Safety and tolerability of nabiximols oromucosal spray: a review of real-world experience in observational studies, registries and case reports
Introduction: : Nabiximols oromucosal spray, a cannabis-based medicine containing a balanced ratio of Δ-9-tetrahydrocannabinol and cannabidiol, is approved widely as add-on therapy for symptomatic relief of spasticity in persons with multiple sclerosis (MS). Most safety data for nabiximols derive from its use in MS spasticity, with some data available from the analgesia area.
Areas covered: : This review compiles safety and tolerability data from all published observational studies, registry analyses and case reports identified in systematic searches in which nabiximols oromucosal spray was investigated for spasticity (n = 20) and/or chronic non-cancer pain (n = 4). Aligning with the known safety profile of nabiximols as demonstrated in randomised controlled trials, common adverse events reported consistently across studies conducted under clinical practice conditions were dizziness, fatigue and somnolence. The serious adverse events (SAE) rate with nabiximols in observational studies of MS spasticity was 3.1% (137/4351). A total of 39 treatment-related SAEs were reported in 32 patients with spasticity, all of which (where specified) were resolved. No treatment-related SAEs were recorded in studies of patients receiving nabiximols for pain.
Expert opinion: : Real-world experience with nabiximols oromucosal spray in treating spasticity and chronic pain indicates that, overall, it is well tolerated and has a good safety profile.
Keywords: Multiple sclerosis spasticity; Nabiximols; Neurological pain; Safety; Sativex; Tolerability; observational studies.