Cannabinoids

The antiemetic site of action of tetrahydrocannabinol (THC) (Marinol) is unknown, although it appears to affect the central cerebral cortex axis. Relief may occur in individuals refractory to other antiemetics. It is less effective in the elderly, primarily because of its side effects. The antiemetic effect is associated with a high, and this appears to be better tolerated in the young. Sedation is seen in approximately 30% of patients. Ataxia, drowsiness, dry mouth, or orthostatic hypotension may be seen in up to 35% of the older patient population. GI absorption is variable, though blood levels correlate with efficacy. The bioavailability is not as variable if the agent is smoked. The coadministration of prochlorperazine may prevent some of the central nervous system side effects seen with the use of tetrahydro-cannabinol.

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