From the FDA Drug Label
1 INDICATIONS AND USAGE Dronabinol capsules are indicated in adults for the treatment of:
• anorexia associated with weight loss in patients with Acquired Immune Deficiency Syndrome (AIDS). • nausea and vomiting associated with cancer chemotherapy in patients who have failed to respond adequately to conventional antiemetic treatments.
The best treatment for chronic nausea not responding to antiemetics is dronabinol (PO), as it is indicated for the treatment of nausea and vomiting associated with cancer chemotherapy in patients who have failed to respond adequately to conventional antiemetic treatments 1.
From the Research
The most effective treatment for chronic nausea not responding to antiemetics is olanzapine, as it has been shown to be effective in reducing nausea and vomiting in patients with advanced cancer and those undergoing chemotherapy, as demonstrated in a study published in 2019 2. This approach is based on the strongest and most recent evidence available. When considering treatment options, it's essential to identify and address the underlying cause of chronic nausea, which may include conditions like gastroparesis, functional dyspepsia, or cyclic vomiting syndrome. Some key points to consider when treating chronic nausea include:
- Identifying and addressing the root cause of nausea
- Using medication options such as low-dose tricyclic antidepressants, neuromodulators, prokinetic agents, or cannabinoids for refractory cases
- Implementing non-pharmacological approaches like small, frequent meals, avoiding trigger foods, and behavioral therapies
- Considering complementary therapies such as ginger supplements, acupuncture, or acupressure for additional relief Olanzapine's efficacy in treating chronic nausea is attributed to its ability to block multiple neuronal receptors involved in the nausea and vomiting pathways, as discussed in a study published in 2014 3. Additionally, a study published in 2019 4 highlights the importance of understanding the central and peripheral circuitry of nausea and vomiting symptoms to develop effective treatment strategies. While other treatment options like tricyclic antidepressants, gabapentin, and pregabalin may be effective in modulating gut sensitivity and central nervous system sensitization, olanzapine has been shown to be a valuable option for patients with chronic nausea not responding to antiemetics, as demonstrated in a study published in 2015 5. It's also worth noting that olanzapine has been used effectively in patients with advanced cancer, as reported in a study published in 2003 6, and its antiemetic effects have been further investigated in a study published in 2019 2.