11 - Retrospective Analysis on the Use of Aprepitant in Cannabinoid Hyperemesis Syndrome

Poster Number: 11
Publication Number: 11.207

Natasha Dilwali, NewYork-Presbyterian Komansky Children’s Hospital, New York, NY, United States; Taylor Jackvony, NewYork-Presbyterian Komansky Children’s Hospital, New York, NY, United States; Melissa Rose, NewYork-Presbyterian Komansky Children’s Hospital, New York, NY, United States; Irina Trifonova, NewYork Presbyterian Hospital, New York City, NY, United States; Aaron Turkish, Weill Cornell Medicine, Fresh Meadows, NY, United States; Charlene Thomas, Weill Cornell Medicine, New York, NY, United States

Background: Cannabinoid hyperemesis syndrome (CHS) is a functional gastrointestinal disorder presenting as recurrent paroxysms of severe nausea and vomiting, similar to episodes exhibited by cyclic vomiting syndrome (CVS). Cannabinoid use has increased among adolescents over the past decade and hospital admissions have increased by almost 30 percent over the past 5 years. Given the rising prevalence, cost, and healthcare burden associated with CHS, it is necessary to identify novel agents for treatment. Aprepitant is a neurokinin-1-receptor antagonist frequently used in the treatment of chemotherapy induced vomiting and CVS. Given the demonstrated benefit of aprepitant in these disorders, it may prove to be useful in the treatment of CHS.

Objective: Describe the use of aprepitant in pediatric patients with CHS, explore the characteristics of these patients and the use of alternative antiemetics when aprepitant is administered. ED visits and number of hospitalizations will also be described for all patients receiving aprepitant.

Design/Methods: A retrospective chart review was completed of patients ages 10-22 who were seen in the ED or admitted to the pediatric inpatient unit due to symptoms of CHS from 2018-2020.

Results: 26 patients were seen for CHS and 6 received aprepitant from 2018-2020. 73% of all patients were 18 years or older and there were no significant differences in gender or race (table 1). Patients who received aprepitant were refractory to treatment, had increased severity in symptoms, and all required inpatient admission. 5 of 6 patients who received aprepitant had no further visits to our institution (table 2). 4 of 6 patients who received aprepitant required less total doses of antiemetics post-aprepitant (49%) and the remaining 2 patients required no additional doses of antiemetics post-aprepitant. There was an absolute reduction in ondansetron (46%), metoclopramide (83%), and other antiemetics (14%). The other antiemetics included lorazepam, diphenhydramine and haloperidol; all of which have sedating adverse effects (table 3).Conclusion(s): The use of aprepitant in CHS is advantageous by decreasing overall medication use, limiting other antiemetic side effect profiles, and decreasing further hospital visits. By using aprepitant, patients were able to receive fewer doses of medications associated with QTc prolongation and sedation. Additionally, all patients who received aprepitant did not require antipsychotic medication. Aprepitant significantly decreased further visits to our institution, removing a large healthcare burden in an illness characterized by multiple admissions and ED visits.
Table 1: Demographics of CHS Patients 2018 -2020
Table 2: Visit and Length of Stay Data for Patients Who Received Aprepitant