Coates Shelby, Bardhi Keti, Lazarus Philip
Department of Pharmaceutical Sciences, College of Pharmacy and Pharmaceutical Sciences, Washington State University, 412 E. Spokane Falls Blvd, Spokane, WA 99202, USA.
Pharmaceutics. 2024 Mar 18;16(3):418. doi: 10.3390/pharmaceutics16030418.
Opioids are commonly prescribed for the treatment of chronic pain. Approximately 50% of adults who are prescribed opioids for pain co-use cannabis with their opioid treatment. Morphine is primarily metabolized by UDP-glucuronosyltransferase (UGT) 2B7 to an inactive metabolite, morphine-3-glucuronide (M3G), and an active metabolite, morphine-6-glucuronide (M6G). Previous studies have shown that major cannabis constituents including Δ-tetrahydrocannabinol (THC) and cannabidiol (CBD) inhibit major UGT enzymes. To examine whether cannabinoids or their major metabolites inhibit morphine glucuronidation by UGT2B7, in vitro assays and mechanistic static modeling were performed with these cannabinoids and their major metabolites including 11-hydroxy-Δ-tetrahydrocannabinol (11-OH-THC), 11-nor-9-carboxy-Δ-tetrahydrocannabinol (11-COOH-THC), 7-hydroxy-cannabidiol (7-OH-CBD), and 7-carboxy-cannabidiol (7-COOH-CBD). In vitro assays with rUGT-overexpressing microsomes and human liver microsomes showed that THC and CBD and their metabolites inhibited UGT2B7-mediated morphine metabolism, with CBD and THC exhibiting the most potent K values (0.16 µM and 0.37 µM, respectively). Only 7-COOH-CBD exhibited no inhibitory activity against UGT2B7-mediated morphine metabolism. Static mechanistic modeling predicted an in vivo drug-drug interaction between morphine and THC after inhaled cannabis, and between THC, CBD, and 7-OH-CBD after oral consumption of cannabis. These data suggest that the co-use of these agents may lead to adverse drug events in humans.
阿片类药物常用于治疗慢性疼痛。约50%接受阿片类药物止痛治疗的成年人在使用阿片类药物的同时还使用大麻。吗啡主要通过尿苷二磷酸葡萄糖醛酸基转移酶(UGT)2B7代谢为无活性代谢物吗啡-3-葡萄糖醛酸苷(M3G)和活性代谢物吗啡-6-葡萄糖醛酸苷(M6G)。先前的研究表明,包括Δ-四氢大麻酚(THC)和大麻二酚(CBD)在内的大麻主要成分会抑制主要的UGT酶。为了研究大麻素或其主要代谢物是否会抑制UGT2B7介导的吗啡葡萄糖醛酸化,对这些大麻素及其主要代谢物进行了体外试验和机制静态建模,这些代谢物包括11-羟基-Δ-四氢大麻酚(11-OH-THC)、11-去甲-9-羧基-Δ-四氢大麻酚(11-COOH-THC)、7-羟基-大麻二酚(7-OH-CBD)和7-羧基-大麻二酚(7-COOH-CBD)。使用过表达rUGT的微粒体和人肝微粒体进行的体外试验表明,THC、CBD及其代谢物抑制UGT2B7介导的吗啡代谢,CBD和THC表现出最强的K值(分别为0.16 μM和0.37 μM)。只有7-COOH-CBD对UGT2B7介导的吗啡代谢没有抑制活性。静态机制建模预测,吸入大麻后吗啡与THC之间以及口服大麻后THC、CBD和7-OH-CBD之间会发生体内药物相互作用。这些数据表明,同时使用这些药物可能会导致人类出现不良药物事件。