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Cannabis-Disease State Precautions

Disease State or Patient population Precautions/Warnings
Psychiatric Disorders Common side effects of cannabinoids include depression, euphoria, disorientation and dissociation. Less common side effects include hallucinations, paranoia, delusions, and suicidal ideation. Mood, cognitive, and behavioral changes can occur with cannabinoid use. Avoid use in patients with a history of psychosis or bipolar disorder.
Lung Disease Potential for respiratory depression and bronchoconstriction via CB1 receptor stimulation. Heavy or long-term use of inhaled cannabis has been associated with increased risk of chronic bronchitis and COPD.
Hypoglycemia Potential for hypoglycemia though CB1 and CB2 receptor stimulation
Cardiac Disease Cannabinoids have been shown to cause palpitations, tachycardia, syncope and hyper/hypotension. Use with caution in patients with ischemic heart disease, heart failure or arrhythmia. 
Renal/Hepatic Dysfunction

Although no direct data has been reported regarding dose adjustments, cannabinoids are metabolized by the liver and excreted via the kidneys. Dysfunction of the liver or kidneys could have the potential to prolong the effects and/or increase adverse effects from cannabinoids. 

 

In clinical trials, high doses of CBD (Epidiolex) was shown to be associated with Hepatotoxicity and there are dose adjustment warnings based on liver function.  There is more to learn about this adverse effect, for example CBD and concurrent divalproic acid was associated with poorer liver function results.

Eplilepsy Cannabinoids can either raise or lower seizure threshold. 
Older Adults Common side effects of cannabinoids include dizziness, drowsiness and blurred vision which can increase the risk of falls.  

 

References:

1.       Wilcock A, Twycross R. Therapeutic Review of Cannabinoids. Journal of Pain and Symptom Management. 2013; 5.

2.        Medical Cannabis: Adverse Effects and Drug Interactions. District of Columbia Department of Health. doh.dc.gov/dcrx  

 

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