School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, NSW, 2006, Australia.
Westmead Hospital, Westmead, NSW, 2145, Australia.
Int J Pharm Pract. 2023 Mar 13;31(1):70-79. doi: 10.1093/ijpp/riac073.
This study aimed to explore the incidence of adverse events (AEs) reported by patients when initiating medicinal cannabis treatment for chronic pain, and the association of cannabis constituents, dose and concomitant medicines with AE incidence.
Patient demographics, cannabis products and AE data were collected as part of the Cannabis Access Clinics Observational Study, and concomitant medicines were obtained from patient health summaries provided by referring doctors. Cannabis products were grouped by their constituents as either cannabidiol-only or containing both cannabidiol and Δ-9-tetrahydrocannabinol.
From a total of 275 patients, each had a median of six concomitant medicines, with opioids (n = 179; 65%) the most common. A total of 35.6% patients took 10 or more other medicines, and they were associated with a 3.6 times higher likelihood to report the AE of fatigue (P = 0.048). Patients who received concomitant gabapentinoids were 2.4 times more likely to report dizziness (P = 0.036), patients on tricyclic antidepressants were 1.8 times more likely to report somnolence (P = 0.034) and 3.4 times more likely to report anxiety (P = 0.04), when compared with patients who were not prescribed those classes of medications. Those patients who were prescribed products containing both cannabidiol and Δ-9-tetrahydrocannabinol were 1.5 times more likely (P = 0.004) to have experienced an AE when compared with those prescribed only cannabidiol.
These findings show that certain concomitant medications and cannabis constituents may be associated with AE incidence when initiating medicinal cannabis. These potential pharmacokinetic and pharmacodynamic interactions require further study to develop guidance for prescribers and pharmacists.
本研究旨在探讨慢性疼痛患者起始使用医用大麻治疗时报告的不良事件（AE）发生率，以及大麻成分、剂量和伴随药物与 AE 发生率的关系。
患者人口统计学资料、大麻产品和 AE 数据作为大麻准入诊所观察性研究的一部分进行收集，同时通过主治医生提供的患者健康记录获取伴随药物信息。大麻产品根据其成分分为仅含大麻二酚或同时含有大麻二酚和 Δ-9-四氢大麻酚的产品。
在总共 275 名患者中，每位患者平均同时使用六种伴随药物，其中最常见的是阿片类药物（n = 179；65%）。共有 35.6%的患者同时服用 10 种或更多其他药物，他们报告疲劳 AE 的可能性高出 3.6 倍（P = 0.048）。同时使用加巴喷丁类药物的患者报告头晕的可能性高出 2.4 倍（P = 0.036），同时使用三环类抗抑郁药的患者报告嗜睡的可能性高出 1.8 倍（P = 0.034），报告焦虑的可能性高出 3.4 倍（P = 0.04），与未开具这些类药物的患者相比。与仅使用大麻二酚的患者相比，使用同时含有大麻二酚和 Δ-9-四氢大麻酚的产品的患者发生 AE 的可能性高出 1.5 倍（P = 0.004）。
这些发现表明，某些伴随药物和大麻成分可能与起始医用大麻治疗时 AE 的发生有关。这些潜在的药代动力学和药效学相互作用需要进一步研究，以制定为处方者和药剂师提供指导。
