A cannabis-extract mouth spray for muscle stiffness in MS
Nabiximols
A cannabis-extract mouth spray used to ease muscle stiffness and spasms in multiple sclerosis.
What is Nabiximols?
Nabiximols is a specialist medicine made from cannabis-plant extracts, given as a spray into the mouth, used to ease muscle stiffness and spasms (called spasticity) in people with multiple sclerosis whose symptoms have not improved enough with other treatments. It contains both THC and CBD, the two best-known cannabis compounds. Because it contains THC, it can affect the mind, so it is used with caution in people with mental-health conditions, it can impair driving, and it carries some potential for dependence. It can also irritate the mouth where it is sprayed. It is started under specialist supervision with a careful trial to see if it helps.
Education and reference only. This is a plain-language guide to Nabiximols — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Nabiximols is a medicine made from extracts of the cannabis plant, containing two main compounds, THC and CBD. It is sprayed into the mouth, onto the inside of the cheek or under the tongue, and is used to ease spasticity, the muscle stiffness and painful spasms that can affect people with multiple sclerosis. It is used when these symptoms have not responded well enough to other treatments. Because it is derived from cannabis and can affect the mind, it is prescribed under specialist supervision, started with a trial period to check whether it genuinely helps before continuing.
How it works
The body has a natural signalling system, sometimes called the endocannabinoid system, that helps regulate muscle tone, pain and other functions. The cannabis compounds in nabiximols, THC and CBD, act on this system, which can reduce the over-activity in nerves and muscles that causes the stiffness and spasms of spasticity. Because THC also acts on the parts of the brain involved in mood, alertness and thinking, the same action that helps muscles can cause mental effects such as drowsiness or feeling 'high', which is why it is introduced gradually and used carefully.
Company & origin
Originated / developed by: Specialist manufacturer.
A specialist cannabis-extract mouth spray used in the UK to ease muscle stiffness and spasms (spasticity) in multiple sclerosis.
Practical use
How to take Nabiximols
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- Spray it into the mouth, onto the inside of the cheek or under the tongue, building the dose up gradually as advised.
- Rotate where you spray it to reduce stinging or soreness of the mouth.
- Do not drive or operate machinery if it makes you drowsy or affects your concentration.
- Avoid alcohol and be cautious with other sedating medicines, as they add to drowsiness.
- Report any marked changes in mood, thinking or behaviour to your specialist team.
Weighing it up
Advantages & disadvantages of Nabiximols
Advantages
- Can ease muscle stiffness and spasms in MS when other treatments have not helped enough.
- Given as a mouth spray, with the dose adjusted to suit the person.
- Started with a trial period so it is only continued if it genuinely helps.
Disadvantages
- Contains THC, so it can affect the mind and is used with caution in people with mental-health conditions.
- Can impair driving and concentration, and has some potential for dependence.
- Can irritate or sting the mouth where it is sprayed.
Practical use
Good to know
Because nabiximols contains THC, the active part of cannabis, it can affect the mind: it can cause drowsiness, dizziness, changes in mood, and, uncommonly, more serious psychiatric effects, so it is used with particular caution in people with a personal or family history of serious mental-health conditions such as psychosis. It can impair driving and the ability to operate machinery, so you should not drive if affected, and there is some potential for dependence with longer use. Where it is sprayed, it can irritate or sting the mouth, so the spray site is rotated. It is started with a careful trial: the dose is built up gradually, and if it has not clearly helped after the trial period it is usually stopped. Alcohol and other sedating medicines add to its drowsiness. The specialist team reviews whether the benefit is worth continuing.
Who should not take it / use with caution
- People who have had a serious allergic reaction to nabiximols or its ingredients should not use it.
- It is used with particular caution, or avoided, in people with a personal or family history of serious mental-health conditions such as psychosis.
- It is not used in pregnancy or breastfeeding unless a specialist judges it essential.
- It is used with caution in people with certain heart conditions and only under specialist supervision.
Monitoring
- Reviewing during the trial period whether it has clearly eased spasticity before continuing.
- Watching for effects on mood, thinking and alertness, and for signs of dependence.
- Checking the mouth where it is sprayed for soreness, and reviewing the dose over time.
Side effects
- Drowsiness, dizziness or tiredness, especially when first starting.
- Soreness or stinging in the mouth where it is sprayed.
- Changes in mood, feeling 'high', or problems with memory and concentration.
- Uncommonly but importantly, more serious psychiatric effects such as confusion or psychosis, which need review.
Key interactions
- Alcohol and other sedating medicines add to its drowsiness and effects on the mind.
- Medicines that change how the liver handles it can raise or lower its levels.
- Give a full medicines list, including anything that makes you sleepy, to your specialist team.
Available as: A spray used in the mouth.
Answers
Nabiximols: frequently asked questions
What is nabiximols used for?
It is used to ease muscle stiffness and spasms (spasticity) in people with multiple sclerosis whose symptoms have not improved enough with other treatments.
Will it make me feel high?
It contains THC, the active part of cannabis, so it can affect the mind and cause drowsiness or a 'high' feeling; the dose is built up gradually to limit this.
Can I drive while using it?
You should not drive or operate machinery if it makes you drowsy or affects your concentration, as it can impair your ability to do so safely.
Why does it sting my mouth?
The spray can irritate or sting the inside of the mouth where it lands, so rotating the spray site helps reduce soreness.
Is it addictive?
Because it contains THC, there is some potential for dependence with longer use, which is one reason it is used under specialist supervision and reviewed regularly.
Authoritative sources
- BNF
- NICE CKS
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