Nabilone, a synthetic cannabinoid approved for chemotherapy-induced nausea, works through a unique mechanism and may be particularly useful for "delayed" nausea that other antiemetics fail to control.
Readers interested in medical cannabinoids for nausea, especially in cancer treatment.
Nabilone works through a mechanism distinct from all other available antiemetic drug classes
What the researchers found
The review examined nabilone's pharmacology and clinical trial evidence for treating chemotherapy-induced nausea and vomiting (CINV). Nabilone is a single-entity synthetic cannabinoid receptor agonist with a mechanism of action distinct from existing antiemetics like 5-HT3 antagonists, NK1 antagonists, and dopamine antagonists.
Existing preventive therapies for CINV are often inadequate, particularly for delayed nausea and vomiting that occurs hours to days after chemotherapy. Nabilone's unique cannabinoid receptor-mediated mechanism makes it a valuable addition to the antiemetic toolkit, especially when standard agents fall short.
The authors note that cannabinoid antiemetics may have been underutilized historically due to the stigma and legal status of marijuana, despite nabilone being a single synthetic compound unrelated to botanical cannabis.
Why it matters
Chemotherapy-induced nausea remains one of the most feared side effects of cancer treatment and can cause patients to delay or refuse life-saving chemotherapy. Having additional effective antiemetics, particularly for delayed nausea that resists conventional treatments, directly affects cancer treatment outcomes and patient quality of life.
The numbers in context
Marijuana contains nearly 500 components. Nabilone is a single-entity synthetic cannabinoid. CINV affects the majority of patients on certain chemotherapy regimens. Existing antiemetic classes include 5-HT3 antagonists, dopamine receptor antagonists, NK1 receptor antagonists, antimuscarinic anticholinergics, and antihistamines.
How the study worked
Narrative review of nabilone's basic pharmacology, mechanism of action, and clinical trial data for prophylaxis and treatment of CINV.
What this study cannot tell us
Narrative review without systematic search methodology. The clinical trial data reviewed was not assessed for risk of bias. Side effects including psychoactive effects (drowsiness, dizziness, euphoria, dysphoria) are present with nabilone, though the review emphasizes efficacy over adverse effects. Direct comparison data with newer antiemetics is limited.
How to read the evidence
Moderate evidence from a narrative review summarizing existing clinical trial data and pharmacological research on an approved medication.
When this study was published
Published in 2017. Nabilone has been approved since the 1980s.
The bigger picture
The medical use of cannabinoids for nausea was one of the earliest therapeutic applications to gain mainstream acceptance. Nabilone represents the pharmaceutical approach: a standardized, single-compound drug that can be prescribed and dosed precisely, sidestepping the variability and psychoactive complexity of botanical cannabis while retaining the antiemetic benefits of cannabinoid receptor activation.
Questions still open
- How does nabilone compare to newer NK1 receptor antagonists for delayed CINV? Could combination therapy with nabilone and standard antiemetics improve outcomes? Why has nabilone remained underutilized despite decades of availability?
Common questions
Is nabilone the same as marijuana?
Why is nabilone not used more often for chemo nausea?
Read the original research
Concise review of the management of iatrogenic emesis using cannabinoids: emphasis on nabilone for chemotherapy-induced nausea and vomiting.
Cancer chemotherapy and pharmacology, 79(3), 467-477
Citation
Pergolizzi, Joseph V; Taylor, Robert; LeQuang, Jo Ann; Zampogna, Gianpietro; Raffa, Robert B. (2017). Concise review of the management of iatrogenic emesis using cannabinoids: emphasis on nabilone for chemotherapy-induced nausea and vomiting.. Cancer chemotherapy and pharmacology, 79(3), 467-477. https://doi.org/10.1007/s00280-017-3257-1
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