Cesamet (Nabilone)
A synthetic THC analog prescribed for chemotherapy-induced nausea, with limited but real evidence for a few other uses.
Nabilone is one of the few cannabinoid drugs with genuine regulatory approval, but that approval is narrow: chemotherapy-induced nausea that hasn't responded to standard antiemetics. Everything else — chronic pain, PTSD, spasticity, sleep — is off-label with thinner evidence. It's a real synthetic THC analog, not CBD, and it will get you high at therapeutic doses. It's also expensive, sedating, and often outperformed by cheaper modern antiemetics like ondansetron. Useful in specific niches. Not a miracle drug.
Plain-language summary
Nabilone (brand name Cesamet) is a lab-made drug that mimics THC, the main psychoactive compound in cannabis. It was first synthesized by Eli Lilly and approved by the FDA in 1985 [1]. Unlike whole-plant cannabis, it's a single molecule in a capsule with a known dose.
Its one approved use is treating nausea and vomiting from chemotherapy when standard drugs haven't worked [1][2]. Doctors sometimes prescribe it off-label for chronic pain, PTSD-related nightmares, spasticity in multiple sclerosis, and fibromyalgia — but the evidence for those uses is thinner and often based on small studies.
Because nabilone is essentially a THC analog, it produces cannabis-like effects: sedation, dry mouth, dizziness, euphoria, and sometimes anxiety or dysphoria. It is a controlled substance (Schedule II in the US).
> This is not medical advice. Nabilone is a prescription drug with real side effects and interactions. Talk to a physician who knows your full medical history before starting, stopping, or changing any medication.
What probably works
Chemotherapy-induced nausea and vomiting (CINV) — refractory cases. [evidence:strong for older comparisons; moderate overall]
A 2015 Cochrane review of cannabinoids for CINV found that nabilone and dronabinol were more effective than placebo and comparable to older antiemetics like prochlorperazine, though patients often preferred cannabinoids for subjective reasons despite more side effects [2]. The evidence base is largely from the 1980s, before modern 5-HT3 antagonists (ondansetron, granisetron) and NK1 antagonists (aprepitant) became standard.
Current guidelines from ASCO and NCCN position nabilone as a second- or third-line option — used when first-line antiemetics fail or aren't tolerated [3]. It is not a first-choice drug in 2024 chemotherapy protocols.
So: nabilone works for CINV. It just isn't usually the best tool available anymore.
What might work
Chronic non-cancer pain. Weak / limited
Small randomized trials suggest modest analgesic effects in neuropathic pain and fibromyalgia [4][5]. A 2008 trial in fibromyalgia (n=40) found nabilone reduced pain and anxiety versus placebo over 4 weeks [5]. Effect sizes are small, trials are short, and dropout from side effects is common. Systematic reviews of cannabinoids for chronic pain generally rate the evidence as low to moderate quality [6].
PTSD-related nightmares. Weak / limited
A 2015 randomized crossover trial in Canadian military personnel (n=10) reported nabilone reduced nightmare frequency compared to placebo [7]. This is intriguing but a very small study. Open-label case series in incarcerated populations also suggested benefit but had major methodological limitations.
Spasticity in multiple sclerosis. Weak / limited
Some small trials suggest symptomatic improvement in spasticity and pain in MS [8]. Nabiximols (Sativex, THC:CBD spray) has more evidence in this indication than nabilone specifically.
Anorexia and weight loss. Weak / limited
Dronabinol (a different synthetic THC) has more data here. Nabilone has been used similarly but evidence is limited to small studies.
What doesn't work or has weak evidence
Acute post-operative pain. Disputed
A trial in post-surgical patients actually found nabilone increased pain scores compared to placebo or ketoprofen [9]. Cannabinoids and acute pain don't clearly mix.
Anxiety as a primary treatment. Weak / limited
While some patients report anxiety relief, THC-like drugs including nabilone are biphasic — low doses may reduce anxiety, higher doses commonly cause it. No good evidence supports nabilone as a first-line anxiolytic.
Sleep as a standalone indication. Anecdote
Sedation is a side effect, not a validated therapeutic mechanism. Chronic use of THC-agonists can suppress REM sleep and worsen sleep architecture over time.
Cancer treatment (not symptom relief). No data
Nabilone treats symptoms. There is no clinical evidence it treats cancer itself. Claims otherwise are marketing folklore.
What we don't know
- Long-term safety at therapeutic doses. Most trials are 4–12 weeks. Multi-year data are sparse.
- Optimal dosing for off-label indications. Trials use widely varying regimens.
- How nabilone compares head-to-head with inhaled or oral whole-plant cannabis for the same indications. Almost no direct comparisons exist.
- Interactions with newer psychiatric medications are not well characterized.
- Whether it's genuinely better than dronabinol for any specific indication. Both are THC-like; direct comparisons are rare.
Comparison with standard treatments
For CINV: 5-HT3 antagonists (ondansetron, palonosetron), NK1 antagonists (aprepitant), and dexamethasone are first-line and generally more effective with fewer psychoactive side effects [3]. Nabilone is reserved for refractory cases.
For neuropathic pain: Gabapentin, pregabalin, duloxetine, and tricyclic antidepressants have larger evidence bases. Nabilone is not a first-line agent.
For MS spasticity: Baclofen and tizanidine remain standard. Nabiximols (Sativex) has more MS-specific evidence than nabilone in jurisdictions where it's available.
For PTSD nightmares: Prazosin has more data, though results are mixed. Trauma-focused psychotherapy (CPT, PE, EMDR) remains the strongest evidence base for PTSD overall.
vs. medical cannabis flower or oil: Nabilone offers precise dosing, insurance coverage in some jurisdictions, and a predictable pharmacokinetic profile. Whole-plant cannabis offers faster onset (inhaled), lower cost in legal markets, and additional cannabinoids/terpenes that some patients find more tolerable. Neither is universally 'better.'
Risks and side effects
Common: drowsiness, dizziness, dry mouth, euphoria, dysphoria, ataxia, blurred vision, headache, orthostatic hypotension [1].
Serious but less common: psychiatric effects including hallucinations, paranoia, depersonalization, and acute psychosis, especially at higher doses or in patients with a history of psychotic illness [1]. Tachycardia and hypotension can be significant in older adults.
Impairment: Nabilone impairs cognition and psychomotor function. Do not drive or operate machinery. Effects can persist longer than the subjective 'high' due to long half-lives of active metabolites.
Dependence and withdrawal: As a CB1 agonist, chronic use can produce tolerance and a cannabis-like withdrawal syndrome on discontinuation.
Contraindications: Known hypersensitivity to cannabinoids. Use with extreme caution in patients with psychiatric history, cardiovascular disease, hepatic impairment, or in the elderly.
Interactions: Additive CNS depression with alcohol, benzodiazepines, opioids, and other sedatives. Nabilone is metabolized in the liver; interactions with strong CYP enzyme inducers/inhibitors are possible.
> This is not medical advice. Individual risk depends on your health, other medications, and history. Consult a qualified prescriber.
Sources
- Government U.S. Food and Drug Administration. Cesamet (nabilone) capsules prescribing information. Meda Pharmaceuticals, revised 2006.
- Peer-reviewed Smith LA, Azariah F, Lavender VTC, Stoner NS, Bettiol S. Cannabinoids for nausea and vomiting in adults with cancer receiving chemotherapy. Cochrane Database of Systematic Reviews, 2015, Issue 11.
- Peer-reviewed Hesketh PJ, Kris MG, Basch E, et al. Antiemetics: ASCO Guideline Update. Journal of Clinical Oncology, 2020;38(24):2782-2797.
- Peer-reviewed Whiting PF, Wolff RF, Deshpande S, et al. Cannabinoids for Medical Use: A Systematic Review and Meta-analysis. JAMA, 2015;313(24):2456-2473.
- Peer-reviewed Skrabek RQ, Galimova L, Ethans K, Perry D. Nabilone for the treatment of pain in fibromyalgia. Journal of Pain, 2008;9(2):164-173.
- Peer-reviewed National Academies of Sciences, Engineering, and Medicine. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press, 2017.
- Peer-reviewed Jetly R, Heber A, Fraser G, Boisvert D. The efficacy of nabilone, a synthetic cannabinoid, in the treatment of PTSD-associated nightmares: A preliminary randomized, double-blind, placebo-controlled cross-over design study. Psychoneuroendocrinology, 2015;51:585-588.
- Peer-reviewed Wissel J, Haydn T, Müller J, et al. Low dose treatment with the synthetic cannabinoid Nabilone significantly reduces spasticity-related pain: a double-blind placebo-controlled cross-over trial. Journal of Neurology, 2006;253(10):1337-1341.
- Peer-reviewed Beaulieu P. Effects of nabilone, a synthetic cannabinoid, on postoperative pain. Canadian Journal of Anesthesia, 2006;53(8):769-775.
How this page was made
Generation history
Drafting assistance and fact-check automation are used, with a human operator spot-checking on a weekly basis. See how articles are made.