;37(7):1689–98

			* Naltrexone
			** Haney M, Ramesh D, Glass A, Pavlicova M, Bedi G, Cooper ZD. Naltrexone Maintenance Decreases Cannabis Self-Administration and Subjective Effects in Daily Cannabis Smokers. Neuropsychopharmacology. 2015 Oct;40(11):2489-98. doi: 10.1038/npp.2015.108. Epub 2015 Apr 16. PMID: 25881117; PMCID: PMC4569951.
			** Notzon, D. P., Kelly, M. A., Choi, C. J., Pavlicova, M., Mahony, A. L., Brooks, D. J., Mariani, J. J., & Levin, F. R. (2018). Open-label pilot study of injectable naltrexone for cannabis dependence. The American Journal of Drug and Alcohol Abuse., 44(6), 619–627. https://doi.org/10.1080/00952990.2017.1423321
			** Shamabadi A, Arabzadeh Bahri R, Karimi H, Heidari E, Akhondzadeh S. Emerging pharmacotherapy for the treatment of cannabis use disorder. Expert Opin Pharmacother. 2024 Apr;25(6):695-703. doi: 10.1080/14656566.2024.2353638. Epub 2024 May 15. PMID: 38717605.

			* Amitriptyline
			** Sharaf, R., Venkatesan, T., Shah, R. Management of cyclic vomiting syndrome in adults: evidence review. Neurogastroenterol Motil. 2019; 31, e13605

			=Patient Resources=
			* Hotlines
			** https://www.samhsa.gov/find-help/national-helpline (#1-800-662-HELP (4357))
			** https://marijuana-anonymous.org/ (#1-800-766-6779)
			** https://recovered.org/ (#1-800-NCA-CALL (622-2255))
			* LA Area (Meetings)
			** https://marijuana-anonymous.org/ (online & in person meetings / 12 step program)
			* Rehab Centers
			** https://muirwoodteen.com/ (Riverside, CA)
			** https://bnitreatment.com/tour/ (Calabasas or Agora Hills)
			** https://www.lacada.com/residential.php
			** https://www.bhs-inc.org/residential-inpatient-treatment
			* Other
			** https://recovered.org/treatment (different treatment options)
			*Text Messages
			** Marijuana Resource Center - Partnership to End Addiction
			*Skill building
			** Marijuana Resource Center - Partnership to End Addiction
			* Apps
			** Marijuana Anonymous App - Marijuana Anonymous Info, meetings, obtain sponsor
			** IamSober- Tracks time sober and give symptom timeline
			** SoberGrid- allows linkage of sobriety and social media (eg, sends posts); for fee can get coaching
			** Iam- Daily affirmations
			** Nomo- journaling

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2025-03-18T16:46:03Z

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Harbor:Cannabis Abuse - Revision history

Bchap23: /* Cannabis Hyperemesis */

Bchap23 at 17:11, 18 March 2025

Bchap23 at 17:09, 18 March 2025

Bchap23: Created page with "Start Here"