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Cited by 610Nausea and vomiting managementCannabis and Cannabinoid ResearchCancer survivorship and care

Cannabinoids for control of chemotherapy induced nausea and vomiting: quantitative systematic review

Open access
Tramèr, Martin R, Carroll, Dawn, Campbell, Fiona A, Reynolds, D John M, Moore, R Andrew, McQuay, Henry J·2001·BMJ
DOI 10.1136/bmj.323.7303.16PMC PMC34325
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Abstract

Objective: To quantify the antiemetic efficacy and adverse effects of cannabis used for sickness induced by chemotherapy. Design: Systematic review. Data sources: Systematic search (Medline, Embase, Cochrane library, bibliographies), any language, to August 2000. Studies: 30 randomised comparisons of cannabis with placebo or antiemetics from which dichotomous data on efficacy and harm were available (1366 patients). Oral nabilone, oral dronabinol (tetrahydrocannabinol), and intramuscular levonantradol were tested. No cannabis was smoked. Follow up lasted 24 hours. Results: Cannabinoids were more effective antiemetics than prochlorperazine, metoclopramide, chlorpromazine, thiethylperazine, haloperidol, domperidone, or alizapride: relative risk 1.38 (95% confidence interval 1.18 to 1.62), number needed to treat 6 for complete control of nausea; 1.28 (1.08 to 1.51), NNT 8 for complete control of vomiting. Cannabinoids were not more effective in patients receiving very low or very high emetogenic chemotherapy. In crossover trials, patients preferred cannabinoids for future chemotherapy cycles: 2.39 (2.05 to 2.78), NNT 3. Some potentially beneficial side effects occurred more often with cannabinoids: “high” 10.6 (6.86 to 16.5), NNT 3; sedation or drowsiness 1.66 (1.46 to 1.89), NNT 5; euphoria 12.5 (3.00 to 52.1), NNT 7. Harmful side effects also occurred more often with cannabinoids: dizziness 2.97 (2.31 to 3.83), NNT 3; dysphoria or depression 8.06 (3.38 to 19.2), NNT 8; hallucinations 6.10 (2.41 to 15.4), NNT 17; paranoia 8.58 (6.38 to 11.5), NNT 20; and arterial hypotension 2.23 (1.75 to 2.83), NNT 7. Patients given cannabinoids were more likely to withdraw due to side effects 4.67 (3.07 to 7.09), NNT 11. Conclusions: In selected patients, the cannabinoids tested in these trials may be useful as mood enhancing adjuvants for controlling chemotherapy related sickness. Potentially serious adverse effects, even when taken short term orally or intramuscularly, are likely to limit their widespread use. What is already known on this topic: Requests have been made for legalisation of cannabis (marijuana) for medical use Long term smoking of cannabis can have physical and neuropsychiatric adverse effects Cannabis may be useful in the control of chemotherapy related sickness What this study adds: Oral nabilone and dronabinol and intramuscular levonantradol are superior to conventional antiemetics (such as prochlorperazine or metoclopramide) in chemotherapy Side effects are common with cannabinoids, and although some may be potentially beneficial (euphoria, “high,” sedation), others are harmful (dysphoria, depression, hallucinations) Many patients have a strong preference for cannabinoids

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Crossref · 10.1136/bmj.323.7303.16

Cites

73 of 73 references verified0 citation errors · 0 not checkable

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  • In that systematic review, the risk of euphoria was RR 10.6 (NNH 3.2).

    “euphoria (relative risk [RR] 10.6, number needed to harm [NNH] 3.2)”

    From Nabilone for the Management of Pain (2016) · cites this paper as [28]

    Table 3 lists euphoria at RR 12.5 and a number needed to treat of 7.3, not 10.6 and 3.2. The cited figures belong to the separate “high” sensation row. (LLM, conf=0.90)

    Checked by a reasoning model — may be wrong.

    Experimental — accuracy not yet measured

  • In that systematic review, the risk of drowsiness, sedation, or somnolence was RR 1.66 (NNH 5.0).

    “drowsiness, sedation, or somnolence (RR 1.66, NNH 5.0)”

    From Nabilone for the Management of Pain (2016) · cites this paper as [28]

    Table 3 (Side effects) reports a relative risk of 1.66 and a number needed to treat of 5.0 for drowsiness, sedation, or somnolence. The figures match, but the paper classifies this as a potentially beneficial side effect and does not label 5.0 as a number needed to harm (NNH). (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • The most common ADRs in that systematic review included drowsiness (50%), dizziness (49%), euphoria (14-35%), hypotension (13%), hallucination (10%), and dysphoria or depression (10%).

    “The most common ADRs included drowsiness (50%), dizziness (49%), euphoria (14-35%), hypotension (13%) hallucination (10%), and dysphoria or depression (10%).28”

    From Nabilone for the Management of Pain (2016) · cites this paper as [28]

    Table 3 (in the copy’s “What this study adds” section; page not supplied) reports drowsiness at 50%, dizziness at 49%, a “high” sensation at 35%, and euphoria at 14%. But it reports hypotension at 25%, hallucination at 6%, and dysphoria or depression at 13%—not the percentages claimed. The numbers 13 and 10 in those rows are counts of trials, not event rates. (LLM, conf=0.93)

    Experimental — accuracy not yet measured

  • In that systematic review, the risk of dizziness was RR 2.97 (NNH 3.1).

    “dizziness (RR 2.97, NNH 3.1)”

    From Nabilone for the Management of Pain (2016) · cites this paper as [28]

  • In that systematic review, the risk of hypotension was RR 2.23 (NNH 7.1).

    “hypotension (> 20% decrease in blood pressure compared with baseline; RR 2.23, NNH 7.1)”

    From Nabilone for the Management of Pain (2016) · cites this paper as [28]

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Cites

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Research works printed but not linked: 5

  1. [19]19. Gilbert CJ, Ohly KV, Rosner G, Peters WP. Randomized, double-blind comparison of a prochlorperazine-based versus a metoclopramide-based antiemetic regimen in patients undergoing autologous bone marrow transplantation. Cancer 1995;76:2330-7.
  2. [24]24. Ekert K, Waters KD, Jurk IH, Mobilia J, Loughnan P. Amelioration of can- cer chemotherapy induced nausea and vomiting by delta-9- tetrahydrocannabinol. Med J Aus 1979;2:657-9.
  3. [25]25. Garb S, Beers AL, Bograd M, McMahon RT, Magalik A, Ashmann A, et al. Two-pronged study of tetrahydrocannabinol (THC) prevention of vomit- ing from cancer chemotherapy. IRCS Med Sci 1980;8:203-4.
  4. [60]60. Ungerleider JT, Andrysiak T, Fairbanks L, Goodnight J, Sarna G, Jamison K. Cannabis and cancer therapy: a comparison of Delta-9-THC and prochlorperazine. Cancer 1982;50:636-45.
  5. [65]65. Moore RA, Gavaghan D, Tramèr MR, Collins S, McQuay HJ. Size is everything-the impact of event rate variation on clinical trials and meta- analysis. Pain 1998;78:208-16.

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Authors
Tramèr, M. R., Carroll, D., Campbell, F. A., Reynolds, D. J. M., Moore, R. A., & McQuay, H. J.
Affiliations
University of Oxford (GB)
Corresponding author
Tramèr, Martin R
ORCID
Tramèr, Martin R
Venue
BMJ
Publisher
BMJ
Published
2001-07-07
Volume
323
Issue
7303
Pages
16
ISSN
  • 0007-1447 (ISSN-L)
  • 0959-8138
  • 1468-5833
DOI
10.1136/bmj.323.7303.16
PMC
PMC34325
OpenAlex
W2158351380
Cited by
610
References
73
Citations by year
2026: 12 · 2025: 16 · 2024: 18 · 2023: 26 · 2022: 19 · 2021: 30 · 2020: 21 · 2019: 19 · 2018: 25 · 2017: 20 · 2016: 19 · 2015: 40 · 2014: 22 · 2013: 22 · 2012: 20
FWCI
5.88
Type
journal article
Language
en
Open access
Licence
www.bmj.com/company/legal-information/terms-conditions/legal-information/tdm-licencepolicy (tdm)
Locations
  • BMJ (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Science Foundation
  • Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung (51939)
  • Schweizerische Akademie der Medizinischen Wissenschaften
Topics
  • Health Sciences › Medicine › Surgery › Nausea and vomiting management
  • Health Sciences › Medicine › Pharmacology › Cannabis and Cannabinoid Research
  • Health Sciences › Medicine › Oncology › Cancer survivorship and care
Keywords
cannabinoids, chemotherapy-induced nausea and vomiting, antiemetics, nabilone, dronabinol, levonantradol, prochlorperazine, metoclopramide, emetogenic chemotherapy, adverse effects, sedation, hallucinations, paranoia, dysphoria, patient preferences, number needed to treat, placebo comparison, crossover trial, patient dropout
MeSH terms
Antiemetics, Antineoplastic Agents, Cannabinoids, Humans, Nausea, Vomiting, Randomized Controlled Trials as Topic, Treatment Outcome, Patient Satisfaction

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