THOUGHTS FROM DOC
Medical Cannabis-Related
Drug Interactions
by Dr . Michael J . Poppa DO , MBA
When considering medical cannabis-related drug interactions , in general , cannabinoids are usually well-tolerated . However , as in prescribing any medication , individuals , especially the elderly and people with chronic diseases or kidney and liver conditions , should be monitored more frequently .
Generally speaking , drug interactions occur as drug / drug interactions due to pharmacodynamics mechanisms involving absorption , distribution , metabolism , and excretion . Most drug interactions occur through affecting drug metabolism enzymes such as cytochrome P450 . In addition , it is important to remember that THC-CBD ratios , as well as different strain profiles with variable cannabinoids and terpenes can also influence drug side-effects with interactions .
According to drugs . com , they found a total of 365 drugs that are known to interact with cannabis . Of those , 27 demonstrated major drug interactions ( Highly clinically significant — avoid combinations ; the risk of interaction outweighs the benefit ). Then there are the Moderately clinically significant — usually avoid combinations , use it only under special circumstances . The drugs listed with major interactions include the following : Morphine and Tramadol . The combination of these drugs with medical cannabis can consist of serious side-effects such as respiratory distress , coma , and death .
The drugs listed with moderate drug interactions included the following medications , but certainly , there are probably more which have not been tested . The drugs that have been tested and are in the moderate category include alcohol ( alcoholic beverages ), Amitriptyline , Ativan ( Lorazepam ), Benadryl ( Diphenhydramine ), Cymbalta ( Duloxetine ), Flexeril ( Cyclobenzaprine ), Klonopin ( Clonazepam ), Lexapro ( Escitalopram ), Lyrica ( Pregabalin ), Seroquel ( Quetiapine ), Xanax ( Alprazolam ), Zoloft ( Sertraline ), and Zyrtec ( Cetirizine ).
There are also several drugs for which no reported drug interactions occurred with cannabis , and those include Adderall , ibuprofen , acetaminophen , Tylenol , vitamins , and Zofran ( Ondansetron ).
Although this list is not exhaustive , it does categorize many of the commonly used medications for the treatment of psychological conditions , painful conditions , as well as other medical conditions that people have received treatment for , and for which they are or will be taking medical cannabis .
58 January 2023
The bottom line is , always discuss your medications with your treating physician and undergo routine blood serum laboratory testing . Blood serum is the liquid part of the blood that contains no clotting factors or blood cells . When doctors check for serum blood levels , they are usually checking for lithium levels in the bloodstream to be sure that the right dosage is being administered . It is important to tell your doctor about all other medications you use , including vitamins and herbs . Do not stop using any medications without first talking to your doctor .
� Drug Interaction Classification by Drugs . com
These classifications are only a guideline . The relevance of a particular drug interaction to a specific individual is difficult to determine . Always consult your healthcare provider before starting or stopping any medication .
Major
Moderate
Minor
Highly clinically significant . Avoid combinations ; the risk of the interaction outweighs the benefit .
Moderately clinically significant . Usually avoid combinations ; use it only under special circumstances .
Minimally clinically significant . Minimize risk ; assess risk and consider an alternative drug , take steps to circumvent the interaction risk and / or institute a monitoring plan .
Unknown No interaction information available .
Michael J . Poppa , D . O .,
R . Ph , MBA Board Certified Occupational Medicine . He can be reached at Missouri Cannabis Clinic , 816.353.0420 , 10001 E . 67th St . Raytown , MO . 64133 . Visit Missouri Cannabis Clinic online at
www . MissouriCannabis . clinic .
Notice : The information contained herein is not intended or implied to be a substitute for professional medical advice , but rather a sharing of knowledge and information based on research and experience .
TRY TELEHEALTH TO BECOME A “ QUALIFIED PATIENT ”