Delta-9-Tetrahydrocannabinol and Cannabidiol Drug-Drug Interactions

Paul T Kocis; Kent E Vrana

doi:10.1159/000507998

Delta-9-Tetrahydrocannabinol and Cannabidiol Drug-Drug Interactions

Med Cannabis Cannabinoids. 2020 Jul 7;3(1):61-73. doi: 10.1159/000507998. eCollection 2020 Aug.

Authors

Paul T Kocis^{1

2}, Kent E Vrana²

Affiliations

¹ Department of Pharmacy, Penn State Health, Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA.
² Department of Pharmacology, Penn State College of Medicine, Hershey, Pennsylvania, USA.

Abstract

Although prescribing information (PI) is often the initial source of information when identifying potential drug-drug interactions, it may only provide a limited number of exemplars or only reference a class of medications without providing any specific medication examples. In the case of medical cannabis and medicinal cannabinoids, this is further complicated by the fact that the increased therapeutic use of marijuana extracts and cannabidiol oil will not have regulatory agency approved PI. The objective of this study was to provide a detailed and comprehensive drug-drug interaction list that is aligned with cannabinoid manufacturer PI. The cannabinoid drug-drug interaction information is listed in this article and online supplementary material as a PRECIPITANT (cannabinoid) medication that either INHIBITS/INDUCES the metabolism or competes for the same SUBSTRATE target (metabolic enzyme) of an OBJECT (OTHER) medication. In addition to a comprehensive list of drug-drug interactions, we also provide a list of 57 prescription medications displaying a narrow therapeutic index that are potentially impacted by concomitant cannabinoid use (whether through prescription use of cannabinoid medications or therapeutic/recreational use of cannabis and its extracts).

Keywords: Cannabidiol; Cannabis; Cytochrome P450; Drug-drug interactions; Medical marijuana; Metabolism; Tetrahydrocannabinol.

Publication types

Review