dronabinol

dronabinol /dro·nab·i·nol/ (dro-nab´in-ol) one of the major active substances in cannabis, used as an antiemetic for cancer chemotherapy and anorexia and weight loss in AIDS; it is subject to abuse because of its psychotomimetic activity.

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dro·nab·i·nol (dr-nb-nôl)

n.

The principal psychoactive substance present in Cannabis sativa used therapeutically to control nausea and vomiting associated with cancer chemotherapy.

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dronabinol

[drōnab′inol]

an oral antiemetic that is a synthetic derivative of THC, the principal psychotropic constituent of marijuana.

indications It is prescribed for the treatment of refractory nausea and vomiting caused by cancer chemotherapy.

contraindications It should not be given to persons with known hypersensitivity to the drug or to tetrahydrocannabinol, its active ingredient.

adverse effects Among adverse effects reported are drowsiness, dizziness, impaired coordination, and hallucinations. Dronabinol is a Schedule III controlled substance with a high potential for abuse. It can produce both physical and psychologic dependence. It is not recommended for patients who are using a central nervous system depressant or other psychoactive drugs.

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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.

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dronabinol

Marinol^® A synthetic Δ9THC-tetrahydrocannabinol, an active ingredient of marijuana, which may be used to manage glaucoma, pain, N&V, anorexia, wasting linked to chemotherapy, AIDS Adverse effect Drowsiness, confusion, poor coordination. See Marijuana, THC.