PMID- 36445409
OWN - NLM
STAT- MEDLINE
DCOM- 20230728
LR  - 20230728
IS  - 2042-7174 (Electronic)
IS  - 0961-7671 (Linking)
VI  - 31
IP  - 1
DP  - 2023 Mar 13
TI  - Medicinal cannabis for patients with chronic non-cancer pain: analysis of safety 
      and concomitant medications.
PG  - 70-79
LID - 10.1093/ijpp/riac073 [doi]
AB  - OBJECTIVES: This study aimed to explore the incidence of adverse events (AEs) 
      reported by patients when initiating medicinal cannabis treatment for chronic 
      pain, and the association of cannabis constituents, dose and concomitant 
      medicines with AE incidence. METHODS: Patient demographics, cannabis products and 
      AE data were collected as part of the Cannabis Access Clinics Observational 
      Study, and concomitant medicines were obtained from patient health summaries 
      provided by referring doctors. Cannabis products were grouped by their 
      constituents as either cannabidiol-only or containing both cannabidiol and 
      Delta-9-tetrahydrocannabinol. KEY FINDINGS: From a total of 275 patients, each had a 
      median of six concomitant medicines, with opioids (n = 179; 65%) the most common. 
      A total of 35.6% patients took 10 or more other medicines, and they were 
      associated with a 3.6 times higher likelihood to report the AE of fatigue (P = 
      0.048). Patients who received concomitant gabapentinoids were 2.4 times more 
      likely to report dizziness (P = 0.036), patients on tricyclic antidepressants 
      were 1.8 times more likely to report somnolence (P = 0.034) and 3.4 times more 
      likely to report anxiety (P = 0.04), when compared with patients who were not 
      prescribed those classes of medications. Those patients who were prescribed 
      products containing both cannabidiol and Delta-9-tetrahydrocannabinol were 1.5 times 
      more likely (P = 0.004) to have experienced an AE when compared with those 
      prescribed only cannabidiol. CONCLUSIONS: These findings show that certain 
      concomitant medications and cannabis constituents may be associated with AE 
      incidence when initiating medicinal cannabis. These potential pharmacokinetic and 
      pharmacodynamic interactions require further study to develop guidance for 
      prescribers and pharmacists.
CI  - (c) The Author(s) 2022. Published by Oxford University Press on behalf of the Royal 
      Pharmaceutical Society.
FAU - Schubert, Elise A
AU  - Schubert EA
AUID- ORCID: 0000-0002-2533-0001
AD  - School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, 
      NSW, 2006, Australia.
FAU - Alffenaar, Johannes C
AU  - Alffenaar JC
AUID- ORCID: 0000-0001-6703-0288
AD  - School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, 
      NSW, 2006, Australia.
AD  - Westmead Hospital, Westmead, NSW, 2145, Australia.
FAU - Johnstone, Masego T
AU  - Johnstone MT
AD  - George Clinical, Newtown, NSW, 2042, Australia.
FAU - Barlow, John W
AU  - Barlow JW
AD  - Applied Cannabis Research, Sydney, 2000, Australia.
FAU - Wheate, Nial J
AU  - Wheate NJ
AUID- ORCID: 0000-0002-0505-1363
AD  - School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, 
      NSW, 2006, Australia.
LA  - eng
PT  - Journal Article
PT  - Observational Study
PL  - England
TA  - Int J Pharm Pract
JT  - The International journal of pharmacy practice
JID - 9204243
RN  - 0 (Analgesics, Opioid)
RN  - 19GBJ60SN5 (Cannabidiol)
RN  - 7J8897W37S (Dronabinol)
RN  - 0 (Medical Marijuana)
SB  - IM
MH  - Humans
MH  - Analgesics, Opioid/adverse effects
MH  - Cannabidiol/adverse effects
MH  - *Cannabis
MH  - *Chronic Pain/drug therapy
MH  - Dronabinol/adverse effects
MH  - *Medical Marijuana/adverse effects
OTO - NOTNLM
OT  - concomitant medicines
OT  - drug interactions
OT  - medicinal cannabis
EDAT- 2022/11/30 06:00
MHDA- 2023/03/16 06:00
CRDT- 2022/11/29 11:13
PHST- 2022/01/27 00:00 [received]
PHST- 2022/09/13 00:00 [accepted]
PHST- 2022/11/30 06:00 [pubmed]
PHST- 2023/03/16 06:00 [medline]
PHST- 2022/11/29 11:13 [entrez]
AID - 6852742 [pii]
AID - 10.1093/ijpp/riac073 [doi]
PST - ppublish
SO  - Int J Pharm Pract. 2023 Mar 13;31(1):70-79. doi: 10.1093/ijpp/riac073.