Written by Gabriele Dennert and the CAM-Cancer Consortium.
Updated November 25, 2011

Cannabinoids

Abstract and key points

  • Cannabinoids are active substances that work as agonists at cannabinoid receptors.
  • The antiemetic efficacy of cannabinoids in comparison to placebo in chemotherapy-induced nausea/vomiting has been established in a systematic review.
  • The use of cannabinoids for anorexia-cachexia-syndrome in advanced cancer is not supported by the evidence from randomised controlled trials.
  • Several randomised controlled trials indicate a mild analgesic effect of cannabinoids in cancer patients.
  • Dose-limitating central nervous and cardiovascular adverse effects have frequently been observed in clinical studies.

Cannabinoids are active substances that work as agonist ligands at cannabinoid receptors of cells. Medical cannabinoids are claimed to alleviate nausea and vomiting in chemo-/radiotherapy and in palliative care. They are also recommended for the treatment of anorexia and cachexia in patients with advanced cancer and for the control of chronic tumour pain. They work as agonist ligands at cannabinoid receptors.
The antiemetic efficacy of cannabinoids in chemotherapy-induced nausea/vomiting has been established in a systematic review. If cannabinoids can offer improvements over modern antiemetic medication, especially serotonin antagonists, in preventing acute or delayed chemotherapy induced nausea and vomiting is still unclear. Only anecdotal evidence is available to support the use of medical cannabinoids against radiotherapy-related nausea and nausea in palliative care patients.

The use of cannabinoids for anorexia-cachexia-syndrome in advanced cancer is not supported by the evidence from randomised controlled trials.

For pain, several randomised controlled trials also indicate a mild analgesic effect of cannabinoids in cancer patients. Insufficient evidence is available to support the introduction of cannabinoids into widespread clinical use as analgesics.

The main limitation of cannabinoids is seen in the high frequency of serious adverse effects on the central nervous system and the cardiovascular system. Known absolute and relative contraindications and pharmacological interactions should be carefully considered. Medical cannabinoids are subject to country-specific prohibitory legislation.

Considering the availability of well-investigated and established medications for chemotherapy-induced nausea and chronic pain, medical cannabinoids are not for first-line use. They might be beneficial in individual cases as adjuncts to other antiemetic or analgesic medication when standard treatment fails in symptom control. Potential hazards and toxicities should be considered.

Citation

Gabriele Dennert, CAM-Cancer Consortium. Cannabinoids [online document]. http://cam-cancer.org/CAM-Summaries/Herbal-products/Cannabinoids. November 25, 2011.

Document history

Last updated in November 2011 by Gabriele Dennert.
Fully updated and revised in November 2009 by Gabriele Dennert.
Summary first published in November 2005, authored by Gabriele Dennert.

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