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Treatment of anorexia associated w/ weight loss in AIDS patients and N/V associated w/ cancer chemotherapy in patients who have failed to respond adequately to conventional antiemetic treatments.
Associated w/ Weight Loss in AIDS Patients:
Initial: 2.5mg bid before lunch and supper Titrate: Reduce dose to 2.5mg/day, administered as qpm or qhs, if 5mg/day dose is intolerable Max: 20mg/day in divided doses
Use in patients who have failed to respond to conventional antiemetics
Initial: 5mg/m2 given 1-3 hrs before chemotherapy, then q2-4h after chemotherapy, for a total of 4-6 doses/day Titrate: May increase dose by 2.5mg/m2 increments Max: 15mg/m2/dose
Initial: 5mg/m2 given 1-3 hrs before chemotherapy, then q2-4h afterchemotherapy, for a total of 4-6 doses/dayTitrate: May increase dose by 2.5mg/m2 incrementsMax: 15mg/m2/dose
ElderlyStart at lower end of dosing range
Cap: 2.5mg, 5mg, 10mg
Sesame oil hypersensitivity.
May impair mental/physical abilities. Seizure and seizure-like activity reported; d/c immediately if seizures develop. Caution in patients w/ history of seizure disorders, and history of substance abuse, including alcohol abuse or dependence. Caution in patients w/ cardiac disorders due to occasional hypotension, possible HTN, syncope, or tachycardia. Caution in patients w/ mania, depression, or schizophrenia; exacerbation of these illnesses may occur. Caution in elderly patients w/ dementia.
Abdominal pain, N/V, dizziness, euphoria, paranoid reaction, somnolence, abnormal thinking.
May displace highly protein-bound drugs; monitor for dose requirement changes. Additive or synergistic CNS effects w/ sedatives, hypnotics, or other psychoactive drugs. Additive HTN, tachycardia, and possible cardiotoxicity w/ sympathomimetics (eg, amphetamines, cocaine). Additive or super-additive tachycardia, and drowsiness w/ anticholinergics (eg, atropine, scopolamine, antihistamines). Additive tachycardia, HTN, and drowsiness w/ TCAs (eg, amitriptyline, amoxapine, desipramine). Additive drowsiness and CNS depression w/ CNS depressants (eg, barbiturates, benzodiazepines, ethanol, lithium, opioids, buspirone, antihistamines, muscle relaxants). May result in hypomanic reaction w/ disulfiram and fluoxetine in patients who smoke marijuana. May decrease clearance of antipyrine and barbiturates. May increase theophylline metabolism in patients who smoke marijuana/tobacco.
Pregnancy: Category C.Lactation: Not for use in nursing.
Cannabinoid; has complex effects on the CNS, including central sympathomimetic activity.
Absorption: Cmax= 1.32ng/mL (2.5mg bid), 2.96ng/mL (5mg bid), 7.88ng/mL (10mg bid); (median) Tmax=1 hr (2.5mg bid), 2.5 hr (5mg bid), 1.5 hr (10mg bid); AUC0-12= 2.88ng•hr/mL (2.5mg bid), 6.16ng•hr/mL (5mg bid), 15.2ng•hr/mL (10mg bid). Distribution: Vd=10L/kg; plasma protein binding (97%); found in breast milk. Metabolism: Extensive 1st-pass hepatic metabolism primarily by microsomal hydroxylation; 11-OH-delta-9-THC (active metabolite). Elimination: Urine (10-15%), feces (50%, <5% unchanged); T1/2=25-36 hrs.
Assess for history of hypersensitivity to the drug and sesame oil, history of seizure disorders, history of substance abuse (including alcohol abuse/dependence), cardiac disorders, mania, depression, schizophrenia, pregnancy/nursing status, and possible drug interactions.
Monitor for psychiatric illness exacerbation, seizure and seizure-like activity, hypotension or HTN, syncope, tachycardia, dependence, and other adverse reactions.
Inform about additive CNS depression effect if taken concomitantly w/ alcohol or other CNS depressants (eg, benzodiazepines, barbiturates). Warn not to drive, operate machinery, or engage in any hazardous activity while receiving treatment until effect is well tolerated. Advise of possible mood changes and other behavioral effects that may occur during therapy. Advise that patients must be under constant supervision of a responsible adult during initial use and following dosage adjustments. Instruct to immediately report to physician any adverse effects and to notify if pregnant or breastfeeding.
8-15°C (46-59°F) and alternatively could be stored in a refrigerator. Protect from freezing.