Cesamet (Nabilone) - Oral

What Is Cesamet?

Cesamet (nabilone) is a Schedule II medication treatment option for chemotherapy-induced nausea and vomiting (CINV).

Cesamet is in the cannabinoid medication class. It's thought to work by interacting with the cannabinoid receptor (binding site) system in the brain.

Cesamet is available as prescription capsules.

What Is Cesamet Used For?

Cesamet is used to treat nausea and vomiting in people receiving chemotherapy.

A number of treatments and medications are available for cancer. Chemotherapy (chemo) is a possible option. Unfortunately, approximately 80% of people on chemo will experience nausea and vomiting. This side effect is also known as chemotherapy-induced nausea and vomiting (CINV).

CINV has different types, including:

• Acute: Acute CINV usually occurs within 24 hours of chemo treatment.
• Delayed: Delayed CINV typically happens after 24 hours of chemo treatment.
• Breakthrough: Breakthrough CINV might occur in some who have already taken preventative CINV medications.
• Refractory: After undergoing several chemo treatments, your CINV might become refractory (resistant) to your current medication regimen.

Experts don't typically recommend Cesamet as a first-choice option for CINV. Cesamet, however, is one of the second-line options for breakthrough CINV. If you experience breakthrough CINV, you'll likely try Zyprexa (olanzapine) first. If olanzapine isn't a viable option for you, then your healthcare provider might consider adding Cesamet to your current medication regimen.

Preventing and treating CINV is important to prevent the following:

• Negative impact on your quality of life
• Malnutrition from appetite loss
• Tears in your esophagus (tube that moves food from your mouth to the stomach)
• Bone fractures (breaks)

Some people are more likely to experience CINV than others. Possible risk factors may include:

• Being assigned female at birth
• Being younger in age
• Drinking little to no alcohol
• Experiencing anxiety or nervousness
• Going through chemotherapy in the past
• Having a history of morning sickness while pregnant
• Having a history of vomiting during an illness
• Possessing a history of motion sickness
  
  

How to Take Cesamet

The following is some general information about taking Cesamet:

• Cesamet is taken by mouth two to three times daily.
• Start Cesamet one to three hours before the first dose on day number one of your chemo treatment period. However, some people might benefit from starting Cesamet the night before instead.
• Take Cesamet up to 48 hours (two days) after the last chemo day of your chemotherapy treatment cycle.
  

Storage

When you receive Cesamet from the pharmacy, place the medication at room temperature at 77 degrees Fahrenheit (F)—with a short-term safety storage range between 59 degrees to 86 degrees F.

With Cesamet being a scheduled II controlled medication, consider using a locked cabinet or closet to keep your medication out of the reach of children and pets.

If you plan to travel with Cesamet, get familiar with your final destination's regulations. Checking with the U.S. embassy or consulate might be a helpful resource. In general, it's a good idea to make a copy of your Cesamet prescription and ask your healthcare provider for a letter of medical necessity. If possible, keep your medication in its original container from your pharmacy with your name on the label. If you have any questions about traveling with your medicine, be sure to ask your pharmacist or healthcare provider.

You can also ask your pharmacist or healthcare provider about the best ways to dispose of your medications. The FDA's website is a potentially helpful resource to know where and how to discard all unused and expired drugs. You can also find disposal boxes in your area.

Off-Label Uses

Cesamet doesn't currently have any off-label uses.

What Are the Side Effects of Cesamet?

This is not a complete list of side effects and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or a healthcare provider. You may report side effects to the FDA at fda.gov/medwatch or 800-FDA-1088.

Common Side Effects

Common side effects with Cesamet may include:

• Appetite changes
• Changes in mood
• Confusion
• Difficulties with concentration or focus
• Dizziness
• Drowsiness
• Dry mouth
• Headaches
• Nausea
• Sleeping problems
• Unsteady gait (walk)
• Weakness
  

Severe Side Effects

Get medical help right away if you develop any of the following serious side effects:

• Severe allergic reaction symptoms (e.g., itchiness, rash, swelling, breathing difficulties)
• Abnormal changes in mood or behavior
• Delusions
• Hallucinations
• Extremely low blood pressure
• Rapid heartbeat

Call 911 if your symptoms feel life-threatening.

Long-Term Side Effects

Cesamet isn't typically considered a long-term medication. It's usually only taken as early as the night before the first day of your chemo treatment and for two days after the last chemo day of your chemotherapy treatment cycle.

This medication, however, does have the potential to be habit-forming. Long-term use of cannabinoids has also been linked to medical conditions relating to motivation, thinking, and decision-making.

Reach out to your healthcare provider if you or loved ones notice the following substance use disorder (SUD)-like symptoms:

• Abnormal changes in thinking, mood, or behavior
• Absence of body hygiene
• Changes in sleeping habits
• Decrease in performance at school, work, or home
• Disheveled appearance
• Low motivation
• Relationship problems
• Weight changes

Abruptly stopping long-term cannabinoid use might also result in discontinuation symptoms, which may include:

• Diarrhea
• Feelings of distress
• Hiccups
• Runny nose
• Sleeping problems
• Sweating

Dosage: How Much Cesamet Should I Take?

Modifications

The following modifications (changes) should be kept in mind when using Cesamet:

Severe allergic reaction: Avoid using Cesamet if you have a known allergy to it or its ingredients. Ask your pharmacist or healthcare provider for a complete list of the ingredients if you're unsure.

Pregnancy: In rat and rabbit animal studies, Cesamet was found to have negative effects on the fetus. We don't know enough about the safety and effectiveness of Cesamet in pregnant people and their unborn fetuses. Discuss with your healthcare provider if you plan to become pregnant or are pregnant. They will help you weigh the benefits and risks of taking Cesamet during pregnancy.

Breastfeeding: It's not known whether Cesamet is present in human breastmilk, but cannabinoids have been found in breastmilk. Therefore, Cesamet isn't recommended while breastfeeding.

Talk with your healthcare provider if you plan to breastfeed. Your healthcare provider will help you weigh the benefits and harms of taking Cesamet while nursing. They can also discuss the different ways available to feed your baby.

Older adults over 65: Clinical studies haven't included a large enough number of people in this age group to see whether they respond differently from younger adults. However, older adults with several medical conditions or taking several medications should use caution with Cesamet. Older adults might also be more sensitive to Cesamet's side effects.

Children: There is limited safety and effectiveness information about Cesamet in children.

Substance use disorder (SUD) risk: You may have a risk for SUD if you have a medical or family history of SUD. Having a mental health condition may also put you at risk. If you have an increased risk of SUD, your healthcare provider may closely monitor you for SUD-like symptoms and help you with any necessary next steps.

Missed Dose

If you accidentally forgot your Cesamet dose, take it as soon as you remember. If it's already close to your next scheduled dose, then skip the missed dose and take the following dose at your next scheduled dosing time. Don't try to double up to make up for the missed dose.

Try to find ways that work for you to help yourself remember to keep your appointments and take your medication routinely. If you miss too many doses, Cesamet might be less effective at treating your chemotherapy-induced nausea and vomiting (CINV).

Overdose: What Happens If I Take Too Much Cesamet?

An overdose of Cesamet tends to exaggerate the common or serious side effects of this medication. Some typical symptoms of a suspected overdose may include abnormal blood pressure changes and rapid heartbeat.

If you think that you're experiencing an overdose or life-threatening symptoms, seek immediate medical attention.

Precautions

What Are Reasons I Shouldn’t Take Cesamet?

Before taking Cesamet, talk with your healthcare provider if any of the following applies to you:

• Severe allergic reaction: Avoid this medication if you have a severe allergic reaction to Cesamet.
• Pregnancy: In animal studies, Cesamet might be linked to negative effects on the unborn fetus. In humans, however, there isn't enough information to assess a connection between Cesamet and its negative impact on the unborn fetus. Talk with your healthcare provider to discuss the benefits and risks of taking Cesamet during pregnancy.
• Breastfeeding: We don't know if Cesamet is present in human breastmilk. Cannabinoids, however, do tend to be detected in breastmilk. Therefore, Cesamet isn't recommended while nursing.
• Children: There is little safety and effectiveness information about Cesamet in children.
• Older adults over 65: There isn't enough data to compare differences in responses to Cesamet between older and younger adults.
• Heart conditions: Cesamet may affect your heart rate and blood pressure. If you have high blood pressure or heart conditions, use caution with Cesamet.
• History of SUD: Cesamet might be habit-forming. If you have a history of SUD, be careful with Cesamet.
• Mental health conditions: Use Cesamet with caution if you have a past or current history of a mental health condition (e.g., depression, schizophrenia). Cesamet might worsen symptoms of your medical condition.
  

What Other Medications Interact With Cesamet?

Since Cesamet affects the central nervous system (CNS), be careful with other medications that also affect the CNS (brain and spinal cord). Try to avoid alcohol, too.

Talk with your pharmacist or healthcare provider for more detailed information about medication interactions with Cesamet.

And be sure to talk with your healthcare provider about any other medicines you take or plan to take, including over-the-counter, nonprescription products, vitamins, herbs, or plant-based medicines.

What Medications Are Similar?

The cannabinoid class is one possible option for breakthrough chemotherapy-induced nausea and vomiting (CINV). Besides Cesamet, the small cannabinoid class also includes Marinol (dronabinol).

The following are some advantages of Cesamet over Marinol:

• Unopened containers of Cesamet don't require refrigeration.
• Cesamet doesn't expire in 28 days at room temperature once opened.
• Cesamet is taken less frequently.

Since Cesamet and Marinol are both cannabinoids, they're not typically taken together.

How Can I Stay Healthy While Taking Cesamet?

Navigating and adjusting to chemotherapy can take time and energy. Consider talking with your loved ones to help with certain tasks like assisting you with the drive to the cancer center and other responsibilities. Websites like Caring Bridge or Lotsa Helping Hands can also help update loved ones about your treatments and organize tasks.

During your treatment, be sure to stay hydrated, especially if you experience vomiting or diarrhea as a treatment side effect. You can do this by drinking more water or even consuming broth. Be sure to eat a balanced diet with enough protein to help your body stay strong. ESPEN nutrition guidelines suggest that people undergoing cancer treatment need more protein (0.5 to 0.8 grams of protein per pound of body weight) compared to sedentary individuals. While some sources may encourage eating animal protein as the best way to increase your protein intake, there are many ways to get enough protein, including a balanced vegetarian diet. There are registered dietitian nutritionists (RDs/RDNs) that specialize in nutrition during cancer treatment to help support you during this time. Talk with your healthcare provider about connecting with a registered dietitian nutritionist as you map out your nutrition plan during treatment. This course may help you avoid malnutrition and can help support your body. Eating smaller meals more frequently throughout the day can help you manage any nausea.

As for nausea, there are things that you can do—in addition to Cesamet and other CINV medications. In general, you can try the following:

• After a meal, quietly rest and sit upright for at least one hour.
• Slowly sip liquids throughout the day. Consider clear liquids—like apple juice, broth, ginger ale, or tea.
• Try popsicles or hard candies.
• Don’t skip meals and snacks, which might worsen your nausea.
• Try to have a snack before your chemo treatment.
• Try to eat small amounts of food with high calories—like yogurt—multiple times a day.

For vomiting, keep the following in mind:

• If you’re lying down, immediately turn to your side when you vomit. This will prevent inhaling your vomit.
• After vomiting stops, sit upright and slowly drink small amounts of clear liquids. You can also try ice chips or frozen juice chips.