Cesamet: Synthetic Marijuana

Marijuana for therapeutic purposes is not a new concept. People have smoked pot to help alleviate symptoms related to Alzheimer’s, to help with nerve pain and also to help with nausea. However, marijuana for the most part is still illegal in most states. Some states are working to legalize it by allowing people with known illnesses that benefit from its use to obtain it as a medicine.

The drawback of using pot as a drug is that the inhaled smoke contains many different chemicals with many different effects, some of which are harmful. By isolating the active ingredient and producing it synthetically, scientists hope they can eliminate the nasty side effects of smoking cannabis. Cesamet, also known as nabilone, is one synthetically produced medication. It is used as an antiemetic (anti-vomiting drug) in cancer chemotherapy patients who experience nausea and vomiting associated with the treatment.

Nausea and vomiting related to chemotherapy is the one of the fears that most cancer patients face. If left untreated, the nausea can affect a patient’s day to day life. The patient may also end up dealing with the effects associated with dehydration. Emesis is triggered by an area in the brain called the vomiting center. This center is triggered by several receptors, with the most noteworthy receptors being those associated with the neurotransmitters dopamine and serotonin. The whole nausea reaction is normally triggered by a complex series of impulses originating from the gut when an emetogenic (nauseating) substance is consumed. It is hypothesized that chemotherapy stimulates the sequence of impulses directly. Since marijuana is known to have an effect in the brain affecting both dopamine and serotonin levels, nabilone may somehow interfere with the impulse chain triggered by chemotherapy. The exact mechanism is unknown.

Patients who have adverse reactions to cannabinoid based medications or to marijuana should not take this medication.

This medication is administered as a 1 mg pill. A patient is prescribed either one or two pills twice a day. The first dose is administered the night before the chemotherapy with the second dose being administered 1 to 3 hours before the treatment. The medicine stays in the system for up to 72 hours after dosage. Dosage can continue after chemotherapy if needed with a maximum cumulative dosage of 6 mg being given.

This medication affects a patient's psyche and may impair physical and mental abilities. Paients are cautioned to avoid driving or operating heavy machinery while under the effects of the medication.

Elderly patients with high blood pressure or heart disease should be monitored carefully. Cannabiods are known to affect heart rate.

As a medication affecting brain activity, Cesamet requires caution when combined with other drugs that exert their effect in the brain. Diazepam (Valium), alcohol and codeine were tested, and when interacted with nabilone they asserted an additive effect. Lorazepam (Xanax) is related to diazepam and likely also has an additive effect.

The most common side effect associated with this medication is drowsiness and vertigo. Other side effects are a psychological high, dry mouth, depression, ataxia and blurred vision. In some extreme cases the psychotic effects of the drug may cause tachycardia, tremors and drug induced nightmares.

Patients with liver dysfunction should not uses this medication, nor should patients who have a history of non-pyschotic emotional disorders. This medications affects brain processes and should not be taken with alcohol, sedatives or other medications that also affect a person’s mental state. The safety of Cesamet has not been tested in pregnant women, nursing mothers or children and therefore it should not be used in these populations.

Drug Monograph