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Cancer Treatment Side Effects & Supportive and Palliative Care

Ginger for nausea

Ginger (Zingiber officinale) is a member of the family of plants that includes cardamom and turmeric. The strong aroma of ginger is the result of pungent ketones including gingerol, the extract that primarily has been used in research studies.

A recent meta-analysis evaluating the use of ginger for postoperative nausea and vomiting showed that, in five randomized trials with a total of 363 patients, ginger was more effective than placebo.

Few clinical trials in humans have explored the efficacy of ginger in chemotherapy-induced nausea and vomiting. At least one RCT showed ginger to be more effective than a placebo in the treatment of chemotherapy-induced nausea and vomiting. Animal studies have shown decreased emetic episodes in dogs challenged by cisplatin. Because Ginger has been shown efficacious in RCTs investigating nausea and vomiting in pregnant women and post-surgical patients, it has been inferred that its effects may translate to patients suffering from chemotherapy-induced nausea and vomiting. However, the evidence for the use of ginger in chemotherapy-induced nausea and vomiting is not yet clear.

The exact mechanism of action of ginger in relation to its antiemetic properties is unclear, although it appears to inhibit serotonin receptors and to exert antiemetic effects at the level of the gastrointestinal system and in the central nervous system.

Safety

Adverse effects after ingestion of ginger are uncommon, but they can include mild gastrointestinal effects such as heartburn, diarrhea, and irritation of the mouth. Because it may increase risk of fibrinolysis, it may be prudent to exercise caution in patients taking high doses of anticoagulants such as warfarin (Coumadin).

Although no specific dosing studies have been reported, most clinical research has used between 250 mg and 1 g of the powdered root in capsules, taken one to four times daily.

Recommendation

Given that many antiemetic medications have the potential for sedation as a side effect, the use of ginger may be a safe alternative for the treatment of postoperative nausea and vomiting. Although effectiveness is not clear, because of safety and potential effectiveness, it may also be helpful for the co-management of chemotherapy-induced nausea and vomiting.

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  • DerMarderosian A, Beutler JA. The Review of Natural Products. St. Louis, Mo.: Wolters Kluwer, 2006.
  • Borrelli F, Capasso R, Aviello G, Pittler MH, Izzo AA. Effectiveness and safety of ginger in the treatment of pregnancy-induced nausea and vomiting. Obstet Gynecol 2005;105:849-56.
  • Chaiyakunapruk N, Kitikannakorn N, Nathisuwan S, Leeprakobboon K, Leelasettagool C. The efficacy of ginger for the prevention of postoperative nausea and vomiting: a meta-analysis. Am J Obstet Gynecol 2006;194:95-9.
  • Manusirivithaya S, Sripramote M, Tangjitgamol S, Sheanakul C, Leelahakorn S, Thavaramara T, et al. Antiemetic effect of ginger in gynecologic oncology patients receiving cisplatin. Int J Gynecol Cancer 2004;14:1063-9.
  • Ernst E, Pittler MH. Efficacy of ginger for nausea and vomiting: a systematic review of randomized clinical trials. Br J Anaesth 2000;84:367-71.
  • Jiang X, Williams KM, Liauw WS, Ammit AJ, Roufogalis BD, Duke CC, et al. Effect of ginkgo and ginger on the pharmacokinetics and pharmacodynamics of warfarin in healthy subjects. Br J Clin Pharmacol 2005;59:425-32.
  • Verma SK, Bordia A. Ginger, fat and fibrinolysis. Indian J Med Sci 2001;55:83-6.
  • Langner E, Greifenberg S, Gruenwald J. Ginger: history and use. Adv Ther 1998;15:25-44.
  • Quimby EL.The use of herbal therapies in pediatric oncology patients: treating symptoms of cancer and side effects of standard therapies. J Pediatr Oncol Nurs. 2007 Jan-Feb;24(1):35-40.