Nabilone

(nab-uh-lone)

Trade/other name(s): Cesamet

Why would this drug be used?

This drug is used in preventing and controlling nausea and vomiting from cancer treatment, such as chemotherapy, that is not controlled by other anti-nausea medicines. It is also being tested as a possible additive drug for controlling pain.

How does this drug work?

Nabilone is part of a general class of drugs called cannabinoids used to treat and prevent nausea and vomiting after chemotherapy. Exactly how it works is unknown.

Before taking this medicine

Tell your doctor…

• If you are allergic to anything, including medicines, dyes, additives, or foods, or if you have ever reacted badly to marijuana.
• If you have any medical conditions such as kidney disease, liver disease (including hepatitis), diabetes, gout, heart disease, or infections.
• If you have heart disease, congestive heart failure, high blood pressure, or low blood pressure. This drug can speed up the heart, and in combination with certain other drugs, it may raise blood pressure (see "Interactions" section.)
• If you take any blood pressure medicines or have ever fainted. This drug may lower your blood pressure, which could be dangerous if it is already low, or if it is affected by other medicines.
• If you have ever had emotional problems or mental illness, such as depression, anxiety, panic attacks, bipolar disorder, or schizophrenia. This drug can cause symptoms similar to some of these, and may worsen existing problems.
• If you have trouble with addiction, alcohol or drug abuse now or have had one in the past. Nabilone can be habit forming, especially for those who have had problems before.
• If any family members have or have had an addiction or drug problem. This can also make you more likely to have problems with addiction.
• If you are pregnant, trying to get pregnant, or if there is any chance of pregnancy. It is not known if this drug can cause birth defects if the male or female is taking it at the time of conception or during pregnancy. Men and women who are taking this drug need to use some kind of birth control. It is important to check with your doctor about what kinds of birth control can be used with this medicine.
• If you are breast-feeding. It is not known whether this drug passes into breast milk, although similar drugs (cannabinoids) do. If the drug does pass into breast milk, it could harm the baby.
• About any other prescription or over-the-counter medicines you are taking, including vitamins and herbs. In fact, keeping a written list of each of these medicines (including the doses of each and when you take them) with you in case of emergency may help prevent complications if you get sick.

Interactions with other drugs

This medicine may cause drowsiness and dizziness, and change your perception of reality, which can affect activities such as driving. Other substances that can impair the brain can increase these side effects if used during treatment with nabilone, such as:

• anti-anxiety drugs, sedatives, or "nerve pills" such as diazepam (Valium), lorazepam (Ativan) alprazolam (Xanax), triazolam (Halcion)
• muscle relaxers (for muscle spasms and some types of back pain)
• antihistamines (allergy drugs)
• opioid pain medicines such as morphine or codeine
• anti-seizure medicines such as phenobarbital
• sleeping pills such as secobarbital, temazepam (Restoril), or flurazepam (Dalmane)
• alcohol

Barbiturate drugs can build up in the body if nabilone is in the system and cause these effects to last longer.

These drugs can seriously raise the heart rate and blood pressure if used with nabilone:

• amphetamines or stimulants such as dextroamphetamine (Dexedrine) or methylphenidate (Ritalin) and others
• tricyclic antidepressants such as amitriptyline (Elavil), nortriptyline (Pamelor), desipramine (Norpramin), doxepin (Sinequan), and others)

Check with your doctor or nurse about whether other medicines, vitamins, herbs, and supplements can cause problems with this medicine.

Interactions with foods

Do not drink alcohol while taking nabilone. Otherwise, no serious interactions with food are known at this time. Check with your doctor, nurse, or pharmacist about whether foods may be a problem.

Tell all the doctors, dentists, nurses, and pharmacists you visit that you are taking this drug.

How is this drug taken or given?

When taken to control or prevent nausea from chemotherapy, a capsule is usually taken from 1 to 3 hours before the chemotherapy is scheduled. Sometimes, a dose may be taken 12 hours after chemotherapy. The medicine is usually taken twice a day, and may be used until 2 days after the last dose of chemotherapy if needed to control the nausea. The doctor may increase the dose if smaller amounts do not work. The doctor may also prescribe it to be taken 3 times a day if needed to control symptoms.

Take this drug exactly as directed by your doctor. If you do not understand the instructions, ask your doctor or nurse to explain them to you.

Keep the medicine in a tightly closed container away from heat and moisture and out of the reach of children and pets. Do not allow others to share your medicines.

Precautions

This medicine can cause drowsiness and lightheadedness. Do not drive, operate machinery, or perform other activities that require alertness and good judgment while taking this medicine. These symptoms may be worse in older people.

Be careful getting up, changing position, or walking. This drug may cause low blood pressure, which can make you feel dizzy or faint. Get up slowly and hold onto something or someone to keep you steady. Let your doctor know if this problem persists.

Nabilone can also distort your perceptions and sense of reality, which can impair your judgment. Have a responsible adult with you for a few days after starting nabilone, and after any increase in dose, until you have adjusted to the medicine.

Since nabilone affects the central nervous system, it is important not to take other drugs or substances that slow down the brain or nervous system such as alcohol, sedatives, muscle relaxers, and sleeping pills unless your doctor tells you to do so.

Nabilone can also produce psychological dependence, which can lead to addiction. Some signs of psychological dependence are a strong desire to keep taking the medicine and wanting more or larger doses of the medicine. Talk with your doctor if you think this is happening to you.

Talk with your doctor or nurse before you change medicines or start new medicines while taking this drug.

Call your doctor or nurse right away if you notice dizziness, confusion, fainting, seeing or hearing things that aren’t there, or other serious side effects. These effects can last for up to 2 or 3 days after the last dose.

If you have trouble passing urine, call your doctor.

Possible side effects

You will probably not have most of the following side effects, but if you have any talk to your doctor or nurse. They can help you understand the side effects and cope with them.

Common

• dry mouth
• clumsiness
• drowsiness*
• unsteady walking*
• muddled thinking, trouble concentrating, and poor memory while taking the drug
• mood changes (anxiety, depression, paranoia, euphoria, apathy, and more)
• feeling like you are moving when you are not (vertigo)

Less common

• rapid heartbeat
• feeling "high"
• disturbed sleep

Rare

• dizziness*
• low blood pressure
• fainting*
• seizures
• headache
• confusion*
• blurred vision
• trouble urinating*
• poor appetite
• nausea
• increased appetite
• altered perceptions and awareness of reality*
• seeing or hearing things that aren't there (hallucinations)*

*See "Precautions" section for more detailed information.

Other side effects not listed above can also occur in some patients. Tell your doctor or nurse if you develop these or any other problems.

FDA approval

Yes – first approved in 2007.

Disclaimer: This information does not cover all possible uses, actions, precautions, side effects, or interactions. It is not intended as medical advice, and should not be relied upon as a substitute for talking with your doctor, who is familiar with your medical needs.