Cannabinoids
Indications for Prior Authorization
Marinol (dronabinol) capsule, Syndros (dronabinol) oral solution
-
For diagnosis of Chemotherapy-induced nausea and vomiting
Indicated in adults for the treatment of nausea and vomiting associated with cancer chemotherapy in patients who have failed to respond adequately to conventional antiemetic treatments. -
For diagnosis of Anorexia in patients with AIDS
Indicated in adults for the treatment of anorexia associated with weight loss in patients with Acquired Immune Deficiency Syndrome (AIDS)
Criteria
Brand Marinol
*This product may require prior authorization.
Prior Authorization
Length of Approval: 6 Month(s)
For diagnosis of Chemotherapy-induced nausea and vomiting
- Diagnosis of chemotherapy-induced nausea and vomiting AND
- Trial and failure, contraindication, or intolerance to formulary generic dronabinol capsules* AND
- Trial and failure, contraindication, or intolerance to a 5HT-3 receptor antagonist (e.g., Anzemet [dolasetron], Kytril [granisetron], or Zofran [ondansetron]) [1] AND
- Trial and failure, contraindication, or intolerance to one of the following: [1, A]
- Ativan (lorazepam)
- Compazine (prochlorperazine)
- Decadron (dexamethasone)
- Haldol (haloperidol)
- Phenergan (promethazine)
- Reglan (metoclopramide)
- Zyprexa (olanzapine)
Generic dronabinol
Prior Authorization
Length of Approval: 6 Month(s)
For diagnosis of Chemotherapy-induced nausea and vomiting
- Diagnosis of chemotherapy-induced nausea and vomiting AND
- Trial and failure, contraindication, or intolerance to a 5HT-3 receptor antagonist (e.g., Anzemet [dolasetron], Kytril [granisetron], or Zofran [ondansetron]) [1] AND
- Trial and failure, contraindication, or intolerance to one of the following: [1, A]
- Ativan (lorazepam)
- Compazine (prochlorperazine)
- Decadron (dexamethasone)
- Haldol (haloperidol)
- Phenergan (promethazine)
- Reglan (metoclopramide)
- Zyprexa (olanzapine)
Syndros
*This product may require prior authorization.
Prior Authorization
Length of Approval: 6 Month(s)
For diagnosis of Chemotherapy-induced nausea and vomiting
- Diagnosis of chemotherapy-induced nausea and vomiting AND
- One of the following:
- Trial and failure or intolerance to formulary generic dronabinol capsules*
- Patient is unable to swallow capsules
- Trial and failure, contraindication, or intolerance to a 5HT-3 receptor antagonist (e.g., Anzemet [dolasetron], Kytril [granisetron], or Zofran [ondansetron]) [1] AND
- Trial and failure, contraindication, or intolerance to one of the following: [1, A]
- Ativan (lorazepam)
- Compazine (prochlorperazine)
- Decadron (dexamethasone)
- Haldol (haloperidol)
- Phenergan (promethazine)
- Reglan (metoclopramide)
- Zyprexa (olanzapine)
Brand Marinol
*This product may require prior authorization.
Prior Authorization
Length of Approval: 3 Month(s)
For diagnosis of Anorexia in Patients with AIDS
- Diagnosis of anorexia with weight loss in patients with AIDS AND
- Patient is on antiretroviral therapy [8, 9] AND
- One of the following [3-6, 9]:
- Patient is 65 years of age or greater OR
- Both of the following:
- Patient is less than 65 years of age
- Trial and failure, contraindication, or intolerance to megestrol acetate oral suspension
- Trial and failure or intolerance to formulary generic dronabinol capsules*
Generic dronabinol
Prior Authorization
Length of Approval: 3 Month(s)
For diagnosis of Anorexia in Patients with AIDS
- Diagnosis of anorexia with weight loss in patients with AIDS AND
- Patient is on antiretroviral therapy [8, 9] AND
- One of the following [3-6, 9]:
- Patient is 65 years of age or greater OR
- Both of the following:
- Patient is less than 65 years of age
- Trial and failure, contraindication, or intolerance to megestrol acetate oral suspension
Syndros
*This product may require prior authorization.
Prior Authorization
Length of Approval: 3 Month(s)
For diagnosis of Anorexia in Patients with AIDS
- Diagnosis of anorexia with weight loss in patients with AIDS AND
- Patient is on antiretroviral therapy [8, 9] AND
- One of the following [3-4, 9]:
- Patient is 65 years of age or greater OR
- Both of the following:
- Patient is less than 65 years of age
- Trial and failure, contraindication, or intolerance to megestrol acetate oral suspension
- One of the following:
- Trial and failure or intolerance to formulary generic dronabinol capsules*
- Patient is unable to swallow capsules
P & T Revisions
2024-04-01, 2023-08-08, 2023-03-29, 2022-04-22, 2021-11-25, 2021-09-28, 2021-05-20, 2021-05-05, 2020-04-25
References
- National Comprehensive Cancer Network (NCCN). Clinical Practice Guidelines in Oncology: Antiemesis v.1.2021. Available by subscription at: https://www.nccn.org/professionals/physician_gls/pdf/antiemesis.pdf. Accessed March 9, 2022.
- Marinol prescribing information. Patheon Softgels, Inc. High Point, NC. March 2021.
- The National Committee for Quality Assurance (NCQA). Use of high-risk medications in the elderly (DAE). Available at www.ncqa.org. Accessed August 22, 2016.
- American Geriatrics Society 2019 Beers Criteria Update Expert Panel. American Geriatrics Society Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc. 2019;00:1-21.
- Pascual Lopez A, Roque i Figuls M, Urrutia Cuchi G, et al. Systematic review of megestrol acetate in the treatment of anorexia-cachexia syndrome. J Pain Symptom Manage 2004;27:360-369.
- Per clinical consult with HIV specialist, February 4, 2013.
- Syndros prescribing information. Benuvia Therapeutics, Inc. Chandler, AZ. January 2021.
- Williams B, Waters D, Parker K. Evaluation and Treatment of Weight Loss in Adults with HIV Disease. Am Fam Physician. 1999;60(3):843-854.
- Grinspoon S, Mulligan K; Department of Health and Human Services Working Group on the Prevention and Treatment of Wasting and Weight Loss. Weight loss and wasting in patients infected with human immunodeficiency virus. Clin Infect Dis. 2003;36(Suppl 2):S69-78.
End Notes
- Per NCCN, cannabinoids are agents that can be used for breakthrough treatment. Other agents used for breakthrough treatment include: phenothiazines (prochlorperazine, promethazine), prokinetic agents (metoclopramide), antipsychotic agents (haloperidol, olanzapine), corticosteroids (dexamethasone), benzodiazepines (lorazepam), and 5-HT3 receptor antagonists (dolasetron, granisetron, ondansetron). [1]
Revision History
- 2024-04-01: Annual Review
- 2023-08-08: Updated clinical criteria
- 2023-03-29: Annual review - step criteria updated from Megace to megestrol acetate oral suspension for Weight loss in AIDS
- 2022-04-22: Update to references section.
- 2021-11-25: Removed Cesamet as a target from guideline.
- 2021-09-28: Addition of EHB formulary to guideline, no changes to criteria
- 2021-05-20: Addition of EHB formulary to guideline, no changes to criteria
- 2021-05-05: Updated references section.
- 2020-04-25: Updated references section.
HEALTHY LIVING