Nabilone

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.