Nabilone
Cannabinoids (medical antiemetics and appetite stimulants)
Cannabinoids (medical antiemetics and appetite stimulants)
A synthetic oral cannabinoid, related to THC, for chemotherapy nausea and vomiting that other antiemetics have not controlled.
Quick facts
- Group
- Cannabinoids (medical antiemetics and appetite stimulants)
- Target
- Cannabinoid receptor 1 (CB1)
- Used for
- Nausea and vomiting caused
- Key effects
- Drowsiness · Dry mouth · Feeling 'high'
- Monitor
- Mood · Heart rate and blood pressure · Signs of misuse
- ATC
- A04AD11
No doses: the clinician sets them by the current guideline.
Mechanism of action
No structure of nabilone bound to CB1 exists; the figure shows AM11542, a synthetic agonist built on the same THC-like scaffold, in the orthosteric pocket of the human CB1 receptor.
Nabilone is a synthetic cannabinoid with a structure close to delta-9-tetrahydrocannabinol (THC). It activates CB1 receptors in the brainstem vomiting centre and related areas, which reduces nausea and vomiting. The same CB1 action in the cortex and limbic system explains the 'high', drowsiness, dizziness and mood changes, and its potential for misuse.
- Activates CB1 cannabinoid receptors
- Damps the brainstem vomiting centre
- Less chemotherapy-induced nausea and vomiting
- CB1 in cortex: drowsiness, 'high', mood change
Indications
- Nausea and vomiting caused by cancer chemotherapy, when usual antiemetics have not worked
Adverse effects
Common
- Drowsiness, dizziness, unsteady walking
- Dry mouth
- Feeling 'high', trouble concentrating
- Headache, appetite change, sleep problems
- Dizziness on standing
Contraindications
- Hypersensitivity to nabilone or other cannabinoids
- Used with great caution in a personal or family history of psychosis, bipolar disorder or depression, or substance misuse
Key interactions
- Alcohol, sedatives and sedating antihistamines (for example diphenhydramine)
- More drowsiness and impaired judgement.
- Drugs that speed the heart or raise blood pressure
- Added tachycardia; caution in heart disease or hypertension.
What is monitored
- Mood, perception and behaviour
- Heart rate and blood pressure, including on standing
- Signs of misuse
Administration and safety
- Oral capsule taken during a chemotherapy cycle, beginning before the first dose.
- Given under supervision, especially at first: mood and thinking can change.
- No alcohol; no driving or dangerous tasks during and for several days after treatment.
Pregnancy and breastfeeding
Information on use in pregnancy is limited; a pregnancy during treatment is reported to the prescriber.
Nursing care
- Before: ask about psychiatric illness, substance use and heart disease.
- During: watch for confusion, hallucinations or low mood; keep the patient safe from falls.
- Check pulse and standing blood pressure; teach to rise slowly.
- Keep the supply secure because it can be misused.
Pharmacokinetics
- Absorption
- Oral capsule.
- Onset and duration
- Started before the first chemotherapy dose and continued for a short time after the cycle.
Test yourself
Think of the answer, then tap the question to see it.
On which receptor does nabilone act to stop vomiting?
The CB1 cannabinoid receptor.
When is nabilone used for chemotherapy nausea?
When standard antiemetics have not controlled it.
Which psychiatric histories call for caution with nabilone?
Any two of psychosis (schizophrenia), bipolar disorder, depression or substance misuse.
Connections
← Back to the class: Cannabinoids (medical antiemetics and appetite stimulants)
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: Nabilone: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2016); Crystal structure of the human CB1 in complex with agonist AM11542 (RCSB Protein Data Bank, 2017); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).
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Representative model, for educational purposes only.