Nurses Compass
Drug Guide
Nabilone
Classification
Therapeutic: Antiemetic, Anesthetic
Pharmacological: Synthetic cannabinoid
FDA Approved Indications
- Chemotherapy-induced nausea and vomiting in patients who have not responded to conventional antiemetics
Mechanism of Action
Nabilone is a synthetic cannabinoid that acts on cannabinoid receptors in the brain and central nervous system, primarily CB1 receptors, to exert antiemetic and appetite-stimulating effects.
Dosage and Administration
Adult: Typically, 1-2 mg orally 1-3 times daily as needed. Dose may be increased cautiously by 1 mg increments to a maximum of 6 mg per day.
Pediatric: Not approved for use in children.
Geriatric: Use with caution; monitor for CNS side effects and consider lower starting doses.
Renal Impairment: Adjust dosing based on clinical response and tolerability.
Hepatic Impairment: Use with caution; no specific dosage adjustments established.
Pharmacokinetics
Absorption: Absorbed well from gastrointestinal tract, with peak plasma concentrations approximately 1-3 hours after oral administration.
Distribution: Widely distributed to tissues, crossing the blood-brain barrier.
Metabolism: Primarily metabolized in the liver via glucuronidation and possibly pathways involving CYP enzymes.
Excretion: Excreted mainly in feces and urine.
Half Life: Approximately 2.5 to 5 hours.
Contraindications
- Hypersensitivity to nabilone or other cannabinoids.
- Pregnancy and lactation due to potential harm.
Precautions
- Cautious use in patients with a history of psychiatric disorders, cardiovascular disease, or substance abuse.
Adverse Reactions - Common
- Dizziness (Common)
- Euphoria (Common)
- Somnolence (Common)
- Dry mouth (Common)
Adverse Reactions - Serious
- Psychosis or hallucinations (Uncommon)
- Ventricular tachycardia or other cardiac arrhythmias (Uncommon)
- Severe psychiatric disturbances (Rare)
Drug-Drug Interactions
- CNS depressants (enhanced sedation)
- Anticholinergic agents (increased adverse anticholinergic effects)
Drug-Food Interactions
N/ADrug-Herb Interactions
N/ANursing Implications
Assessment: Monitor for CNS effects, psychiatric symptoms, blood pressure, and cardiac status.
Diagnoses:
- Risk for CNS depression
- Risk for psychiatric adverse effects
Implementation: Administer with food or milk to minimize nausea. Instruct patients to avoid operating machinery.
Evaluation: Assess effectiveness in controlling nausea, monitor for adverse side effects.
Patient/Family Teaching
- Use as directed, do not increase dosage on your own.
- Report any unusual mental changes or adverse reactions.
- Avoid alcohol and other CNS depressants during therapy.
Special Considerations
Black Box Warnings:
- Potential for severe psychiatric adverse effects, including hallucinations, psychosis, and panic reactions.
Genetic Factors: Pharmacogenetic considerations are limited.
Lab Test Interference: No significant interference with standard laboratory tests reported.
Overdose Management
Signs/Symptoms: Severe CNS depression, hallucinations, agitation, tachycardia, hypotension.
Treatment: Supportive care, ensure airway patency, administered activated charcoal if ingestion is recent, and manage symptoms accordingly.
Storage and Handling
Storage: Store at room temperature (20°C to 25°C), protected from light and moisture.
Stability: Stable under proper storage conditions for specified shelf life.