Recent Cannabinoid Delivery Systems
Betty Wedman-St Louis in Cannabis as Medicine, 2019
Dronabinol (Marinol® from Abbvie Inc, US) is a semi-synthetic form of THC, which is available in capsule form and as a solution, that has been approved by the FDA for appetite stimulation and the treatment of chemotherapy-induced nausea in patients with AIDS. Oh et al. have published a PK study that compares the oral solution and capsule forms of dronabinol under fasting and fed conditions. The solution formulation showed lower inter-individual absorption variability than the capsule formulation, especially in fed conditions, and this fact may be an important consideration in the selection of an appropriate dronabinol product for patients [56]. Dronabinol exerted a modest, but clinically relevant, analgesic effect on central pain in the pain treatment of patients with multiple sclerosis. Although the proportion of patients that showed adverse reactions was higher in dronabinol-treated than in placebo-treated patients, it decreased over the drug’s long-term use [57,58].
The Widening Schism
Jonathan C. Beazley, Stephanie Field in Cannabis on Campus, 2018
Any organization or research group wanting to study the possible therapeutic properties of marijuana must run a gauntlet of administrative obstacles. First, they must obtain a Drug Enforcement Administration (DEA) license to handle a Schedule I substance. Second comes the undertaking of applying for and receiving funding through the National Institutes of Health (NIH) or an approved non-NIH entity registered with the Food and Drug Administration (FDA) as an Investigational New Drug (IND) study.3 Finally, and perhaps most difficult, researchers must obtain scientific-grade marijuana to be used from the one source available to them, NIDA’s cannabis farm at the University of Mississippi.4 This is a major reason why much of the past research on the effects of cannabis utilized dronabinol—a synthetic THC—because it is easier to obtain, cleaner, and more consistent in dosage as it is one chemical versus a complex plant containing over 60 cannabinoids. Legalization proponents cite this as a research flaw, arguing that the effects of pure THC and those of smoking marijuana differ, though this has not been supported by the limited research.56
Antiemetics and Cancer Chemotherapy
John Kucharczyk, David J. Stewart, Alan D. Miller in Nausea and Vomiting: Recent Research and Clinical Advances, 2017
In summary, trials have shown THC to be an effective antiemetic in certain groups of patients. Used alone, it is equivalent or slightly superior in potency to prochlorperazine, but inferior to metoclopramide for cisplatin-based chemotherapy. Patients’ attitudes toward THC and its side effects obviously play a major role in the extent to which this drug is tolerated and effective. THC is generally more effective in younger patients and this may be related to prior marijuana exposure. Certainly the high incidence of toxicity noted by Frytak et al. appeared to be age-related. Any antiemetic benefit resulting from THC appears to be associated with subjective reports of a “high”. The most frequent treatment schedule used has been 10 mg/m2 p.o. every 3 h beginning at least 2 h prechemotherapy and continuing for several doses. Lower doses in the range of 5 mg/m2 may be just as effective, while increasing the dose to 15 mg/m2 may result in a higher incidence of somnolence and toxicity.14 In most countries THC remains a controlled substance, but a commercial formulation known generally as dronabinol (Maronol) has recently been marketed in the U.S.52
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.
Related Knowledge Centers
- Anorexia
- Cannabidiol
- Cannabis
- Enantiomer
- Psychoactive Drug
- Sleep Apnea
- Tetrahydrocannabinol
- Antiemetic
- HIV/AIDS
- Chemotherapy-Induced Nausea & Vomiting