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Prescription Cannabinoid

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Prescription Cannabinoid, Synthetic Cannabinoid Receptor Agonist, Prescribed Tetrahydrocannabinol, Dronabinol, Marinol, Syndros, Nabilone, Cesamet, Cannabidiol, Epidiolex

  • See Also
  • Indications
  • Purified Cannabidiol (CBD, Epidiolex)
  • Mechanism
  • Two product types derived from Marijuana and hemp
  1. Synthetic Tetrahydrocannabinol (THC)
    1. Will generate a positive Urine Drug Screen
  2. Purified Cannabidiol (CBD)
    1. Does not cause the "high" seen with THC
    2. Typically will not generate a positive Urine Drug Screen (but may if trace THC in product)
  • Preparations
  • Cannabidiol (CBD)
  1. Preparations
    1. Cannabidiol (Epidiolex) oral solution
      1. FDA approved in U.S. as of 2018, with a cost of $32,000/year
      2. DEA Schedule 5
    2. OTC products (various forms)
      1. Legal status depends on U.S. State
      2. Not regulated or studied for efficacy and safety
  2. Indications: Used to treat rare forms of childhood Epilepsy
    1. Dravet Syndrome
    2. Lennox-Gastaut Syndrome
    3. Tuberous Sclerosis
  3. Dosing
    1. Dosed 2.5 mg/kg twice daily (max: 20 mg/kg/day)
  1. Nabilone (Cesamet)
    1. THC analogue used to treat intractable Nausea, Vomiting (e.g. Chemotherapy)
    2. Dosed 1 mg orally twice daily (max: 6 mg/day in divided doses)
    3. DEA Schedule 2
  2. Dronabinol (Marinol)
    1. THC formulation Indicated for intractable Nausea, Vomiting (e.g. Chemotherapy, AIDS-related Anorexia)
    2. Dosed 2.5 mg orally (or SL, PR) twice daily, increased to 5-10 mg orally twice daily (max: 20 mg/day)
    3. DEA Schedule 3 (misuse is less likely due to formulation)
  • Drug Interactions
  • Cannabidiol (CBD)
  1. Cannabidiol inhibits CYP2C19, CYP2C8, CYP2C9
    1. Increases levels of Citalopram, Phenytoin, Amitriptyline, Valproic Acid, Warfarin
  2. Cannabidiol levels may be lowered
    1. Strong CYP3A4 Inducers lower CBD levels (e.g. St. John's Wort, Carbamazepine, Phenytoin, Rifampin)
    2. Strong CYP3A4 inhibitors raise CBD levels (e.g. Clarithromycin)
  • Adverse Effects
  • CBD
  1. Drowsiness or sedation (esp. in combination with other CNS Depressants)
  2. Diarrhea
  3. Liver Function Test abnormalities
  • Safety
  1. Avoid THC and CBD in pregnancy, Lactation and those taking multiple medications
  2. Check CBD product for a certificate of analysis that reports CBD levels, THC levels and contaminants
  • Resources
  • References
  1. (2019) Presc Lett 26(6)
  2. (2018) Presc Lett 25(4)
  3. (2018) Presc Lett 25(9):51