Dronabinol and prochlorperazine in combination for treatment of cancer chemotherapy-induced nausea and vomiting

Abstract

Dronabinol (Marinol, Roxane Laboratories, Columbus, OH) and prochlorperazine were tested alone and in combination in a randomized, double-blind, parallel group, multicenter study. Patients were randomized to receive either 1) dronabinol 10 mg every 6 hr plus placebo; 2) placebo plus prochlorperazine 10 mg every 6 hr; or 3) dronabinol and prochlorperazine, each 10 mg every 6 hr. Antiemetic treatment was begun 24 hr prior to and continued for 24 hr after the last dose of chemotherapy; all was given orally. Only 29% of patients in group 3 versus 47% in group 1 and 60% in group 2 experienced nausea after chemotherapy. In addition, the median duration per episode and severity of nausea were significantly less with combination therapy. Vomiting occurred after chemotherapy in 41%, 55%, and 35% of patients in groups 1, 2, and 3, respectively. The median duration per episode of vomiting was 1 min in group 3 versus two in group 1 and four in group 2. Side effects, primarily CNS, were more common in group 1 than in group 2; addition of prochlorperazine to dronabinol appeared to decrease the frequency of dysphoric effects seen with the latter agent. The combination was significantly more effective than was either single agent in controlling chemotherapy-induced nausea and vomiting.

Cannabinoids

“…Moreover, it is possible that certain effects are enhanced and others reduced, as is the case with phenothiazines applied against side effects of cancer chemotherapy. In a study by Lane et al (1991), a combination of prochlorperazine and dronabinol was more effective in reducing unwanted effects of the antineoplastic medication than the phenothiazine alone, and the incidence of cannabinoid-induced adverse effects was decreased when dronabinol was combined with prochlorperazine, which also has antipsychotic properties [384]. Cannabis, caffeine and tobacco reduced the blood pressure reactivity protection of ascorbic acid, probably through their dopaminergic effects [385].…”

Treatment of gastroparesis

“…It works presumably through its effects on cannabinoid receptors in the CNS. It is very effective in preventing nausea, especially when combined with prochlorperazine, in patients with chemotherapy-induced nausea [21]. It is fairly expensive ($3.00 per 5-mg dose) and has the potential for CNS-related side effects, such as euphoria, somnolence, and confusion, but is reasonable to try in patients with refractory symptoms from gastroparesis and can also be used to stimulate appetite.…”

Cannabinoide in der Behandlung von �belkeit und Erbrechen

“…Die orale Applikation von Nabilone wurde in 16 Studien untersucht [1,5,6,7,10,12,14,17,20,25,26,28,38], Dronabinol in 13 Studien [3,4,11,13,18,19,23,24,27,31,32,41] und die intramuskuläre Gabe von Levonantradol in einer Studie [16]. In diesen Studien wurden Cannabinoide nach 1-6 Chemotherapiezyklen eingesetzt und die antiemetische Effektivität über 24 h untersucht.…”