Department of Pharmaceutical Sciences, Faculty of Chemistry, Universidad de la República, Montevideo, Uruguay.
Instituto de Investigaciones Biológicas Clemente Estable - MEC, Montevideo, Uruguay.
Curr Pharm Des. 2024;30(4):241-254. doi: 10.2174/0113816128288510240113170116.
Concomitant use of cannabinoids with other drugs may result in pharmacokinetic drug-drug interactions, mainly due to the mechanism involving Phase I and Phase II enzymes and/or efflux transporters. Cannabinoids are not only substrates but also inhibitors or inducers of some of these enzymes and/or transporters. This narrative review aims to provide the available information reported in the literature regarding human data on the pharmacokinetic interactions of cannabinoids with other medications. A search on Pubmed/Medline, Google Scholar, and Cochrane Library was performed. Some studies were identified with Google search. Additional articles of interest were obtained through cross-referencing of published literature. All original research papers discussing interactions between cannabinoids, used for medical or recreational/adult-use purposes, and other medications in humans were included. Thirty-two studies with medicinal or recreational/adult-use cannabis were identified (seventeen case reports/series, thirteen clinical trials, and two retrospective analyses). In three of these studies, a bidirectional pharmacokinetic drug-drug interaction was reported. In the rest of the studies, cannabinoids were the perpetrators, as in most of them, concentrations of cannabinoids were not measured. In light of the widespread use of prescribed and non-prescribed cannabinoids with other medications, pharmacokinetic interactions are likely to occur. Physicians should be aware of these potential interactions and closely monitor drug levels and/or responses. The existing literature regarding pharmacokinetic interactions is limited, and for some drugs, studies have relatively small cohorts or are only case reports. Therefore, there is a need for high-quality pharmacological studies on cannabinoid-drug interactions.
同时使用大麻素与其他药物可能导致药代动力学的药物相互作用，主要是由于涉及 I 相和 II 相酶和/或外排转运体的机制。大麻素不仅是底物，也是一些这些酶和/或转运体的抑制剂或诱导剂。本叙述性综述旨在提供文献中关于大麻素与其他药物的药代动力学相互作用的人类数据的现有信息。在 Pubmed/Medline、Google Scholar 和 Cochrane Library 上进行了搜索。通过谷歌搜索确定了一些研究。通过交叉引用已发表的文献获得了其他感兴趣的文章。所有讨论大麻素（用于医疗或娱乐/成人用途）与其他药物之间相互作用的原始研究论文，均被包括在内。共确定了 32 项使用药用或娱乐/成人使用大麻的研究（十七项病例报告/系列、十三项临床试验和两项回顾性分析）。在其中三项研究中，报告了双向药代动力学药物相互作用。在其余的研究中，大麻素是肇事者，因为在大多数研究中，没有测量大麻素的浓度。鉴于处方和非处方大麻素与其他药物的广泛使用，可能会发生药代动力学相互作用。医生应该意识到这些潜在的相互作用，并密切监测药物水平和/或反应。关于药代动力学相互作用的现有文献有限，对于一些药物，研究的队列相对较小，或者只是病例报告。因此，需要对大麻素药物相互作用进行高质量的药理学研究。
