The clinical use of cannabinoid therapies in oncology patients
Betty Wedman-St. Louis in Cannabis, 2018
Radiotherapy involving specific body areas (abdomen, chest, whole brain) can induce nausea and vomiting (RINV), but very few reports of the use of cannabinoids to treat this condition are found in the literature. Those that are published mainly employ pharmaceutical cannabinoids [52]. A recently published placebo-controlled study demonstrated that global measurement of quality of life for patients undergoing radiotherapy for head and neck cancer is not improved nor worsened using nabilone [53]. Secondary measures of pain, appetite, weight gain, and nausea were also not impacted using nabilone. The authors postulated that nabilone on its own is not potent enough to have impact upon symptoms such as pain and nausea. A second recently published study of patients with previously treated head and neck cancer patients surveyed their use of medical cannabis. Fifteen respondents endorsed the use of cannabis (smoked, vaporized, or eaten) in the treatment of long-term residual effects of radiation, including pain, appetite, and weight maintenance [54].
‘Bundling with big pharma’: ethics and the drug industry
Peter Wemyss-Gorman, John D Loeser in Pain, Suffering and Healing, 2018
My interest in cannabis as a potential agent for relieving pain started in the early 1990s and was derived from knowledge of its historical use. I was seeing many patients who were getting inadequate analgesia from the drugs and other techniques available. Surprisingly, the synthetic cannabinoid Nabilone was available. It had been licensed in the 1980s for the treatment of nausea and vomiting secondary to chemotherapy. Whilst it was effective, it commonly caused dysphoria thereby limiting its use. The advent of the H2 serotonin reuptake antagonists provided a range of new anti-emetics that were much more effective, so Nabilone became an orphan drug. Although it was not licensed for such use, I started to use it for treating intractable pain problems. About two-thirds of patients got some benefit but half of these found the side effects excessive. All patients who had also used cannabis in the past found it preferable to Nabilone.
Antiemetics and Cancer Chemotherapy
John Kucharczyk, David J. Stewart, Alan D. Miller in Nausea and Vomiting: Recent Research and Clinical Advances, 2017
Nabilone has also been compared to prochlorperazine. Ahmedzai et al.56 employed a double-blind crossover study to compare nabilone to prochlorperazine in 34 patients with lung cancer undergoing chemotherapy with cyclophosphamide, adriamycin, and VP-16. Patients were at the same stage of chemotherapy and in this study could also receive metoclopramide or chlorpromazine if they experienced severe, ongoing nausea. Nabilone was given 2 mg p.o. every 12 h for 3 days starting 12 h prechemotherapy. Prochlorperazine was also started 12 h pretherapy and was given 10 mg p.o. t.i.d. over 3 days. Symptom scores for nausea, retching, and vomiting were significantly better for patients on nabilone and more patients preferred nabilone for antiemetic control; however, adverse effects were more common with nabilone including drowsiness (57%), postural dizziness (35%), lightheadedness (18%), euphoria (14%), and a “high” (7%). After taking adverse effects into account, the number of patients who wished to continue receiving nabilone during subsequent chemotherapy was not statistically significant. The authors concluded that nabilone was an effective antiemetic for moderately toxic chemotherapy, but the range and unpredictability of its side effects warranted cautious use. Nabilone has been compared to prochlorperazine in patients receiving predominantly cisplatin-based chemotherapy with similar results.19
Effectiveness of Cannabinoids for Treatment of Dementia: A Systematic Review of Randomized Controlled Trials
Published in Clinical Gerontologist, 2021
Thammanard Charernboon, Tiraya Lerthattasilp, Thitipon Supasitthumrong
Four studies reported adverse drug events. In one study by Walther et al. (2011), the ascertainment method of adverse event was unclear. Trials of nabilone found that sedation was the most common adverse effect with statistical significance (nabilone 44.7% vs. placebo 15.8%). There were no significant differences in incidences of falls or other adverse effects (Herrmann et al., 2019). Two studies of THC by van den Elsen et al. (2015a, 2015b) demonstrated no significant differences for adverse events between THC and placebo, e.g., somnolence, dizziness, falls or euphoric mood. One trial also reported no significant change in blood pressure, heart rate and electrocardiogram (van den Elsen et al., 2015a). A dronabinol trial by Volicer et al. (1997) reported a serious adverse event as seizure in one patient. Other adverse events included tiredness, somnolence and euphoria. These were observed more frequently during the dronabinol phase than the placebo phase (Volicer et al., 1997).
Medication overuse headache: an overview of clinical aspects, mechanisms, and treatments
Published in Expert Review of Neurotherapeutics, 2020
Abouch V. Krymchantowski, Carla C. Jevoux, Ana G. Krymchantowski, Rodrigo Salvador Vivas, Raimundo Silva-Néto
The cannabinoid nabilone was evaluated for intractable MOH patients in a randomized, double-blind, active-controlled, cross-over study in Italy with 30 patients. The subjects received 0.5 mg/day of oral nabilone for 8 weeks followed by 8 more weeks in which 400 mg ibuprofen was given daily in a blinded sequence. Between the two active drug periods, there was a wash-out phase of 1 week [67]. The synthetic cannabinoid CB1-receptor agonist nabilone was significantly superior than ibuprofen after 20 weeks of follow up in reducing headache severity, consumption of acute medications, and in improving quality of life (QoL) indicators such as Short-Form (SF)-36. Despite the conclusion that nabilone is efficacious for the MOH treatment, the knowledge about its long-term efficacy and safety is warranted according to the authors of the study [67].
Synthetic cannabinoid for the treatment of severe chronic noncancer pain in children and adolescents
Published in Canadian Journal of Pain, 2022
Naiyi Sun, Natasha Cunha, Shawnee Amar, Stephen Brown
Nabilone is an orally administered synthetic cannabinoid and analogue of delta-9-tetrahydrocannabinol (THC), which is the main psychoactive component in cannabis. It is licensed in Canada and United States as an antiemetic for management of nausea and vomiting associated with cancer chemotherapy. The use of nabilone for treatment of chronic pain is off-label. Nabilone acts as an agonist of two endogenous cannabinoid receptors, CB1 and CB2. Stimulation of the CB1 receptor, which is located in neuron terminals throughout the nervous system, reduces neuronal excitability. Stimulation of the CB2 receptor results in anti-inflammatory effects. Nabilone has also been shown to improve sleep in adults likely due to the sedative effects of THC.8
Related Knowledge Centers
- Cannabis
- Pain Management
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- Analgesic
- Antiemetic
- Synthetic Cannabinoids
- Medical Cannabis