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Study register · detail Narrative Review · Safety & Adverse Effects · 2018

Medicinal Cannabis—Potential Drug Interactions

Alsherbiny et al. ·Medicines Impact 2.4
No direction reported 158 citations
SampleNarrative Review
DesignNarrative Review
Summary

Narrative overview of pharmacokinetic and pharmacodynamic interactions of medical cannabinoids; bidirectional effects via P-glycoprotein, BCRP, MRP and CYP450/UGT enzymes. Particular caution recommended in elderly patients and persons with renal/hepatic disease.

P
PopulationOncology patients with various indications (CINV, tumor-associated pain, chemotherapy-induced neuropathy), pooled samples n=64 to n=399 per study
I
InterventionVarious cannabinoid preparations: nabiximols (Sativex®, THC:CBD 27:25 mg/mL oromucosal spray), dronabinol (Marinol®, oral 2.5–20 mg), nabilone, cannabis cigarettes (3.56% THC inhaled)
O
OutcomeMixed evidence: nabiximols effective at low-to-medium dose against tumor pain, no superiority in treatment-refractory pain (phase 3 RCTs n=177/399); dronabinol effective against CINV; nabilone with poor nausea control
Quality profile
Sample size —
Blinding —
Effect size —
Citations / year ★★★★★
Authors
Alsherbiny M A, Li C G
DOI 10.3390/medicines6010003↗
Design: Narrative Review
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Indication
Further studies on Safety & Adverse Effects
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Systematische Review + Meta-Analyse über k=58 RCTs (n=6.611, Alter ≥50 Jahre, 50% männlich, n=3.450 erhielten Cannabis-Produkte). Incidence Rate Difference (IRD) für alle unerwünschten Ereignisse bei THC-haltigen Produkten: THC allein IRD=18,83 (95% CI 1,47–55,79), THC:CBD-Kombination IRD=19,37 (95% CI 4,24–45,47). IRD für schwere Nebenwirkungen, Abbrüche, Todesfälle nicht signifikant erhöht. THC-dosisabhängig: Mundtrockenheit, Schwindel, Koordinationsschwierigkeiten, Somnolenz. Wöchentliche THC:CBD-Dosis-Interaktion relevant für neurologische, psychiatrische, kardiale Nebenwirkungen.

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A Velayudhan et al. · 2021 · PLOS Medicine
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Safety and tolerability of natural and synthetic cannabinoids in adults aged over 50 years: A systematic review and meta-analysis
Mixed Systematische Review + Meta-Analyse

SR+MA, k=46 RCTs, n=6.216 Erwachsene ≥50 Jahre; THC-haltige CBMs erhöhten alle UAW signifikant: THC allein IRR 1,42 [95% CI 1,12–1,78]; THC:CBD-Kombination IRR 1,58 [95% CI 1,26–1,98]; THC:CBD erhöhte Abbruchrate wegen UAW (RR 1,40 [95% CI 1,08–1,80]); kein signifikant erhöhtes Risiko für schwere UAW oder Todesfälle; CBD allein: IRR 1,02 [95% CI 0,90–1,16], kein erhöhtes UAW-Risiko.

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A Chesney et al. · 2020 · Neuropsychopharmacology
278 citations
Adverse effects of cannabidiol: a systematic review and meta-analysis of randomized clinical trials
Harm Meta-Analyse

Systematische Review + Meta-Analyse zu CBD-Sicherheit über k=12 doppelblinde RCTs (n=803). CBD vs. Placebo: erhöhtes Risiko für Studienabbruch (OR 2.61, 95% CI 1.38-4.96), schwere unerwünschte Ereignisse (OR 2.30, 95% CI 1.18-4.48), abnorme Leberwerte (OR 11.19, 95% CI 2.09-60.02), Pneumonie (OR 5.37, 95% CI 1.17-24.65), Appetitminderung (OR 3.56, 95% CI 1.94-6.53), Diarrhö (OR 2.61, 95% CI 1.46-4.67), Somnolenz (OR 2.23, 95% CI 1.07-4.64). Leberwert-Anomalien, Somnolenz, Sedierung und Pneumonie limitiert auf kindliche Epilepsie-Studien (Interaktion mit Clobazam/Valproat möglich). Nach Ausschluss kindlicher Epilepsie: nur Diarrhö assoziiert (OR 5.03, 95% CI 1.44-17.61).

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