Chemotherapy-Induced Nausea & Vomiting

Research indicates that cannabinoid medicine can alleviate nausea and vomiting by suppressing nervous system signals through activating the CB1 and HT1A receptors. In jurisdictions where patients have access to cannabis medicine, health care providers frequently prescribe cannabis medical products as an alternative treatment option for chemotherapy-induced nausea and vomiting (CINV).

CINV is among the most common and severe side effects experienced by patients undergoing treatment for cancer. Not all patients receiving chemotherapy will experience nausea and vomiting. For those who do, the severity will be impacted by a patient’s condition, dosage, and medication type. Persistent nausea and vomiting can lead to dehydration and make it difficult to eat, resulting in unintentional weight loss and nutrient deficiencies. When left untreated, CINV can also result in tearing of the esophagus.

Causes / Predispositions

The exact causes of CINV are not fully understood and some chemotherapy medications have a higher probability of causing CINV than others. Research suggests that chemotherapy treatment may trigger nausea and vomiting by activating receptors in the small intestine, and through the body’s reaction to intestinal cell damage.

Certain patient groups such as women, young people, and those with genetic predispositions may have a higher likelihood of experiencing CINV. While those with a history of excess alcohol consumption appear to be less likely to experience CINV.

Symptoms

There are 3 varieties of CINV:

Acute Emesis
– Episodes of vomiting experienced within 24 hours following chemotherapy treatment. Typically beginning within the first 1-2 hours, with peak severity being experienced approximately 4-6 hours following treatment.

Delayed Emesis
– Episodes of vomiting experienced after the first 24 hours following treatment.

Anticipatory Emesis
– Episodes of vomiting experienced prior to receiving chemotherapy treatment. Anticipatory emesis is a conditioned response experienced by patients who have previously undergone cycles of treatment.

Patients with CINV may also experience:

Dizziness
Elevated Heart Rate
Increased Salivation
Light Headed
Loss of Appetite
Sweating
Weakness

The effects of CINV can persist for up to 4 days following treatment. However, patients generally report a reduction in symptoms of nausea and vomiting within 1-2 days.

Traditional Treatments

Preventing the onset of CINV symptoms is the primary goal of treatment through the use of antiemetic medications such as:

Aprepitant
Azasetron
Dexamethasone
Dolasetron
Fosaprepitant
Granisetron
Metoclopramide
Olanzapine
Ondansetron
Palonosetron
Prochlorperazine
Ramosetron
Rolapitant
Tropisetron

Treatment with Cannabis Medicine

Research has shown that cannabis medicine has the potential to prevent/alleviate nausea and vomiting by suppressing nervous system signals through activating the CB1 and HT1A receptors. However, additional research is needed to fully understand the potential benefits and possible side effects of cannabis as a treatment for patients experiencing CINV.

In markets where medical cannabis is regulated, THC is currently being used by patients suffering from CINV who have not shown improvement from the use of traditional antiemetic medications. CBD is commonly used in addition to THC in order to limit the possibility of unwanted side effects.

Recommended Intake Method(s)

Edible Oils – Useful as a preventative treatment. Effectiveness limited by slow onset.
Inhalation via Vaporizer – Useful in achieving immediate relief due to fast onset.