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Efficacy and tolerability of high-dose dronabinol maintenance in HIV-positive marijuana smokers: a controlled laboratory study

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Abstract

Rationale

Dronabinol (Δ9tetrahydrocannabinol) is approved for HIV-related anorexia, yet, little is known about its effects in HIV-positive marijuana smokers. HIV-negative marijuana smokers require higher than recommended dronabinol doses to experience expected effects.

Objectives

Employing a within-subjects, double-blind, placebo-controlled design, we assessed the effects of repeated high-dose dronabinol in HIV-positive marijuana smokers taking antiretroviral medication.

Methods

Participants (N = 7), who smoked marijuana 4.2 ± 2.3 days/week, resided in a residential laboratory for two 16-day stays, receiving dronabinol (10 mg QID) in one stay and placebo in the other. Efficacy was assessed with objectively verified food intake and body weight. Tolerability was measured with sleep, subjective, and cognitive assessments. For analyses, each inpatient stay was divided into two phases, days 1–8 and 9–16; we compared dronabinol’s effects with placebo in each 8-day phase to investigate tolerance.

Results

Despite sustained increases in self-reported food cravings, dronabinol only increased caloric intake in the initial 8 days of dosing. Similarly, sleep quality was improved only in the first 8 days of dosing. Dronabinol’s mood-enhancing effects were sustained across the 16-day inpatient stay. Dronabinol was well tolerated, causing few negative subjective or cognitive effects.

Conclusions

In HIV-positive marijuana smokers, high dronabinol doses safely and effectively increased caloric intake. However, repeated high-dose dronabinol appeared to result in selective tolerance to these effects. These findings indicate that HIV-positive individuals who smoke marijuana may require higher dronabinol doses than are recommended by the FDA. Future research to establish optimal dosing regimens, and reduce the development of tolerance, is required.

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Acknowledgements

Thanks to Brooke Roe, Diana Paksarian, and Michael Rubin for assistance in data collection, and to Jennifer Redman for input into interpretation of sleep measurements. This study complies with the laws of the country in which it was performed (USA).

Funding

National Center for Complementary and Alternative Medicine (DA0126980).

The authors have no conflicts to declare.

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Authors and Affiliations

  1. Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA

    Gillinder Bedi, Richard W. Foltin, Erik W. Gunderson, Judith Rabkin, Carl L. Hart, Sandra D. Comer, Suzanne K. Vosburg & Margaret Haney

  2. Division on Substance Abuse, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 120, New York, NY, 10032, USA

    Gillinder Bedi, Richard W. Foltin, Erik W. Gunderson, Judith Rabkin, Carl L. Hart, Sandra D. Comer, Suzanne K. Vosburg & Margaret Haney

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  1. Gillinder Bedi
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  2. Richard W. Foltin
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  3. Erik W. Gunderson
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  4. Judith Rabkin
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  5. Carl L. Hart
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  7. Suzanne K. Vosburg
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  8. Margaret Haney
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Corresponding author

Correspondence to Margaret Haney.

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Bedi, G., Foltin, R.W., Gunderson, E.W. et al. Efficacy and tolerability of high-dose dronabinol maintenance in HIV-positive marijuana smokers: a controlled laboratory study. Psychopharmacology 212, 675–686 (2010). https://doi.org/10.1007/s00213-010-1995-4

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  • DOI: https://doi.org/10.1007/s00213-010-1995-4

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