Your Dose of Cannabis Education
Your Dose of Cannabis Education
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Your Dose of Cannabis Education is based on data from the studies and reviews published in the current peer-reviewed medical journals. Whether you are a healthcare provider, patient, caregiver, an individual working in the healthcare sector, or just a curious person, you can benefit from Your Dose of Cannabis Education.
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2024-05-18
Does THC bind to plasma proteins?
THC is highly bound to plasma proteins and might displace and increase the free fraction of other concomitantly administered protein-bound drugs. Although this displacement has not been confirmed in vivo, it has been suggested to monitor patients for increased adverse reactions to narrow therapeutic index drugs that are highly protein-bound (e.g. warfarin, cyclosporine, amphotericin B) when initiating treatment or adjusting the dosage of THC. Prescribing Cannabis Medicines for Chronic Non-cancer Pain v2 September 2019 c10. - by the Australian Centre for Cannabinoid Clinical and research Excellence https://www.ces.edu.co/wp-content/uploads/2020/09/acre-prescribing-guidance-chronic-non-cancer-pain.pdf
2024-05-17
THC is metabolized by Cytochrome P450 enzymes, including CYP2C9 and CYP3A4. What are commonly consumed medications that inhibit these CYP enzymes?
If inhibitors of CYP2C9 (e.g. amiodarone, fluconazole) and/or inhibitors of CYP3A4 enzymes (e.g. ketoconazole, itraconazole, clarithromycin, ritonavir, erythromycin, grapefruit juice) are co-administered with a THC product, there may be an increased THC-related adverse reaction. Prescribing Cannabis Medicines for Chronic Non-cancer Pain v2 September 2019 c10. - by the Australian Centre for Cannabinoid Clinical and research Excellence https://www.ces.edu.co/wp-content/uploads/2020/09/acre-prescribing-guidance-chronic-non-cancer-pain.pdf
2024-05-16
Should the cannabinoid dosing regimen be adjusted for a patient with renal insufficiency?
After being metabolized by the liver, cannabinoids are excreted through the GI tract and kidney. One of the key points of the European Pain Federation position paper is “Consider a lower starting dose in patients with renal and hepatic insufficiency.”Häuser, W, Finn, DP, Kalso, E, et al. European Pain Federation (EFIC) position paper on appropriate use of cannabis‐based medicines and medical cannabis for chronic pain management. Eur J Pain.. 2018; 22: 1547– 1564. https://pubmed.ncbi.nlm.nih.gov/30074291/ Grotenhermen F. Clinical pharmacokinetics of cannabinoids. J Cannabis Ther, 2003; 3(1): 3-51. https://www.tandfonline.com/doi/abs/10.1300/J175v03n01_02
2024-05-15
Should the dosing regimen of cannabinoid-based products be altered for patients with hepatic insufficiency?
Cannabinoids are metabolized by the liver and excreted through the GI tract and kidney. When considering cannabinoid-based products for patients with severe liver impairment, the dosage of the cannabinoid-based products may need to be adjusted. For example, according to the prescribing information for an FDA-approved cannabidiol product, patients with hepatic impairment require dosage adjustment. A slower dose titration in patients with moderate or severe hepatic impairment than in patients without hepatic impairment is recommended.Highlights for prescribing information for Epidiolex. https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/210365lbl.pdf
2024-05-14
Compared to younger adults, are elderly patients more or less sensitive to the pharmacological effects of cannabinoids?
In general, there is a greater frequency of decreased hepatic, renal, and/or cardiac function in the elderly population compared to younger populations. Also, concomitant disease and other drug therapy is more common in the elderly population, and elderly patients typically metabolize drugs more slowly. As a result of all of these factors, elderly patients are affected by cannabinoids differently than the younger populations are affected. According to the drug monographs of cannabinoid medications approved by the Medicines and Healthcare Products Regulatory Agency in the UK, Health Canada and/or the US Food and Drug Administration, elderly patients may be more sensitive to the psychoactive and neurologic side effects of cannabinoids compared to younger adults. Also, elderly patients may be more sensitive to the hypotensive effects of cannabinoids. FDA Product data for nabilone for oral administration https://www.accessdata.fda.gov/drugsatfda_docs/label/2006/018677s011lbl.pdf accessed 12/24/18
Hughes SG. Prescribing for the elderly patient: why do we need to exercise caution? Br J Clin Pharmacol. 1998;46(6):531-3.
Lloyd SL, Striley CW. Marijuana Use Among Adults 50 Years or Older in the 21st Century. Gerontol Geriatr Med. 2018;4:2333721418781668. Published 2018 Jun 21.
Valeant Canada. Cesamet Product Monograph. 2009. - https://pdf.hres.ca/dpd_pm/00007760.PDF
Abbott Products Inc. Marinol product Monograph. 2010 - https://pdf.hres.ca/dpd_pm/00013378.PDF
GW Pharmaceuticals. Sativex Product Monograph. 2013. - https://pdf.hres.ca/dpd_pm/00016162.PDF
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