(droe NAB i nol)
- Delta-9 THC
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Marinol: 2.5 mg, 5 mg, 10 mg [contains sesame oil]
Generic: 2.5 mg, 5 mg, 10 mg
Brand Names: U.S.
- Appetite Stimulant
Dronabinol (synthetic delta-9-tetrahydrocannabinol [delta-9-THC]), an active cannabinoid and natural occurring component of Cannabis sativa L. (marijuana), activates cannabinoid receptors CB1 and CB2. Activation of the CB1 receptor produces marijuana-like effects on psyche and circulation, whereas activation of the CB2 receptor does not. Dronabinol has approximately equal affinity for the CB1 and CB2 receptors; however, efficacy is less at CB2 receptors. Activation of the cannabinoid system with dronabinol causes psychological effects that can be divided into 4 groups: affective (euphoria and easy laughter); sensory (increased perception of external stimuli and of the person’s own body); somatic (feeling of the body floating or sinking in the bed); and cognitive (distortion of time perception, memory lapses, difficulty in concentration). Most effects (eg, analgesia, appetite enhancement, muscle relaxation, hormonal actions) are mediated by central cannabinoid receptors (CB1), their distribution reflecting many of the medicinal benefits and adverse effects (Grotenhermen 2003).
Oral: 90% to 95%; 10% to 20% of dose gets into systemic circulation
Vd: ~10 L/kg; dronabinol is highly lipophilic
Extensive first-pass hepatic primarily via microsomal hydroxylation to metabolites, some of which are active; 11-hydroxy-delta-9-tetrahydrocannabinol (11-OH-THC) is the major active metabolite
Feces (50%, 5% as unchanged drug); urine (10% to 15%)
Onset of Action
~0.5 to 1 hour; Peak effect: 2 to 4 hours
Time to Peak
Serum: 0.5 to 4 hours
Duration of Action
4 to 6 hours (psychoactive effects); ≥24 hours (appetite stimulation)
Biphaisc: Alpha: 4 hours; Terminal: 25 to 36 hours
Use: Labeled Indications
Appetite stimulation in AIDS patients: Treatment of anorexia associated with weight loss in patients with AIDS.
Chemotherapy-induced nausea and vomiting: Treatment of nausea and vomiting associated with cancer chemotherapy in patients who have failed to respond adequately to conventional antiemetic treatments.
Hypersensitivity to dronabinol, cannabinoids, sesame oil, or any component of the formulation.
Note: Use caution when increasing the dose of dronabinol because of the increased frequency of dose-related adverse reactions at higher dosages.
Appetite stimulation in AIDS patients: Oral: Initial: 2.5 mg twice daily (before lunch and dinner); for patients unable to tolerate this dosage, may reduce to 2.5 mg once daily (in the evening or at bedtime). May increase dose gradually based on response and tolerability (maximum: 20 mg per day [in divided doses]).
Chemotherapy-induced nausea and vomiting (manufacturer’s labeling): Oral: 5 mg/m2 administered 1 to 3 hours before chemotherapy, then give 5 mg/m2/dose every 2 to 4 hours after chemotherapy for a total of 4 to 6 doses/day; increase doses in increments of 2.5 mg/m2 based on response and tolerability (maximum: 15 mg/m2/dose). Note: Initiate with the lowest recommended dose and titrate to response; most patients respond to 5 mg 3 to 4 times daily; based on initial results, the dose may be escalated during a chemotherapy cycle or with subsequent cycles.
Chemotherapy-induced nausea and vomiting, refractory (off-label dosing): Oral: 2.5 to 10 mg 3 or 4 times daily (Lohr 2008)
Refer to adult dosing.
Chemotherapy-induced nausea and vomiting: Oral: Refer to adult dosing. Use caution when increasing the dose because of the increased frequency of dose-related adverse reactions at higher dosages.
Dosing: Renal Impairment
There are no dosage adjustments provided in the manufacturer’s labeling.
Dosing: Hepatic Impairment
There are no dosage adjustments provided in the manufacturer’s labeling.
Oral: For appetite stimulation, administer twice-daily doses before lunch and dinner; administer single doses in the evening or at bedtime.
Capsules contain sesame oil.
Store in a cool environment between 8°C and 15°C (46°F and 59°F) or refrigerated; protect from freezing.
Alcohol (Ethyl): Dronabinol may enhance the CNS depressant effect of Alcohol (Ethyl). Monitor therapy
Amphotericin B: Dronabinol may increase the serum concentration of Amphotericin B. Specifically, dronabinol may displace amphotericin B from its protein-binding sites, leading to an increased concentration of active, unbound drug. Monitor therapy
Anticholinergic Agents: May enhance the tachycardic effect of Cannabinoid-Containing Products. Monitor therapy
CNS Depressants: Dronabinol may enhance the CNS depressant effect of CNS Depressants. Monitor therapy
Cocaine: May enhance the tachycardic effect of Cannabinoid-Containing Products. Monitor therapy
CycloSPORINE (Systemic): Dronabinol may increase the serum concentration of CycloSPORINE (Systemic). Specifically, dronabinol may displace cyclosporine from its protein-binding sites, leading to an increased concentration of active, unbound drug. Monitor therapy
CYP2C9 Inhibitors (Moderate): May increase the serum concentration of Dronabinol. Monitor therapy
CYP2C9 Inhibitors (Strong): May increase the serum concentration of Dronabinol. Monitor therapy
CYP3A4 Inducers (Strong): May decrease the serum concentration of Dronabinol. Monitor therapy
CYP3A4 Inhibitors (Moderate): May increase the serum concentration of Dronabinol. Monitor therapy
CYP3A4 Inhibitors (Strong): May increase the serum concentration of Dronabinol. Monitor therapy
Disulfiram: May enhance the adverse/toxic effect of Dronabinol. Specifically, disulfiram may produce severe intolerance to the alcohol contained in the dronabinol oral solution. Consider therapy modification
MetroNIDAZOLE (Systemic): May enhance the adverse/toxic effect of Dronabinol. Specifically, metronidazole may produce severe intolerance to the alcohol contained in the dronabinol oral solution. Consider therapy modification
Ritonavir: May increase the serum concentration of Dronabinol. Monitor therapy
Sympathomimetics: Cannabinoid-Containing Products may enhance the tachycardic effect of Sympathomimetics. Monitor therapy
Warfarin: Dronabinol may increase the serum concentration of Warfarin. Specifically, dronabinol may displace warfarin from its protein-binding sites, leading to an increased concentration of active, unbound drug. Monitor therapy
Frequency not always defined.
Cardiovascular: Facial flushing, palpitations, tachycardia, vasodilatation
Central nervous system: Euphoria (antimetic: 24%; appetite stimulant: 8%), abnormality in thinking (3% to 10%), dizziness (3% to 10%), drowsiness (3% to 10%), paranoia (3% to 10%), amnesia, anxiety, ataxia, confusion, depersonalization, hallucination, nervousness
Gastrointestinal: Abdominal pain (3% to 10%), nausea (3% to 10%), vomiting (3% to 10%)
Neuromuscular & skeletal: Weakness
<1% (Limited to important or life-threatening): Anorexia, burning sensation of skin, chills, conjunctival injection, conjunctivitis, cough, delirium, depression, diaphoresis, diarrhea, disorientation, exacerbation of depression, falling, fatigue, fecal incontinence, flushing, headache, hypotension, increased liver enzymes, insomnia, loss of consciousness, malaise, mental status change (exacerbation of mania or schizophrenia), movement disorder, myalgia, nightmares, oral lesion, panic attack, pharyngeal edema, rhinitis, seizure, sinusitis, skin rash, speech disturbance, swelling of lips, syncope, tinnitus, urticaria, visual disturbance
Concerns related to adverse effects:
• Cardiovascular effects: May cause occasional hypotension, possible hypertension, syncope, or tachycardia; use with caution in patients with cardiac disorders.
• CNS depression: May cause CNS depression, which may impair physical or mental abilities; patients must be cautioned about performing tasks that require mental alertness (eg, operating machinery, driving).
• Drug abuse: Use with caution in patients with a history of substance abuse, including alcohol abuse or dependence; potential for drug dependency exists. Tolerance, psychological and physical dependence may occur with prolonged use.
• Psychiatric disorders: Use with caution in patients with mania, depression, or schizophrenia; careful psychiatric monitoring is recommended because dronabinol may exacerbate these conditions.
• Seizure disorder: Use with caution in patients with a history of seizure disorder; may lower seizure threshold. Discontinue dronabinol immediately in patients who develop seizures.
• Elderly: Since the elderly are more sensitive to the neurological, psychoactive, and postural hypotensive effects of dronabinol, use with caution.
• Appropriate use: Administration with phenothiazines (eg, prochlorperazine) for the management of chemotherapy-induced nausea and vomiting may result in improved efficacy (compared to either drug alone) without additional toxicity.
• Withdrawal: May cause withdrawal symptoms upon abrupt discontinuation.
CNS effects, heart rate, blood pressure, behavioral profile
Pregnancy Risk Factor
Adverse events have been observed in animal reproduction studies.
• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)
• Patient may experience euphoria. Have patient report immediately to prescriber confusion, difficulty focusing, severe dizziness, passing out, headache, behavioral changes, mood changes, tachycardia, severe fatigue, abdominal pain, memory impairment, seizures, vision changes, nausea, or vomiting (HCAHPS).
• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.
Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for healthcare professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience and judgment in diagnosing, treating and advising patients.
More about dronabinol
- Other brands: Marinol