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Cannabinoids for control of chemotherapy induced nausea and vomiting: quantitative systematic review.

Abstract

OBJECTIVE

To quantify the antiemetic efficacy and adverse effects of cannabis used for sickness induced by chemotherapy.

DESIGN

Systematic review.

DATA SOURCES

Systematic search (Medline, Embase, Cochrane library, bibliographies), any language, to August 2000.

STUDIES

30 randomised comparisons of cannabis with placebo or antiemetics from which dichotomous data on efficacy and harm were available (1366 patients). Oral nabilone, oral dronabinol (tetrahydrocannabinol), and intramuscular levonantradol were tested. No cannabis was smoked. Follow up lasted 24 hours.

RESULTS

Cannabinoids were more effective antiemetics than prochlorperazine, metoclopramide, chlorpromazine, thiethylperazine, haloperidol, domperidone, or alizapride: relative risk 1.38 (95% confidence interval 1.18 to 1.62), number needed to treat 6 for complete control of nausea; 1.28 (1.08 to 1.51), NNT 8 for complete control of vomiting. Cannabinoids were not more effective in patients receiving very low or very high emetogenic chemotherapy. In crossover trials, patients preferred cannabinoids for future chemotherapy cycles: 2.39 (2.05 to 2.78), NNT 3. Some potentially beneficial side effects occurred more often with cannabinoids: "high" 10.6 (6.86 to 16.5), NNT 3; sedation or drowsiness 1.66 (1.46 to 1.89), NNT 5; euphoria 12.5 (3.00 to 52.1), NNT 7. Harmful side effects also occurred more often with cannabinoids: dizziness 2.97 (2.31 to 3.83), NNT 3; dysphoria or depression 8.06 (3.38 to 19.2), NNT 8; hallucinations 6.10 (2.41 to 15.4), NNT 17; paranoia 8.58 (6.38 to 11.5), NNT 20; and arterial hypotension 2.23 (1.75 to 2.83), NNT 7. Patients given cannabinoids were more likely to withdraw due to side effects 4.67 (3.07 to 7.09), NNT 11.

CONCLUSIONS

In selected patients, the cannabinoids tested in these trials may be useful as mood enhancing adjuvants for controlling chemotherapy related sickness. Potentially serious adverse effects, even when taken short term orally or intramuscularly, are likely to limit their widespread use.

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  • Authors+Show Affiliations

    ,

    Division d'Anesthésiologie, Département Anesthésiologie, Pharmacologie Clinique et Soins Intensif de Chirurgie, Hôpitaux Universitaires, CH-1211 Genève 14, Switzerland. martin.tramer@hcuge.ch

    , , , ,

    Source

    BMJ (Clinical research ed.) 323:7303 2001 Jul 07 pg 16-21

    MeSH

    Antiemetics
    Antineoplastic Agents
    Cannabinoids
    Humans
    Nausea
    Patient Satisfaction
    Randomized Controlled Trials as Topic
    Treatment Outcome
    Vomiting

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't
    Review
    Systematic Review

    Language

    eng

    PubMed ID

    11440936

    Citation

    Tramèr, M R., et al. "Cannabinoids for Control of Chemotherapy Induced Nausea and Vomiting: Quantitative Systematic Review." BMJ (Clinical Research Ed.), vol. 323, no. 7303, 2001, pp. 16-21.
    Tramèr MR, Carroll D, Campbell FA, et al. Cannabinoids for control of chemotherapy induced nausea and vomiting: quantitative systematic review. BMJ. 2001;323(7303):16-21.
    Tramèr, M. R., Carroll, D., Campbell, F. A., Reynolds, D. J., Moore, R. A., & McQuay, H. J. (2001). Cannabinoids for control of chemotherapy induced nausea and vomiting: quantitative systematic review. BMJ (Clinical Research Ed.), 323(7303), pp. 16-21.
    Tramèr MR, et al. Cannabinoids for Control of Chemotherapy Induced Nausea and Vomiting: Quantitative Systematic Review. BMJ. 2001 Jul 7;323(7303):16-21. PubMed PMID: 11440936.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Cannabinoids for control of chemotherapy induced nausea and vomiting: quantitative systematic review. AU - Tramèr,M R, AU - Carroll,D, AU - Campbell,F A, AU - Reynolds,D J, AU - Moore,R A, AU - McQuay,H J, PY - 2001/7/7/pubmed PY - 2001/8/10/medline PY - 2001/7/7/entrez SP - 16 EP - 21 JF - BMJ (Clinical research ed.) JO - BMJ VL - 323 IS - 7303 N2 - OBJECTIVE: To quantify the antiemetic efficacy and adverse effects of cannabis used for sickness induced by chemotherapy. DESIGN: Systematic review. DATA SOURCES: Systematic search (Medline, Embase, Cochrane library, bibliographies), any language, to August 2000. STUDIES: 30 randomised comparisons of cannabis with placebo or antiemetics from which dichotomous data on efficacy and harm were available (1366 patients). Oral nabilone, oral dronabinol (tetrahydrocannabinol), and intramuscular levonantradol were tested. No cannabis was smoked. Follow up lasted 24 hours. RESULTS: Cannabinoids were more effective antiemetics than prochlorperazine, metoclopramide, chlorpromazine, thiethylperazine, haloperidol, domperidone, or alizapride: relative risk 1.38 (95% confidence interval 1.18 to 1.62), number needed to treat 6 for complete control of nausea; 1.28 (1.08 to 1.51), NNT 8 for complete control of vomiting. Cannabinoids were not more effective in patients receiving very low or very high emetogenic chemotherapy. In crossover trials, patients preferred cannabinoids for future chemotherapy cycles: 2.39 (2.05 to 2.78), NNT 3. Some potentially beneficial side effects occurred more often with cannabinoids: "high" 10.6 (6.86 to 16.5), NNT 3; sedation or drowsiness 1.66 (1.46 to 1.89), NNT 5; euphoria 12.5 (3.00 to 52.1), NNT 7. Harmful side effects also occurred more often with cannabinoids: dizziness 2.97 (2.31 to 3.83), NNT 3; dysphoria or depression 8.06 (3.38 to 19.2), NNT 8; hallucinations 6.10 (2.41 to 15.4), NNT 17; paranoia 8.58 (6.38 to 11.5), NNT 20; and arterial hypotension 2.23 (1.75 to 2.83), NNT 7. Patients given cannabinoids were more likely to withdraw due to side effects 4.67 (3.07 to 7.09), NNT 11. CONCLUSIONS: In selected patients, the cannabinoids tested in these trials may be useful as mood enhancing adjuvants for controlling chemotherapy related sickness. Potentially serious adverse effects, even when taken short term orally or intramuscularly, are likely to limit their widespread use. SN - 0959-8138 UR - https://www.unboundmedicine.com/medline/citation/11440936/Cannabinoids_for_control_of_chemotherapy_induced_nausea_and_vomiting:_quantitative_systematic_review_ L2 - http://www.bmj.com/cgi/pmidlookup?view=long&pmid=11440936 DB - PRIME DP - Unbound Medicine ER -