Can nabilone be used to treat anxiety?

Nabilone for Anxiety: Not Recommended as First-Line Treatment

Nabilone is not recommended for the treatment of anxiety disorders due to lack of FDA approval for this indication, significant side effect profile, and availability of better-established treatment options. 1, 2

Safety Concerns and Contraindications

• Nabilone can cause significant adverse effects including drowsiness (66% of patients), vertigo/dizziness (59%), euphoria (38%), dry mouth (22%), and concentration difficulties (12%) 2
• Postural hypotension and tachycardia are common cardiovascular effects, requiring caution in elderly patients and those with hypertension or heart disease 2
• Nabilone should be used with caution in patients with current or previous psychiatric disorders as it may unmask symptoms of depression, schizophrenia, or other mental health conditions 2
• The drug has potential for additive CNS depression when combined with sedatives, hypnotics, or other psychoactive medications 2
• There is potential for substance abuse, particularly in patients with a history of alcohol or marijuana dependence 2, 3

Evidence for Anxiety Treatment

• While nabilone has mild anxiolytic properties as noted in some studies, this is considered a secondary effect and not its primary mechanism of action 4, 5
• A 1978 study comparing nabilone (2mg) to diazepam (5mg) found that anxiety induced by experimental procedures was alleviated by diazepam and, to a lesser extent, by nabilone 5
• No consensus exists among expert panels regarding the appropriateness of nabilone for anxiety management 6
• The American Geriatrics Society recommends immediate dose reduction when moderate to severe dizziness affects daily activities or when falls occur in patients taking nabilone 7

Established Alternatives for Anxiety Treatment

• First-line pharmacological treatments for anxiety disorders include:
  • Selective serotonin reuptake inhibitors (SSRIs)
  • Serotonin-norepinephrine reuptake inhibitors (SNRIs) 8
• Benzodiazepines have substantial evidence supporting their use in panic disorder and generalized anxiety disorder, though concerns about dependence limit long-term use 1, 8
• Cognitive behavioral therapy (CBT) is a well-established non-pharmacological treatment for anxiety disorders with strong evidence of efficacy 1

Risk Management if Considering Off-Label Use

• If considering nabilone for off-label use despite these concerns:
  • Start with lower doses (0.5mg daily) and monitor closely for side effects, particularly in older adults 7
  • Regular assessment of orthostatic vital signs is recommended before and during therapy 7
  • Avoid abrupt discontinuation; tapering is recommended to prevent withdrawal symptoms 1, 2
  • Patients should be warned not to drive, operate machinery, or engage in hazardous activities while taking nabilone 2
  • Patients should remain under supervision of a responsible adult while using nabilone 2

Common Pitfalls and Caveats

• Nabilone may cause disorientation (2% of patients) and depersonalization (2% of patients), which could worsen anxiety symptoms in some patients 2
• Tolerance to euphoria and dry mouth develops after a few days of use, but relaxation effects may persist 9
• The risk of drug interactions is significant, particularly with CNS depressants, which could lead to additive drowsiness and CNS depression 2
• Patients with anxiety disorders often have comorbid conditions that may be exacerbated by nabilone's side effect profile 8
• Cannabis withdrawal syndrome can occur with abrupt cessation of nabilone, potentially worsening anxiety 6