marinol

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    Have any of you ever seen marinol prescribed as an appetite stimulant in an elderly Alzheimer's patient? It's a first for me and I am having a probelm finding specific info on the drug as it pertains to anyone but advanced AIDS pts and pts on chemo...Our pt is new to us from an AL and we don't have a great deal of history-don't know how long she has been on marinol or exactly who ordered it-we know it ain't working-her mouth is so DRY and she won't eat more then 2 or 3 bites of food a day...she also seems to be having a paradoxical effect-she is so hyper.....She has only been with us for a few days and the charge nurse and her staff doc won't touch her meds until she is seen by our psych...I can understand giving her time to adjust before rocking her boat...but marinol? She is in her mid 90's.....She acts like she is on a bad trip-paranoid to boot...it's a shame.....
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    Hmm. We have used megace and another med (smelt like ETOH) . I have also had a res put on low dose steroid for appetite..
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    While Marinol is usually employed to control nausea & vomiting for patients on chemo, I have seen it prescribed for appetite stimulation, dosage at 2.5 mg po bid ac lunch & dinner. As you may know "grass" or "pot" often gives users the "munchies". Since Marinol's basic ingredient is dronabinol (a component of marijuana) the appetite stimulant aspect is readily recognized.

    Noted, however, is your reference to the patient's dry mouth. This is often a symptom of overdosage along with euphoria, hallucinations, mood disturbances, paranoia, etc. It would seem that, from your description of the patient's appetite, the drug is not achieving its intended usage.
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    Mid-90's, end stage Alzheimer's....perhaps she's not eating because it's time for her not to eat so much. I've never seen Marinol used in someone that old and never have seen it work all that well. We use Remeron as an appetite stimulant, but only if the family is pushing. Mostly I just give them whatever it is they will eat even if it's 3 bowls of ice cream and nothing else....and,yes, I had a nurse question me once why I "let" the woman eat her ice cream because she hadn't finished her vegetables!
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    I have seen and used it several times in the elderly to appieite stimulant. If it is going to work for the resident it does well. Not all states will allow it useage in this manner for the elderly.
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    We had one resident on marinol and ritalin at the same time. Still had no appetite and since they were both dc'd she is eating a little better.

    Ya can't stop eating, ya know!!
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    I'm seeing marinol prescribed for those with anorexia. I'm not seeing it written for those with dementia. (In my job I see medical records on tens of thousands of people a year, hence the odd patient population).
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    [QUOTE=CapeCodMermaid]Mid-90's, end stage Alzheimer's....perhaps she's not eating because it's time for her not to eat so much. I've never seen Marinol used in someone that old and never have seen it work all that well. We use Remeron as an appetite stimulant, but only if the family is pushing. Mostly I just give them whatever it is they will eat even if it's 3 bowls of ice cream and nothing else....and,yes, I had a nurse question me once why I "let" the woman eat her ice cream because she hadn't finished her vegetables![/QUOTE ]Actually I would say she is in the mid-stages (early to mid) She is alert and ambulatory-continent of b&b and can do her adl's with set up and verbal cuing and is very delusional,impulsive and needy...I found out today that there is more to her story-She was living out of state with and elderly sister until her care overwhelmed the sister and she was then placed in assisted living locally...I can imagine how bad it was at her sister's house-her children have NO idea what she is like...none at all....According to the AL she was confused and wandering but suddenly really became much worse-ended up in a psych unit and then came to our facility...The marinol was started at the psych unit....I am on the same page as you as far as appetite goes when you are talking about end-stage dementia----we have the most problems with un-realistic loved ones,don't we? It's all moot-she was going out for a psych vacation when I left today-I hope they can help her-she is one of my favorites...
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    Usually I see Megace or Remoron used. But I have had at least one pt we did use Marinol for appetite stimulant.


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