New York State Practitioner Education Medical Use of Marijuana 2-hr Required Course

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Section 3.0: The Use of Cannabis-based Products in Specific Patient Populations and Drug Interactions

Part 2

Drug Interactions

Patients suffering from multiple sclerosis, chronic pain, cancer or AIDS often take several medications concurrently. In fact, sometimes cannabis and cannabinoid- based oral medicines (e.g. dronabinol, nabilone, nabiximols) are used as adjuvant therapy to alleviate some of the symptoms associated with these various chronic diseases. Presently, we will discuss the metabolism of cannabis and cannabinoid- based medicines. Also, we will address some of the potential drug interactions between cannabinoid medicines and therapeutic agents.

What are the potential drug interactions between chemotherapy agents and nabilone, a synthetic cannabinoid used to treat nausea and vomiting associated with chemotherapy?

What are the potential drug interactions between antiretroviral medications and dronabinol, a cannabinoid drug used for the treatment of AIDS-related cachexia?

Nabiximols (a cannabinoid medicine containing THC and CBD) is approved in Europe for the treatment of neuropathic pain, spasticity and bladder dysfunction in patients suffering from multiple sclerosis. What are the potential drug interactions between nabiximols and analgesic medications?

Some individuals with epilepsy use cannabidiol (CBD) in conjunction with other antiepileptic drugs (AEDs). Are there any known drug/drug interactions between CBD and antiepileptic drugs?

What is the impact of cytochrome P450 isozymes genetic polymorphism on the pharmacokinetics of cannabinoids?

What are the drugs that are inhibitors to cytochrome P450 and therefore decrease the metabolism of cannabinoids?

What are the drugs that are inducers of CYP450 and therefore accelerate the metabolism of cannabinoids? What are the possible clinical repercussions?

Overall, what are the most clinically significant drug interactions that may occur when cannabis is used with other drugs?

Does THC bind to plasma proteins?

Some foods interact with drugs. For example, the consumption of kale or spinach can alter the effectiveness of warfarin. What foods have been found to interact with a mixture of THC and CBD when administered via oromucosal spray?

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