Name of the Cannabinoids Drugs
- Dronabinol
| Dronabinol |
| Availability Capsules: 2.5 mg, 5 mg, 10 mg |
| Indications and dosages Prevention of nausea and vomiting caused by chemotherapy Adults and children: Initially, 5 mg/m2 P.O. 1 to 3 hours before chemotherapy. Repeat dose q 2 to 4 hours after chemotherapy, up to four to six doses per day. If 5-mg/m2 dose is ineffective and patient has no significant adverse reactions, dosage may be increased in increments of 2.5 mg/m2 to a maximum dosage of 15 mg/m2. Appetite stimulant Adults and children: Initially, 2.5 mg P.O. b.i.d. May reduce dosage to 2.5 mg/day given as a single evening or bedtime dose. Maximum dosage is 10 mg P.O. b.i.d. |
Mechanism of Action
May exert antiemetic effect by inhibiting the vomiting control mechanism in the medulla oblongata. As the main psychoactive substance in marijuana (Cannabis sativa L.), dronabinol’s effects may be mediated by cannabinoid receptors in neural tissues
Pharmacokinetics
- Peak plasma time: 0.5-4 hr (dronabinol and major active metabolite: 11-hydroxy-delta-9-THC)
- Bioavailability: 90-95%
- Protein bound: 97%
- Metabolism: Extensive first-pass hepatic metabolism
- Metabolites: 11-hydroxy-delta-9-tetrahydrocannabinol (active)
- Half-life:5.6 hr (parent drug); 44-59 hr (metabolites)
- Excretion: 50% feces; 15% urine
Administration
When used to stimulate appetite, give before lunch and dinner.
Adverse reactions
- CNS: drowsiness, anxiety, impaired coordination, irritability, depression, headache, hallucinations, memory loss, paresthesia, ataxia, paranoia, disorientation, nightmares, speech difficulties, syncope, suicidal ideation
- CV: tachycardia, hypotension, hypertension
- EENT: visual disturbances, tinnitus
- GI: dry mouth
- Skin: facial flushing, diaphoresis
Contraindications
- Hypersensitivity to cannabinoids or sesame oil
- Breastfeeding
Precautions:
- Hypertension, heart disease, bipolar disorder, schizophrenia, drug abuse, seizures
- Pregnant patients.
Patient monitoring
- Monitor vital signs for hypotension and tachycardia.
- Check for adverse CNS reactions. Report significant depression, paranoid reaction, or emotional lability.
Monitor nutritional status and hydration.
Patient teaching
- Teach patient about drug’s significant adverse CNS and cardiovascular effects. Emphasize that he should take it only as prescribed and needed.
- Advise patient (and significant other) to immediately report depression, suicidal thoughts, paranoid reactions, seizures, and other serious CNS reactions.
- Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
- As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and behaviors mentioned above.
Nursing Considerations
- Use cautiously in patients with history of seizures because drug may lower seizure threshold. Notify prescriber of seizures immediately and expect to stop drug.
- Patients under age 45 may tolerate drug better than those over age 45.
- Watch for adverse reactions that mimic psychosis, such as hallucinations and, possibly, acute anxiety, especially at high doses.
- Anticipate higher risk of cardiovascular reactions, such as increased heart rate and blood pressure changes (especially orthostatic hypotension), at higher doses.
- Be aware that short-term, low-dose therapy doesn’t typically lead to physical and psychological dependence, which may occur with long-term, high-dose therapy.
- Expect drug to alter REM sleep pattern, even after therapy stops.
REFERENCES
- Robert Kizior, Keith Hodgson, Saunders Nursing Drug handbook,1st edition 2024, Elsevier Publications. ISBN-9780443116070
- McGraw Hill- Drug Handbook, Seventh Edition, 2013, McGraw Hill Education Publications,9780071799430.
- April Hazard, Cynthia Sanoski, Davi’s Drug Guide for Nurses -Sixteenth Edition 2019, FA Davis Company Publications,9780803669451.
- Jones and Bartlet, Pharmacology for Nurses, Second Edition, 2020, Jones and Bartlet Learning Publications, ISBN 9781284141986.
- Nursebro.com, Search – Nursebro
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