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Prescription Cannabinoid
Aka: Prescription Cannabinoid, Synthetic Cannabinoid Receptor Agonist, Prescribed Tetrahydrocannabinol, Dronabinol, Marinol, Syndros, Nabilone, Cesamet, Cannabidiol, Epidiolex
- See Also
- Cannabinoid
- Indications: Synthetic Tetrahydrocannabinol (THC)
- See Cachexia in Cancer
- See Geriatric Failure to Thrive
- See Nausea in Terminally Ill Patients
- Anorexia in Chronic Renal Failure
- Chemotherapy induced Nausea or Vomiting
- Cachexia in AIDS
- Indications: Purified Cannabidiol (CBD, Epidiolex)
- Lennox–Gastaut Syndrome (rare Seizure Disorder)
- Devinsky (2018) N Engl J Med 378(20):1888-97 [PubMed]
- Dravet Syndrome (rare Seizure Disorder)
- Devinsky (2017) N Engl J Med 376(21):2011-20 [PubMed]
- Mechanism: Two product types derived from Marijuana and hemp
- Synthetic Tetrahydrocannabinol (THC)
- Will generate a positive Urine Drug Screen
- Purified Cannabidiol (CBD)
- Does not cause the "high" seen with THC
- Typically will not generate a positive Urine Drug Screen (but may if trace THC in product)
- Preparations: Cannabidiol (CBD)
- Preparations
- Cannabidiol (Epidiolex) oral solution
- FDA approved in U.S. as of 2018, with a cost of $32,000/year
- DEA Schedule 5
- OTC products (various forms)
- Legal status depends on U.S. State
- Not regulated or studied for efficacy and safety
- Indications: Used to treat rare forms of childhood Epilepsy
- Dravet Syndrome
- Lennox-Gastaut Syndrome
- Tuberous Sclerosis
- Dosing
- Dosed 2.5 mg/kg twice daily (max: 20 mg/kg/day)
- Preparations: Synthetic Tetrahydrocannabinol (THC)
- Nabilone (Cesamet)
- THC analogue used to treat intractable Nausea, Vomiting (e.g. Chemotherapy)
- Dosed 1 mg orally twice daily (max: 6 mg/day in divided doses)
- DEA Schedule 2
- Dronabinol (Marinol)
- THC formulation Indicated for intractable Nausea, Vomiting (e.g. Chemotherapy, AIDS-related Anorexia)
- Dosed 2.5 mg orally (or SL, PR) twice daily, increased to 5-10 mg orally twice daily (max: 20 mg/day)
- DEA Schedule 3 (misuse is less likely due to formulation)
-
Drug Interactions: Cannabidiol (CBD)
- Cannabidiol inhibits CYP2C19, CYP2C8, CYP2C9
- Increases levels of Citalopram, Phenytoin, Amitriptyline, Valproic Acid, Warfarin
- Cannabidiol levels may be lowered
- Strong CYP3A4 Inducers lower CBD levels (e.g. St. John's Wort, Carbamazepine, Phenytoin, Rifampin)
- Strong CYP3A4 inhibitors raise CBD levels (e.g. Clarithromycin)
- Adverse Effects: CBD
- Drowsiness or sedation (esp. in combination with other CNS Depressants)
- Diarrhea
- Liver Function Test abnormalities
- Safety
- Avoid THC and CBD in pregnancy, Lactation and those taking multiple medications
- Check CBD product for a certificate of analysis that reports CBD levels, THC levels and contaminants
- Resources
- Simplified Guideline for prescribing Medical Cannabinoids in Primary Care
- http://www.cfp.ca/content/cfp/64/2/111.full.pdf
- Allan (2018) Can Fam Physician 64(2): 111-20 [PubMed]
- References
- (2019) Presc Lett 26(6)
- (2018) Presc Lett 25(4)
- (2018) Presc Lett 25(9):51