NABILONE

NABILONE
(nab'i-lone)
Cesamet
Classifications: synthetic cannabinoid; antiemetic;
Therapeutic:antiemetic
; cannabinoid
Pregnancy Category: C
Controlled Substance: Schedule II

Availability

1 mg capsules

Action

Nabilone is a synthetic cannabinoid with multiple effects on the CNS. It is thought that the antiemetic effect results from its interaction with the cannabinoid receptor system (CB 1 receptor) in neural tissues. In therapeutic doses, it produces relaxation, drowsiness, and euphoria.

Therapeutic Effect

It effectively controls emesis in patients receiving chemotherapy when other drugs have failed.

Uses

Prevention and treatment of nausea and vomiting in adult patients induced by cancer chemotherapy refractory to standard antiemetic therapy.

Contraindications

Hypersensitivity to any cannabinoid; hypovolemia; pregnancy (category C); lactation.

Cautious Use

Children; older adults; history of psychosis.

Route & Dosage

Nausea and Vomiting
Adult: PO Initial dose of 1 or 2 mg b.i.d. 1–3 h before chemotherapy. May increase to max of 2 mg t.i.d. May continue for 48 h after last dose of chemotherapy.

Administration

Oral
  • Give 1–3 h before chemotherapy is begun. A dose of 1–2 mg the night before chemotherapy may be helpful in relieving nausea.
  • Store at 15°–30° C (59°–86° F).

Adverse Effects (≥1%)

CNS: Asthenia, ataxia, confusion difficulties, depersonalization, depression, disorientation, drowsiness, dysphoria, euphoria, headache, sedation, sleep disturbance, vertigo. CV: Hypotension. GI: Anorexia, dry mouth, increased appetite, nausea. Special Senses: Visual disturbances.

Interactions

Drug: sedatives, hypnotics, and other psychoactive substances can potentiate the CNS effects of nabilone. Coadministration of cannabinoids with amphetamine, cocaine, tricyclic antidepressants, and/or sympathomimetic agents can produce additive hypertension and tachycardia. Coadministration of cannabinoids with antihistamines or anticholinergic agents can produce additive tachycardia and drowsiness. Coadministration of cannabinoids with barbiturates, benzodiazepines, buspirone, ethanol, lithium, muscle relaxants, opioids, and other cns depressants can produce additive drowsiness and CNS-depressant effects. Food: Alcohol can potentiate the CNS effects of nabilone.

Pharmacokinetics

Absorption: Complete absorption from GI tract. Peak: 2 h. Metabolism: Extensive hepatic metabolism. Elimination: Fecal (major) and urine. Half-Life: 2 h.

Nursing Implications

Assessment & Drug Effects

  • Monitor for and report S&S of adverse psychiatric reactions (e.g., disorientation, hallucinations, psychosis) for 48–72 h after last dose of nabilone.
  • Monitor for S&S of tachycardia and postural hypotension, especially in the older adult and those with a history of heart disease or hypertension.
  • Lab tests: Periodic CBC with Hgb & Hct.

Patient & Family Education

  • Do not use alcohol or other CNS depressants while using this medication.
  • Do not drive or engage in potentially hazardous activities until response to drug is known.
  • Report any of the following to a health care provider: confusion, disorientation, hallucinations, or other bizarre behavior.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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