Nabilone — Drug Monograph

Brand names: Cesamet

Drug class: Supportive Care Agent

Mechanism of Action

Synthetic cannabinoid analogue of Δ9-THC. CB1 and CB2 receptor agonist. Centrally suppresses the vomiting reflex via brainstem CB1 activation. Approximately 2–10 times more potent than dronabinol on a milligram basis. Has a slightly different side-effect and psychoactive profile than dronabinol.

FDA Indications

• Nausea and vomiting associated with cancer chemotherapy in patients who have failed to respond adequately to conventional antiemetic treatments

Common Side Effects

• Drowsiness/sedation
• Vertigo/dizziness
• Euphoria or dysphoria
• Ataxia
• Dry mouth
• Concentration difficulty
• Headache

Clinical Pearl

Nabilone is the more potent and more regulated synthetic cannabinoid (Schedule II vs. Schedule III for dronabinol). It is generally reserved for patients who failed dronabinol or for whom dronabinol was unavailable. The psychiatric adverse effects (paranoia, perceptual disturbances) are more prominent than with dronabinol in some patients, and the drug requires particularly careful psychiatric prescreening. In palliative care settings, the appetite stimulation and anxiolytic effects may also…

Related Therapies & Mechanisms

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• Defibrotide (Defitelio) — Supportive Care Agent