Marijuana, Ondansetron, and Promethazine Are Perceived as Most Effective Treatments for Gastrointestinal Nausea

Zikos, Thomas; Nguyen, Linda Anh B.; Kamal, A. N.; Fernandez‐Becker, Nielsen; Regalia, Kirsten; Nandwani, Monica; Sonu, Irene; Garcia, Mildred; Okafor, Philip N.; Neshatian, Leila; Grewal, Damanpreet; Garcia, Patrícia Azevedo; Triadafilopoulos, George; Clarke, John O.

doi:10.1007/s10620-020-06195-5

Cited by 18 publications

(16 citation statements)

References 22 publications

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“…For the present mechanistic analysis, drugs used to inhibit vomiting and/or increase gastric emptying were identified from reviews on treatments for gastroparesis 1,2,9–13,20–24 . For some, there are few or no controlled studies and/or poor pharmacological characterisation, severely hampering interpretation of data 20,23,25 .…”

Section: Background and Scope Of Reviewmentioning

confidence: 99%

“…The older drugs are non‐selective, influencing more than one mechanism, including sometimes, a pathway leading to vomiting 30,96 . Included is the mACh receptor agonist bethanechol, sometimes given to patient's refractory to other treatments 12,13 . However, bethanechol does not induce a coordinated increase in gastric emptying, so is not discussed further.…”

Section: Drugs Increasing Gastric Emptyingmentioning

confidence: 99%

“…More recently, patients with nausea, of assumed gastrointestinal (GI) origin (mostly gastroparesis; also functional, oesophageal and other diagnoses) were found to prefer marijuana, ondansetron and promethazine. Least effective were ‘neuromodulators’ (amitriptyline, gabapentin, pregabalin, buspirone), complementary/alternatives, diphenhydramine, and erythromycin 13 …”

Section: Introductionmentioning

confidence: 99%

“…Least effective were 'neuromodulators' (amitriptyline, gabapentin, pregabalin, buspirone), complementary/alternatives, diphenhydramine, and erythromycin. 13 Particularly striking is the absence of clear, mechanism-based evidence to support prescribing any particular 'anti-emetic' drug for patients with gastroparesis. This suggests they are given because they are effective against nausea and vomiting in other groups of patients or human volunteers.…”

Section: Introductionmentioning

confidence: 99%

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Review article: An analysis of the pharmacological rationale for selecting drugs to inhibit vomiting or increase gastric emptying during treatment of gastroparesis

Sanger

Andrews

2023

Aliment Pharmacol Ther

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Background: Drugs which can inhibit nausea/vomiting and/or increase gastric emptying are used to treat gastroparesis, mostly 'off-label'. Within each category, they act at different targets and modulate different physiological mechanisms.Aims: Address the questions: In gastroparesis, why should blocking one pathway causing vomiting, be more appropriate than another? Why might increasing gastric emptying via one mechanism be more appropriate than another? Methods: Drugs used clinically were identified via consensus opinions and reviews, excluding the poorly characterised. Their pharmacology was defined, mapped to mechanisms influencing vomiting and gastric emptying, and rationale developed for therapeutic use. Results:Vomiting: Rationale for 5-HT 3 , D 2 , H 1 or muscarinic antagonists, and mirtazapine, amitriptyline, nortriptyline, are poor. Arguments for inhibiting central consequences of vagal afferent transmission by NK 1 antagonism are complicated by doubts over effects on nausea. Gastric emptying: Confusion emerges because of side-effects of drugs increasing gastric emptying: Metoclopramide (5-HT 4 agonist, D 2 and 5-HT 3 antagonist; also blocks some emetic stimuli and causes tardive dyskinesia) and Erythromycin (high-efficacy motilin agonist, requiring low doses to minimise side-effects). Limited trials with selective 5-HT 4 agonists indicate variable efficacy.Conclusions: Several drug classes inhibiting vomiting have no scientific rationale. NK 1 antagonism has rationale but complicated by limited efficacy against nausea. Studies must resolve variable efficacy of selective 5-HT 4 agonists and apparent superiority over motilin agonists. Overall, lack of robust activity indicates a need for novel approaches targeting nausea (e.g., modulating gastric pacemaker or vagal activity, use of receptor agonists or new targets such as GDF15) and objective assessments of nausea.

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Section: Background and Scope Of Reviewmentioning

confidence: 99%

Section: Drugs Increasing Gastric Emptyingmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Review article: An analysis of the pharmacological rationale for selecting drugs to inhibit vomiting or increase gastric emptying during treatment of gastroparesis

Sanger

Andrews

2023

Aliment Pharmacol Ther

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“…My clinical observation was supported by a recent survey of 153 non-cancer patients presenting to the Stanford University outpatient general gastroenterology and motility clinics in Palo Alto, California who were asked to rate the efficacy of 29 antiemetics during visits in 2017 to 2018. 39 Antiemetics were scored on a 0-5 scale and the mean efficacy score was 1.73. Cannabis (2.75), ondansetron (2.64), and promethazine (2.46) all scored significantly higher than the mean.…”

Section: Therapeutic Use Of Cannabis and Cannabinoids In Cancer Sympt...mentioning

confidence: 99%

Cannabis, Cannabinoids and Cannabis-Based Medicines in Cancer Care

Abrams

2022

Integr Cancer Ther

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As medical cannabis becomes legal in more states, cancer patients are increasingly interested in the potential utility of the ancient botanical in their treatment regimen. Although eager to discuss cannabis use with their oncologist, patients often find that their provider reports that they do not have adequate information to be helpful. Oncologists, so dependent on evidence-based data to guide their treatment plans, are dismayed by the lack of published literature on the benefits of medical cannabis. This results largely from the significant barriers that have existed to effectively thwart the ability to conduct trials investigating the potential therapeutic efficacy of the plant. This is a narrative review aimed at clinicians, summarizing cannabis phytochemistry, trials in the areas of nausea and vomiting, appetite, pain and anticancer activity, including assessment of case reports of antitumor use, with reflective assessments of the quality and quantity of evidence. Despite preclinical evidence and social media claims, the utility of cannabis, cannabinoids or cannabis-based medicines in the treatment of cancer remains to be convincingly demonstrated. With an acceptable safety profile, cannabis and its congeners may be useful in managing symptoms related to cancer or its treatment. Further clinical trials should be conducted to evaluate whether the preclinical antitumor effects translate into benefit for cancer patients. Oncologists should familiarize themselves with the available database to be able to better advise their patients on the potential uses of this complementary botanical therapy.

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Nutrition, endocannabinoids, and the use of cannabis: An overview for the nutrition clinician

Russell,

Condo,

DeFlorville

2024

Nut in Clin Prac

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The endocannabinoid system (ECs) is composed of multiple signaling compounds and receptors within the central and peripheral nervous system along with various organs, including the gut, liver, and skeletal muscle. The ECs has been implicated in metabolism, gut motility, and eating behaviors. The ECs is altered in disease states such as obesity. Recent studies have clarified the role of the gut microbiome and nutrition on the ECs. Exogenous cannabinoid (CB) use, either organic or synthetic, stimulates the ECs through CB1 and CB2 receptors. However, the role of CBs is unclear in regard to nutrition optimization or to treat disease states. This review briefly summarizes the effect of the ECs and exogenous CBs on metabolism and nutrition. With the increased legalization of cannabis, there is a corresponding increased use in the United States. Therefore, nutrition clinicians need to be aware of both the benefits and harm of cannabis use on overall nutrition status, as well as the gaps in knowledge for future research and guideline development.

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Marijuana, Ondansetron, and Promethazine Are Perceived as Most Effective Treatments for Gastrointestinal Nausea

Cited by 18 publications

References 22 publications

Review article: An analysis of the pharmacological rationale for selecting drugs to inhibit vomiting or increase gastric emptying during treatment of gastroparesis

Review article: An analysis of the pharmacological rationale for selecting drugs to inhibit vomiting or increase gastric emptying during treatment of gastroparesis

Cannabis, Cannabinoids and Cannabis-Based Medicines in Cancer Care

Nutrition, endocannabinoids, and the use of cannabis: An overview for the nutrition clinician

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