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What is Marinol?

What is Marinol and How is it Used in HIV?

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Updated May 07, 2014

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

I've heard Marinol (dronabinol) referred to as "the marijuana pill" but it is far from the smokable drug you find tucked away in peoples homes, cars, or back packs. While its uses are similar to those of medical marijuana, Marinol is different; namely because it is legal to possess and use by prescription. Medical marijuana is legal in a few states but is illegal in all states from a federal government point of view. So why do people refer to Marinol as the marijuana pill? And more importantly, what is Marinol and how is it used in HIV?

What is Marinol?

Marinol (dronabinol) is a prescription drug that is typically prescribed to relieve the nausea and vomiting associated with chemotherapy. It's also used in HIV as an appetite stimulant in addition to treating nausea and vomiting. In the case of nausea and vomiting, Marinol is typically used when the patient does not get relief from more commonly used meds such as Compazine, Zofran, or Vistaril. As an appetite stimulant, Marinol is used in patients suffering from AIDS wasting in hopes of improving appetite, caloric intake, and weight.

How is Marinol Like Marijuana?

More and more states in the U.S. are voting to allow marijuana to be used medicinally. Medical marijuana is used to relieve the signs and symptoms of glaucoma, nausea and vomiting, and poor appetite. Despite being approved for use in certain states (e.g Michigan and California), the use of medical marijuana is still considered illegal by the U.S. federal government. Marinol (dronabinol) contains a synthetic version of the active ingredient in marijuana; tetrahydrocannabinol or THC for short. Because Marinol contains THC, one of the world's oldest known hallucinogenic drugs, it's often referred to as the "marijuana pill."

Does Marinol Make You "High"?

From the patients I talk to in my clinic and from what I have read across the Internet, the answer to this question is never the same twice. Some people say yes; the high is the same as smoked marijuana. Some people say no; there is no high with Marinol at all; and still others say it depends on factors like dosage, frequency, and the length of time you have been on Marinol. Simply put, it all depends on the person taking the medication and how their body responds to the drug.

Important Warning!
Marinol should never be taken in doses that exceed prescribed amounts or in a manner other than by mouth in an effort to get "high."

How is Marinol Used in HIV Positive Patients?

As was mentioned earlier, Marinol is typically prescribed when other medications have not been effective. Patients undergoing chemotherapy experience a great deal of nausea and are frequent users of Marinol. In HIV the use of Marinol is two-fold. At times it's used to help fight the nausea caused by some HIV medications. However, Marinol is also prescribed as an appetite stimulant in HIV-positive people experiencing weight loss or poor appetite. A common problem in HIV, poor appetite and weight loss can be the result of the virus itself, opportunistic infections, or most commonly HIV medications. Marinol helps the HIV-positive person in two ways; decreasing the nausea associated with HIV and at the same time stimulating the appetite. This two-fold affect helps the person to eat more and therefore maintain or gain weight.

How is Marinol Prescribed?

Marinol is supplied in 2.5mg (white), 5mg (dark brown) and 10mg (orange) capsules. The capsules should be stored in the refrigerator to prevent them from becoming soft and gummy when they get warm. They should not however, be allowed to freeze.

What is the Typical Dose of Marinol?

In the HIV positive patient, Marinol is typically prescribed in doses of 2.5mg twice daily to a maximum dose of 10mg twice daily; before lunch and dinner. In people who can't tolerate those doses, a dose of 2.5mg at bedtime is sometimes used.

Important Note!
Capsules should be swallowed whole; never crushed, chewed or bitten.

Are There Side Effects from Marinol?

There are side effects that can occur even if you are taking Marinol in prescribed doses. They include:
  • feeling "high"
  • drowsiness
  • confusion
  • an exaggerated sense of well-being
  • headache
  • dry mouth
  • confusion
  • mental status changes

Things to Keep in Mind When Taking Marinol

There are a few things to be aware of before you start taking Marinol. They include:
  • notify your provider if you have a known allergy to Marinol, marijuana, or sesame oil (Marinol contains sesame oil)
  • notify your provider if you have a history of alcohol or substance abuse
  • make certain your provider is aware of your past medical history; both emotional and physical
  • don't operate heavy machinery, power tools, or make important decisions when taking Marinol.

Marinol vs. Marijuana

Some people tell me they prefer smoking marijuana over taking Marinol. Many say that it is just a better option for them. Is there a difference between the two? Actually there are pros and cons to using Marinol over smoking marijuana.

Pros

  • Marinol is legal in every state.
  • Marinol is available in pharmacies across the country by prescription.
  • Marinol has been proven safe in countless clinical trials and studies.
  • Marinol is taken orally, meaning there is no exposure to smoke and the chemicals contained in marijuana smoke.
  • Marinol is typically covered by prescription insurance.
Cons
  • The onset of symptoms relief is much quicker with marijuana than it is with Marinol.
  • Marinol adds to the pill burden of the HIV positive person.

In My Humble Opinion

Many of my patients have asked me what I suggest; Marinol or marijuana. I look at it this way. Marijuana has some built in problems; namely it's illegal and hard to get. Plus, I'm not convinced there aren't better and more proven ways to relieve nausea and stimulate appetite. That being said, if you live in a state where marijuana is an option, it's ultimately up to you to have a discussion with your provider to decide which is best for you. Sources

Morrow, A.; "Is Marinol Better than Smoked Marijuana?"; About Palliative Care; 6 May 2009.

Solvay Pharmaceuticals; Marinol Drug Insert; March 2008.

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