Davis, M.P. (2008). Oral nabilone capsules in the treatment of chemotherapy-induced nausea and vomiting and pain. Expert Opinion on Investigational Drugs, 17(1), 85-95.

Keywords searched were cannabinoids, nabilone, nausea, pain, tetrahydrocannabinol, and vomiting.

This was a review of published English literature, including reviews, meta-analysis, and treatment trials from 1975–1997 on using cannabinoids to control or prevent chemotherapy-induced nausea and vomiting (CINV), with very few trials found after 1997. From this review, 30 randomized control trials were found that looked at cannabinoids to control or prevent CINV. Overall, the trials received low scores for adequacy of randomization, blinding design, and description of withdrawal. Three cannabinoids were studied: nabilone (16), dronabinol (13), and levonantradol (1). The medications were compared to prochloperazine (12), placebo (10), metochlorpramide (4), chlorpromazine (2), domperidone (2), alizapride (1), thiethylperazine (1), and haloperidol (1). Twelve studies involved various scoring systems. No clear separation existed between acute and delayed CINV.

The trials included 1,760 patients, with 394 excluded.

• Nabilone was found to be superior to placebo, domperidone, and prochlorperazine but not metoclorpramide.
• Cannabinoids did not add to the benefits of 5-HT₃ receptor antagonists.
• Side effects were greater for nabilone than prochloperazine in these studies, but patients preferred nabilone to prochloperazine.

• The major limitation of these studies was the grading of response and the inability to differentiate between acute and delayed CINV.
• The adequacy of randomization, blinding design, and description of withdrawal were insufficient.
• The time period for the review was limited to 1975–1997. From 1997–present, many changes in managing CINV have occurred.
• The databases of the search were not indicated.

Cannabinoids, like nabilone, may have a role in reducing delayed or refractory CINV, but more evidence is needed.