Action and Spectrum

Actions and Spectrum: 

dronabinol is a medication that contains a synthetic version of delta-9-tetrahydrocannabinol (THC), which is the primary psychoactive compound in cannabis. It is a Schedule III controlled substance that is FDA-approved for the treatment of nausea and vomiting associated with chemotherapy, and for the treatment of anorexia associated with weight loss in patients with AIDS. 

dronabinol acts by binding to cannabinoid receptors in the brain, which are part of the endocannabinoid system. These receptors are involved in various physiological processes, including pain perception, mood, appetite, and nausea. By activating these receptors, dronabinol can help to reduce nausea and vomiting, increase appetite, and improve overall well-being. 

The spectrum of dronabinol’s effects can vary depending on the individual patient and the dosage used. Some common side effects of dronabinol include dizziness, drowsiness, confusion, and dry mouth. Additionally, because dronabinol is derived from THC, it can produce feelings of euphoria or a “high” in some patients. However, these effects are typically mild and well-tolerated. 

Drug Interaction

Adverse Reaction

1-10% 

Dizziness 

Euphoria 

Paranoid reaction 

Somnolence 

Abnormal thinking 

Abdominal pain 

Nausea 

Vomiting  

<1% 

Depression 

Nightmares 

Speech difficulties 

Emotional lability 

Hypotension 

Tremors 

Flushing 

Sweating 

Anorexia 

Hepatic enzyme elevation 

Tinnitus  

Frequency not defined 

Amnesia 

Anxiety/nervousness 

Hallucination 

Ataxia 

Confusion 

Depersonalization 

Asthenia 

Palpitations 

Tachycardia 

Black Box Warning

Contraindication / Caution

Contraindication/Caution: 

• Hypersensitivity: dronabinol should not be used in patients who have a known hypersensitivity to THC or any of the ingredients in the medication. 
• Psychiatric disorders: Patients with a history of psychiatric disorders, such as schizophrenia or bipolar disorder, may be at increased risk of experiencing psychiatric symptoms, such as paranoia or hallucinations, when using dronabinol. 
• Substance abuse: Patients with a history of substance abuse may be at increased risk of developing dependency or addiction when using dronabinol. 
• Cardiovascular disease: dronabinol can cause an increase in heart rate and blood pressure, and as such, it should be used with caution in patients with a history of cardiovascular disease. 
• Respiratory disease: dronabinol can cause respiratory depression, and as such, it should be used with caution in patients with respiratory disease, such as asthma or chronic obstructive pulmonary disease (COPD). 
• Pregnancy and breastfeeding: dronabinol should not be used during pregnancy or breastfeeding, as the effects of the medication on the developing fetus or nursing infant are not known. 

Pregnancy / Lactation

Pregnancy consideration:  

dronabinol should not be used in pregnant females as it may cause fetal harm 

Breastfeeding warnings: lactating females should not breastfeed during the treatment. 

Pregnancy category: 

• Category A: Satisfactory and well-controlled studies show no risk to the fetus in the first or later trimester. 
• Category B: There is no affirmation of risk to the fetus found in animal reproduction studies, and there are not enough studies on pregnant women. 
• Category C: Adverse effects on the fetus found with evidence in animal reproduction studies and no adequate evidence for a product in humans; Pregnant women must take care of the potential risks. 
• Category D: There is adequate data available with sufficient evidence of human fetal risk from various platforms. However, despite potential dangers may be used only in emergency cases for potential benefits. 
• Category X: Drugs listed in this category outweigh risks over benefits. The drug is not for pregnant women. 
• Category N: No data is available for the drug under this category. 

Pharmacology

Pharmacology: 

dronabinol is a synthetic form of delta-9-tetrahydrocannabinol (THC), the primary psychoactive compound found in the cannabis plant. It is marketed under the brand name Marinol and is used to treat nausea and vomiting associated with chemotherapy, as well as to stimulate appetite in patients with AIDS. 

The pharmacology of dronabinol is like that of THC, as it binds to and activates cannabinoid receptors in the brain and body. Specifically, dronabinol binds to both CB1 and CB2 receptors, which are located throughout the body, including in the brain, immune system, and gastrointestinal tract. 

Activation of these receptors by dronabinol leads to a range of effects, including pain relief, relaxation, altered perception and mood, increased appetite, and decreased nausea and vomiting. These effects are mediated by the release of various neurotransmitters and other signaling molecules in the brain and body. 

Pharmacodynamics: 

The pharmacodynamics of dronabinol involves its interactions with the cannabinoid receptors in the brain and other parts of the body. dronabinol is a synthetic form of delta-9-tetrahydrocannabinol (THC), which is the primary psychoactive component of the cannabis plant. Like THC, dronabinol binds to and activates both CB1 and CB2 receptors, which are widely distributed in the body. 

Pharmacokinetics: 

Absorption 

The bioavailability is 90-95% 

The peak plasma concentration is achieved in 0.5-4 hours  

The peak plasma concentration is 1.9 ng/mL 

The area under the curve is 3.8 ng·hr/mL 

Distribution 

Protein bound is about 97% 

The volume of distribution is 10 L/kg 

Metabolism 

Metabolites obtained by extensive first-pass hepatic metabolism are 11-hydroxy-delta-9-tetrahydrocannabinol (active) 

Elimination and Excretion 

The half-life is 5.6 hours (for parent drug) and 44-59 hours (for metabolites) 

The rate of renal clearance is 18-20 mL/min 

The total body clearance is 0.2 L/kg/hr 

The drug is excreted 50% in feces and 15% urine 

Adminstartion

Administration: 

dronabinol is available in capsule form and is administered orally. It is typically taken with food to increase its absorption and reduce the risk of side effects, such as dizziness and nausea. 

The dosing of dronabinol depends on the condition being treated and the patient’s individual response to the medication. For the treatment of chemotherapy-induced nausea and vomiting, the usual starting dose is 5 mg taken two to four times a day, with a maximum daily dose of 20 mg. For the stimulation of appetite in patients with AIDS, the usual starting dose is 2.5 mg taken twice daily, with a maximum daily dose of 20 mg. 

The onset of action of dronabinol is slow, with peak plasma levels reached several hours after administration. The effects of dronabinol can last up to six hours, although individual responses can vary. Patients taking dronabinol should be monitored for adverse effects, particularly in the first few days of treatment, and the dose may need to be adjusted based on the patient’s response. 

Patient Information Leaflet

Patient information leaflet 

Generic Name: dronabinol 

Pronounced: dro-nah-bin-ol 

Why do we use dronabinol? 

dronabinol is used to treat a variety of medical conditions, including: 

• Nausea and vomiting: dronabinol is approved for the treatment of chemotherapy-induced nausea and vomiting in patients who do not respond to conventional antiemetic medications. 
• Appetite stimulation: dronabinol is used to stimulate appetite and promote weight gain in patients with HIV/AIDS-related cachexia (wasting syndrome) who have not responded to other therapies. 
• Pain relief: dronabinol may be used to relieve chronic pain, particularly in patients with neuropathic pain that is refractory to other treatments. 
• Muscle spasms: dronabinol may be used to treat muscle spasms and spasticity associated with multiple sclerosis and other neurological conditions.