Abstract
The major progress in controlling chemotherapy-induced emesis benefits thousands of patients each day. Antiemetic efficacy is found with agents of many different classes, including phenothiazines, butyrophenones, cannabinoids, corticosteroids, substituted benzamides, and serotonin receptor antagonists. To date, the most effective antiemetic regimens are combinations of serotoninreceptor antagonists with corticosteroids.
Most antiemetic studies with cannabinoids have methodological difficulties and can be difficult to interpret. If one concentrates on the better-conducted trials, however, it is clear that cannabinoids possess antiemetic properties in patients receiving cancer chemotherapy. The degree of antiemetic activity demonstrated by cannabinoids is not as high as that seen with several other classes of agents. The side effects associated with cannabinoid use are tolerable, but greater that those seen with other classes of agents.
Studies have not demonstrated an advantage of one tested cannabinoid over another. Results of trials with synthetic cannabinoids, such as levonantradol or nabilone, do not indicate a superior therapeutic index over naturally occurring cannabinoids. Only limited data from well-designed trials can be found comparing inhalant marihuana with other cannabinoids. From that which exists, there is no clear advantage for either inhalant marihuana or for oral THC. Additionally, there is no demonstration that the inhalant agent results in an improved pharmacokinetic profile, an advantage in self titration, or in a different pattern of side effects.
Further studies with cannabinoids, using accepted methodology, could more accurately outline their activity. Decisions should be made whether or not the current moderate degree of efficacy and moderate amount of associated side effects with all tested cannabinoid antiemetics warrant such trials in the context of substantially more active agents that have more favorable toxicity profiles.
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Gralla, R.J. (1999). Cannabinoids and the Control of Chemotherapy-Induced Nausea and Vomiting. In: Nahas, G.G., Sutin, K.M., Harvey, D., Agurell, S., Pace, N., Cancro, R. (eds) Marihuana and Medicine. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-710-9_59
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DOI: https://doi.org/10.1007/978-1-59259-710-9_59
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