How to Use CBD for Nausea: What Science Can Tell us About Effects and Dosages

Today you will learn about the benefits of CBD for nausea and vomiting relief.

In this article, we will explore:

• How CBD relieves nausea and vomiting
• Benefits and effects of CBD on nausea in animal and human studies
• What doses of CBD brought nausea relief

By the end, you will know what type of CBD oil may work best for nausea. And you’ll get a guideline for how to dose it.

How Might CBD Reduce Nausea?

Cannabidiol (CBD) has many therapeutic benefits. Many of these benefits are related to CBD’s interactions with various receptor systems.

Two key receptors include CB1 and CB2 of the endocannabinoid system (ECS). Our body makes compounds called endocannabinoids that can interact with these receptors.

Why is this relevant to CBD?

CBD is one of over 100 phytocannabinoids (pCBs) found in the Cannabis plant. Like endocannabinoids, cannabinoids can interact with receptors part of the ECS. Through these interactions, they have many different pharmacological effects.

For example, Tetrahydrocannabinol (THC) is a well-known activator of CB1 receptors. Actiavtion of the CB1 receptor suppresses vomiting. Activation of the CB1 receptor can also correlate with reduced release of serotonine, which may reduce nausea in specific cases like cancer chemotherapeutics (18).

THC is the most studied pCB, and is well-known to reduce the effects of nausea. However, its use as a treatment has been limited because of its psychoactive effects.

CBD is non-psychoactive and also has anti-nausea effects, but acts on different receptors.

Unlike THC, CBD only has weak interaction with CB1 and CB2.

Instead, CBD’s mechanism for nausea and vomiting relief comes from its action on serotonin receptors. Serotonin plays a critical role in regulating nausea and vomiting (17).

CBD Reduces Nausea and Vomiting Through Serotonin Receptors

CBD interacts with these types of serotonin receptors:

• 5-HT1A;
• 5-HT2A;
• 5-HT3A (16)

CBD reduces nausea and vomiting by activating the 5-HT1A receptor in animal models. The 5-HT2A receptor is also activated by CBD.

The 5-HT3A receptor is functionally different from other serotonin receptors. It plays a critical role in the vomiting mechanism of serotonin as follows:

5-HT3 serotonin is released by the small intestine and binds to nerves in the GI tract. This action creates signals that are sent to the brain, and then to the abdomen area to induce nausea and vomiting (10).

Inhibiting the 5-HT3A receptor (antagonism) disrupts this process. CBD can bind outside of the receptor’s active site and slow the release of serotonin (20).

5-HT3 antagonists are highly effective anti-nausea agents and can prevent acute vomiting (7).

So naturally, CBD has therapeutic potential for nausea and vomiting relief by antagonizing this receptor.

CBD does not target all types of nausea. For example, it does not help with motion sickness because CBD doesn’t interact with the condition’s signaling pathways (14)

The Link Between Chemotherapy and Nausea

Chemotherapy drugs are cancer treatments that can cause severe nausea. As much as 80% of cancer patients experience chemotherapy induced nausea and vomiting (CINV) (10)

CINV has two phases:

1. Acute: Occurring within 24 hours of chemo
2. Delayed: Between 24-120 hours after chemo (1)

The effects of 5-HT3A antagonists on symptoms of nausea and vomiting extends to CINV.

Medications that target 5-HT3A as well as NK-1 receptors are recommended for patients with CINV.

40% of chemo patients have delayed vomiting despite being treated with these medications (9).

Because of CBD’s anti-nausea effects at serotonin receptors, it may help relieve CINV.

However, the conclusions that we can draw are limited. No clinical studies that looked into the effects of CBD alone on nausea and vomiting to date.

The research that does exist supports using CBD and THC in combination for nausea and vomiting.

Both of these pCBs have anti-nausea and anti-emetic effects.

The best part is that they produce these effects at different receptors and can work in tandem with limited side effects.

Review of Studies That Found Anti-Nausea Effects Associated with CBD

Several preclinical studies have investigated CBD’s therapeutic potential as an anti-nausea agent. In these studies, either rats or shrews are used.

Although humans are distantly related to these animals, we are biologically similar. Thus, rodents are often used in preclinical studies.

That is not to say that preclinical findings will always be confirmed in humans, but it can justify new clinical studies (10).

In the case of CBD and nausea, there is a dire need for clinical research.

Clinical studies that looked into the role of CBD in nausea and vomiting relief did so in combination with THC.

Nutshell: Does CBD help with nausea?

CBD is known to provide relief from symptoms of induced nausea in animals. In combination with THC, CBD shows this same pattern in clinical studies. It is not clear whether CBD has this effect by itself in humans, but the results of preclinical studies are promising.

Preclinical Studies

A 2012 study looked into the potential anti-emetic effects of injected CBD in an animal model of nausea. Rats and shrews were given substances that can induce nausea and vomiting, including nicotine and a chemotherapy drug.

Injection doses of 5 mg/kg CBD reduced vomiting in both of these animals, but it was not effective against all doses of the nauseating agents.

The emetic effects of nicotine were suppressed at all doses. Nauseating effects from chemotherapy doses of 20 mg/kg were suppressed by CBD, but not at 40 mg/kg.

The anti-nausea effects of CBD came from its ability to activate the 5-HT1A receptor (13).

Huge doses of CBD does not necessarily mean you will get more nausea relief. Previous studies have found that CBD’s level of action on serotonin receptors has a bell-shaped distribution:

This means that there is an optimal dose range of CBD for managing nausea and vomiting. This pattern is consistent with past findings on CBD’s anti-nausea and anti-anxiety effects (14).

More recent animal models of nausea have suggested a wider dose range, with injected doses as low as 0.5 mg/kg reducing vomiting reactions in rats.

Methyl ester CBDA, a synthetic analog of CBD, has shown to be effective for vomiting relief at much smaller doses (1 microgram/kg) in rats (12).

If you are interested in learning more about CBDA products, check this out.

Anti-Nausea Effects of 1:1 THC:CBD Products in Animals

Preclinical studies show another interesting pattern:

When THC and CBD are used in combination, not only are they more effective for nausea relief; much lower doses are needed.

In one study, rats were injected with a 1:1 THC:CBD ratio. Doses as low as 0.1 mg/kg suppressing vomiting reactions in these animals, but larger doses were not effective (16)

But these findings do not confirm whether a 1:1 THC:CBD ratio is optimal for nausea relief (8)

Clinical Studies of Chemotherapy-Induced Nausea and Vomiting (CIMV)

Currently, no clinical trials have evaluated the anti-nausea effects of CBD alone.

The studies that are available were focused exclusively on CINV patients that had persistent nausea and vomiting despite standard medications given after chemotherapy.

Patients in these studies were treated with a 1:1 THC:CBD oral extract.

Study #1

A 2010 phase II clinical trial looked into the effects of a 1:1 THC:CBD spray on patients with CINV.

Each spray contained 2.7 mg THC / 2.5 mg CBD, and patients used an average of roughly 5 sprays per day. The first dose was given within 2 hours of receiving chemotherapy. In addition to this treatment, patients were given standard anti-emetics.

What was found?

The pCB spray was more effective than the placebo. There were no changes in the severity and duration of vomiting, but delayed vomiting was prevented. Over 71% of patients had a complete response (4).

Study #2

A more recent larger-scale (n=78) clinical study looked into the effects of a similar pCB formulation on CINV.

Cancer patients were given an exact 1:1 ratio of THC:CBD in the form of oral capsules; taken 3 times a day over a 6 day period.

• 31% of patients had moderate to severe side effects
• 85% of patients preferred pCB treatment over placebo

These patients had more side effects from the pCB treatment, they also had more control over nausea and vomiting.

Like the last study, these patients were also given standard anti-emetics. The group treated with both these medications and the pCB treatment saw a complete response in 25% of patients, compared to 14% in the placebo group (5).

Both of these studies show that oral cannabinoids can be used to relieve symptoms of CINV when standard medications are not enough.

Side Effects of CBD

Cannabinoids have consistently worse side effect profiles compared to placebo treatments.

But compared to THC, CBD has mild side effects. Clinical trials show that most of these effects are either mild or moderate.

Potential side effects of CBD include:

• Digestive Tract – Nausea, vomiting, Diarrhea
• Central nervous system – Sedation, dizziness, fatigue, convulsion
• Metabolic – Decreased appetite

Although rare, CBD can have serious side effects in a limited context, including:

• Lethargy and sedation
• Upper respiratory infections
• Elevated liver enzymes

These side effects only occur when CBD interacts with the seizure medications Valproate and Clobazam (3).

Why does CBD oil make me nauseated?

CBD oil can make you nauseated in higher doses, but carrier oils in oral CBD products are the primary culprit. You can reduce this effect by eating within 2 hours of taking a dose of CBD oil.

What’s the Best CBD Oil for Nausea Relief?

Because of the complete lack of human studies into the effects of CBD alone on nausea, this question cannot be fully answered.

However, findings from animal studies do support its therapeutic potential for nausea and vomiting.

We also know that when CBD and THC are used together, they enhance each other’s anti-nausea properties (16).

Edible CBD oils typically fall into 3 categories:

1. CBD Isolate
2. Broad Spectrum
3. Full Spectrum

Isolate oils only contain purified CBD and have neither terpenes nor additional pCBs. Broad and full spectrum oils both contain terpenes and minor cannabinoids, but only full spectrum oils contain THC.

Which CBD oil is best for nausea?

If tolerable, opt for a full spectrum product that contains THC. Both CBD and THC will boost each other’s effects while lowering the dose needed for nausea relief with CBD alone.

To choose a CBD oil that is right for you, check out this article.

How to Use CBD Oil for Nausea

There are two ways you can take edible CBD oil by mouth:

• Oral – Immediately swallowed
• Sublingual – Taken under the tongue

Orally taken CBD has a low bioavailability because it undergoes first-pass metabolism in the liver. This means that less CBD is absorbed by your body compared to other CBD product types.

Bioavailability: Percentage of a CBD dose that gets absorbed into your bloodstream.

You can work around this problem by using edible CBD oils sublingually. This method results in more rapid CBD absorption and avoids first-pass metabolism. (6).

To use CBD sublingually, apply the edible CBD oil under your tongue and keep it there for at least 60 seconds, then swallow it.

How fast does CBD oil work for nausea?

You may feel the effects of edible CBD oil within 30 minutes and its concentration peaks in 2-5 hours, depending on dose, absorption and individual differences.

How to Dose CBD Oils for Nausea

CBD has mostly mild to moderate side effects. It is well tolerated in adults in doses up to 1600 mg (2).

According to animal models, the lowest effective CBD dose for vomiting relief is 0.5 mg/kg (15). Assuming a weight of 60 kg (132 lbs), this translates into a human dose of roughly 30 mg.

For CINV patients, maximum daily doses of 45 mg THC and 36 mg CBD have been recommended (18).

CBD may help settle your stomach, albeit within a limited dose range (11).

What will be an effective dose for you will depend on:

• Your individual biology (e.g. weight, metabolism)
• Method of consumption
• Type of CBD product

So a 30 mg dose of CBD oil may be a good starting point, but you can adjust the dose as needed.

Tip: Taking CBD oil within 2 hours of a meal results in more absorption (19).

Click here for a more detailed explanation on dosing CBD products.

What’s Next…

Go  to our CBD Hub to learn more about CBD-related topics.

Scientific References:

1. Chow, R., Valdez, C., Chow, N., Zhang, D., Im, J., Sodhi, E., & Lock, M. (2020). Oral cannabinoid for the prophylaxis of chemotherapy-induced nausea and vomiting—a systematic review and meta-analysis. Supportive Care in Cancer, 28(5), 2095–2103. https://doi.org/10.1007/s00520-019-05280-4
2. Cuñetti, L., Manzo, L., Peyraube, R., Arnaiz, J., Curi, L., & Orihuela, S. (2018). Chronic pain treatment with cannabidiol in kidney transplant patients in Uruguay. Transplantation Proceedings, 50(2), 461–464. https://doi.org/10.1016/j.transproceed.2017.12.042
3. Dos Santos, R. G., Guimarães, F. S., Crippa, J. A., Hallak, J. E., Rossi, G. N., Rocha, J. M., & Zuardi, A. W. (2020). Serious adverse effects of cannabidiol (CBD): A review of randomized controlled trials. Expert Opinion on Drug Metabolism & Toxicology, 16(6), 517–526. https://doi.org/10.1080/17425255.2020.1754793
4. Duran, M., Pérez, E., Abanades, S., Vidal, X., Saura, C., Majem, M., Arriola, E., Rabanal, M., Pastor, A., Farré, M., Rams, N., Laporte, J.-R., & Capellà, D. (2010). Preliminary efficacy and safety of an oromucosal standardized cannabis extract in chemotherapy-induced nausea and vomiting. British Journal of Clinical Pharmacology, 70(5), 656–663. https://doi.org/10.1111/j.1365-2125.2010.03743.x
5. Grimison, P., Mersiades, A., Kirby, A., Lintzeris, N., Morton, R., Haber, P., Olver, I., Walsh, A., McGregor, I., Cheung, Y., Tognela, A., Hahn, C., Briscoe, K., Aghmesheh, M., Fox, P., Abdi, E., Clarke, S., Della-Fiorentina, S., Shannon, J., … Stockler, M. (2020). Oral THC:CBD cannabis extract for refractory chemotherapy-induced nausea and vomiting: A randomised, placebo-controlled, phase II crossover trial. Annals of Oncology, 31(11), 1553–1560. https://doi.org/10.1016/j.annonc.2020.07.020
6. Hammell, D. C., Zhang, L. P., Ma, F., Abshire, S. M., McIlwrath, S. L., Stinchcomb, A. L., & Westlund, K. N. (2015). Transdermal cannabidiol reduces inflammation and pain-related behaviours in a rat model of arthritis. European Journal of Pain, 20(6), 936–948. https://doi.org/10.1002/ejp.818
7. Kwiatkowska, M., Parker, L. A., Burton, P., & Mechoulam, R. (2004). A comparative analysis of the potential of cannabinoids and Ondansetron to suppress cisplatin-induced emesis in the suncus murinus (House musk shrew). Psychopharmacology, 174(2). https://doi.org/10.1007/s00213-003-1739-9
8. Madras, B. K. (2018). Tinkering with THC-to-CBD ratios in marijuana. Neuropsychopharmacology, 44(1), 215–216. https://doi.org/10.1038/s41386-018-0217-3
9. Mersiades, A. J., Tognela, A., Haber, P. S., Stockler, M., Lintzeris, N., Simes, J., McGregor, I., Olver, I., Allsop, D. J., Gedye, C., Kirby, A. C., Morton, R. L., Fox, P., Clarke, S., Briscoe, K., Aghmesheh, M., Wong, N., Walsh, A., Hahn, C., & Grimison, P. (2018). Oral cannabinoid-rich THC/CBD cannabis extract for secondary prevention of chemotherapy-induced nausea and vomiting: A study protocol for a pilot and definitive randomised double-blind placebo-controlled trial (CannabisCINV). BMJ Open, 8(9). https://doi.org/10.1136/bmjopen-2017-020745
10. Mortimer, T. L., Mabin, T., & Engelbrecht, A.-M. (2019). Cannabinoids: The lows and the highs of chemotherapy-induced nausea and vomiting. Future Oncology, 15(9), 1035–1049. https://doi.org/10.2217/fon-2018-0530
11. Parker, L. A., Rock, E. M., & Limebeer, C. L. (2011). Regulation of nausea and vomiting by cannabinoids. British Journal of Pharmacology, 163(7), 1411–1422. https://doi.org/10.1111/j.1476-5381.2010.01176.x
12. Pertwee, R. G., Rock, E. M., Guenther, K., Limebeer, C. L., Stevenson, L. A., Haj, C., Smoum, R., Parker, L. A., & Mechoulam, R. (2017). Cannabidiolic acid methyl ester, a stable synthetic analogue of cannabidiolic acid, can produce 5-HT1A receptor-mediated suppression of nausea and anxiety in rats. British Journal of Pharmacology, 175(1), 100–112. https://doi.org/10.1111/bph.14073
13. Rock, E. M., Bolognini, D., Limebeer, C. L., Cascio, M. G., Anavi-Goffer, S., Fletcher, P. J., Mechoulam, R., Pertwee, R. G., & Parker, L. A. (2012). Cannabidiol, a non-psychotropic component of cannabis, attenuates vomiting and nausea-like behaviour via indirect agonism of 5-HT1A somatodendritic autoreceptors in the dorsal raphe nucleus. British Journal of Pharmacology, 165(8), 2620–2634. https://doi.org/10.1111/j.1476-5381.2011.01621.x
14. Rock, E. M., Goodwin, J. M., Limebeer, C. L., Breuer, A., Pertwee, R. G., Mechoulam, R., & Parker, L. A. (2011). Interaction between non-psychotropic cannabinoids in marihuana: Effect of Cannabigerol (CBG) on the anti-nausea or anti-emetic effects of cannabidiol (CBD) in rats and Shrews. Psychopharmacology, 215(3), 505–512. https://doi.org/10.1007/s00213-010-2157-4
15. Rock, E. M., Sullivan, M. T., Collins, S. A., Goodman, H., Limebeer, C. L., Mechoulam, R., & Parker, L. A. (2020). Evaluation of repeated or acute treatment with cannabidiol (CBD), cannabidiolic acid (CBDA) or CBDA methyl ester (HU-580) on nausea and/or vomiting in rats and shrews. Psychopharmacology, 237(9), 2621–2631. https://doi.org/10.1007/s00213-020-05559-z
16. Rock, E. M., Sullivan, M. T., Pravato, S., Pratt, M., Limebeer, C. L., & Parker, L. A. (2020). Effect of combined doses of Δ9-tetrahydrocannabinol and cannabidiol or tetrahydrocannabinolic acid and cannabidiolic acid on acute nausea in male Sprague-Dawley Rats. Psychopharmacology, 237(3), 901–914. https://doi.org/10.1007/s00213-019-05428-4
17. Rojas, C., Raje, M., Tsukamoto, T., & Slusher, B. S. (2014). Molecular mechanisms of 5-HT3 and NK1 receptor antagonists in prevention of emesis. European Journal of Pharmacology, 722, 26–37. https://doi.org/10.1016/j.ejphar.2013.08.049
18. Serafimovska, T., Darkovska-Serafimovska, M., Stefkov, G., Arsova-Sarafinovska, Z., & Balkanov, T. (2020). Pharmacotherapeutic considerations for use of cannabinoids to relieve symptoms of nausea and vomiting induced by chemotherapy. Folia Medica, 62(4), 668–678. https://doi.org/10.3897/folmed.62.e51478
19. Silmore, L. H., Willmer, A. R., Capparelli, E. V., & Rosania, G. R. (2021). Food effects on the formulation, dosing, and administration of cannabidiol (CBD) in humans: A systematic review of Clinical Studies. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 41(4), 405–420. https://doi.org/10.1002/phar.2512
20. Yang, K.-H., Galadari, S., Isaev, D., Petroianu, G., Shippenberg, T. S., & Oz, M. (2010). The nonpsychoactive cannabinoid cannabidiol inhibits 5-HT3a receptor-mediated currents in xenopus laevis oocytes. Journal of Pharmacology and Experimental Therapeutics, 333(2), 547–554. https://doi.org/10.1124/jpet.109.162594