Dronabinil (Marinol) is an oral synthetic form of 9-tetrahydrocannibinol (THC), the intoxicating substance that is found in marijuana. It is a Schedule III drug under the Controlled Substances Act. Dronabinil is approved by the Food and Drug Administration (FDA) for the treatment of the anorexia and wasting away of people who have AIDS, as well as for the treatment of the nausea and vomiting associated with some forms of chemotherapy treatment for cancer. The drug is given to stimulate appetite and decrease nausea. Dronabinil was developed with the cooperation of the Drug Enforcement Administration (DEA) and was first approved by the FDA in 1985.

A related drug, Sativex, which is a liquid cannabis extract that patients spray under the tongue, was approved for use in Canada in 2005 for the neuropathic pain of multiple sclerosis, according to the New England Journal of Medicine. This drug includes dronabinil and cannabidiol, both ingredients in marijuana. The manufacturer is testing the drug for the pain of cancer and rheumatoid arthritis and for other uses.

Patients considering use of dronabinol should tell their doctors whether they have any allergies to marijuana or sesame oil. Studies have not been performed on pregnant women, but animal studies in which the animals were given high doses of dronabinil found the drug increased the risk of the death of a fetus. Women who are breastfeeding should know that the drug passes into human breast milk and can affect the nursing infant.

When patients first start taking dronabinil, they should avoid driving or operating equipment until they know how the drug affects them. Dronabinil may be very sedating to some patients. Patients taking the drug should avoid alcohol, marijuana, and other drugs that affect the central nervous system, such as sedatives or tricyclic antidepressants. Sedating cold medications may also interact with dronabinil.

Common side effects, which may disappear as the body adjusts to the drug, include dizziness, drowsiness, clumsiness, a false sense of well-being, nausea, trouble with thinking, and vomiting. Less common side effects are blurred vision, dryness of the mouth, restlessness, flushed face, a feeling of lightheadedness when getting up from a lying down or sitting position, and unusual fatigue or weakness.

Adverse side effects associated with toxic levels of dronabinil include delusions, hallucinations, depression, anxiety, heart palpitations, and tachycardia (rapid heartbeat).

The drug should be used with caution by patients who have heart disease, new or worsened hypertension, or a history of substance abuse. The drug should also be used with care among patients who have depression, schizophrenia, or mania, since it may exacerbate the psychiatric problem.

Advocates of smoking marijuana rather than taking dronabinil say that it is difficult to find the right dose of the drug and it may be overly sedating. However, the DEA bans all use of marijuana that is smoked, whether for medical purposes or recreational purposes. The federal ban against marijuana continues despite some state laws that allow certain patients to use marijuana for medical purposes. Federal law prevails over state law; however, enforcement by state officials may be less strict in states with medical marijuana laws.

References:

Okie, Susan, M.D. "Medical Marijuana and the Supreme Court." New England Journal of Medicine 353, no. 7 (August 18, 2005): 648-651.

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