A review of nabilone in the treatment of chemotherapy-induced nausea and vomiting

Mark A Ware, Paul Daeninck, Vincent Maida, Mark A Ware, Paul Daeninck, Vincent Maida

Abstract

Chemotherapy-induced nausea and vomiting (CINV) in cancer patients places a significant burden on patients' function and quality of life, their families and caregivers, and healthcare providers. Despite the advances in preventing CINV, a substantial proportion of patients experience persistent nausea and vomiting. Nabilone, a cannabinoid, recently received Food and Drug Administration approval for the treatment of the nausea and vomiting in patients receiving cancer chemotherapy who fail to achieve adequate relief from conventional treatments. The cannabinoids exert antiemetic effects via agonism of cannabinoid receptors (CB1 and CB2). Clinical trials have demonstrated the benefits of nabilone in cancer chemotherapy patients. Use of the agent is optimized with judicious dosing and selection of patients.

Keywords: chemotherapy-induced nausea/vomiting; nabilone; pain.

Figures

Figure 1
Figure 1
The mechanism of action of cannabinoids. The innate cannabinoid system inhibits release of neurotransmitters via a multi-step retrograde signaling pathway. Nabilone mimics the action of endocannabinoids via direct activation of CB1 receptors (derived from Croxford 2003; Freund et al 2003; Navari 2003; Piomelli 2003; Diana and Mart 2004). Abbreviations: THC, tetrahydrocannabinol.
Figure 2
Figure 2
a Nabilone reduces frequency of vomiting on chemotherapy days 1 through 5. Reproduced with permission from Einhorn LH, Nagy C, Furnas B, Williams SD. 1981. Nabilone: An effective antiemetic in patients receiving cancer chemotherapy. J Clin Pharmacol, 21(suppl):64–69. Copyright © 1981 SAGE Publications. b Nabilone significantly reduces the severity of nausea throughout the chemotherapy cycle. Reproduced with permission from Einhorn LH, Nagy C, Furnas B, Williams SD. 1981. Nabilone: An effective antiemetic in patients receiving cancer chemotherapy. J Clin Pharmacol, 21(suppl):64–69. Copyright © 1981 SAGE Publications. Grading of nausea: 1 = mild; 2 = moderate; 3 = severe.
Figure 2
Figure 2
a Nabilone reduces frequency of vomiting on chemotherapy days 1 through 5. Reproduced with permission from Einhorn LH, Nagy C, Furnas B, Williams SD. 1981. Nabilone: An effective antiemetic in patients receiving cancer chemotherapy. J Clin Pharmacol, 21(suppl):64–69. Copyright © 1981 SAGE Publications. b Nabilone significantly reduces the severity of nausea throughout the chemotherapy cycle. Reproduced with permission from Einhorn LH, Nagy C, Furnas B, Williams SD. 1981. Nabilone: An effective antiemetic in patients receiving cancer chemotherapy. J Clin Pharmacol, 21(suppl):64–69. Copyright © 1981 SAGE Publications. Grading of nausea: 1 = mild; 2 = moderate; 3 = severe.

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