Dronabinol shows promise in reducing agitation in Alzheimer's patients

In a study led by the Johns Hopkins University School of Medicine and Tufts University School of Medicine, researchers show that a pill form of the drug dronabinol, an FDA-approved synthetic version of marijuana's main ingredient, THC, reduces agitation in patients with Alzheimer's by an average of 30%.

The researchers say that compared to current treatments for agitation, such as antipsychotics, dronabinol produced similar calming effects without adverse results such as delirium or seizures.

Results of the eight-year clinical trial were presented at the International Psychogeriatric Association conference in Buenos Aires, Argentina, on Sept. 26.

Paul Rosenberg, M.D., professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine and co-principal investigator for this studyThese new findings represent eight years of work dedicated to people who have Alzheimer's as well as their caregivers. Agitation is one of the most distressing symptoms of Alzheimer's dementia, and we are pleased to make positive strides forward in treatment of these patients."

Although mild agitation can sometimes be moderated by behavioral intervention, in moderate to severe cases, some form of medication is typically required to manage symptoms and provide relief for caregivers."It is the agitation, not the memory loss, that often drives individuals with dementia to the emergency department and long-term-care facilities," says Brent Forester, M.D., psychiatrist-in-chief and chairman of the Department of Psychiatry at Tufts Medical Center and co-principal investigator on the study. "Dronabinol has the potential to both reduce health care costs and make an important, positive impact on caregivers' mental and physical health."

In the new study, researchers recruited 75 patients with severe Alzheimer's agitation across five clinical sites, including 35 admitted to The Johns Hopkins Hospital between March 2017 and May 2024. To qualify, patients had to have a formal clinical diagnosis of Alzheimer's disease and show at least one major symptom of agitation for at least two weeks. Prior to treatment, patients were tested for agitation using the Pittsburgh Agitation Scale (PAS) and the Neuropsychiatric Inventory Agitation/Aggression subscale (NPI-C).

The PAS scores agitation from 0 to 4, with 4 being the most agitated. The NPI-C provides a brief assessment of neuropsychiatric symptoms including delusions, hallucinations, anxiety/depression and other factors. Baseline scores were acquired from caregivers at the onset of the trial.

Participants were then randomly selected to get either 5 milligrams of dronabinol in pill form or a placebo in pill form twice daily for three weeks, and then retested using the PAS and NPI-C.

The researchers say they plan longer-term studies of dronabinol for Alzheimer's disease, as well as expanded sample sizes. They also hope to continue to explore other ways medical cannabis can benefit both patients and caregivers.

Dronabinol is a synthetic form of THC, the psychoactive main ingredient in cannabis (marijuana). The drug was approved by the U.S. Food and Drug Administration in 1985 to treat loss of appetite in patients with HIV/AIDS, and is currently prescribed to treat nausea and vomiting in those undergoing cancer chemotherapy.

The investigators caution that their current study results are not intended to encourage or inform the use of other forms of medical marijuana available in 38 states and the District of Columbia.

Co-investigators include Halima Amjad, Haroon Burhanullah and Milap Nowrangi at the Johns Hopkins University School of Medicine, Marc Agronin at Miami Jewish Health, and James Wilkins and David Harper at McLean Hospital.

Source:

Johns Hopkins Medicine