Nausea/Vomiting

Nausea/Vomiting

conditions nausea header

Nausea with or without vomiting can come on for a variety of reasons and can last a few minutes or remain constant. Short-term episodes might be due to pain, stress, motion sickness, reaction to medications, overeating or excess alcohol. Long duration can be the result of infection, food poisoning, or pregnancy. Chronic nausea can be caused by liver disorders and brain abnormalities. It also can come with some cancers, especially as a result of chemotherapy. Vomiting is more likely to occur with infections, food reactions or when food stops moving through the GI tract. In rare cases with chronic cannabis use, there can be Cannabis Hyperemesis Syndrome, a paradoxical condition that causes severe vomiting.

Nausea/Vomiting and Cannabis

NOTE FOR FIRST TIME READERS: Cannabinoids – such as THC, CBD – and terpenes are the main medically active components in cannabis (aka marijuana). For more information on these components, and much more about the plant, see our section on the Science of Cannabis.

Cannabis has been used since ancient times to treat nausea. The body contains naturally occurring cannabinoid receptors that are part of the endocannabinoid system, which is involved in regulating nausea and vomiting in humans as well as other animals. Ineffective treatment of chemotherapy-induced nausea and vomiting prompted the investigation of the anti-emetic properties of cannabinoids in the late 1970s and early 1980s. Δ9-Tetrahydrocannabinol (THC) is currently approved in the US (since 1985) as dronabinol (Marinol), for treating nausea and vomiting associated with chemotherapy. It is also used to treat anorexia.

Dronabinol and ondansetron (a strong anti-emetic) or the combination of the two was part of a 5-day, double-blind, placebo-controlled study on chemotherapy-induced nausea and vomiting. An absence of nausea was 71% with dronabinol, 64% with ondansetron and 15% with placebo. This confirmed the anti-emetic effect of a THC-type drug. Cannabidiol (CBD) also suppresses nausea and vomiting within a limited dose range (in animal models). Sativex (CBD/THC approx. 1:1) has been found to decrease chemotherapy-induced nausea and vomiting in preclinical trials.

Methods of delivery include inhalation, or sublingual (under the tongue) THC or CBD products. Both of these approaches avoid loss of ingested medicine due to vomiting. Small doses in the 5-10 mg range are usually effective, or 1-2 puffs of a smoked or vaporized product.

References

Darmani NR. Mechanisms of broad-spectrum antiemetic efficacy of cannabinoids against chemotherapy-induced acute and delayed vomiting. Pharmaceutical. 2010, 3: 2930-2955.

Meiri E, et al. Efficacy of dronabinol alone and in combination with ondansetron versus ondansetron alone for delayed chemotherapy-induced nausea and vomiting. Curr Med Res Opin. 2007, 23: 533-543.

Söderpalm AH, Schuster A, de Wit H. Antiemetic efficacy of smoked marijuana: subjective and behavioral effects on nausea induced by syrup of ipecac. Pharmacol Biochem Behav. 2001, 69(3-4): 343-50.

Parker LA, Rock EM, Limebeer CL. Regulation of nausea and vomiting by cannabinoids. Br J Pharmacol. 2011, 163(7):1411-22.

Duran M, et al. Preliminary efficacy and safety of an oromucosal standardized cannabis extract in chemotherapy-induced nausea and vomiting. Br J Clin Pharmacol. 2010, 70(5):656-63.

Galli JA, Andari Sawaya R, Friedenberg FK. Cannabinoid hyperemesis syndrome. Current Drug Abuse Reviews. 2011, (4)4: 241-249.

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