![]() ![]() They can range from seeing the great potential to ease suffering to believing molecules derived from cannabis have no place in modern medicine. ![]() Opinions and values regarding cannabinoids in medicine vary by individual. Nabilone has reported adverse effects that include acute intoxication, ataxia, headache, drowsiness, and deficits in concentration. Dronabinol has reported adverse effects of gastrointestinal upset, dizziness, paranoia, somnolence, and abnormal thoughts. In vitro studies have shown an association between CBD and reduced fertility and alterations of cell viability. CBD is a CYP3A4 inhibitor, potentially leading to drug interactions and toxicities in molecules metabolized by the CYP3A4 system. Cannabinoid formulas containing only a CBD component have less potential to cause behavioral side effects, although drowsiness occurs frequently. Individuals using THC-containing cannabinoid products chronically and at a high volume are also at risk of developing cannabis hyperemesis syndrome, which can present as intractable nausea and vomiting. Psychoses manifest most commonly as perceptual alteration but also frequently include panic attacks, anxiety, paranoia, and depression. The most common adverse effects of formulas containing a THC component are acute intoxication, tachycardia, aboulia, and psychosis. ![]() Īdverse effects depend on the cannabinoid administered. Doses for these generally range between 5 mg and 15 mg and are typically taken as needed as opposed to daily due to their psychotropic effects. Products containing significant THC levels are sold legally by medicinal and recreational dispensaries in several states, depending on legal status. However, doses generally range from 10 mg to 50 mg at a time, taken either as needed or daily. CBD is sold legally throughout the United States without a prescription by many private entities that are not FDA regulated there are no concrete guidelines for dosing. Patients should receive instruction to take one dose the night before starting their chemotherapy session, one dose twice a day during the entirety of the chemotherapy course, and one dose twice a day after chemotherapy has concluded. These doses can be increased or decreased based on practitioner discretion. ĭronabinol dosing can be via either oral pill and oral solution forms, available in doses of 2.5 mg, 5 mg, and 10 mg. In CINV, the patients should take it 1 to 3 hours before starting their chemotherapy session, with a repeat dose available 2 to 4 hours after beginning the session as needed. Nabilone is available in oral pill form, in doses of 1 mg or 2 mg. THC and CBD were once credited with inhibiting fatty acid amide hydrolase (FAAH), leading to an increased concentration of anandamide that could exert its anti-emetic properties at a higher intensity, but recent studies into this mechanism have been equivocal. However, this effect may be mainly through its activation of the 5-HT1A receptor. The activation of the 5-HT1A receptor ultimately reduces the amount of serotonin released, and thus a lower potential to trigger emesis. CBD is also thought to activate the CB1 receptors in the gastrointestinal tract through their G-protein-coupled receptor inhibitory effect, leading to decreased gastrointestinal motility. Animal models have also shown that cannabinoids may work on pre-synaptic CB1to decrease the release of serotonin into the synapse, thus inhibiting the nausea/emetic response.Īnimal models have also indicated CBD to have an allosteric inhibitory effect on the 5-HT3 receptor. Studies in animal models have shown that anandamide, an endogenous cannabinoid, THC, and several synthetic cannabinoids have demonstrated allosteric inhibitor effects on the 5-HT3 receptors in the DVC, providing a mechanism through which emesis control occurs. A significant contributor to emesis appears to be via activation of 5-HT3 receptors in the DVC, specifically in the area postrema. Cannabinoids exert their anti-emetic properties through interactions with the centrally located CB1 receptors and 5-HT3 receptors in the dorsal vagal complex (DVC), which mediates emesis. Cannabinoids and their anti-emetic potential are still under research, and many of the intricacies behind their mechanisms are still unknown or lack universal consensus. ![]()
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