Arellano Ana Lucia, Papaseit Esther, Romaguera Anna, Torrens Marta, Farré Magi
Clinical Pharmacology Department, Hospital Universitari Germans Trias i Pujol-IGTP and Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Carretera de Canyet s/n. 08916 Badalona, Spain.
Clinical Pharmacology Department, Hospital Universitari Germans Trias i Pujol-IGTP. Carretera de Canyet s/n. 08916 Badalona, Spain.
CNS Neurol Disord Drug Targets. 2017;16(5):554-566. doi: 10.2174/1871527316666170413104516.
BACKGROUND & OBJECTIVE: Cannabis is the most widely used illicit drug. The two most important natural cannabinoids are delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD). The THC content of cannabis has been increasing during the last years and recently appeared in the market as a series of synthetic cannabinoids with potent agonist activity. Recreational users frequently combine cannabis with other drugs of abuse as alcohol, amphetamines and derivatives, nicotine and cocaine. In addition, these subjects can be taking medicines for acute and chronic medical conditions. The increasing use of medicinal cannabis for chronic pain and neurological and psychiatric disorders can produce potential interactions with medications used for the symptomatic treatment of these or other diseases.
THC and CBD are metabolized mainly in the liver by cytochrome P-450 isoenzymes (mainly CYP2Cs and CYP3A4). In vitro studies indicate that THC and CBD both inhibit CYP1A1, 1A2 and 1B1 enzymes, and recent studies have indicated that CBD is also a potent inhibitor of CYP2C19 and CYP3A4. Both cannabinoids may interact with other medications metabolized by the same pathway or by inducers/inhibitors of the isoenzymes. Cannabis produces sedation, impairs psychomotor performance, and increases blood pressure and heart rate. Pharmacodynamic interactions with other sedatives can potentiate the central effects but can be decreased by psychostimulants. This review focuses on the interactions between cannabinoids and alcohol, other drugs of abuse, and prescription medicines.
大麻是使用最为广泛的非法药物。两种最重要的天然大麻素是Δ⁹-四氢大麻酚（THC）和大麻二酚（CBD）。在过去几年里，大麻中的THC含量一直在增加，最近市场上出现了一系列具有强效激动剂活性的合成大麻素。消遣性使用者经常将大麻与其他滥用药物如酒精、苯丙胺及其衍生物、尼古丁和可卡因混合使用。此外，这些人可能正在服用治疗急慢性疾病的药物。医用大麻用于治疗慢性疼痛、神经和精神疾病的使用增加，可能会与用于这些疾病或其他疾病对症治疗的药物产生潜在相互作用。
THC和CBD主要在肝脏中通过细胞色素P-450同工酶（主要是CYP2C和CYP3A4）进行代谢。体外研究表明，THC和CBD均抑制CYP1A1、1A2和1B1酶，最近的研究表明，CBD也是CYP2C19和CYP3A4的强效抑制剂。两种大麻素都可能与通过相同途径代谢的其他药物或同工酶的诱导剂/抑制剂相互作用。大麻会产生镇静作用，损害精神运动表现，并升高血压和心率。与其他镇静剂的药效学相互作用可增强中枢作用，但可被精神兴奋剂减弱。本综述重点关注大麻素与酒精、其他滥用药物和处方药之间的相互作用。
