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Prescription Cannabinoid

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

  • 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. Epidiolex oral solution
    1. FDA approved in U.S. as of 2018, with a cost of $32,000/year
  2. OTC products (various forms)
    1. Legal status depends on U.S. State
    2. Not regulated or studied for efficacy and safety
  • Preparations
  • Synthetic Tetrahydrocannabinol (THC)
  1. Nabilone (Cesamet, FDA CII) 1-2 mg orally every 12 hours
  2. Dronabinol
    1. Marinol capsules (FDA CIII as misuse is less likely due to formulation)
      1. Dose: 5-10 mg orally, rectally or sublingual every 6-8 hours
    2. Syndros liquid (FDA CII)
  • 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
  1. Simplified Guideline for prescribing Medical Cannabinoids in Primary Care
    1. http://www.cfp.ca/content/cfp/64/2/111.full.pdf
    2. Allan (2018) Can Fam Physician 64(2): 111-20 [PubMed]
  • References
  1. (2019) Presc Lett 26(6)
  2. (2018) Presc Lett 25(4)
  3. (2018) Presc Lett 25(9):51