nabilone and Vomiting

Topics: Aged; Anorexia; Antineoplastic Agents; Cancer Pain; Cannabidiol; Cannabinoid Receptor Agonists; Cannabinoids; Dizziness; Dose-Response Relationship, Drug; Dronabinol; Humans; Middle Aged; Multiple Sclerosis; Nausea; Neurodegenerative Diseases; Pain; Perceptual Disorders; Randomized Controlled Trials as Topic; Regression Analysis; Self Report; Vomiting

Chemotherapy-induced nausea and vomiting (CINV) is a burdensome adverse event frequently associated with chemotherapy treatment of cancer. Evidence suggests that cannabinoid CB2 receptors are present in brainstem neurons, and thus, there may exist a role for cannabinoids to counter CINV. The aim of this paper is to conduct a systematic review and meta-analysis of the efficacy and safety of oral cannabinoids compared with other treatments as documented in randomized controlled trials (RCTs).. A literature search was conducted using Ovid MEDLINE up until December 31, 2018; Embase Classic and Embase up until 2018 week 53; and Cochrane Central Register of Controlled Trials up until November 2018. Study data were extracted and included in this meta-analysis if they reported on at least one of the following efficacy endpoints: no nausea and no vomiting, no nausea, and no vomiting. The Mantel-Haenszel method and random effects analysis model were used, to generate odds ratio (OR) and accompanying 95% confidence intervals (CI).. In the setting of prophylactic treatment against both nausea and vomiting, oral cannabinoid was more efficacious than placebo or other studied antiemetic treatments. When controlling for vomiting, oral cannabinoid was equally as efficacious as others. Against nausea, oral cannabinoid was equally as effective as other treatments. A greater percentage of patients administered oral cannabinoid for CINV experienced dysphoria, euphoria, and sedation.. Although there exists some evidence suggesting that oral cannabinoids may have a role in controlling for emesis from a neurophysiological perspective, these conclusions are currently not mirrored in the published RCTs to date. However, there exists only a limited number of RCTs, comparisons with older treatment regimens and a lack of standard reporting practice across published literature. Further RCTs should investigate the efficacy and safety of oral cannabinoids, to secure a better picture of the efficacy of oral cannabinoids against CINV.

Topics: Adult; Antiemetics; Antineoplastic Agents; Cannabinoids; Dronabinol; Humans; Induction Chemotherapy; Nausea; Neoplasms; Receptor, Cannabinoid, CB2; Vomiting

Chemotherapy-induced nausea and vomiting (CINV) is a prevalent, distressing, and burdensome side effect of cancer chemotherapy. It is estimated to affect the majority of patients receiving certain anti-cancer drug regimens and can be treatment-limiting, even for life-saving medications. Despite seemingly numerous options, such as antimuscarinic anticholinergics, antihistamines, 5-HT

Topics: Antiemetics; Antineoplastic Agents; Cannabinoids; Cannabis; Dronabinol; Humans; Iatrogenic Disease; Randomized Controlled Trials as Topic; Vomiting

With 23 states and the District of Columbia having enacted medical marijuana laws as of August 2014, it is important that psychiatrists be able to address questions about medical marijuana from patients, families, and other health care professionals. The author discusses the medical literature on synthetic cannabinoids and medical marijuana. The synthetic cannabinoids dronabinol and nabilone are approved by the United States Food and Drug Administration for nausea and vomiting associated with cancer chemotherapy and appetite stimulation in patients with wasting diseases such as acquired immunodeficiency syndrome (AIDS). Results of clinical trials of these agents for other conditions have varied widely thus far. In addition, few data are available on the use of the marijuana plant as a medical treatment. The author concludes that there is a clear need for additional research on possible medical uses of cannabinoids. He notes that discussions with prospective medical marijuana patients should emphasize the importance of communication among all parties due to the possible side effects of treatment with marijuana and its potential to interact with other medications the patient may be taking. Facilitating a thorough substance abuse consultation is one of most positive ways that psychiatrists, especially addiction psychiatrists, can make an impact as medical marijuana becomes increasingly common. A careful review of the prospective medical marijuana user's substance use history, co-occurring medical and psychiatric conditions, family history, and psychosocial stressors is essential in evaluating the potential risks of medical marijuana for these patients. The author concludes that psychiatrists can have a significant impact by increasing the likelihood that medical marijuana will be used in a safe and responsible way.

Topics: Antiemetics; District of Columbia; Dronabinol; Humans; Medical Marijuana; Nausea; Psychiatry; United States; Vomiting; Wasting Syndrome

Biological activity of cannabinoids is caused by binding to two cannabinoid receptors CB1 and CB2. Psychoactive is not only tetrahydrocannabinol (THC) but also: cannabidiol, cannabigerol or cannabichromen. Formerly, the usefulness of hemp was assessed in the relation to temporary appeasement of the symptoms of some ailments as nausea or vomiting. Present discoveries indicates that cannabis-based drugs has shown ability to alleviate of autoimmunological disorders such as: Multiple sclerosis (MS), Rheumatoid arthritis (RA) or inflammatory bowel disease. Another studies indicates that cannabinoids play role in treatment of neurological disorders like Alzheimer disease or Amyotrophic lateral sclerosis (ALS) or even can reduce spreading of tumor cells. Cannabinoids stand out high safety profile considering acute toxicity, it is low possibility of deadly overdosing and side-effects are comprise in range of tolerated side-effects of other medications. In some countries marinol and nabilone are used as anti vomiting and nausea drug. First cannabis-based drug containg naturally occurring cannabinoids is Sativex. Sativex is delivered in an mucosal spray for patients suffering from spasticity in MS, pain relevant with cancer and neuropathic pain of various origin. Despite the relatively low acute toxicity of cannabinoids they should be avoid in patients with psychotic disorders, pregnant or breastfeeding woman. Cannabinoids prolong a time of reaction and decrease power of concentration that's why driving any vehicles is forbidden. Cannabis side-effects varies and depend from several factors like administrated dose, rout of administration and present state of mind. After sudden break from long-lasting use, withdrawal symptoms can appear, although they entirely disappear after a week or two.

Topics: Arthritis, Rheumatoid; Cannabidiol; Cannabinoids; Cannabis; Contraindications; Dronabinol; Drug Combinations; Humans; Inflammatory Bowel Diseases; Multiple Sclerosis; Muscle Spasticity; Nausea; Nervous System Diseases; Pain; Plant Extracts; Vomiting

Before the introduction of the serotonin receptor antagonists (5-HT3 receptor antagonists) in the early 1990s, limited effective options were available to prevent and treat chemotherapy-induced nausea and vomiting (CINV). In 1985, the FDA approved 2 cannabinoid derivatives, dronabinol and nabilone, for the treatment of CINV not effectively treated by other agents. Today, the standard of care for prevention of CINV for highly and moderately emetogenic chemotherapy is a 5-HT3 receptor antagonist, dexamethasone, with or without aprepitant or fosaprepitant. With the approval of safer and more effective agents, cannabinoids are not recommended as first-line treatment for the prevention of CINV and are reserved for patients with breakthrough nausea and vomiting. Because of medical and legal concerns, the use of marijuana is not recommended for management of CINV and is not part of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Antiemesis. Although patients may like to pursue this treatment option in states that have approved the use of marijuana for medical purposes, its use remains legally and therapeutically controversial.

Topics: Antiemetics; Antineoplastic Agents; Cannabinoids; Dronabinol; Humans; Nausea; Vomiting

Nabilone has been approved to treat chemotherapy-induced nausea and vomiting. Recent studies have explored cannabinoids in pain management.. To review the evidence for the use of cannabinoids in general and nabilone in particular; i) in managing chemotherapy-induced nausea and vomiting; and ii) in treating pain.. A systematic review of published English literature used the terms: cancer, cannabinoid, nabilone, nausea, pain, tetrahydrocannabinol and vomiting as search terms. Reviews, meta-analyses and treatment trials were reviewed.. Nabilone is superior to placebo, domperidone and prochlorperazine but not metoclopramide or chlorpromazine. Cannabinoids do not add to benefits of 5-HT(3) receptor antagonists. Side effects are greater for nabilone than for prochlorperazine, in most studies patients prefered nabilone over prochlorperazine. Nabilone is ineffective in acute pain but benefits in neuropathic pain and central hypersensitization. Recent guidelines place nabilone as a second to fourth line drug for neuropathic pain.

Topics: Administration, Oral; Analgesics, Non-Narcotic; Antiemetics; Antineoplastic Agents; Clinical Trials as Topic; Dronabinol; Humans; Nausea; Pain; Treatment Outcome; Vomiting

The cannabinoids nabilone (Cesamet) and dronabinol (Marinol) are indicated for the management of chemotherapy-induced nausea and vomiting (CINV) in cancer patients who have failed to respond adequately to conventional antiemetic therapy.. The endocannabinoid (CB) system interacts with numerous other systems and pharmaceutical cannabinoids target ubiquitous CB1 and CB2 receptors in the central nervous system and periphery, relieving nausea and vomiting and pain.. The benefits of this novel class of medications in cancer may extend beyond CINV, as indicated by data from preclinical studies and animal models.

Topics: Administration, Oral; Analgesics, Non-Narcotic; Antiemetics; Antineoplastic Agents; Breast Neoplasms; Dronabinol; Female; Humans; Middle Aged; Pain; Receptors, Cannabinoid; Spinal Neoplasms; Vomiting

Topics: Antineoplastic Agents; Dronabinol; Humans; Nausea; Vomiting

Topics: Adrenal Cortex Hormones; Antiemetics; Antineoplastic Agents; Butyrophenones; Chemoreceptor Cells; Dronabinol; Drug Therapy, Combination; Humans; Metoclopramide; Nausea; Phencyclidine; Phenothiazines; Vomiting

Evaluation of the activity of anti-emetic drugs in randomized controlled trials has, in most cases, demonstrated the superiority of treatment over placebo administration for the control of chemotherapy-induced emesis (see Table 15). The degree of control of emesis relates both to the intensity of the emetogenic stimulus and to the effectiveness of the anti-emetic agent employed. Prochlorperazine is a relatively weak anti-emetic. The drug exhibits modest activity in the treatment of emesis produced by mild emetogenic stimuli, but is relatively ineffective in the treatment of patients on moderate to severely emetogenic drugs. Domperidone has demonstrated activity against moderately emetogenic stimuli but has not been evaluated in cisplatin-treated patients. The cannabinoids have proved efficacious in the treatment of emesis induced by more severe emetogenic stimuli. THC therapy, however, has been limited in some studies by toxicity. High-dose metoclopramide has demonstrated efficacy in small series of patients in the treatment of cisplatin-induced vomiting. Dexamethasone activity as a single agent is in doubt but the drug may improve the efficacy of metoclopramide when used in combination. For the future, the use of combinations of anti-emetics with differing sites of action and non-overlapping toxicities, may lead to further improvement in efficacy. Combinations of centrally-acting drugs such as the cannabinoids plus dopamine antagonists such as metoclopramide or domperidone, are worth evaluating. The control of anticipatory nausea and vomiting is another major area of interest which has, as yet, not been studied in any depth. A single comparative trial has been reported in the literature (50) and in this study, behavioural therapy rather than drug therapy was evaluated. There may be a place for the evaluation of behavioural therapy in combination with drugs exhibiting anxiolytic properties such as the benzodiazepines and the cannabinoids. Finally, new anti-emetic drugs with an improved therapeutic index will be welcomed by the patient.

Topics: Antiemetics; Antineoplastic Agents; Chemoreceptor Cells; Clinical Trials as Topic; Dexamethasone; Domperidone; Dronabinol; Humans; Metoclopramide; Nausea; Prochlorperazine; Random Allocation; Receptors, Neurotransmitter; Vomiting

Topics: Antiemetics; Antineoplastic Agents; Cannabinoids; Dronabinol; Humans; Metoclopramide; Nausea; Vomiting

To describe the safety and efficacy of nabilone given to pediatric patients to prevent acute chemotherapy-induced nausea and vomiting (CINV).. A multicenter, retrospective review of pediatric patients who received nabilone for acute CINV prophylaxis between December 1, 2010 and August 1, 2015 was undertaken. One course of nabilone was evaluated per patient. Adverse effects associated with nabilone use were noted. The proportion of patients who experienced complete acute chemotherapy-induced vomiting (CIV) control during the acute phase was determined. The acute phase was defined as starting with the first chemotherapy dose and continuing until 24 h after administration of the last chemotherapy dose of the chemotherapy block.. One hundred ten eligible patients (median age: 14.0 years, range: 1.1-18.0 years; 65 male) were identified. Most (109/110) received nabilone plus a 5-HT3 antagonist for CINV prophylaxis. Adverse effects associated with nabilone were experienced by 34% (37/110) of children. All were of CTCAE Version 4.03 Grade 2 or less. Sedation (20.0%), dizziness (10.0%), and euphoria (3.6%) were the most commonly reported adverse events. Nabilone was discontinued in 10 patients due to an adverse event. The proportions of patients receiving highly or moderately emetogenic chemotherapy who experienced complete acute CIV control were 50.6% (42/83) and 53.8% (14/26), respectively.. Adverse events associated with nabilone were common but of minor clinical significance. Acute CIV control in children receiving nabilone as a part of their antiemetic regimen was poor. Future work should focus on implementation of guideline-consistent CINV prophylaxis and treatment.

Topics: Adolescent; Antineoplastic Agents; Child; Child, Preschool; Dronabinol; Female; Humans; Infant; Male; Nausea; Neoplasms; Retrospective Studies; Vomiting

In a prospective, double-blind study, we have examined the effect of preoperative nabilone on postoperative nausea and vomiting (PONV). Sixty women, less than 70 yr old, undergoing total abdominal hysterectomy, were allocated randomly to receive either nabilone 2 mg or metoclopramide 10 mg orally 90 min before induction of anaesthesia. The study was designed to detect a 50% difference in the incidence of postoperative vomiting between the two groups, with an 80% power of achieving a statistically significant result at the 5% level. Data from 53 patients were analysed: the incidences of nausea and vomiting for the metoclopramide group were 70% and 67%, respectively; the corresponding values for the nabilone group were 73% and 54%. These differences were not significant.

Topics: Adult; Aged; Antiemetics; Double-Blind Method; Dronabinol; Drug Administration Schedule; Female; Humans; Hysterectomy; Metoclopramide; Middle Aged; Nausea; Postoperative Complications; Premedication; Prospective Studies; Vomiting

Eighty patients receiving their first course of chemotherapy with regimens containing cisplatin or cisplatin analogues entered this open crossover study comparing nabilone 2 mg and prochlorperazine 5 mg given orally every 12 h for four doses against metoclopramide 2 mg/kg loading dose intravenously (i.v.), then 3 mg/kg as an (i.v.) infusion over 8 h and dexamethasone 20 mg (i.v.) over 3-5 min at the time of chemotherapy. There was complete control of nausea and vomiting in 24 patients (32%) given metoclopramide and dexamethasone compared to 14 patients (19%) given nabilone and prochlorperazine. For the 70 patients who completed the crossover assessment of emesis on a linear analogue scale significantly favoured metoclopramide and dexamethasone (P = 0.02). However, there was no overall patient preference for the metoclopramide and dexamethasone combination (nabilone and prochlorperazine 31 vs. metoclopramide and dexamethasone 26; 13 no preference), because a significant proportion of the patients receiving the cisplatin analogue carboplatin preferred nabilone and prochlorperazine (16 vs. 5; 1 no preference; P = 0.013). For patients receiving cisplatin chemotherapy metoclopramide and dexamethasone remains the antiemetic of choice but for regimens containing carboplatin, nabilone and prochlorperazine is better tolerated and preferred by the patients.

Topics: Adolescent; Adult; Aged; Antiemetics; Cisplatin; Clinical Trials as Topic; Dexamethasone; Dronabinol; Drug Therapy, Combination; Female; Humans; Male; Metoclopramide; Middle Aged; Nausea; Neoplasms; Prochlorperazine; Random Allocation; Vomiting

In a randomized, double-blind, crossover trial, nabilone was compared to prochlorperazine for control of cancer chemotherapy-induced emesis in 30 children 3.5 to 17.8 years of age. All subjects received two consecutive identical cycles of chemotherapy with the trial antiemetics given in accordance to a body weight-based dosage schedule beginning eight to 12 hours before treatment. The overall rate of improvement of retching and emesis was 70% during the nabilone and 30% during the prochlorperazine treatment cycles (P = .003, chi 2 test). On completion of the trial, 66% of the children stated that they preferred nabilone, 17% preferred prochlorperazine, and 17% had no preference (P = .015, chi 2 test). Major side effects (dizziness, drowsiness, and mood alteration) were more common (11% v 3%) during the nabilone treatment cycles. CNS side effects appeared to be dose related and were most likely to occur when the nabilone dosage exceeded 60 micrograms/kg/d, but individual tolerance to nabilone varied considerably. Lower dosages of nabilone were associated with equivalent efficacy and no major side effects. Nabilone appears to be a safe, effective, and well-tolerated antiemetic drug for children receiving cancer chemotherapy. Although major side effects may occur at higher dosages, nabilone is preferable to prochlorperazine because of improved efficacy.

Topics: Adolescent; Antiemetics; Antineoplastic Agents; Child; Child, Preschool; Clinical Trials as Topic; Double-Blind Method; Dronabinol; Humans; Prochlorperazine; Random Allocation; Vomiting

In a previous study on the antiemetic effect of nabilone (N) in patients with lung cancer receiving chemotherapy (CT), we found that N was only moderately effective and that its side effects limited its use, especially in elderly outpatients. We, therefore, performed a new study of N in combination with dexamethasone (DXM), a potent antiemetic in itself, to evaluate whether the addition of DXM to N would improve the antiemetic effect and/or reduce the side effects. Forty patients with lung cancer were enrolled in the study. A randomized, third-party-blinded, crossover design was used. Study drugs were given during two consecutive, identical CT cycles. N was given at a fixed dosage regimen of 2 mg b.i.d. The initial dose was administered the evening before CT, the second dose at 0.5 h before CT, and the third dose in the evening 12 h after CT. DXM, 8 mg, or placebo was given orally with the first dose of N. The subsequent doses (either 10 mg DXM or saline) were given intravenously 0.5 h before CT and at 2 and 6 h after the start of CT. The CT regimens given included the following drugs in various combinations: cisplatin, cyclophosphamide, adriamycin, etoposide (VP-16), vincristine, and vindesine. The combination of N and DXM was significantly superior to N alone in the reduction of vomiting episodes, both in subgroups of patients receiving cisplatin and in those receiving other CT combinations. There was no statistically significant difference between the treatments with regard to the patients' assessments of the severity of nausea or effects on appetite. Approximately half the patients (63% with N plus DXM versus 47% with N) reported no side effects. The frequency and severity of central nervous system adverse reactions, mainly vertigo, were similar in both treatment groups. The fall in blood pressure was significantly greater after N alone. Two thirds of the patients preferred N plus DXM. Thus, the addition of DXM to N enhanced the therapeutic yield of N, and we recommend DXM as an adjunct to N, when the use of steroids is not contraindicated. The optimal dose and schedule of DXM was not investigated in our study; a higher dose of DXM might increase the clinical benefit of the drug combination tested.

Topics: Antiemetics; Antineoplastic Combined Chemotherapy Protocols; Blood Pressure; Clinical Trials as Topic; Dexamethasone; Double-Blind Method; Dronabinol; Drug Therapy, Combination; Humans; Lung Neoplasms; Nausea; Random Allocation; Vomiting

Twenty nonseminomatous testicular cancer patients not pretreated with emetogenic chemotherapy were included in a crossover study of antiemetic therapy. Patients were randomly assigned to receive either nabilone (2 X 2 mg/day) or alizapride (3 X 150 mg/day) prior to beginning low-dose cisplatin chemotherapy. Patients on nabilone had significantly fewer episodes of emesis than those on alizapride (medians, 1.1 vs 2.9; p less than 0.01). Nabilone was superior to alizapride in giving complete relief from nausea (medians, 65% vs 30%; p less than 0.01), and was more effective in shortening the duration of nausea (medians, 1.3 h vs 5.1 h; p less than 0.01); however, it caused more adverse effects. It is concluded that nabilone has greater antiemetic activity than alizapride in young patients receiving low-dose cisplatin chemotherapy. Nabilone dosage should be reduced to decrease the incidence and degree of adverse reactions while leaving the definite antiemetic activity unchanged.

Topics: Administration, Oral; Adult; Antiemetics; Cisplatin; Dose-Response Relationship, Drug; Dronabinol; Humans; Male; Middle Aged; Pyrrolidines; Testicular Neoplasms; Vomiting

A prospective randomised double blind crossover trial was conducted comparing the new synthetic cannabinoid nabilone with oral domperidone in a group of children receiving repeated identical courses of emetogenic chemotherapy for a variety of malignant diseases. Eighteen of 23 consecutive eligible children, aged 10 months to 17 years, completed the trial. When taking nabilone they experienced significantly fewer vomiting episodes and less nausea, and two thirds expressed a preference for the drug. The most common side effects of treatment with nabilone were somnolence and dizziness, with one patient being disturbed by hallucinations. The results indicate that nabilone is an effective antiemetic for children having chemotherapy, even for young children. It seems to be superior in this respect to domperidone, and although it has a higher incidence of side effects, these are mostly acceptable to patients. It can be recommended as an alternative to conventional antiemetic treatment throughout childhood.

Topics: Adolescent; Antiemetics; Antineoplastic Agents; Child; Child, Preschool; Clinical Trials as Topic; Domperidone; Double-Blind Method; Dronabinol; Female; Humans; Infant; Male; Nausea; Random Allocation; Vomiting

A prospective randomized double-blind trial comparing the butyrophenone analogue domperidone (D) and the synthetic cannabinoid nabilone (N) in the treatment of cytotoxic-induced emesis was conducted in 38 patients receiving highly emetogenic chemotherapy regimens (70% containing cisplatin). Patients received 20 mg D or 1 mg N the night before chemotherapy and 8-hourly on each chemotherapy day for two consecutive cycles of treatment. Three of 19 patients randomized to N completed only one cycle because of disease progression or subjectively adverse effects. Four of 19 patients completed only one cycle of D because of lack of efficacy or chemotherapy toxicity. In all, 32 cycles of N and 33 cycles of D were evaluable for efficacy. The mean number of vomiting episodes in cycle 1 was 4.76 for N and 12.95 for D (P less than 0.02). The corresponding values for cycle 2 were 4.27 and 7.69 (P greater than 0.10), and for cycles 1 and 2 combined, 4.53 for N and 10.81 for D (P less than 0.01). Nausea and food intake scores did not differ significantly, although there was a trend towards less nausea and an increased food intake with N. Subjectively adverse effects were more frequent with N and included drowsiness, dizziness, dry mouth, and postural hypotension. N is superior to D for the control of cytotoxic-induced emesis.

Topics: Adult; Aged; Antiemetics; Antineoplastic Agents; Domperidone; Double-Blind Method; Dronabinol; Drug Evaluation; Female; Humans; Male; Middle Aged; Prospective Studies; Random Allocation; Vomiting

Topics: Adult; Aged; Antiemetics; Antineoplastic Agents; Clinical Trials as Topic; Double-Blind Method; Dronabinol; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Prochlorperazine; Vomiting

An anti-emetic drug, nabilone, a synthetic cannabinoid, has been compared with prochlorperazine in 24 lung cancer patients receiving cancer chemotherapy. Each of the drugs studied was given orally every 12 hours, starting the night before chemotherapy, during one of two consecutive identical chemotherapy cycles in accordance with a double-blind cross-over random order assignment. Single doses were 2 mg of nabilone, or 15 mg of prochlorperazine. The chemotherapeutic regimens given included the following drugs in various combinations: cis-platinum, vincristine, cyclophosphamide, adriamycin, vindesine, and etoposide (VP16). Nabilone was significantly superior to prochlorperazine in the reduction of vomiting episodes. Side effects, mainly vertigo, were evident in nearly half of the patients after nabilone, and three patients were withdrawn from the study due to decreased coordination and hallucinations after nabilone. Side effects from prochlorperazine were limited to mild drowsiness in one patient. Two-thirds of the patients preferred nabilone to prochlorperazine. We conclude that nabilone is a moderately effective anti-emetic drug, but that the unpredictability of its side effects call for careful patient information, especially with elderly outpatients. We recommend that at least after the first dose of nabilone, the patient should be kept under close observation during 4 hours.

Topics: Administration, Oral; Aged; Antineoplastic Combined Chemotherapy Protocols; Appetite; Blood Pressure; Clinical Trials as Topic; Double-Blind Method; Dronabinol; Drug Evaluation; Female; Humans; Lung Neoplasms; Male; Middle Aged; Nausea; Prochlorperazine; Random Allocation; Vomiting

Evaluation of the activity of anti-emetic drugs in randomized controlled trials has, in most cases, demonstrated the superiority of treatment over placebo administration for the control of chemotherapy-induced emesis (see Table 15). The degree of control of emesis relates both to the intensity of the emetogenic stimulus and to the effectiveness of the anti-emetic agent employed. Prochlorperazine is a relatively weak anti-emetic. The drug exhibits modest activity in the treatment of emesis produced by mild emetogenic stimuli, but is relatively ineffective in the treatment of patients on moderate to severely emetogenic drugs. Domperidone has demonstrated activity against moderately emetogenic stimuli but has not been evaluated in cisplatin-treated patients. The cannabinoids have proved efficacious in the treatment of emesis induced by more severe emetogenic stimuli. THC therapy, however, has been limited in some studies by toxicity. High-dose metoclopramide has demonstrated efficacy in small series of patients in the treatment of cisplatin-induced vomiting. Dexamethasone activity as a single agent is in doubt but the drug may improve the efficacy of metoclopramide when used in combination. For the future, the use of combinations of anti-emetics with differing sites of action and non-overlapping toxicities, may lead to further improvement in efficacy. Combinations of centrally-acting drugs such as the cannabinoids plus dopamine antagonists such as metoclopramide or domperidone, are worth evaluating. The control of anticipatory nausea and vomiting is another major area of interest which has, as yet, not been studied in any depth. A single comparative trial has been reported in the literature (50) and in this study, behavioural therapy rather than drug therapy was evaluated. There may be a place for the evaluation of behavioural therapy in combination with drugs exhibiting anxiolytic properties such as the benzodiazepines and the cannabinoids. Finally, new anti-emetic drugs with an improved therapeutic index will be welcomed by the patient.

Topics: Antiemetics; Antineoplastic Agents; Chemoreceptor Cells; Clinical Trials as Topic; Dexamethasone; Domperidone; Dronabinol; Humans; Metoclopramide; Nausea; Prochlorperazine; Random Allocation; Receptors, Neurotransmitter; Vomiting

Topics: Antiemetics; Antineoplastic Agents; Clinical Trials as Topic; Double-Blind Method; Dronabinol; Humans; Metoclopramide; Nausea; Vomiting

Nabilone, a synthetic cannabinoid, and Prochlorperazine were compared in a double-blind crossover study of 34 patients with lung cancer undergoing a 3-day schedule of chemotherapy with Cyclophosphamide, Adriamycin and Etoposide. Symptom scores were significantly better for patients on nabilone for nausea, retching and vomiting (P less than 0.05). Fewer subjects vomited with nabilone (P = 0.05) and the number of vomiting episodes was lower (P less than 0.05); no patients on nabilone required additional parenteral anti-emetic. More patients preferred nabilone for anti-emetic control (P less than 0.005). Adverse effects common with nabilone were drowsiness (57%), postural dizziness (35%) and lightheadedness (18%). Euphoria was seen in 14% and a "high" in 7%. Erect systolic blood pressure was lower in nabilone patients on Day 1 (P = 0.05) but postural hypotension was a major problem in only 7%. Nabilone is an effective oral anti-emetic drug for moderately toxic chemotherapy, but the range and unpredictability of its side-effects warrant caution in its use.

Topics: Adult; Aged; Antiemetics; Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Small Cell; Clinical Trials as Topic; Dizziness; Double-Blind Method; Dronabinol; Female; Humans; Lung Neoplasms; Male; Middle Aged; Nausea; Prochlorperazine; Sleep Stages; Vomiting

Topics: Adolescent; Adult; Aged; Antiemetics; Antineoplastic Agents; Clinical Trials as Topic; Double-Blind Method; Dronabinol; Female; Humans; Male; Middle Aged; Prochlorperazine; Vomiting

Topics: Antiemetics; Antineoplastic Agents; Clinical Trials as Topic; Double-Blind Method; Dronabinol; Humans; Research Design; Vomiting

Topics: Adolescent; Adult; Aged; Aging; Antiemetics; Antineoplastic Agents; Clinical Trials as Topic; Double-Blind Method; Dronabinol; Female; Humans; Male; Middle Aged; Placebos; Sex Factors; Vomiting

Topics: Adult; Antiemetics; Antineoplastic Agents; Clinical Trials as Topic; Dronabinol; Female; Humans; Male; Middle Aged; Nausea; Placebos; Vomiting

Topics: Adolescent; Adult; Age Factors; Aged; Antiemetics; Antineoplastic Agents; Clinical Trials as Topic; Double-Blind Method; Dronabinol; Female; Humans; Male; Middle Aged; Nausea; Placebos; Vomiting

The clinical efficacy of antiemetic drugs was tested in cancer patients who were given a placebo and two antiemetic drugs alone and in combination according to random sequences. The method of investigation allowed assessment of the antiemetic effect and side effects of each drug or combination of drugs using a minimum number of patients. The trial design takes into account carry-over effects and biased selection and is potentially useful in the study of drug side effects. Fifteen patients received cyclizine, metoclopramide, cyclizine and metoclopramide, or placebo in a random sequence without evidence that the drugs tested were better than the placebo. A combination of Nabilone and metoclopramide was used in an unrandomized pilot study (prior to the withdrawal of Nabilone from clinical use); these patients recorded better scores for nausea and vomiting and patient acceptability than those in the randomized study. Present antiemetics remain inadequate and although cannabinol derivatives show an improved antiemetic effect, they cause moderate side effects themselves.

Topics: Adolescent; Adult; Aged; Antiemetics; Cisplatin; Cyclizine; Dronabinol; Drug Therapy, Combination; Female; Humans; Male; Metoclopramide; Middle Aged; Nausea; Neoplasms; Pilot Projects; Vomiting

Two double-blind, crossover trials comparing the antiemetic effectiveness of nabilone, a new synthetic cannabinoid, with that of prochlorperazine were conducted in patients with severe nausea and vomiting associated with anticancer chemotherapy. Of 113 patients evaluated, 90 (80 per cent) responded to nabilone therapy, whereas only 36 (32 per cent) responded to prochlorperazine (P less than 0.001). Complete relief of symptoms was infrequent, occurring only in nine patients (8 per cent) given nabilone. When both drugs were compared, both nausea (P less than 0.01) and vomiting episodes (P less than 0.001) were significantly lower in patients given nabilone. Moreover, patients clearly favored nabilone for continued use (P less than 0.001). Predominant side effects noted by patients were similar for both agents and included somnolence, dry mouth and dizziness but were about twice as frequent and more often severe in patients receiving nabilone. In addition, four patients (3 per cent) taking nabilone had side effects (hallucinations in three, hypotension in one) that required medical attention. Euphoria associated with nabilone was infrequent (16 per cent) and mild.

Topics: Adolescent; Adult; Aged; Antiemetics; Antineoplastic Agents; Clinical Trials as Topic; Dronabinol; Drug Evaluation; Female; Humans; Male; Middle Aged; Neoplasms; Prochlorperazine; Vomiting

Topics: Antiemetics; Antineoplastic Agents; Cannabidiol; Cannabinoid Receptor Agonists; Chronic Pain; Decision Making, Shared; Dronabinol; Drug and Narcotic Control; Drug Resistant Epilepsy; Epilepsies, Myoclonic; Humans; Lennox Gastaut Syndrome; Medical Marijuana; Multiple Sclerosis; Muscle Spasticity; Nausea; Needs Assessment; Physicians, Primary Care; Practice Guidelines as Topic; Specialization; United Kingdom; Vomiting

There is considerable public and political interest in the use of cannabis products for medical purposes.. The task force of the European Pain Federation (EFIC) conducted a survey with its national chapters representatives on the status of approval of all types of cannabis-based medicines, the covering of costs and the availability of a position paper of a national medical association on the use of medical cannabis for chronic pain and for symptom control in palliative/supportive care.. Thirty-one out of 37 contacted councillors responded. Plant-derived tetrahydrocannabinol/cannabidiol (THC/CBD) oromucosal spray is approved for spasticity in multiple sclerosis refractory to conventional treatment in 21 EFIC chapters. Plant-derived THC (dronabinol) is approved for some palliative care conditions in four EFIC chapters. Synthetic THC analogue (nabilone) is approved for chemotherapy-associated nausea and vomiting refractory to conventional treatment in four EFIC chapters'. Eight EFIC chapters' countries have an exceptional and six chapters an expanded access programme for medical cannabis. German and Israeli pain societies recommend the use of cannabis-based medicines as third-line drug therapies for chronic pain within a multicomponent approach. Conversely, the German medical association and a team of finish experts and officials do not recommend the prescription of medical cannabis due to the lack of high-quality evidence of efficacy and the potential harms.. There are marked differences between the countries represented in EFIC in the approval and availability of cannabis-based products for medical use. EFIC countries are encouraged to collaborate with the European Medicines Agency to publish a common document on cannabis-based medicines.. There are striking differences between European countries in the availability of plant-derived and synthetic cannabinoids and of medical cannabis for pain management and for symptom control in palliative care and in the covering of costs by health insurance companies or state social security systems.

Topics: Antiemetics; Antineoplastic Agents; Cannabidiol; Cannabinoid Receptor Agonists; Chronic Pain; Dronabinol; Drug Approval; Drug Combinations; Europe; Germany; Humans; Israel; Medical Marijuana; Multiple Sclerosis; Muscle Spasticity; Nausea; Pain Management; Palliative Care; Societies, Medical; Surveys and Questionnaires; Vomiting

Cannabis is one of the most commonly used recreational drugs worldwide. Psychoactive properties of the principal compound, δ-9-tetrahydrocannabinol include euphoria, a sense of relaxation and increased appetite. Chronic cannabis use has been associated with the development of a withdrawal syndrome on abrupt discontinuation. Withdrawal symptoms typically begin within 24 h of abstinence and manifest as irritability, nervousness, sleep disturbances and decreased appetite. There is growing evidence that supports the use of plant-derived and synthetic cannabinoids for the treatment of cannabis withdrawal. In this case report, we present 20-year-old woman who developed protracted nausea and vomiting secondary to cannabis withdrawal and was successfully treated with nabilone. Nausea and vomiting is not listed in the Diagnostic and Statistical Manual-5 diagnostic criteria for cannabis withdrawal syndrome and is an uncommon symptom presentation.

Topics: Cannabinoids; Cannabis; Diagnosis, Differential; Dronabinol; Female; Humans; Nausea; Substance Withdrawal Syndrome; Vomiting; Young Adult

Topics: Antiemetics; Dronabinol; Humans; Postoperative Complications; Vomiting

Topics: Acquired Immunodeficiency Syndrome; Adult; Antiemetics; Dronabinol; Humans; Male; Nausea; Pneumonia, Pneumocystis; Terminal Care; Vomiting

Marijuana has been reported to be an effective antinauseant and antiemetic in patients receiving cancer chemotherapy. Whether this is due to psychological changes, central antiemetic properties and/or direct effects on gastrointestinal (GI) function is not known. The purpose of these investigations was to determine whether the major constituents of marijuana and the synthetic cannabinoid nabilone have any effects on GI function which can be detected in rodent models of GI transit and motility. Intravenous delta 9-tetrahydrocannabinol (delta 9-THC) slowed the rate of gastric emptying and small intestinal transit in mice and in rats. Delta 9,11-THC, cannabinol and nabilone given i.v. also inhibited small intestinal transit in mice, but were less effective in reducing gastric emptying. Cannabidiol given i.v. had no effect on gastric emptying or intestinal transit. Those cannabinoids which inhibited GI transit did so at doses equal to, or lower, than those reported to produce central nervous system activity. In rats, delta 9-THC produced greater inhibition of gastric emptying and small intestinal transit than large bowel transit, indicating a selectivity for the more proximal sections of the gut. In addition, i.v. delta 9-THC decreased the frequency of both gastric and intestinal contractions without altering intraluminal pressure. Such changes probably reflect a decrease in propulsive activity, without change in basal tone. These data indicate that delta 9-THC, delta 9,11-THC, cannabinol and nabilone (but not cannabidiol) exert an inhibitory effect on GI transit and motility in rats.

Topics: Analgesia; Animals; Cannabinoids; Cannabinol; Depression, Chemical; Dronabinol; Gastric Emptying; Gastrointestinal Motility; Male; Mice; Mice, Inbred ICR; Nausea; Rats; Rats, Inbred Strains; Vomiting

Topics: Acquired Immunodeficiency Syndrome; Dronabinol; Humans; Male; Middle Aged; Nausea; Vomiting

Topics: Antiemetics; Antineoplastic Agents; Dronabinol; Humans; Nausea; Vomiting

Topics: Antineoplastic Agents; Dronabinol; Humans; Nausea; Vomiting

Topics: Antineoplastic Agents; Dronabinol; Humans; Nausea; Prochlorperazine; Vomiting

Topics: Age Factors; Aged; Antiemetics; Cisplatin; Dronabinol; Humans; Metoclopramide; Vomiting

Nabilone is a cannabinoid anti-emetic which has been extensively evaluated in control of chemotherapy-induced vomiting. A pilot study was undertaken to assess the efficacy of Nabilone in controlling radiotherapy-induced vomiting resistant to a conventional anti-emetic (metoclopramide). Thirty patients receiving wide-field upper abdominal irradiation were prospectively monitored. Fourteen developed no significant nausea or vomiting and in 10 symptoms were controlled by metaclopramide. All six patients who failed to respond to this agent responded to Nabilone. Toxicity with both drugs was minimal. Although patient numbers were small, this initial assessment suggests that Nabilone may be a useful agent in the control of resistant radiation-induced sickness.

Topics: Adult; Antiemetics; Dronabinol; Female; Humans; Male; Metoclopramide; Middle Aged; Nausea; Radiotherapy; Vomiting

Topics: Antiemetics; Antineoplastic Agents; Dronabinol; Humans; Nausea; Vomiting

Topics: Antiemetics; Antineoplastic Agents; Domperidone; Dronabinol; Humans; Metoclopramide; Phenothiazines; Vomiting

Topics: Antiemetics; Antineoplastic Agents; Blood Pressure; Dronabinol; Humans; Nausea; Prochlorperazine; Vomiting

Topics: Ambulatory Care; Antiemetics; Antineoplastic Agents; Dronabinol; Humans; Vomiting

Topics: Antineoplastic Agents; Cannabinoids; Cannabis; Dronabinol; Humans; Nausea; Neoplasms; Vomiting

Cisplatin (cis-diammine-dichloro-platinum) administered at a dose of 3 mg/kg iv induced a reproducible and characteristic emetic response in the dog. It was characterized by a latency period (90-120 min) and multiple emetic episodes occuring within 5 hours following drug administration with sporadic delayed emesis later within the first 24 hours. There was a qualitative similarity between the emetic response of Cisplatin seen in dogs and cancer patients. Metoclopramide (1, 3 mg/kg sc) was found to be the most effective antagonsit of Cisplatin emesis in the dog while haloperidol (1 mg/kg sc) and chlorpromazine (0.3, 1, 3 mg/kg sc) offered a less complete protection. Nabilone (0.1 mg/kg iv) and AL-1612 (1 mg/kg sc) failed to to demonstrate any significant activity. A relationship between antagonism patterns of emetic responses induced by Cisplatin and apomorphine was discussed.

Topics: Animals; Antiemetics; Chlorpromazine; Cisplatin; Dogs; Dronabinol; Female; Haloperidol; Indoles; Male; Metoclopramide; Piperidines; Vomiting