Nabilone is a synthetic cannabinoid, a medication manufactured to mimic compounds in the cannabis plant. Sold under brand names like Cesamet, it is prescribed for a specific purpose. The U.S. Food and Drug Administration (FDA) has approved its use for treating severe nausea and vomiting from cancer chemotherapy when patients have not found relief from conventional anti-nausea medications. The drug is taken orally in capsule form.
Medical Applications of Nabilone
The primary application for nabilone is managing chemotherapy-induced nausea and vomiting (CINV). It is considered a second-line treatment, prescribed after standard antiemetic therapies have proven insufficient. This provides an alternative for patients undergoing difficult cancer treatments.
Nabilone is also used for conditions not officially listed in its FDA indication, a practice known as off-label prescribing. It has been used as an adjunctive therapy for chronic pain management, particularly for neuropathic pain. Studies have explored its use for relieving symptoms of fibromyalgia and multiple sclerosis, with some reviews indicating modest effectiveness.
Other off-label applications include:
- Appetite stimulation, as it has been observed to increase caloric intake in cancer patients.
- Managing anorexia and weight loss associated with other chronic illnesses.
- Treating nightmares associated with post-traumatic stress disorder (PTSD).
- Addressing medication overuse headaches.
Mechanism of Action
Nabilone functions by interacting with the body’s endocannabinoid system (ECS), a network of cell-signaling receptors that helps regulate processes like mood, pain sensation, and the vomiting reflex. Nabilone is a synthetic molecule designed to be structurally similar to delta-9-tetrahydrocannabinol (THC), the main psychoactive component of cannabis.
The medication works by binding to and activating cannabinoid receptors, specifically CB1 and CB2. CB1 receptors are highly concentrated in the brain and central nervous system in areas that control nausea and vomiting. By activating these sites, nabilone helps suppress the emetic reflex.
This interaction with the ECS also influences the release of neurotransmitters like serotonin and dopamine, contributing to its effects on mood and pain perception. Its engagement with CB2 receptors, found more in the peripheral nervous system and immune cells, is thought to contribute to its analgesic properties.
Potential Side Effects and Precautions
Nabilone can cause a range of side effects, many affecting the central nervous system. The most frequently reported adverse effects include drowsiness, dizziness, dry mouth, and difficulty with coordination (ataxia). Some individuals may also experience psychological effects such as euphoria (intense happiness) or dysphoria (unease or dissatisfaction).
Less common but more serious side effects can occur, including confusion, disorientation, hallucinations, anxiety, or paranoia. In some instances, patients may experience a psychotic episode, even at lower doses. Due to these potential effects on mental state, nabilone is prescribed with caution, and prescriptions may be limited to the amount needed for a single chemotherapy cycle.
Precautions are necessary when taking this medication. Due to its effects on coordination and alertness, patients are advised against driving, operating heavy machinery, or performing other hazardous tasks. Combining nabilone with alcohol or other central nervous system depressants, like certain pain relievers or sedatives, should be avoided. The medication is not recommended for individuals with a history of psychiatric disorders.
Nabilone Compared to Medical Marijuana
Nabilone and medical marijuana have several distinctions, primarily in their source and composition. Nabilone is a synthetic, single-molecule drug manufactured in a controlled laboratory setting. In contrast, medical marijuana is a plant-based substance from the Cannabis sativa plant, which contains hundreds of different compounds.
Nabilone contains only one active ingredient that mimics THC. Marijuana, however, contains a complex mixture of cannabinoids, including THC and cannabidiol (CBD), as well as other compounds called terpenes. Some researchers believe these compounds work together to produce therapeutic outcomes, a concept known as the “entourage effect.”
Regulation and dosing also set them apart. Nabilone is a federally approved prescription medication, meaning its production is standardized, and each capsule contains a precise, consistent dose. In contrast, the legal status, quality control, potency, and dosage of medical marijuana can vary significantly depending on state and local regulations, leading to less consistency for patients.