Nabilone

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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

  1. abdominal pain
  2. abnormal dreams
  3. akathisia
  4. amblyopia
  5. anemia
  6. angioedema
  7. anhidrosis
  8. anorexia
  9. anxiety
  10. appetite stimulation
  11. asthenia
  12. ataxia
  13. back pain
  14. chest pain (unspecified)
  15. chills
  16. confusion
  17. constipation
  18. cough
  19. depression
  20. diarrhea
  21. dizziness
  22. drowsiness
  23. dyspepsia
  24. dysphoria
  25. dyspnea
  26. emotional lability
  27. epistaxis
  28. euphoria
  29. fatigue
  30. fever
  31. flushing
  32. gastritis
  33. hallucinations
  34. headache
  35. hot flashes
  36. hyperactivity
  37. hyperhidrosis
  38. hypertension
  39. hypotension
  40. hypotonia
  41. impaired cognition
  42. increased urinary frequency
  43. infection
  44. insomnia
  45. irritability
  46. leukopenia
  47. malaise
  48. mydriasis
  49. nasal congestion
  50. nausea
  51. ocular irritation
  52. oral ulceration
  53. orthostatic hypotension
  54. palpitations
  55. paranoia
  56. paresthesias
  57. pharyngitis
  58. photophobia
  59. photosensitivity
  60. pruritus
  61. psychosis
  62. rash
  63. seizures
  64. sinus tachycardia
  65. syncope
  66. tinnitus
  67. tremor
  68. urinary retention
  69. vertigo
  70. vomiting
  71. wheezing
  72. xerophthalmia
  73. 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

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