Marinol

Mar·i·nol (mr-nôl)

A trademark for the drug dronabinol.

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Marinol,

trademark for an oral antiemetic (dronabinol).

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dronabinol

Marinol

Pharmacologic class: Cannabinoid

Therapeutic class: Antiemetic

Controlled substance IV

Pregnancy risk category B

Action

Unknown. May exert antiemetic effect by inhibiting vomiting control mechanism in medulla oblongata.

Availability

Capsules: 2.5 mg, 5 mg, 10 mg

⊘Indications and dosages

➣ Prevention of nausea and vomiting caused by chemotherapy

Adults and children: Initially, 5 mg/m² P.O. 1 to 3 hours before chemotherapy. Repeat dose q 2 to 4 hours after chemotherapy, up to four to six doses per day. If 5-mg/m² dose is ineffective and patient has no significant adverse reactions, dosage may be increased in increments of 2.5 mg/m² to a maximum dosage of 15 mg/m².

➣ Appetite stimulant

Adults and children: Initially, 2.5 mg P.O. b.i.d. May reduce dosage to 2.5 mg/day given as a single evening or bedtime dose. Maximum dosage is 10 mg P.O. b.i.d.

Contraindications

• Hypersensitivity to cannabinoids or sesame oil
• Breastfeeding

Precautions

Use cautiously in:
• hypertension, heart disease, bipolar disorder, schizophrenia, drug abuse
• pregnant patients.

Administration

• When used to stimulate appetite, give before lunch and dinner.

Route	Onset	Peak	Duration
P.O.	30-60 min	2-4 hr	4-6 hr

Adverse reactions

CNS: drowsiness, anxiety, impaired coordination, irritability, depression, headache, hallucinations, memory loss, paresthesia, ataxia, paranoia, disorientation, nightmares, speech difficulties, syncope, suicidal ideation

CV: tachycardia, hypotension, hypertension

EENT: visual disturbances, tinnitus

GI: dry mouth

Skin: facial flushing, diaphoresis

Interactions

Drug-drug. Anticholinergics, antihistamines, tricyclic antidepressants: increased tachycardia and hypertension

CNS depressants: increased CNS depression

Ritonavir: increased dronabinol blood level and risk of toxicity

Drug-behaviors. Alcohol use: increased CNS depression

Patient monitoring

• Monitor vital signs for hypotension and tachycardia.
☞ Check for adverse CNS reactions. Report significant depression, paranoid reaction, or emotional lability.
• Monitor nutritional status and hydration.

Patient teaching

• Teach patient about drug's significant adverse CNS and cardiovascular effects. Emphasize that he should take it only as prescribed and needed.
☞ Advise patient (and significant other) to immediately report depression, suicidal thoughts, paranoid reactions, and other serious CNS reactions.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and behaviors mentioned above.