Dronabinol: A Controversial Acute Leukemia Treatment
Although dronabinol is considered controversial, a recent study suggests the cannabinoid derivative has useful effects in treating patients with acute leukemia.
Researchers from University Hospital Tübingen, Germany, say that although the data for treating acute leukemia with dronabinol (THC), a cannabinoid derivative, are “controversial,” it has been shown to have antitumor potential for several cancers. When the researchers tested THC in several leukemia cell lines and native leukemia blasts cultured ex vivo, they found “meaningful” antiproliferative and proapoptotic effects.
From the data, they also found cannabinoid receptor agonists may be useful as low-toxic agents, especially for patients who are “heavily pretreated,” elderly, or have refractory disease. Evidence was cited that THC retained antileukemic activity in a sample from a patient with otherwise chemotherapy- and steroid-refractory acute lymphocytic leukemia (ALL).
Due to the excellent safety profile of THC, the researchers say, effective doses are achievable in vivo, although tolerable doses may vary widely. They suggest starting with a subeffective dose and increasing gradually, which will help the patient build tolerance to the well-known psychoactive effects, which have been a drawback to widespread use of THC for patients with cancer.
They add that, due to sparse densities of cannabinoid receptors in lower brain stem areas, severe intoxications with THC rarely have been reported.
In addition to the direct antileukemic effects, the researchers suggest that therapeutic use of THC has many desirable adverse effects, such as general physical well-being, cachexia control, and relief of pain, anxiety and stress—which, they note, should “facilitate the decision process.”
Kampa-Schittenhelm KM, Salitzky O, Akmut F, et al. BMC Cancer. 2016;16(25)1-12.
Marinol (Dronabinol) – Oral
Oncology Certified Nurse Practitioner and freelance healthcare writer with over a decade of medical oncology and hematology experience.
Mary Choy, PharmD, is board-certified in geriatric pharmacotherapy and is an active leader in professional pharmacy associations.
What Is Marinol?
Marinol (dronabinol) is a prescription oral cannabinoid medication used to improve appetite in patients with acquired immune deficiency syndrome (AIDS) and decrease nausea due to chemotherapy in patients with cancer. It comes in capsule and solution form.
Cannabinoids are chemicals found in the cannabis plant. Marinol contains a synthetic form of a cannabinoid called delta-9-tetrahydrocannabinol (THC) that acts on the central nervous system to stimulate appetite and reduce nausea.
Marinol is a controlled substance, which means it can potentially lead to abuse or dependence.
Generic Name: Dronabinol
Brand Name: Marinol
Drug Availability: Prescription
Therapeutic Classification: Antiemetic
Available Generically: Yes
Controlled Substance: Potential for abuse
Administration Route: Oral
Active Ingredient: Dronabinol
Dosage Form: Capsule, solution
What Is Marinol Used For?
The Food and Drug Administration (FDA) has approved Marinol to treat:
- Decreased appetite and weight loss in patients with AIDS
- Nausea and vomiting due to chemotherapy in patients who have not responded to other anti-nausea therapies
How to Take Marinol
When using for appetite stimulation in AIDS, take Marinol twice each day, one hour before lunch and dinner, with the dose adjusted based on how it is tolerated.
For chemotherapy-induced nausea, take Marinol one to three hours before your chemotherapy treatment, and then every two to four hours after chemotherapy, for a total of four to six doses per day.
Verywell / Zoe Hansen
Keep Marinol in a refrigerator or a cool place (between 49 and 56 degrees F) in a sealed bottle. Be sure to store it out of children's reach.
Healthcare providers can prescribe Marinol off-label for purposes not specified on the product label.
Marinol is often used off-label to improve appetite in patients with cancer. It has also been used to treat neuropathic pain associated with multiple sclerosis.
How Long Does Marinol Take to Work?
Marinol starts to work about 30 minutes to one hour after taking it, with peak effect at two to four hours. Marinol’s psychoactive effects may last for four to six hours, but the appetite stimulant effect may continue for 24 hours or longer.
What Are the Side Effects of Marinol?
This is not a complete list of side effects, and others may occur. A medical professional can advise you on side effects. If you experience other effects, contact your pharmacist or a medical professional. You may report side effects to the FDA at www.fda.gov/medwatch or 1-800-FDA-1088.
Marinol can cause side effects due to the dose and frequency of taking the medication. However, side effects can improve after taking the medication for a few days.
Common Side Effects
The most common side effects of Marinol include:
- Feeling extremely happy (euphoria)
- Fast heart rate
- Feeling “high”
- Abdominal pain
- Flushing or feeling hot
- Memory problems
Severe Side Effects
Contact your healthcare provider if you’re experiencing a serious side effect from Marinol. If you’re experiencing any life-threatening symptoms or having a medical emergency, call 911 or go to the closest emergency room.
Serious side effects from Marinol can include:
Report Side Effects
Marinol may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.
If you experience a serious side effect, you or your provider may send a report to the Food and Drug Administration’s (FDA) MedWatch Adverse Event Reporting Program or by phone (800-332-1088).
Dosage: How Much Marinol Should I Take?
The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
- For oral dosage form (capsules):
- For increasing appetite in patients with AIDS:
- Adults and teenagers—At first, 2.5 milligrams (mg) two times a day, taken before lunch and supper. Your doctor may change your dose depending on your condition. However, the dose is usually not more than 20 mg per day.
- Children—Use and dose must be determined by your doctor.
- Adults and teenagers—Dose is based on body surface area and must be determined by your doctor. Your doctor will tell you how much medicine to take and when to take it.
- Children—Dose is based on body surface area and must be determined by your doctor.
- For increasing appetite in patients with AIDS:
- Adults—At first, 2.1 milligrams (mg) two times a day, taken 1 hour before lunch and 1 hour before dinner. Your doctor may gradually increase your dose as needed and tolerated. However, the dose is usually not more than 8.4 mg two times a day.
- Older adults—At first, 2.1 mg once a day, taken 1 hour before dinner or at bedtime. Your doctor may gradually increase your dose as needed and tolerated.
- Children—Use and dose must be determined by your doctor.
- Adults—Dose is based on body surface area and must be determined by your doctor. The dose is usually 4.2 milligrams (mg) per square meter (m) taken 1 to 3 hours before chemotherapy and then every 2 to 4 hours after chemotherapy for a total of 4 to 6 doses per day. Your doctor may gradually increase your dose as needed and tolerated. However, the dose is usually not more than 12.6 mg/m per dose for 4 to 6 doses per day.
- Older adults—Dose is based on body surface area and must be determined by your doctor. The dose is usually 2.1 milligrams (mg) per square meter (m) taken 1 to 3 hours before chemotherapy.
- Children—Use and dose must be determined by your doctor.
Do not take Marinol if you are pregnant or nursing. Marinol is also not recommended for use in children.
If you miss a dose, take it as soon as possible unless it is too close to the next scheduled dose.
Overdose: What Happens If I Take Too Much Marinol?
Seek medical advice if you think you have taken too much Marinol.
Symptoms of a Marinol overdose can include:
- Heightened senses
- Mood changes
- Difficulty urinating
- Slurred speech
- Difficulty walking
What Happens If I Overdose on Marinol?
If you think you or someone else may have overdosed on Marinol (dronabinol), call a healthcare provider or the Poison Control Center (800-222-1222).
If someone collapses or isn’t breathing after taking dronabinol, call 911 immediately.
It is very important that your doctor check your progress at regular visits to allow for changes in your dose and to check for any unwanted effects.
Do not take this medicine if you are also using disulfiram (Antabuse®) or metronidazole (Flagyl®) within the past 14 days. Do not use disulfiram or metronidazole within 7 days after treatment with Syndros™.
Using this medicine while you are pregnant may cause serious unwanted effects in your newborn baby. Tell your doctor right away if you think you are pregnant or if you plan to become pregnant while using this medicine.
Dronabinol will add to the effects of alcohol and other CNS depressants (medicines that make you drowsy or less alert). Some examples of CNS depressants are antihistamines or medicine for allergies or colds, sedatives, tranquilizers, or sleeping medicine, prescription pain medicines including other narcotics, medicine for seizures (eg, barbiturates), muscle relaxants, or anesthetics, including some dental anesthetics. Check with your doctor before taking any of the above while you are taking this medicine.
This medicine may cause some people to become drowsy, dizzy, lightheaded, or to feel a false sense of well-being. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are dizzy or are not alert and clearheaded.
Dizziness, lightheadedness, or fainting may occur, especially when you get up suddenly from a lying or sitting position. Getting up slowly may help lessen this problem.
If you develop any unusual or strange thoughts and behavior while using dronabinol, be sure to discuss it with your doctor. Some changes that have occurred in people receiving this medicine are like those seen in people who drink too much alcohol.
If you think you or someone else may have taken an overdose of dronabinol, get emergency help at once. Taking an overdose of this medicine or taking alcohol or CNS depressants with this medicine may lead to severe mental effects. Signs of overdose include changes in mood, confusion, hallucinations, mental depression, nervousness or anxiety, and fast or pounding heartbeat.
Tell your doctor right away if you have a new or worsening nausea, vomiting, or stomach pain after taking Syndros™.
Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.
What Are Reasons I Shouldn’t Take Marinol?
Marinol is a controlled substance that has the potential for physical and psychological dependence. Therefore, people with a history of substance use disorder may not want to take Marinol.
Additionally, Marinol can worsen the symptoms of schizophrenia or bipolar disorder. People with a history of either of these conditions may want to avoid this medication.
You should also avoid taking Marinol if you have ever had an allergic reaction to dronabinol or sesame oil.
What Other Medications Interact With Marinol?
Marinol is generally safe to take with other medications. However, some medications should be avoided or used with caution when taken with Marinol.
The following medications may cause heart issues such as fast heart rate and hypertension (high blood pressure) when used at the same time as Marinol:
- Tricyclic antidepressants
Some interactions with Marinol can cause symptoms such as central nervous system depression or severe drowsiness. These include:
- Benzodiazepines (Ativan, Xanax)
Be sure to review your medication list with your healthcare provider or pharmacist to ensure that Marinol is safe to take with your other medications.
What Medications Are Similar?
Nabilone (Cesamet) is another medication in the cannabinoid family that is prescribed for chemotherapy-induced nausea and vomiting.
Another FDA-approved cannabinoid medication, Epidiolex (cannabidiol), can treat seizures for people living with Dravet syndrome or Lennox-Gastaut syndrome.
Frequently Asked Questions
Marinol is used to treat weight loss and poor appetite in people living with AIDS. It is also used to treat nausea and vomiting caused by chemotherapy.
Marinol is a synthetic form of delta-9-tetrahydrocannabinol (THC), the active substance in marijuana. It acts on the central nervous system to stimulate appetite and reduce nausea.
Side effects of Marinol may vary based on the dose and frequency in which it is taken but may include:
- Abdominal pain
- Increased hunger
How Can I Stay Healthy While Taking Marinol?
Marinol can be a very effective medication for people experiencing poor appetite, weight loss, or nausea and vomiting from chemotherapy.
It is important to remember that Marinol is not the same as marijuana but does have the potential for abuse if not used properly. If you’ve been prescribed Marinol for any reason, be sure to speak with your healthcare team if you have any questions or concerns.
Verywell Health’s drug information is meant for education purposes only and not intended as a replacement for medical advice, diagnosis, or treatment from a healthcare professional. Consult your doctor before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.
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- For increasing appetite in patients with AIDS: