Dronabinol Is Not a Game Changer in Pediatric Palliative Care: Results from a Retrospective Study

Area of Science:

• Pediatric palliative care
• Neuropharmacology
• Cannabinoid therapeutics

Background:

• Patients with life-limiting conditions (LLCs) experience symptoms such as restlessness, spasticity, pain, and seizures.
• Dronabinol (DRB), a cannabinoid, may offer relief, but data in pediatric inpatients with LLCs are scarce.
• This study aimed to evaluate the efficacy and safety of DRB in this population.

Purpose of the Study:

• To assess the effectiveness of Dronabinol (DRB) in managing symptoms in pediatric inpatients with life-limiting conditions (LLCs).
• To evaluate the safety profile of Dronabinol (DRB) in this vulnerable patient group.
• To compare DRB efficacy when initiated during hospitalization versus prior use.

Main Methods:

• Retrospective analysis of inpatient data from 2011 to 2021.
• Inclusion of 63 pediatric patients with LLCs treated with DRB, predominantly those with neurological diseases.
• Comparison of patients initiating DRB during the study period versus those already on DRB upon admission.

Main Results:

• Subjective improvements in spasticity (47.6%) and restlessness (27%) were reported, but objective measures showed no reduction in seizures or restlessness.
• Effective DRB doses differed between newly initiated patients (0.21 mg/kg/BW/day) and those with pre-existing treatment (0.48 mg/kg/BW/day).
• Severe side effects, including respiratory depression, occurred in three patients, with fatigue and behavioral issues also reported.

Conclusions:

• Subjective benefits of Dronabinol (DRB) in pediatric inpatients with LLCs were not consistently supported by objective data.
• The potential for severe adverse events necessitates careful monitoring and clear indications for DRB use.
• Initiation of DRB should occur in a controlled, monitored setting for pediatric patients with life-limiting conditions.