Study register · detail
Dronabinol for chemotherapy-induced nausea and vomiting unresponsive to antiemetics
No direction reported
SampleNarrative Review
ControlProchlorperazine, metoclopramide…
DesignNarrative Review
Cannabinoidthc
Routeoral
Summary
Narrative review on dronabinol (synthetic delta-9-THC) in chemotherapy-induced nausea/vomiting (CINV), unresponsive to standard antiemetics. Evaluates evidence for dronabinol as monotherapy as well as in combination with ondansetron and prochlorperazine. Cannabinoids show lower efficacy and more side effects than serotonin/neurokinin antagonists, and belong among alternative CINV options.
P
PopulationAdult cancer patients with chemotherapy-induced nausea and vomiting (CINV), refractory to standard antiemetics; pooled n=1.366 from 30 RCTs (meta-analysis 1) or n from 13 RCTs (meta-analysis 2)
I
InterventionDronabinol (oral, synthetic THC) as monotherapy or in combination with standard antiemetics
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ControlProchlorperazine, metoclopramide, ondansetron, placebo and other standard antiemetics
O
OutcomeNNT=3,4 for antiemetic efficacy of dronabinol vs. control (p=0,03); complete CINV control better than comparators (NNT=6 for nausea, NNT=8 for vomiting); however increased rate of adverse drug reactions (dysphoria, hallucinations, hypotension) and study dropout (1 of 11 patients)
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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 Cannabis) 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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