Clinical Overview: Cannabis May Interact With Prescription Medications

Clinical Overview: Cannabis May Interact With Prescription Medications
Clinical Overview: Cannabis May Interact With Prescription Medications

A rise in hashish use has led to rising issues surrounding interactions between its elements, THC and CBD, and prescription medicines.

Cannabis use has develop into more and more extra widespread all through the USA. In keeping with the CDC, almost 1 in 5 adults reported utilizing hashish not less than as soon as in 2019.1

Picture credit score: Elroi |

As well as, as of June 2023, 23 states, 2 territories, and the District of Columbia have legalized its leisure use.2 With the rise in hashish use, issues surrounding interactions between its elements (tetrahydrocannabinol [THC] and cannabidiol [CBD]) and prescription medicines have gotten more and more related.

Medications which can be substrates of cytochrome P450 (CYP), glycoprotein P (P-gp), and different drug transporters (summarized within the desk under) might theoretically work together with hashish. In vitro research have proven that each THC and CBD competitively inhibit a number of of those enzymes which can be chargeable for the metabolism of many prescribed drugs.3,4

Desk 1. Abstract of main drug interactions with THC5

One among Many Affected person Populations at Danger: Stable Organ Transplant Recipients

CBD has been reported to work together with a number of of the principle immunosuppressant medicines that function life-long remedy for sufferers who’ve obtained a strong organ transplant. Particularly, CBD has been proven to have an effect on the metabolism of calcineurin inhibitors and mTOR inhibitors, comparable to cyclosporine, tacrolimus, sirolimus, and everolimus, leading to a rise in serum blood ranges of every of those medicines that may result in poisonous opposed results (AEs).6

One particular instance of this can be a case report of a 32-year-old participant in a CBD scientific trial for refractory epilepsy who was additionally receiving tacrolimus. The affected person had a 3-fold improve in dose-normalized tacrolimus concentrations whereas receiving 2000-2900 mg/day of CBD.7

The administration of serum tacrolimus trough ranges could be difficult in sufferers who concomitantly use hashish because of an absence in regulation of accessible merchandise presently. The dose, route, and frequency of hashish use extremely influences the extent of interplay.8

Danger by Product Formulation

Routes of administration for hashish embrace inhalation (smoking), oral consumption, and topical utility with the very best danger for AEs related to inhalation. Each THC and CBD are quickly absorbed following inhalation, rising the imply dose-normalized most focus by larger than 3-35 occasions compared with oral consumption.

Oral formulations pose a reasonable danger for interplay and topical utility poses the bottom danger.8 Out there topical formulations embrace cream, gel, oil, and transdermal patches.

Determine 1. Antagonistic response danger by hashish product formulation

Concerning the Authors

Katherine Kreusel, BSPS, PharmD Candidate, College of Mississippi Class of 2025.

Preceptors: Karen Kolbet, PharmD, and Linda Huang, PharmD, BCPS, BCACP.


  1. Marijuana and Public Well being: Knowledge and Statistics. Facilities for Illness Management and Prevention. Up to date June 8, 2021. Accessed June 15, 2023.
  2. State Medical Cannabis Legal guidelines. Nationwide Convention of State Legislatures. Up to date June 22, 2023. Accessed July 12, 2023.
  3. Iffland Ok, Grotenhermen F. An Replace on Security and Aspect Results of Cannabidiol: A Evaluate of Clinical Knowledge and Related Animal Research. Cannabis Cannabinoid Res. 2017;2(1):139-154. Revealed 2017 Jun 1. doi:10.1089/can.2016.0034
  4. Lopera V, Rodríguez A, Amariles P. Clinical Relevance of Drug Interactions with Cannabis: A Systematic Evaluate. J Clin Med. 2022;11(5):1154. Revealed 2022 Feb 22. doi:10.3390/jcm11051154
  5. Brown JD. Potential Antagonistic Drug Occasions with Tetrahydrocannabinol (THC) As a consequence of Drug-Drug Interactions. J Clin Med. 2020;9(4):919. Revealed 2020 Mar 27. doi:10.3390/jcm9040919
  6. Balachandran P, Elsohly M, Hill KP. Cannabidiol Interactions with Medications, Illicit Substances, and Alcohol: a Complete Evaluate. J Gen Intern Med. 2021;36(7):2074-2084. doi:10.1007/s11606-020-06504-8
  7. Leino AD, Emoto C, Fukuda T, Privitera M, Vinks AA, Alloway RR. Proof of a clinically important drug-drug interplay between cannabidiol and tacrolimus. Am J Transplant. 2019;19(10):2944-2948. doi:10.1111/ajt.15398
  8. Melaragno JI, Bowman LJ, Park JM, et al. The Clinical Conundrum of Cannabis: Present Practices and Suggestions for Transplant Clinicians: An Opinion of the Immunology/Transplantation PRN of the American School of Clinical Pharmacy. Transplantation. 2021;105(2):291-299. doi:10.1097/TP.0000000000003309



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