Drug interactions- summary-

+ Cannabinoids

Amphetamines, cocaine, other sympathomimetics agents + cannabinoids/
Cannabinoids + amphetamines, cocaine, other sympathomimetics agents-
additive hypertension ,tachcardia, and cardiotoxicity may occur

Antihistamines, atropine, scopalamine, other anticholenergic agents + cannabinoids/
Cannabinoids + antihistamine, atropine, scopalamine, other anticholenergic agents -
additive or super-additive tachycardia, or drowsiness may occur

Barbiturates, benzodiazepines, buspirone, ethanol, lithium, muscle relaxants, opioids,
other CNS depressants + cannabinoids /
 Cannabinoids + Barbiturates, benzodiazepines,
 buspirone, ethanol, lithium, muscle relaxants, opioids,other CNS depressants-
additive drowsiness and CNS depressant effects .psychomotor functions impaired

Natrexone + cannabinoids-
oral THC effects enhanced by opioids receptor blockade

Opioids+ cannabinoids/Cannabinoids + Opioids-
cross tolerance and mutual potentation occur

Tricyclic antidepressants eg amitriptyline, amoxapine + Cannbinoids/
Cannabinoids + tricylic antidepressants eg amitriptylene, amoxapine-
active tachycardia,hypertension or drowsiness occur

Cannabinoids + antipyrine. barbiturates -
decreased clearance of amitriptyline and barbiturates, presumbly via
competitive inhibition of metabolism

Cannabinoids + disulfram -
reversible hypomaniac reaction was reported

Cannabinoids + theophylline-
increased theophylline metabolism reported with smoking marijuana,
effect similar to smoking tobacco

Prevention of nausea /vomiting associated with chemotherapy
 

Adverse reactions-

CNS-     ataxia    125     drowsiness  50%   dysphoria   8%  euphoria   10%
              headache  5%     sleep disturbances  10%     vertigo   50%

GI -      dry mouth    35%     nausea  4%

Dermatologic -    allergic reactions,  photosensitivity , pruritus, rash

Musculoskeletal -   back pain, joint pain, muscle pain, neck pain

Respiratory -   chest pain, cough, dry nose, dry throat, nasal congestion

Special senses -   ear tightness, equillibrium dysfunction, eye disoder,  eye dryness,
                                eye irritation, eye swelling, vision disturbances

Miscellaneous-    anemia, bacterial infection, chills, excessive sweating, fever, thirst

Histoy of hypersensitivity with cannabinoids

Special precautions-

Duration of effects- effects of nabilone may persist for avariable and unpredictable time.

CNS effects- nabilolne hasthe potential to affect the CNS and might manifest itself in
dizziness, drowsiness, euphoria, ataxia, anxiety, disoreintation, hallucinations
and psychosis

Cardiovascular effects- nabilone can cause tachycardia, and orthostatic hypotension

Close supervision- patients should remain under the supervision of a responsible adult,
especially during the initial use of nabilone and during dose adjustments

Special risk- carefully evaluate benefits/risk ratio of nabilone use in patients with the
following medical conditions  because of individual variance in response and tolerance-

 - Nabilone can elevate supine and standing heart rate and cause postural hypotension.
   Use it with caution in elderly and in patients with hypertension or heart disease

 - Use Nabilone  with caution in patients with current or previous psychotic disorders  
  eg, bladder disorder, depression, schizophrenia, because symptoms of these diseases
  may be unmasked by the use of cannabinoids

- Use nabilone with caution in patients with a history of substance abuse, including alcohol
   abuse or dependentce on marijauna use

Drug abuse- long term use of nabilone has been associated with disoders of motivation

Dependence- physical dependence capacity of nabilone is unknown

Hazardous tasks- Warn patients receiving nabilone that should not operate machinery or drive
vehicles.

Pregnancy- use during pregnancy only if needed

Lactation- it is not  recommended that nabilone should be given to breasr feeding mothers

Children- safety and efficacy on patients younger than 18 years have not been established

Elderly- caution in dose to excercised, Start elderly patients on a low dose.
 
 

Indiation-
Prevention of nausea /vomiting associated with chemotherapy

Dosage-
Adults - 1 or 2mg twice a day. On day of chemotherapy the initial dose should be given
1 to 3 hours before chemotherapeutic agent is administered
A dose 1 or 2mg the night before may be useful

Maximum dose recommended-  6mg given  divided doses 3 times daily

1. Nabilone has the potential for additive CNS depression. Alert patients not to                 consume alcohol or  take other depressants such as benzodizepines while on              Nabilone treatment

2. Alert patients not drive or operate hazarous machinery which require mental                altrness while on  treatment

3. Make patients aware of possible changes in mood and other adverse behaviour                      effects of the  drug so as to avoid panic in case such manifestations

4.Tell patients to remain under the supervision of responsible adult while using nabilone

Pharmacology-
Nabilone is an orally active synthetic cannobinoid that like other cannabinoids has complex
effects on CNS systems. it is suggested that the antiemetic effect of nabilone is caused by
nteraction of cannabinoid receptor system ( the CB1 receptor ) which has been discovered
in neutral tissues 

Pregnancy-
Use during pregnancy only if needed

Lactation-
It is not  recommended that nabilone should be given to breasr feeding mothers

Children-
Safety and efficacy on patients younger than 18 years have not been established

Elderly-
Caution in dose to excercised, Start elderly patients on a low dose.