Dronabinol

Trade Names:
Marinol
- Capsules, gelatin 2.5 mg
- Capsules, gelatin 5 mg
- Capsules, gelatin 10 mg

Pharmacology

User Reviews & Ratings As a treatment for... Avg User Ratings [?] AIDS Related Wasting 1 reviews Rate it! 10 Nausea/Vomiting, Chemotherapy Induced 2 reviews Rate it! 9.0 Anorexia 3 reviews Rate it! 8.0 Compare with other drugs.

Principal psychoactive substance derived from cannabis (marijuana); mechanism by which it prevents nausea and vomiting is unknown.

Pharmacokinetics

Absorption

90% to 95% absorbed. T _max approximately 2 to 4 h.

Distribution

10% to 20% reaches systemic circulation. Vd approximately 10 L/kg. Approximately 97% protein bound.

Metabolism

Extensive first-pass metabolism yielding active and inactive metabolites.

Elimination

Initial t _½ approximately 4 h. Terminal t _½ is 25 to 36 h. Cl is 0.2 L/kg/h.

Approximately 50% of dose; less than 5% unchanged drug.

10% to 15%.

Onset

0.5 to 1 h.

Peak

2 to 4 h.

Duration

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.

Contraindications

Hypersensitivity to marijuana or sesame oil.

Dosage and Administration

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.

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.

Storage/Stability

Refrigerate capsules; do not freeze.

Drug Interactions

Hypertension; tachycardia.

Increased CNS adverse effects.

Laboratory Test Interactions

None well documented.

Adverse Reactions

Cardiovascular

Tachycardia; hypotension.

CNS

Euphoria; dizziness; paranoid reaction; somnolence; seizures in patients with existing seizure disorders.

Miscellaneous

Tolerance, psychological and physical dependence with chronic use.

Precautions

Pregnancy

Category B .

Lactation

Excreted in breast milk.

Children

Not recommended in children with AIDS cachexia.

Elderly

More sensitive to psychoactive effects.

Drug dependence

Drug has abuse potential.

Overdosage

Symptoms

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.

Patient Information

• 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.

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