Pharmacotherapeutic considerations for use of cannabinoids to relieve symptoms of nausea and vomiting induced by cytotoxic therapy

Darkovska-Serafimovska, Marija and Serafimovska, Tijana and Taleski, Vaso and Zdravkovska, Milka and Gjorgjeska, Biljana and Balkanov, Trajan (2017) Pharmacotherapeutic considerations for use of cannabinoids to relieve symptoms of nausea and vomiting induced by cytotoxic therapy. Knowledge - International Journal, Scientific Papers. pp. 1939-1943. ISSN 2545-4439

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Patients suffering from malignant diseases, during the treatment, most often receive high-emetogenic chemotherapy. Effective therapeutic options, which do not cause nausea and vomiting for those patients, are limited. Cannabis preparations have been used as a remedy for thousands of years in traditional medicine. Clinical use of cannabinoid substances is restricted, due to legal and ethical reasons, as well as limited evidence showing benefits. Although cannabinoids can cause excessive nausea and vomiting, the antiemetic effect of cannabinoids in patients with malignant disease treated with emetogenic antitumour therapy is well-known. Two medicines - nabilon (Cesamet) and dronabinol (Marinol) in many countries have approved indication „prevention / treatment by chemotherapy induced nausea and vomiting". A systematic review of thirty Randomized Controlled Trials (RCTs) that compared efficacy of nabilon and drobaninol in this indication to placebo and to phenothiazines, can be evidence who demonstrate that cannabis (Tetrahydrocannabinol) is moderately efficacious for relieve nausea and vomiting induced by cytotoxic therapy. Subsequently, a small RCT in 2010, with only 15 patients, indicated that similar effects could be expected from nabiksimols (Sativex), but Sativex was never further developed and explored in that indication. The entrance of new drugs in this indication, especially the newer generations of the 5-HT3 receptor antagonists, and the neurokinine NK1 receptor antagonists (aprepitant), redefined the place and importance of cannabinoids - due to the relatively high incidence of significant psychotropic effects and the need for careful dose titration. Currently, cannabinoids (nabilon, dronabinol) are considered as third or fourth line of choice, or as the last option in patients in which previous "standard" treatments do not achieve the desired effect. Unfortunately, absolutely is unknown ratio of the effectiveness of cannabinoid compared to effectiveness of conventional therapy. A small double blind RCT (a total of 61 patients randomized in three gropus, first one on standard dose of ondansetron, second one on dronabinol and third one on combination of bouth or placebo) indicates a similar effect of dronabinol compared to ondansetron and the lack of additive effect. Based on the recommendations for the use of dronabinol and the described RCT with nabiksimols for treatment of multiple sclerosis (MS) it is to be assumed that a preparation containing similar amounts of tetrahydrocannabinol (THC) and cannabidiol (CBD) (for example 2.5/2.0 mg per dose), opposed to the preparation recommended for patients with MS, (2.5/1.25 mg per dose), could be „add-on" to standard antiemetic therapy (5-HT3 antagonists, dexamethasone) and enable benefit for patients. Further large studies of cannabinoids is required.

Item Type: Article
Subjects: Medical and Health Sciences > Clinical medicine
Divisions: Faculty of Medical Science
Depositing User: Marija Darkovska-Serafimovska
Date Deposited: 30 Jan 2018 11:17
Last Modified: 30 Jan 2018 11:17

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