From the Guidelines
Dronabinol should not be used as a first-line treatment for cancer-related anorexia/cachexia due to its limited efficacy and potential side effects, as evidenced by a randomized trial comparing megestrol acetate to dronabinol, which showed megestrol acetate to be superior for promoting weight gain and appetite in patients with advanced cancer 1.
Overview of Dronabinol
Dronabinol is a synthetic form of THC, the main psychoactive component in cannabis, available as a prescription medication. It's primarily used to treat severe nausea and vomiting caused by chemotherapy, as well as appetite loss and weight loss in patients with HIV/AIDS.
Dosage and Administration
The typical starting dose for chemotherapy-induced nausea is 5 mg/m² taken 1-3 hours before chemotherapy and then every 2-4 hours after chemotherapy for a total of 4-6 doses per day. For appetite stimulation in AIDS patients, the usual starting dose is 2.5 mg twice daily before lunch and dinner. However, according to the most recent guideline, oral dronabinol may be started at a 2.5 mg dose three times a day and can be up-titrated to 10 mg three to four times daily 1.
Side Effects and Precautions
Common side effects include dizziness, euphoria, paranoia, drowsiness, and confusion. Patients should avoid driving or operating machinery while taking this medication due to its psychoactive effects. Dronabinol works by activating cannabinoid receptors in the brain that regulate nausea, vomiting, and appetite. It's essential to note that dronabinol is a controlled substance with potential for dependence, so it should be used exactly as prescribed.
Clinical Use in Cancer-Related Anorexia/Cachexia
While dronabinol may have some benefits in improving appetite and weight gain in patients with cancer-related anorexia/cachexia, the evidence is limited, and it is not recommended as a first-line treatment. A combination therapy approach, including medications such as megestrol acetate, medroxyprogesterone, and L-carnitine, may yield better outcomes for patients with cancer cachexia 1.
Key Points to Consider
- Dronabinol has limited efficacy in treating cancer-related anorexia/cachexia
- Megestrol acetate is superior to dronabinol in promoting weight gain and appetite in patients with advanced cancer
- Combination therapy may be a more effective approach for managing cancer cachexia
- Dronabinol can be used as a salvage antiemetic for refractory chemotherapy-induced nausea and vomiting 1
From the FDA Drug Label
Dronabinol capsules is a cannabinoid indicated in adults for the treatment of: (1) • Anorexia associated with weight loss in patients with AIDS. (1) • Nausea and vomiting associated with cancer chemotherapy in patients who have failed to respond adequately to conventional antiemetic treatments.
Dronabinol capsules are indicated in adults for the treatment of: • anorexia associated with weight loss in patients with Acquired Immune Deficiency Syndrome (AIDS). • nausea and vomiting associated with cancer chemotherapy in patients who have failed to respond adequately to conventional antiemetic treatments.
Dronabinol capsules are a prescription medicine used in adults to treat: o loss of appetite (anorexia) in people with AIDS (Acquired Immune Deficiency Syndrome) who have lost weight. o nausea and vomiting caused by anti-cancer medicine (chemotherapy) in people whose nausea and vomiting have not improved with usual anti-nausea medicines
Dronabinol is used to treat two main conditions:
- Anorexia associated with weight loss in patients with AIDS
- Nausea and vomiting associated with cancer chemotherapy in patients who have failed to respond adequately to conventional antiemetic treatments 2, 2, 2
From the Research
Dronabinol Overview
- Dronabinol is an oral form of delta-9-tetrahydrocannabinol indicated for treatment of anorexia associated with weight loss in individuals with AIDS, and nausea and vomiting associated with cancer chemotherapy 3.
- It is also used to treat visceral hypersensitivity causing noncardiac chest pain 4.
- Dronabinol has been studied for its effects on metabolic parameters, and it does not significantly affect basic metabolic components after a period of 28 days 4.
Abuse Potential
- There is no evidence of abuse or diversion of dronabinol 3.
- Available prescription tracking data indicates that use remains within the therapeutic dosage range over time 3.
- Dronabinol does not provide effects that are considered desirable in a drug of abuse, with a slow and gradual onset of action, weakly reinforcing, and dysphoric and unappealing effects 3.
Efficacy in Nausea and Vomiting
- Dronabinol is effective in treating refractory nausea and vomiting related to peritoneal carcinomatosis 5.
- It is also effective in treating delayed chemotherapy-induced nausea and vomiting, with similar efficacy to ondansetron 6.
- Dronabinol can be used as monotherapy or in combination with other antiemetics, such as ondansetron and prochlorperazine 7.