Marinol

Marinol

dronabinol

(droe-nab-i-nol) ,

delta-9-tetrahydrocannabinol

(trade name),

THC

(trade name),

Marinol

(trade name) Pregnancy Category: C

Indications

Action

Pharmacokinetics

Time/action profile (antiemetic effect)

ROUTE	ONSET	PEAK	DURATION
PO	unknown	2–4 hr	4–6 hr†

†Appetite stimulation lasts 24 hr or longer

Contraindications/Precautions

Adverse Reactions/Side Effects

Central nervous system

• anxiety (most frequent)
• concentration difficulty (most frequent)
• confusion (most frequent)
• dizziness (most frequent)
• drowsiness (most frequent)
• mood change (most frequent)
• abnormal thinking
• depression
• disorientation
• hallucinations
• headache
• impaired judgment
• memory lapse
• paranoia

Ear, Eye, Nose, Throat

• dry mouth (most frequent)

Cardiovascular

• palpitations
• syncope
• tachycardia

Gastrointestinal

• abdominal pain
• nausea
• vomiting

Dermatologic

• facial flushing

Neurologic

• ataxia
• paresthesia

Miscellaneous

• physical dependence
• psychological dependence (high doses or prolonged therapy)

Interactions

Drug-Drug interaction

Additive CNS depression with alcohol, antihistamines,barbiturates, benzodiazepines, atropine, scopolamine,lithium, buspirone, muscle relaxants, opioid analgesics, tricyclicantidepressants, and sedative/hypnotics.Increased risk of tachycardia with amphetamine, atropine, scopolamine, cocaine, sympathomimetics, antihistamines, and tricyclicantidepressants.May increase blood levels of theophylline.Increased risk of tachycardia with caffeine -containing herbs (cola nut, guarana, mate, tea, coffee).Concomitant use of kava, valerian, skullcap, chamomile, or hopscan increase CNS depression.

Route/Dosage

Availability (generic available)

Nursing implications

Nursing assessment

• Assess nausea, vomiting, appetite, bowel sounds, and abdominal pain prior to and following the administration of this drug.
• Monitor hydration, nutritional status, and intake and output. Patients with severe nausea and vomiting may require IV fluids in addition to antiemetics.
• Monitor BP and heart rate periodically throughout therapy.
• Patients on dronabinol therapy should be monitored closely for side effects because the effects of dronabinol vary with each patient.

Potential Nursing Diagnoses

Risk for deficient fluid volume (Indications)
Imbalanced nutrition: less than body requirements (Indications)
Risk for injury (Side Effects)

Implementation

• Dronabinol capsules should be refrigerated (not frozen).
  • Physical or psychological dependence may occur with high doses or prolonged therapy, causing a withdrawal syndrome (irritability, restlessness, insomnia, hot flashes, sweating, rhinorrhea, loose stools, hiccups, anorexia) when discontinued. This is unlikely to occur with therapeutic doses and short-term use of dronabinol.
• Antiemetic: This drug may be administered prophylactically 1–3 hr prior to chemotherapy and repeated every 2–4 hr after chemotherapy up to 4–6 doses daily. Most patients respond to 5 mg three or four times daily.
• Appetite Stimulant: Give 2.5 mg twice daily before lunch and supper initially. Reduce dose to 2.5 mg/day in the evening or at bedtime for patients unable to tolerate 5 mg/day dose. May increase dose to 2.5 mg at lunch and 5 mg before supper or 5 mg at lunch and 5 mg after supper if further therapeutic effect is desired and adverse effects are minimal. Most patients respond to 2.5 mg twice daily dose, but up to 10 mg bid have been tolerated in about 50% of patients. Adverse effects are dose related.

Patient/Family Teaching

• Instruct patient to take dronabinol exactly as directed. Take missed doses as soon as possible but not if almost time for next dose; do not double doses. Signs of overdose (mood changes, confusion, hallucinations, depression, nervousness, fast or pounding heartbeat) may occur with increased doses.
• Advise patient to call for assistance when ambulating, because this drug may cause dizziness, drowsiness, and impaired judgment and coordination. Avoid driving or other activities requiring alertness until response to the drug is known.
• Instruct patient to change positions slowly to minimize orthostatic hypotension.
• Caution patient to avoid taking alcohol or other CNS depressants during dronabinol therapy.
• Advise patient and family to use general measures to decrease nausea (begin with sips of liquids and small, nongreasy meals; provide oral hygiene; remove noxious stimuli from environment).

Evaluation/Desired Outcomes

• Prevention of and decrease in nausea and vomiting associated with chemotherapy.
• Increased or maintained weight in patients with AIDS.