Cannabinoids in the Management of Severe Nausea and Vomiting from Cancer Chemotherapy. Some Additional Considerations

Cannabis occurs naturally in the dried flowering or fruiting tops of the Cannabis sativa plant. Cannabis is most often consumed by smoking marihuana. Cannabinoids are the active compounds extracted from cannabis. Recently, there has been renewed interest in cannabinoids for medicinal purposes. The two proven indications for the use of the synthetic cannabinoid (dronabinol) are chemotherapy-induced nausea and vomiting and AIDS-related anorexia. Other possible effects that may prove beneficial in the oncology population include analgesia, antitumor effect, mood elevation, muscle relaxation, and relief of insomnia. Two types of cannabinoid receptors, CB1 and CB2, have been detected. CB1 receptors are expressed mainly in the central and peripheral nervous system. CB2 receptors are found in certain nonneuronal tissues, particularly in the immune cells. Recent discovery of both the cannabinoid receptors and endocannabinoids has opened a new era in research on the pharmaceutical applications of cannabinoids. The use of cannabinoids should be continued in the areas indicated, and further studies are needed to evaluate other potential uses in clinical oncology.

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“…The antiemetic effect of cannabis was suggested in 1972 [20]. The antiemetic effect of cannabis was suggested in 1972 [20].…”

Section: Antiemeticmentioning

confidence: 99%

Established and potential therapeutic applications of cannabinoids in oncology

Walsh

Nelson

Mahmoud

2003

Support Care Cancer

145

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“…Early clinical data regarding Δ 9 -THC were similar to those regarding DEX, in that Δ 9 -THC in combination with other antiemetics (e.g. prochlorperizine) enhances the antiemetic efficacy of treatment relative to either compound administered alone (Garb, 1981; Lane et al, 1990). More recently published data specifically confirm the enhanced antiemetic efficacy of 5-HT 3 receptor antagonists when paired with Δ 9 -THC (Kwiatkowska et al, 2004), although this work was limited by only testing single doses of each compound in combination.…”

Section: Introductionmentioning

confidence: 83%

“…Indeed, a significant body of literature has described several distinct combinations which are superior in terms of antiemetic potency: a) a 5-HT 3 receptor antagonist (e.g. tropisetron or ondansetron) and DEX; b) Δ 9 -THC with dopamine D 2 receptor antagonists; or c) Δ 9 -THC with a 5-HT 3 receptor antagonist (Garb, 1981; Hesketh et al, 2006; Kwiatkowska et al, 2004; Lane et al, 1990). While they are mostly effective against the acute phase of CIV, none have proven particularly efficacious against the delayed phase.…”

Section: Discussionmentioning

confidence: 99%

“…The present protocols were based upon our published findings that tropisetron dose-dependently attenuated cisplatin-induced vomiting (Darmani, 1998), and upon the basic and clinical studies examining combinations of Δ 9 -THC, prochlorperizine, and dexamethasone (Garb, 1981; Hesketh et al, 2006; Kwiatkowska et al, 2004; Lane et al, 1990). Briefly, all animals were randomly divided into two groups.…”

Section: Methodsmentioning

confidence: 99%

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The antiemetic interaction of Δ9-tetrahydrocannabinol when combined with tropisetron or dexamethasone in the least shrew

Wang

Ray

McClanahan

et al. 2009

Pharmacology Biochemistry and Behavior

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5-HT 3 receptor antagonists (e.g. tropisetron) combined with dexamethasone are effective for the acute phase of cisplatin (CIS)-induced emesis. This study determined the possible additive or synergistic antiemetic efficacy of Δ 9 -THC when combined with tropisetron or dexamethasone (DEX). Δ 9 -THC (0 -10 mg/kg i.p.) was injected in combination with tropisetron (0 -5 mg/kg i.p.) or dexamethasone (0 -20 mg/kg i.p.) prior to CIS (20 mg/kg i.p.) in the least shrew, and the induced emesis was recorded for 60 minutes. CIS-induced vomiting was dose-dependently and significantly attenuated by individual administration of Δ 9 -THC (59-97% reductions) and tropisetron (79-100% attenuation), but not dexamethasone (26-40%), although a trend (p < .1) towards reduced vomiting frequency following DEX was noted. Low doses of Δ 9 -THC (0.25 or 0.5 mg/kg) when combined with low doses of tropisetron (0.025, 0.1, or 0.25 mg/kg) were more efficacious in reducing emesis frequency than when given individually, but Δ 9 -THC had no antiemetic interactions with DEX. However, no tested combination provided a significantly greater effect on the number of animals vomiting than their individually-administered counterparts. The modest interaction of Δ 9 -THC with tropisetron suggests they activate overlapping antiemetic mechanisms, while the lack of interaction with dexamethasone needs further clarification.

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“…Δ 9 -THC is the most psychoactive constituent in cannabis. It has many diverse pharmacological effects with therapeutic value in the treatment of different medical conditions [2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Quantification of Cannabinoids in Cannabis Oil Using GC/MS: Method Development, Validation, and Application to Commercially Available Preparations in Argentina

Fernández

Carreras

Larcher

et al. 2020

Planta Medica International Open

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The medicinal use of cannabis oil is increasing all over the world. Few analytical methods for the quantification of cannabinoids have been validated using internationally accredited guidelines. This work describes the development and validation of a selective and sensitive gas chromatography-mass spectrometry method for the qualitative analysis of the main cannabinoids, namely cannabidiolic acid, tetrahydrocannabinolic acid, cannabigerol, and cannabichromene as well as quantitative determination of cannabidiol, Δ9-tetrahydrocannabinol, and cannabinol, present in cannabis oils. The method was fully validated according to Food and Drug Administration and International Conference on Harmonization guidelines. A linear range of 0.1–30 μg/mL was obtained for CBD and Δ9-THC and 0.034–11.7 μg/mL for CBN, presenting determination coefficients above 0.99. The lower limits of quantification ranged from 0.034 to 0.1 μg/mL. The intra- and inter-day precision, calculated in terms of relative standard deviation, were 3.9–13.8 and 4.7–14.1%, respectively. Extraction efficiency at lower limits of quantification was 95–103%. Verification of method validity was performed with authentic cannabis oil samples. To our knowledge, this is the first method available in Argentina, validated according to international guidelines, for quantification of CBD, Δ9-THC, and CBN in cannabis oil. The primary application of this method is to differentiate between cannabis oils with high or low content of Δ9-THC, CBD, or mixed Δ9-THC/CBD. This is of fundamental importance for the patient and so that the physicians can carry out a suitable therapy.

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Cannabinoids in the Management of Severe Nausea and Vomiting from Cancer Chemotherapy. Some Additional Considerations

Cited by 13 publications

References 7 publications

Established and potential therapeutic applications of cannabinoids in oncology

Established and potential therapeutic applications of cannabinoids in oncology

The antiemetic interaction of Δ9-tetrahydrocannabinol when combined with tropisetron or dexamethasone in the least shrew

Quantification of Cannabinoids in Cannabis Oil Using GC/MS: Method Development, Validation, and Application to Commercially Available Preparations in Argentina

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