Chrobak Adrian Andrzej, Woroń Jarosław, Siwek Marcin
Department of Adult Psychiatry, Chair of Psychiatry, Jagiellonian University Medical College, Kraków, Poland.
Department of Clinical Pharmacology, Chair of Pharmacology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland.
Front Pharmacol. 2024 Oct 22;15:1500312. doi: 10.3389/fphar.2024.1500312. eCollection 2024.
Our objective was to systematically assess the prevalence and clinical features of adverse events related to interactions between cannabinoids and psychotropic drugs through a retrospective chart review.
1586 adverse event reports were assessed. Cases included in the analysis showed a high probability of a causal relationships between cannabinoid-psychotropic drug interactions and adverse events. Data extracted included age, sex, psychotropic drug, cannabinoid products, other medications, and the clinical outcomes and mechanisms of these interactions.
Cannabinoids were involved in 8% of adverse events associated with the concomitant use of psychotropic drugs and other preparations. We identified 20 reports in which side effects presented a causal relationship with the use of psychotropic drugs and cannabinoids. Preparations containing 18% or more tetrahydrocannabinol (THC), presented significant side effects with the following antidepressants: mianserine (restless legs syndrome, urogenital pain, ventricular tachycardia), mirtazapine (pancreatitis, hyperhidrosis, arthralgia), quetiapine (myocarditis, renal failure, bradycardia, sialorrhea), haloperidol (ventricular arrhythmia, prolonged QTc), aripiprazole (prolonged QTc), ventricular tachycardia) and cariprazine (stomach pain, hepatotoxicity), sertraline (ataxia, hyperactivity, coma, hallucinations, anxiety, agitation, tachycardia, panic attacks, disorientation, headache, dizziness, blurry vision, severe emesis, xerostomia, dry eyes), trazodone (disorientation, memory impairment, sedation), fluvoxamine (tachycardia, tachypnoea, dysarthria, auditory hallucinations). Two out of 20 reports (10%) analyzed in our study was related with the simultaneous use of cannabidiol (CBD) oil and sertraline. Concomitant use of those substances was associated with the adverse events in form of diarrhea, emesis, fever and severe fatigue.
Clinicians need to closely monitor adverse events resulting from the combined use of cannabinoids and psychotropic medications. The accumulation of side effects and pharmacokinetic interactions (including CYP and p-glycoprotein inhibition) between these drugs can lead to clinically significant adverse outcomes.
我们的目标是通过回顾性病历审查，系统评估大麻素与精神药物相互作用相关不良事件的发生率和临床特征。
评估了1586份不良事件报告。分析纳入的病例显示大麻素 - 精神药物相互作用与不良事件之间存在因果关系的可能性很高。提取的数据包括年龄、性别、精神药物、大麻素产品、其他药物以及这些相互作用的临床结果和机制。
在与精神药物及其他制剂联合使用相关的不良事件中，8%涉及大麻素。我们确定了20份报告，其中副作用与精神药物和大麻素的使用存在因果关系。含18%或更多四氢大麻酚（THC）的制剂与以下抗抑郁药出现显著副作用：米安色林（不宁腿综合征、泌尿生殖系统疼痛、室性心动过速）、米氮平（胰腺炎、多汗、关节痛）、喹硫平（心肌炎、肾衰竭、心动过缓、流涎）、氟哌啶醇（室性心律失常、QTc延长）、阿立哌唑（QTc延长、室性心动过速）和卡立普唑（胃痛、肝毒性）、舍曲林（共济失调、多动、昏迷、幻觉、焦虑、激动、心动过速、惊恐发作、定向障碍、头痛、头晕、视力模糊、严重呕吐、口干、眼干）、曲唑酮（定向障碍、记忆障碍、镇静）、氟伏沙明（心动过速、呼吸急促、构音障碍、幻听）。我们研究分析的20份报告中有两份（10%）与同时使用大麻二酚（CBD）油和舍曲林有关。这些物质的联合使用与腹泻、呕吐、发热和严重疲劳形式的不良事件相关。
临床医生需要密切监测大麻素与精神药物联合使用产生的不良事件。这些药物之间副作用和药代动力学相互作用（包括CYP和P - 糖蛋白抑制）的累积可导致具有临床意义的不良后果。
