Nabilone Brand Name– Cesamet
What is Nabilone
Nabilone is an orally administered synthetic cannabinoid that is approved for the treatment of refractory nausea and vomiting associated with chemotherapy in patients who failed to respond adequately to conventional antiemetic agents.
Nabilone is derived from cannabinol, a non-psychoactive chemical constituent of Cannabis sativa L. (marijuana), from which active delta-9-tetrahydrocannabinol (delta-9-THC) forms.
Chemically, nabilone is similar to delta-9-THC. Marijuana has been used for centuries as an herbal remedy and intoxicant.
Although the antiemetic effects of marijuana have been studied for years, crude marijuana contains approximately 480 substances and is not approved by the FDA for medical use.
Nabilone provides standardized THC concentrations without extraneous substances.
Data from randomized clinical trials show cannabinoids to be slightly better than historical agents for treating chemotherapy-induced emesis.
In a systematic review of chemotherapy-induced emesis trials, nabilone has been reported to be more effective than active comparators (e.g., alizapride, chlorpromazine, domperidone, and prochlorperazine) or placebo in all 16 trials evaluated.
Trials that assess patient preference have reported that the majority of patients prefer cannabinoid treatment over traditional comparative agents.
While more psychotoxic effects have been reported with the use of cannabinoids, patients may prefer cannabinoids due to the associated euphoric and sedative effects.
According to the American Society of Clinical Oncologists, 5-HT3 serotonin receptor antagonists, NKI receptor antagonists, and dexamethasone are considered first-line agents for chemotherapy-induced emesis.
Cannabinoids are reserved for patients who are intolerant or refractory to first-line therapy.
Cannabinoids such as nabilone may provide an alternative treatment option to dopamine antagonists, butyrophenones, and phenothiazines in refractory patients.
Indications
- chemotherapy-induced nausea/vomiting
- chemotherapy-induced nausea/vomiting prophylaxis
- Huntington’s Disease (Huntington’s Chorea)
For treatment of refractory chemotherapy-induced nausea/vomiting (CINV) and for chemotherapy-induced nausea/vomiting prophylaxis (CINV prophylaxis)
Side Effects
- abdominal pain
- abnormal dreams
- akathisia
- amblyopia
- anemia
- angioedema
- anhidrosis
- anorexia
- anxiety
- appetite stimulation
- asthenia
- ataxia
- back pain
- chest pain (unspecified)
- chills
- confusion
- constipation
- cough
- depression
- diarrhea
- dizziness
- drowsiness
- dyspepsia
- dysphoria
- dyspnea
- emotional lability
- epistaxis
- euphoria
- fatigue
- fever
- flushing
- gastritis
- hallucinations
- headache
- hot flashes
- hyperactivity
- hyperhidrosis
- hypertension
- hypotension
- hypotonia
- impaired cognition
- increased urinary frequency
- infection
- insomnia
- irritability
- leukopenia
- malaise
- mydriasis
- nasal congestion
- nausea
- ocular irritation
- oral ulceration
- orthostatic hypotension
- palpitations
- paranoia
- paresthesias
- pharyngitis
- photophobia
- photosensitivity
- pruritus
- psychosis
- rash
- seizures
- sinus tachycardia
- syncope
- tinnitus
- tremor
- urinary retention
- vertigo
- vomiting
- wheezing
- xerophthalmia
- xerostomia
Monitoring Parameters
- laboratory monitoring not necessary
Contraindications
- alcoholism
- bipolar disorder
- breast-feeding
- cardiac disease
- children
- coadministration with other CNS depressants
- depression
- driving or operating machinery
- ethanol ingestion
- geriatric
- hepatic disease
- hypertension
- infants
- mania
- neonates
- orthostatic hypotension
- pregnancy
- psychosis
- renal disease
- renal failure
- renal impairment
- schizophrenia
- substance abuse
- tachycardia
Interactions
- Acetaminophen; Dichloralphenazone; Isometheptene
- Acetaminophen; Tramadol
- Amitriptyline
- Amitriptyline; Chlordiazepoxide
- Amoxapine
- Anticholinergics
- Apomorphine
- Atropine; Difenoxin
- Atropine; Diphenoxylate
- atypical antipsychotic
- Barbiturates
- Benzodiazepines
- Bupropion; Naltrexone
- Buspirone
- Butyrophenone
- Cannabidiol
- Carbidopa; Levodopa
- Carbidopa; Levodopa; Entacapone
- Cenobamate
- Cetirizine
- Cetirizine; Pseudoephedrine
- Chlorpromazine
- Chlorthalidone; Clonidine
- Clobazam
- Clomipramine
- Clonidine
- Cocaine
- Codeine; Phenylephrine; Promethazine
- Codeine; Promethazine
- Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
- Desipramine
- Deutetrabenazine
- Dexmedetomidine
- Dextromethorphan; Promethazine
- Disulfiram
- Doxepin
- Dronabinol
- Entacapone
- Eszopiclone
- Ethanol
- Ezogabine
- Fenfluramine
- Flibanserin
- Fluoxetine
- Fluoxetine; Olanzapine
- Fluphenazine
- food
- Gabapentin
- General anesthetics
- Guanfacine
- Heterocyclic antidepressants
- Hydrochlorothiazide, HCTZ; Methyldopa
- Imipramine
- Lasmiditan
- Lemborexant
- Levocetirizine
- Levodopa
- Lithium
- Lofexidine
- Lopinavir; Ritonavir
- Maprotiline
- Melatonin
- Meperidine; Promethazine
- Meprobamate
- Mesoridazine
- Methocarbamol
- Methyldopa
- Metoclopramide
- Metyrapone
- Mirtazapine
- Molindone
- Monoamine oxidase inhibitors
- Naltrexone
- Nefazodone
- Nortriptyline
- Ombitasvir; Paritaprevir; Ritonavir
- Opiate Agonists
- Opiate Agonists-Antagonists
- Perampanel
- Perphenazine
- Perphenazine; Amitriptyline
- Phenothiazines
- Phenylephrine; Promethazine
- Pimavanserin
- Pimozide
- Pramipexole
- Pregabalin
- Prochlorperazine
- Promethazine
- Protriptyline
- Ramelteon
- Rasagiline
- Ritonavir
- Ropinirole
- Rotigotine
- Safinamide
- Sedating H1-blockers
- Selegiline
- Skeletal Muscle Relaxants
- Sodium Oxybate
- Solifenacin
- Suvorexant
- Sympathomimetics
- Tapentadol
- Tasimelteon
- Tetrabenazine
- Thalidomide
- Theophylline, Aminophylline
- Thiethylperazine
- Thioridazine
- Thiothixene
- Tizanidine
- Tolcapone
- Tramadol
- Trazodone
- Tricyclic antidepressants
- Trifluoperazine
- Trimethobenzamide
- Trimipramine
- Trospium
- Valerian, Valeriana officinalis
- Valproic Acid, Divalproex Sodium
- Vigabatrin
- Vilazodone
- Zaleplon
- Zolpidem
