scholarly journals Potential Adverse Drug Events with Tetrahydrocannabinol (THC) Due to Drug–Drug Interactions

2020 ◽  
Vol 9 (4) ◽  
pp. 919 ◽  
Author(s):  
Joshua D. Brown
Keyword(s):  
Drug Interactions ◽  
Adverse Drug Events ◽  
Alternative Therapy ◽  
Medical Marijuana ◽  
Racial Groups ◽  
Metabolizing Enzymes ◽  
Potential Risks ◽  
Neurological Effects ◽  
Medical Marijuana Use ◽  
Future Work

Tetrahydrocannabinol (THC) is the primary psychoactive ingredient in cannabis. While the safety of THC and cannabis has been extrapolated from millennia of recreational use, medical marijuana programs have increased exposure among medically complex individuals with comorbid conditions and many co-prescribed medications. Thus, THC should be recognized as a pharmacologically complex compound with potential for drug–drug interactions and adverse drug events. This review summarizes potential adverse drug events related to THC when combined with other medications. Metabolic drug–drug interactions are primarily due to THC conversion by CYP3A4 and CYP2C9, which can be impacted by several common medications. Further, CYP2C9 polymorphisms are highly prevalent in certain racial groups (up to 35% in Caucasians) and increase the bioavailability of THC. THC also has broad interactions with drug-metabolizing enzymes and can enhance adverse effects of other medications. Pharmacodynamic interactions include neurological effects, impact on the cardiovascular system, and risk of infection. General clinical recommendations for THC use include starting with low doses and titrating to desired effects. However, many interactions may be unavoidable, dose-limiting, or a barrier to THC-based therapy. Future work and research must establish sufficient data resources to capture medical marijuana use for such studies. Meanwhile, clinicians should balance the potential risks of THC and cannabis and the lack of strong evidence of efficacy in many conditions with patient desires for alternative therapy.

scholarly journals Potential Adverse Drug Events and Drug–Drug Interactions with Medical and Consumer Cannabidiol (CBD) Use

2019 ◽  
Vol 8 (7) ◽  
pp. 989 ◽  
Author(s):  
Joshua Brown ◽  
Almut Winterstein
Keyword(s):  
Drug Interactions ◽  
Sleep Disturbances ◽  
Adverse Drug Events ◽  
Alternative Therapy ◽  
Consumer Products ◽  
Medical Cannabis ◽  
Biological Targets ◽  
Safety Issues ◽  
Treatment Regimens ◽  
Potential Safety

Cannabidiol (CBD) is ubiquitous in state-based medical cannabis programs and consumer products for complementary health or recreational use. CBD has intrinsic pharmacologic effects and associated adverse drug events (ADEs) along with the potential for pharmacokinetic and pharmacodynamic drug–drug interactions (DDIs). Given CBD use among patients with complex conditions and treatment regimens, as well as its expanded consumer use, awareness of potential safety issues with CBD is needed. Prescribing information for federally approved products containing CBD were reviewed. Data on ADEs and DDIs were extracted and summarized. Nearly one-half of CBD users experienced ADEs, which displayed a general dose-response relationship. Common ADEs include transaminase elevations, sedation, sleep disturbances, infection, and anemia. Given CBD effects on common biological targets implicated in drug metabolism (e.g., CYP3A4/2C19) and excretion (e.g., P-glycoprotein), the potential for DDIs with commonly used medication is high. General clinical recommendations of reducing substrate doses, monitoring for ADEs, and finding alternative therapy should be considered, especially in medically complex patients. CBD is implicated as both a victim and perpetrator of DDIs and has its own ADE profile. These effects should be considered in the risk-benefit assessment of CBD therapy and patients and consumers made aware of potential safety issues with CBD use.

Potential Risks Resulting from Fruit/Vegetable-Drug Interactions: Effects on Drug-Metabolizing Enzymes and Drug Transporters

2011 ◽  
Vol 76 (4) ◽  
pp. R112-R124 ◽  
Author(s):  
Lourdes Rodríguez-Fragoso ◽  
José Luis Martínez-Arismendi ◽  
Danae Orozco-Bustos ◽  
Jorge Reyes-Esparza ◽  
Eliseo Torres ◽  
...  
Keyword(s):  
Drug Interactions ◽  
Drug Transporters ◽  
Drug Metabolizing Enzymes ◽  
Metabolizing Enzymes ◽  
Potential Risks

Verdicts on Medical Marijuana Use

Science News ◽  
1997 ◽  
Vol 151 (20) ◽  
pp. 299
Author(s):  
Anthony M. Castaldo ◽  
Sandy Shaw ◽  
Paul Hewitt ◽  
Lyle D. Courtsal
Keyword(s):  
Medical Marijuana ◽  
Marijuana Use ◽  
Medical Marijuana Use

scholarly journals Medical Marijuana Use Among Adolescents in Substance Abuse Treatment

2012 ◽  
Vol 51 (7) ◽  
pp. 694-702 ◽  
Author(s):  
Stacy Salomonsen-Sautel ◽  
Joseph T. Sakai ◽  
Christian Thurstone ◽  
Robin Corley ◽  
Christian Hopfer
Keyword(s):  
Substance Abuse ◽  
Substance Abuse Treatment ◽  
Medical Marijuana ◽  
Marijuana Use ◽  
Abuse Treatment ◽  
Medical Marijuana Use

Marijuana Use and Breastfeeding

2012 ◽  
Vol 3 (3) ◽  
pp. 101-107 ◽  
Author(s):  
Carrie W. Miller
Keyword(s):  
United States ◽  
Adverse Effects ◽  
Motor Development ◽  
District Of Columbia ◽  
Medical Marijuana ◽  
Marijuana Use ◽  
The United States ◽  
Breastfed Infants ◽  
Feeding Difficulty ◽  
Medical Marijuana Use

Marijuana is one of the most widely used recreational substances in the United States, with high rates of use during peak childbearing years. Medical marijuana use is also becoming more widely accepted in the United States, with legalization in 17 states and the District of Columbia. The available literature suggests that maternal marijuana use during breastfeeding is associated with potentially negative outcomes for infants and children. Adverse effects can include feeding difficulty, lethargy, and delayed cognitive and motor development. Mothers considered heavy or chronic users of marijuana are advised to not breastfeed infants. The aim of this article is to examine the prevalence of marijuana use, the potential effects on breastfed infants, and current recommendations from lactation experts.

Documentation of medical marijuana use in cancer patients

2019 ◽  
Vol 26 (5) ◽  
pp. 1117-1127 ◽  
Author(s):  
Jessica N LeClair ◽  
Kevin W Chamberlin ◽  
Jessica Clement ◽  
Lisa M Holle
Keyword(s):  
Quality Improvement ◽  
Cancer Patients ◽  
Chart Review ◽  
Medical Marijuana ◽  
Retrospective Chart Review ◽  
Marijuana Use ◽  
Cancer Center ◽  
Medication List ◽  
Post Test ◽  
Medical Marijuana Use

Purpose Medical marijuana is often used as adjuvant therapy in cancer patients for symptom management, although limited evidence-based studies evaluating its efficacy or safety exist. Similar to over-the-counter medications, supplements, or herbal products, documentation of medical marijuana is important to monitor efficacy, potential adverse effects, or interactions. The objective of this quality improvement study was to improve the consistency of medical marijuana documentation in cancer patients by assessing current practices; educating healthcare team members about the importance of documentation and newly established documentation process; and evaluating the new documentation process. Methods This three-part quality improvement study was approved by the Institutional Review Board. In part I, a voluntary survey was sent via email to Cancer Center healthcare personnel to assess the current documentation process of medical marijuana. In part II, a best practice process for documenting medical marijuana in the electronic medical record was established. Medical marijuana was to be listed as a historical medication in the medication list. In-person and electronic education sessions were offered to Cancer Center clinical staff. The education emphasized the importance of documenting medical marijuana use and provided a detailed process for electronic medical record documentation. A pre- and post-test to assess understanding was also included. Part III was a retrospective chart review to evaluate documentation practices of certified medical marijuana users in the Cancer Center. Patients included in the study were greater than 18 years old and certified for medical marijuana use on or after 1 January 2018. Department of Corrections patients were excluded. Descriptive statistics were used for data analysis. Results The survey results in part I demonstrated a lack of consistency in the documentation of medical marijuana in the Cancer Center. The pre- and post-test scores measured in part II showed a significant improvement in understanding after education was provided. The average pre-test score was a 61 and post-test score was 88, indicating an average increase of 27 points. A larger increase in test scores was observed in those attending the in-person education than the online sessions ( p < 0.002). The results of the retrospective chart review in part III revealed 56 patients who met inclusion criteria, but only 39 patients were alive and evaluated at the time of the retrospective chart review. Of the 39 patients, 22 never completed the patient registration process and therefore, would never have been able to obtain medical marijuana. Seven patients had medical marijuana properly documented in their medication list and 10 patients were missing documentation in the medication list, showing room for improvement in documentation practices. Conclusions This quality improvement study led to the implementation of medical marijuana documentation in the medication list. Education increased healthcare team members understanding of medical marijuana utilization and the importance of documentation.

scholarly journals Potential Pharmacokinetic Drug-Drug Interactions between Cannabinoids and Drugs Used for Chronic Pain

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Marta Vázquez ◽  
Natalia Guevara ◽  
Cecilia Maldonado ◽  
Paulo Cáceres Guido ◽  
Paula Schaiquevich
Keyword(s):  
Chronic Pain ◽  
Drug Interactions ◽  
Pain Control ◽  
Cytochromes P450 ◽  
Pain Medication ◽  
Atp Binding ◽  
Metabolizing Enzymes ◽  
Appropriate Treatment ◽  
Few Data ◽  
Pharmacokinetic Drug

Choosing an appropriate treatment for chronic pain remains problematic, and despite the available medication for its treatment, still, many patients complain about pain and appeal to the use of cannabis derivatives for pain control. However, few data have been provided to clinicians about the pharmacokinetic drug-drug interactions of cannabinoids with other concomitant administered medications. Therefore, the aim of this brief review is to assess the interactions between cannabinoids and pain medication through drug transporters (ATP-binding cassette superfamily members) and/or metabolizing enzymes (cytochromes P450 and glucuronyl transferases).

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