||This article needs more medical references for verification or relies too heavily on primary sources. (January 2014)|
Bottom: Space-filling model of (R,R)-(−)-nabilone
|Systematic (IUPAC) name|
|Trade names||Cesamet, Canemes|
|By mouth (capsules)|
|Bioavailability||20% after first-pass by the liver|
|Protein binding||similar to THC (±97%)|
|Biological half-life||2 hours, with metabolites around 35 hours|
|ATC code||A04AD11 (WHO)|
|Molar mass||372.541 g/mol|
Nabilone is a synthetic cannabinoid with therapeutic use as an antiemetic and as an adjunct analgesic for neuropathic pain. It mimics tetrahydrocannabinol (THC), the primary psychoactive compound found naturally occurring in Cannabis.
In Canada, the United States, the United Kingdom and Mexico, nabilone is marketed as Cesamet. It was approved in 1985 by the U.S. Food and Drug Administration (FDA) for treatment of chemotherapy-induced nausea and vomiting (CINV) that has not responded to conventional antiemetics. Though it was approved by the FDA in 1985, the drug only began marketing in the United States in 2006. In Austria Nabilone is marketed as Canemes and got its approval for CINV in 2013.
Although it does not have any indication officially (except in Mexico), nabilone is widely used as an adjunct therapy for chronic pain management. Numerous trials and case studies have demonstrated modest effectiveness for relieving fibromyalgia and multiple sclerosis.
Nabilone has shown modest effectiveness in relieving fibromyalgia. A 2011 systematic review of cannabinoids for chronic pain determined there was evidence of safety and modest efficacy for some conditions.
The main settings that have seen published clinical trials of nabilone include movement disorders such as parkinsonism, chronic pain, dystonia and spasticity neurological disorders, multiple sclerosis, and the nausea of cancer chemotherapy. Nabilone is also effective in the treatment of inflammatory bowel disease, especially ulcerative colitis. Medical cannabis patients report that nabilone is more similar in effect to cannabidiol (CBD) than tetrahydrocannabinol (THC), indicating that it has more of a therapeutic effect on the body than a "high" effect on the mind.
A study comparing nabilone with metoclopramide, conducted before the development of modern 5-HT3 antagonist anti-emetics such as ondansetron, revealed that patients taking cisplatin chemotherapy preferred metoclopramide, while patients taking carboplatin preferred nabilone to control nausea and vomiting.
Nabilone is also occasionally used for the adjuvant treatment of severe anxiety.[medical citation needed]
Nabilone is sometimes used for nightmares in PTSD, but there have not been studies longer than nine weeks, so effects of longer term use are not known. Nabilone has also been used for medication overuse headache.
Nabilone is given in 1 or 2 mg doses multiple times a day up to a total of 6 mg. It is completely absorbed from oral administration and highly plasma protein bound. Multiple P450 enzymes extensively metabolize nabilone to various metabolites that have not been fully characterized.
Nabilone can increase—rather than decrease—post-operative pain. In the treatment of fibromyalgia, adverse effects limits the useful dose. Adverse effects of nabilone include, but are not limited to: dizziness/vertigo, euphoria, drowsiness, dry mouth, ataxia, sleep disturbance, dysphoria, headache, nausea, disorientation, depersonalization, asthenia.
- Sativex — a prescription-only medication, sold in various countries worldwide, which contains both tetrahydrocannabinol (THC) and cannabidiol (CBD)
- "How to use Cesamet". Artek LLC. 2008.
- "Canemes (nabilone)" (PDF).
- Fine PG, Rosenfeld MJ (2013). "The endocannabinoid system, cannabinoids, and pain". Rambam Maimonides Med J (Review). 4 (4): e0022. doi:10.5041/RMMJ.10129. PMC . PMID 24228165.
- [non-primary source needed]Wissel J, et al. (2006). "Low dose treatment with the synthetic cannabinoid Nabilone significantly reduces spasticity-related pain : a double-blind placebo-controlled cross-over trial". J Neurol. (Research article). 253 (10): 1337–41. doi:10.1007/s00415-006-0218-8. PMID 16988792.
- "Cannabinoids for treatment of chronic non-cancer pain; a systematic review of randomized trials". Br J Clin Pharmacol. 72: 735–44. Nov 2011. doi:10.1111/j.1365-2125.2011.03970.x. PMC . PMID 21426373.
- [non-primary source needed]Cunningham D, et al. (1988). "A randomized trial of oral nabilone and prochlorperazine compared to intravenous metoclopramide and dexamethasone in the treatment of nausea and vomiting induced by chemotherapy regimens containing cisplatin or cisplatin analogues". Eur J Cancer Clin Oncol (Randomized controlled trial). 24 (4): 685–9. doi:10.1016/0277-5379(88)90300-8. PMID 2838294.
- Canadian Agency for Drugs and Technologies in Health (Oct 2015). "Long-term Nabilone Use: A Review of the Clinical Effectiveness and Safety". CADTH Rapid Response Reports. PMID 26561692. Retrieved 19 November 2015.
- Pini, Luigi Alberto; Guerzoni, Simona; Cainazzo, Maria Michela; Ferrari, Anna; Sarchielli, Paola; Tiraferri, Ilaria; Ciccarese, Michela; Zappaterra, Maurizio (2012-11-01). "Nabilone for the treatment of medication overuse headache: results of a preliminary double-blind, active-controlled, randomized trial". The Journal of Headache and Pain. 13 (8): 677–684. doi:10.1007/s10194-012-0490-1. ISSN 1129-2377. PMC . PMID 23070400.
- "Cesamet (nabilone) Prescribing Information" (PDF). http://www.cesamet.com/pdf/Cesamet_PI_50_count.pdf. Meda Pharmaceuticals Inc. Retrieved 16 July 2014. External link in