Nabiximols

Nabiximols

Combination of
Tetrahydrocannabinol	Cannabinoid
Cannabidiol	Cannabinoid
Clinical data
Trade names	Sativex
Pregnancy cat.	?
Legal status	℞ Prescription only
Routes	Oromucosal spray
Identifiers
CAS number	56575-23-6 N
ATC code	N02BG10
PubChem	CID 44148067
N(what is this?)  (verify)

Canadian packaging of a case of Sativex vials

Nabiximols (USAN^[1], trade name Sativex) is a cannabinoid oromucosal mouth spray developed by the UK company GW Pharmaceuticals for multiple sclerosis (MS) patients, who can use it to alleviate neuropathic pain, spasticity, overactive bladder, and other symptoms. Nabiximols is also being developed in Phase III trials as a potential treatment to alleviate pain due to cancer. It has also been researched in various models of peripheral and central neuropathic pain. Nabiximols is distinct from all other pharmaceutically produced cannabinoids currently available because it is derived from cannabis plants, rather than a solely synthetic process. The drug is a pharmaceutical product standardised in composition, formulation, and dose, although it is still effectively a tincture of the cannabis plant. Its principal active cannabinoid components are the cannabinoids: tetrahydrocannabinol (THC) and cannabidiol (CBD). The product is formulated as an oromucosal spray which is administered by spraying into the mouth. Each spray delivers a fixed dose of 2.7 mg THC and 2.5 mg CBD.

In April 2011, GW licensed to Novartis the rights to commercialise nabiximols in Asia (excluding China and Japan), Africa and the Middle East (excluding Israel).

Availability

In June 2010, the Medicines and Healthcare products Regulatory Agency of the United Kingdom licensed nabiximols as a prescription-only medicine for the treatment of spasticity due to multiple sclerosis. This regulatory authorization represents the world's first full regulatory approval for the medicine. The spray is being marketed in the UK by Bayer Schering Pharma. Many MS patients cannot receive nabiximols due to local primary care trust resistance to its funding.^[2][3]

Nabiximols was also approved in Spain for MS spasticity in the second half of 2010 and was launched in that country in March 2011. It was approved in the Czech Republic in April 2011, in Germany in May 2011 and in Denmark in June 2011. It has also been recommended for approval in Italy, Sweden and Austria with formal approvals expected in these countries during 2011. In Spain and other European markets (excluding the UK), nabiximols will be marketed by Almirall.

In Canada, nabiximols has been approved by Health Canada for the treatment of MS spasticity. It has also received a licence with conditions (NOC/c) for two additional uses: as adjunctive treatment for the symptomatic relief of neuropathic pain in multiple sclerosis,^[4] and also for pain due to cancer.^[5][6]

Nabiximols is available in a number of countries as an unlicensed medicine, which enables doctors to prescribe the product to individual patients who they consider may benefit. The product has been exported from the UK to a total of 28 countries to date.

In February 2007, GW and Otsuka Pharmaceutical announced an exclusive agreement for Otsuka to develop and market the drug in the United States. The first large scale US Phase IIb trial, Spray Trial, for cancer patients reported positive results in March 2010. GW and Otsuka have now commenced the Phase III development of nabiximols in cancer pain.

Effectiveness

Of the two preliminary Phase III studies investigating the treatment of MS patients, one showed a reduction of spasticity of 1.2 points on the 0–10 points rating scale (versus 0.6 points under placebo), the other showed a reduction of 1.0 versus 0.8 points. Only the first study reached statistical significance. The Phase III approval study consisted of a run-in phase where the response of individuals to the drug was determined. The responders (42% of patients) showed a significant effect in the second, placebo controlled, phase of the trial.^[7] A 2009 meta-analysis of six studies found large variations of effectiveness, with a trend towards a reduction of spasticity.^[8]

Side effects

In early clinical trials, nabiximols has generally been well tolerated.^[9][10][11] The most common adverse effects in Phase III trials were dizziness (25%), drowsiness (8.2%) and disorientation (4%). 12% of patients stopped taking the drug because of the side effects. No investigations regarding the potential for dependence are available, but such a potential is unlikely considering the pharmacological properties of the two components.^[7]

See also

• Medical cannabis
• Nabilone
• Dronabinol

References

1. ^ United States Adopted Names Coincil: [Statement on a nonproprietary name adopted by the USAN council http://www.ama-assn.org/ama1/pub/upload/mm/365/nabiximols.pdf]
2. ^ Ryan, Siobhan (4 June 2011). "Sussex MS sufferers call for drug funding". Argus (Sussex,UK). http://www.theargus.co.uk/news/9064713.Sussex_MS_sufferers_call_for_drug_funding/. Retrieved 8 June 2011. 
3. ^ "Sativex rejected by healthcare provider". Lincolnshire. 20 June 2011. http://www.thisislincolnshire.co.uk/Cannabis-based-MS-drug-rejected-NHS-Lincolnshire/story-12801496-detail/story.html. Retrieved 20 June 2011. 
4. ^ GW Pharmaceuticals. "Multiple Sclerosis". Accessed 24 July 2011.
5. ^ GW Pharmaceuticals. "Cancer Pain" Accessed 24 July 2011.
6. ^ "Sativex - Investigational Cannabis-Based Treatment for Pain and Multiple Sclerosis Drug Development Technology". www.drugdevelopment-technology.com. http://www.drugdevelopment-technology.com/projects/sativex/. Retrieved 2008-08-08. 
7. ^ ^{a b} Schubert-Zsilavecz, M, Wurglics, M, Neue Arzneimittel 2011/2012 (German)
8. ^ Lakhan, Shaheen E; Rowland, Marie (2009). "Whole plant cannabis extracts in the treatment of spasticity in multiple sclerosis: a systematic review". BMC Neurol 9: 59. doi:10.1186/1471-2377-9-59. PMC 2793241. PMID 19961570. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2793241. 
9. ^ Wade D, Makela P, Robson P, House H, Bateman C (2004). "Do cannabis-based medicinal extracts have general or specific effects on symptoms in multiple sclerosis? A double-blind, randomized, placebo-controlled study on 160 patients". Mult Scler 10 (4): 434–41. doi:10.1191/1352458504ms1082oa. PMID 15327042. 
10. ^ Wade D, Makela P, House H, Bateman C, Robson P (2006). "Long-term use of a cannabis-based medicine in the treatment of spasticity and other symptoms in multiple sclerosis". Mult Scler 12 (5): 639–45. doi:10.1177/1352458505070618. PMID 17086911. 
11. ^ Wade D, Robson P, House H, Makela P, Aram J (2003). "A preliminary controlled study to determine whether whole-plant cannabis extracts can improve intractable neurogenic symptoms". Clin Rehabil 17 (1): 21–9. doi:10.1191/0269215503cr581oa. PMID 12617376. 

External links

• GW Pharmaceuticals Website