{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T18:12:15Z","timestamp":1791396735702,"version":"4.3.3"},"reference-count":50,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2024,12,30]],"date-time":"2024-12-30T00:00:00Z","timestamp":1735516800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"The Indiana University-Ohio State University Maternal and Pediatric Precision in Therapeutics Data, Model, Knowledge, and Research Coordination Center","award":["IU-OSU MPRINT DMKRCC"],"award-info":[{"award-number":["IU-OSU MPRINT DMKRCC"]}]},{"name":"The Indiana University-Ohio State University Maternal and Pediatric Precision in Therapeutics Data, Model, Knowledge, and Research Coordination Center","award":["P30HD106451"],"award-info":[{"award-number":["P30HD106451"]}]},{"name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","award":["IU-OSU MPRINT DMKRCC"],"award-info":[{"award-number":["IU-OSU MPRINT DMKRCC"]}]},{"name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","award":["P30HD106451"],"award-info":[{"award-number":["P30HD106451"]}]},{"name":"Pediatric Pharmacology and Therapeutics Branch","award":["IU-OSU MPRINT DMKRCC"],"award-info":[{"award-number":["IU-OSU MPRINT DMKRCC"]}]},{"name":"Pediatric Pharmacology and Therapeutics Branch","award":["P30HD106451"],"award-info":[{"award-number":["P30HD106451"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Cannabinoid Hyperemesis Syndrome (CHS), associated with long-term cannabinoid use, has been increasingly observed in emergency room visits as more states in the U.S. have legislatively permitted medical and recreational marijuana use. The acute management of CHS primarily focuses on antiemetic treatment and supportive care. However, both the condition itself and the antiemetic drugs, such as haloperidol, may cause QTc prolongation. Methods: We reported two adolescent cases admitted to the emergency department for acute antiemesis management of CHS who received haloperidol treatment. A literature review was performed through October 2024 for previously published cases of QTc prolongation and\/or Torsades de Pointes (TdP) in adolescents and young adults. Results: A 15-year-old female presented with hypokalemia and hypomagnesemia upon admission. She complained of chest pain and tachycardia, and the electrocardiogram (EKG) showed prolonged QTc (528 msec). The haloperidol infusion was discontinued. She recovered well post-discharge without complaints. A 17-year-old female had a borderline prolonged QT interval (476 msec). Her nausea and vomiting improved with a three-dose course of intravenous fosaprepitant before discharge. Our literature search identified five severe cases with life-threatening episodes of QTc prolongation and\/or TdP in adolescents and young adults. Conclusions: Patients with CHS are at higher risk of QTc prolongation due to cannabis use, electrolyte imbalance, and antiemetic medications. We recommend vigilant EKG monitoring, particularly before initiating and throughout haloperidol treatment. If the patient presents with an increased risk of QTc prolongation, consider using topical capsaicin, lorazepam, aprepitant\/fosaprepitant, and olanzapine as alternatives.<\/jats:p>","DOI":"10.3390\/jcm14010163","type":"journal-article","created":{"date-parts":[[2024,12,31]],"date-time":"2024-12-31T07:34:19Z","timestamp":1735630459000},"page":"163","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Mitigating the Risk of QTc Prolongation When Using Haloperidol for Acute Treatment of Cannabinoid Hyperemesis Syndrome in Adolescents and Young Adults"],"prefix":"10.3390","volume":"14","author":[{"given":"Sandra","family":"Merino","sequence":"first","affiliation":[{"name":"Department of Pharmacy, CHOC Children\u2019s Hospital, Orange, CA 92868, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lissette","family":"Tordera","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, CHOC Children\u2019s Hospital, Orange, CA 92868, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison","family":"Jun","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, CHOC Children\u2019s Hospital, Orange, CA 92868, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8463-7468","authenticated-orcid":false,"given":"Sun","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, CHOC Children\u2019s Hospital, Orange, CA 92868, USA"},{"name":"Department of Pharmacy Practice, Chapman University School of Pharmacy, Irvine, CA 92618, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,12,30]]},"reference":[{"key":"ref_1","unstructured":"Cannabis Overview (2024, December 10). National Conference of State Legislatures. Updated 20 June 2024. Available online: https:\/\/www.ncsl.org\/civil-and-criminal-justice\/cannabis-overview."},{"key":"ref_2","unstructured":"Substance Abuse and Mental Health Services Administration (2022). Key Substance Use and Mental Health Indicators in the United States: Results from the 2021 National Survey on Drug Use and Health (HHS Publication No. PEP22-07-01-005, NSDUH Series H-57), Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration."},{"key":"ref_3","unstructured":"Substance Abuse and Mental Health Services Administration (2023). Key Substance Use and Mental Health Indicators in the United States: Results from the 2022 National Survey on Drug Use and Health (HHS Publication No. PEP23-07-01-006, NSDUH Series H-58), Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration."},{"key":"ref_4","first-page":"A13812","article-title":"Abstract 13812: Daily Marijuana Use is Associated with Incident Heart Failure: \u201cAll of Us\u201d Research Program","volume":"148","author":"Osei","year":"2023","journal-title":"Circulation"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Mondal, A., Dadana, S., Parmar, P., Mylavarapu, M., Dong, Q., Butt, S.R., Kali, A., Bollu, B., and Desai, R. (2024). Association of Cannabis Use Disorder with Major Adverse Cardiac and Cerebrovascular Events in Older Non-Tobacco Users: A Population-Based Analysis. Med. Sci., 12.","DOI":"10.3390\/medsci12010013"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"578","DOI":"10.1111\/ajad.13215","article-title":"Cannabis use disorder and increased risk of arrhythmia-related hospitalization in young adults","volume":"30","author":"Patel","year":"2021","journal-title":"Am. J. Addict."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1966","DOI":"10.1016\/j.amjcard.2019.09.002","article-title":"Cardiac Arrhythmias Among Teenagers Using Cannabis in the United States","volume":"124","author":"Ramphul","year":"2019","journal-title":"Am. J. Cardiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1663","DOI":"10.1039\/C6TX00259E","article-title":"Synthetic cannabinoid, JWH-030, induces QT prolongation through hERG channel inhibition","volume":"5","author":"Yun","year":"2016","journal-title":"Toxicol. Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2079","DOI":"10.21037\/jtd.2017.06.104","article-title":"Role of cannabis in cardiovascular disorders","volume":"9","author":"Goyal","year":"2017","journal-title":"J. Thorac. Dis."},{"key":"ref_10","first-page":"6621496","article-title":"Torsades de Pointes due to Excessive Marijuana Use in a Susceptible Patient","volume":"2021","author":"Shah","year":"2021","journal-title":"Case Rep. Cardiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1186\/1757-1626-2-208","article-title":"Cardiac arrest following cannabis use: A case report","volume":"2","author":"Sattout","year":"2009","journal-title":"Cases J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2124","DOI":"10.1016\/S0735-1097(21)03480-X","article-title":"First Described Case of Torsades De Pointes Triggered by Cannabis Hyperemesis Syndrome","volume":"77","author":"Patel","year":"2021","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1542\/pir.2019-0097","article-title":"Cannabinoid Hyperemesis Syndrome in Pediatrics: An Emerging Problem","volume":"42","author":"Dosani","year":"2021","journal-title":"Pediatr. Rev."},{"key":"ref_14","first-page":"339","article-title":"Management of Pediatric Cannabinoid Hyperemesis Syndrome: A Review","volume":"26","author":"Reinert","year":"2021","journal-title":"J. Pediatr. Pharmacol. Ther."},{"key":"ref_15","first-page":"222","article-title":"Comparison of Antiemetics in the Management of Pediatric Cannabinoid Hyperemesis Syndrome","volume":"28","author":"Geraci","year":"2023","journal-title":"J. Pediatr. Pharmacol. Ther."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1016\/j.jadohealth.2020.07.035","article-title":"Diagnosis and Acute Management of Adolescent Cannabinoid Hyperemesis Syndrome: A Systematic Review","volume":"68","author":"Zhu","year":"2021","journal-title":"J. Adolesc. Health"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1016\/j.annemergmed.2020.08.021","article-title":"Intravenous Haloperidol Versus Ondansetron for Cannabis Hyperemesis Syndrome (HaVOC): A Randomized, Controlled Trial","volume":"77","author":"Ruberto","year":"2021","journal-title":"Ann. Emerg. Med."},{"key":"ref_18","unstructured":"Haldol Brand of Haloperidol Injection (For Immediate Release) (2024, December 26). Labeling-Package Insert. 17 November 2020, Available online: https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2020\/015923s093s098,018701s071s076lbl.pdf."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1007\/s12024-021-00410-z","article-title":"Death of a young woman with cyclic vomiting: A case report","volume":"17","author":"Santos","year":"2021","journal-title":"Forensic Sci. Med. Pathol."},{"key":"ref_20","first-page":"5","article-title":"Cardiovascular Complications of Cannabis: Reports of Prolonged QTc in Adolescents with Cannabinoid Hyperemesis Syndrome","volume":"6","author":"Kwag","year":"2022","journal-title":"J. Fam. Med. Prim. Care Open Acc."},{"key":"ref_21","first-page":"e8615","article-title":"Cannabinoid-Induced Brugada Syndrome: A Case Report","volume":"12","author":"Stockholm","year":"2020","journal-title":"Cureus"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Thompson, J.L. (2024, December 26). Drug-Induced QT Prolongation. U.S. Pharm., Available online: https:\/\/www.uspharmacist.com\/article\/drug-induced-qt-prolongation.","DOI":"10.34883\/PI.2023.26.6.004"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e285","DOI":"10.1016\/j.ajem.2021.09.048","article-title":"QTc prolongation in cannabis hyperemesis syndrome patients exposed to antiemetics: A retrospective chart review","volume":"53","author":"Noelle","year":"2022","journal-title":"Am. J. Emerg. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1097\/PRA.0000000000000732","article-title":"Acute Treatment of Adolescent Cannabinoid Hyperemesis Syndrome with Haloperidol, Lorazepam, and\/or Capsaicin: A Single Institution Case Series","volume":"29","author":"Brown","year":"2023","journal-title":"J. Psychiatr. Pract."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1016\/S0196-0644(05)82660-5","article-title":"Droperidol versus haloperidol for chemical restraint of agitated and combative patients","volume":"21","author":"Thomas","year":"1992","journal-title":"Ann. Emerg. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"375","DOI":"10.3109\/10903127.2013.864353","article-title":"Comparison of droperidol and haloperidol for use by paramedics: Assessment of safety and effectiveness","volume":"18","author":"Macht","year":"2014","journal-title":"Prehospital Emerg. Care"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1080\/15563650.2018.1564324","article-title":"The utility of droperidol in the treatment of cannabinoid hyperemesis syndrome","volume":"57","author":"Lee","year":"2019","journal-title":"Clin. Toxicol."},{"key":"ref_28","unstructured":"Maccabee-Ryaboy, N.P.P., Johnson, J., Montague, A., Weinstein, C., Wu, B., Zarin-Pass, M., Carter, C., and Miller, K. (2024, December 26). Cannabinoid Hyperemesis Syndrome (CHS). Evaluation and Emergency Department Management (Age 12+). Rev 05\/2024. Available online: https:\/\/www.childrensmn.org\/references\/CDS\/cannabinoid-hyperemesis-syndrome-clinical-pathway.pdf."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1007\/s13181-016-0595-z","article-title":"Cannabinoid Hyperemesis Syndrome: Diagnosis, Pathophysiology, and Treatment-a Systematic Review","volume":"13","author":"Sorensen","year":"2017","journal-title":"J. Med. Toxicol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1016\/j.ajem.2021.06.049","article-title":"Efficacy of topical capsaicin for cannabinoid hyperemesis syndrome in a pediatric and adult emergency department","volume":"49","author":"Kum","year":"2021","journal-title":"Am. J. Emerg. Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"241","DOI":"10.2174\/1874473711104040241","article-title":"Cannabinoid hyperemesis syndrome","volume":"4","author":"Galli","year":"2011","journal-title":"Curr. Drug Abuse. Rev."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"3113","DOI":"10.1007\/s10620-010-1131-7","article-title":"The Cannabis Hyperemesis Syndrome Characterized by Persistent Nausea and Vomiting, Abdominal Pain, and Compulsive Bathing Associated with Chronic Marijuana Use: A Report of Eight Cases in the United States","volume":"55","author":"Batke","year":"2010","journal-title":"Dig. Dis. Sci."},{"key":"ref_33","first-page":"e49629","article-title":"Cannabinoid-Associated Hyperemesis Syndrome Treated with Dronabinol: Killing a Poison with the Poison","volume":"15","author":"Hussain","year":"2023","journal-title":"Cureus"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e20163795","DOI":"10.1542\/peds.2016-3795","article-title":"Capsaicin Cream for Treatment of Cannabinoid Hyperemesis Syndrome in Adolescents: A Case Series","volume":"140","author":"Graham","year":"2017","journal-title":"Pediatrics"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1016\/j.ajem.2021.01.073","article-title":"Efficacy of topical capsaicin for the treatment of cannabinoid hyperemesis syndrome: A retrospective cohort study","volume":"43","author":"Yusuf","year":"2021","journal-title":"Am. J. Emerg. Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1166","DOI":"10.1111\/acem.14062","article-title":"A Pilot Trial of Topical Capsaicin Cream for Treatment of Cannabinoid Hyperemesis Syndrome","volume":"27","author":"Dean","year":"2020","journal-title":"Acad. Emerg. Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"2782","DOI":"10.1200\/JCO.20.01296","article-title":"Antiemetics: ASCO Guideline Update","volume":"38","author":"Hesketh","year":"2020","journal-title":"J. Clin. Oncol."},{"key":"ref_38","unstructured":"National Comprehensive Cancer Network\u00ae (NCCN\u00ae) (2024, December 26). NCCN Clinical Practice Guidelines in Oncology: Antiemesis. Version 2, 2024, 27 September 2024. Available online: https:\/\/www.nccn.org\/professionals\/physician_gls\/pdf\/antiemesis.pdf."},{"key":"ref_39","first-page":"312","article-title":"Evidence-Based Antiemetic Decision Tool for Management of Postoperative Nausea and Vomiting in Patients at High Risk of QT Prolongation and Patients Receiving Neurotransmitter-Modulating Medications","volume":"88","author":"Hymel","year":"2020","journal-title":"AANA J."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Yang, C., Xu, P., Wu, T., Fan, Y., Li, Q., Zhang, J., Shen, X., and Dong, X. (2024). Safety assessment of neurokinin-1 receptor antagonist: Real-world adverse event analysis from the FAERS database. Front. Pharmacol., 15.","DOI":"10.3389\/fphar.2024.1413709"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1111\/apt.12822","article-title":"Efficacy of the neurokinin-1 receptor antagonist aprepitant in children with cyclical vomiting syndrome","volume":"40","author":"Cristofori","year":"2014","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"e241132","DOI":"10.1136\/bcr-2020-241132","article-title":"Highly effective use of aprepitant in an adolescent girl with severe cyclic vomiting syndrome","volume":"14","author":"Nivatsi","year":"2021","journal-title":"BMJ Case Rep."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"e14530","DOI":"10.1111\/nmo.14530","article-title":"Efficacy of aprepitant as a prophylactic medication in adults with cyclic vomiting syndrome","volume":"35","author":"Patel","year":"2023","journal-title":"Neurogastroenterol. Motil."},{"key":"ref_44","first-page":"e4825","article-title":"Emerging Role of Aprepitant in Cannabis Hyperemesis Syndrome","volume":"11","author":"Parvataneni","year":"2019","journal-title":"Cureus"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"S-100","DOI":"10.1016\/S0016-5085(24)00725-X","article-title":"455 Efficacy and Safety of Aprepitant for Children with Cyclic Vomiting Syndrome and Cannabinoid Hyperemesis Syndrome","volume":"166","author":"Schottenstein","year":"2024","journal-title":"Gastroenterology"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1143","DOI":"10.1007\/s00520-014-2138-y","article-title":"Olanzapine for chemotherapy-induced nausea and vomiting: A systematic review","volume":"22","author":"Hocking","year":"2014","journal-title":"Support. Care Cancer"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1097\/PRA.0000000000000564","article-title":"Treatment of Cannabinoid Hyperemesis with Olanzapine: A Case Series","volume":"27","author":"Hsu","year":"2021","journal-title":"J. Psychiatr. Pract."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1007\/s13181-014-0460-x","article-title":"Presentations to the Emergency Department Following Cannabis use\u2014A Multi-Centre Case Series from Ten European Countries","volume":"11","author":"Dines","year":"2015","journal-title":"J. Med. Toxicol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1016\/j.jemermed.2017.12.010","article-title":"Cannabinoid Hyperemesis Syndrome: Pathophysiology and Treatment in the Emergency Department","volume":"54","author":"Richards","year":"2018","journal-title":"J. Emerg. Med."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"e2020031468","DOI":"10.1542\/peds.2020-031468","article-title":"Self-reported and Documented Substance Use Among Adolescents in the Pediatric Hospital","volume":"147","author":"Masonbrink","year":"2021","journal-title":"Pediatrics"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/1\/163\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:57:06Z","timestamp":1760115426000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/1\/163"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,30]]},"references-count":50,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1]]}},"alternative-id":["jcm14010163"],"URL":"https:\/\/doi.org\/10.3390\/jcm14010163","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,30]]}}}