Research Index | Medline Index


Cannabis Research - Medical Uses - anti-emetic


Authors
Ungerleider JT, Andrysiak TA, Fairbanks LA, Tesler AS, Parker RG
Title
Tetrahydrocannabinol vs. prochlorperazine. The effects of two antiemetics on patients undergoing radiotherapy.
Source
Radiology
Date
1984 Feb
Issue
150(2)
Pages
598-9
Abstract
The authors tested the effectiveness of orally administered delta-9-tetrahydrocannabinol (THC) as compared to prochlorperazine for the alleviation of symptoms, such as vomiting and nausea, experienced by patients receiving radiotherapy. The test subjects rated the severity of their illness, as well as the extent of their subsequent moods, their level of concentration, their amount of physical activity, and their desire for social interaction. They chose the drug they preferred and recorded its side effects. The use of THC was slightly more beneficial than the use of prochlorperazine.

Authors
Vincent BJ, McQuiston DJ, Einhorn LH, Nagy CM, Brames MJ
Title
Review of cannabinoids and their antiemetic effectiveness.
Source
Drugs
Date
1983 Feb
Issue
25 Suppl 1
Pages
52-62
Abstract
Marijuana has been used for over 2 centuries. Its major psychoactive constituent, delta-9-tetrahydrocannabinol (THC) was isolated in 1964 and first used to control nausea and vomiting during chemotherapy in the 1970s. THC has cardiovascular, pulmonary and endocrinological effects as well as actions on the central nervous system. Alterations in mood, memory, motor coordination, cognitive ability, sensorium, spatial- and self-perception are commonly experienced. The precise antiemetic mechanism is unknown. THC and nabilone act at a number of sites within the central nervous system. Cannabinoids have also been shown to inhibit prostaglandin synthesis in vitro. In controlled clinical trials, THC is superior to placebo and prochlorperazine in antiemetic effectiveness. Effectiveness of THC correlates to a 'high' experienced by the patient. A variety of chemotherapy regimens respond to THC including high-dose methotrexate and the doxorubicin, cyclophosphamide, fluorouracil combination. Cisplatin is more resistant. Side effects are generally well tolerated but may limit THC use in the elderly or when high doses are administered. Nabilone, a synthetic cannabinoid, is also an effective antiemetic which is more active than prochlorperazine in preventing chemotherapy-induced emesis, including cisplatin-containing regimens. Side effects are similar to THC and may be dose-limiting. Levonantradol, another synthetic cannabinoid, is an effective antiemetic. It may provide more flexibility in the outpatient setting since it can be administered orally or intramuscularly. Most side effects are mild except for dysphoria which may be dose-limiting.

Authors
Ungerleider JT, Andrysiak T, Fairbanks L, Goodnight J, Sarna G, Jamison K
Title
Cannabis and cancer chemotherapy: a comparison of oral delta-9-THC and prochlorperazine.
Source
Cancer
Date
1982 Aug 15
Issue
50(4)
Pages
636-45
Abstract
Delta-9-tetrahydrocannabinol (THC) and prochlorperazine (Compazine) were found to be equally efficacious in reducing nausea and vomiting associated with cancer chemotherapy across a wide range of chemotherapeutic regimens and tumor types. Both drugs were administered orally one hour before chemotherapy, then every four hours for a total of four doses. Compazine was administered in a fixed dose of 10 mg; THC was administered by body surface area (BSA): BSA less than 1.4 m2 = 7.5 mg; BSA 1.4-1.8 m2 = 10- mg; and BSA greater than 1.8 m2 = 12.5 mg. Two hundred and fourteen subjects (75% of whom had previously received Compazine with varying results) were evaluated employing a double-blind, crossover design. Additional parameters evaluated were study drug effects on appetite, food intake, mood, activity, relaxation, interaction, and concentration. There were significant drug effects with THC: less ability to concentrate (P less than 0.01), less social interaction (P less than 0.05), and less activity (P less than 0.05). There were no significant differences between the two drugs in the level of food intake or appetite. Patients of all ages did equally well on both drugs. Neither past marijuana use nor past Compazine use were related to study the drug efficacy. Those patients who correctly identified their THC cycle did better on THC versus those who could not correctly identify which antiemetic they had received (P less than 0.05). There were more drug-related effects associated with THC, but these did not reduce the patients' preference for the drug, and were associated with nausea reduction (P less than 0.05).

Authors
Orr LE, McKernan JF
Title
Antiemetic effect of delta 9-tetrahydrocannabinol in chemotherapy-associated nausea and emesis as compared to placebo and compazine.
Source
Journal of Clinical Pharmacology
Date
1981 Aug-Sep
Issue
21(8-9 Suppl)
Pages
76S-80S
Abstract
Fifty-five patients harboring a variety of neoplasms and previously found to have severe nausea or emesis from antitumor drugs were given antiemetic prophylaxis in a double-blind, randomized crossover fashion. delta 9-Tetrahydrocannabinol (THC), prochlorperazine, and placebo were compared. Nausea was absent in 40 of 55 patients receiving THC, in 8 of 55 patients receiving prochlorperazine, and in 5 of 55 in the placebo group. THC appeared to be more efficacious in controlling the emesis associated with cyclophosphamide, 5-fluorouracil, and doxorubicin and less so for nitrogen mustard and the nitrosourea. THC appears to offer significant control of nausea in most patients and exceeds by far that provided by prochlorperazine (P less than 0.005).

Authors
Sweet DL, Miller NJ, Weddington W, Senay E, Sushelsky L
Title
delta 9-Tetrahydrocannabinol as an antiemetic for patients receiving cancer chemotherapy. A pilot study.
Source
Journal of Clinical Pharmacology
Date
1981 Aug-Sep
Issue
21(8-9 Suppl)
Pages
70S-75S
Abstract
We conducted a pilot study to ascertain the potential toxicity and possible efficacy of delta 9-tetrahydrocannabinol (THC) at the oral dose of 5 mg/m2. Over one third of the study population, which consisted of 25 patients, reported significant dysphoric reactions. Four patients (16 per cent) elected not to take THC rather than experience loss of motivation which interfered with their professional life. Paradoxically, on eight occasions nausea seemed to worsen with THC. After the first administration of THC, 18 patients (72 per cent) described less nausea and only two individuals (8 per cent) noted complete resolution of nausea. Two patients reported worsening of their nausea. Eighteen patients noted less vomiting (69 per cent) after the first administration of THC and four patients (15 per cent) reported completed resolution of their vomiting. By the third administration of THC, one of 14 patients (7 per cent) and two of 14 (14 per cent) noted complete alleviation of nausea and vomiting, respectively. Patients who scored high on the Brief Psychiatric Rating Scale, who reported euphoria, or who had psychogenic nausea and vomiting were most likely to have a favorable antiemetic response. The results of this pilot study suggest that orally administered THC is a toxic but transiently effective antiemetic when administered at 5 mg/m2.

Authors
Anderson PO, McGuire GG
Title
Delta-9-tetrahydrocannabinol as an antiemetic.
Source
American Journal of Hospital Pharmacy
Date
1981 May
Issue
38(5)
Pages
639-46
Abstract
The use of delta-9-tetrahydrocannabinol (THC) as an antiemetic in patients undergoing cancer chemotherapy is reviewed. The pharmacokinetics of THC is discussed, and the agent's effects on the central nervous, cardiovascular, respiratory, gastrointestinal, immune, endocrine, and reproductive systems are presented. The toxicology, potential hazards, and adverse reactions of THC are reviewed. Also reviewed are studies of THC's use as an antiemetic. THC appears to be an effective antiemetic in cancer patients undergoing chemotherapy. The maximal antinauseant effects often correlate with the attainment of a "high". THC has been found consistently more effective than placebo and at least as effective as prochlorperazine. In phenothiazine-resistant patients, THC's effectiveness has exceeded that of the phenothiazines. Efficacy may depend on the chemotherapeutic agent causing emesis. Elderly patients do not tolerate the THC "high" well. Concurrent administration of phenothiazines with THC may block the "high" without reducing THC's antiemetic effectiveness. Because of variations in individual tolerance, absorption, and the form of chemotherapy, flexibility is necessary in establishing the correct dose of THC.

Authors
Poster DS, Penta JS, Bruno S, Macdonald JS
Title
delta 9-tetrahydrocannabinol in clinical oncology.
Source
JAMA
Date
1981 May 22-29
Issue
245(20)
Pages
2047-51
Abstract
After anecdotal reports of marijuana's providing antiemetic activity in cancer chemotherapy patients refractory to standard agents, orally administered delta 9-tetrahydrocannabinol (THC) was formally studied by a number of investigators. In six of seven well-controlled studies, orally administered THC was a superior antiemetic agent compared with control agents. The THC toxic effects are notable but manageable. Patients rarely require hospitalization after the development of THC-induced dysphorias. However, serious toxic effects are uncommon and the most frequently noted effects are somnolence, conjunctivitis, and tachycardias. Because certain subgroups of patients are more prone to have toxicities develop, careful selection of the candidates to receive this agent is mandatory. Overall, the benefits of orally administered THC use represent a major advance in antiemetic therapy.

Authors
Chang AE, Shiling DJ, Stillman RC, Goldberg NH, Seipp CA, Barofsky I, Rosenberg SA
Title
A prospective evaluation of delta-9-tetrahydrocannabinol as an antiemetic in patients receiving adriamycin and cytoxan chemotherapy.
Source
Cancer
Date
1981 Apr 1
Issue
47(7)
Pages
1746-51
Abstract
A randomized, double-blind, placebo-controlled trial of oral and smoked delta-9-tetrahydrocannabinol (THC) was performed in eight patients with resected soft tissue sarcomas who received adjuvant Adriamycin and Cytoxan chemotherapy. Each patient served as his own control. Delta-9-tetrahydrocannabinol, in comparison with a placebo, did not significantly reduce the number of vomiting and retching episodes, volume of emesis, degree of nausea, or duration of nausea. In contrast to a previous report where significant antiemetic effects of THC were observed in patients receiving high-dose methotrexate, THC did not effectively reduce emesis induced by Adriamycin and Cytoxan. These findings suggest that the antiemetic properties of THC are effective only against specific chemotherapeutic drugs.

Authors
Orr LE, McKernan JF, Bloome B
Title
Antiemetic effect of tetrahydrocannabinol. Compared with placebo and prochlorperazine in chemotherapy-associated nausea and emesis.
Source
Archives of Internal Medicine
Date
1980 Nov
Issue
140(11)
Pages
1431-3
Abstract
Fifty-five patients harboring a variety of neoplasms and previously found to have severe nausea or emesis from antitumor drugs were given antiemetic prophylaxis in a double-blind, randomized, crossover fashion. Tetrahydrocannabinol (THC), prochlorperazine, and placebo were compared. Nausea was absent in 40 of 55 patients receiving THC, eight of 55 patients receiving prochlorperazine, and five of 55 in the placebo group. The antiemetic effect of THC appeared to be more efficacious for cyclophosphamide, fluorouracil, and doxorubicin hydrochloride, and less so for mechlorethamine hydrochloride and the nitrosureas. Tetrahydrocannabinol appears to offer significant control of nausea in most patients and exceeding by far that provided by prochlorperazine.

Authors
Colls BM, Ferry DG, Gray AJ, Harvey VJ, McQueen EG
Title
The antiemetic activity of tetrahydrocannabinol versus metoclopramide and thiethylperazine in patients undergoing cancer chemotherapy.
Source
New Zealand Medical Journal
Date
1980 Jun 25
Issue
91(662)
Pages
449-51
Abstract
A double blind-cross-over randomised clinical trial has been conducted to compare the antiemetic effects of tetrahydrocannabinol, thiethylperazine and metoclopramide. There were no significant differences in the antiemetic effects of these drugs. The incidence of adverse reactions as recorded by both the staff and the patients was significantly higher in the tetrahydrocannabinol group than in either the metoclopramide or thiethylperazine groups. This trial has established that in the dosages used tetrahydrocannabinol given by mouth has an antiemetic effect of approximately the same order as thiethylperazine and metoclopramide. However, its adverse effects are sufficiently greater than those of the other agents to prevent is widespread usage for this purpose. Tetrahydrocannabinol taken by mouth is not recommended as a routine antiemetic agent in cancer chemotherapy.

Authors
Lucas VS Jr, Laszlo J
Title
delta 9-Tetrahydrocannabinol for refractory vomiting induced by cancer chemotherapy.
Source
JAMA
Date
1980 Mar 28
Issue
243(12)
Pages
1241-3
Abstract
Fifty-three patients receiving antineoplastic chemotherapy who had experienced severe nausea and vomiting refractory to standard antiemetic agents were treated with delta 9-tetrahydrocannabinol (THC). These patients were given THC 8 to 12 hours before, during, and for 24 hours after chemotherapy. Ten patients (19%) had no further nausea and vomiting; 28 (53%) had at least a 50% reduction of nausea and vomiting compared to previous courses with the same agents. No appreciable reduction of nausea and vomiting was seen in 15 patients (28%). Toxic reactions were generally mild, with only four patients experiencing reactions that necessitated stopping THC therapy. We suggest that, since THC is a useful antimetic agent in patients having refractory chemotherapy-induced vomiting, existing restrictions prohibiting its therapeutic use should promptly be eased.

Authors
Laszlo J
Title
Nausea and vomiting as major complications of cancer chemotherapy.
Source
Drugs
Date
1983 Feb
Issue
25 Suppl 1
Pages
1-7
Abstract
Significant advances in the treatment of certain disseminated malignancies have been accompanied by an increased awareness of the consequences of inadequate antiemetic therapy. Nausea and vomiting are predisposing factors to patient non-compliance with treatment regimens and impose mental and physical suffering that diminishes the quality of life. The extent of medical complications associated with vomiting depends on its severity and duration and can include oesophageal tears, bone fractures, malnutrition and major metabolic derangements. The pharmacological management of chemotherapy-induced nausea and vomiting is influenced by the aetiology and mechanism as well as whether therapy is to take place in the hospital or outpatient setting. No single drug is successful in all cases. Side effects due to antiemetic drugs also limit their usefulness. Major treatment alternatives at present include the phenothiazines, antihistamines, benzquinamide derivatives, butyrophenones such as haloperidol, the dopamine receptor antagonist domperidone, and metoclopramide. Cannabinoids, particularly delta-9-tetrahydrocannabinol and nabilone have stimulated considerable research interest. Studies of the role of high dose corticosteroids either alone or in combination with other antiemetics have also been undertaken. Newer chemotherapeutic regimens are more emetic than in the past. Inadequate management of nausea and vomiting is deleterious to the health and well-being of patients and any delay in providing an aggressive therapeutic approach aggravates the problem. This symposium is designed to provide some answers to this therapeutic problem.

Authors
Sallan SE, Cronin C, Zelen M, Zinberg NE
Title
Antiemetics in patients receiving chemotherapy for cancer: a randomized comparison of delta-9-tetrahydrocannabinol and prochlorperazine.
Source
New England Journal of Medicine
Date
1980 Jan 17
Issue
302(3)
Pages
135-8
Abstract
Delta-9-tetrahydrocannabinol (THC) is an effective antiemetic as compared with placebos in patients receiving chemotherapy for cancer. In this study we compared THC with prochlorperazine (compazine) in a randomized, double-blind, crossover trial with patients who had failed to benefit from standard antiemetic therapy. Regardless of the emetic activity of the chemotherapeutic agents, there were more complete responses to THC courses (in 36 of 79 courses) than to prochlorperazine (in 16 of 78 courses). Of 25 patients who were treated with both drugs and who expressed a preference, 20 preferred THC (P = 0.005). Among patients under 20 years of age there was a higher proportion of complete responses to THC courses (15 of 20) than among older patients (21 of 59 courses; P = 0.004). Increased food intake occurred more frequently with THC (P = 0.008) and was associated with the presence of a "high." Of 36 THC courses resulting in complete antiemetic responses, 32 were associated with a high. We conclude that THC is an effective antiemetic in many patients who receive chemotherapy for cancer and for whom other antiemetics are ineffective. (N Engl J Med 302:135--138, 1980).

Authors
Doblin RE, Kleiman MA
Title
Marijuana as antiemetic medicine: a survey of oncologists' experiences and attitudes [see comments]. CM - Comment in: J Clin Oncol 1991 Nov;9(11):2079-80
Source
Journal of Clinical Oncology
Date
1991 Jul
Issue
9(7)
Pages
1314-9
Abstract
A random-sample, anonymous survey of the members of the American Society of Clinical Oncology (ASCO) was conducted in spring 1990 measuring the attitudes and experiences of American oncologists concerning the antiemetic use of marijuana in cancer chemotherapy patients. The survey was mailed to about one third (N = 2,430) of all United States-based ASCO members and yielded a response rate of 43% (1,035). More than 44% of the respondents report recommending the (illegal) use of marijuana for the control of emesis to at least one cancer chemotherapy patient. Almost one half (48%) would prescribe marijuana to some of their patients if it were legal. As a group, respondents considered smoked marijuana to be somewhat more effective than the legally available oral synthetic dronabinol ([THC] Marinol; Unimed, Somerville, NJ) and roughly as safe. Of the respondents who expressed an opinion, a majority (54%) thought marijuana should be available by prescription. These results bear on the question of whether marijuana has a "currently accepted medical use," at issue in an ongoing administrative and legal dispute concerning whether marijuana in smoked form should be available by prescription along with synthetic THC in oral form. This survey demonstrates that oncologists' experience with the medical use of marijuana is more extensive, and their opinions of it are more favorable, than the regulatory authorities appear to have believed.

Id Code
76010695
Authors
Sallan SE, Zinberg NE, Frei E 3d
Title
Antiemetic effect of delta-9-tetrahydrocannabinol in patients receiving cancer chemotherapy.
Source
New England Journal of Medicine
Date
1975 Oct 16
Issue
293(16)
Pages
795-7
Abstract
Anecdotal accounts suggested that smoking marihuana decreases the nausea and vomiting associated with cancer chemotherapeutic agents. Oral delta-9-tetrahydrocannabinol was compared with placebo in a controlled, randomized, "double-blind" experiment. All patients were receiving chemotherapeutic drugs known to cause nausea and vomiting of central origin. Each patient was to serve as his own control to determine whether tetrahydrocannabinol had an antiemetic effect. Twenty-two patients entered the study, 20 of whom were evaluable. For all patients an antiemetic effect was observed in 14 of 20 tetrahydrocannabinol courses and in none of 22 placebo courses. For patients completing the study, response occurred in 12 of 15 courses of tetrahydrocannabinol and in none of 14 courses of placebo (P less than 0.001). No patient vomited while experiencing a subjective "high". Oral tetrahydrocannabinol has antiemetic properties and is significantly better than a placebo in reducting vomiting caused by chemotherapeutic agents.

Id Code
80142796
Authors
Ekert H, Waters KD, Jurk IH, Mobilia J, Loughnan P
Title
Amelioration of cancer chemotherapy-induced nausea and vomiting by delta-9-tetrahydrocannabinol.
Source
Medical Journal of Australia
Date
1979 Dec 15
Issue
2(12)
Pages
657-9
Abstract
The antinausea and antivomiting effects of delta-9-tetrahydrocannabinol (THC) in children receiving cancer chemotherapy were compared with those of metoclopramide syrup and prochlorperazine tablets in two double-blind studies. THC was found to be a significantly better antinausea and antivomiting agent, but not all patients obtained relief of nausea and vomiting with THC. In some patients, THC enhanced appetite during a course of chemotherapy. In two patients, a "high" associated with THC administrationwas reported. Drowsiness was reported significantly more frequently with THC.

Id Code
79125620
Authors
Roth SH
Title
Stereospecific presynaptic inhibitory effect of delta9-tetrahydrocannabinol on cholinergic transmission in the myenteric plexus of the guinea pig.
Source
Canadian Journal of Physiology & Pharmacology
Date
1978 Dec
Issue
56(6)
Pages
968-75
Abstract
delta9-Tetrahydrocannabinol (THC) is very lipid soluble, as are many anesthetic agents. The action of anesthetics is nonspecific; isomers are equieffective. THC is optically active; therefore, the effects of its stereoisomers were studied on the electrically and chemically stimulated longitudinal muscle strip of guinea pig ileum. The results demonstrate that both isomers depress the response to electrical stimulation in a dose-related manner. The maximum effect is gradually reached in approximately 20 min. The (-) isomer is 24.6-fold more active than the (+) isomer (ED50 for (-) THC is 1.25 X 10(-7) M, for (+) THC, 3.08 X 10(-6) M) and the site of action appears to be presynaptic because responses to ACh are not significantly depressed. The depressant effects are relatively nonreversible. Membrane concentrations calculated at the ED50 values for the (-) isomer are of the order of 0.5 mM/kg dry membrane, well within the range for anesthesia. Thus THC may be regarded as a partial anesthetic since some of its actions are similar to those of the classical anesthetics, yet it possesses selective action at the neuronal membrane or tissue level.

Id Code
80086122
Authors
Chang AE, Shiling DJ, Stillman RC, Goldberg NH, Seipp CA, Barofsky I, Simon RM, Rosenberg SA
Title
Delata-9-tetrahydrocannabinol as an antiemetic in cancer patients receiving high-dose methotrexate. A prospective, randomized evaluation.
Source
Annals of Internal Medicine
Date
1979 Dec
Issue
91(6)
Pages
819-24
Abstract
Fifteen patients with osteogenic sarcoma receiving high-dose methotrexate chemotherapy were studied in a randomized, double-blind, placebo-controlled trial of oral and smoked delta-9-tetrahydrocannabinol (THC) as an antiemetic. Each patient served as his or her own control. Fourteen of 15 patients had a reduction in nausea and vomiting on THC as compared to placebo. Delta-9-tetrahydrocannabinol was significantly more effective than placebo in reducing the number of vomiting and retching episodes, degree of nausea, duration of nausea, and volume of emesis (P less than 0.001). There was a 72% incidence of nausea and vomiting on placebo. When plasma THC concentrations measured less than 5.0 ng/mL, 5.0 to 10.0 ng/mL, and greater than 10.0 ng/mL, the incidences of nausea and vomiting were 44%, 21%, and 6%, respectively. Delta-9-tetrahydrocannabinol appears to have significant antiemetic properties when compared with placebo in patients receiving high-dose methotrexate.

Id Code
80086123
Authors
Frytak S, Moertel CG, O'Fallon JR, Rubin J, Creagan ET, O'Connell MJ, Schutt AJ, Schwartau NW
Title
Delta-9-tetrahydrocannabinol as an antiemetic for patients receiving cancer chemotherapy. A comparison with prochlorperazine and a placebo.
Source
Annals of Internal Medicine
Date
1979 Dec
Issue
91(6)
Pages
825-30
Abstract
The antiemetic activity and side-effects of delta-9-tetrahydrocannabinol (THC) were evaluated in 116 patients (median age 61 years) receiving combined 5-fluorouracil and semustine (methyl CCNU) therapy for gastrointestinal carcinoma. In a double-blind study, patients were randomized to receive THC, 15 mg orally three times a day, prochlorperazine, 10 mg orally three times a day, or placebo. The THC had superior antiemetic activity in comparison to placebo, but it showed no advantage over prochlorperazine. Central nervous system side-effects, however, were significantly more frequent and more severe with THC. With the dosage and schedule we used, and in our patient population of largely elderly adults, THC therapy resulted in an overall more unpleasant treatment experience than that noted with prochlorperazine or placebo. Although THC may have a role in preventing nausea and vomiting associated with cancer chemotherapy, this role must be more clearly defined before THC can be recommended for general use.

Id Code
80083181
Authors
Kluin-Neleman JC, Neleman FA, Meuwissen OJ, Maes RA
Title
delta 9-Tetrahydrocannabinol (THC) as an antiemetic in patients treated with cancerchemotherapy; a double-blind cross-over trial against placebo.
Source
Veterinary & Human Toxicology
Date
1979 Oct
Issue
21(5)
Pages
338-40
Abstract
A double-blind cross-over trial with delta 9-tetrahydrocannabinol (THC) and placebo was employed to test the antiemetic effect on nausea and vomiting after MOPP-therapy. Although THC had remarkable antiemetic effects, the side effects were severe. Most patients preferred the nausea and the vomiting after MOPP-therapy to the use of THC. A relation between the antiemetic action or the side-effects and the blood-level of THC could not be demonstrated.

Id Code
89053621
Authors
McCabe M, Smith FP, Macdonald JS, Woolley PV, Goldberg D, Schein PS
Title
Efficacy of tetrahydrocannabinol in patients refractory to standard antiemetic therapy.
Source
Investigational New Drugs
Date
1988 Sep
Issue
6(3)
Pages
243-6
Abstract
Oral delta-9-tetrahydrocannabinol (THC), 15 mg/m2, was compared to prochlorperazine (PCZ), 10 mg. for the control of cancer chemotherapy-related emesis. Thirty-six patients whose vomiting was refractory to standard antiemetic therapy were entered in this randomized comparative cross-over study. THC decreased nausea and vomiting in 23 of 36 (64%) patients compared to 1 of 36 receiving PCZ. THC efficacy was not dependent on the class of antineoplastic-agent inducing the emetic symptoms, age of patients or type of sensorial change experienced. Using the 15 mg/m2 dose, all patients experienced transient sensorial changes, characterized as a pleasant "high" in 19 or a variable state of dysphoria in 17 cases. This study confirms the usefulness of THC in patients whose chemotherapy-induced nausea and vomiting is refractory to other standard antiemetics. While excellent antiemetic control was achieved at the dosage 15 mg/m2, dysphoria was encountered at this dose level and we recommend that an initial dose of 5 mg/m2 which, if necessary, can be carefully increased to achieve maximum antiemetic benefit.

Id Code
95295499
Authors
Abrahamov A, Abrahamov A, Mechoulam R
Title
An efficient new cannabinoid antiemetic in pediatric oncology.
Source
Life Sciences
Date
1995
Issue
56(23-24)
Pages
2097-102
Abstract
Delta-8-tetrahydrocannabinol (delta-8-THC), a cannabinoid with lower psychotropic potency than the main Cannabis constituent, delta-9-tetrahydrocannabinol (delta-9-THC), was administered (18 mg/m2 in edible oil, p.o.) to eight children, aged 3-13 years with various hematologic cancers, treated with different antineoplastic drugs for up to 8 months. The total number of treatments with delta-8-THC so far is 480. The THC treatment started two hours before each antineoplastic treatment and was continued every 6 hrs for 24 hours. Vomiting was completely prevented. The side effects observed were negligible.

Id Code
94289499
Authors
Schwartz RH, Beveridge RA
Title
Marijuana as an antiemetic drug: how useful is it today? Opinions from clinical oncologists [see comments]. CM - Comment in: J Addict Dis 1995;14(1):5-14
Source
Journal of Addictive Diseases
Date
1994
Issue
13(1)
Pages
53-65
Abstract
OBJECTIVE: To determine the antiemetic drug preferences of practicing adult oncologists and to estimate the frequency of use of marijuana smoke as an antiemetic agent. DESIGN: Identical mailed questionnaire surveys on antiemetic preferences, distributed prior to approval of ondansetron. SAMPLE: Two groups of practicing clinical adult oncologists were surveyed. The first group (N = 120) consisted of every twentieth board-certified, American member of the American Society of Clinic Oncology culled from the 1990 ASCO membership directory in alphabetical order. The second group (N = 60) consisted of every adult clinical oncologist in metropolitan Washington, D.C. MEASUREMENTS/RESULTS: Completed surveys were returned by 141 (78%) physicians; the responses from both groups were almost identical (Wilcoxon Rank Sum Test). Marijuana (either as marijuana smoke or oral tetrahydrocannabinol) ranked ninth in order of preference for the treatment of mild to moderate nausea and vomiting, and sixth for the treatment of more severe symptoms induced by chemotherapy. Most (94 or 65%) respondents reported having prescribed marijuana or oral THC 10 times or less; only 5 (3.5%) had prescribed such drugs more than 100 times which represented for them about 1% of their average lifetime clinical patient load. The respondents who had prescribed marijuana in any form thought that it had effectively relieved post-chemotherapy nausea or vomiting in 50% of patients. Unpleasant adverse effects were estimated to have occurred in 25% of treated patients. Only 8 (6%) respondents indicated that they would prescribe marijuana much more frequently--if there were no legal barriers associated with its medical use. CONCLUSION: Marijuana in any form was believed to be efficacious for 50% of patients with pre- or post-chemotherapy nausea or vomiting. However, one of four patients who received it complained of bothersome adverse effects. At the time of the study, cannabis was prescribed or recommended relatively infrequently by American clinical oncologists (i.e., those who actually prescribed chemotherapy). Even if it was freely available and restrictions on its use liberalized, smokeable marijuana, according to responses given on this survey, would not be used much more frequently by American oncologists.

Id Code
93197343
Authors
Mattes RD, Shaw LM, Edling-Owens J, Engelman K, Elsohly MA
Title
Bypassing the first-pass effect for the therapeutic use of cannabinoids.
Source
Pharmacology, Biochemistry & Behavior
Date
1993 Mar
Issue
44(3)
Pages
745-7
Abstract
An oral formulation of delta-9-tetrahydrocannabinol (THC) in sesame oil (Marinol) is at present used for the management of chemotherapy-related nausea and emesis. However, due partly to poor bioavailability, its efficacy is variable. To circumvent possible metabolism in the gut and a first-pass effect by the liver, a suppository formulation of THC hemisuccinate ester was prepared. Administration of the suppository containing 11.8 mg of the hemisuccinate ester (equivalent to 9 mg THC) to three adult females (two of whom had previously exhibited low plasma drug levels following a 10-mg dose of the oral formulation) led to a marked and sustained elevation of plasma drug levels. Areas under the curves for plasma THC were more than 30-fold higher than after oral dosing. The suppository was well tolerated. The higher and more sustained plasma drug level achieved with this new formulation should enhance its antiemetic efficacy.

Authors
- Gonzalez-Rosales F, Walsh D
Title
- Intractable nausea and vomiting due to gastrointestinal mucosal metastases relieved by tetrahydrocannabinol (dronabinol).
Language
- Eng
Date
- 1997 Nov
Issue
- 0885-3924
Source
- J Pain Symptom Manage
Pages
- 311-4
Country
- UNITED STATES
Abstract
- Four years following resection of a Clark's level IV malignant melanoma, a 50-year-old man developed widespred metastatic disease involving the liver, bones, brain, gastrointestinal mucosa, and lungs. One week after whole brain radiation therapy, he was admitted to the hospital for nausea, vomiting, and pain. He was treated with several antiemetic drugs, but it was not until dronabinol was added that the nausea and vomiting stopped. Dronabinol was an effective antiemetic used in combination with prochlorperazine in nausea and vomiting unresponsive to conventional antiemetics.
Research Institute
- Department of Hematology/Oncology, Cleveland Clinic Cancer Center, Cleveland Clinic Foundation, Ohio 44195, USA.
Source
- J Pain Symptom Manage 1997 Nov;14(5):311-4

Authors
- Holdcroft A, Smith M, Jacklin A, Hodgson H, Smith B, Newton M, Evans F
Title
- Pain relief with oral cannabinoids in familial Mediterranean fever [see comments]
Language
- Eng
Date
- 1997 May
Issue
- 0003-2409
Source
- Anaesthesia
Pages
- 483-6
Country
- ENGLAND
Abstract
- Cannabinoids have analgesic and, possibly, anti-inflammatory properties but their clinical use has been restricted by legislation. This is the first United Kingdom report of the controlled use of a standardised pharmaceutical preparation of cannabinoids in capsular form. The therapy was assessed in a patient with familial Mediterranean fever, who presented with chronic relapsing pain and inflammation of gastrointestinal origin. After determining a suitable analgesic dosage, a double-blind placebo-controlled cross-over trial was conducted using 50 mg tetrahydrocannabinol daily in five doses in the active weeks and measuring effects on parameters of inflammation and pain. Although no anti-inflammatory effects of tetrahydrocannabinol were detected during the trial, a highly significant reduction (p < 0.001) in additional analgesic requirements was achieved. Future study designs can now incorporate prescribable forms of cannabinoids but the choice of previous cannabis users only as patients has clinical limitations. Cannabis naive patients would tolerate controlled investigations but may generate medicolegal problems.
Research Institute
- Hammersmith Hospital, London, UK.
Comment
- Comment in: Anaesthesia 1997 Nov;52(11):1116-7
Source
- Anaesthesia 1997 May;52(5):483-6

Authors
- Dansak DA
Title
- Medical use of recreational drugs by AIDS patients.
Language
- Eng
Date
- 1997
Issue
- 1055-0887
Source
- J Addict Dis
Pages
- 25-30
Country
- UNITED STATES
Abstract
- A survey of 72 patients at an AIDS clinic regarding self-medication with recreational drugs for medical or psychological conditions related to their illness disclosed that marijuana was the primary drug used. The perceived benefit was for gastrointestinal conditions such as nausea, vomiting, indigestion and appetite improvement. Use of other "recreational" drugs as self-medication was reported to usually be ineffective or to worsen the condition they sought to help. Fifty-eight percent of patients reported some attempt to self-medicate. Thirty-two percent were currently using marijuana, and most admitted to pre-AIDS marijuana use. Fifty-seven percent of the sample reported some pre-AIDS drug use, primarily alcohol and marijuana. Results are discussed in terms of potential clinical problems arising from continued recreational drug use among AIDS patients.
Research Institute
- Department of Psychiatry, College of Medicine, University of South Alabama, Mobile 36693, USA.
Source
- J Addict Dis 1997;16(3):25-30