Dosing and uses of Cesamet (nabilone)
Adult dosage forms and strengths
capsule: Schedule II
- 1mg
Chemotherapy-Induced Nausea/Vomiting
1-2 mg PO q8-12hr
Renal Impairment
Dose adjustment not necessary
Administration
Give 1-3 hours before chemotherapy
May give one dose the night before chemotherapy
May continue 24 hours after chemotherapy
No more than 6 mg/day
Pediatric dosage forms and strengths
capsule: Schedule II
- 1mg
Chemotherapy-Induced Nausea/Vomiting (Off-label)
>4 years
- <18 kg: 0.5 mg PO q12hr
- 18-30 kg: 1 mg PO q12hr
- >30 kg: 1 mg PO q8hr
Geriatric dosage forms and strengths
Chemotherapy-induced nausea/vomiting
1-2 mg PO q8-12hr; not to exceed 6 mg divided q8hr
Cesamet (nabilone) adverse (side) effects
>10%
Vertigo (52%)
Drowsiness (52%)
Dry mouth (36%)
Ataxia (14%)
Visual disturbance (13%)
Blurred vision (12.8%)
Concentration difficulties (12%)
Euphoria (11%)
Sleep disturbance (11%)
1-10%
Depersonalization
Disorientation
Dysphoria
Headache
Hypotension
Nausea
Warnings
Contraindications
Hypersensitivity to cannabinoids
History of psychotic reactions
Cautions
Severe liver impairment
Give only to patients in whom conventional antiemetics have failed
Emotionally disturbed patients (non-psychotic)
Concomitant use of alcohol or other psychoactive substances can potentiate psychotropic effects
May cause tachycardia and orthostatic hypotension
May impair ability to drive or perform hazardous tasks
Pregnancy and lactation
Pregnancy category: C
Lactation: not recommended
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Cesamet (nabilone)
Mechanism of action
Cannabinoid antiemetic may act in the central nervous system by acting on cannabinoid receptors
Pharmacokinetics
Excretion: Feces (65%; primarily bile); urine (20%)
Half-life elimination: 2 hr (parent compound); 35 hr (metabolites)
Peak plasma time: 2 hr
Distribution: 12.5 L/kg
Metabolism: Direct enzymatic oxidation and possibly CYP450 enzymes
