Cannabinoids such as
dronabinol can be considered for
refractory nausea and vomiting,
and as a rescue antiemetic
according to NCCN and ASCO
guidelines. 6,7
The use of medicinal
cannabinoids, however, is
accompanied by legal concerns in
many countries and therapeutically
controversial for management of
CINV and is not included in most
recent guidelines. 1,3,6–9
A multicentre, retrospective
review in children concluded
that adverse effects associated
with the use of nabilone were
common but of minor clinical
significance and resolved with
dose reduction or discontinuation,
although its contribution to a CINV
prophylactic regimen including a
5-HT 3 RA is questioned. 67 recent guidelines. 3,6–9,68–71
Other agents
Ginger, the rhizome of Zingiber
officinalis, has been used for
centuries in Asian countries
to treat nausea and vomiting
induced by different stimuli.
Ginger phytochemicals may act
as a 5-HT 3 RA, NK 1 antagonist and
an antihistaminic. In addition, it
has prokinetic properties. As with
other alternative therapies, there is
little literature available in medical
journals. Reports indicate a
promising role of ginger; however,
clinical data are insufficient so
far to draw firm conclusions, and
its use has not been included in Conclusions
5-HT 3 RAs, NK 1 RAs and
glucocorticosteroids remain the
standard for prevention and
treatment of CINV.
Although the majority of
patients gain complete protection
with these agents, a number of
patients still experience nausea
and vomiting.
In order to improve quality of
life for both adult and paediatric
cancer patients, continuing
research on the pharmacological
approaches to CINV is necessary,
particularly for nausea, as is the
development of new antiemetics.
Non-pharmacological strategies
Many non-pharmacological
strategies are used to reduce
CINV. Literature data provide
limited support for several non-
pharmacological methods to
reduce CINV, including cognitive
distraction (for example, playing
video games during treatment),
systematic desensitisation
(a cognitive approach using
visualisation and learned
relaxation techniques), exercise,
hypnosis, and acupuncture and
acupressure. 3,7
Apart from these strategies,
lifestyle measures regarding food
(eating small but frequent amounts
of food, food at room temperature,
etc) might help to alleviate nausea
and vomiting.
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