Cannabidiol (CBD) is the main non-intoxicating component in the Cannabis sativa L. plant and has recently attracted interest as a therapeutic for the treatment of a number of diseases and conditions due to observed beneficial effects in many preclinical disease models, including epilepsy, cardiovascular disease, inflammation, and cancer (Pacher, Kogan, & Mechoulam, 2020). Like other drugs, CBD has intrinsic pharmacologic effects and thus has the potential for adverse drug events (ADEs) along with the potential for pharmacokinetic and pharmacodynamic drug–drug interactions (DDIs). Given CBD use among patients with complex conditions and treatment regimens, as well as its expanded consumer use, awareness of potential safety issues with CBD is needed. Prescribing information for federally approved products containing CBD were reviewed. Common ADEs include transaminase elevations, sedation, sleep disturbances, infection, and anemia. Given CBD effects on common biological targets implicated in drug metabolism (e.g., CYP3A4/2C19) and excretion (e.g., P-glycoprotein), the potential for DDIs with commonly used medication is high. General clinical recommendations of reducing substrate doses, monitoring for ADEs, and finding alternative therapy should be considered, especially in medically complex patients. CBD is implicated as both a victim and perpetrator of DDIs and has its own ADE profile. These effects should be considered in the risk-benefit assessment of CBD therapy and patients and consumers made aware of potential safety issues with CBD use.
*Article adapted from Potential Adverse Drug Events and Drug–Drug Interactions with Medical and Consumer Cannabidiol (CBD) Use (Brown & Winterstein, 2019), licensed by a Creative Commons Attribution license (CC BY 4.0).
Enzymes as drug targets: curated pharmacological information in the 'Guide to...Guide to PHARMACOLOGY
Presented at the British Pharmacological Society Focused meeting in April 2015, this poster summarises the current coverage of our curation of enzyme drug targets and supplements our previous poster covering this target class
Identify primary drug interaction concepts
Describe types and mechanisms of interactions
Identify drug interactions commonly encountered with antiretroviral drugs
Describe how to manage known interactions
Enzymes as drug targets: curated pharmacological information in the 'Guide to...Guide to PHARMACOLOGY
Presented at the British Pharmacological Society Focused meeting in April 2015, this poster summarises the current coverage of our curation of enzyme drug targets and supplements our previous poster covering this target class
Identify primary drug interaction concepts
Describe types and mechanisms of interactions
Identify drug interactions commonly encountered with antiretroviral drugs
Describe how to manage known interactions
Immunotherapeutic drugs can be broadly classified into four types: checkpoint inhibitors, cytokines, monoclonal antibodies, and vaccines. However, immunotherapeutic drugs still have some problems, such as off-target side effects and poor pharmacokinetics.
This presentation includes details about ADEPT(Antibody Directed Enzyme prodrug Therapy), various challenges that one should meet to design an ADEPT and various enzymes and prodrugs that are reported and also the data of clinical studies.
This is a set of powerpoint slides with self-assessment questions interspersed throuought on drug metabolism and pharmacogenetics. The aim is to understand the mechanism of clinically significant drug interactions, recognize potentially clinically significant genetic influences on drug efficacy and toxicity, and genetic predispositions to disease due to altered drug metabolism or transport. This resource is appropriate for medical students or graduate healthcare professionals such as nursing students.
Prodrug. Introduction of prodrug. Classification of prodrug. Rational for the use of prodrug. Prodrug for oculary. Prodrug for buccal delivery. Prodrug for brain targeting. Recent advancement. Antibody directed enzyme prodrug. gene directed enzyme prodrug therapy. Virus directed enzymes prodrug therapy. prodrug in novel drug delivery.
Immunotherapeutic drugs can be broadly classified into four types: checkpoint inhibitors, cytokines, monoclonal antibodies, and vaccines. However, immunotherapeutic drugs still have some problems, such as off-target side effects and poor pharmacokinetics.
This presentation includes details about ADEPT(Antibody Directed Enzyme prodrug Therapy), various challenges that one should meet to design an ADEPT and various enzymes and prodrugs that are reported and also the data of clinical studies.
This is a set of powerpoint slides with self-assessment questions interspersed throuought on drug metabolism and pharmacogenetics. The aim is to understand the mechanism of clinically significant drug interactions, recognize potentially clinically significant genetic influences on drug efficacy and toxicity, and genetic predispositions to disease due to altered drug metabolism or transport. This resource is appropriate for medical students or graduate healthcare professionals such as nursing students.
Prodrug. Introduction of prodrug. Classification of prodrug. Rational for the use of prodrug. Prodrug for oculary. Prodrug for buccal delivery. Prodrug for brain targeting. Recent advancement. Antibody directed enzyme prodrug. gene directed enzyme prodrug therapy. Virus directed enzymes prodrug therapy. prodrug in novel drug delivery.
ϖ Definition & Concepts
ϖ Epidemiology
ϖ Risk factors
ϖ Causes of unwanted drug effect
ϖ Classification of Drug Interaction (DI)
ϖ Drug-Drug Interaction
Behavioral DI
Pharmaceutical DI
Pharmacokinetic DI
Pharmacodynamic DI
ϖ Interactions involving Drug Transport Protein
ϖ Interaction involving Therapeutic Proteins
ϖ Food Drug Interaction
ϖ Herb Drug Interaction
ϖ Drug-Disease Interaction
ϖ Drug interaction Management
COVID-19 & Drug Interaction
Contribution of metabolites to the drug drug interactionRx Ravi Goyani
1. The contribution of drug metabolites to the drug drug interaction presented by RAVI GOYANI M.S(Pharm)pharmaceutics(NIPER).
2. Contents of the presentation: Introduction, Drug-drug interaction, regulatory perspectives of drug-drug interaction, potential pharmacokinetic interaction produced by metabolites, case study, evaluation of metabolites to drug interaction, conclusion , references.
3. Introduction of metabolites and its examples.
4.Types of metabolites and how its formation in to the body by phase 1&2 metabolism.
5.Types of drug drug interaction.
6.7. Short discussion about the pharmacokinetics drug interation which are essential for the preclinical pharmacokinetics drug interaction.
8. Regulatory perspective on the metabolites contribution to the drug drug interaction.
9. Criteria for the absence of a based drug interaction on the results of a clinical study.
10.11.12. Case study of the some drug metabolites(efavirenz, verapamil) participate in to the drug drug interaction by the known mechanism such as irreversible of CYP 450 enzymes bye protein adduct formation or intermediate complex formation.
13. Evaluation of metabolites drug interaction by following study.
1. Estimation of metabolites concentration
2. Metabolites and parent cytochrome P450 inhibition potency comparison
3. RMet strategy
14.15.16. Brief discussion about the evaluation and specific criteria for that evaluation parameters which are considering for the metabolites drug interaction.
17. Proposed algorithm for the evaluation of drug metabolites interaction.
18. Conclusion.
19. List of references.
Peptide Drug Conjugates (PDCs) Novel Targeted Therapeutics For Cancer.pdfDoriaFang
Peptide-drug conjugates (PDCs) are the next generation of targeted therapies after ADCs. PDCs has been developed as targeted therapeutic candidates for cancer, COVID-19, metabolic diseases, etc.
Could PDC Be A New Direction For Targeted Therapy After ADC.pdfDoriaFang
Peptide-drug conjugates (PDCs) are the next generation of targeted therapeutics after ADCs, and their core advantages are enhanced cell permeability and improved drug selectivity.
Clinical pharmacokinetics and its application--
1)definition
2) APPLICATIONS OF CLINICAL PHARMACOKINETICS
Design of dosage regimens:
a) Nomograms and Tabulations in designing dosage regimen,
b) Conversion from intravenous to oral dosing,
c) Determination of dose and dosing intervals,
d) Drug dosing in the elderly and pediatrics and obese patients.
Pharmacokinetics of Drug Interaction:
a) Pharmacokinetic drug interactions
b) Inhibition and Induction of Drug metabolism
c) Inhibition of Biliary Excretion.
Therapeutic Drug monitoring:
a) Introduction
b) Individualization of drug dosage regimen (Variability – Genetic, Age and Weight, disease, Interacting drugs).
c) Indications for TDM. Protocol for TDM.
d) Pharmacokinetic/Pharmacodynamic Correlation in drug therapy.
e) TDM of drugs used in the following disease conditions: cardiovascular disease, Seizure disorders, Psychiatric conditions, and Organ transplantations
Dosage adjustment in Renal and Hepatic Disease.
a. Renal impairment
b. Pharmacokinetic considerations
c. General approach for dosage adjustment in renal disease.
d. Measurement of Glomerular Filtration rate and creatinine clearance.
e. Dosage adjustment for uremic patients.
f. Extracorporeal removal of drugs.
g. Effect of Hepatic disease on pharmacokinetics.
Population Pharmacokinetics.
a) Introduction to Bayesian Theory.
b) Adaptive method or Dosing with feedback.
c) Analysis of Population pharmacokinetic Data
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Potential Adverse Drug Events and Drug-Drug Interactions with Medical and Consumer Cannabidiol (CBD) Use
1. with Medical and Consumer
Cannabidiol (CBD) Use
Like other medications, CBD has a complex pharmacokinetic and pharmacodynamic
profile and therefore has the potential to interact with other medications and medical
conditions.
C A N N A B I D I O L
( C B D )
Potential Drug-Drug Interactions
1
P H A R M A C O D Y N A M I C
I N T E R A C T I O N S
CBD can potentially alter the
sensitivity or responsiveness of
tissues to another drug by having
the same (agonistic) or a blocking
(antagonistic) effect.
T Y P E S O F C B D
P H A R M A C O K I N E T I C
I N T E R A C T I O N S
CBD may alter the absorption,
distribution, protein binding,
metabolism, or elimination of
another drug, changing the amount
and persistence of available drug at
receptor sites.
Drug-Drug Interactions
2,3,4
clinical practice and cannabinoid drug development.1,2,3
Drug-drug interactions remain a critical issue in
2,4
C B D M E T A B O L I C E N Z Y M E
Substrates, Inhibitors, & Inducers
Adverse pharmacokinetic drug interactions
may occur when drugs that are
of the same metabolizing enzymes are co-
administered, potentially altering the expected
rate of metabolism of one or both compounds.
substrates, inducers and/or inhibitors
3
CYP2C19
CYP3A4
CBD is
metabolized
primarily by
the enzymes
2
a family of isozymes
that catalyze the
biotransformation of
many endo/exogenous
compounds, including
xenobiotics, drugs,
and fatty acids.
Cytochrome
P450 (CYP450)
3,6
CY3PA4 enzyme
The clinical
consequences of
may include altered
drug disposition
altered efficacy,
and/or toxicity.3
drug-drug
interactions (DDIs)
I N H I B I T O R S
An inhibitor is a drug that
impairs the ability of drug-
metabolizing enzymes (eg.,
CYP3A4) to metabolize other
coadministered substrates
by competing for the same
enzyme receptor site.
The more potent inhibitor
will predominate, resulting
in decreased metabolism of
the competing drug. Co-
administration of CBD with
enzyme inhibitors may
increase CBD bioavailability
and increased serum levels.
S U B S T R A T E S
A substrate is a drug that requires
metabolism to a more hydrophilic
compound for ultimate
elimination.
I N D U C E R S
Inducers are drugs that increase
metabolic activity by increasing
the synthesis of the CYP enzymes
involved.
Because inducers increase CYP450
enzyme activity, co-administration
with CBD may decrease CBD
bioavailability and may decrease
its effectiveness.
The endogenous and
exogenous cannabinoids
can behave as substrates,
inhibitors, and/or inducers.
1,2,4,7
2
3
3
3
2,6,7
Metabolic Drug-Drug Interactions Between
Cannabidiol and Enzyme Substrates,
Inhibitors, or Inducers
Table adapted from Brown & Winterstein, 2019, p 5.
CYP3A4
substrates
Immunosuppressants,
chemotherapeutics, antidepressants,
antipsychotics, opioids,
benzodiazepines, z-hypnotics, statins,
calcium channel blockers, others
Increased risk of side effects related to
substrate. Avoid co-administration, reduce
substrate dose, monitor for adverse effects and
toxicity. Avoid prescribing cascade with new
treatment for side effects.
ENZYME
ISOFORM
MEDICATION EXAMPLES EFFECT/RECOMMENDATION
CYP3A4
inhibitors
Strong: Protease inhibitors,
ketoconazole, loperamide, nefazodone
Moderate: Amiodarone, verapamil,
cimetidine, aprepitant, imatinib
Increased CBD bioavailability, possible increase
in risk of adverse effects. Reduce CBD dose.
CYP3A4
inducers
Strong: Enzalutamide, phenytoin
Moderate: Carbamazepine,
topiramate, phenobarbital, rifampicin,
efavirenz, pioglitazone
Decreased CBD bioavailability, possible decrease
in CBD effectiveness. Increase CBD dose.
CYP2C19
substrates
Antidepressants, antiepileptics, proton
pump inhibitors, clopidogrel,
propranolol, carisoprodol,
cyclophosphamide, warfarin
Increased risk of side effects related to
substrate. Avoid co-administration, reduce
substrate dose, monitor for adverse effects and
toxicity. Avoid prescribing cascade with new
treatment for side effects.
CYP2C19
inhibitors
Strong: Fluvoxamine, fluoxetine
Other: Proton pump inhibitors,
cimetidine, ketoconazole, clopidogrel,
fluconazole, efavirenz
Increased CBD bioavailability, possible increase
in risk of adverse effects. Reduce CBD dose.
CYP2C19
inducers
Rifampin, carbamazepine,
phenobarbital, phenytoin, St. John’s
Wort
Decreased CBD bioavailability, possible decrease
in CBD effectiveness. Increase CBD dose.
CYP2C8/9
substrates
Rosiglitazone, burprenorphine,
montelukast, celecoxib, sulfonylureas,
losartan, naproxen, phenobarbital,
phenytoin, rosuvastatin, valsartan,
warfarin
Increased risk of side effects related to
substrate. Avoid co-administration, reduce
substrate dose, monitor for adverse effects and
toxicity. Avoid prescribing cascade with new
treatment for side effects.
1
CBD inhibits uridine 5’-diphospho-glucuronosyltransferase
(UGT) enzymes, which catalyze glucuronidation of
xenobiotics in a primary pathway of phase II
metabolism. In addition to UGT, CBD may also inhibit
certain membrane transporter proteins.
1
Drug-Drug Interactions Between Cannabidiol
and Secondary Metabolism or
Membrane Transporter Proteins
UGT1A9
Regorafenib,
acetaminophen,
canagliflozin,
sorafenib, irinotecan,
propofol,
mycophenolate,
valproic acid,
haloperidol,
ibuprofen,
dabigatran,
dapagliflozin, others
Hydromorphone,
losartan,
ibuprofen,
naproxen,
ezetimibe,
lovastatin,
simvastatin,
carbamazepine,
valproate, others
Paclitaxel,
digoxin, statins,
telmisartan,
glyburide,
ketoconazole,
rosiglitazone,
celecoxib
UGT2B7 BCRP BSEP
Effect/Recommendation
Glyburide,
imatinib,
methotrexate,
mitoxantrone,
nitrofurantoin,
prazosin,
statins,
dipyridamole
Increased risk of side effects related to substrate.
Monitor co-administration closely, reduce substrate dose,
monitor for adverse effects and toxicity.
UGT = uridine 5′-diphospho-glucoronosyltransferase; BCRP = breast cancer resistance protein; BSEP = bile salt
export pump. Table adapted from Brown & Winterstein, 2019, p 7.
1
CLINICAL IMPLICATIONS
Expect that interactions involving cannabinoids will vary widely in
their clinical significance due to the considerable variability in
products, doses, routes of administration, populations using
cannabinoids, genetics, and other factors.7
Current recommended cannabinioid initiation and
maintenance: START LOW, GO SLOW, STAY LOW.8
Medical CBD users under clinical supervision should be screened for
potential DDIs and adverse drug events between CBD, other
pharmacotherapies, and patients' underlying conditions.1
Be aware of the potential for DDIs with CBD and strategically
prescribe and manage patients on multidrug regimens while
considering patient desires for complementary or alternative
therapies.1
Limited data exist on significant drug interactions caused by CBD.
Thus, evidence-based clinical guidelines on interactions of drugs with
CBD and other cannabinoids are still lacking.1
WORKS CITED
1. Brown, J. D., & Winterstein, A. G. (2019). Potential adverse drug events and drug-drug interactions with medical and consumer cannabidiol
(CBD) use. Journal of Clinical Medicine, 8(7), 989. https://doi.org/10.3390/jcm8070989
2. Zendulka, O., Dovrtělová, G., Nosková, K., Turjap, M., Šulcová, A., Hanuš, L., & Juřica, J. (2016). Cannabinoids and Cytochrome P450
Interactions. Current Drug Metabolism, 17(3), 206–226. https://doi.org/10.2174/1389200217666151210142051
3. Zhou S. F. (2008). Drugs behave as substrates, inhibitors and inducers of human cytochrome P450 3A4. Current Drug Metabolism, 9(4), 310–
322. https://doi.org/10.2174/138920008784220664 | OPEN ACCESS
4. Lynch, S. S. (2019). Drug Interactions. Merck Manual: Professional Version [Webpage]. Retrieved from
https://www.merckmanuals.com/professional/clinical-pharmacology/factors-affecting-response-to-drugs/drug-interactions (February 2, 2021)
| OPEN ACCESS
5. US FDA (2020). Drug Development and Drug Interactions: Table of Substrates, Inhibitors and Inducers. Drug Interactions and Labeling
[Website]. https://www.fda.gov/drugs/drug-interactions-labeling/drug-development-and-drug-interactions-table-substrates-inhibitors-and-
inducers#table3-2
6. FDA (2018). EPIDIOLEX: Highlights of prescribing information. https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/210365lbl.pdf
7. Stout, S. M., & Cimino, N. M. (2014). Exogenous cannabinoids as substrates, inhibitors, and inducers of human drug metabolizing enzymes:
a systematic review. Drug Metabolism Reviews, 46(1), 86–95. https://doi.org/10.3109/03602532.2013.849268
8. MacCallum, C. A., & Russo, E. B. (2018). Practical considerations in medical cannabis administration and dosing. European Journal of
Internal Medicine, 49, 12–19. https://doi.org/10.1016/j.ejim.2018.01.004
W W W . C A N N A S C I O P E N . C O M
IMAGE CREDITS
Title photo CBD Oil by CBD Infos on Unsplash
Types of CBD DDI hexagons: 1QPS enzyme by Boghog2, Public domain, via Wikimedia Commons; Balls in the Sky by Raphaël Biscaldi on
Unsplash; Colorful Drug Mix by Myriam Zilles on Unsplash
Pharmacodynamic interactions: Photo by David Clarke on Unsplash; pharmacokinetic interactions: photo by Alvaro Pinot on Unsplash
CYP3A4 Enzyme by Minutemen 20:03, Public Domain, Wikimedia Commons
Substrates hexagon: Photo by Andrea Leopardi on Unsplash; Inhibitors hexagon: Colorful Drug Mix by Myriam Zilles on Unsplash; Inducers
hexagon: Dancing Roof by Ricardo Gomez Angel on Unsplash
Metabolic Drug-Drug Interactions Between Cannabidiol and Enzyme Substrates, Inhibitors, or Inducers: Undulating Negative Space by
Tobias van Schneider on Unsplash
Drug-Drug Interactions Between CBD and Secondary Metabolism or Membrane Transporter Proteins: The Palm by Nick Fewings on Unsplash
Stethoscope photo by Hush Naidoo on Unsplash
Green Rope Meshwork by Clint Adair on Unsplash
Works Cited: 6bd7 by Astrogan, Creative Commons Attribution-Share Alike 4.0 International license
CannaSci Open (2021). Potential Drug-Drug Interactions Between Medical and Consumer Cannabidiol (CBD) Use [INFOGRAPHIC].
Licensed by a Creative Commons Attribution-ShareAlike 4.0 International (CC BY-SA 4.0) license. Available at: www.cannasciopen.com
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