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Dronabinol | CAS No: 1972-08-3 | GMP-certified suppliers

A medication that addresses anorexia with weight loss in AIDS patients and chemotherapy-induced nausea and vomiting unresponsive to standard antiemetics.

Therapeutic categories

Agents producing tachycardiaAlimentary Tract and MetabolismAnalgesicsAnalgesics, Non-NarcoticAntiemetics and AntinauseantsBCRP/ABCG2 Inhibitors
Generic name
Dronabinol
Molecule type
small molecule
CAS number
1972-08-3
DrugBank ID
DB00470
Approval status
Approved drug, Illicit drug
ATC code
A04AD10

Primary indications

  • Dronabinol is indicated for the treatment of anorexia associated with weight loss in patients with AIDS, and nausea and vomiting associated with cancer chemotherapy in patients who have failed to respond adequately to conventional antiemetic treatments

Product Snapshot

  • Dronabinol is supplied primarily as oral capsules and buccal sprays, including liquid-filled and metered-dose formulations
  • It is used mainly for managing anorexia-related weight loss in AIDS patients and chemotherapy-induced nausea and vomiting unresponsive to standard antiemetics
  • The compound holds regulatory approval in the US and Canada

Clinical Overview

Dronabinol (CAS 1972-08-3) is the synthetic form of delta-9-tetrahydrocannabinol (Δ⁹-THC), the principal psychoactive constituent of cannabis. It acts as a weak partial agonist at cannabinoid receptors CB1 and CB2, which are part of the endogenous endocannabinoid system distributed throughout the central and peripheral nervous systems. Activation of CB1 receptors in the brain, especially in the hippocampus and amygdala, modulates appetite, mood, cognition, memory, and pain perception. CB2 receptors are predominantly located on immune cells and influence inflammatory and immune responses.

Clinically, dronabinol is indicated for managing anorexia associated with weight loss in patients with AIDS and for controlling nausea and vomiting induced by cancer chemotherapy in patients who have not responded sufficiently to standard antiemetics. Its onset of action following oral administration is approximately 30 minutes to 1 hour, with peak effects reached within 2 to 4 hours. Psychoactive effects last 4 to 6 hours, while appetite stimulation may continue for 24 hours or more.

Pharmacodynamically, dronabinol can produce sympathomimetic responses such as tachycardia and conjunctival injection. Effects on blood pressure are variable; orthostatic hypotension and syncope have been reported, particularly with abrupt posture changes. Tolerance develops to cardiovascular and central nervous system effects over time with continued use, but appetite stimulation appears sustained up to five months in treated patients.

Dronabinol is metabolized primarily by cytochrome P450 enzymes, including CYP2C9, CYP2C19, and CYP3A4 isoforms, which should be considered for potential drug-drug interactions. It also acts as an inhibitor of multiple CYP enzymes and transport proteins, influencing the disposition of concomitant medications.

Regarding safety, central nervous system effects such as dizziness, euphoria, or cognitive impairment necessitate caution in activities requiring alertness. The potential for dependency and misuse must be monitored due to its psychoactive profile. Dose titration and patient monitoring are recommended to manage adverse reactions.

Dronabinol is marketed under the brand name Marinol and is regulated as a controlled substance in many jurisdictions due to its psychoactive properties.

For API sourcing, ensuring pharmaceutical-grade dronabinol meeting stringent purity criteria is critical, given its potent biological activity and narrow therapeutic window. Suppliers should provide comprehensive documentation including certificates of analysis, stability data, and compliance with international regulatory standards to support formulation and regulatory efforts.

Identification & chemistry

Generic name Dronabinol
Molecule type Small molecule
CAS 1972-08-3
UNII 7J8897W37S
DrugBank ID DB00470

Pharmacology

SummaryDronabinol is a synthetic analogue of delta-9-tetrahydrocannabinol that acts as a partial agonist at cannabinoid receptors CB1 and CB2. Its pharmacodynamic effects include modulation of appetite, pain, mood, cognition, and sympathetic nervous system activity. Therapeutically, dronabinol is utilized for appetite stimulation in anorexia related to AIDS and for antiemetic control in chemotherapy-induced nausea and vomiting.
Mechanism of actionDronabinol is a synthetic form of delta-9-tetrahydrocannabinol (Δ⁹-THC), the primary psychoactive component of cannabis (marijuana). THC demonstrates its effects through weak partial agonist activity at Cannabinoid-1 (CB1R) and Cannabinoid-2 (CB2R) receptors, which results in the well-known effects of smoking cannabis such as increased appetite, reduced pain, and changes in emotional and cognitive processes.
PharmacodynamicsDronabinol-induced sympathomimetic activity may result in tachycardia and/or conjunctival injection. Its effects on blood pressure are inconsistent, but subjects have experienced orthostatic hypotension and/or syncope upon abrupt standing. Dronabinol also demonstrates reversible effects on appetite, mood, cognition, memory, and perception. These phenomena appear to be dose-related, increasing in frequency with higher dosages, and subject to great inter-patient variability. After oral administration, dronabinol capsules have an onset of action of approximately 0.5 to 1 hour and a peak effect at 2 to 4 hours. Duration of action for psychoactive effects is 4 to 6 hours, but the appetite stimulant effect of dronabinol may continue for 24 hours or longer after administration. Tachyphylaxis and tolerance develop to some of the cardiovascular and CNS pharmacologic effects of dronabinol with chronic use, suggesting an indirect effect on sympathetic neurons. In a study of the pharmacodynamics of chronic dronabinol exposure, healthy male subjects (N = 12) received 12 times the maximum dose for anorexia associated with weight loss in patients with AIDS of dronabinol capsules in divided doses for 16 days. An initial tachycardia induced by dronabinol was replaced successively by normal sinus rhythm and then bradycardia. A decrease in supine blood pressure, made worse by standing, was also observed initially. These subjects developed tolerance to the cardiovascular and subjective adverse CNS effects of dronabinol within 12 days of treatment initiation. Tachyphylaxis and tolerance do not appear to develop to the appetite stimulant effect of dronabinol. In clinical studies of dronabinol capsules in AIDS patients, at the recommended dosage, the appetite stimulant effect was sustained for up to five months.
Targets
TargetOrganismActions
Cannabinoid receptor 1Humansagonist
Cannabinoid receptor 2Humansagonist

ADME / PK

AbsorptionDronabinol is almost completely absorbed (90 to 95%) after a single oral dose. Due to the combined effects of first-pass hepatic metabolism and high lipid solubility, only 10 to 20% of the administered dose reaches systemic circulation. Relative bioavailability data from healthy male and female subjects suggest that a dose of 4.2 mg of SYNDROS provides comparable systemic exposure (Cmax and AUC) to a 5 mg dronabinol capsule, under fasted conditions, with the C<sub>max</sub> and AUC<sub>inf</sub> of 1.9 ± 1.3 ng/mL and 3.8 ± 1.8 ng.h/mL respectively. The concentrations of both dronabinol and its major active metabolite (11-hydroxy-delta-9-THC) peak at approximately 0.5 to 4 hours after oral dosing with SYNDROS and decline over several days. The mean inter- and intra-subject variability in dronabinol pharmacokinetics (C<sub>max</sub> and AUC<sub>inf</sub>) was approximately 66% and 47% and 67% and 14%, respectively, following the administration of SYNDROS to healthy subjects.
Half-lifeThe elimination phase of dronabinol can be described using a two-compartment model with an initial (alpha) half-life of about 4 hours and a terminal (beta) half-life of 25 to 36 hours.
Protein bindingThe plasma protein binding of dronabinol and its metabolites is approximately 97%.
MetabolismTHC is primarily metabolized in the liver by microsomal hydroxylation and oxidation reactions catalyzed by Cytochrome P450 enzymes. 11-hydroxy-▵9-tetrahydrocannabinol (11-OH-THC) is the primary active metabolite, capable of producing psychological and behavioural effects, which is then metabolized into 11-nor-9-carboxy-▵ 9-tetrahydrocannabinol (THC-COOH), THC's primary inactive metabolite . Dronabinol and its principal active metabolite, 11-OH-delta-9-THC, are present in approximately equal concentrations in plasma. Concentrations of both parent drug and metabolite peak at approximately 0.5 to 4 hours after oral dosing and decline over several days.
Route of eliminationDronabinol and its biotransformation products are excreted in both feces and urine. Biliary excretion is the major route of excretion with about half of a radiolabeled oral dose being recovered from the feces within 72 hours as contrasted with 10 to 15% recovered from urine. Less than 5% of an oral dose is recovered unchanged in the feces. Due to its redistribution, dronabinol and its metabolites may be excreted for prolonged periods of time. Following single-dose administration, dronabinol metabolites have been detected for more than 5 weeks in the urine and feces. In a study of dronabinol capsules involving AIDS patients, urinary cannabinoid/creatinine concentration ratios were studied bi-weekly over a six-week period. The urinary cannabinoid/creatinine ratio was closely correlated with the dose. No increase in the cannabinoid/creatinine ratio was observed after the first two weeks of treatment, indicating that steady-state cannabinoid levels had been reached. This conclusion is consistent with predictions based on the observed terminal half-life of dronabinol.
Volume of distributionDronabinol has a large apparent volume of distribution, approximately 10 L/kg, because of its lipid solubility.
ClearanceThe value for clearance average is about 0.2 L/kg-hr but is highly variable due to the complexity of cannabinoid distribution.

Formulation & handling

  • Dronabinol is a small molecule oral and transmucosal agent primarily formulated as capsules and solutions for buccal and oral administration.
  • High lipophilicity (LogP 5.94) and low water solubility necessitate formulation strategies to enhance bioavailability.
  • Food delays absorption; dosing should be coordinated to occur on an empty stomach to optimize pharmacokinetics.

Regulatory status

LifecycleThe API has one patent that expired in the United States in 2011, while additional patents are set to expire in 2028, indicating a transitioning market phase in the US and Canada with ongoing patent protections influencing product availability.
MarketsUS, Canada
Supply Chain
Supply chain summaryThe manufacturing and supply landscape for dronabinol includes multiple originator companies involved in both manufacturing and packaging, indicating a diversified supply base. Branded products are primarily present in the US and Canadian markets. Patent expirations range from 2011 to 2028, with several patents extending into 2028, suggesting the presence of ongoing patent protection and limited generic competition in the near term.

Safety

ToxicitySYNDROS, a synthetic cannabinoid containing alcohol, may cause fetal harm. Avoid the use of SYNDROS in pregnant women. Although there is little published data on the use of synthetic cannabinoids during pregnancy, the use of cannabis (e.g., marijuana) and the use of alcohol during pregnancy have been associated with adverse fetal/neonatal outcomes (see Clinical Considerations). Cannabinoids have been found in the umbilical cord blood of pregnant women who smoke cannabis. In animal reproduction studies, no teratogenicity was reported in mice administered dronabinol (delta-9-THC) at up to 30 times the MRHD (maximum recommended human doses) and up to 5 times the MRHD for patients with AIDS and cancer, respectively. Similar findings were reported in pregnant rats administered dronabinol at up to 5 to 20 times the MRHD and 3 times the MRHD for patients with AIDS and cancer, respectively. Decreased maternal weight gain and the number of viable pups and increased fetal mortality and early resorptions were observed in both species at doses that induced maternal toxicity. In rats, maternal administration of dronabinol from pregnancy (implantation) through weaning was associated with maternal toxicity, including mortality of pups, and adverse developmental and 10 neurodevelopmental effects on the pups at 2 to 20 times the MRHD for patients with AIDS and less than and up to 3.3 times the MRHD for patients with cancer. The estimated background risk of major birth defects and miscarriage for the indicated populations is unknown. All pregnancies have a background risk of birth defect, loss, or other adverse outcomes. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2 to 4% and 15 to 20%, respectively. For mothers infected with the Human Immunodeficiency Virus (HIV), the Centers for Disease Control and Prevention recommend that HIV-infected mothers not breastfeed their infants to avoid risking postnatal transmission of HIV. Because of the potential for HIV transmission (in 12 HIV-negative infants) and serious adverse reactions in a breastfed infant, instruct mothers not to breastfeed if they are receiving SYNDROS. For mothers with nausea and vomiting associated with cancer chemotherapy, there are limited data on the presence of dronabinol in human milk, the effects on the breastfed infant, or the effects on milk production. The reported effects of inhaled cannabis transferred to the breastfeeding infant have been inconsistent and insufficient to establish causality. The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for SYNDROS and any potential adverse effects on the breastfed infant from SYNDROS or from the underlying maternal condition. The safety and effectiveness of SYNDROS have not been established in pediatric patients. Pediatric patients may be more sensitive to the neurological and psychoactive effects of SYNDROS. SYNDROS contains the excipients 50% (w/w) dehydrated alcohol and 5.5% (w/w) propylene glycol. Ethanol competitively inhibits the metabolism of propylene glycol, which may lead to elevated concentrations of propylene glycol. Preterm neonates may be at increased risk of propylene glycol-associated adverse events due to diminished ability to metabolize propylene glycol, thereby, leading to accumulation. Clinical studies of dronabinol capsules in AIDS and cancer patients did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Elderly patients may be more sensitive to the neuropsychiatric and postural hypotensive effects of SYNDROS. Elderly patients with dementia are at increased risk for falls as a result of their underlying disease state, which may be exacerbated by the CNS effects of somnolence and dizziness associated with SYNDROS. These patients should be monitored closely and placed on fall precautions prior to initiating SYNDROS therapy. In antiemetic studies, no difference in efficacy was apparent in patients greater than 55 years of age compared to younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of falls decreased hepatic, renal, or cardiac function, increased sensitivity to psychoactive effects, and concomitant disease or other drugs therapy. SYNDROS contains dronabinol, the main psychoactive component in marijuana. Ingestion of high doses of dronabinol increases the risk of psychiatric adverse reactions if abused or misused, while continued administration can lead to addiction. Psychiatric adverse reactions may include psychosis, hallucinations, depersonalization, mood alteration, and paranoia. In vitro studies demonstrate that SYNDROS can be easily and effectively abused without manipulation. SYNDROS contains 50% (w/w) dehydrated alcohol. In a randomized, single-dose, double-blind, placebo- and active-controlled crossover pharmacodynamic study of 43 experienced marijuana smokers, “drug liking” responses and safety of SYNDROS were compared with placebo and dronabinol in sesame oil oral capsules. Treatment arms were 10 mg and 30 mg dronabinol capsules, 10 mg and 30 mg dronabinol from= SYNDROS, and placebo oral solution and capsules. Greater “drug liking” scores were reported with the 30 mg dose, compared with the 10 mg dose, for both SYNDROS and dronabinol-containing capsules. Overall, the pharmacodynamic results from this study demonstrated no statistically significant differences in various measures of drug liking for the doses taken, though the SYNDROS results were consistently greater than those of dronabinol capsules. Similarly, observed adverse reactions were greater for SYNDROS. The pharmacodynamic and safety effects of SYNDROS following multiple doses have not been evaluated. Patients should be instructed to keep SYNDROS in a secure place out of reach of others for whom the medication has not been prescribed. Physical dependence is a state that develops as a result of physiological adaptation in response to repeated drug use. Physical dependence manifests by drug class-specific withdrawal symptoms after abrupt discontinuation or a significant dose reduction of a drug. The appearance of a withdrawal syndrome when the administration of the drug is terminated is the only actual evidence of physical dependence. Physical dependence can develop during chronic therapy with SYNDROS and develops after chronic abuse of marijuana. A withdrawal syndrome was reported after the abrupt discontinuation of dronabinol capsules in subjects receiving dosages of 210 mg per day for 12 to 16 consecutive days. Within 12 hours after discontinuation, subjects manifested symptoms such as irritability, insomnia, and restlessness. By approximately 24 hours post-dronabinol discontinuation, withdrawal symptoms intensified to include “hot flashes”, sweating, rhinorrhea, loose stools, hiccoughs, and anorexia. These withdrawal symptoms gradually dissipated over the next 48 hours. Electroencephalographic changes consistent with the effects of drug withdrawal (hyperexcitation) were recorded in patients after abrupt dechallenge. Patients also complained of disturbed sleep for several weeks after discontinuing therapy with high dosages of dronabinol. Signs and symptoms of dronabinol overdose include drowsiness, euphoria, heightened sensory awareness, altered time perception, reddened conjunctiva, dry mouth, tachycardia, memory impairment, depersonalization, mood alteration, urinary retention, reduced bowel motility, decreased motor coordination, lethargy, slurred speech, and postural hypotension. Patients may also experience panic reactions if they have a prior history of nervousness or anxiety and seizures may occur in patients with existing seizure disorders. It is not known if dronabinol can be removed by dialysis in cases of overdose.
High Level Warnings:
  • 1
  • SYNDROS contains 50% dehydrated alcohol and 5
  • 5% propylene glycol

Dronabinol is a type of Non-opioid analgesics


Non-opioid analgesics are a subcategory of pharmaceutical active pharmaceutical ingredients (APIs) that are widely used for the management of pain. Unlike opioids, which are known to have addictive properties, non-opioid analgesics offer pain relief without the risk of dependence or addiction.

These APIs work by inhibiting the production of prostaglandins, which are substances in the body that contribute to pain and inflammation. Non-opioid analgesics are typically available over-the-counter (OTC) and come in various forms such as tablets, capsules, creams, and gels.

One of the most common non-opioid analgesics is acetaminophen, which is highly effective in relieving mild to moderate pain. It is commonly used to alleviate headaches, toothaches, and musculoskeletal pain. Another popular non-opioid analgesic is non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen. These medications not only reduce pain but also have anti-inflammatory properties, making them particularly useful for conditions such as arthritis.

Non-opioid analgesics are generally well-tolerated but can have potential side effects, including gastrointestinal disturbances and, in rare cases, liver or kidney damage. It is important to follow recommended dosages and consult a healthcare professional if there are any concerns or underlying medical conditions.

In conclusion, non-opioid analgesics are a vital category of pharmaceutical APIs that offer effective pain relief without the risk of addiction. Their accessibility, diverse formulations, and relatively favorable safety profile make them a popular choice for individuals seeking relief from various types of pain.


Dronabinol (Non-opioid analgesics), classified under Analgesics


Analgesics are a category of pharmaceutical Active Pharmaceutical Ingredients (APIs) that are commonly used to relieve pain. They are designed to alleviate discomfort by targeting the body's pain receptors or by reducing inflammation. Analgesics are widely utilized in the medical field to manage various types of pain, ranging from mild to severe.

One of the primary classes of analgesics is nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs work by inhibiting the production of prostaglandins, substances that contribute to pain and inflammation. This class includes well-known drugs like ibuprofen and naproxen. Another class of analgesics is opioids, which are derived from opium or synthetic compounds that mimic the effects of opium. Opioids act on the central nervous system to reduce pain perception and provide potent pain relief. Examples of opioids include morphine, codeine, and oxycodone.

Analgesics are available in various forms, such as tablets, capsules, creams, and injections, allowing for different routes of administration based on the patient's needs. They are commonly used to manage pain associated with conditions like arthritis, headaches, dental procedures, and post-operative recovery.

It is important to note that analgesics should be used under medical supervision, as improper use or overuse can lead to adverse effects, including gastrointestinal complications, addiction, and respiratory depression in the case of opioids. Therefore, it is crucial for healthcare professionals to assess each patient's individual needs and prescribe the appropriate analgesic and dosage.

In summary, analgesics are a vital category of pharmaceutical APIs used to alleviate pain by targeting pain receptors or reducing inflammation. With various classes and forms available, they provide valuable options for pain management when used responsibly and under medical guidance.