Dronabinol nausea/vomiting

Dronabinol is indicated for the treatment of the nausea and vomiting produced by cancer chemotherapy in patients who have failed to respond adequately to other conventional treatments. This agent may be habit forming and can be expected to produce disturbing psychomimetic reactions. It should only be used under close supervision. 

Dronabinol (tetrahydrocannabinol), the active principle from cannabis and synthetic cannabinoids, nabilone and levonantradol are effective in treating nausea and vomiting in cancer chemotherapy. The mode of action is unclear but appears to involve cannabinoid CBi receptors. Cannabinoids have been shown to reduce acetylcholine release in the cortex and hippocampus, and have been suggested to inhibit medullary activity by a cortical action. Inhibition of prostaglandin synthesis and release of endorphins may also be involved in the antiemetic effect. A review of trials of dronabinol, nabilone or levonantradol concluded that while the cannabinoids were superior to placebo or dopamine receptor antagonists in controlling emesis... 

So, the 20th century actually led to an almost total disappearance of C. sativa for medicinal purposes. The only source for THC, which became the focus of scientific research, was fhe rafher fedious exfracfion and purification from confiscated hashish or marihuana. In 1972 the first commercially viable total synthesis of A9-THC was established and it became the first cannabinoid available as a modern medicine in the form of soft gel capsules (the active ingredient being called dronabinol from tetrahydrocannabinol) under the trade name Marinol for the prevention of nausea and vomiting during cancer chemotherapy. 

Standardised preparations of cannabinoid agonists are available for therapeutic use in some countries [238]. Dronabinol (Marinol ), an oral preparation of A -THC (67), is used clinically as an appetite stimulant in AIDS patients and an antiemetic in cancer chemotherapy. A synthetic analogue of (67), nabilone (Cesamet ), (381), is also used to suppress nausea and vomiting in cancer chemotherapy. 

Chlorpromazine, prochlorperazine, promethazine, methylprednisolone, lorazepam, metoclopramide, dexamethasone, or dronabinol may be used for adult patients. Around the clock dosing should be considered. The choice of specific agent should based on patient specific factors, including potential for adverse drug reactions, and cost. SSRIs are effective for breakthrough nausea and vomiting but they are not superior to the less expensive antiemetics above. 

Much debate has been waged over medicinal uses of cannabis. Several therapeutic uses have been proposed, including antiemetic, analgesic, appetite stimulant, and muscle relaxant. A synthetic cannabinoid, dronabinol (Marinol) has been marketed for clinical treatment of appetite loss, nausea, and vomiting. Although synthetic, it is identical to the main psychoactive chemical constituent of cannabis (A9-THC). 

Cannabinoids Dronabinol is available for use in chemotherapy-induced nausea and vomiting, but is associated with CNS marijuana effects ... 

Oral preparations of A9-THC (dronabinol, marinol) and the synthetic structural analog nabilone are marketed as suppressants of nausea and vomiting provoked by antitumor agents. Furthermore A9-THC is employed to stimulate the appetite of AIDS patients. 

A9-THC is marketed as marinol or dronabinol for the treatment of chemotherapy-induced nausea and vomiting in Australia, Canada, Israel, South Africa and the USA. It was granted orphan drug status in the US for the stimulation of appetite and prevention of weight loss in patients with a confirmed diagnosis of AIDS. A9-THC is in phase I trials for spasticity, multiple sclerosis and postoperative pain. Several small clinical studies have confirmed the effectiveness of A9-THC as an analgesic, with doses of 15 to 20 mg being comparable to 60 to 120 mg of codeine (Williamson and Evans, 2000). 

Dronabinol (A9-tetrahydrocannabinol THC Marinol) is FDA approved for treatment of nausea and vomiting associated with cancer chemotherapy in patients who have failed to respond adequately to conventional antiemetics. With mildly or moderately emetogenic chemotherapy, it is more effective than placebo and equivalent or superior to oral prochlorperazine. Dry mouth, sedation, orthostatic hypotension, ataxia, dizziness, and dysphoria occur frequently, particularly in middle-aged and older patients. 

Therapeutic THC is called dronabinol (Marinol) and has been marketed with approval by the Food and Drug Administration to reduce nausea and vomiting in patients undergoing cancer chemotherapy and to stimulate appetite in AIDS patients. It has also been shown to reduce intraocular pressure in glaucoma. Levonantradol, an analog, may be useful as an analgesic. 

HT3 antagonists are effective for acute nausea, but are not effective for anticipatory nausea, and efficacy is low for delayed nausea. Lorazepam is very effective for anticipatory nausea. Other agents used in chemotherapy-induced emesis are dopamine antagonists, scopolamine, and dronabinol. Antihistamines are generally less effective for chemotherapy-induced nausea and vomiting. 

Delta-9-THC and some synthetic analogs are used therapeutically, for example, for nausea and vomiting produced by antineoplastic chemotherapy, analgesic, anticonvulsant for epilepsy, anti-inflammatory agent, appetite stimulant for patients with AIDS, as well as treatment for conditions such as asthma and glaucoma. Synthetic cannabinoids used therapeutically include dronabinol, nabilone, and levonamtradol. 

Although marijuana is the most frequently used illicit drug, it does have some limited legitimate medicinal use. Dronabinol (Marmol) contains synthetic THC and is used to treat anorexia and nausea in AIDS patients, nausea and vomiting associated with chemotherapy, and asthma and glaucoma, ... 

Sesame oU solubilizes 2.5 mg, 5 mg or 10 mg dronabinol, also known as A-9-tetrahydrocannabinol, in Marinol soft gelatin capsules. Dronabinol is the principal psychoactive component of cannabis and hnds therapeutic application as an anti-emetic for treatment of the nausea and vomiting associated with cancer chemotherapy or as an appetite stimulant to treat AIDS wasting syndrome. Dronabinol exists as a hydrophobic oil at ambient room temperature, and after oral administration is almost completely absorbed (90-95%). However, the bioavailability of dronabinol is only about 10-20% due to extensive hepatic hrst-pass metabolism. The dose of dronabinol is 2.5-10 mg (one capsule) twice daily. Marinol soft gelatin capsules should be stored at 8-15° C and must be protected from freezing. Marinol is available in the USA. 

Dronabinol is an antiemetic/antivertigo agent, which is indicated in the control of chemotherapy-induced nausea and vomiting unresponsive to other antiemetics and appetite stimulation in AIDS cachexia. 

Antihistamines, dronabinol, glucocorticoids, and metoclopramide have antiemetic actions that are useful in the management of vomiting caused by anticancer drugs. Levodopa causes nausea because it is converted to dopamine, which activates dopamine receptors in the emetic center. The answer is (C). 

A -frar s-Tetrahydrocannabinol (THC) is the major psychoactive (euphoriant) constituent of marijuana. Cannabis sativa. The synthetic form of THC (dronabinol) was approved approximately 20 years ago to treat nausea and vomiting associated with cancer chemotherapy, and it has been used for a lesser amount of time to treat appetite loss in patients with HIV/AIDS (44). More recently, an approximately 1 1 mixture of THC and the structurally related marijuana constituent cannabidiol has been approved in Canada for the alleviation of neuropathic pain and spasticity fcr patients with multiple sclerosis and is administered in low doses as a buccal spray (53). Ccnsiderable interest exists in using cannabinoid derivatives based on THC for medicinal purpcses, but it is necessary to minimize the central nervous system effects of these compounds. 

Acceptable, but limited, medical uses have been found for THC. The pharmaceutical company Unimed manufactures Marinol , currently the only manufactured drug containing a synthetic isomer of THC (dronabinol) in its formulation. Marinol is listed on Schedule III. The medicine is used to stimulate the appetite in AIDS patients and to treat nausea and vomiting associated with chemotherapy. The synthesis of THC and cannabinols is difficult and complex thus, there is little reason to expect clandestine synthesis to be a factor in the restricted legal use of marijuana. 

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