Nausea and vomiting
Mangement and treatment
Treating the cause
Symptomatic management: non-pharmacological
- Symptomatic management: pharmacological
- Integral approach
Clinical question 2i:
What is the effect of medicinal cannabis in the treatment of nausea and/or vomiting in patients in the palliative phase of cancer, heart failure, COPD, MS, ALS or renal failure?
Medicinal cannabis is not recommended for patients in the palliative phase of nausea and/or vomiting.
Medicinal cannabis (dronabinol (THC), cannabidiol (CBD) binds to cannabinoid receptors in the central and peripheral nervous system. The agonistic effect of cannabinoid agents on these receptors in the central nervous system inhibits neurotransmission, so that the central mechanism of nausea is inhibited.
Medicinal cannabis is administered orally (liquid; tea) or inhaled by means of a nebuliser. Medicinal cannabis is registered in the Netherlands for the treatment of nausea and vomiting. Medicinal cannabis products that are currently available on the market in the Netherlands are: Bedrocan, Bedrobinol and Bediol (granulate).
There are indications that medicinal cannabis has an effect on nausea and vomiting with chemotherapy [Machado 2008; Tramer 2001]. This will not be discussed further here.
No literature has been found on the effect of medicinal cannabis in patients in the palliative phase with nausea and vomiting.
No statement can be made about the effectiveness of medicinal cannabis for nausea and/or vomiting in patients in the palliative phase.
The use of medicinal cannabis may be associated with central side effects, like dizziness (48%), dysphoria/depression (12%), hallucinations (6%) and paranoid delusions (5%) [Tramer 2001].