Dr Sharon Rees @reesprescribe
Day 1: Identification of the psychoactive substance in cannabis (THC) in the 1960s led to analogue development to harness the therapeutic effects. #nabilone was produced in 1980s, but was not available in Europe until mid 2000s. UK use was further delayed until legal changes in 2018
Dr Sharon Rees @reesprescribe
Day 2: An orally active synthetic cannabinoid, #nabilone is licensed in adults for 2nd line nausea & vomiting related to cytotoxic chemotherapy. It is an abusable substance & a Schedule 2 controlled drug. Dosing 1-2mg × 2-3/day during treatment cycle, usually as in-pt. Off-label use as appetite stimulant
Dr Sharon Rees @reesprescribe
Day 3: Good oral absorption/high 1st pass metabolism; cmax 2hrs. Metabolised in liver via direct oxidation (main) & CYP450 reduction. Active metabolite carbinol forms quickly & has extended activity. Major excretion route faeces;25% urine; avoid in severe hepatic impairment. T½ 2-35 hrs
Dr Sharon Rees @reesprescribe
Day 4: Twice as active as tetrahydrocannabinol (THC), #nabilone acts on endogenous cannabinoid system as an agonist at the CB1 receptor in the central nervous system. The mechanism for regulation of the emetic pathway & increased appetite remain unknown
Dr Sharon Rees @reesprescribe
Day 5: #nabilone has a caution if history of psychiatric disorders & in the elderly. Impairs psycho-motor function:care driving. Common ADEs include drowsiness, vertigo, euphoria, dry mouth, depression, visual disturbance. Frequency is unknown for psychosis. Rapid tolerance to CNS effects occurs. NOT exhaustive
Dr Sharon Rees @reesprescribe
Day 6: #nabilone has synergistic effects with other CNS suppressing drugs including alcohol. ‘Severe’ DDIs only with (lis)dexamfetamine. Caution is because of increased risk of cardiovascular effects e.g tachycardia. NOT exhaustive
Dr Sharon Rees @reesprescribe
Day 7: Interest in cannabinoid products continues to grow as the potential range of therapeutic effects is disclosed with more research. Uses being investigated for #nabilone include chronic pain, insomnia, dyskinesia, chronic anxiety & PTSD
Earn Your CPD Certificate
With the help of Prescribing and Therapeutics Training Ltd and the Journal of Prescribing Practice, you can earn your 1-hour CPD certificate
In addition to the tweets, read the BNF monograph on nabilone and the related treatment summary on nausea and labyrinth disorders. Another useful source is the Summary of Product Characteristics for nabilone – see links below. Once you have completed this, answer the 10 questions. Submit your answers to reesprescribe@gmail.com. If you answer at least eight out of 10 questions correctly, you will receive your CPD certificate via email.