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Dronabinol for chemotherapy-induced nausea and vomiting unresponsive to antiemetics

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Abstract

Chemotherapy-induced nausea and vomiting (CINV) is one of the most common symptoms feared by patients, but may be prevented or lessened with appropriate medications. Several antiemetic options exist to manage CINV. Corticosteroids, serotonin receptor antagonists, and neurokinin receptor antagonists are the classes most commonly used in the prevention of CINV. There are many alternative drug classes utilized for the prevention and management of CINV such as antihistamines, benzodiazepines, anticonvulsants, cannabinoids, and dopamine receptor antagonists. Medications belonging to these classes generally have lower efficacy and are associated with more adverse effects. They are also not as well studied compared to the aforementioned agents. This review will focus on dronabinol, a member of the cannabinoid class, and its role in CINV. Cannabis sativa L. (also known as marijuana) contains naturally occurring delta-9-tetrahydrocannibinol (delta-9-THC). The synthetic version of delta-9-THC is the active ingredient in dronabinol that makes dronabinol an orally active cannabinoid. Evidence for clinical efficacy of dronabinol will be analyzed in this review as monotherapy, in combination with ondansetron, and in combination with prochlorperazine.
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... Various pure and synthetic cannabinoid formulations have been approved to treat cancer-associated pain and chemotherapy-induced nausea and vomiting in patients who failed to respond to conventional anti-emetic and analgesic treatments. The most common anti-emetic treatments include corticosteroids, serotonin receptor agonists, and neurokinin receptor antagonists (May and Glode 2016). Analgesic treatment in cancer patients can range from non-steroidal anti-inflammatory drugs to weak opioids and then potent opioids, depending on pain severity (Jose et al. 2020). ...
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... A synthetic formulation of D 9 -THC, sold under the trade names DronabinolÒ, MarinolÒ or SyndrosÒ, is an approved drug used to stimulate appetite in patients with immunodeficiency syndrome or cancer (Badowski and Yanful 2018). It is also used to treat chemotherapy-induced nausea and vomiting (May and Glode 2016). A cannabis extract containing roughly equal quantities of D 9 -THC and CBD, often referred to as nabiximols and marketed under the trade ...
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... Cannabinoids are widely used in pain relief and may be synthetically modified for use [14]. Dronabinol is a synthetic form of THC with the same psychoactive and pain modulation properties as the plant counterpart [15]. Pharmaceutical cannabinoids include dronabinol (brand names Mari-nol© and Syndros©); nabilone (a synthetic THC derivative with the brand name Cesamet©); and nabiximols (oral spray containing THC and CBD also known as brand names Cesamet© and Epidiolex©) [16]. ...
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... Genotype testing seems to be considered for patients with documented CINV severity (Niewiński, 2018;Trammel, 2013). The above deficiencies may be the reason for insufficient CINV control (Bossi, 2020;May, 2016). On the other hand, literature data show that the scope of compliance with the guidelines is at an unsatisfactory level (Aapro, 2018). ...
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... According to studies, the incidence of nausea and vomiting can be reduced by activating the CB 1 receptor with THC [113]. As a result of receptor stimulation, the proemetic effects of dopamine and serotonin are abolished [114]. In the fight against CINV, oral cannabinoid preparations are more effective than a placebo. ...
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... Genotype testing seems to be considered for patients with documented CINV severity (Niewiński, 2018;Trammel, 2013). The above deficiencies may be the reason for insufficient CINV control (Bossi, 2020;May, 2016). On the other hand, literature data show that the scope of compliance with the guidelines is at an unsatisfactory level (Aapro, 2018). ...
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