# _Cannabis sativa_ L. as a Natural Drug Meeting the Criteria of a Multitarget Approach to Treatment
## 4 Pharmacological Application
### Vomiting and Nausea Prevention  
Approximately 45-61% of cancer patients suffer from chemotherapy-induced nausea and vomiting (CINV). In antiemetic prophylaxis during chemotherapy, the following are used: (i) drugs from the group of 5-HT\({}_{3}\) receptor antagonists--ondanestron, granisetron, tropisetron, dolasetron, palonosteron; (ii) drugs from the group of neurokinin-1 receptor antagonists--appeitrant; (iii) corticosteroids--the most commonly recommended dexamethasone or methylprednisolone; and (iv) complementary drugs: dopamine receptor antagonists (metoclopramide), phenothiazze derivatives (chlorpromazine), antihistamines, and butylrophenone derivatives (haloperidol and droperiod) [112]. The guidelines propose the use of antiemetic drugs in monotherapy or according to a schedule of two-to-three drugs, depending on the degree of risk of nausea and vomiting and the individual sensitivity of the patient. If the antiemetic prophylaxis proves ineffective, additional antiemetic drugs are used when needed. An acute episode due to the stimulation of gastrointestinal  
\begin{table}
\begin{tabular}{c c} \hline \hline
**The Form** & **Effects on Symptoms** \\ \hline smoked marijuana & spasticity \(\downarrow\), pain \(\downarrow\) \\ nabiximols & spasticity \(\downarrow\), pain \(\downarrow\) \\ oral _Cannabis_ extract & muscle spasticity \(\downarrow\) \\ dronabinol & spasticity \(\downarrow\), pain \(\downarrow\) \\ nabilone (+gabapentin) & pain \(\downarrow\) \\ \hline \hline \end{tabular}
\end{table}
Table 5: Cannabinoid therapies and their impacts on the symptoms of multiple sclerosis determined in clinical trials [109]. \(\downarrow\): decrease.  
receptors occurs up to 24 h after the initiation of chemotherapy, and delayed CINV occurs within one-five days, mainly due to the activation of receptors located in the brain. Statistically, the delayed effect is more frequent, and the incidence of nausea outweighs the incidence of vomiting [113].  
According to studies, the incidence of nausea and vomiting can be reduced by activating the CB\({}_{1}\) receptor with THC [113]. As a result of receptor stimulation, the proemetic effects of dopamine and serotonin are abolished [114]. In the fight against CINV, oral cannabinoid preparations are more effective than a placebo. However, compared with other antiemetrics, studies lead to different conclusions. Some of them suggest the superiority of THC, others, a similar effectiveness, and still others show that the best effect is obtained when combining traditional drugs with cannabinoids [110].  
After reviewing randomized controlled trials, the conclusions are that administering cannabinoids to patients during chemotherapy allows for 70% control of nausea and 66% control of vomiting, while, after administration of a placebo, the results reached 57% and 36%, respectively [115]. During the research carried out in the seventies and eighties, THC's superiority in the prevention of nausea and vomiting occurring during radio- and chemotherapy over the placebo and antieetic drugs used at that time was found. Currently, however, we are already in possession of more effective drugs for this indication. The comparisons show that newer drugs can control nausea in 90% of patients, compared to 30% with cannabinoids. For this reason, they are not used in the first line of treatment but only as an adjunct or second-line treatment [116]. Cesamet(r) or Marinol(r) can be used in the treatment of CINV [56].