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Table 2: Relationship of THC percent in plant material to available dose in a joint %THC mg per 100 mg cannabis ; mg THC per 750 mg * " average joint" ; 1 7.5 2.5 * WHO average weight Assuming the desired peak plasma concentration of smoked THC is in the 50-100 ng mL range, see Section 2.3 ; it has been shown Huestis, et al., 1992 ; that this can be readily achieved with smoke from a single 3.55 % marihuana cigarette with about 900 mg plant material approximately 32 mg THC ; . A 750 mg joint of 5% strength i.e., 37.5 mg THC ; would yield slightly higher plasma levels. If the current average "street" marihuana contains 10% THC, then plants yielding joints from such a source might have an available 75 mg dose and could result in rapid attainment of plasma concentrations above 300 ng mL. Clearly even more potent strains of cannabis have been reported. Patients initiating smoked marihuana therapy should be cautioned to begin slowly and to stop smoking if tachycardia occurs. 3.2 Oral The pharmacokinetic information described in section 2.2 reports the erratic and slow absorption from the oral route and doses are estimated from the information for Marinol. 4.0 Purported Indications and Clinical Use The oral form of synthetic THC, dronabinol 2.5, 5 or 10 mg, dissolved in sesame oil ; in capsules is marketed in the US and Canada as Marinol. It is indicated for treatment of chemotherapy-induced emesis and for appetite stimulation in AIDS- related anorexia associated with weight loss Compendium of Pharmaceuticals and Specialties, 2003; Marinol US monograph ; . While there are many anecdotal reports of the therapeutic value of smoked marihuana, scientific studies supporting the safety and efficacy of marihuana for therapeutic claims are inconclusive. The existing scientific evidence for various symptoms is summarized in the following sections. Chlorpromazine Thorazine ; 0.25-1 mg kg dose slow IV over 20 min IM PO q4-8h prn, max 50 mg dose [inj: 25 mg mL, ; oral concentrate 30 mg mL; supp: 25, 100 mg; syrup: 10 mg 5 mL; tabs: 10, 25, 50, mg]. -Diphenhydramine Benadryl ; 1 mg kg dose IM IV PO q6h prn, max 50 mg dose [caps: 25, 50 mg; inj: 10 mg mL, 50 mg mL; liquid: 12.5 mg 5 mL; tabs: 25, 50 mg]. -Dimenhydrinate Dramamine ; 12 yrs: 5 mg kg day IM IV PO q6h prn, max 300 mg day Not recommended in 12y due to high incidence of extrapyramidal side effects. [cap: 50 mg; inj: 50 mg mL; liquid 12.5 mg 4 mL; tab: 50 mg; tab, chew: 50mg]. -Prochlorperazine Compazine ; 12 yrs: 0.1-0.15 mg kg dose IM, max 10 mg dose or 5-10 mg PO q6-8h, max 40 mg day OR 5-25 mg PR q12h, max 50 mg day Not recommended in 12y due to high incidence of extrapyramidal side effects [caps, SR: 10, 15, 30 mg; inj: 5 mg mL; supp: 2.5, 5, 25 mg; syrup: 5 mg 5 mL; tabs: 5, 10, 25 mg]. -Promethazine Phenergan ; 0.25-1 mg kg dose PO IM IV over 20 min or PR q4-6h prn, max 50 mg dose [inj: 25, 50 mg mL; supp: 12.5, 25, 50 mg; syrup 6.25 mg 5 mL, 25 mg 5 mL; tabs: 12.5, 25, 50 mg]. -Trimethobenzamide Tigan ; 15 mg kg day IM PO PR q6-8h, max 100 mg dose if 13.6 kg or 200 mg dose if 13.6-41kg. [caps: 100, 250 mg; inj: 100 mg mL; supp: 100, 200 mg]. Post-Operative Nausea and Vomiting: -Ondansetron Zofran ; 0.1 mg kg IV x 1, max 4 mg. -Droperidol Inapsine ; 0.01-0.05 mg kg IV IM q4-6h prn, max 5 mg [inj: 2.5 mg mL]. Chemotherapy-Induced Nausea: -Dexamethasone 10 mg m2 dose max 20 mg ; IV x 1, then 5 mg m2 dose max 10 mg ; IV q6h prn [inj: 4 mg mL, 10 mg mL] -Dronabinol Marinol ; 5 mg m2 dose PO 1-3 hrs prior to chemotherapy, then q4h prn afterwards. May titrate up in 2.5 mg m2 dose increments to max of 15 mg m2 dose. [cap: 2.5, 5, 10 mg] -Granisetron Kytril ; 10-20 mcg kg IV given just prior to chemotherapy single dose ; [inj: 1 mg mL] Adults oral ; 1 mg PO bid or 2 mg PO qd [tab: 1 mg] -Metoclopramide Reglan ; 0.5-1 mg kg dose IV q6h prn. Pretreatment with diphenhydramine 1 mg kg IV is recommended to decrease the risk of extrapyramidal reactions. [inj: 5 mg mL] -Ondansetron Zofran ; 0.15 mg kg dose IV 30 minutes before chemotherapy and repeated 4 hr and 8 hr later total of 3 doses ; OR 0.3 mg kg dose IV x 1 minutes before chemotherapy OR 0.45 mg kg day as a continuous IV infusion OR Oral: 0.3 m2: 1 mg PO three times daily 0.3-0.6 m2: 2 mg PO three times daily 0.6-1 m2: 3 mg PO three times daily 1 m2: 4 mg PO three times daily OR 4-11 yr: 4 mg PO three times daily 11 yr: 8 mg PO three times daily [inj: 2 mg mL; oral soln: 4mg 5 mL; tab: 4, 8, 24 mg; tab, orally disintegrating: 4, 8 mg] and mecamylamine.

6 months ago i not saying that marinol is ideal in this situation, i' m just wondering why a doctor would choose to prescribe fentanyl in large daily doses ; when the desired level of pain control has already been achieved with marinol.

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