Section 19 · Monograph
Dronabinol
Reviewed Nov 2026FDA label
Marinol / SyndrosCannabinoid (CIII)
- Forms
- Cap: 2.5, 5, 10mg | Soln: 5mg/mL (Syndros)
- Dose
- Appetite or nausea: 2.5mg twice daily (before lunch and dinner), titrate; also used off-label for spasticity or pain
- MOA
- CB1/CB2 receptor agonism
Indications
- Anorexia associated with weight loss in AIDS patientsFDA-labeled
- Chemotherapy-induced nausea and vomiting refractory to conventional antiemeticsFDA-labeled
Off-Label Uses
- Appetite and nausea in palliative neurology; adjunct for MS or ALS symptoms and neuropathic painOff-label
Mechanism of Action
- Synthetic delta-9-THC that agonizes CB1 and CB2 cannabinoid receptors, stimulating appetite and reducing nausea
Full Dosing
Adult / usual
- Anorexia: 2.5mg twice daily before lunch and dinner; may titrate to a maximum of 20mg/day (as tolerated)
- Nausea: 5mg/m² 1-3 hours before chemotherapy, then every 2-4 hours; maximum 4-6 doses/day
- Start low in older adults; Schedule III controlled substance
Contraindications
- Hypersensitivity to dronabinol or sesame oil (capsules)
- Alcohol-containing oral solution: disulfiram or metronidazole use within 14 days
Drug Interactions
- Additive CNS depression with alcohol, benzodiazepines and opioids
- Sympathomimetics, anticholinergics and TCAs: tachycardia and hypotension
- CYP2C9/3A4 inhibitors raise levels; disulfiram and metronidazole contraindicated with the oral solution
Adverse Effects
- Dizziness, somnolence, euphoria or dysphoria
- Cognitive impairment and paranoia
- Tachycardia, orthostatic hypotension
- Abdominal pain, nausea
Monitoring Parameters
- Mental status, mood and psychosis symptoms
- Heart rate and blood pressure
- Misuse potential
Pregnancy & Lactation
- Avoid in pregnancy (may affect fetal neurodevelopment)
- THC is excreted in milk; avoid breastfeeding