Cannabis has been used medically for its antiemetic, sedative, and analgesic effects and for its ability to stimulate appetite. The major psychoactive ingredient of cannabis is delta-9-tetrahydrocannabinol (THC). Nabilone is a synthetic cannabinoid analog of THC and is approved for use in Canada for the treatment of severe nausea and vomiting associated with chemotherapy in adults over the age of 18 years. For its approved indication, nabilone (1 mg to 2 mg) is used short-term, administered the night before and one to three hours prior to chemotherapy and can be continued up to 24 hours following chemotherapy. A systematic review of randomized controlled trials (RCTs) found that 70% of patients undergoing chemotherapy who received cannabinoids had complete control of nausea compared to 57% of placebo patients (RR 1.21; 95% CI 1.03 to 1.42). As well, 66% of patients had complete control of vomiting with cannabinoids compared to 36% of patients treated with placebo (RR 1.84; 95% CI 1.42 to 2.38).

Nabilone exerts its therapeutic effect by acting as an agonist at the CB1 cannabinoid receptor, a receptor that has a role in the regulation of nausea and vomiting, appetite, movement, and pain. As such, nabilone has the potential to be used ‘off-label’ for a number of conditions, for example, in the management of nausea and vomiting attributed to factors other than chemotherapy. In addition, the appetite stimulating properties of cannabinoids have been used to manage problematic or excessive weight loss secondary to medical conditions, such as AIDS and cancers. This report will review the evidence of clinical effectiveness and safety of nabilone when used for the treatment of non-chemotherapy related nausea and vomiting and to manage weight loss attributed to medical conditions.

Contents

• CONTEXT AND POLICY ISSUES
• RESEARCH QUESTIONS
• KEY FINDINGS
• METHODS
  • Literature Search Strategy
  • Selection Criteria and Methods
  • Exclusion Criteria
  • Critical Appraisal of Individual Studies
• SUMMARY OF EVIDENCE
  • Quantity of Research Available
  • Summary of Study Characteristics
  • Summary of Critical Appraisal
  • Summary of Findings
  • Limitations
• CONCLUSIONS AND IMPLICATIONS FOR DECISION OR POLICY MAKING
• REFERENCES
• APPENDIX 1 Selection of Included Studies
• APPENDIX 2 Summary of Individual Study Characteristics
• APPENDIX 3 Summary of Critical Appraisal
• APPENDIX 4 Results

Disclaimer: The Rapid Response Service is an information service for those involved in planning and providing health care in Canada. Rapid responses are based on a limited literature search and are not comprehensive, systematic reviews. The intent is to provide a list of sources and a summary of the best evidence on the topic that CADTH could identify using all reasonable efforts within the time allowed. Rapid responses should be considered along with other types of information and health care considerations. The information included in this response is not intended to replace professional medical advice, nor should it be construed as a recommendation for or against the use of a particular health technology. Readers are also cautioned that a lack of good quality evidence does not necessarily mean a lack of effectiveness particularly in the case of new and emerging health technologies, for which little information can be found, but which may in future prove to be effective. While CADTH has taken care in the preparation of the report to ensure that its contents are accurate, complete and up to date, CADTH does not make any guarantee to that effect. CADTH is not liable for any loss or damages resulting from use of the information in the report.