Superiority of nabilone over prochlorperazine as an antiemetic in patients receiving cancer chemotherapy

Two double-blind, crossover trials comparing the antiemetic effectiveness of nabilone, a new synthetic cannabinoid, with that of prochlorperazine were conducted in patients with severe nausea and vomiting associated with anticancer chemotherapy. Of 113 patients evaluated, 90 (80 per cent) responded to nabilone therapy, whereas only 36 (32 per cent) responded to prochlorperazine (P less than 0.001). Complete relief of symptoms was infrequent, occurring only in nine patients (8 per cent) given nabilone. When both drugs were compared, both nausea (P less than 0.01) and vomiting episodes (P less than 0.001) were significantly lower in patients given nabilone. Moreover, patients clearly favored nabilone for continued use (P less than 0.001). Predominant side effects noted by patients were similar for both agents and included somnolence, dry mouth and dizziness but were about twice as frequent and more often severe in patients receiving nabilone. In addition, four patients (3 per cent) taking nabilone had side effects (hallucinations in three, hypotension in one) that required medical attention. Euphoria associated with nabilone was infrequent (16 per cent) and mild.

Antiemetic effect of droperidol after ophthalmic surgery

Postoperative nausea with emesis is an undesirable side effect of general anesthesia in patients who have undergone ophthalmic surgery. The antiemetic effect of intravenous droperidol (Inapsine) was measured in a double-blind, controlled study of 78 patients undergoing general (enflurane [Ethrane]) anesthesia for a variety of ophthalmic procedures. There was a significant difference in the incidence of postoperative nausea and/or emesis in the droperidol-treated group, 13 of 78 (16%) as compared with the control population (37 of 87 [42%]). No complications of droperidol administration were observed. Droperidol may be an effective antiemetic drug if used prophylactically in patients who receive general anesthesia for ophthalmic surgery.

Toward drugs derived from cannabis

Recent work aimed at the introduction of natural and synthetic cannabinoids as drugs is reviewed. Delta1-Tetrahydrocannabinol (delta1-THC) is mainly investigated as a potential drug against glaucoma and asthma, and as an antiemetic agent in cancer chemotherapy. Cannabidiol is being tried in the clinic against epilepsy and as a hypnotic. Numerous synthetic cannabinoids are currently being investigated as analgetics and as sedative-relaxants.

An apomorphine-induced vomiting model for antiemetic studies in man

Apomorphine-induced vomiting is often used for preclinical efficacy testing of putative antiemetics in normal volunteers. The usual technique of individual intravenous titration for finding the threshold emitic dose of apomorphine in each subject is slow and tedious. We used a uniform dose of 0.05 mg/kg apomorphine given subcutaneously to test the antiemetic action of metoclopramide and votracon in ten healthy, young male volunteers. All ten subjects vomited in response to this dose of apomorphine when pretreated with placebo. Pretreatment with metoclopramide prevented vomiting in all subjects, and votracon prevented vomiting in two. Apomorphine, 0.05 mg/kg, subcutaneously appears to be an appropriate challenge dose for testing compounds for antiemetic activity in normal human volunteers.

Pharmacological studies of o-chloro-alpha-[(tert.-butylamino)methyl]benzylalcohol hydrochloride (C-78), a new bronchodilator. III. Actions on the nervous systems and miscellaneous organs

Pharmacological effects of o-chloro-alpha-[(tert.-butylamino)methyl]benzylalcohol hydrochloride (C-78) on the nervous systems and miscellaneous organs were studied. 1. Through a low dosage of C-78 had little influence on the central nervous system, a high dosage of C-78 had a little slow-waving effect on the spontaneous EEG in rabbits, inhibitory action of the convulsion caused by pentetrazol or electroshock in mice and anti-pyrogenic action in rabbits. C-78 also dose-dependently inhibited the increase of motility caused by amphetamine in mice. 2. Only high concentrations of C78 had a local anesthetic action on the cornea and the skin of the back in guinea pigs. 3. C-78 significantly increased non-esterified fatty acids (NEFA) and glucose contents of blood in rabbits, but these actions were inhibited by propranolol. Another, high dosage of C-78 had anti-ulcer and anti-inflammatory action. From the results of the previous experiments and this study, it was concluded that C-78 is a new beta 2-receptor stimulating drug where beta 2-receptor selectivity is greater than that of isoproterenol, salbutamol and clorprenaline.

[On the cholinolytic activity of pramiverine]

Pharmacological experiments with the spasmolytic 4,4-diphenyl-N-isopropyl-cyclohexylamine hydrochloride (pramiverine, Sistalgin) are reported. The anticholinergic and spasmolytic action was tested in vitro on segments of abdominal organs in comparison with atropin, hyoscin-N-butylbromide and Eupaverin. Acetylcholine, arecoline, carbachol and pilocarpine were used as cholinergic agonists. Besides, neostigmine was applied. Pramiverine is distinguished by a strong anticholinergic and a papaverine-like spasmolytic component. In vitro the anticholinergic action of pramiverine on the small intestine (guinea pig, rabbit), gall bladder (guinea pig) and uterus (guinea pig, rat) was equally strong as the effect of atropine, but on the urinary bladder (guinea pig) the effect was 5 times weaker. The anticholinergic effect was also demonstrated in other models: intestinal spasms after neostigmine injection in the guinea pig; hypotensive effect after acetylcholine administration in rabbits, cats and dogs; salivation after pilocarpine administration in rabbits; tremorine test in rats. The gastric secretion in the Shay rat and the gastrointestinal passage were reduced or inhibited by pramiverine. The test substance was also active on oral application.

Pharmacological studies of drug action on CNS, with special reference to effects of maprotiline

The effects of maprotiline, mainly on the CNS, were examined and compared with those of imipramine, methamphetamine and chlorpromazine. In the repeated administration and the stroboscope studies, maprotiline exhibited actions to increase behavioral activities of animals, just like amphetamine and imipramine. This appears to attest to pharmacological effects of maprotiline as an anti-depressant. It is noted, however, that whereas maprotiline shows a slight anti-apomorphine action in dogs and an inhibition of the spinal reflex action potential in cats, such actions are not recognized in other anti-depressants of the tricyclic groups including imipramine, amitriptyline, etc. These differences suggest the tranquilizing action of maprotiline at work, probably forming a specific pharmacological feature of maprotiline. Also, maprotiline increases body weight of rats strikingly, which seems to offer a wide range of clinical applications of this drug.

A comparison of the efficacy of cyclizine and perhenazine in reducing the emetic effects of morphine and pethidine

1 The ability of cyclizine (50 mg) and perphenazine (2.5 and 5.0 mg) to counteract the emetic effects of pethidine (100 mg) and morphine (10 and 15 mg) was compared in women undergoing a standard minor operation with a standard anaesthetic. 2 Perphenazine (5.0 mg) was as effective an anti-emetic as cyclizine (50 mg) and both were more effective than perphenazine (2.5 mg). 3 The reduction in vomiting and nausea by cyclizine (50 mg) and perphenazine (5 mg) was approximately the same following pethidine (100 mg) and morphine (10 mg) but much less against the larger dose of morphine. 4 Both anti-emetics had a rapid onset of action but their anti-emetic activity did not last as long as the emetic effect of morphine. 5 Perphenazine (5 mg) was accompanied by an unacceptably high incidence of restlessness. 6 In clinical practice cyclizine (50 mg) is preferred to perphenazine (5 mg) as an anti-emetic.