During the last 5 years, a dramatic rise in the use of cannabis led to an increased number of patients taking it simultaneously with their previous medication. This situation could result in several problems as cannabinoids may be classified as either perpetrators or substrates depending on the concomitant drugs leading to altered exposure, adverse events, and/or lack of clinical efficacy. However, scarce evidence is available about cannabis drug interactions with potential implications in clinical efficacy and safety.
Morphine is glucuronidated via UGT2B7 to morphine-3-glucuronide (M3G) and morphine-6-glucuronide (M6G), being the latter a highly active analgesic .
To sum up, drug interactions between cannabinoids and antidepressants, if they occur, may be due to metabolizing enzyme inhibition. This inhibition may increase the levels of the antidepressants or their active metabolites resulting in side effects such as the serotonin syndrome, hyponatraemia [78–80], hemorrhagic events [81–84], and QT interval prolongation among others [85, 86]. In the case of duloxetine and amitriptyline, as both drugs are metabolized by CYP1A2, chronic smoked cannabis use may result in lower concentrations of these drugs and perhaps lower efficacy.
However, “to date, there are few data on CBD’s interactions with other AEDs,” write the investigators.
In addition, the most common type of seizures for the adults was partial only (n = 26), followed by generalized only (n=8). For the children, generalized-only seizures were the most common (n = 28), followed by partial only (n=8).
Results from the full group showed that increasing CBD dose was significantly associated with increased levels of the following:
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