What is the recommended dosage of dronabinol (cannabis-based medication) for a 53-year-old patient with poor appetite?

Dronabinol Dosing for Poor Appetite in a 53-Year-Old Patient

For a 53-year-old patient with poor appetite, the recommended starting dose of dronabinol is 2.5 mg orally twice daily, taken one hour before lunch and dinner. 1

Initial Dosing Approach

• Starting dose: 2.5 mg twice daily (one hour before lunch and dinner)
• Alternative starting approach: If concerned about CNS side effects, consider 2.5 mg once daily one hour before dinner or at bedtime 1
• Timing consideration: Dosing later in the day may reduce frequency of CNS adverse reactions 1

Monitoring and Dose Titration

• Monitor for CNS adverse reactions (feeling high, dizziness, confusion, somnolence)

  • These typically resolve in 1-3 days without dosage reduction 1
  • If severe or persistent, reduce to 2.5 mg in evening or at bedtime

• If initial dose is tolerated but greater therapeutic effect is desired:

  • Gradually increase to 2.5 mg before lunch and 5 mg before dinner 1
  • Further titration can be considered up to maximum of 5 mg before lunch and 5 mg before dinner (10 mg daily total) 1

Side Effects to Monitor

• Common side effects: Dizziness, somnolence, cognitive impairment, dysphoria 2
• Monitoring parameters:
  • Weight changes
  • Appetite improvement
  • Cognitive function
  • Mood changes

Clinical Considerations

• Most patients respond adequately to 2.5 mg twice daily 1, 3
• For patients who don't show appetite improvement after 2-4 weeks at 2.5 mg daily, consider increasing to 5 mg daily 3
• Dronabinol can be continued indefinitely if beneficial and well-tolerated 3

Important Caveats

• The evidence for cannabinoids in treating anorexia outside of AIDS and cancer settings is limited 2
• In a small pilot study in long-term care residents with anorexia, dronabinol showed a trend toward weight gain, with 53.5% of subjects gaining weight 4
• Older adults may be more sensitive to CNS effects, so consider starting with a lower dose (2.5 mg once daily) in patients with any history of CNS sensitivity 1
• Failure to respond to dronabinol may indicate increased risk of mortality in some populations 4

Alternative Considerations

If dronabinol is ineffective or poorly tolerated, consider other appetite stimulants such as mirtazapine (especially if depression is present) or megestrol acetate, though each has its own risk profile 5, 3.