II. Indications: Synthetic Tetrahydrocannabinol (THC)
- See Cachexia in Cancer
- See Geriatric Failure to Thrive
- See Nausea in Terminally Ill Patients
- Anorexia in Chronic Renal Failure
- Chemotherapy induced Nausea or Vomiting
- Cachexia in AIDS
III. Indications: Purified Cannabidiol (CBD, Epidiolex)
IV. Mechanism: Two product types derived from Marijuana and hemp
- Synthetic Tetrahydrocannabinol (THC)
- Will generate a positive Urine Drug Screen
- Purified Cannabidiol (CBD)
- Does not cause the "high" seen with THC
- Typically will not generate a positive Urine Drug Screen (but may if trace THC in product)
V. Preparations: Cannabidiol (CBD)
- Epidiolex oral solution
- FDA approved in U.S. as of 2018, with a cost of $32,000/year
- OTC products (various forms)
- Legal status depends on U.S. State
- Not regulated or studied for efficacy and safety
VI. Preparations: Synthetic Tetrahydrocannabinol (THC)
- Nabilone (Cesamet, FDA CII) 1-2 mg orally every 12 hours
- Dronabinol
- Marinol capsules (FDA CIII as misuse is less likely due to formulation)
- Dose: 5-10 mg orally, rectally or sublingual every 6-8 hours
- Syndros liquid (FDA CII)
- Marinol capsules (FDA CIII as misuse is less likely due to formulation)
VII. Drug Interactions: Cannabidiol (CBD)
- Cannabidiol inhibits CYP2C19, CYP2C8, CYP2C9
- Increases levels of Citalopram, Phenytoin, Amitriptyline, Valproic Acid, Warfarin
- Cannabidiol levels may be lowered
- Strong CYP3A4 Inducers lower CBD levels (e.g. St. John's Wort, Carbamazepine, Phenytoin, Rifampin)
- Strong CYP3A4 inhibitors raise CBD levels (e.g. Clarithromycin)
VIII. Adverse Effects: CBD
- Drowsiness or sedation (esp. in combination with other CNS Depressants)
- Diarrhea
- Liver Function Test abnormalities
IX. Safety
- Avoid THC and CBD in pregnancy, Lactation and those taking multiple medications
- Check CBD product for a certificate of analysis that reports CBD levels, THC levels and contaminants
X. Resources
- Simplified Guideline for prescribing Medical Cannabinoids in Primary Care
XI. References
- (2019) Presc Lett 26(6)
- (2018) Presc Lett 25(4)
- (2018) Presc Lett 25(9):51
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Related Studies (from Trip Database) Open in New Window
| dronabinol (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| DRONABINOL 10 MG CAPSULE | Generic | $7.86 each |
| DRONABINOL 2.5 MG CAPSULE | Generic | $2.86 each |
| DRONABINOL 5 MG CAPSULE | Generic | $4.85 each |
Ontology: Tetrahydrocannabinol (C0039663)
| Definition (CHV) | an organic chemical extracted from Marihuana |
| Definition (CHV) | an organic chemical extracted from Marihuana |
| Definition (CHV) | an organic chemical extracted from Marihuana |
| Definition (CHV) | an organic chemical extracted from Marihuana |
| Definition (CHV) | an organic chemical extracted from Marihuana |
| Definition (MSH) | A psychoactive compound extracted from the resin of Cannabis sativa (marihuana, hashish). The isomer delta-9-tetrahydrocannabinol (THC) is considered the most active form, producing characteristic mood and perceptual changes associated with this compound. |
| Definition (NCI_NCI-GLOSS) | A synthetic pill form of delta-9-tetrahydrocannabinol (THC), an active ingredient in marijuana that is used to treat nausea and vomiting associated with cancer chemotherapy. |
| Definition (NCI) | A synthetic form of delta-9-tetrahydrocannabinol, a psychoactive substance found in Cannabis sativa. Dronabinol acts directly on the appetite and vomiting control centers in the brain to stimulate appetite and prevent emesis. (NCI04) |
| Definition (PDQ) | A synthetic form of delta-9-tetrahydrocannabinol, a psychoactive substance found in Cannabis sativa. Dronabinol acts directly on the appetite and vomiting control centers in the brain to stimulate appetite and prevent emesis. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=39707&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=39707&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C867" NCI Thesaurus) |
| Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
| MSH | D013759 |
| SnomedCT | 386846008, 72024007, 108415005, 96225007 |
| LNC | LP16059-5, MTHU003348 |
| English | delta(1)-Tetrahydrocannabinol, delta(1)-THC, delta(9)-Tetrahydrocannabinol, delta(9)-THC, THC, 6H-Dibenzo(b,d)pyran-1-ol, 6a,7,8,10a-tetrahydro-6,6,9-trimethyl-3-pentyl-, (6aR-trans)-, 9 ene Tetrahydrocannabinol, 9-ene-Tetrahydrocannabinol, Delta 9-Tetrahydrocannabinol, Tetrahydrocannabinol, Synthetic delta-9-Tetrahydrocannabinol, delta-9-tetrahydrocannabinol, DELTA THC 09, dronabinol (medication), DRONABINOL, tetrahydrocannabinol (THC), Dronabinol, dronabinol, Dronabinol [Chemical/Ingredient], (-)-.DELTA.9-Tetrahydrocannabinol, tetrahydrocannabinol, delta-9-Tetrahydrocannabinol, Dronabinol (product), Dronabinol (substance), Tetrahydrocannabinol (substance), delta-9-Tetrahydrocannabinol (substance), delta 9-tetrahydrocannabinol |
| Swedish | Tetrahydrocannabinol |
| Spanish | delta-9-tetrahidrocannabinol (sustancia), delta-9-tetrahidrocanabinol sintético, delta-9-tetrahidrocanabinol, delta-9-tetrahidrocannabinol, delta-9-tetrahidrocanabinol (sustancia), Dronabinol, Tetrahidrocannabinol, Not Translated[Dronabinol], dronabinol (producto), dronabinol (sustancia), dronabinol, tetrahidrocanabinol (sustancia), tetrahidrocanabinol, THC, delta(9)-THC |
| Czech | tetrahydrokanabinol |
| Finnish | Tetrahydrokannabinoli |
| Italian | THC, Delta(1)-THC, Delta(1)-tetraidrocannabinolo, Delta(9)-THC, Delta(9)-tetraidrocannabinolo, 9-ene-tetraidrocannabinolo, Dronabinolo, Tetraidrocannabinolo |
| Russian | TETRAGIDROKANNABINOL, DRONABINOL, ТЕТРАГИДРОКАННАБИНОЛ, ДРОНАБИНОЛ, DELTA (9)-THC, THC |
| Japanese | テトラヒドロカンナビノール, デルタ9THC, ドロナビノール, Δ1-3,4-trans-テトラヒドロカンナビノール |
| German | DELTA THC 09, Delta(9)-THC, Dronabinol, THC, Tetrahydrocannabinol |
| Polish | Tetrahydrokannabinol |
| French | D9-THC, THC (TétraHydroCannabinol), Dronabinol, Tétrahydrocannabinol |
| Portuguese | Not Translated[Dronabinol], Tetra-Hidrocanabinol, Dronabinol, THC, delta (9)-THC |
Ontology: nabilone (C0068333)
| Definition (NCI) | A synthetic cannabinoid and dibenzopyrane derivative with anti-emetic activity. Although the mechanism of action has not been fully elucidated yet, it has been suggested that nabilone is a highly selective and strong agonist for the cannabinoid receptors CB1 and CB2, both of which are coupled to Gi/o proteins. The CB1 receptors are expressed predominantly in central and peripheral neurons and receptor stimulation has been implicated in the reduction of chemotherapy-induced nausea. |
| Definition (PDQ) | A synthetic cannabinoid and dibenzopyrane derivative with anti-emetic activity. Although the mechanism of action has not been fully elucidated yet, it has been suggested that nabilone is a highly selective and strong agonist for the cannabinoid receptors CB1 and CB2, both of which are coupled to Gi/o proteins. The CB1 receptors are expressed predominantly in central and peripheral neurons and receptor stimulation has been implicated in the reduction of chemotherapy-induced nausea. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=39760&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=39760&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C1171" NCI Thesaurus) |
| Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
| MSH | C011941 |
| SnomedCT | 322124005, 395806009 |
| English | 3-(1,1-dimethylheptyl)-6,6a,7,8,10,10a- hexahydro-1-hydroxy-6,6-dimethyl-9H-dibenzo(b,d)pyran-9-one, nabilone, NABILONE, nabilone [Chemical/Ingredient], Nabilone, Nabilone (product), Nabilone (substance) |
| Spanish | nabilona (producto), nabilona (sustancia), nabilona |
Ontology: Marinol (C0728767)
| Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
| MSH | D013759 |
| Italian | Marinolo, Tetraidrocannabinolo, Solvay |
| English | marinol, Marinol, Solvay Brand of Tetrahydrocannabinol |
Ontology: Cesamet (C1263104)
| Concepts | Organic Chemical (T109) , Pharmacologic Substance (T121) |
| MSH | C011941 |
| English | cesamet, Lilly Brand of Nabilone, Cesamet |
Ontology: Synthetic cannabinoid receptor agonist (C1720260)
| Concepts | Organic Chemical (T109) , Pharmacologic Substance (T121) |
| SnomedCT | 421537003, 422207008 |
| English | Synthetic cannabinoid receptor agonist (product), Synthetic cannabinoid receptor agonist (substance), Synthetic cannabinoid receptor agonist |
| Spanish | agonista sintético del receptor canabinoide (producto), agonista sintético del receptor canabinoide, agonista sintético del receptor canabinoide (sustancia) |
