Pregnancy Category C
Uses. This is a pure form of THC, the main active ingredient found in the Schedule I substance marijuana. Dronabinol can be obtained from marijuana or manufactured synthetically. Compared to infrequent marijuana users, frequent marijuana users are better at identifying whether they have received dronabinol or a placebo.
Dronabinol is used to reduce nausea in persons undergoing cancer chemotherapy and to stimulate appetite in AIDS (acquired immunodeficiency syndrome) patients. Alzheimer's patients who received experimental drona-binol showed improved appetites and reduction of behavior associated with the disease. Research indicates that the drug may widen airways, a help to persons suffering from breathing difficulty. Experimental success has also been achieved in treating spasticity, reducing not only that affliction but its associated rigidity and pain. Research has also examined whether dronabinol may work as a cough medicine. Human testing shows that oral dosage of dronabinol's active ingredient THC can help reduce pain.
Drawbacks. Dronabinol can redden eyes and accelerate or slow heartbeat. Sometimes users feel faint upon suddenly standing up. Many of marijuana's actions are experienced with dronabinol: euphoria, hallucinations, more acute-ness in physical senses, altered time perception, memory trouble, confusion, and drowsiness. Not everyone finds marijuana actions to be pleasant, and some nausea patients find those effects so unpleasant that they would rather forgo the dronabinol and endure the nausea. Some other effects associated with marijuana have not been observed with medical use of dronabinol, such as trouble with thinking skills and lack of ambition.
Abuse factors. Tolerance occurs to some of the drug's actions but not to appetite stimulation. Dependence is reported, with withdrawal symptoms in-
eluding sleeping difficulty, peevishness, fidgeting, perspiration, runny nose, appetite loss, and loose bowel movements. In one study withdrawal symptoms lasted three days and gradually cleared up over that time. Addiction is uncommon. No one in a five-month study, including persons who had previously abused other drugs, began abusing dronabinol; nor did any of these persons exhibit changes of personality or changes of ability to function in society. An effort to discover evidence of illicit use in San Francisco found none. Apparently persons interested in recreational effects of dronabinol prefer marijuana.
Drug interactions. Animal experimentation has found that dronabinol substantially increases the pain relieving qualities of codeine, heroin, hydro-morphone, meperidine, methadone, morphine, and oxymorphone. The antinausea drug prochlorperazine appears to reduce the unwanted marijuana actions of dronabinol.
Cancer. Dronabinol's potential for causing cancer is unknown. The Ames test, a standard laboratory procedure for detecting cancer-causing potential, revealed none.
Pregnancy. No birth defects have been attributed to dronabinol in mice and rat experiments, although more pregnancy failures occurred. THC passes from a pregnant animal into the fetus. Pregnant women are advised to be cautious with the drug. It passes into milk of nursing mothers, and levels in milk are higher than in the mothers' bloodstream.
Additional scientific information may be found in:
Beal, J.E., et al. "Long-Term Efficacy and Safety of Dronabinol for Acquired Immunodeficiency Syndrome-Associated Anorexia." Journal of Pain and Symptom Management 14 (1997): 7-14. Calhoun, S.R., G.P. Galloway, and D.E. Smith. "Abuse Potential of Dronabinol (Mari-
nol)." Journal of Psychoactive Drugs 30 (1998): 187-96. Devine, J.W., L.A. Mahr, and C.R. Rieck. "Effectiveness of Delta-9-Tetrahydrocannabinol in Chemotherapy-Induced Nausea and Vomiting." Journal of the Iowa Pharmacy Association 54 (1999): 22-24, 47-50. Gonzalez-Rosales, F., and D. Walsh. "Intractable Nausea and Vomiting Due to Gastrointestinal Mucosal Metastases Relieved by Tetrahydrocannabinol (Dronabinol)." Journal of Pain and Symptom Management 14 (1997): 311-14. Haney, M., et al. "Abstinence Symptoms Following Oral THC Administration to Humans." Psychopharmacology 141 (1999): 385-94. Kirk, J.M., and H. de Wit. "Responses to Oral Delta-9-Tetrahydrocannabinol in Frequent and Infrequent Marijuana Users." Pharmacology, Biochemistry, and Behavior 63 (1999): 137-42.
Struwe, M., et al. "Effect of Dronabinol on Nutritional Status in HIV Infection." Annals of Pharmacotherapy 27 (1993): 827-31. Wright, P.L., et al. "Reproductive and Teratologic Studies with DELTA-9-Tetrahydrocannabinol and Crude Marijuana Extract." Toxicology and Applied Pharmacology 38 (1976): 223-35.
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