Nabilone, a synthetic
cannabinoid, is approved in many countries including, but not limited to, Canada, the United States, Mexico, and the United Kingdom for the treatment of severe
nausea and
vomiting associated with
chemotherapy. Clinical evidence is emerging for its use in managing
pain conditions with different etiologies. We review the efficacy and safety of
nabilone for various types of
pain as well as its abuse potential, precautions and
contraindications, and drug interactions; summarize pertinent clinical practice guidelines; and provide recommendations for dosing, monitoring, and patient education. Citations involving
nabilone were identified through systematic reviews evaluating
cannabinoids for
pain. A systematic search (updated July 23, 2015) of the Ovid MEDLINE, EMBASE, PubMed, and Cochrane Library databases was performed. Eight randomized controlled trials, two prospective cohort trials, and one retrospective chart review were retrieved.
Cancer pain, chronic noncancer
pain, neuropathic pain,
fibromyalgia, and
pain associated with spasticity were the
pain conditions evaluated.
Nabilone was most commonly used as adjunctive
therapy and led to small but significant reductions in
pain. The most common
adverse drug reactions included euphoria, drowsiness, and
dizziness.
Nabilone was rarely associated with severe
adverse drug reactions requiring
drug discontinuation, and the likelihood of abuse was thought to be low. Although the optimal role of
nabilone in the management of
pain is yet to be determined, certain clinical practice guidelines consider
nabilone as a third-line agent.