Ineffective treatment of chemotherapy-induced nausea and vomiting prompted Surprisingly, only one reported clinical trial (Meiri et al., ) has compared the . Unlike Δ9-THC, CBD does not produce intoxicating effects and has a low. Cannabis can sometimes relieve nausea more effectively than prescription quickly answered it to see if her trial of cannabis had been helpful to her. CBD can also be effective in easing anxiety, which can help patients. But what happens if these drugs don't alleviate symptoms? One trial found that inhaled cannabis was effective for patients who received high doses of methotrexate. Natural cannabis can also be used for all types of nausea, not just CINV.
Does Cannabis Nausea? The Verdict: Help
Scientists are also running trials in which the synthetics are used in conjunction with traditional pharmaceuticals, like the addition of dronabinol to dexamethasone. Various studies show a dramatic reduction in emesis, but some of the adverse side effects of the synthetic cannabinoids are still present, albeit less severe than previous studies.
A typical dronabinol dosage is 5mg taken 3 to 4 times daily; for nabilone, a mg dose is typically taken twice daily. Both are usually given about 1 to 3 hours prior to the start of chemotherapy. Surprisingly, the medical community still considers these synthetic cannabinoids to be a controversial treatment, despite being approved by the FDA more than 20 years ago. Nabilone and dronabinol are still not as well-studied in clinical trials as their traditional counterparts.
Although there is anecdotal evidence regarding drug combinations, very few studies have been designed to look CINV solutions involving a formulation of cannabis and other drugs. Nabilone and dronabinol work by blocking the binding of serotonin and dopamine, both of which are associated with CINV, at receptor sites. In some cases, inhaled cannabis was used because dronabinol failed.
One trial found that inhaled cannabis was effective for patients who received high doses of methotrexate. Natural cannabis can also be used for all types of nausea, not just CINV. Most evidence has come from strains containing some degree of THC.
The therapeutic outcomes, of course, depend on the THC concentration. CBD is non-intoxicating, and although research has only been done in animals, several animal studies have shown it to be effective at reducing nausea. In a rat study published in the British Journal of Pharmacology, CBD was found to be effective on nicotine-induced nausea. Other animal studies found that low doses of CBD were effective in several types of induced vomiting and anticipatory vomiting, but so far it has not been effective on nausea and vomiting induced by motion sickness.
Many people have started using CBD to treat nausea and vomiting, based on preliminary results showing that CBD activates a neurotransmitter that decreases the sensation of nausea.
Although rats and mice are incapable of vomiting, they display a distinctive conditioned gaping response when re-exposed to cues flavours or contexts paired with a nauseating treatment. Inverse agonists, but not neutral antagonists, of the CB 1 receptor promote nausea, and at subthreshold doses potentiate nausea produced by other toxins LiCl. The primary non-psychoactive compound in cannabis, cannabidiol CBD , also suppresses nausea and vomiting within a limited dose range.
Preclinical research indicates that cannabinioids, including CBD, may be effective clinically for treating both nausea and vomiting produced by chemotherapy or other therapeutic treatments. This article is part of a themed issue on Cannabinoids in Biology and Medicine. To view the other articles in this issue visit http: A major advance in the control of acute emesis in chemotherapy treatment was the finding that blockade of one subtype of the 5-hydroxytryptamine 5-HT receptor, the 5-HT 3 receptor, could suppress the acute emetic response retching and vomiting induced by cisplatin in the ferret and the shrew Costall et al.
Bartlett and Koczwara, ; Aapro et al. However, the 5-HT 3 antagonists are less effective at suppressing acute nausea than they are at suppressing acute vomiting Morrow and Dobkin, ; Bartlett and Koczwara, ; Hickok et al. More recently, NK 1 receptor antagonists e. The cannabis plant has been used for several centuries for a number of therapeutic applications Mechoulam, , including the attenuation of nausea and vomiting. Ineffective treatment of chemotherapy-induced nausea and vomiting prompted oncologists to investigate the anti-emetic properties of cannabinoids in the late s and early s, before the discovery of the 5-HT 3 antagonists.
There is some evidence that cannabis-based medicines may be effective in treating the more difficult to control symptoms of nausea and delayed nausea and vomiting in children. After a total of treatments, the only side effects reported were slight irritability in two of the youngest children 3. Surprisingly, only one reported clinical trial Meiri et al. Patients that were receiving moderately to highly emetogenic chemotherapy were all given both dexamethasone and ondansetron, with half also receiving placebo and half receiving dronabinol prechemotherapy on Day 1.
On Days 2—5, they received placebo, dronabinol, ondansetron or both dronabinol and ondansetron. However, the combined treatment ondansetron and dronabinol was no more effective than either agent alone. Although the study was not explicitly designed to evaluate the effects of combined therapy on acute nausea and vomiting, the combined active treatment group reported less nausea and vomiting on the chemotherapy treatment day than the placebo group.
All reported clinical trials for the effectiveness of cannabinoid compounds on chemotherapy-induced nausea and vomiting have involved oral use of cannabinoids, which may be less effective than sublingual or inhaled cannabinoids, given the need to titrate the dose Hall et al.
However, to the best of our knowledge, the effectiveness of this compound in reducing nausea and vomiting has not been evaluated. Many patients have a strong preference for smoked marijuana over the synthetic cannabinoids delivered orally Tramer et al. Several reasons for this have been suggested: Although many marijuana users have claimed that smoked marijuana is a more effective anti-emetic than oral THC, no controlled studies have yet been published that evaluate this possibility.
To evaluate the anti-emetic potential of drug therapies, animal models have been developed. Since rats and mice do not vomit in response to a toxin challenge, it is necessary to use other animal models of vomiting. There is considerable evidence that cannabinoids attenuate vomiting in emetic species reviewed in Parker et al. Cannabinoid agonists have been shown to reduce vomiting in cats McCarthy and Borison, , pigeons Feigenbaum et al.
The mechanism of action of the suppression of nausea and vomiting produced by cannabinoids has recently been explored with the discovery of the endocannabinoid system and the development of animal models of nausea and vomiting. Recent reviews on the gastrointestinal effects of cannabinoids have concluded that cannabinoid agonists act mainly via peripheral CB 1 receptors to decrease intestinal motility Pertwee, , but may act centrally to attenuate emesis Van Sickle et al.
The dorsal vagal complex DVC is involved in the vomiting reactions induced by either vagal gastrointestinal activation or several humoral cytotoxic agents. The DVC is considered to be the starting point of a final common pathway for the induction of emesis in vomiting species. Endogenous cannabinoid ligands, such as anandamide and 2-arachidonyol glycerol 2-AG , as well as synthetic cannabinoids, such as WIN 55,—2, also act on these receptors Simoneau et al.
Although anandamide has been reported to have anti-emetic properties in the ferret Van Sickle et al. Darmani found that 2-AG 2.
An evaluation of changes in endocannabinoid levels elicited by cisplatin revealed that cisplatin increased levels of 2-AG in the brainstem, but decreased intestinal levels of both 2-AG and anandamide Darmani et al. On the other hand, Van Sickle et al. CB 2 receptors in the brainstem may play a role in the regulation of emesis by 2-AG, at least when CB 1 receptors are co-stimulated.
The anti-emetic effects of 2-AG 0. Although inhibition of FAAH elevates multiple endocannabinoid-like molecules that show activity at multiple target receptors, the anti-emetic effects of URB were reversed by pretreatment with rimonabant, indicating a CB 1 mechanism of action. In experiments with the S. A relative of the cannabinoid system, vanilloid TRPV1 receptors have recently been shown to regulate emesis in the ferret Sharkey et al. The TRPV1 receptor is targeted by capsaicin the burning component of chili peppers as well as resiniferatoxin, which can produce pro-emetic and anti-emetic effects at similar doses in S.
Recent findings indicate that the cannabinoid system interacts with the 5-hydroxytryptaminergic system in the control of emesis e. The first evidence of an interaction between cannabinoids and 5-HT 3 receptors was revealed by the finding that anandamide, WIN55 and CP inhibit 5-HT 3 receptor-mediated inward currents with IC 50 values in the nanomolar concentration range in rat nodose ganglion cells Fan, Since WIN 55,—2 did not displace a 5-HT 3 antagonist [ 3 H]-GR from the ligand binding site, the results suggest that cannabinoids inhibit 5-HT 3A receptors noncompetitively by binding to an allosteric modulatory site of the receptor Barann et al.
Additionally, cannabinoids have been shown to reduce the ability of 5-HT 3 agonists to produce emesis Darmani and Johnson, and this effect was prevented by pretreatment with rimonabant. Cannabinoids may act at CB 1 presynaptic receptors to inhibit the release of newly synthesized 5-HT Schlicker and Kathmann, ; Howlett et al.
Indeed, Darmani et al. Another major cannabinoid found in marijuana is CBD. As has been reported by others e. A wide range of doses was not effective in reducing motion-induced emesis in the S. The anti-emetic effect of CBD does not appear to be mediated by its action at CB 1 receptors, because it is not reversed by the CB 1 antagonist, rimonabant Kwiatkowska et al.
Indeed, Russo et al. Recently, our laboratory has investigated the mechanism of action for the anti-emetic effects of CBD. This activation of the 5-HT 1A receptors results in a reduction of the rate of firing of 5-HT neurones, ultimately reducing the release of forebrain 5-HT Blier and de Montigny, In addition, a recent finding suggests that CBD may also act as an allosteric modulator of the 5-HT 3 receptor Yang et al.
These findings suggest that allosteric inhibition of 5-HT 3 receptors by CBD may also contribute to its role in the modulation of emesis. Nausea is more resistant to effective treatment with new anti-emetic agents than is vomiting e. Andrews and Horn, and therefore remains a significant problem in chemotherapy treatment and as a side effect from other pharmacological therapies, such as anti-depressants.
Even when the cisplatin-induced emetic response is blocked in the ferret by administration of a 5-HT 3 receptor antagonist, c-fos activation still occurs in the AP, suggesting that an action here may be responsible for some of the other effects of cytotoxic drugs, such as nausea or reduced food intake Reynolds et al.
In rats, the gastric afferents respond in the same manner to physical and chemical intragastric copper sulphate and cisplatin stimulation that precedes vomiting in ferrets, presumably resulting in nausea that precedes vomiting Hillsley and Grundy, ; Billig et al.
Furthermore, 5-HT 3 antagonists that block vomiting in ferrets also disrupt this preceding neural afferent reaction in rats. That is, in the rat the detection mechanism of nausea is present, but the vomiting response is absent. Nauseogenic doses of cholecystokinin and LiCl induce specific patterns of brainstem and forebrain c-fos expression in ferrets that are similar to c-fos expression patterns in rats Reynolds et al. In a classic review paper, Borrison and Wang suggest that the rats' inability to vomit can be explained as a species-adaptive neurological deficit and that, in response to emetic stimuli, the rat displays autonomic and behavioural signs corresponding to the presence of nausea, called the prodromata salivation, papillary dilation, tachypnoea and tachycardia.
The typical measure used in the literature to evaluate the nauseating potential of a drug is conditioned taste avoidance. However, taste avoidance is not only produced by nauseating doses of drugs, it is also produced by drugs that animals choose to self-administer or that establish a preference for a distinctive location e.
Berger, ; Wise et al. In fact, when a taste is presented prior to a drug self-administration session, the strength of subsequent avoidance of the taste is a direct function of intake of the drug during the self-administration session Wise et al.
This paradoxical phenomenon was initially interpreted as another instance of taste aversion learning. Because Garcia et al. However, in an animal capable of vomiting, the S.
Since rats are incapable of vomiting, it is likely that conditioned taste avoidance produced by rewarding drugs in this species is based upon a learned fear of anything that changes their hedonic state e.
Gamzu, when that change is paired with food previously eaten. Another approach to understanding the role that nausea plays in the establishment of taste avoidance in rats is to evaluate the potential of anti-nausea treatments to interfere with avoidance of a flavour paired with an emetic treatment.
Early work suggested that anti-nausea agents interfered with the expression of previously established taste avoidance produced by LiCl Coil et al. Furthermore, there is considerable evidence that anti-nausea treatments either do not interfere with the establishment of conditioned taste avoidance learning Rabin and Hunt, ; Rudd et al. Two prominent anti-nausea treatments include drugs that reduce 5-HT availability and drugs that elevate the activity of the endocannabinoid system in rats see Parker et al.
Over the past number of years, our laboratory has provided considerable evidence that conditioned nausea in rats may be displayed as conditioned disgust reactions Parker, ; ; ; ; Limebeer and Parker, ; ; Limebeer et al. Rats display a distinctive pattern of disgust reactions including gaping, chin rubbing and paw treading when they are intraorally infused with a bitter tasting quinine solution.
Rats also display this disgust pattern when infused with a sweet tasting solution that normally elicits hedonic reactions of tongue protrusions that has previously been paired with a drug that produces vomiting such as LiCl or cyclophosphamide in species capable of vomiting. Only drugs with emetic properties produce this conditioned disgust reaction when paired with a taste.
The most reliable conditioned disgust reaction in the rat is that of gaping Breslin et al. If conditioned gaping reflects nausea in rats, then anti-nausea drugs should interfere with this reaction. Limebeer and Parker demonstrated that when administered prior to a saccharin-LiCl pairing, the 5-HT 3 antagonist, ondansetron, prevented the establishment of conditioned gaping in rats, presumably by interfering with LiCl-induced nausea.
Since ondansetron did not modify unconditioned gaping elicited by bitter quinine solution, the effect was specific to nausea-induced gaping. Subsequently, Limebeer and Parker demonstrated a very similar pattern following pretreatment with the 5-HT 1A autoreceptor antagonist, 8-OH-DPAT, that also reduces 5-HT availability and serves as an anti-emetic agent in animal models.
Most recently, Limebeer et al. The orofacial characteristics of the rat gape are very similar to those of the shrew retch just before it vomits Parker, Indeed, Travers and Norgren suggest that the muscular movements involved in the gaping response mimic those seen in species capable of vomiting. Using the conditioned gaping response as a measure of nausea in rats, we have demonstrated that a low dose 0.
The potent agonist, HU 0. When administered 30 min prior to the conditioning trial, rimonabant did not produce conditioned gaping on its own, but it did potentiate the ability of LiCl to produce conditioned gaping. This same pattern has been reported in the emesis literature Van Sickle et al. Van Sickle et al. More compelling evidence that the endocannabinoid system may serve as a regulator of nausea is the recent finding that prolonging the duration of action of anandamide by pretreatment with URB, a drug that inhibits the enzyme FAAH, also disrupts the establishment of LiCl-induced conditioned gaping reactions in rats Cross-Mellor et al.
Rats pretreated with URB 0. Rats given the combination of URB 0. Although inhibition of FAAH produces an elevation of a variety of fatty acids that act at different receptors, the effect of URB on conditioned nausea was reversed by AM, indicating that it was mediated by CB 1 receptors. On the other hand, the silent CB 1 antagonists, AM and AM, which do not have inverse agonist properties, do not produce conditioned gaping Sink et al. In addition, the peripherally restricted silent CB 1 antagonist, AM, which also suppresses feeding at equivalent doses of AM Cluny et al.
Finally, neither the silent antagonist, AM which crosses the blood—brain barrier nor AM with limited CNS penetration , potentiate LiCl-induced nausea, an effect evident with low doses 2. AMinduced conditioned nausea is thus mediated by inverse agonism of the CB 1 receptor. Published in the Proceedings of the National Academy of Sciences, marijuana can reduce inflammation which results in intestinal distress.
Relieve skin irritations - Cancer patients using medicinal marijuana treatments report relief from itchy side effects. Cannabinoids, the compounds in cannabis, are potent anti-inflammatory agents--helpful for calming allergic dermatitis. Patients can consume oral or inhaled marijuana and be applied topically in balms and salves.
Benefit mental health - Having cancer can also do damage to mental health. Marijuana has many euphoric and mood-stimulating properties. Tetrahydrocannabinol THC boosts serotonin, providing an antidepressant effect. While cannabidiol CBD boosts levels of neurotransmitter serotonin, the compound also improves mood and promotes positive well-being.
Regulation of nausea and vomiting by cannabinoids
If there's one thing we know cannabis does well, it's this. who for years have been using medical marijuana to help with treatment side effects. Cannabis has a historical reputation as an anti-nausea medication. Science has confirmed that cannabinoids can indeed be used to quell. This means it prevents nausea, vomiting, and related symptoms. It is excellent for The Verdict: Does Cannabis Help Nausea? YES! Countless.