Dronabinol — Drug Monograph

Brand names: Marinol, Syndros

Drug class: Supportive Care Agent

Mechanism of Action

Synthetic Δ9-tetrahydrocannabinol (THC), the principal psychoactive compound in Cannabis sativa. Agonist at cannabinoid CB1 receptors in the CNS (cerebral cortex, basal ganglia, cerebellum, brainstem) and peripheral tissues. CB1 activation in the dorsal vagal complex and cortex suppresses the vomiting reflex. Also stimulates appetite via hypothalamic CB1 receptors — the basis for its AIDS anorexia indication.

FDA Indications

• Nausea and vomiting associated with cancer chemotherapy in patients who have failed to respond adequately to conventional antiemetic treatments
• Anorexia associated with weight loss in patients with AIDS

Common Side Effects

• Euphoria / feeling "high"
• Sedation/somnolence
• Dizziness
• Confusion/disorientation
• Ataxia
• Increased appetite (may be beneficial in anorexia)
• Dry mouth
• Tachycardia

Clinical Pearl

Dronabinol occupies a specific niche: FDA-approved rescue antiemetic for patients who have failed conventional therapy. Clinical trials in the pre-5-HT3 era showed it to be superior to placebo and comparable to prochlorperazine for CINV. In the modern era, it is primarily used as a 3rd- or 4th-line rescue agent. The psychoactive effects (euphoria, dysphoria, paranoia) are often acceptable — even desirable — in some patients but can be distressing in elderly or cognitively impaired individuals.…

Related Therapies & Mechanisms

• Aprepitant (Emend) — Supportive Care Agent
• Avatrombopag (Doptelet) — Supportive Care Agent
• Darbepoetin Alfa (Aranesp) — Supportive Care Agent
• Defibrotide (Defitelio) — Supportive Care Agent