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Synthetic cannabinoid Pregnancy: Use during pregnancy is not recommended — no or very limited experience in pregnant women and animal studies have shown reproductive toxicity. Breastfeeding should be discontinued during treatment and for 7 days after the end of treatment.

Nabilone

Brand names: Cesamet

Nabilone is a synthetic cannabinoid licensed for the management of nausea and vomiting caused by cytotoxic chemotherapy that is unresponsive to conventional antiemetics.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 1 mg or 2 mg twice a day (usual adult dosage). To minimise side-effects it is recommended that the lower starting dose is used and that the dose is increased as necessary
Route: Oral
Frequency: Twice a day
Max: The maximum daily dose should not exceed 6 mg, given in three divided doses
For administration to adults only. The first dose should be administered the evening before initiation of chemotherapy, and the second dose should be given one to three hours before the first dose of the oncolytic agent is administered. May be administered throughout each cycle of chemotherapy and, if necessary, for 48 hours after the last dose of each cycle. Data on chronic use are not available; prescriptions should be limited to the necessary duration (a few days) during chemotherapy (§4.8). Patients should be closely observed, if possible within an inpatient setting, especially when naive to cannabinoids. Elderly: insufficient clinical trial data in patients aged 65 years and older — select dose with caution. Hepatic impairment: no data available, use with caution; use in severe liver impairment is not recommended. Renal impairment: no data available, use with caution. Children and adolescents under 18 years: safety and efficacy have not been established, no data available, and use is not recommended.

Dose adjustments

Renal

No data available in renal impairment — use with caution; no studies have been conducted in patients with renal impairment.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • Known allergy to cannabinoid agents
  • Nausea and vomiting arising from any cause other than cancer chemotherapy
  • Patients with mental illnesses, including manic-depressive illness and depression, should not use nabilone (§4.4)

Side effects

  • Somnolence / drowsiness, ataxia and headache (common)
  • Euphoric mood, sleep disorder and dysphoria (common)
  • Vertigo / dizziness and visual impairment (common)
  • Hypotension (common); tachycardia (rare)
  • Dry mouth and nausea (common)

Interactions

  • Other psychoactive drugs and CNS depressants, including alcohol, barbiturates and narcotic analgesics — administer with caution; nabilone has an additive CNS depressant effect when given with diazepam, secobarbitone sodium, alcohol or codeine
  • Benzodiazepines, lithium, opioids, buspirone, muscle relaxants and other CNS depressants
  • Amphetamines, cocaine and other sympathomimetics
  • Atropine, scopolamine, antihistamines and other anticholinergics
  • Amitriptyline, amoxapine, desipramine and other tricyclic antidepressants
  • Disulfiram, fluoxetine, phenazone, theophylline, naltrexone and alcohol

Clinical monograph

How it works

As a synthetic analogue of tetrahydrocannabinol it acts as an agonist at central cannabinoid receptors, modulating pathways involved in the emetic reflex.

Prescribing in practice

  • It commonly causes marked central nervous system effects including drowsiness, dizziness and psychiatric disturbances, so patients must avoid driving and operating machinery.
  • It is a controlled drug and should be used cautiously in patients with a history of psychiatric illness.
  • Use with caution alongside other CNS depressants and in patients with cardiovascular disease.

Monitoring

Monitor for psychiatric and central nervous system adverse effects, postural hypotension and tachycardia, particularly during initial treatment.

Counselling the patient

  • Warn patients that mood changes and disorientation can occur and may persist for some time after the last dose.
  • Advise patients not to drive, operate machinery or drink alcohol while taking it.

Evidence & guidelines

Nabilone's licensed role is limited to chemotherapy-induced nausea and vomiting refractory to standard antiemetics, as reflected in its SPC.

Reference: NICE TA313; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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