Class: Antiemetic, Antivertigo agent
- Capsules, gelatin 2.5 mg
- Capsules, gelatin 5 mg
- Capsules, gelatin 10 mg
Principal psychoactive substance derived from cannabis (marijuana); mechanism by which it prevents nausea and vomiting is unknown.
90% to 95% absorbed. T max approximately 2 to 4 h.
10% to 20% reaches systemic circulation. Vd approximately 10 L/kg. Approximately 97% protein bound.
Extensive first-pass metabolism yielding active and inactive metabolites.
Initial t ½ approximately 4 h. Terminal t ½ is 25 to 36 h. Cl is 0.2 L/kg/h.Feces
Approximately 50% of dose; less than 5% unchanged drug.Urine
10% to 15%.
0.5 to 1 h.
2 to 4 h.
4 to 6 h (psychoactive effects), 24 h or longer (appetite stimulant).
Indications and Usage
Control of chemotherapy-induced nausea and vomiting unresponsive to other antiemetics; appetite stimulation in AIDS cachexia.
Hypersensitivity to marijuana or sesame oil.
Dosage and AdministrationAntiemetic
Adults and Children
PO 5 mg/m 2 1 to 3 h before chemotherapy and every 2 to 4 h after chemotherapy. Can give 4 to 6 doses/day and increase by 2.5 mg/m 2 /dose; do not exceed 15 mg/m 2 /dose.Appetite Stimulation
PO 2.5 mg twice daily before lunch and supper. Can give single daily dose of 2.5 mg to patients in whom adverse effects develop. Can increase by 2.5 mg/day; do not exceed 20 mg/day.
Refrigerate capsules; do not freeze.
Drug InteractionsAmphetamines, cocaine, sympathomimetics
Hypertension; tachycardia.CNS depressants
Increased CNS adverse effects.
Laboratory Test Interactions
None well documented.
Euphoria; dizziness; paranoid reaction; somnolence; seizures in patients with existing seizure disorders.
Tolerance, psychological and physical dependence with chronic use.
Assess for nausea, vomiting, appetite, bowel sounds, and abdominal pain before and after drug is administered. Monitor BP and pulse rate during therapy, especially in patients with hypotension or cardiac disease. Monitor I&O, hydration, nutritional status, and weight regularly. Assess for signs of withdrawal syndrome.
Category B .
Excreted in breast milk.
Not recommended in children with AIDS cachexia.
More sensitive to psychoactive effects.
Drug has abuse potential.
Drowsiness, euphoria, heightened sensory awareness, altered time perception, reddened conjunctiva, dry mouth, tachycardia (mild intoxication). Memory impairment, depersonalization, mood alteration, urinary retention, reduced bowel motility (moderate intoxication). Decreased motor coordination, lethargy, slurred speech, postural hypotension (severe intoxication). Apprehensive patients may experience panic reactions. Patients with seizure disorder may experience seizures.
- Instruct patient to take drug exactly as ordered by health care provider.
- Discuss psychoactive symptoms with patient and family. Symptoms may be minimized by providing quiet, supportive environment.
- Explain that signs of overdose (eg, mood changes, confusion, hallucinations, depression, nervousness, fast or pounding heartbeat) may occur with increased doses.
- Instruct patient to make position changes slowly to prevent orthostatic hypotension.
- Advise patient and family that adult supervision is necessary as patient may experience drowsiness, dizziness, difficulty concentrating, and perceptual and coordination impairment.
- Instruct patient to avoid intake of alcoholic beverages, barbiturates, and other CNS depressants.
- Advise patient that drug may cause drowsiness and to use caution while driving or performing other tasks requiring mental alertness.
Copyright © 2009 Wolters Kluwer Health.
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