Dronabinol Prescribing and Exposure Among Children and Young Adults Diagnosed with Cancer

Purpose:The therapeutic utility ofCannabisin cancer is a topic of intense interest. Dronabinol is synthetic Delta(9)-tetrahydrocannabinol (THC), the primary psychoactive component ofCannabis sativa, and is approved for treating refractory chemotherapy-induced nausea and vomiting. Little is known about dronabinol prescribing in children and young adults, and no published concentration data are available. This study evaluated national level dronabinol use and assessed concentrations of THC and its primary metabolites in patients with cancer Methods:Observational review of records from the Pediatric Health Information System (PHIS) and a regional network of hospitals in the Intermountain West, including a tertiary care children's hospital, Primary Children's Hospital (PCH), for inpatients Results:Across PHIS institutions, overall dronabinol prescribing aligned with the pharmacy records for those with cancer (p < 0.0001), and of these, 10.4% received dronabinol as inpatients. Blood collected within 72 hours of dronabinol administration was available from 10 children with a median age of 12.5 (range 6-17) years. Quantifiable concentrations were found in 4 (13%), 6 (20%), and 1 (3%) samples assayed for THC, 11-nor-9-carboxy-Delta(9)-tetrahydrocannabinol (COOH-THC), and 11-hydroxy-Delta(9)-tetrahydrocannabinol (OH-THC), respectively. THC concentrations ranged between 0.100 and 0.128 ng/mL and were not associated with dose. Conclusion:Dronabinol prescribing appears exclusive to patients diagnosed with cancer, and its use has increased steadily in the past decade. In a small sample of children administered dronabinol, THC and metabolite concentrations were consistently low or undetectable.

Automated summary

Dronabinol is used in cancer patients for treating chemotherapy-induced nausea and vomiting, with a steady increase in its use over the past decade. Concentrations of THC and its metabolites in children receiving dronabinol were consistently low or undetectable.