Adjunctive treatment with aprepitant was significantly associated with shorter hospital stays and faster symptom resolution in adolescents with cannabinoid hyperemesis syndrome (CHS), based on new data presented at the Pediatric Hospital Medicine (PHM) 2026.

Cannabis use continues to rise, as does the number of patients admitted to hospitals with CHS, said lead author Guru Bhoojhawon, MD, a physician at Driscoll Children’s Hospital, Corpus Christi, Texas.

“We had not had great success with the traditional medications used for CHS until we started using aprepitant, which made a big difference to duration of symptoms and the time pediatric patients spend in the hospital,” he said.

CHS results from long-term, frequent cannabis use and causes cyclic bouts of nausea, vomiting, and abdominal pain. The neurokinin-1 receptor antagonist aprepitant has shown potential for managing refractory nausea and vomiting in other conditions, but its use in CHS has not been well studied, Bhoojhawon and colleagues noted in their poster.

“As access to and social acceptance of cannabis have increased, adolescents are increasingly exposed to and influenced by these changing attitudes toward cannabis use,” said Margaret Thew, DNP, FNP-BC, a Wisconsin-based doctor of nursing practice in family medicine, who was not involved in the study.

Aprepitant became a significant advancement in the treatment of chemotherapy-induced nausea and vomiting when it came to market, said Thew. Aprepitant works by blocking neurokinin-1 receptors, which are activated by substance P and play an important role in the vomiting reflex, she said.

“Aprepitant has a relatively long duration of action compared with some standard antiemetic medications, which may provide adolescent patients more time to tolerate oral fluids and recover from dehydration, potentially reducing the need for prolonged hospitalization,” she added.

In the current study, the researchers compared data from 112 adolescents aged 12-21 years who were hospitalized with CHS at a single center over a 5-year period (2014-2019). Patients were classified into two groups: 44 who received a standard antiemetic regimen plus oral aprepitant and 68 who received standard care alone.

The primary outcomes were length of hospital stay (LOS) and time to hospital discharge; secondary outcomes included time to symptom resolution, 7-day and 30-day emergency department visits, and hospital readmission rates.

Both hospital stay and time to symptom resolution were significantly shorter in the aprepitant group than in the standard care group (30.9 hours vs 46.4 hours; P = .002; 22.6 hours vs 26.6 hours; P = .004; respectively).

In a multivariate analysis, aprepitant was associated with an approximately 25% reduction in LOS compared with standard therapy. “Length of stay reductions accounted for 75.8% of the total estimated economic benefit for the aprepitant group at our institution,” the researchers noted. Use of aprepitant was associated with an estimated cost savings of $2671 per patient because of reduced hospital stay.

Male gender and longer duration of preadmission abdominal pain were associated with longer LOS, whereas female gender was independently associated with shorter time to symptom resolution. No complications associated with CHS were reported in either group.

The study confirmed Bhoojwaron’s clinical experience, and aprepitant is now his first-line medication once a CHS diagnosis is confirmed. “I had started seeing much faster symptom resolution in our pediatric patients, but the extent to which aprepitant helped them was surprising,” he said. Additional research to determine whether use of the medication in the emergency department or primary care setting would prevent hospital admission would be useful, he noted.

Promising Help for a Growing Problem

“For adolescents who do require hospitalization, reducing the duration of symptoms and length of stay could improve patient outcomes while also reducing healthcare costs and freeing hospital beds for other patients,” Thew said.

The current study was limited by several factors including the single-center, retrospective study, which limits the generalizability of the findings to other populations and healthcare settings, Thew said. Other limitations include the lack of blinding and the reliance on existing medical records.

However, larger, multicenter, prospective studies with randomized and blinded designs could help confirm the effectiveness of aprepitant for CHS, establish optimal dosing and timing, and determine whether early treatment can safely reduce hospital admissions and LOS in adolescents, Thew said.

The study received no outside funding. The researchers had no financial conflicts to disclose. Thew had no financial conflicts to disclose.