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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.

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

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

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