Pharmacotherapeutic Considerations for Use of Cannabinoids to Relieve Symptoms of Nausea and Vomiting Induced by Chemotherapy

Abstract

Patients suffering from malignant diseases receive very often highly emetogenic chemotherapy as part of their treatment. With the aim of assessing the efficacy of cannabinoids in treating chemotherapy-induced nausea and vomiting (CINV), we searched the literature published until April 2020 in Medline/PubMed, Embase, the Cochrane Controlled Trials Register, and in specific web pages. Randomized clinical trials comparing cannabinoids efficacy in managing CINV with that of placebo reported absence of vomit-ing (3 trials, 168 patients) and absence of nausea and vomiting (3 trials, 288 participants). In comparison with patients receiving other antiemetics, patients receiving cannabinoids reported no nausea (5 trials, 258 participants), no vomiting (4 trials, 209 participants), and absence of both (4 trials, 414 patients). Across all trials, cannabinoids were more effective in relieving the symptoms of nausea and vomiting induced by cytotoxic therapy than placebo was and slightly better than conventional antiemetics. A retrospective review com-paring nabilone, dronabinol, delta-9-THC, and delta 8-THC with other antiemetics used to manage CINV in pediatric patients showed that these drugs could also be used as adjuvant antiemetics. Cancer patients on highly emetogenic chemotherapy but with insufficiently effective standard antiemetic therapy can be given cannabis preparations containing similar amounts of tetrahydrocannabinol and can-nabidiol, which should be received in strict compliance with the professional guidelines for the treatment of CINV. 

Raman-Based Differentiation of Hemp, Cannabidiol-Rich Hemp, and Cannabis

“…1 Lastly, CBD is capable of mitigating symptoms of neurological disorders, such as reduction of muscle spasticity in people with multiple sclerosis. 6,7 THC is considered to be an illicit drug due to its welldefined psychoactive properties. On a federal and state-specific level, its trafficking and possession are considered a felony offense that carries serious consequences such as prison time and significant monetary fines.…”

Ten reasons to consider cannabinoids in everyday clinical practice

“…Approximately 45 to 61% of patients suffering from cancer experience chemotherapy-induced nausea and vomiting (CINV), which are considered to be a result of highly emetogenic chemotherapy and its metabolites activating neurotransmitter receptors in the gastrointestinal system -5-hydroxytryptamine type 3 (5-HT3) and brain -neurokinin-1 (NK-1) [3,43]. Delayed CINV (1-5 days after starting chemotherapy) occurs more often and involves the receptors in the alimentary tract, whereas acute CINV (appears within 24 hours) is a less frequent component of the disorder and is mediated by the receptors in the brain [3].…”

“…Delayed CINV (1-5 days after starting chemotherapy) occurs more often and involves the receptors in the alimentary tract, whereas acute CINV (appears within 24 hours) is a less frequent component of the disorder and is mediated by the receptors in the brain [3]. Discovering that the blockade of 5-HT3 receptors may suppress emesis proved to be a significant breakthrough [43].…”

“…Considering that cannabinoid receptor agonists downregulate the function of the peripheral 5-HT3 receptors, therefore inhibiting serotonin release, and activate CB1 and CB2 receptors in the brainstem, where emetic reflexes are located, it can be assumed that cannabinoids may play a key role in the prevention from CINV [43,44]. Conventional therapeutic options for alleviating nausea and vomiting include corticosteroids, 5-HT3 antagonists, NK1 antagonists, antihistamines, benzodiazepines, anticonvulsants and dopamine receptor antagonists [43]. Although cannabinoids may be similarly or less potent compared to other pharmaceuticals, in some patients they are the only line of therapy that proves effective and, moreover, they are the only antiemetics which also increase appetite [43].…”

Determination of Terpenoid Profile in Dry Cannabis Flowers and Extracts Obtained from Different Cannabis Varietes

“…Cannabis sativa L. (Cannabaceae) is the frequently used plant, yet notorious and controversial, but considered to have therapeutic potential [1]. Several cannabis-based medicines are now available for the treatment of various pathological conditions such as treatment of pain in cancer patients, treatment of nausea and vomiting induced by chemotherapy, loss of appetite and treatment of cachexia in patients with cancer and acquired immunodeficiency syndrome (AIDS), treatment of neuropathic and chronic pain and spasticity in multiple sclerosis [2][3][4][5][6].…”