The emerging role of cannabinoid neuromodulators in symptom management

Davis, Mellar P.; Maida, Vincent; Daeninck, Paul; Pergolizzi, Joseph V.

doi:10.1007/s00520-006-0180-0

Cited by 34 publications

(26 citation statements)

References 15 publications

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“…However, cannabis has also been suggested to have therapeutic properties with anticonvulsive, analgesic, antianxiety and anti-emetic activities. Cannabis has also been used to treat anorexia in patients with acquired immunodeficiency syndrome [3][4][5] . The actions of cannabis are mediated by specific cannabinoid receptors.…”

Section: Discussionmentioning

confidence: 99%

“…The CB-1 receptors exert a neuromodulatory role in the central nervous system and enteric plexus [8] . Cannabinoid type 2 receptors have an immunomodulatory effect and are located on tissues such as microglia [5] . The presence of other receptors, transporters, and enzymes responsible for the synthesis or metabolism of endocannabinoids are being recognised at an extraordinary pace.…”

Section: Discussionmentioning

confidence: 99%

“…Research into the neurobiology of the compound has led to the discovery of an endogenous cannabinoid system. The therapeutic potential of cannabinoids has been recognized and these compounds are utilized as anti-emetics [3][4][5] . Recently, a distinct syndrome in chronic cannabis abusers characterized by recurrent vomiting associated with abdominal pain and a tendency to take hot showers has been increasingly recognised.…”

Section: Introductionmentioning

confidence: 99%

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Cannabinoid hyperemesis syndrome: Clinical diagnosis of an underrecognised manifestation of chronic cannabis abuse

Sontineni

Chaudhary

Sontineni

et al. 2009

WJG

120

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Cannabis is a common drug of abuse that is associated with various long-term and short-term adverse effects. The nature of its association with vomiting after chronic abuse is obscure and is underrecognised by clinicians. In some patients this vomiting can take on a pattern similar to cyclic vomiting syndrome with a peculiar compulsive hot bathing pattern, which relieves intense feelings of nausea and accompanying symptoms. In this case report, we describe a twentytwo year-old-male with a history of chronic cannabis abuse presenting with recurrent vomiting, intense nausea and abdominal pain. In addition, the patient reported that the hot baths improved his symptoms during these episodes. Abstinence from cannabis led to resolution of the vomiting symptoms and abdominal pain. We conclude that in the setting of chronic cannabis abuse, patients presenting with chronic severe nausea and vomiting that can sometimes be accompanied by abdominal pain and compulsive hot bathing behaviour, in the absence of other obvious causes, a diagnosis of cannabinoid hyperemesis syndrome should be considered.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Cannabinoid hyperemesis syndrome: Clinical diagnosis of an underrecognised manifestation of chronic cannabis abuse

Sontineni

Chaudhary

Sontineni

et al. 2009

WJG

120

View full text Add to dashboard Cite

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“…8 Cannabinoid type 2 receptors, which are typically found in nonneuronal tissues but which are also present in microglia, have an immunomodulatory effect. 9 Marijuana and its derivatives, such as nabilone and dronabinol, have been used as antiemetics and appetite stimulants in patients undergoing chemotherapy or those with AIDS. The antiemetic action of the cannabinoids appears to be centrally mediated.…”

Section: Discussionmentioning

confidence: 99%

Cannabinoid Hyperemesis Relieved by Compulsive Bathing

Chang

Windish

2009

Mayo Clinic Proceedings

106

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Cannabinoid hyperemesis is a clinical syndrome characterized by repeated vomiting and associated learned compulsive hot water bathing behavior due to long-term marijuana use. Research has indentified type 1 cannabinoid receptors in the intestinal nerve plexus that have an inhibitory effect on gastrointestinal motility. This inhibitory effect may lead to hyperemesis in marijuana users. The thermoregulatory role of endocannabinoids may be responsible for the patient's need to take hot showers. We report 2 cases of cannabinoid hyperemesis that demonstrate this unusual adverse effect of marijuana use. © 2009 Mayo Foundation for Medical Education and Research Cannabis is one of the most widely used illicit drugs in the United States. The prevalence of past-year cannabis use disorders has increased to 3 million cases during the past decade, 1 with a lifetime prevalence of 7.2% in adults.2 In 2004, Allen et al 3 reported a syndrome called cannabinoid hyperemesis in South Australia. Symptoms in long-term marijuana users included intractable vomiting that was unresponsive to antiemetics and associated with learned compulsive bathing behavior. Treatment was supportive care with intravenous fluids for 24 to 48 hours; symptoms resolved when patients stopped using cannabis. We report 2 cases of cannabinoid hyperemesis that, to our knowledge, are the first to be reported in the United States. Our goal is to increase awareness of this unusual adverse effect of marijuana use. REPORT OF CASES CASE 1An obese 25-year-old woman who was a long-term cannabinoid user presented to the emergency department with nausea, vomiting, and abdominal pain that worsened for several days. During the previous 5 years, the patient had noted intermittent episodes of similar symptoms, each lasting about a week and often requiring hospitalization for dehydration. Her symptoms were refractory to all types of antiemetic medications and only responded to prolonged hot showers, some lasting 6 hours or more. Her medical history included bipolar disorder, reflux esophagitis, polycystic ovarian disease, and mild cerebral palsy with chronic mild left facial droop. She had no history of surgery or known drug allergies and reported that she took only lamotrigine. She had begun smoking marijuana 6 to 7 years earlier and used the substance almost daily. Her last marijuana use was 1 day before admission to the hospital. She denied alcohol, tobacco, or other illicit drug use.On physical examination, the patient's vital signs included a temperature of 36.9°C, a pulse of 74 beats/min, a respiratory rate of 20 breaths/min, a blood pressure of 110/80 mm Hg, and an oxygen saturation of 98% while breathing room air. She was in moderate distress and found to be writhing in bed. She had a mild left facial droop, her pupils were equal and reactive to light, and extraocular movements were intact. She had moist mucous membranes. There was no lymphadenopathy or thyromegaly. Results of a cardiovascular examination were normal, and her chest was clear. The abdomen was soft and ...

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“…A current example is the development of new cannabinoid products for the treatment of the side effects associated with cancer chemotherapy. 8 It is possible, and no doubt desirable, to develop compounds that exhibit the attributes of the therapeutic approaches just described. Multifunctional compounds might be designed with the ability to: 1) offer both palliative and disease modifying actions, 2) act on targets that produce additive or synergistic therapeutic responses, 3) simultaneously evoke a therapeutic response at the desired target and prevent an undesired response mediated by an alternate target, 4) allow one component to promote the drugable characteristics (e.g., brain penetration) of the therapeutic component, and 5) prolong the duration of effectiveness of one compound by contributing the pharmacodynamic actions of another.…”

Section: Why Target Multiple Systems For the Treatment Of Cns Disorders?mentioning

confidence: 99%

Multifunctional Receptor-Directed Drugs for Disorders of the Central Nervous System

Buccafusco

2009

Neurotherapeutics

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The emerging role of cannabinoid neuromodulators in symptom management

Abstract: The benefits of this novel class of medications in cancer may extend beyond CINV, as indicated by data from preclinical studies and animal models.

Cited by 34 publications

References 15 publications

Cannabinoid hyperemesis syndrome: Clinical diagnosis of an underrecognised manifestation of chronic cannabis abuse

Cannabinoid hyperemesis syndrome: Clinical diagnosis of an underrecognised manifestation of chronic cannabis abuse

Cannabinoid Hyperemesis Relieved by Compulsive Bathing

Multifunctional Receptor-Directed Drugs for Disorders of the Central Nervous System

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