Dronabinol is an orally available cannabinoid agonist that
is used to treat nausea and vomiting and to stimulate appetite,
particularly in patients with wasting disease or
cachexia. Dronabinol is associated with a minimal rate of
serum enzyme elevations during therapy and has not been linked
to cases of clinically apparent liver injury with
Dronabinol (droe nab’ i nol) is the main isomer of
tetrahydrocannabinol, the principal psychoactive constituent of
the marijuana plant (Cannabis sativa). Dronabinol is a
partial agonist of the cannabinoid receptors which are found in
the central nervous system (CB1 receptor), but also
peripherally (largely CB2 receptors). Activation of CB
receptors results in effects on appetite, mood, cognition,
memory and perception. Dronabinol therapy has been shown
to improve in patients with AIDS related weight loss and to
decrease the nausea and vomiting associated with cancer
chemotherapy. Dronabinol was approved for use in the
United States in 1985 and current indications include treatment
of anorexia associated with weight loss in patients with AIDS,
and prevention of cancer chemotherapy associated nausea and
vomiting. Dronabinol is available as 2.5, 5 and 10 mg
capsules generically and under the brand name Marinol.
The typical adult oral dose is 2.5 mg twice daily, which can be
increased based upon tolerance and effect to a maximum of 20
mg/day. Common side effects include fatigue, somnolence,
dizziness, euphoria, abnormal thinking, paranoid reactions,
conjunctivitis, diarrhea, nausea, vomiting and abdominal
pain. Rare side effects include hallucinations and
seizures. Dronabinol is classified as a Schedule III
drug, indicating that it has mild potential for physical and
psychological dependency and abuse.
Serum aminotransferase elevations during dronabinol therapy
were reported to occur in 6% of treated patients compared to
4.3% in controls who receiving cancer chemotherapy. The
aminotransferase elevations were transient, mild-to-moderate in
severity, and not associated with symptoms or jaundice.
There have been no convincing cases of clinically apparent
liver injury attributable to dronabinol published in the
literature and, thus, significant liver injury from dronabinol
must be exceeding rare, if it occurs at all.
Likelihood score: E (unlikely cause of clinically apparent liver injury).
Mechanism of Injury
Dronabinol is metabolized by the liver and undergoes
extensive first-pass metabolism to both active and inactive
metabolites. Despite its hepatic metabolism and high
level of plasma protein binding, it has not been implicated in
causing drug-drug interactions. The lack of reported
cases of liver injury due to dronabinol may be due to the low
doses of typical therapy.
REPRESENTATIVE TRADE NAMES
Dronabinol – Generic, Marinol®
Product labeling at DailyMed, National Library of
||CAS REGISTRY NO.
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