Moderator EMEDPA Posted December 22, 2019 Moderator Share Posted December 22, 2019 Yes, we have enough pts in our dept with cyclic vomiting from cannabis use that we now have THPs and single unit dose packs of capsaicin. Someone asked me what the instructions on the THP should be. I wanted to say this: 2 2 Quote Link to comment Share on other sites More sharing options...
ohiovolffemtp Posted December 22, 2019 Share Posted December 22, 2019 Have you had any success with haldol for cyclic vomiting from cannabis? Quote Link to comment Share on other sites More sharing options...
MediMike Posted December 23, 2019 Share Posted December 23, 2019 My wife swears by it. As in she gives it to all her patients with CVS. Not that she takes it for her CVS. She just toughs it out. 1 2 Quote Link to comment Share on other sites More sharing options...
Randito Posted December 23, 2019 Share Posted December 23, 2019 Have used Haldol and Benadryl for multiple patients with very good success. These are patients that didn’t respond to the more run of the mill antiemetics. The problem that I’ve had with capsaicin is that insurance doesn’t cover it and patients don’t want to pay for it. Many would rather just come back to the ED for more Haldol. Quote Link to comment Share on other sites More sharing options...
kargiver Posted December 24, 2019 Share Posted December 24, 2019 (edited) If I suspect CVS I give Haldol IM (2.5-5mg) and usually within 30 min, symptoms have abated. Its the only agent I have used that singularly works for CVS. Love it. G Edited December 24, 2019 by kargiver 1 Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted December 24, 2019 Author Moderator Share Posted December 24, 2019 14 hours ago, kargiver said: If I suspect CVS I give Haldol IM (2.5-5mg) and usually within 30 min, symptoms have abated. Its the only agent I have used that singularly works for CVS. Love it. G Agree- This is my first line tx as well. Some of our pts after multiple doses of haldol now state they are "allergic to it" because some idiot gave them dilaudid for their abd cramps and it's the only thing they think works for them now. I don't give opiates for CVS. Hard and fast line in the sand. You want an IV pain medication? We have tylenol or toradol. 1 Quote Link to comment Share on other sites More sharing options...
dphy83 Posted December 25, 2019 Share Posted December 25, 2019 Heck yes to the haldol. My go-to, as well. For pain they usually get toradol, ibuprofen, tylenol, possibly some Bentyl. Agree with EMED - no opiates from me for CVS. The beauty of giving the PO meds as it also can act as their PO challenge. I genuinely try to keep these patients for as little while as possible, so once I stop the vomiting, give an analgesic, ensure they're PO tolerant, and dump a liter or two of IV fluids in them they're out the door (assuming all workup in the interim is normal). Quote Link to comment Share on other sites More sharing options...
jtpas Posted January 15, 2020 Share Posted January 15, 2020 On 12/24/2019 at 11:53 AM, EMEDPA said: Agree- This is my first line tx as well. Some of our pts after multiple doses of haldol now state they are "allergic to it" because some idiot gave them dilaudid for their abd cramps and it's the only thing they think works for them now. I don't give opiates for CVS. Hard and fast line in the sand. You want an IV pain medication? We have tylenol or toradol. Haldol seems to work when nothing else does for our repeat CVS offenders. Unsure about how much you can give with Zofran before you start seeing relevant QT prolongation though, if anyone has any experience. Have heard and read great things about IV Tylenol but don't know how available it is due to $$$. When/where do you see the most benefit with it? Quote Link to comment Share on other sites More sharing options...
ohiovolffemtp Posted January 16, 2020 Share Posted January 16, 2020 When I had IV tylenol - Ofirmev - I used it extensively. About 2-3 years ago it became generic and cost came down significantly, about $80-85, so it's not really all that expensive. Unfortunately, it's not available at any of my current sites. Quote Link to comment Share on other sites More sharing options...
dphy83 Posted January 16, 2020 Share Posted January 16, 2020 IV tylenol is interesting and has a role. Not sure if it has same efficacy on visceral type pain as MSK but this study is interesting: https://jamanetwork.com/journals/jama/fullarticle/2661581 I worked with the PI during the study so maybe I'm biased. Kind of an apples to oranges comparision but food for thought. And if you're worried about QTc prolongation just use compazine. Quote Link to comment Share on other sites More sharing options...
kargiver Posted February 7, 2020 Share Posted February 7, 2020 On 12/22/2019 at 6:55 PM, ohiovolffemtp said: Have you had any success with haldol for cyclic vomiting from cannabis? Giving some to a CVC patient as I review and answer this thread. It has become by first line medication for CVC. I don't bother with anything else anymore - Haven't had a need for it. Takes about 15-25 min to kick in (a touch longer if I give it IM, which I generally prefer). Haven't really encountered the need for IV tylenol - suspect its a difference of practice approach. G Quote Link to comment Share on other sites More sharing options...
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