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

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-pr...

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Autor principal: Brown, Joshua D.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7231229/
https://www.ncbi.nlm.nih.gov/pubmed/32230864
http://dx.doi.org/10.3390/jcm9040919
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author Brown, Joshua D.
author_facet Brown, Joshua D.
author_sort Brown, Joshua D.
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description 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.
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spelling pubmed-72312292020-05-22 Potential Adverse Drug Events with Tetrahydrocannabinol (THC) Due to Drug–Drug Interactions Brown, Joshua D. J Clin Med Review 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. MDPI 2020-03-27 /pmc/articles/PMC7231229/ /pubmed/32230864 http://dx.doi.org/10.3390/jcm9040919 Text en © 2020 by the author. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Brown, Joshua D.
Potential Adverse Drug Events with Tetrahydrocannabinol (THC) Due to Drug–Drug Interactions
title Potential Adverse Drug Events with Tetrahydrocannabinol (THC) Due to Drug–Drug Interactions
title_full Potential Adverse Drug Events with Tetrahydrocannabinol (THC) Due to Drug–Drug Interactions
title_fullStr Potential Adverse Drug Events with Tetrahydrocannabinol (THC) Due to Drug–Drug Interactions
title_full_unstemmed Potential Adverse Drug Events with Tetrahydrocannabinol (THC) Due to Drug–Drug Interactions
title_short Potential Adverse Drug Events with Tetrahydrocannabinol (THC) Due to Drug–Drug Interactions
title_sort potential adverse drug events with tetrahydrocannabinol (thc) due to drug–drug interactions
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7231229/
https://www.ncbi.nlm.nih.gov/pubmed/32230864
http://dx.doi.org/10.3390/jcm9040919
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