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Marijuana (Cannabis sativa)



Interactions

Cannabis/Drug Interactions:
  • AlcoholAlcohol: The combination of alcohol plus CBD has been reported to result in significantly lower blood alcohol levels in humans compared to alcohol given alone, though similar pharmacological effects were induced (132). In human research, the combined use of alcohol and THC resulted in altered performance in driving and physiological state (47; 48).
  • AnalgesicsAnalgesics: A number of studies have indicated that cannabinoids have a marked analgesic effect (138; 16; 1; 6; 23; 21; 139).
  • Anticoagulants and antiplateletsAnticoagulants and antiplatelets: Both THC and CBD have been shown to inhibit platelet aggregation in vitro (human platelets), with THC exhibiting a significantly more potent effect than CBD (49; 50).
  • Anticonvulsant agentsAnticonvulsant agents: Findings from animal (rat) research indicate that cannabinoids may possess anticonvulsant properties (140; 141; 142). In other research, delta-9-tetrahydrocannabinol (THC) and cannabidiol have both been observed to increase seizure threshold, except at the maximally tested shock (60Hz), whereas cannabidiol was ineffective and THC lowered the observed threshold (143). The effects with anticonvulsant agents are not well understood.
  • Antidiabetic agentsAntidiabetic agents: Marijuana use has been reported to increase blood glucose levels in humans (51).
  • AntiemeticsAntiemetics: Cannabinoids have been shown to have antiemetic properties in cancer patients (21; 139). Similarly, THC has been shown to reduce vomiting in animal research, although CBD was ineffective (144). The effects with other antiemetic agents are not well understood.
  • AntihypertensivesAntihypertensives: In human research, cases of hypotension have been reported to occur following administration of cannabis medicinal extracts containing THC and CBD in a 1:1 ratio (52).
  • Antineoplastic agentsAntineoplastic agents: Cannabidiol has been reported to have antineoplastic activity in vitro against human leukemia cells (4; 35; 21; 36), several human cancer cell lines (145), including U373 glioma cell lines (146; 8; 10; 147), tumors in rodents (4; 7; 69; 15), and multidrug-resistant mouse lymphoma cells. Cannabinoid derivatives have also been shown to inhibit viral tumor antigen expression (148).
  • AntipyrineAntipyrine: In human research, THC and CBD were found to inhibit the metabolism of antipyrine (54).
  • Antiretroviral agentsAntiretroviral agents: In laboratory research, cannabinoids exacerbated HIV infections (34). However, human experimentation has indicated that neither smoked nor oral cannabinoids adversely affect HIV RNA levels, CD4+ or CD8+ cell counts, or protease inhibitor levels in the short term (149).
  • BarbituratesBarbiturates: In findings from human research, THC and CBD may inhibit the metabolism of barbiturates (54), although other human experimentation has reported that CBD does not appear to inhibit secobarbital metabolism (133). CBD has been reported to inhibit hexobarbital clearance; however, the effects of hexobarbital were not affected by CBD (55).
  • BronchodilatorsBronchodilators: In a human study, THC was found to have acute bronchodilator activity; however, cannabinol and CBD did not (150).
  • CNS depressantsCNS depressants: In clinical trials, dizziness, sleepiness, fatigue, disturbances in attention, and headache have been the most common reported adverse effects in patients using cannabis-based drugs (56; 57; 58; 59; 60; 52; 61; 62). Theoretically, concurrent use of cannabis-based agents and CNS depressants may increase the risk of CNS adverse effects.
  • CorticosteroidsCorticosteroids: CBD has been reported to interfere with cortisol secretion in humans (151).
  • Cytochrome P450-metabolized agentsCytochrome P450-metabolized agents: In animal research, cannabis was found to induce the expression of CYP 2E1, which may alter the therapeutic action and metabolism of various types of drugs, including N-nitrosamines and aromatic hydrocarbons (64). In vitro and in vivo, CBD was found to slow cocaine N-demethylation and metabolism-related hepatotoxicity by inhibition of P450 3A (37).
  • EstrogensEstrogens: In laboratory research, a marijuana smoke condensate was found to have an antiestrogenic effect, while three major cannabinoids, THC, CBD, and cannabinol (CBN), did not (134).
  • Hepatotoxic agentsHepatotoxic agents: In human research, intravenous usage of marijuana has been shown to cause toxic hepatosis (53).
  • Hormonal agentsHormonal agents: In other research, THC has been reported to stimulate prolactin and luteinizing hormone levels in vitro (152), though the prolactin-stimulating effect of THC may be rapidly diminished by successive exposures to the drug (153).
  • ImmunosuppressantsImmunosuppressants: In an in vivo study, cannabidiol (CBD) was reported to have the potential to clinically affect the metabolism of the immunosuppressive drug cyclosporine, suggesting the possibility of an increase in cyclosporine blood levels and its toxic side effects (68). In human and laboratory research, constituents of marijuana (THC, CBD) were found to be immunomodulating (65; 66; 67)
  • P-glycoprotein-regulated drugsP-glycoprotein-regulated drugs: In findings from laboratory research, CBN may affect the absorption and disposition of coadministered compounds that are P-gp substrates (P-gp plays a significant role in the transport of many compounds) (69).
  • VasodilatorsVasodilators: In animal and laboratory research, CBD has been reported to produce vasodilation (154; 19; 20).

Cannabis/Herb/Supplement Interactions:
  • AnalgesicsAnalgesics: A number of studies have indicated that cannabinoids have a marked analgesic effect (138; 16; 1; 6; 23; 21; 139).
  • Anticoagulants and antiplateletsAnticoagulants and antiplatelets: Both THC and CBD have been shown to inhibit platelet aggregation in vitro (human platelets), with THC exhibiting a significantly more potent effect than CBD (49; 50).
  • AnticonvulsantsAnticonvulsants: Findings from animal (rat) research indicate that cannabinoids may possess anticonvulsant properties (140; 141; 142). In other research, delta-9-tetrahydrocannabinol (THC) and cannabidiol have both been observed to increase seizure threshold, except at the maximally tested shock (60Hz), whereas cannabidiol was ineffective and THC lowered the observed threshold (143). The effects with anticonvulsant agents are not well understood.
  • AntiemeticsAntiemetics: Cannabinoids have been shown to have antiemetic properties in cancer patients (21; 139). Similarly, THC has been shown to reduce vomiting in animal research, although CBD was ineffective (144). The effects with other antiemetic agents are not well understood.
  • AntineoplasticsAntineoplastics: Cannabidiol has been reported to have antineoplastic activity in vitro against human leukemia cells (4; 35; 21; 36), several human cancer cell lines (145), including U373 glioma cell lines (146; 8; 10; 147), tumors in rodents (4; 7; 69; 15), and multidrug-resistant mouse lymphoma cells. Cannabinoid derivatives have also been shown to inhibit viral tumor antigen expression (148).
  • AntioxidantsAntioxidants: THC has been reported to act as an antioxidant in vitro (14; 155).
  • Antiviral agentsAntiviral agents: In laboratory research, cannabinoids exacerbated HIV infections (34). However, human experimentation has indicated that neither smoked nor oral cannabinoids adversely affect HIV RNA levels, CD4+ or CD8+ cell counts, or protease inhibitor levels in the short term (149).
  • BronchodilatorsBronchodilators: In a human study, THC was found to have acute bronchodilator activity; however, cannabinol and CBD did not (150).
  • Cytochrome P450-metabolized agentsCytochrome P450-metabolized agents: In animal research, cannabis was found to induce the expression of CYP 2E1, which may alter the therapeutic action and metabolism of various types of drugs, including N-nitrosamines and aromatic hydrocarbons (64). In vitro and invivo, CBD was found to slow cocaine N-demethylation and metabolism-related hepatotoxicity by inhibition of P450 3A (37).
  • Hepatotoxic herbsHepatotoxic herbs: In human research, intravenous usage of marijuana has been shown to cause toxic hepatosis (53).
  • Hormonal herbs and supplementsHormonal herbs and supplements: CBD has been reported to interfere with cortisol secretion in humans (151). In other research, THC has been reported to stimulate prolactin and luteinizing hormone levels in vitro (152), though the prolactin-stimulating effect of THC may be rapidly diminished by successive exposures to the drug (153).
  • HypoglycemicsHypoglycemics: Marijuana use has been reported to increase blood glucose levels in humans (51).
  • HypotensivesHypotensives: In human research, cases of hypotension have been reported to occur following administration of cannabis medicinal extracts containing THC and CBD in a 1:1 ratio (52).
  • ImmunosuppressantsImmunosuppressants: In an in vivo study, cannabidiol (CBD) was reported to have the potential to clinically affect the metabolism of the immunosuppressive drug cyclosporine, suggesting the possibility of an increase in cyclosporine blood levels and its toxic side effects (68). In human and laboratory research, constituents of marijuana (THC, CBD) were found to be immunomodulating (65; 66; 67).
  • P-glycoprotein modulatorsP-glycoprotein modulators: In findings from laboratory research, CBN may affect the absorption and disposition of coadministered compounds that are P-gp substrates (P-gp plays a significant role in the transport of many compounds) (69).
  • PhytoestrogensPhytoestrogens: In laboratory research, a marijuana smoke condensate was found to have an antiestrogenic effect, while three major cannabinoids, THC, CBD, and cannabinol (CBN), did not (134).
  • SedativesSedatives: In clinical trials, dizziness, sleepiness, fatigue, disturbances in attention, and headache have been the most common reported adverse effects in patients using cannabis-based drugs (56; 57; 58; 59; 60; 52; 61; 62). Theoretically, concurrent use of cannabis-based agents and CNS depressants may increase the risk of CNS adverse effects.
  • Vasodilator herbs and supplementsVasodilator herbs and supplements: CBD has been reported to produce vasodilation in rodents and in vitro (154; 19; 20).

Cannabis/Food Interactions:
  • Insufficient available evidence.

Cannabis/Lab Interactions:
  • Blood alcoholBlood alcohol: The combination of alcohol plus CBD has been reported to result in significantly lower blood alcohol levels in humans compared to alcohol given alone, though similar pharmacological effects were induced (132).
  • Blood glucoseBlood glucose: Marijuana use has been reported to increase blood glucose levels in humans (51).
  • Blood pressureBlood pressure: In human research, cases of hypotension have been reported to occur following administration of cannabis medicinal extracts containing THC and CBD in a 1:1 ratio (52).
  • CD4/CD8 cell countsCD4/CD8 cell counts: In laboratory research, cannabinoids exacerbated HIV infections (34). However, human experimentation has indicated that neither smoked nor oral cannabinoids adversely affect HIV RNA levels, CD4+ or CD8+ cell counts, or protease inhibitor levels in the short term (149).
  • Coagulation panelCoagulation panel: Both THC and CBD have been shown to inhibit platelet aggregation in vitro (human platelets), with THC exhibiting a significantly more potent effect than CBD (49; 50).
  • CortisolCortisol: CBD has been reported to interfere with cortisol secretion in humans (151).
  • Drug screenDrug screen: Foods or supplements containing cannabis seeds or oil may contain a concentration of delta-9-tetrahydrocannabinol (THC) high enough to trigger a positive drug screen (73; 74). However, other research has reported that ingestion of foods containing cannabis seeds or oil did not induce a level high enough register as positive on drug tests (50ng/mL) (75; 76; 77; 78).
  • EstrogenEstrogen: In laboratory research, a marijuana smoke condensate was found to have an antiestrogenic effect; however, the cannabinoids, THC, CBD, and cannabinol (CBN), did not (134).
  • ProlactinProlactin: In in vitro research, THC has been reported to stimulate prolactin levels (152).
  • Luteinizing hormone (LH)Luteinizing hormone (LH): THC has been reported to stimulate prolactin and luteinizing hormone levels in vitro (152), though the prolactin-stimulating effect of THC may be rapidly diminished by successive exposures to the drug (153).
  • Radiation therapyRadiation therapy: Cannabinoids, cannabidiol (CBD), and cannabidiol-dimethylheptyl (CBD-DMH) have been reported to induce apoptosis in a human acute myeloid leukemia (AML) HL-60 cell line, with prior exposure of the cells to gamma-irradiation (800cGy) markedly enhancing apoptosis (147).
  • Semen analysisSemen analysis: Exposure to the three active marijuana components (THC, CBD, and CBN) has been reported to adversely affect spermatogenesis in both humans and rodents (125).

Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

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