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    Nausea and Vomiting (PDQ®): Supportive care - Health Professional Information [NCI] - Prevention of Acute / Delayed Nausea and Vomiting (Emesis)

    Table 2. Comparison of Aprepitant and Standard Regimens continued...

    Dexamethasone is also used orally for delayed N&V. Long-term corticosteroid use, however, is inappropriate and may cause substantial morbidity, including the following:

    • Immunosuppression.
    • Proximal muscle weakness (especially involving the thighs and upper arms).
    • Aseptic necrosis of the long bones.
    • Cataract formation.
    • Hyperglycemia and exacerbation of preexisting diabetes or escalation of subclinical diabetes to clinical pathology.
    • Adrenal suppression with hypocortisolism.
    • Lethargy.
    • Weight gain.
    • GI irritation.
    • Insomnia.
    • Anxiety.
    • Mood changes.
    • Psychosis.

    A study that examined chemotherapy in a group of patients with ovarian cancer found that short-term use of glucocorticoids as antiemetics had no negative effects on outcomes (e.g., overall survival or efficacy of chemotherapy).[78] As previously shown with metoclopramide, numerous studies have demonstrated that dexamethasone potentiates the antiemetic properties of 5-HT3 -blocking agents.[79,80,81,82,83] If administered by IV, dexamethasone may be given over 10 to 15 minutes, since rapid administration may cause sensations of generalized warmth, pharyngeal tingling or burning, or acute transient perineal and/or rectal pain.[75,84,85,86]

    Prednisone and adrenocorticotropic hormone (ACTH) given concomitantly with other active antiemetic agents have also demonstrated efficacy against N&V caused by cisplatin-containing chemotherapy during the acute phase (within 24 hours after receiving chemotherapy).[87,88,89] In a double-blind, randomized study of metoclopramide and dexamethasone with or without 1 mg of ACTH, patients receiving ACTH prophylaxis for cisplatin-containing chemotherapy experienced a significantly decreased incidence and severity of delayed emesis for up to 72 hours after treatment.[89]

    Cannabis

    The plant Cannabis contains more than 60 different types of cannabinoids, or components that have physiologic activity. The most popular, and perhaps the most psychoactive, is delta-9-tetrahydrocannabinol (delta-9-THC).[90] There are two FDA-approved products for CINV:

    • Dronabinol (a synthetic delta-9-THC), as prophylaxis for CINV, 5 mg/m2 orally 1 to 3 hours before chemotherapy and every 2 to 4 hours after chemotherapy, for a total of no more than 6 doses per day.
    • Nabilone, 1 to 2 mg orally twice a day, for CINV that has failed to respond to other antiemetics.

    With respect to CINV, Cannabis products probably target cannabinoid-1 (CB-1) and CB-2 receptors, which are in the CNS.[91] Another product, Sativex, a cannabidiol that is a buccal spray, is under investigation.[92,93]

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