Marinol / Dronabinol

Marinol is a cannabinoid-based oral medication approved by the U.S. Food and Drug Administration. Food and Drug Administration (FDA) in 1985.

It contains dronabinol, a synthetic type of THC, the intoxicating ingredient in cannabis. Dronabinol is chemically identical to (-)-trans-Δ9-THC - the naturally active form of THC - but produced by chemical synthesis in the laboratory rather than extracted from the plant. It is a pure 100% THC isolate, with no other cannabinoids or terpenes.

Marinol has been approved by the FDA specifically to treat anorexia associated with weight loss in HIV/AIDS patients, as well as the nausea and vomiting experienced by many cancer patients during chemotherapy.

It is marketed in France under the name dronabinol and under AAP (Autorisation d'Accès Précoce), formerly known as Autorisation Temporaire d'Utilisation (ATU). It is distinct from botanical cannabis-based medicines (such as Sativex) in that it contains only synthetic THC, without the plant's other cannabinoids or terpenes.

Learn more about Marinol

Marinol is a oral capsule containing synthetic THC in sesame oil. The THC simultaneously stimulates appetite and reduces nausea, as it binds to certain receptors in the nervous system.

Marinol is absorbed more slowly by the body than inhaled cannabis, which is comparatively rapid. Once absorbed, Marinol can cause an altered state of mind, with some people experiencing a high or euphoric effect, and others becoming depressed. In either case, it is not advisable to drive while taking this drug, and nursing mothers should not take it at all.

A prescription is required for Marinol and the drug is intended for use by patients aged 18 and over. Sleeping pills, anxiolytics and antidepressants are among the drugs that should not be taken with Marinol.

Therapeutic properties of Marinol

At present, Marinol is only FDA-approved in the USA to treat two conditions: AIDS-related anorexia and severe nausea resulting from chemotherapy. Studies on Marinol as a treatment for sleep apnea, multiple sclerosis (MS) and depression are currently underway.

Marinol and sleep apnea

Dronabinol was found to reduce daytime sleepiness and improve symptoms of obstructive sleep apnea in a randomized trial in 2018 involving 73 adults. Published in the journal Sleep, the results of this trial indicate that participants taking the highest dose of dronabinol (10 milligrams versus 2.5 milligrams) experienced the best results.

Marinol and MS

A study originally published in European Neurology examined dronabinol as a long-term treatment option for MS patients. The study involved 240 patients who received either dronabinol or placebo for 16 weeks. Although the potential pain-relieving effect of dronabinol was not clearly established, the researchers were satisfied with the good tolerability of cannabis-based medicine synthetic, as they wrote: «Overall, this trial demonstrated the long-term therapeutic potential, good tolerability and favorable safety profile of dronabinol - particularly in terms of drug abuse and dependence.»

Marinol and back pain

Some lower back pain can also be described as neuropathic, and researchers are investigating whether Marinol could play a role in its treatment. The University of California, San Diego, is currently recruiting a clinical trial which will test the potential efficacy of dronabinol and vaporized cannabis in reducing neuropathic back pain. The objectives of the trial are broad, and aim to clarify how a combination of whole-plant vaporized cannabis and dronabinol influences mood and other psychological factors.

Marinol and Alzheimer's disease

Another clinical trial, sponsored by Johns Hopkins University in Baltimore, Maryland, in collaboration with McLean Hospital, is testing how dronabinol might treat symptoms of agitation in Alzheimer's patients. This clinical trial is currently underway, and the results may help elucidate how Marinol could be prescribed for another purpose in the future.

The limits of Marinol in the face of medical cannabis

Marinol has long been the argument of opponents to the legalization of medical cannabis: «If THC is useful, take Marinol.» But clinical practice and research have highlighted several important limitations.

Low and variable oral bioavailability When taken orally, THC passes through the liver before reaching the bloodstream, the same process that transforms THC into 11-OH-THC, a more potent metabolite with less predictable effects. Marinol's oral bioavailability is estimated at just 6-20%, depending on the individual, with considerable variability from patient to patient. Conversely, cannabis vaporization achieves 40-60% of bioavailability, with an almost immediate and easily titratable effect.

No entourage effect Marinol contains only pure THC, no CBD, CBG, CBN or terpenes. The’entourage effect, the synergy between all the plant's compounds, is increasingly documented as a key factor in the therapeutic efficacy of cannabis. Studies suggest that full-spectrum cannabis produces therapeutic effects superior to isolated THC for certain indications, notably chronic pain and spasms.

More intense psychoactive effects Without CBD to modulate CB1 receptors, Marinol's pure THC can produce psychoactive effects that are more marked and less well tolerated than cannabis with a balanced THC/CBD ratio, which is paradoxically less well accepted by patients than botanical medical cannabis.

These limitations explain why Marinol, despite being approved as early as 1985, has never really succeeded in establishing itself as a satisfactory alternative to medical cannabis in clinical practice.