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Cancer treatment, including chemotherapy, is associated with multiple adverse effects which represent a real challenge for the patients. Patients may experience unpleasant sensation in their throat or the upper part of the abdomen (nausea) or forceful expulsion of the stomach content due to a specific reflex (vomiting) as a result of chemotherapy. Actually, nausea and vomiting are the most commonly reported side effects, affecting the compliance to treatment and thereby its efficacy. Therefore, it is important to find suitable medications that work in a safe manner to control such burden.
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For that purpose, physicians use the antiemetic medications, such as metoclopramide, chlorpromazine, and prochlorperazine. These drugs are used with varying degrees of efficacy and drawbacks. Given that cannabinoids have been successfully introduced for several therapeutic indications, their antiemetic efficacy is questionable. This systematic review demonstrated the available randomized controlled trials concerned with comparing the cannabinoids and other antiemetics or no-treatment in patients with cancer.
Cannabinoid efficacy for chemotherapy-induced nausea and vomiting
Synthetic cannabinoids were given to the patients via the oral (nabilone or dronabinol) or intramuscular (levonantradol) route, with no smoked cannabis. Across all studies under investigation, cannabinoids showed a superior efficacy when compared to metoclopramide and prochlorperazine to control nausea and vomiting. The antiemetic effect of cannabinoids extended up to 4 days, indicating a prolonged action. In addition, cannabinoids led to a complete control of nausea and vomiting as compared to placebo, especially when the chemotherapy induced mild to moderate levels of emesis. However, the impact of increasing the dosage to treat severe cases was not evaluated in the study.
Safety of cannabinoids
Safety is important for any medication prior its approval for use. Side effects occur more frequently with using cannabinoids compared with placebo or active antiemetics. The most reported adverse effects are possibly due to the action of cannabinoids on the central nervous system, producing both neuropsychiatric and physical effects. Patients may experience beneficial side effects, such as the “high” sensation, euphoria, and sedation. Furthermore, dysphoria, depression, hallucination, and decreased blood pressure are considered harmful side effects in cancer patients. As a consequence, more significant numbers of patients discontinued the treatment with cannabinoids.
Although the previously reported side effects were frequent, the patients preferred the treatment with cannabinoids than other medications, where their range was between 38% and 90%. This is potentially because cannabinoids produced rapid and approximately complete therapeutic effects against nausea and vomiting. It is worthy to note that the preference profile was apparent for cannabinoid therapy during future chemotherapy cycles.
Oral and intramuscular cannabinoid treatments are highly effective to control nausea and vomiting in cancer patients receiving chemotherapy. Nonetheless, it is important to administer them at minimal effective doses to avoid their harmful side effects. With the development of modern antiemetics, it is plausible to compare their efficacy and safety to both the plant-derived and synthetic cannabinoids in chemotherapy-receiving patients.