Home Drug Guide Nabilone

Drug Guide

Generic Name

Nabilone

Brand Names Cesamet

Classification

Therapeutic: Antiemetic, Anesthetic

Pharmacological: Synthetic cannabinoid

FDA Approved Indications

Chemotherapy-induced nausea and vomiting in patients who have not responded to conventional antiemetics

Mechanism of Action

Nabilone is a synthetic cannabinoid that acts on cannabinoid receptors in the brain and central nervous system, primarily CB1 receptors, to exert antiemetic and appetite-stimulating effects.

Dosage and Administration

Adult: Typically, 1-2 mg orally 1-3 times daily as needed. Dose may be increased cautiously by 1 mg increments to a maximum of 6 mg per day.

Pediatric: Not approved for use in children.

Geriatric: Use with caution; monitor for CNS side effects and consider lower starting doses.

Renal Impairment: Adjust dosing based on clinical response and tolerability.

Hepatic Impairment: Use with caution; no specific dosage adjustments established.

Pharmacokinetics

Absorption: Absorbed well from gastrointestinal tract, with peak plasma concentrations approximately 1-3 hours after oral administration.

Distribution: Widely distributed to tissues, crossing the blood-brain barrier.

Metabolism: Primarily metabolized in the liver via glucuronidation and possibly pathways involving CYP enzymes.

Excretion: Excreted mainly in feces and urine.

Half Life: Approximately 2.5 to 5 hours.

Contraindications

Hypersensitivity to nabilone or other cannabinoids.
Pregnancy and lactation due to potential harm.

Precautions

Cautious use in patients with a history of psychiatric disorders, cardiovascular disease, or substance abuse.

Adverse Reactions - Common

Dizziness (Common)
Euphoria (Common)
Somnolence (Common)
Dry mouth (Common)

Adverse Reactions - Serious

Psychosis or hallucinations (Uncommon)
Ventricular tachycardia or other cardiac arrhythmias (Uncommon)
Severe psychiatric disturbances (Rare)

Drug-Drug Interactions

CNS depressants (enhanced sedation)
Anticholinergic agents (increased adverse anticholinergic effects)

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor for CNS effects, psychiatric symptoms, blood pressure, and cardiac status.

Diagnoses:

Risk for CNS depression
Risk for psychiatric adverse effects

Implementation: Administer with food or milk to minimize nausea. Instruct patients to avoid operating machinery.

Evaluation: Assess effectiveness in controlling nausea, monitor for adverse side effects.

Patient/Family Teaching

Use as directed, do not increase dosage on your own.
Report any unusual mental changes or adverse reactions.
Avoid alcohol and other CNS depressants during therapy.

Special Considerations

Black Box Warnings:

Potential for severe psychiatric adverse effects, including hallucinations, psychosis, and panic reactions.

Genetic Factors: Pharmacogenetic considerations are limited.

Lab Test Interference: No significant interference with standard laboratory tests reported.

Overdose Management

Signs/Symptoms: Severe CNS depression, hallucinations, agitation, tachycardia, hypotension.

Treatment: Supportive care, ensure airway patency, administered activated charcoal if ingestion is recent, and manage symptoms accordingly.

Storage and Handling

Storage: Store at room temperature (20°C to 25°C), protected from light and moisture.

Stability: Stable under proper storage conditions for specified shelf life.