What is the recommended dose and frequency of Marinol (dronabinol) for chemotherapy-induced nausea and vomiting and AIDS-related weight loss?

From the Guidelines

For chemotherapy-induced nausea and vomiting and AIDS-related weight loss, Marinol (dronabinol) is recommended at a starting dose of 2.5 mg twice daily, which can be gradually increased to a maximum of 20 mg daily divided into multiple doses if necessary, as supported by the most recent guidelines 1. The dose and frequency of Marinol may vary depending on the individual patient's response and tolerance to the medication.

• For chemotherapy-induced nausea and vomiting, the dose can be increased by 2.5 mg increments to a maximum of 15 mg/m² per dose if needed, with subsequent doses every 2-4 hours after chemotherapy for a total of 4-6 doses per day.
• For AIDS-related weight loss, the recommended starting dose is 2.5 mg twice daily (before lunch and dinner), which can be gradually increased to a maximum of 20 mg daily divided into multiple doses if necessary. It is essential to monitor patients for side effects such as dizziness, confusion, and euphoria, especially when starting treatment or increasing doses, as noted in the guidelines 1. Additionally, elderly patients and those with no prior cannabis exposure may require lower initial doses, and the medication should be taken with food to enhance absorption and reduce gastrointestinal irritation.
• Patients should avoid alcohol and other CNS depressants while taking Marinol and should not drive or operate machinery until they know how the medication affects them. The use of Marinol for chemotherapy-induced nausea and vomiting and AIDS-related weight loss is supported by its ability to activate cannabinoid receptors in the brain that help regulate nausea and appetite, although the data for cancer-related anorexia/cachexia is limited 1.

From the FDA Drug Label

The recommended adult starting dosage of dronabinol capsules is 2.5 mg orally twice daily, one hour before lunch and dinner. The recommended starting dosage of dronabinol capsules is 5 mg/m2, orally administered 1 to 3 hours prior to the administration of chemotherapy and then every 2 to 4 hours after chemotherapy, for a total of 4 to 6 doses per day.

The recommended dose and frequency of Marinol (dronabinol) are:

• For anorexia associated with weight loss in patients with AIDS: 2.5 mg orally twice daily, one hour before lunch and dinner, with a maximum dosage of 10 mg twice daily 2.
• For nausea and vomiting associated with cancer chemotherapy: 5 mg/m2, orally administered 1 to 3 hours prior to the administration of chemotherapy and then every 2 to 4 hours after chemotherapy, for a total of 4 to 6 doses per day, with a maximum dosage of 15 mg/m2 per dose for 4 to 6 doses per day 2. Key points:
• Dose titration may be necessary to achieve a therapeutic effect.
• Patients should be monitored for adverse reactions, particularly CNS symptoms.
• The dosage may need to be reduced in elderly patients or those with a history of psychiatric illness. 2

From the Research

Marinol Dose and Frequency

The recommended dose and frequency of Marinol (dronabinol) for chemotherapy-induced nausea and vomiting and AIDS-related weight loss are as follows:

• For chemotherapy-induced nausea and vomiting, the dose is 5 mg/m², administered 1 to 3 hours before chemotherapy, then every 2 to 4 hours after chemotherapy, for a total of 4 to 6 doses per day 3.
• For AIDS-related weight loss, the recommended dose is 2.5 mg twice daily, before lunch and supper 4.

Administration

Marinol can be administered orally, and the dose may be titrated to achieve the desired effect.

• The administration of Marinol should be started at a low dose and gradually increased as needed and tolerated.
• Patients should be monitored for adverse effects, such as dizziness, confusion, and dysphoria, and the dose adjusted accordingly.

Combination Therapy

Marinol may be used in combination with other antiemetic agents, such as prochlorperazine, for the treatment of chemotherapy-induced nausea and vomiting.

• The combination of Marinol and prochlorperazine has been shown to be more effective than either agent alone in controlling chemotherapy-induced nausea and vomiting 3.
• The use of combination therapy may allow for a lower dose of Marinol to be used, which may reduce the risk of adverse effects.

Abuse Potential

Marinol has a low abuse potential, and there is no evidence of abuse or diversion of the drug 4.

• The slow onset of action and dysphoric effects of Marinol make it unappealing as a drug of abuse.
• The use of Marinol should be monitored, and patients should be advised of the potential risks and benefits of the drug.