CBD - A novel measure for management of nausea and vomiting
Table of contents
Overview of Nausea and Vomiting
CBD - A novel measure for management of nausea and vomiting
- Therapeutic values of CBD to control nausea/vomiting
- Choose the right dose
- How to use
- Notice about using CBD to treat nausea/vomiting
- Drug - CBD interaction
Conclusion
Reference
Overview of Nausea and Vomiting
Nausea is stomach discomfort and that often comes before vomiting. Vomiting is the forcible discharge of gastric content through the mouth. These conditions are associated with various underlying causes and can be prevented.
What causes nausea?
In some cases, nausea is the symptoms of disease, but some people are highly sensitive to certain foods, motion sickness, medications. All these things can lead to nausea and vomiting. Common causes are listed below:
- Gastrointestinal tract problems: These issues include constipation, gastroesophageal reflux disease, irritable bowel syndrome, liver disease.
- Central nervous system: Nausea and vomiting are symptoms of stroke, increased intracranial pressure, head injury, motion sickness.
- Psychiatric conditions: Anxiety or depression may cause nausea and vomiting
Other conditions: Pregnancy, cardiovascular disease, post operative, noxious odor, food poisoning, etc.
- Nausea and vomiting are also common side effects when using medications, such as antibiotics, sudden discontinuation of drugs, and opioids.
The causes of nausea depends on age and time of onset. For example, if nausea appears shortly after meals, it may be caused by food poisoning. For children, the common causes are viral infection, overeating, coughing, and constipation.
Generally, nausea/vomiting is harmless, however it may be signs or symptoms of illness. It may be mild or severe conditions, such as stroke, meningitis, brain tumors, or appendicitis.
In some special populations, such as young children, they are at risk of becoming dehydrated, especially if they have diarrhea because they are unable to communicate and describe the symptoms. Recurrent vomiting in pregnant women can lead to serious complications that can endanger the life of their child due to imbalance of body fluid and electrolytes.
If nausea/vomiting are associated with blood in the vomit, severe headache, unconsciousness, diarrhea, you must immediately seek medical care.
How can I prevent nausea?
- Eat small meals
- Eat what appeals to you
- Drink a lot of fluid: water, unsweetened fruit juice, tea, or ginger. It’s best, you should drink small amounts of water throughout the day, rather than drink large amounts less frequently.
- Avoid unpleasant smell
- Make yourself comfortable, including relaxation after eating, paying attention to other activities, etc.
- Complement therapies: you can consider alternative measures, such as aromatherapy, acupuncture which help you feel better when used with medications
These self care measures may help you prevent nausea and vomiting, but they can’t take the place of antiemetics in some conditions, such as nausea-related chemotherapy, pregnancy, and symptoms of other diseases.
How do physicians prevent and treat nausea/vomiting?
Drug therapy can be initiated to prevent and manage nausea/vomiting caused by motion sickness, pregnancy, chemotherapy, and post operation.
For pregnancy, women can use ginger tablets or pyridoxine with mild nausea/vomiting and anti-histamine for moderate and persistent conditions.
Most people undergoing chemotherapy receive anti-emetics to prevent nausea and vomiting. Depending on your situation, doctors may prescribe drugs based on types of chemotherapy medications, patients’ response. These include ondansetron, antihistamine, and anticholinergics. Besides efficacy, all antiemetics are associated with side effects, such as sedation, constipation, headache, and the physician must balance potential adverse events with symptom relief benefit.
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CBD - A novel measure for management of nausea and vomiting
Recent studies demonstrate that the endocannabinoid system plays an important role in regulating nausea and vomiting in humans and animals. Results from animal experiments suggest that cannabinoids may be useful for difficult-to-control nausea and vomiting which are less well-treated with currently available antiemetic medications. Besides THC, CBD which is a non-psychoactive cannabinoid seems to have potential to suppress nausea and vomiting. In the following section, we provide a review of studies about the use of CBD to control nausea/vomiting.
Cannabis offer immediate relief from symptom of nausea
In a study , titled the effectiveness of common cannabis products for treatment of nausea, published in the Journal of Clinical Gastroenterology, researchers showed that the vast majority of patients (96%) using cannabis products to treat nausea experience quick relief within one hour. The study was based on data collected from 2000 cannabis self-administration recorded by 880 people using Releaf App which is a mobile software to help cannabis customers manage their consumption [1].
Preliminary efficacy and safety of oromucosal cannabis extract in chemotherapy-induced nausea/vomiting.
Despite development in antiemetic treatment, many patients still suffer from nausea-related chemotherapy. The trial was designed to assess the tolerability, efficacy of cannabis-based medicine containing CBD and THC, taken in combination with standard therapy in control nausea and vomiting. The participants received standard antiemetics, and were randomized to take cannabis-based medicine or placebo after 120 hours of chemotherapy. The primary endpoint was the proportion of patients showing complete or partial response. There are 7 patients taking cannabis medicine and 9 receiving placebo. At the end of trial, a higher percentage of patients with complete response was shown in cannabis-using group with the average daily dose was about 5 sprays. No serious adverse events were reported in both groups. Compared with standard therapies, combination of Cannabis medicine with conventional antiemetics provide better protection against nausea/vomiting and are well-tolerated [2].
Effects of THC and CBDA (Cannabidiolic acid - a derivative of CBD) on acute nausea in rat models
Some evidence indicated THC and CBDA was beneficial to reduce distressing symptoms of nausea, but their combined effects weren’t understood. Therefore, a Canadian research team designed a study to discover the potential benefits of THC and CBDA to treat acute nausea in rats. Combined doses of THC and CBDA are particularly effective as a treatment for nausea. In addition, the authors suggested that high doses of CBDA may attenuate THC-induced interference with learning [3].
Efficacy of Dronabinol (A THC derivative) alone and combination with ondansetron versus ondansetron for delayed nausea and vomiting caused by chemotherapy
This trial was a placebo-controlled and double blind study which is relatively reliable. The participants received standard antiemetic therapy with ondansetron and dexamethasone with placebo or Dronabinol. The research team used a visual analog scale to evaluate nausea intensity. 64 patients were randomized to 3 groups, including administration of ondansetron, dronabinol, and combination of them. Nausea absence was greater significantly in the active treatment group, and nausea intensity was lowest in patients treated with dronabinol. In conclusion, the authors suggested that dronabinol and ondansetron were similarly effective for the treatment of nausea caused by chemotherapy [4].
Choosing the right dose of CBD
There is no one size fits all dosage for CBD. What’s optimal mainly depends on a range of factors, such as body weight, tolerance, symptoms, metabolism, and so on. These factors can yield unique effects for each CBD consumer. Keep in mind that you should pay close attention to how you feel after each dose. It might not occur immediately, and you should be patient to remember that you’re unlikely to get immediate results. As soon as you experience positive effects, lock in that dose and stick with it.
With oral route, start at a dose of 20 milligrams per day (using twice or three times a day) and increase the dose gradually to achieve desirable effects. Do not increase or decrease your dose more often or longer than recommended. Your condition may not improve faster, your risks of side effects will increase.
With topical CBD products, take sufficient amounts of CBD to apply directly into the skin (2-3 times a day) and start at low dose and increase the dose gradually. You can combine using topical CBD products with oral route for maximizing effects.
The recommended dosage forms are CBD capsule and CBD oil. As compared to capsule, CBD oil is extremely versatile because it can be taken under the tongue, vaporized, infused in food, or cosmetics.
How to use
Taking capsules is the simplest and most convenient way to use CBD. You only need to swallow the capsule with at least 300 ml of water. The drawbacks of the oral route are low availability and delayed onset of effects.
There are some ways to take CBD oil, and we will provide two most common and effective methods to use CBD in this section.
Firstly, applying CBD sublingually is incredibly easy. CBD oil needs to be put under the tongue and held from 60 to 120 seconds without swallowing to allow adequate time for CBD to diffuse completely across the epithelial cells. The method remains the same when you use CBD oils or tinctures. You must hold the CBD under the tongue since different areas of the mouth might not be permeable enough for diffusion into the bloodstream. Taking CBD sublingually provides fast onset of action and high bioavailability.
Vaping CBD seems to be slightly more difficult than taking CBD sublingually. The first step to vaping properly is to determine how much CBD you consume each time. If you feel unconfident at first, you should start with the easiest option. Disposable cartridges and pods are the simplest tools for new users. Refillable vape pens are a little bit more advanced but more cost-effective in the long term. It is important to read the instructions carefully before using them.
Notice about using CBD for Nausea and Vomiting
How you choose the best CBD products for Nausea and Vomiting?
Overall, it is vital that your doctor check your improvements, disease progression, side effects, and interaction with food or drugs at regular visits to make sure CBD is working properly.
- Notice any side effects and tell your doctor right away.
- Don’t take other medicine (including ETC, OTC medicines, herbal, or vitamin supplements) unless they have been discussed with your doctor.
As regards CBD products, they are made by a company that provides
- Third-party test
- Business certification
- Certificate of analysis (COA), no contain more than 0.3% THC and pass tests for heavy metals, pesticides, etc.
- Source of their hemp
- Product information (Brand, CBD content, ingredients, potency, route of administration, indication, instruction)
- Customers’ review
- No subject of FDA warning letter or make any unsupported health claim
If you use CBD by taking it under the tongue or vaping, there are a few things that you should take into account. We will provide details in the following section.
Applying CBD sublingually
Shake well before use
Determine the number of drops in accordance with the dose of CBD consuming each time
Start at a low dose as we recommend above and increase the dose to have the therapeutic effects.
Hold the CBD under the tongue for at least 60 seconds
Accidentally swallowing the CBD oil won’t pose any risks to your body. However, once you swallow this substance, you no longer take it sublingually. Instead, you are eating it, which means that it has to pass the digestive system and metabolism before your body can utilize it. Although it’s not dangerous, it does mean decreased bioavailability and slower onset of action.
Taking CBD sublingual bypasses the digestive system, there’s no need to worry about taking it with or without food.
After the necessary time is up, drinking water or eating food won’t interfere with the working of the CBD. At best, you might wait a few minutes prior to drinking water.
Putting a few drops of CBD under the tongue won’t turn your teeth yellow as well as make your breath smell.
Vaping CBD
Determine your suitable CBD dosage, the number of puffs each time, and types of CBD vape
Read carefully the user manual, especially if you are a new user
Wait 5 – 10 minutes between puffs and observe how CBD affects you
Always start at low dose, and work your way up to the optimal dose
After inhaling, you should check the battery life or clean the vape tank if needed
Drug interaction
People considering or taking CBD products should always mention their use to their doctor, especially if you are taking other medications or have underlying ailments, such as kidney disease, liver disease, heart failure, or immunocompromised condition. Pharmacists are also a reliable source to help you learn about potential drug interaction with supplements, over-the-counter drugs or prescribed drugs.
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Conclusion
Through various studies, CBD shows promise as a potential measure to control nausea and vomiting through various clinical and preclinical studies. If you try using CBD to manage nausea and vomiting, you should talk to your doctor, they can help you determine the most effective and safest way to take CBD.
Reference
1. http://news.unm.edu/news/cannabis-offers-mmediate-relief-from-symptoms-of-nausea-but-product-use-matters
2. https://pubmed.ncbi.nlm.nih.gov/21039759/
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3165951/
4. https://pubmed.ncbi.nlm.nih.gov/26381155/