How cannabis is used for nausea and vomiting relief
When medical cannabis laws made their debut in the latter half of the 1990s, they were intended to protect cancer patients from prosecution. These patients found a medication that combatted the harsh, nauseating side effects of chemotherapy, and though cannabis’ efficacy was largely anecdotal at the time, we can now look at the science of cannabinoids to better understand why it works to suppress nausea and vomiting.
What is CINV and how is it treated?
Overpowering. That’s how cancer patients describe the onslaught that occurs within the first 24 hours after starting chemotherapy. Certainly patients fear the hair loss, but the most dreaded side effect is the extreme bouts of nausea and vomiting (called emesis). This isn’t just regular nausea–chemotherapy-induced nausea and vomiting (CINV) is severe and usually occurs right away, with a peak window of 6-24+ hours after treatment.
Traditional pharmaceuticals are used as anti-nausea (anti-emetic) therapies to prevent or minimize CINV. Dexamethasone, a corticosteroid prescribed for inflammatory conditions, is most commonly prescribed; as it turns out, it is also very effective in treating CINV. Serotonin receptor agonists called 5-HT3 (ondansetron, palonosetron, and aprepitant) have been effective when used with dexamethasone. Even antihistamines, antidepressants and anticonvulsants have been tried.
But what happens if these drugs don’t alleviate symptoms? Many chemotherapy patients don’t respond to traditional drugs and report that they can leave them feeling more drugged, more lethargic, and even delusional.
Cannabinoids have shown success in treating the symptoms of CINV. Two medicines, nabilone and dronabinol, are orally-administered synthetic cannabinoids (not to be confused with synthetic cannabis like K2 and Spice). The two are slightly different variations of delta-9-tetrahydrocannibinol (Δ9-THC), which naturally occurs in a cannabis plant. Dronabinol is marketed as Marinol from the US-based Banner Pharmacaps, and nabilone is sold as Cesamet by the Canadian company Valeant Pharmaceuticals International. Both are available in oral and inhaled solutions, and both have been approved for treatment of CINV.
Doctors will usually prescribe traditional medications first, but then try Marinol or Cesamet for patients who don’t respond to other pharmaceuticals.
Research on synthetic cannabinoids for nausea relief
In 1985, dronabinol and nabilone were both approved by the FDA for treatment of CINV. Since then, nearly 30 clinical trials have been conducted and show that synthetic cannabinoids are superior to traditional dopamine receptor antagonist medications for CINV.
Specifically, several clinical trials (1975-1996) involved 1,366 patients. Sixteen trials studied nabilone, and thirteen trials studied dronabinol. Placebos were used, and metoclopramide was used as a control. Cannabinoids alleviated CINV more effectively than either metoclopromide or placebos in all trials.
With synthetic cannabinoids, patients reported beneficial effects such as euphoria, but they also noted negative side effects like drowsiness, depression, drops in blood pressure, and even hallucinations and paranoia. For some patients, the side effects were so intolerable that they dropped out of the studies.
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 1-2mg 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.
How do cannabinoids work to prevent nausea?
Nabilone and dronabinol work by blocking the binding of serotonin and dopamine, both of which are associated with CINV, at receptor sites. Some of the body’s endocannabinoid receptors exist within emetic reflex pathways, making them a promising target for managing CINV. The dorsal vagal complex (DVC) in the brainstem is the overall regulator of emesis (nausea/vomiting), and it is responsible for communication between signals in the blood (like chemotherapy) and the nerve cells that initiate emesis. The DVC and gastrointestinal tract have endocannabinoid receptors, and all have shown to exhibit anti-emetic responses when the receptors are activated by Δ9-THC.
Natural cannabis and nausea treatment
According to the National Cancer Institute, as of April 2017, only 10 human trials have studied the effect of inhaled cannabis for treatment of CINV. 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. Other formulations involve THC and cannabidiol (CBD) in different ratios. Cannabis strains are specifically grown to have different ratios/concentrations to achieve a particular pharmacologic effect.
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. Rats and mice don’t vomit in response to a toxin, so other species such as cats and ferrets must be studied. However, it’s possible to determine the degree of nausea in rats by studying the conditioned gaping response.
In a 2012 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. More research—to identify appropriate combinations, dosages, and drug interactions—is needed for both natural and synthetic cannabinoids used for CINV as well as other types of nausea.
High potency weed linked to psychotic episodes, mysterious vomiting illness in young users
Dangers of high potency cannabis for teenagers
BOULDER, Colo. — One day in fall 2018, Bo Gribbon began to vomit and couldn’t stop. He threw up multiple times an hour from morning to night before his mother drove him to the hospital near their home here.
“It felt like Edward Scissorhands was trying to grab my intestines and pull them out,” said Gribbon, then 17.
Over the next nine months, Gribbon went to the emergency room 11 times for the same problem: severe vomiting and screaming at the same time that lasted for hours. When a physician assistant told him the likely cause, Gribbon didn’t believe it at first. He had never heard of marijuana producing a side effect like that.
Bo Gribbon, 20, went to the ER 11 times in 9 months for a condition that caused bouts of nonstop vomiting and screaming. Medical professionals told him it was from chronic cannabis use but he didn't believe it until stopping cannabis finally made the vomiting stop. Robin Noble
“The only thing that convinced me was that it stopped when I stopped smoking,” said Gribbon, now 20.
Colorado and Washington became the first states to legalize recreational marijuana in 2012. Several years later, doctors in Colorado and other states are expressing alarm over the increasing potency of cannabis and the health risks it may pose for young users — from psychiatric issues, including violent psychotic episodes, to the mysterious condition that plagued Gribbon.
The condition — officially called “cannabinoid hyperemesis syndrome” but now known to health care workers as “scromiting,” a mashup of “screaming” and “vomiting” — has popped up with increasing frequency at hospitals in Colorado, doctors say.
The ER at Parkview Medical Center in Pueblo saw only five scromiting cases in 2009. By 2018, the number had risen to more than 120, according to data compiled by Dr. Brad Roberts, an emergency room physician at the hospital.
Reports of the syndrome doubled in two different ERs in the state shortly after legalization, according to one study.
Roberts said the presence of these patients strains hospital resources. When faced with people suffering from bouts of nonstop vomiting, doctors often order up an array of diagnostic tests to rule out other underlying causes.
“We use up a lot of medical resources to see if there is anything more seriously wrong with them,” Roberts said.
A 2018 national research review called the syndrome “an increasingly prevalent and complicated problem for health care providers and patients.”
Cannabis has been consumed by humans for thousands of years, but relatively little is known about cannabinoid hyperemesis syndrome.
What can you take for nausea relief? 20 nausea medications and remedies
We’ve all felt nauseated before, whether from getting car sick, eating something unpleasant, or taking medicine on an empty stomach. Nausea—the sensation of an upset stomach that can sometimes lead to vomiting—is not an enjoyable feeling. But thankfully, there are nausea medications and home remedies for nausea relief (even during pregnancy).
How to get rid of nausea
“Nausea can be prompted by a wide variety of circumstances such as motion or sea sickness, certain medications, emotional distress, intense pain, food intolerances, drinking too much alcohol, overeating, and early pregnancy,” explains Sunitha Posina , MD, an NYC-based internist.
There are two primary ways to treat nausea: nausea medication and home remedies. Medications work in a variety of ways, depending on which drug you take. One way anti-nausea drugs work is by blocking the receptors that cause the sensation of nausea. Another way is to coat and calm the stomach. Some nausea medicines may also move food through the stomach faster.
Anti-nausea medications work in a variety of ways. One of the most popular over-the-counter medicines for nausea, Pepto Bismol, contains an active ingredient called bismuth subsalicylate (bismuth subsalicylate coupons | bismuth subsalicylate details) . “Bismuth subsalicylate works by protecting your stomach lining and reduces excess stomach acid to ease any discomfort,” Dr. Posina says.
Dramamine (dramamine coupons | dramamine details) is an antiemetic, which means it prevents vomiting. It used to prevent and treat nausea, vomiting, and dizziness caused by motion sickness. It works by blocking receptors in your gut that trigger nausea in the brain. “It may cause drowsiness, so opt for the non-drowsy formula if that is a concern,” Dr. Posina suggests.
Emetrol, another popular over-the-counter medication, works immediately by calming the stomach. Emetrol (emetrol coupon | emetrol details) has fewer common side effects when compared to Dramamine. Many antihistamines are used as nausea medications as they are good at reducing the sensation of nausea from motion sickness.
We have created a list of the most popular prescription drugs and over-the-counter nausea medicines on the market.
Best anti-nausea medications
Home remedies for nausea relief
There are many popular home remedies you can try to help alleviate nausea. Here is a list of some of the most helpful home treatments.
To help calm the stomach and relieve nausea symptoms, “consume clear fluids like water, Jell-O, or broth and gradually introduce bland food, like crackers or plain bread, as tolerated,” suggests Lili Barsky , MD, an LA-based hospitalist and urgent-care physician. “Avoid heavy, greasy, sweet, or spicy foods.” Eating bland foods is also helpful if you frequently experience heartburn .
One of the first medical benefits found for cannabis was nausea treatment . The U.S. Food and Drug Administration has approved two cannabinoid receptor agonists for patients receiving chemotherapy to help alleviate nausea—Marinol ( dronabinol ) and Cesamet (nabilone). In addition to their anti-nausea properties, cannabinoids can also stimulate a person’s appetite. You might also explore CBD oil as a natural solution for nausea.
Ginger is one of the safest home remedies for nausea during pregnancy. Taking 1 gram of ginger each day is an effective way to control nausea and vomiting in pregnant women across multiple studies . Most drugstores sell ginger capsules , but ginger candy is also an option. For children suffering from nausea, ginger ale is a popular drink to help with symptoms.
Aromatherapy will relieve nausea fast. Peppermint oil aromatherapy is effective against nausea. One study found that postoperative patients with nausea had their perception of nausea decreased by 50% when using peppermint oil aromatherapy. Lemon aromatherapy may have similar results to peppermint oil, as well as cardamom aromas , which have had positive benefits with chemotherapy patients.
Acupressure is an alternative therapy. Similar to acupuncture, acupressure is done by applying pressure to specific points in the body. There are findings that acupressure can be useful in alleviating stomach issues.
Taking vitamin B6 has been proven helpful for chemotherapy patients and pregnant women experiencing morning sickness. However, research has not shown its effectiveness in managing nausea. One study found that 42% of people had less nausea after this technique.
Herbal teas can help soothe an upset stomach. Lemon, ginger, and peppermint herbal teas are good options since these herbs are good for nausea. This hot drink will help settle an upset stomach.
Is it nausea or something else? When to see a doctor
“Nausea may often have a benign cause but can also be a harbinger of something dangerous,” Dr. Barsky says. “If nausea persists, recurs, worsens, or is accompanied by other symptoms, one should consider seeking medical attention.”
If you have the following symptoms in addition to nausea, seek medical advice immediately:
- Chest pains
- Severe abdominal cramping
- Blood in vomit
- Severe headache
- High fever
- Blurred vision or visual changes
The combination of these symptoms with nausea can be an indicator of a more serious condition including kidney failure, meningitis, heart attack, intracranial pressure due to concussion or traumatic brain injuries, vestibular disorders, or carbon monoxide poisoning along with other toxin exposure.
Keep in mind that nausea is also a symptom of COVID-19 . If you’re unsure what’s causing your nausea and if any of the following symptoms accompany it, it’s best to speak with your healthcare provider to rule out coronavirus: