Drug Interaction:
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
Indication:
Prevention of nausea /vomiting associated with chemotherapy
Adverse Reaction:
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
Contra-Indications:
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.
Dosages/ Overdosage Etc:
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
Patient Information:
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
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
Ref - USP PDI Vol II 17th Edition (1997)
1.Allergies-
Tell your doctor if you have ever had any unusual or allergic reaction to
Nabilon. Also tell your healthcare care professional if you are allergic to
any other substances such as foods. preservatives or dyes.
2.Pregnancy-
Studies have not been done in pregnant woman.ns. However, Nabilone has not
shown to cause birth defects or other problems in studies in rabbits and rats
given many times the highest human daily dose
3. Breast-feeding-
It is known whether Nabilone passes into breast milk. However, nabilone is
not recommended during breast feeding.
4.Children-
Studies of this medicine has been done only in adult patients and there is
no specific information comparing use of nabilone in children with use in
other age groups.
5.Older adults-
Fast or pounding heartbeat, feeling faint or lightheaded, and unusual tiredeness
or weakness may be especially to occur in elderly patents who are more sensitive
than younger adults
6. Other medicines-
Tell your doctor if you are using any of the following -
CNS depresants or
Tricyclic antidepresants - taking these medicines with nabilone may increase
the CNS depressant effects
7. Other medical problems-
Make sure you tell your doctor if you have any other medical problems
especially-
Alcohol abuse or
Drug abuse - dependence on nabilone may develop.
Heart disease or
Low blood pressure or
Maniac depression or
Schizophrenia - nabilone may make the condition worse
Liver disease- higher blood levels of nabilone may occur,
increasing the chance of side effects
Pharmacology/ Pharmacokinetics:
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 and lactation:
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.
