Nabilone for Chemotherapy-Induced Nausea and Vomiting and Other Indications

Primary FDA-Approved Indication: Chemotherapy-Induced Nausea and Vomiting

• The American Society of Clinical Oncology (ASCO) guidelines recommend either dronabinol or nabilone for breakthrough and refractory CINV, with moderate certainty of evidence for nabilone 1
• ASCO guidelines rate nabilone with moderate certainty of evidence for improving sleep in patients with chronic cancer pain 1
• Nabilone may be considered when sleep disturbances are related to chronic pain conditions, according to ASCO guidelines with moderate certainty of evidence 1
• There is low certainty evidence that nabilone is not recommended for appetite stimulation or cachexia as primary indication, as stated by ASCO guidelines 1
• Insufficient evidence to recommend nabilone for anxiety, depression, or quality of life as primary outcomes, with very low to low certainty evidence, as per ASCO guidelines 1

Nabilone Treatment Guidelines

Primary Indication

• The American Society of Clinical Oncology (ASCO) recommends either dronabinol or nabilone for rescue and refractory chemotherapy-induced nausea and vomiting (CINV) 2, 3

Clinical Considerations for Use

• When a cannabinoid is chosen for rescue and refractory CINV, the American Society of Clinical Oncology (ASCO) recommends either dronabinol or nabilone, with nabilone being a viable option for patients who have failed conventional antiemetic therapy 2, 3

Secondary Uses

• Nabilone may be beneficial for refractory cases of non-chemotherapy related nausea and vomiting, although it is not FDA-approved for this indication 4

Nabilone Indications for Chemotherapy-Induced Nausea and Vomiting

Primary FDA-Approved Indication

• The American Society of Clinical Oncology (ASCO) guidelines recommend nabilone (or dronabinol) specifically for rescue and refractory chemotherapy-induced nausea and vomiting (CINV) when first-line antiemetics have failed, with moderate certainty of evidence 5
• Nabilone should NOT be used as first-line prophylaxis for CINV—standard regimens with 5-HT3 antagonists, NK1 antagonists, and dexamethasone remain the primary approach for moderate and high-emetogenic chemotherapy 6

Clinical Pitfalls to Avoid

• The American Society of Clinical Oncology (ASCO) states that nabilone is not recommended for appetite stimulation or cachexia as a primary indication, with low certainty evidence showing no benefit on weight or appetite outcomes, and evidence is insufficient to recommend nabilone for nausea and vomiting unrelated to chemotherapy, or for prevention of radiotherapy-induced nausea and vomiting 5
• Medical marijuana cannot be substituted for FDA-approved nabilone due to lack of precisely defined doses and schedules, with insufficient evidence supporting this substitution 5, 6