Abstract
Choosing an appropriate treatment for chronic pain remains problematic, and despite the available medication for its treatment, still, many patients complain about pain and appeal to the use of cannabis derivatives for pain control. However, few data have been provided to clinicians about the pharmacokinetic drug-drug interactions of cannabinoids with other concomitant administered medications. Therefore, the aim of this brief review is to assess the interactions between cannabinoids and pain medication through drug transporters (ATP-binding cassette superfamily members) and/or metabolizing enzymes (cytochromes P450 and glucuronyl transferases).
Highlights
A drug-drug interaction (DDI) occurs when one drug alters the clinical effect of another
DDIs are often associated with toxicity or therapeutic failure [1], sometimes they can produce beneficial effects to the patient [2]
Clinicians must be familiar with DDIs in order to improve prescribing tools
Summary
A drug-drug interaction (DDI) occurs when one drug alters the clinical effect of another. 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. The use of cannabinoids for the treatment of pain is supported by some controlled clinical trials [3,4,5], currently and according to BioMed Research International systematic reviews and meta-analysis [6,7,8], there is only moderate evidence to support the use of cannabinoids in treating chronic pain and larger and higher quality clinical trials are needed Despite this fact, chronic pain relief is by far the most common condition cited by patients using cannabis for medical purposes and very little is known about potential pharmacokinetic interactions with common medication prescribed for chronic pain. This review addresses a comprehensive overview of potential pharmacokinetic interactions affecting drug metabolism enzymes such as cytochrome P450 or UGTs and membrane efflux transporters between cannabinoids and drugs used for chronic pain
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