Gabapentin for the Management of Suspected Cannabis Withdrawal in a Pregnant Patient With a History of Cannabinoid Hyperemesis Syndrome: A Case Report.

Cannabinoid hyperemesis syndrome (CHS) is a rare but increasingly recognized condition among chronic cannabis users, characterized by cyclic nausea, vomiting, and relief with hot bathing. During pregnancy, CHS may mimic hyperemesis gravidarum (HG), complicating diagnosis and management. We report the case of a 24-year-old pregnant patient who presented at 20 weeks' gestation with recurrent nausea, vomiting, and labile hypertension. Investigations ruled out preeclampsia and secondary causes of hypertension. She met DSM-5 criteria for cannabis use disorder, had a prior hospitalization for CHS, and had recently reduced her cannabis use, raising concern for withdrawal as a contributing factor to her presentation. Gabapentin was initiated off-label after an Addiction Medicine consultation, resulting in resolution of symptoms and normalization of blood pressure within 24 h. To our knowledge, this is the first reported use of gabapentin in a pregnant patient with a history of CHS and suspected cannabis withdrawal. This report highlights the importance of screening for cannabis use, recent reduction or cessation, and withdrawal symptoms in pregnant patients presenting with severe or refractory hyperemesis. In this case, short-term off-label gabapentin use led to rapid symptom resolution without apparent maternal or fetal complications, suggesting that it may be relatively safe in this population, although data remain limited.