A critical narrative review of medical cannabis in pediatrics beyond epilepsy, part III: chemotherapy-induced nausea and vomiting and inflammatory bowel disease

Background and Objective: Cannabis may play a role in alleviating chemotherapy-induced nausea and vomiting (CINV) and improving symptoms of inflammatory bowel disease (IBD). With the surge of interest and legalization of cannabis, its medical use in children for these indications was evaluated. Methods: In this third section of a three-part comprehensive review, PubMed, Embase and Clinicaltrials.gov (1966 to May 2020) searches were conducted using the key search terms pertinent to cannabis, CINV and IBD. Only articles pertaining to cannabis and these disease states were extracted and critically evaluated. Key Content and Findings: The high emetogenicity of certain chemotherapies prompts the need for an additional antiemetic therapy. Currently, nabilone and dronabinol are approved for adults with refractory CINV, and refractory CINV or AIDS-associated anorexia, respectively. As such, data support the beneficial effects of these synthetic delta-9-tetrahydrocannabinol (THC) medications as adjunctive therapy to partially or completely control CINV. The adverse effects of THC-based products consisted of drowsiness, dizziness, and mood changes. Data for use in IBD remains limited. For symptomatic control of IBD, survey-based studies have demonstrated that various cannabis products improved appetite, abdominal pain, and nausea, but might be accompanied by increased craving, tolerance, lightheadedness, and drowsiness. Conclusions: Further clinical investigations on its safety and efficacy for CINV (especially for prolonged use and as monotherapy) and IBD are necessary to elucidate the best approach to medically use cannabis in children. Improving healthcare provider knowledge is also important, especially for CINV, to optimize its use.