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Nabilone 0.5 mg and 1 mg capsule Shortage

March 22 , 2018

The Issue:
There is back order of nabilone 0.5 mg and 1 mg capsules for all manufacturers. The earliest estimated release date is for the Cesamet® brand from mid-May 2018.

Stock levels are low and may not meet current demands. Inventory might be depleted prior to the resolution of this back order.

Key changes include:

  • Physicians should be aware of the shortage of nabilone capsules
  • Suggested formulary alternatives* for treatment of refractory or breakthrough chemotherapy-induced nausea and vomiting (CINV) despite the use of guideline-consistent CINV prophylaxis include the following, as clinicall appropriate:
  1. Patients receiving receiving acute CINV prophylaxis for minimally low, low, or moderately emetogenic chemotherapy:

    Escalate the acute CINV prophylaxis to that recommended for the next higher level of emetogenic risk
  2. Patients receiving acute CINV prophylaxis for highly emetogenic chemotherapy:

    - Switch ondansetron to granisetron - Olanzapine PO in addition to continuing optimal antiemetic prophylaxis.

    a. Options if olazapine cannot be used (**Pediatric options):
    - Aprepitant PO**                                         - Lorazepam PO**
    - Metoclopramide PO/IV**                        - Alprazolam PO/IV 
    - Methotrimeprazine PO/IV **                   - Prochlorperazine PO

*Alternatives are provided for clinician information and may not be appropriate for all clinical situations. The information provided does not replace clinician judgment.

Action:
Please post this notice in your area and ensure all staff are informed about the change.

Contact:
Please contact your site pharmacy department with any questions or concerns.

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