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. Buy Nabilone UK

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. Buy Nabilone Australia

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. Buy Nabilone Austria

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. Buy Nabilone USA

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. Buy Nabilone Germany

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.

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.

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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.

Unfortunately, natural cannabis is not yet a part of the global standard Clinical Practice Guidelines for Oncology, and in the US, because medical marijuana is still illegal at the federal level, researchers remain somewhat reluctant to register studies on clnicaltrials.gov. The recourse patients have is to pursue nausea treatment options in states that have approved medical cannabis use.