From the Guidelines
Dronabinol is not recommended as a first-line treatment for weight gain in patients with cancer-related anorexia/cachexia due to its limited efficacy and potential side effects, as evidenced by the most recent and highest quality study 1.
Overview of Dronabinol Efficacy
- The study published in 2020 in the Journal of Clinical Oncology 1 found that dronabinol was less effective than megestrol acetate in promoting weight gain, appetite, and quality of life in patients with incurable cancer.
- Another study published in 2017 in Clinical Nutrition 1 also found that the limited and inconsistent evidence does not support a recommendation for dronabinol in patients with cancer anorexia.
- A 2021 guideline published in Clinical Nutrition 1 similarly concluded that the limited and inconsistent evidence does not support a recommendation for dronabinol in patients with cancer anorexia.
Potential Side Effects and Considerations
- Dronabinol can cause side effects such as dizziness, confusion, euphoria, and dry mouth, which can be more pronounced in elderly patients or those without prior cannabis exposure.
- The potential benefits of dronabinol in improving chemosensory perception and appetite in patients with cancer anorexia must be weighed against its potential risks and limitations.
- Regular monitoring of weight, nutritional status, and side effects is essential during treatment with dronabinol, if it is used at all.
Alternative Treatment Options
- Megestrol acetate is a more effective appetite stimulant than dronabinol for some patients, and may be considered as a first-line treatment option.
- Other treatment options, such as combination therapy with medroxyprogesterone, megestrol acetate, eicosapentaenoic acid, and L-carnitine supplementation, may also be effective in promoting weight gain and improving quality of life in patients with cancer-related anorexia/cachexia.
From the FDA Drug Label
The appetite stimulant effect of dronabinol capsules in the treatment of AIDS-related anorexia associated with weight loss was studied in a randomized, double-blind, placebo-controlled study involving 139 patients. Trends toward improved body weight and mood, and decreases in nausea were also seen After completing the 6-week study, patients were allowed to continue treatment with dronabinol capsules in an open-label study, in which there was a sustained improvement in appetite.
Dronabinol has shown efficacy in weight gain by stimulating appetite in patients with AIDS-related anorexia associated with weight loss, as evidenced by trends toward improved body weight in clinical studies 2. However, the evidence is not conclusive, and the primary outcome was improvement in appetite. Weight gain was only a secondary outcome with a trend towards improvement.
From the Research
Efficacy of Dronabinol for Weight Gain
- Dronabinol has been shown to be effective in promoting appetite stimulation and weight gain in patients with HIV/AIDS-related anorexia and weight loss 3, 4, 5.
- Studies have reported that dronabinol is associated with increased appetite, improved mood, and decreased nausea in patients with AIDS-related anorexia and weight loss 4.
- A retrospective chart review found that 63% of patients who received dronabinol for 3 to 12 months maintained or gained weight, with a mean weight gain of 3.7 +/- 10.6 lb in patients receiving dronabinol for 1 year 5.
- However, the efficacy of dronabinol for weight gain in cancer-related anorexia and weight loss is not well established, with no approved indication for this use 6.
Comparison with Other Treatments
- A study compared the effects of megestrol acetate and dronabinol on interleukin-6 (IL-6) levels in patients with cancer-associated anorexia and weight loss, and found no significant differences in IL-6 levels between the two treatments 7.
- Another study found that dronabinol was a well-tolerated option for promoting appetite stimulation, although further studies are needed to establish its efficacy and safety for chronic use beyond 52 weeks 3.
Safety and Tolerability
- Dronabinol has been shown to be safe and well-tolerated in patients with HIV/AIDS-related anorexia and weight loss, with mostly mild to moderate side effects such as euphoria, dizziness, and thinking abnormalities 4.
- However, further studies are needed to establish the safety and efficacy of dronabinol for chronic use beyond 52 weeks 3.