Journal: British journal of clinical pharmacology
This publication is a comprehensive narrative review of pharmacokinetic drug–drug interactions between major cannabinoids and commonly used medications, with a focus on mental health and cardiometabolic comorbidities.
Key points:
- Scope of cannabinoids reviewed: Tetrahydrocannabinol (THC), cannabidiol (CBD), cannabinol (CBN), cannabichromene (CBC), and cannabigerol (CBG).
- Clinical context:
- • Therapeutic and investigational use in chronic/neuropathic pain, depression, anxiety, schizophrenia, epilepsy, and cancer.
- • Widespread recreational use and liberalizing cannabis legislation mean more patients may use cannabinoids concurrently with prescription drugs.
- Core focus – pharmacokinetic interactions:
- • Reviews how cannabinoids can alter absorption, distribution, metabolism, and excretion of co‑administered drugs.
- • Emphasizes interactions via hepatic metabolism and transport pathways that may change systemic exposure of standard therapies.
- Drug classes considered:
- • Neuropsychiatric/neurologic treatments: agents used in neuropathic pain, antidepressants, anxiolytics, antipsychotics, antiseizure medications, and cancer therapies.
- • Cardiometabolic treatments: statins, beta‑blockers, warfarin and other anticoagulants, insulin analogues, and metformin.
- Public health and clinical implications:
- • As cannabis access broadens, prescribers must anticipate and monitor for PK interactions in patients using cannabinoids alongside chronic cardiovascular, metabolic, or psychiatric medications.
- • The review underscores the need for careful medication reconciliation, vigilance for changes in efficacy or toxicity, and more robust clinical data to guide dosing and safety.