| Category | Details |
| Definition | Nausea and vomiting (N&V) are common adverse effects of chemotherapy, classified into acute (0–24 hours), delayed (24–120 hours), and anticipatory types. |
| Global Epidemiology | Acute N&V affects up to 90% of patients undergoing high-emetic-risk chemotherapy (e.g., cisplatin). |
| Delayed N&V occurs in 30–50% of patients despite antiemetic prophylaxis. |
| Prevalence in Key Regions | United States: ~600,000 new chemotherapy patients annually; significant proportion at risk for CINV. |
| European Union: Estimated 1.3 million cancer cases requiring chemotherapy annually, with ~30% experiencing CINV despite treatment. |
| India: Increasing cancer burden; ~1 million chemotherapy patients annually with limited access to advanced antiemetics. |
| China: Over 4.5 million new cancer cases annually; significant demand for effective CINV management. |
| Caribbean: Estimated ~80,000 annual chemotherapy patients; gaps in access to adequate CINV management. |
| Medicinal Cannabis Approvals | United States (FDA): Dronabinol and nabilone approved for refractory N&V since 1985. |
| Canada: Nabilone approved for chemotherapy-induced N&V since 2000. |
| Australia: Cannabis-based medicines approved for CINV under special access pathways since 2017. |
| European Union (EMA): No specific cannabinoid approved; off-label use permitted in some countries. |
| Therapeutic Cannabinoids | THC: Reduces vomiting via CB1 receptor modulation; psychoactive effects limit its use. |
| CBD: Anti-anxiety and anti-nausea properties; enhances tolerability of THC. |
| THC:CBD (1:1): Synergistic effects; shown to reduce N&V in combination with standard antiemetics. |
| Mechanism of Action | THC interacts with CB1 receptors in the brainstem and gastrointestinal tract to inhibit emetic pathways. |
| CBD reduces serotonin and dopamine release, modulating the vomiting reflex. |
| Key Clinical Studies | Grimison et al., 2024: THC:CBD combination increased complete response rates in refractory cases (16% absolute increase vs. placebo). |
| Duran et al., 2010: Nabilone reduced delayed nausea severity in 60% of patients. |
| Tramer et al., 2001: Meta-analysis showed cannabinoids superior to placebo for CINV control. |
| Dosage Guidelines | THC: 2.5 mg oral twice daily; titrate to 10 mg/day as needed. |
| THC:CBD (1:1): Start with 1 spray (2.7 mg THC + 2.5 mg CBD); maximum 12 sprays/day. |
| Administration Methods | Oral Capsules: Preferred for controlled dosing; slower onset (~1 hour). |
| Sublingual Spray: Rapid onset; used for breakthrough symptoms. |
| Adverse Effects | THC: Sedation, dizziness, and psychoactive effects; caution in elderly. |
| THC:CBD: Mild sedation, dry mouth, and dizziness; better tolerability than THC alone. |
| Research Gaps | Need for larger trials comparing THC:CBD with standard antiemetics (e.g., olanzapine). |
| Long-term safety and efficacy of cannabinoids in modern antiemetic regimens remain underexplored. |
| Opportunities in the Caribbean | High burden of untreated CINV due to limited access to modern antiemetics. |
| Potential for cannabis-based clinics to serve as research hubs for innovative CINV treatments. |
