Dronabinol
MARINOL
Pronunciation: droe-NAB-i-nol
“Marijuana Drone”
What it isSynthetic delta-9-THC — the same molecule as the cannabis constituent, a CB1 and CB2 partial 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.
Available strengths
- cap 2.5, 5, 10 mg
- sol 5 mg/mL
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
Cost
| Strength | #/mo | generic $/mo | CostPlus | |
|---|---|---|---|---|
| 2.5 mg | cap | 60 BID | not offered | |
| 5 mg | cap | 60 BID | $201.21 | not offered |
| 10 mg | cap | 60 BID | not offered |
Generic entry2008
NO BOXED WARNINGS
Principal riskDysphoria and dizziness, worst in the elderly
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilitySedation, QT prolongation, extrapyramidal symptoms or anticholinergic toxicity vary by receptor target.
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