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Oral Nutritional Supplements and Appetite Stimulation Therapy
Published in Michael M. Rothkopf, Jennifer C. Johnson, Optimizing Metabolic Status for the Hospitalized Patient, 2023
Michael M. Rothkopf, Jennifer C. Johnson
The most studied CB is dronabinol, a synthetic form of tetrahydrocannabinol (THC), which is the main active ingredient of marijuana. Dronabinol has antiemetic and appetite stimulant properties and may improve mood and pain symptoms. It has been tested in a variety of settings and conditions (Amar 2006; Aoyama, Weintraub, and Reuben 2005; Volicer et al. 1997; Wilson, Philpot, and Morley 2007). However, dronabinol is only FDA approved for a limited list of conditions. These include chemotherapy-associated nausea/vomiting and AIDS-related anorexia.
Treatment – Chronic Illness-Related Malnutrition
Published in Jennifer Doley, Mary J. Marian, Adult Malnutrition, 2023
Jennifer Doley, Michelle Bratton
Dronabinol, a synthetic tetrahydrocannabinol, similar to the active ingredient of cannabis, has also been used for its appetite-stimulating effects, and is approved for anorexia in AIDS patients, and nausea and vomiting in cancer patients.38,40 Mirtazapine is an antidepressant medication, but also has the side effect of increased appetite, as well as weight gain in approximately 10% of patients.41 If a patient has both anorexia and depression, mirtazapine may be beneficial, although research supporting its use for this purpose is limited.38
Symptom Control in Hospice-State of the Art
Published in Inge B. Corless, Zelda Foster, The Hospice Heritage: Celebrating Our Future, 2020
J. Cameron Muir, Lisa M. Krammer, Jacqueline R. Cameron, Charles F. von Gunten
Pharmacological interventions have focused on appetite stimulation. Corticosteroids stimulate appetite and improve weakness without increasing body weight,62 but their effects are short lived (about 3–4 weeks). Dronabinol, an orally active cannabinoid, improves AIDS-related cachexia, yet it also increases appetite without significant weight gain.63–65 Furthermore, dronabinol has significant (dysphoric) CNS side effects which appear to be more prevalent in older patients. Cyproheptadine (blocks serotonin-mediated inhibition of appetite), hydrazine sulfate (inhibits gluconeogenesis) and pentoxifylline (inhibits tumor necrosis factor) have been evaluated in randomized trials and have not had a significant impact in patients with cancer cachexia66–68 Megestrol acetate at high doses is the most potent appetite stimulant available and has been shown to lead to improvement in weight gain with a dose response relationship.69–71 Interestingly, megestrol did not lead to an increase in lean body mass72 and this is the outcome measure that is most likely to correlate with strength, endurance, performance status and ultimately prognosis. The anabolic steroids (oxandralone, nandrolone, testosterone, etc.) have been shown to improve lean body mass in patients with AIDS. Human growth hormone has been shown to have similar effects in patients with AIDS as well as the frail elderly. Clearly, further research is needed to understand this syndrome and better treat our patients.
Medicinal cannabis pharmacokinetics and potential methods of delivery
Published in Pharmaceutical Development and Technology, 2022
Lidya Kebede, Seyedehsara Masoomi Dezfooli, Ali Seyfoddin
Dronabinol, commonly known as Marinol ™, is a synthetic THC medicine that is available in capsule and liquid form. Dronabinol is FDA approved for appetite stimulation as well as nausea relief for patients undergoing chemotherapy. There are two preparations with different absorption variabilities that allow for a customised approach for patient. Dronabinol is also used by patients with multiple sclerosis for pain management due to its analgesic effect on the central nervous system (Bruni et al. 2018). When administering 10–15 mg of oral THC daily, a peak plasma concentration of 2.1–16.9 ng/ml, is observed within 1–8 h. The plasma concentration of THC–COOH, a primary metabolite of THC, was also measured and 74.5–244 ng/ml was detected within 2–8 h. Variation of peak concentration and time-to-peak concentration between participants are frequently observed with orally administered cannabis products (Huestis 2007). In another study, comparison of five oral CBD preparations in adults showed considerable variation in bioavailability data because of variation in the nature of formulations as well as patients’ body composition (Williams et al. 2021).
Why do patients come to the emergency department after using cannabis?
Published in Clinical Toxicology, 2020
Shelby K. Shelton, Eleanor Mills, Jessica L. Saben, Michael Devivo, Kayla Williamson, Diana Abbott, Katelyn E. Hall, Andrew A. Monte
Public perceptions of cannabis have changed in recent decades, with many people classifying it as relatively benign [23]. Svrakic et al. postulated that this was due to the lack of overt signs of intoxication, which enforces this benign classification. Generationally, many later Baby Boomers and Gen X’ers were told that marijuana is a “gateway drug” during the beginning of the “War on Drugs” in the 1970s. Since then, Gil Kerlikowske, the Director of the Office of National Drug Control Policy during the Obama administration, would not use the term “war on drugs,” finding that it was “counterproductive” [24]. A Pew research poll found that just 12% of Americans thought that cannabis should be legalized in 1969, compared to 61% in 2017. A 2018 review noted that US adults and adolescents are gradually viewing cannabis as harmless, though this review also noted numerous comorbidities associated with cannabis use; this finding is corroborated in our study [25]. Cannabis continues to be legalized on the state level for both medical and recreational purposes in states across the US even though the US Food and Drug Administration has approved drugs with cannabidiol, a pharmacologically active component in cannabis, and other synthetic versions of cannabis such as dronabinol for treatment of chemotherapy-induced nausea [26]. This discordance of legality between the state and federal levels can be confusing for consumers, and continues to fuel a knowledge gap in the general public that cannabis is safe to use.
A broader view on deriving a reference dose for THC traces in foods
Published in Critical Reviews in Toxicology, 2021
Bernhard Beitzke, David W. Pate
A review by Plasse et al. (1991) on clinical experiences with dronabinol states "the lowest rates of termination for side effects were in the 2.5 mg … groups, only 1 patient in each group" [8–9 patients per group, i.e. a maximum of 12% of patients] had side-effects and further states that: "Many of the side effects reported may have been related to underlying disease or concomitant medications rather than to dronabinol.", adding that "Drowsiness and sedation are often related to other concomitant medications and the stress of disease and therapy together." Left unmentioned was the fact that many antiretrovirals (e.g. protease inhibitors) are metabolized by the same P450 enzymes as THC, so interactions cannot be excluded.