Allen Matthew R, Wightman Gwenyth Portillo, Zhu Zechariah, Poliak Adam, Smith Davey M, Dredze Mark, Ayers John W
School of Medicine, University of California San Diego, #333 CRSF 9500 Gilman Drive, La Jolla, CA, 92093, USA.
Altman Clinical and Translational Research Institute, University of California San Diego, #333 CRSF 9500 Gilman Drive, La Jolla, CA, 92093, USA.
Drug Saf. 2025 Jan;48(1):99-105. doi: 10.1007/s40264-024-01481-x. Epub 2024 Sep 18.
A clinical trial of Epidiolex, the only US FDA-approved cannabis-derived consumer product (CDP), discovered an interaction with an immunosuppressant (tacrolimus) that led to drug toxicity, highlighting the unique intersection of prescription and commonly unregulated consumer products.
We aimed to identify if similar drug-drug interactions (DDIs) are occurring among the consumer CDP market, even though they cannot be identified through trials.
We searched Reddit for subreddits related to CDPs or health, resulting in 63,561,233 posts. From these, we identified 190 posts discussing both immunosuppressants and CDPs. Two blinded investigators evaluated the following. (1) Was there a concern about a potential DDI between consumer CDPs and immunosuppressants? (2) Was there a unique adverse event attributed to a DDI between consumer CDPs and immunosuppressants?
Of these, 66 posts (35%) expressed concern about a potential DDI, such as "Hey, my partner wants to try my edibles … she's on Prograf [tacrolimus] and wants to talk to a stoner who's had a heart transplant." Four posts (2%) reported a unique DDI, such as "I have clinical results that are semi-anecdotal, showing the coordination to my halting substance use … It's the CBD. Shot my prograf to 30 at like 4 mg." Two of the four reported DDIs are similar to those first reported for Epidiolex. The remaining two reported DDIs include a potential cannabidiol (CBD)/sirolimus or delta-9-tetrahydrocannabinol (THC)/sirolimus interaction and a THC/tacrolimus interaction, both resulting in drug toxicity.
This case study is the first to report on DDIs involving consumer CDPs, including both CBD and THC products, as well as a broader class of immunosuppressants. This demonstrates the risks associated with using consumer CDPs alongside prescription medications while highlighting the need for development of increased surveillance to monitor consumer CDPs for drug safety signals, as well as comprehensive regulations that take into account the unique characteristics of the consumer marketplace.
Epidiolex是美国食品药品监督管理局（FDA）批准的唯一一种源自大麻的消费品（CDP），一项关于它的临床试验发现其与一种免疫抑制剂（他克莫司）存在相互作用，导致药物毒性，凸显了处方药与通常不受监管的消费品之间独特的交叉点。
我们旨在确定在消费品CDP市场中是否正在发生类似的药物相互作用（DDIs），即使这些相互作用无法通过试验识别出来。
我们在Reddit上搜索与CDP或健康相关的子版块，共得到63561233个帖子。从这些帖子中，我们识别出190个同时讨论了免疫抑制剂和CDP的帖子。两名盲法研究者对以下内容进行了评估。（1）是否有人担心消费品CDP与免疫抑制剂之间存在潜在的药物相互作用？（2）是否有因消费品CDP与免疫抑制剂之间的药物相互作用而导致的独特不良事件？
其中，66个帖子（35%）表达了对潜在药物相互作用的担忧，例如“嘿，我伴侣想尝尝我的食用大麻制品……她正在服用普乐可复（他克莫司），想和一个做过心脏移植的瘾君子聊聊。”4个帖子（2%）报告了独特的药物相互作用，例如“我有一些半轶事性的临床结果，显示了我停止使用某种物质后的协调性……是大麻二酚。我的普乐可复剂量在4毫克时飙升到了30。”4个报告的药物相互作用中有2个与最初报道的Epidiolex的药物相互作用相似。其余2个报告的药物相互作用包括一种潜在的大麻二酚（CBD）/西罗莫司或9-四氢大麻酚（THC）/西罗莫司相互作用以及一种THC/他克莫司相互作用，两者均导致药物毒性。
本案例研究首次报告了涉及消费品CDP的药物相互作用，包括CBD和THC产品，以及更广泛的一类免疫抑制剂。这证明了同时使用消费品CDP和处方药所带来的风险，同时强调了加强监测以监测消费品CDP的药物安全信号的必要性，以及制定考虑到消费市场独特特征的全面法规。
