A systematic review studied 30 randomized comparisons of delta-9-THC preparations with placebo or other anti-emetics, data of efficacy and injury were available. 29. Side effects were a feeling of being high, euphoria, sedation or drowsiness, dizziness, dysphoria or depression, hallucinations, paranoia and hypotension.
Despite advances in pharmacological and non-pharmacological management, nausea and vomiting remain worrying side effects for cancer patients and their families. Oral nabilone, oral dronabinol and intramuscular levonantradole (a synthetic analogue of dronabinol) were tested. Inhaled Cannabis trials were not included. 27 The anti-emetic guidelines of the American Society for Clinical Oncology (ASCO), updated in 2017, recommends that the FDA approve cannabinoids , dronabinol or nabilone, are used for N / V treatment that is resistant to standard anti-emetic therapies. Numerous clinical studies and meta-analyzes have shown that dronabinol and nabilone are effective in the treatment of N / V induced by chemotherapy. Nabilone, a synthetic derivative of delta-9-THC, was first approved in Canada in 1982 and is now also available in the United States. However, cannabinoids were not more effective for patients receiving very low or very high emetogenic chemotherapy.
A different analysis of 15 controlled studies compared nabilone with placebo or anti-emetics available. In 600 cancer patients nabilone was superior to prochlorperazine, domperidone and alizapride, with nabilone being preferred for continuous use. Dronabinol, a synthetically produced delta-9-THC, was approved in the United States in 1986 as an anti-emetic for use in cancer chemotherapy. 23-26 The National Comprehensive Cancer Network Guidelines recommend cannabinoids as a breakthrough for chemotherapy-related N / V. Of all 1,366 patients included in the review, cannabinoids were found to be more effective than the conventional anti-emetics prochlorperazine, metoclopramide, chlorpromazine, thiethylperazine, haloperidol, domperidone and alizapride. 22 Both dronabinol and nabilone have been approved by the US Food and Drug Administration (FDA) for the treatment of N / V associated with cancer chemotherapy in patients who have not responded to conventional anti-emetic therapy/
Individuals reported a higher preference for cannabinoids than placebo or prochlorperazine. Although selective neurokinin-1 antagonists that inhibit substance P have been approved for delayed N / V, a study has been conducted on their availability to determine whether dronabinol, ondansetron or its combination prevents chemotherapy-induced delayed
The overall response –
a composite endpoint – including nausea intensity, vomiting / retching and use of rescue medication was comparable to that of dronabinol (54%), ondansetron (58%) and combination therapy (47%) compared with placebo (20%) .
assessed the quality of the evidence as low for most outcomes. The chemotherapy treatments medicines with low, medium or high emetic potential. Ondansetron, a serotonin 5-hydroxytryptamine 3 (5-HT3) receptor antagonist, is one of the pillars in current antiemetic instruments. There was no difference in the anti-emetic effect of cannabinoids compared to prochlorperazine.
Sixty-one patients were analyzed for efficacy.. The conclusion of the review was that people previously reported the complete absence of N / V when they received cannabinoids compared to placebo, although they were more likely to withdraw from the study due to an adverse reaction. The authors concluded that cannabis-based drugs may be useful for the treatment of refractory chemotherapy-induced N / V; however, they warned that their assessment could change with the availability of newer anti-emetic regimes.05 vs placebo for all).A Cochrane meta-analysis of 23 randomized, randomized RCT studies conducted between 1975 and 1991 in which dronabinol or nabilone was studied as monotherapy or as a supplement to the conventional dopamine antagonists that were the standard anti-emetics at that time 31. Prevalence rates for nausea intensity and vomit / retching were lowest in patients treated with dronabinol, suggesting that dronabinol is beneficial compared with ondansetron in this situation where a substance P inhibitor is currently the preferred drug.
At least 50% of patients receiving moderate emetogenic chemotherapy may experience delayed chemotherapy-induced N / V. In this study, the primary goal was to assess the response 2 to 5 days after moderate to severe emetogenic chemotherapy. Nausea absence was greater in the active treatment groups (dronabinol 71%, ondansetron 64%, combination therapy 53%) compared with placebo (15%;
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