Anorexia/cachexia:
Indications for: MARINOL
Anorexia with weight loss in AIDS patients.
Adult Dosage:
Initially 2.5mg twice daily 1hr before lunch and dinner. If intolerable, may reduce to 2.5mg daily in the evening or at bedtime. May increase gradually to max 10mg twice daily. Elderly: initially 2.5mg once daily.
Children Dosage:
Not established.
MARINOL Warnings/Precautions:
Avoid in history of psychiatric disorders (eg, mania, depression, schizophrenia); if unavoidable, monitor for new or worsening symptoms. Reduce dose or discontinue therapy if cognitive impairment develops, or if nausea, vomiting, or abdominal pain worsens. Cardiac disorders. Seizures. Substance abuse. Monitor BP, HR. Write ℞ for smallest practical amount. Keep patient under responsible adult supervision (esp. when dose is adjusted). CYP2C9 polymorphism; monitor. Elderly (monitor: esp. with dementia). Pregnancy: avoid. Nursing mothers: not recommended.
MARINOL Classification:
Cannabinoid.
MARINOL Interactions:
Avoid concomitant amphetamines, sympathomimetics, atropine, scopolamine, antihistamines, anticholinergics, TCAs. CNS depression potentiated with concomitant benzodiazepines, barbiturates, alcohol, other CNS depressants and other psychoactive substances (avoid). May potentiate concomitant highly protein-bound drugs with narrow therapeutic index (eg, warfarin, cyclosporine, amphotericin B); monitor. May be potentiated by inhibitors of CYP2C9 (eg, amiodarone, fluconazole) and CYP3A4 (eg, ketoconazole, itraconazole, clarithromycin, erythromycin, ritonavir, grapefruit juice).
Adverse Reactions:
Abdominal pain, dizziness, euphoria, nausea, paranoid reaction, somnolence, abnormal thinking, vomiting; neuropsychiatric effects, hypotension, hypertension, syncope, tachycardia, seizures (discontinue if occurs).
Drug Elimination:
Fecal (major), renal (10–15%). Half-life: ~4 hours (initial), ~25–36 hours (terminal).
Generic Drug Availability:
YES
How Supplied:
Caps—60
Nausea:
Indications for: MARINOL
Refractory nausea and vomiting associated with cancer chemotherapy.
Adult Dosage:
Give first dose on an empty stomach. Initially 5mg/m2 1–3 hrs before chemotherapy, then every 2–4 hrs after chemo; max 4–6 doses per day. May increase if needed by increments of 2.5mg/m2; max 15mg/m2 per dose. May decrease to 2.5mg once daily before chemo to reduce adverse events. Elderly: initially 2.5mg/m2 once daily.
Children Dosage:
Not established.
MARINOL Warnings/Precautions:
Avoid in history of psychiatric disorders (eg, mania, depression, schizophrenia); if unavoidable, monitor for new or worsening symptoms. Reduce dose or discontinue therapy if cognitive impairment develops, or if nausea, vomiting, or abdominal pain worsens. Cardiac disorders. Seizures. Substance abuse. Monitor BP, HR. Write ℞ for smallest practical amount. Keep patient under responsible adult supervision (esp. when dose is adjusted). CYP2C9 polymorphism; monitor. Elderly (monitor: esp. with dementia). Pregnancy: avoid. Nursing mothers: monitor infants.
MARINOL Classification:
Cannabinoid.
MARINOL Interactions:
Avoid concomitant amphetamines, sympathomimetics, atropine, scopolamine, antihistamines, anticholinergics, TCAs. CNS depression potentiated with concomitant benzodiazepines, barbiturates, alcohol, other CNS depressants and other psychoactive substances (avoid). May potentiate concomitant highly protein-bound drugs with narrow therapeutic index (eg, warfarin, cyclosporine, amphotericin B); monitor. May be potentiated by inhibitors of CYP2C9 (eg, amiodarone, fluconazole) and CYP3A4 (eg, ketoconazole, itraconazole, clarithromycin, erythromycin, ritonavir, grapefruit juice).
Adverse Reactions:
Abdominal pain, dizziness, euphoria, nausea, paranoid reaction, somnolence, abnormal thinking, vomiting; neuropsychiatric effects, hypotension, hypertension, syncope, tachycardia, seizures (discontinue if occurs).
Drug Elimination:
Fecal (major), renal (10–15%). Half-life: ~4 hours (initial), ~25–36 hours (terminal).
Generic Drug Availability:
YES
How Supplied:
Caps—60
