Faculty of Medicine, University of Ottawa, Ont, Canada.
Health Canada, Ottawa, Ont, Canada.
Am J Med. 2019 Nov;132(11):1266-1270. doi: 10.1016/j.amjmed.2019.05.017. Epub 2019 May 30.
Cannabis sativa and related products are widely used, but their potential to cause significant clinical interactions remains unclear, particularly for cannabinoid-enriched or otherwise concentrated products. The pharmacokinetics of most cannabis products is not known. Where information is known, there is wide variation. Extrapolation of limited clinical data is complicated by the complexity and variability of cannabis products as well as their delivery through various routes of administration. In vitro evidence shows that the major cannabinoids are substrates for numerous metabolic enzymes, including the cytochrome P450 metabolizing enzymes. Whereas many consumers consider cannabis products to be safe relative to alternative prescription or narcotic drugs, clinical reports of cannabis-related drug interactions and adverse events are increasing in frequency. Patients using these products, whether for medical or nonmedical purposes, together with conventional therapeutic agents may be at increased risk of adverse events, including therapeutic failure, and require enhanced monitoring.
大麻植物及其相关产品的应用非常广泛，但它们引起显著临床药物相互作用的潜力尚不清楚，尤其是对于富含大麻素或其他浓缩产品。大多数大麻产品的药代动力学尚未明确。已知信息差异较大。由于大麻产品的复杂性和变异性以及它们通过不同给药途径的使用，对有限的临床数据进行推断变得复杂。体外证据表明，主要大麻素是许多代谢酶的底物，包括细胞色素 P450 代谢酶。尽管许多消费者认为大麻产品与替代处方或麻醉药物相比是安全的，但与大麻相关的药物相互作用和不良事件的临床报告频率正在增加。使用这些产品（无论是出于医疗目的还是非医疗目的）的患者与常规治疗药物一起使用，可能会增加发生不良事件（包括治疗失败）的风险，需要加强监测。
