Classifications: antiemetic; cannabinoid; Therapeutic: antiemetic; appetite stimulant
Pregnancy Category: C
Controlled Substance: Schedule III
2.5 mg, 5 mg, 10 mg capsules
Synthetic derivative of tetrahydrocannabinol (THC), the principal psychoactive constituent of marijuana (Cannabis sativa). Mechanism unclear: Inhibits vomiting through the control mechanism in the medulla oblongata, producing potent antiemetic
effect. Has complex CNS effect that necessitates close supervision of the patient during drug use. Decreases REM sleep;
effect on BP is unpredictable; oral temperature may be decreased, and heart rate may be increased. Risk of drug abuse is
Produces potent antiemetic effect and is used to treat chemotherapy-induced nausea and vomiting.
To treat chemotherapy-induced nausea and vomiting in cancer patients who fail to respond to conventional antiemetic therapy.
Appetite stimulant for AIDS patients.
Nausea and vomiting caused by other than chemotherapeutic agents; hypersensitivity to dronabinol or sesame oil; pregnancy
(category C); lactation.
First exposure, especially in the older adult or cardiac patient; hypertension, cardiovascular disorders; epilepsy; psychiatric
illness, patient receiving other psychoactive drugs; severe hepatic dysfunction.
Route & Dosage
Adult/Child: PO 5 mg/m2 13 h before administration of chemotherapy, then q24h after chemotherapy for a total of 46 doses, dose
may be increased by 2.5 mg/m2 (max: of 15 mg/m2 if necessary)
Adult: PO 2.5 mg b.i.d., before lunch and dinner
- Do not repeat dose following a reaction until patient's mental state has returned to normal and the circumstances have been
- Store at 8°15° C (46°59° F).
Adverse Effects (≥1%)CNS: Drowsiness,
psychologic high, dizziness, anxiety, confusion, euphoria, sensory or perceptual difficulties, impaired coordination, depression
irritability, headache, ataxia, memory lapse, paresthesias, paranoia, depersonalization, disorientation, tinnitus, nightmares,
speech difficulty, facial flush, diaphoresis. CV:
Tachycardia, orthostatic hypotension, hypertension, syncope. GI:
Dry mouth, diarrhea
, fecal incontinence. Other:
and other cns depressants
may exaggerate psychoactive effects of dronabinol; tricyclic antidepressants
may cause tachycardia.
Rapidly absorbed from GI tract, with bioavailability of 1020%. Peak:
23 h. Distribution:
Fat soluble; distributed to many organs; distributed into breast milk. Metabolism:
In liver; extensive first-pass metabolism
Principally in bile; 50% in feces within 72 h; 1015% in urine. Half-Life:
Assessment & Drug Effects
- Monitor patients with hypertension or heart disease for BP and cardiac status.
- Response to dronabinol is varied, and previous uneventful use does not guarantee that adverse reactions will not occur. Effects
of drug may persist an unpredictably long time (days). Extended use at therapeutic dosage may cause accumulation of toxic
amounts of dronabinol and its metabolites.
- Watch for disturbing psychiatric symptoms if dose is increased: Altered mental state, loss of coordination, evidence of a
psychologic high (easy laughing, elation and heightened awareness), or depression.
- Note: Abrupt withdrawal is associated with symptoms (within 12 h) of irritability, insomnia, restlessness. Peak intensity occurs
at about 24 h: Hot flashes, diaphoresis, rhinorrhea, watery diarrhea, hiccups, anorexia. Usually, syndrome is over in 96
Patient & Family Education
- Do not drive or engage in other potentially hazardous activities that require alertness and judgment because of high incidence
of dizziness and drowsiness.
- Understand potential (reversible) for drug-induced mood or behavior changes that may occur during dronabinol use.
- Do not ingest alcohol during period of systemic dronabinol effect. Effect on blood ethanol levels is complex and unpredictable.