Nabilone Capsules: Guide To Uses, Dosage & Side Effects

Nabilone is a synthetic cannabinoid medication specifically indicated for the treatment of severe nausea and vomiting associated with cancer chemotherapy in patients who do not respond adequately to conventional antiemetic therapies.

About Nabilone Capsules

Nabilone, available as capsules (brand name Cesamet® in some regions), belongs to a class of drugs known as synthetic cannabinoids. It mimics the effects of natural cannabinoids in the body to block substances that trigger nausea and vomiting, particularly those induced by chemotherapeutic agents. Unlike cannabis-derived products, nabilone is a precisely engineered pharmaceutical for medical use, approved by regulatory bodies like the FDA for adult patients only, as safety in children under 18 has not been established.

The medication is taken orally with water, typically starting before chemotherapy to prevent symptoms. It is not a first-line treatment but reserved for cases where standard antiemetics fail, due to its potential for psychoactive side effects. Nabilone acts primarily through partial agonism at cannabinoid receptors CB1 and CB2 in the central nervous system, inhibiting the emetic response at multiple points in the body’s control systems. Peak plasma levels occur about 2 hours after dosing, with complete absorption from the gastrointestinal tract.

Clinically, nabilone has demonstrated significant antiemetic activity in patients undergoing treatment for malignant neoplasms, though its exact mechanism remains under study, involving interactions beyond simple receptor binding. It is excreted mainly via the biliary route, necessitating caution in patients with severe liver dysfunction.

Before Taking Nabilone

Consult your doctor before starting nabilone if you have any medical conditions or take other medications. Key considerations include:

• Contraindications: Avoid if allergic to cannabinoids or if nausea/vomiting is not from cancer chemotherapy.
• Liver Issues: Not recommended for severe liver dysfunction due to biliary excretion.
• Heart Conditions: Use caution in hypertension, heart disease, or elderly patients, as it can cause tachycardia and postural hypotension.
• Psychiatric History: Caution in those with schizophrenia, manic-depressive illness, or prior psychiatric disorders, due to risk of mood changes, hallucinations, or psychosis.
• Drug Interactions: Additive CNS depression with alcohol, barbiturates, narcotics, diazepam, or other psychoactive drugs.
• Pregnancy/Breastfeeding: Limited data; weigh risks as it may affect fetal development or pass into breast milk.

Inform your healthcare provider of all medications, including over-the-counter drugs and supplements. Nabilone is a Schedule II controlled substance with abuse potential, so prescriptions are limited to single chemotherapy cycles.

How to Take Nabilone

Follow your doctor’s instructions precisely. Nabilone capsules are usually 1 mg each, taken orally with water, spaced evenly apart.

Dosage is individualized, often based on body surface area. Administer the first dose 1-3 hours prior to chemotherapy, with subsequent doses every 8-12 hours. Reduce dose if side effects occur, and observe closely, preferably in an inpatient setting for first-time users. Do not exceed prescribed amounts, and complete the full course only as directed for the chemotherapy cycle.

Tip: Take with food if stomach upset occurs, but consistency aids absorption.

Possible Side Effects of Nabilone

Like all medications, nabilone can cause side effects, many related to its CNS effects. Most are dose-related and tolerance develops quickly to effects like drowsiness and euphoria.

Common Side Effects

• Drowsiness (most frequent)
• Vertigo/dizziness
• Euphoria or ‘high’
• Dry mouth
• Ataxia (loss of coordination)
• Visual disturbances
• Concentration difficulties
• Sleep disturbances
• Dysphoria
• Hypotension
• Headache
• Nausea (ironically, in some cases)

Serious Side Effects

• Psychotomimetic reactions: confusion, hallucinations, psychosis, depression
• Cardiovascular: tachycardia, postural hypotension
• Neurological: tremors, decreased coordination
• Other: decreased appetite, abdominal pain

Report severe symptoms like chest pain, severe dizziness, or psychiatric changes immediately. Effects usually resolve within 72 hours upon discontinuation.

How to Cope with Side Effects of Nabilone

• Drowsiness/Dizziness: Avoid driving or operating machinery; rest until effects subside.
• Dry Mouth: Sip water, use sugar-free lozenges.
• Euphoria/Psychoactive Effects: Stay in a calm environment; inform caregiver.
• Hypotension: Rise slowly from sitting/lying positions.
• Concentration Issues: Avoid complex tasks during peak effect (2 hours post-dose).

Tolerance to many effects develops rapidly and reverses upon stopping. If intolerable, your doctor may lower the dose or switch therapies.

Precautions While Taking Nabilone

Patients should be monitored closely, especially novices, due to unpredictable responses even in experienced users. Key precautions:

• Do not drive or use heavy machinery.
• Avoid alcohol and other CNS depressants.
• Monitor blood pressure and heart rate.
• Limit prescriptions to chemotherapy cycle needs to prevent abuse.
• Physical dependence is unknown, but no withdrawal seen in short trials.

Pregnancy and Breastfeeding

Safety in pregnancy is not established; animal studies suggest potential risks. Use only if benefits outweigh risks. It may pass into breast milk, so breastfeeding is not recommended during treatment.

Other Medicines and Nabilone

Nabilone interacts with CNS depressants, enhancing sedation. Notable combinations:

No significant P450 interference at therapeutic doses. Always disclose full medication list.

Common Questions About Nabilone

Is nabilone addictive?

Nabilone has abuse potential due to euphoria at therapeutic doses but showed no withdrawal in short trials. Limit to necessary amounts.

Does nabilone get you high?

Yes, it can cause euphoria or psychoactive effects, which is why monitoring is essential.

How long do effects last?

Peak at 2 hours; mental status changes resolve within 72 hours.

Can children take it?

No, not recommended under 18; safety unestablished.

What if I miss a dose?

Take as soon as remembered unless near next dose; do not double up.

Overdose and Management

Overdose symptoms extend psychotomimetic effects: psychosis, hallucinations, anxiety, respiratory depression. No cases over 10 mg/day reported in trials. Manage conservatively with support; antipsychotics if severe, but untested. Activated charcoal may help; monitor vitals. Dialysis ineffective.

Storing Nabilone

Store at room temperature, away from moisture and heat. Keep out of reach of children. Dispose unused medication properly.

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Medha Deb is an editor with a master's degree in Applied Linguistics from the University of Hyderabad. She believes that her qualification has helped her develop a deep understanding of language and its application in various contexts.

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