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Expert Opinion on Drug Safety Volume 17, 2018 - Issue 1
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Review

Drug-drug interactions as a result of co-administering Δ9-THC and CBD with other psychotropic agents

Carola RongMood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, Toronto, ON, Canada;School of Medicine, American University of Integrative Sciences, The Netherlands, Sint MaartenORCID Iconhttp://orcid.org/0000-0002-1408-4968View further author information
ORCID Icon,
Nicole E. CarmonaMood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, Toronto, ON, CanadaView further author information
,
Yena L. LeeMood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, Toronto, ON, Canada;Institute of Medical Science, University of Toronto, Toronto, ON, CanadaView further author information
,
Renee-Marie RagguettMood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, Toronto, ON, CanadaView further author information
,
Zihang PanMood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, Toronto, ON, Canada;Institute of Medical Science, University of Toronto, Toronto, ON, CanadaView further author information
,
Joshua D. RosenblatMood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, Toronto, ON, CanadaView further author information
,
Mehala SubramaniapillaiMood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, Toronto, ON, CanadaView further author information
,
Margarita ShekotikhinaMood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, Toronto, ON, CanadaView further author information
,
Fahad AlmathamMood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, Toronto, ON, CanadaView further author information
,
Asem AlageelMood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, Toronto, ON, CanadaView further author information
,
Rodrigo MansurMood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, Toronto, ON, CanadaView further author information
,
Roger C. HoDepartment of Psychological Medicine, National University of Singapore, SingaporeView further author information
&
Roger S. McIntyreMood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, Toronto, ON, Canada;Institute of Medical Science, University of Toronto, Toronto, ON, Canada;Department of Pharmacology, University of Toronto, Toronto, ON, Canada;Department of Psychiatry, University of Toronto, Toronto, ON, CanadaCorrespondence[email protected]
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Pages 51-54 | Received 13 Jul 2017, Accepted 20 Oct 2017, Published online: 31 Oct 2017
 
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ABSTRACT

Introduction: To determine, via narrative, non-systematic review of pre-clinical and clinical studies, whether the effect of cannabis on hepatic biotransformation pathways would be predicted to result in clinically significant drug-drug interactions (DDIs) with commonly prescribed psychotropic agents.

Areas covered: A non-systematic literature search was conducted using the following databases: PubMed, PsycInfo, and Scopus from inception to January 2017. The search term cannabis was cross-referenced with the terms drug interactions, cytochrome, cannabinoids, cannabidiol, and medical marijuana. Pharmacological, molecular, and physiologic studies evaluating the pharmacokinetics of Δ9-tetrahydrocannabinol (Δ9-THC) and cannabidiol (CBD), both in vitro and in vivo, were included. Bibliographies were also manually searched for additional citations that were relevant to the overarching aim of this paper.

Expert opinion: Δ9-Tetrahydrocannabinol and CBD are substrates and inhibitors of cytochrome P450 enzymatic pathways relevant to the biotransformation of commonly prescribed psychotropic agents. The high frequency and increasing use of cannabis invites the need for healthcare providers to familiarize themselves with potential DDIs in persons receiving select psychotropic agents, and additionally consuming medical marijuana and/or recreational marijuana.

Article highlights

  • Δ9-Tetrahydrocannabinol and CBD are substrates and inhibitors of cytochrome P450 enzymatic pathways relevant to the biotransformation of commonly prescribed psychotropic agents

  • Potential for clinically meaningful elevations in Δ9-THC exposure in individuals with diminished CYP2C9 and/or CYP3A4 function, and in CBD exposure in individuals with diminished CYP2C19 and/or CYP3A4 function

  • Patients should be informed that the consumption of Δ9-THC and/or CBD may result in DDIs that are of consequence to the expected probability of efficacy, tolerability, and/or safety of their treatment.

This box summarizes key points contained in the article.

Declaration of interest

RS McIntyre has been supported by Astra Zeneca, Bristol-Myers Squibb, Janssen-Ortho, Eli Lilly, Lundbeck, Pfizer, Shire, Otsuka, Purdue, Takeda and Allergen. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This paper has not been funded.

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