Can nabilone be used to treat anxiety?

Nabilone for Anxiety: Evidence and Recommendations

Nabilone is not recommended as a first-line treatment for anxiety disorders due to limited evidence supporting its efficacy and significant side effect concerns including dizziness, drowsiness, and potential for psychoactive effects. 1

Evidence for Nabilone in Anxiety

• Nabilone is a synthetic cannabinoid receptor agonist with FDA approval for specific indications including chemotherapy-induced nausea and vomiting, not anxiety disorders 2, 1
• A small single-dose study in anxious volunteers found that only 2 out of 4 subjects experienced an antianxiety effect at low doses (1-2mg), while higher doses (4-5mg) caused orthostatic hypotension 3
• Nabilone has documented anxiolytic properties, but these are considered secondary effects and not the primary therapeutic mechanism 4
• Current anxiety disorder treatment guidelines do not include nabilone or cannabinoids as recommended treatments, instead favoring SSRIs, SNRIs, and specific psychotherapies as first-line options 5

Safety Concerns and Side Effects

• Nabilone commonly causes CNS depression with drowsiness reported in 66% of patients, vertigo/dizziness in 59%, and euphoria in 38% of patients in controlled studies 1
• The FDA label warns that nabilone should be used with caution in patients with current or previous psychiatric disorders as it may unmask symptoms of these conditions 1
• Common adverse effects include dry mouth, ataxia, concentration difficulties, and visual disturbances 1
• Postural hypotension is a significant concern, especially at higher doses, making it potentially dangerous for elderly patients or those with cardiovascular conditions 6, 1
• The FDA label specifically cautions about potential additive effects when combined with other CNS depressants, including alcohol, benzodiazepines, and barbiturates 1

Specific Populations and Considerations

• Nabilone has a high potential for misuse due to its psychoactive effects, though reports of actual abuse are rare 7
• Older adults are particularly vulnerable to nabilone-induced dizziness and postural hypotension 6
• The American Geriatrics Society recommends immediate dose reduction when moderate to severe dizziness affects daily activities or when falls occur 6
• Patients with a history of substance abuse should use nabilone with caution 1

Alternative Approaches for Anxiety Treatment

• First-line pharmacological treatments for anxiety disorders include SSRIs and SNRIs, which have substantial evidence supporting their efficacy 5
• Benzodiazepines have evidence supporting their use in panic disorder and generalized anxiety disorder, though concerns about dependence limit long-term use 2
• Cognitive behavioral therapy (CBT) is a well-established non-pharmacological treatment for anxiety disorders 2
• For patients with treatment-resistant anxiety, options include anticonvulsants and atypical antipsychotics as adjunctive treatments 5

Clinical Pitfalls and Practical Considerations

• Patients should be warned not to drive, operate machinery, or engage in hazardous activities while taking nabilone due to its sedative effects 1
• Monitoring for psychiatric symptoms is essential as nabilone may unmask or exacerbate underlying conditions 1
• If considering nabilone for off-label use, start with lower doses (0.5mg daily) and monitor closely for side effects, particularly in older adults 6
• Abrupt discontinuation should be avoided; tapering is recommended to prevent potential withdrawal symptoms 6
• Regular assessment of orthostatic vital signs is recommended before and during nabilone therapy 6

In conclusion, while nabilone has some anxiolytic properties, its significant side effect profile and limited evidence base make it unsuitable as a primary treatment for anxiety disorders. Clinicians should rely on established first-line treatments with stronger evidence of efficacy and safety.