Dronabinol (Marinol®, Syndros®)
Classification: Cannabinoid, Antiemetic, Appetite Stimulant
About: Dronabinol (Marinol®, Syndros®)
Dronabinol is a cannabinoid, a manmade form of cannabis, the active natural substance found in marijuana. It is approved for increasing the appetite and preventing weight loss in patients with HIV infection. It is also approved as an antiemetic to treat nausea and vomiting caused by cancer treatments. Dronabinol may be used for other things under the care of a healthcare provider. It is thought that dronabinol works by interacting with certain receptors on cells, especially in the brain. Dronabinol affects the area of the brain that controls nausea, vomiting, and appetite. This medication sheet will focus on the use of dronabinol as an antiemetic to control nausea and vomiting caused by cancer treatments.
How to take Dronabinol
Dronabinol comes in a capsule form, to be taken by mouth. You should not open, chew, or crush the capsules. They should be taken whole. Dronabinol also comes in a liquid solution, to be taken by mouth or through a feeding tube. Take the liquid form with a full glass of water (8 ounces). Use the provided oral syringe to draw up the correct dose.
Always check to make sure you are taking the prescribed dose. Your dose and how often you take dronabinol will depend on your symptoms and your cancer treatments. Often, your provider will recommend you take dronabinol 1-3 hours before chemotherapy, and then every 2-4 hours after chemotherapy, for a total of 4-6 doses of dronabinol per day. The first dose of the day should be taken on an empty stomach, about 30 minutes before eating. The rest of the doses during the day can be taken with or without food. Be sure to ask your provider how and when you should take this medication.
Be sure to tell your healthcare provider about all medications and supplements you take. Tell your provider if you have a psychiatric history, as it can make mania, depression, or schizophrenia worse. Tell your provider if you have a history of seizures, as dronabinol can interact with anti-seizure medications and can cause seizures in some people. Tell your provider if you take disulfiram (Antabuse®) or metronidazole (Flagyl®), as these medications can interact with the liquid form of dronabinol. This medication can also cause more drowsiness or sleepiness if combined with other medications which have the same side effect, including but not limited to pain medications and other mood medications.
You should not drink alcohol while taking dronabinol. You should not drive a car or operate heavy machinery until you know how dronabinol affects you.
If you have been taking dronabinol on a regular basis, do not stop taking it without first talking with your provider. You may be worried that you may become addicted to this medication. When dronabinol is used to treat physical nausea and vomiting, it is unlikely that patients will become addicted to it. People with addiction use medications for the sole purpose of getting "high.” These people also crave certain medications, lack control over their use, and will continue to use dronabinol despite knowing it is causing them harm. People experiencing nausea and vomiting use dronabinol to relieve their nausea and vomiting. If you have a history of addiction, be sure to talk with your provider.
As a person takes regular doses of dronabinol, their bodies will begin to adapt to the medications. This can cause dependence. Dependence means that the body "gets used to" the medication. Dependence DOES NOT equal addiction. Dependence is a natural, physical phenomenon. The important thing to know about dependence is that once a patient becomes dependent on dronabinol, they will feel very sick if they stop the medication abruptly. This is called withdrawal and the symptoms it causes can start within 12 hours of abruptly stopping dronabinol. These symptoms include irritability, trouble sleeping, restlessness, hot flashes, sweating, a runny nose, and loose stool. Withdrawal is preventable if you lower the dronabinol dose slowly with the help and guidance of your health care team. The exact amount of time to wean off the dronabinol varies based on dose, how long you’ve been taking it, and some other individual factors. Talk to your provider if you have any concerns.
Storage and Handling
Dronabinol capsules should be stored in their original container. It should be stored in a cool place, between 46° and 59°F (8° and 15°C) or it can be refrigerated. Do not freeze.
Dronabinol liquid should be stored in the original multi-dose bottle. Always use the provided oral syringe to draw up the correct dose. Keep the bottle and oral syringe together in the provided carton. Store the liquid formulation in a refrigerator, between 36°F and 46°F (2°C and 8°C). The opened bottle can be stored up to 77°F (25°C). Discard and unused medication 42 days after first opening the bottle.
Due to the risk of diversion (someone else taking your medication to obtain a “high”, rather than for symptom relief), you may want to consider keeping your medication in a lock box or other secure location. Keep this medication out of reach of children and pets.
To prevent someone accidentally taking this medication, it should be disposed of when no longer needed through a medicine take-back program or by dropping them off at a DEA-authorized collector. For locations near you, check www.dea.gov. Ask your pharmacist or care team for assistance in the disposal of unused medications. Do not flush down a toilet or pour down a drain unless you are told to do so.
Where do I get this medication?
Dronabinol is available through retail/mail order pharmacy. Your oncology team will work with your prescription drug plan to identify an in-network retail/mail order pharmacy for medication distribution. You can work with your provider’s office if this medication needs a prior authorization.
This medication may be covered under your prescription drug plan. Patient assistance may be available to qualifying individuals without prescription drug coverage. Co-pay cards, which reduce the patient co-pay responsibility for eligible commercially (non-government sponsored) insured patients, may also be available. Your care team can help you find these resources, if they are available.
Possible Side Effects of Dronabinol
This medication is given to manage and/or prevent side effects of your cancer treatment. If you are having side effects from this medication you should talk to your team about if this medication is necessary to your treatment or if there are other options to help manage the side effect this medication is treating. These are some of the most common side effects:
Some patients will report feeling “high” when taking dronabinol. This is because of its similarity to marijuana. Patients may laugh easily, feel elated, or have heightened awareness.
Less common, but important side effects can include:
- Psychiatric Effects: Dronabinol can make depression, mania, and schizophrenia worse. Tell your provider if you have a history of psychiatric illness before starting dronabinol. Dronabinol can also alter your mental state, including dizziness and drowsiness. Extra caution should be used in elderly patients, including using fall precautions while taking this medication.
- Blood Pressure Changes: Dronabinol may cause occasional low or high blood pressure, dizziness or fainting, or a fast heartbeat. Tell your provider if you have a history of heart problems.
- Interaction with disulfiram (Antabuse®) or metronidazole (Flagyl®): The liquid formulation of dronabinol contains alcohol, which can interact with disulfiram (Antabuse®) and metronidazole (Flagyl®). This reaction can cause abdominal cramps, nausea, vomiting, headaches, and flushing. Tell your provider of all medications and supplements you take.
- Seizures: Seizure and seizure-like activity have been reported with dronabinol. Tell your provider if you have a history of seizures and if you are taking medication to control seizures, as dronabinol may weaken the effects of these medications.
- Worsening Nausea, Vomiting, or Abdominal Pain: Sometimes, dronabinol can have the opposite effect of what it is used for. If your nausea and vomiting gets worse, or if you have new or worsening pain in your belly, call your provider right away.
You should consult with your healthcare team prior to becoming pregnant or fathering a child while taking this medication. Women who are pregnant or plan to become pregnant should not take dronabinol. Women should not breastfeed during treatment with dronabinol and for 9 days after the last dose.