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Safety and Interactions of Cannabinoids

surety

Cannabinoids show a good safety profile when the correct dosage is used and the contraindications and interactions are considered1.2. An overdose of medical cannabis leading to death is unknown and very unlikely, as CB1 receptors in the brainstem, which is responsible for cardiorespiratory control, are only slightly expressed3.4.

side effects

The adverse effects of cannabinoid drugs are subject to a class effect and do not differ significantly between the various preparations. They are usually dependent on the dose of THC and usually occur in moderate form at the start of therapy.

According to the final report of the BfArM monitoring survey on the first five years of use of medical cannabis in Germany (2017 - 2022), side effects occurred with the following frequencies:

Very common (≥ 10%)

  • weariness

Common (≥ 1% to < 10%)

  • vertigo
  • somnolence
  • nausea
  • dry mouth
  • Difficulty concentrating
  • increase in appetite
  • balance disorders
  • memory problems
  • weight gain
  • disorientation
  • lethargy
  • Blurred vision
  • Euphoric mood
  • depression
  • diarrhoea

Uncommon (≥ 0.1% to < 1%)

  • constipation
  • tachycardia
  • vomiting
  • hypotension
  • palpitations
  • hallucinations
  • Delusions of the senses
  • delusions
  • dysarthria
  • hypertension
  • dissociation
  • suicidal ideation

interactions

THC and CBD are metabolized primarily by the cytochrome P450 system.

CBD acts as a stronger inhibitor of certain CYP450 enzymes and is administered in higher doses, which is why it generally has a higher interaction potential than THC:

  • CBD may interact with drugs that are metabolized primarily by the following enzymes: CYP3A, CYP2C9, CYP2C19 and to a lesser extent CYP2D6 and CYP1A2.
  • THC may interact with drugs that are metabolized primarily by the following enzymes: CYP2C9 and CYP3A4.

sources

  1. Whiting PF, Wolff RF, Deshpande S, et al. Cannabinoids for Medical Use: A Systematic Review and Meta-Analysis. JAMA. 2015; 313 (24) :2456-2473.
  2. Price RL, Charlot KV, Frieler S, Dettori JR, Oskouian R, Chapman JR. The Efficacy of Cannabis in Reducing Back Pain: A Systematic Review. Global Spine J. 2022.
  3. Herkenham M, Lynn AB, Johnson MR, et al. Characterization and Localization of Cannabinoid Receptors in Rat Brain. The Journal of Neuroscience, 1991.
  4. Müller-Vahl KR & Grotenhermen F. Cannabis and cannabinoids in medicine. Medical Scientific Publishing Company, 2020.