November 2019

In clinical trials evaluating CBD, adverse effects, including diarrhea, somnolence, decreased appetite, change in weight, and increased levels of liver enzymes have been noted. Of note, the one FDA-approved CBD product is associated with a higher risk of hepatotoxicity necessitating recommended scheduled liver function testing in patients starting the medication.

Actually, both THC and CBD are psychoactive. By definition, a psychoactive drug is a substance that acts primarily upon the central nervous system where it alters brain function and neurotransmitter function, resulting in temporary changes in perception, mood, consciousness and behavior.Unlike THC, however, CBD does not induce euphoric feelings or (a “high”) or induce hallucinations.

The analgesic effectiveness of cannabinoids is comparable to that of the weak opioids.20 mg of THC is equianalgesic to about 120 mg of codeine.

THC has a closed ring, while CBD has a hydroxyl group.

Yes, THC is highly protein-bound, and thus might displace other drugs that are protein- bound. Although studies performed by a manufacturer of a THC:CBD oral spray product did not confirm that drug displacement takes place in vivo, it is suggested to monitor the patient for changes in dosage requirements of all protein-bound medications that the patient is taking.

Yes. CBD is a partial agonist of the serotonin 5-HT1Areceptor, an agonist of the adenosine A2A receptor, an agonist of the transient receptor potential vanilloid ion channel TRPV1 , and acts at several other receptors, too.

“There is conclusive or substantial evidence that cannabis or cannabinoids are effective for the treatment of chronic pain in adults (cannabis).”
“There is moderate evidence that cannabis or cannabinoids are effective for improving short-term sleep outcomes in individuals with sleep disturbance associated with …chronic pain (cannabinoids, primarily nabiximols).”
“There is limited evidence that cannabis or cannabinoids are ineffective for reducing depressive symptoms in individuals with chronic pain or multiple sclerosis (nabiximols, dronabinol, and nabilone).”

According to studies evaluating the metabolism of Epidiolex, (a CBD FDA-approved drug),consuming CBD with fatty foods may increase its absorption and blood levels up to 4-5 times.As a result, it is difficult for patients to control the amount of CBD absorbed if their fat intake changes daily.

According to Health Canada’s document entitled Information for Health Care Professionals: Cannabis and Cannabinoids, “If intolerable adverse effects appear without significant benefit, dosing should be tapered and stopped. Tapering guidelines have not been published, but the existence of a withdrawal syndrome suggests that tapering should be done slowly (i.e. over several days or weeks).”

For adult patients with nausea and vomiting associated with chemotherapy: The recommended starting dosage is 5 mg/m2, administered 1 to 3 hours prior to the administration of chemotherapy, then every 2 to 4 hours after chemotherapy, for a total of 4 to 6 doses per day. Administer the first dose on an empty stomach at least 30 minutes prior to eating; subsequent doses can be taken without regard to meals. (For elderly patients, consider starting at a lower dose of 2.5mg/m2).