Dronabinol
MARINOL
What it isSynthetic delta-9-THC and CB1 agonist; chemotherapy nausea and appetite stimulation in AIDS.
Why this oneIt provides a measured single-cannabinoid product rather than the variable mixture delivered by inhaled cannabis.
What limits itDysphoria, dizziness, and tachycardia are worst in older adults; oral absorption is slow and variable, and it is Schedule III.
FDA-approved for
- chemo nausea/AIDS anorexia (1985)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Anorexia with weight loss in AIDS | Adults | 2.5 mg BID | 2.5–5 mg BID | 10 mg BID |
| Chemotherapy-induced nausea/vomiting (refractory) | Adults | 5 mg/m² pre-chemo, then q2–4h | 5 mg/m² q2–4h | 4–6 doses/day |
Titration AIDS anorexia: increase gradually (e.g., 2.5 mg AM / 5 mg PM, then 5 mg BID) as tolerated.
Renal Undefined
Hepatic Undefined
CINV: repeat every 2–4 h after chemotherapy, 4–6 doses per day.
Instructions
- AIDS anorexia: take 1 h before lunch and dinner; elderly or intolerant may start 2.5 mg QD before dinner or at bedtime.
- CINV: first dose on empty stomach ≥30 min before eating; subsequent doses regardless of meals.
Contraindications
- History of hypersensitivity reaction to dronabinol or sesame oil
Cautions
- Neuropsychiatric adverse reactions; avoid in patients with psychiatric history; may impair mental/physical ability
- Hemodynamic instability (hypotension, hypertension, syncope, tachycardia)
- Seizures/seizure-like activity
- Risk of abuse/misuse; multiple substance abuse
- Paradoxical nausea/vomiting/abdominal pain
Adverse reactions
- Abdominal pain
- Dizziness
- Euphoria
- Nausea
- Paranoid reaction
- Somnolence
- Abnormal thinking
- Vomiting
Pregnancy May cause fetal harm; avoid use in pregnancy
Lactation HIV-infected women advised not to breastfeed (HIV transmission); monitor infant weight where breastfeeding appropriate
NO BOXED WARNINGS
Principal riskDysphoria and dizziness, worst in the elderly
Cost, est. cash$10–$300/month
Generic entry2008
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilitySedation, QT prolongation, extrapyramidal symptoms or anticholinergic toxicity vary by receptor target.
Mechanism of action: Dronabinol ballicule
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Memory aids: mascots and interaction avatars
