Dronabinol

Dronabinol is an orally available cannabinoid agonist, an isomer of tetrahydrocannabinol (THC), the major and most active isomer of the plant Cannabis sativa L., with potential antiemetic, analgesic and appetite stimulating effects. Upon administration, dronabinol, also called "delta-9-THC," targets and binds to cannabinoid receptors (CB1/CB2) in the central nervous system (CNS).

Dronabinol acts directly on the appetite and vomiting control centers in the brain to stimulate appetite and prevent vomiting. In addition, this compound induces analgesia. Dronabinol has relatively poor bioavailability; however, the synthetic THC analog nabilone has better bioavailability.

In the cannabis plant, tetrahydrocannabinol is predominantly present as THC acid. By enzymatic condensation from the two precursors geranyl pyrophosphate and olivetolic acid, cannabigerolic acid is formed, which is subsequently enzymatically converted into tetrahydrocannabinolic acid. Heat and UV radiation decarboxylate the acid to THC.

Four stereoisomers of delta-9-tetrahydrocannabinol exist:

• (-)-Δ9-trans-tetrahydrocannabinol (dronabiol)
• (+)-Δ9-trans-tetrahydrocannabinol(THC)
• (-)-Δ9-cis-tetrahydrocannabinol (no psychoactivity)
• (+)-Δ9-cis-tetrahydrocannabinol (no psychoactivity).

Dronabinol is the most psychoactive isomer. It sit 6 to 100 times more potent than the (+)-Δ9-trans-THC(THC). The cis-forms do not have any psychoactive effect, and there is varying information about their natural occurrence.

Dronabinol is excreted hepatogenically and nephrogenically. Urine levels can be used as a marker to determine exposure to certain preparations containing parts of the cannabis plant, such as marijuana.

Dronabinol is prescribed as an oral cannabinoid agonist for the treatment of nausea and vomiting during chemotherapy and for loss of appetite and weight loss in HIV/AIDS patients. However, dronabinol can also be prescribed for all other indications within the framework of the Cannabis Act (see below Cannabis as a prescription).

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1. Crippa JAS et al. (2020) Oral Cannabidiol Does Not Convert to Δ8-THC or Δ9-THC in Humans: A Pharmacokinetic Study in Healthy Subjects. Cannabis Cannabinoid Res 27: 89-98.
2. Bedi G et al. (2013) Subjective, cognitive and cardiovascular dose-effect profile of nabilone and dronabinol in marijuana smokers. Addict Biol 18:872-81.
3. Graefe KH et al. (2016) Graefe KH et al. Cnetral nervous system. In: Graefe KH et al (Eds) Pharmacology and toxicology. Georg Thieme Verlag Stuttgart SS 352-353.
4. Hoffenberg EJ et al (2019) Cannabis oil use by adolescents and young adults with inflammatory bowel disease. J Pediatr Gastroenterol Nutr 68:348-352
5. Kafil TS et al (2018) Cannabis for the treatment of ulcerative colitis. Cochrane Database Syst Rev 11:CD012954
6. Kafil TS et al. (2018) Cannabis for the treatment of Crohn's disease. Cochrane Database Syst Rev 11:CD012853
7. Muecke M et al. (2018) Cannabis-based medicines for chronic neuropathic pain in adults. Cochrane Database Syst Rev 3:CD012182.
8. Poyatos L et al (2020) Oral administration of cannabis and Δ-9-tetrahydrocannabinol (THC) preparations: A Systematic Review. Medicina (Kaunas) 56:309.
9. Rong C et al. (2017) Cannabidiol in medical marijuana: Research vistas and potential opportunities. Pharmacol Res 121:213-218#
10. Temple LM et al (2020) Tetrahydrocannabinol - friend or foe? - Debate Clin Toxicol (Phila) 58:75-81.
11. Tiwari J et al (2018) Tetrahydrocannabinol: a drug of interest. Panminerva Med 60:228-230.