Suggested Dosing
Analgesia, Antiemetic, Appetite Stimulant, Glaucoma
Dosing of marijuana preparations is highly dependent on a variety of factors (eg, growing and harvesting conditions, plant parts isolated)
No standard guidelines exist for dosage ranges
Oral
- Tincture: 5-15 drops or 1-3 drops of fluid extract
Inhalation
- 1-3 grains (65-195mg) cannabis for smoking
- Potency highly variable
- Drug deteriorates rapidly
Wasting Syndrome (Orphan)
Treatment of HIV-associated wasting syndrome
Orphan indication sponsor
- Multidisciplinary Association for Psychedelic Studies, Inc; 3 Francis St; Belmont, MA 02478
Hepatocellular Carcinoma (Orphan)
Delta-9-tetrahydrocannibinol: Orphan designation for treatment of hepatocellular carcinoma
Sponsor
- Tetra Bio-Pharma Inc; 3005 Blvd Matte, Suite 300A; Brossard, Quebec; Canada
Suggested Uses
Decrease intraocular pressure, analgesia, antiemetic effects, appetite stimulant
Availability
The United States (US) Drug Enforcement Administration (DEA) classifies marijuana as a Schedule 1 substance under the Controlled Substances Act (CSA). Schedule I drugs are recognized as having a high potential for abuse with insufficient evidence for safety and efficacy with no currently accepted medical use for treatment in the US
Marijuana is not approved by the US Food and Drug Administration (FDA) for medical use in the US and remains classified as an illicit drug by the DEA. However, 33 states and the Distric of Columbia have adopted individual State Medical Marijuana Laws
In October of 2009 the US Justice Department announced that it will no longer enforce federal drug laws on persons who use marijuana for medicinal purposes or their sanctioned suppliers, as long as state laws are followed
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (1)
- pimozide
marijuana increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.
Serious - Use Alternative (24)
- abametapir
abametapir will increase the level or effect of marijuana by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. For 2 weeks after abametapir application, avoid taking drugs that are CYP3A4 substrates. If not feasible, avoid use of abametapir.
- apalutamide
apalutamide will decrease the level or effect of marijuana by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered. Adjust dose according to prescribing information if needed.
- calcium/magnesium/potassium/sodium oxybates
marijuana, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
- dihydroergotamine
marijuana will increase the level or effect of dihydroergotamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- dihydroergotamine intranasal
marijuana will increase the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- dronedarone
marijuana will increase the level or effect of dronedarone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- enzalutamide
enzalutamide will decrease the level or effect of marijuana by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- ergotamine
marijuana will increase the level or effect of ergotamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- erythromycin base
marijuana will increase the level or effect of erythromycin base by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- erythromycin ethylsuccinate
marijuana will increase the level or effect of erythromycin ethylsuccinate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- erythromycin lactobionate
marijuana will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- erythromycin stearate
marijuana will increase the level or effect of erythromycin stearate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- everolimus
marijuana will increase the level or effect of everolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- fexinidazole
fexinidazole will increase the level or effect of marijuana by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Fexinidazole inhibits CYP3A4. Coadministration may increase risk for adverse effects of CYP3A4 substrates.
- ivosidenib
ivosidenib will decrease the level or effect of marijuana by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternative therapies. If coadministration is unavoidable, monitor patients for loss of therapeutic effect of these drugs.
- lovastatin
marijuana will increase the level or effect of lovastatin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- ranolazine
marijuana will increase the level or effect of ranolazine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- silodosin
marijuana will increase the level or effect of silodosin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- simvastatin
marijuana will increase the level or effect of simvastatin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- sirolimus
marijuana will increase the level or effect of sirolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- sodium oxybate
marijuana, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
- thioridazine
marijuana will increase the level or effect of thioridazine by affecting hepatic enzyme CYP2D6 metabolism. Contraindicated.
- tolvaptan
marijuana will increase the level or effect of tolvaptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- tucatinib
tucatinib will increase the level or effect of marijuana by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid concomitant use of tucatinib with CYP3A substrates, where minimal concentration changes may lead to serious or life-threatening toxicities. If unavoidable, reduce CYP3A substrate dose according to product labeling.
Monitor Closely (283)
- acarbose
marijuana decreases effects of acarbose by pharmacodynamic antagonism. Use Caution/Monitor.
- albuterol
marijuana increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- alfentanil
alfentanil and marijuana both increase sedation. Use Caution/Monitor.
- almotriptan
marijuana will increase the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- alprazolam
marijuana will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
alprazolam and marijuana both increase sedation. Use Caution/Monitor. - amiodarone
marijuana will increase the level or effect of amiodarone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- amitriptyline
amitriptyline and marijuana both increase sedation. Use Caution/Monitor.
- amobarbital
amobarbital and marijuana both increase sedation. Use Caution/Monitor.
- amoxapine
amoxapine and marijuana both increase sedation. Use Caution/Monitor.
- apomorphine
apomorphine and marijuana both increase sedation. Use Caution/Monitor.
- aprepitant
marijuana will increase the level or effect of aprepitant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- arformoterol
marijuana increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- aripiprazole
marijuana will increase the level or effect of aripiprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
aripiprazole and marijuana both increase sedation. Use Caution/Monitor. - armodafinil
marijuana increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- artemether/lumefantrine
marijuana will increase the level or effect of artemether/lumefantrine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- atorvastatin
marijuana will increase the level or effect of atorvastatin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- azelastine
azelastine and marijuana both increase sedation. Use Caution/Monitor.
- baclofen
baclofen and marijuana both increase sedation. Use Caution/Monitor.
- bazedoxifene/conjugated estrogens
marijuana will increase the level or effect of bazedoxifene/conjugated estrogens by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- belladonna and opium
belladonna and opium and marijuana both increase sedation. Use Caution/Monitor.
- benperidol
benperidol and marijuana both increase sedation. Use Caution/Monitor.
- benzhydrocodone/acetaminophen
marijuana will increase the level or effect of benzhydrocodone/acetaminophen by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Hydromorphone (<3% of the circulating parent hydrocodone [benzhydrocodone is prodrug of hydrocodone]) is mainly formed by CYP2D6 mediated O-demethylation of hydrocodone. Hydromorphone may contribute to the total analgesic effect of hydrocodone.
- benzphetamine
marijuana increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- bosentan
bosentan will decrease the level or effect of marijuana by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- brompheniramine
brompheniramine and marijuana both increase sedation. Use Caution/Monitor.
- budesonide
marijuana will increase the level or effect of budesonide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- buprenorphine
buprenorphine and marijuana both increase sedation. Use Caution/Monitor.
- buprenorphine buccal
buprenorphine buccal and marijuana both increase sedation. Use Caution/Monitor.
- buspirone
marijuana will increase the level or effect of buspirone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- butabarbital
butabarbital and marijuana both increase sedation. Use Caution/Monitor.
- butalbital
butalbital and marijuana both increase sedation. Use Caution/Monitor.
- butorphanol
butorphanol and marijuana both increase sedation. Use Caution/Monitor.
- caffeine
marijuana increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- carbamazepine
marijuana will increase the level or effect of carbamazepine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
carbamazepine will decrease the level or effect of marijuana by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. - carbinoxamine
carbinoxamine and marijuana both increase sedation. Use Caution/Monitor.
- carisoprodol
carisoprodol and marijuana both increase sedation. Use Caution/Monitor.
- carvedilol
marijuana will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- cenobamate
cenobamate will decrease the level or effect of marijuana by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.
- chloral hydrate
chloral hydrate and marijuana both increase sedation. Use Caution/Monitor.
- chlordiazepoxide
chlordiazepoxide and marijuana both increase sedation. Use Caution/Monitor.
- chlorpheniramine
chlorpheniramine and marijuana both increase sedation. Use Caution/Monitor.
- chlorpromazine
chlorpromazine and marijuana both increase sedation. Use Caution/Monitor.
- chlorpropamide
marijuana decreases effects of chlorpropamide by pharmacodynamic antagonism. Use Caution/Monitor.
- chlorzoxazone
chlorzoxazone and marijuana both increase sedation. Use Caution/Monitor.
- cilostazol
marijuana will increase the level or effect of cilostazol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- cinacalcet
marijuana will increase the level or effect of cinacalcet by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- cinnarizine
cinnarizine and marijuana both increase sedation. Use Caution/Monitor.
- clarithromycin
clarithromycin will increase the level or effect of marijuana by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- clemastine
clemastine and marijuana both increase sedation. Use Caution/Monitor.
- clomipramine
marijuana will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
clomipramine and marijuana both increase sedation. Use Caution/Monitor. - clonazepam
clonazepam and marijuana both increase sedation. Use Caution/Monitor.
- clopidogrel
marijuana will decrease the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Inhibition of CYP3A4 will reduce clopidogrel bioactivation
- clorazepate
clorazepate and marijuana both increase sedation. Use Caution/Monitor.
- clozapine
marijuana will increase the level or effect of clozapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
clozapine and marijuana both increase sedation. Use Caution/Monitor. - codeine
codeine and marijuana both increase sedation. Use Caution/Monitor.
- conivaptan
marijuana will increase the level or effect of conivaptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
conivaptan will increase the level or effect of marijuana by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. - conjugated estrogens
marijuana will increase the level or effect of conjugated estrogens by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- conjugated estrogens, vaginal
marijuana will increase the level or effect of conjugated estrogens, vaginal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- cortisone
marijuana will increase the level or effect of cortisone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- cyclizine
cyclizine and marijuana both increase sedation. Use Caution/Monitor.
- cyclobenzaprine
cyclobenzaprine and marijuana both increase sedation. Use Caution/Monitor.
- cyproheptadine
cyproheptadine and marijuana both increase sedation. Use Caution/Monitor.
- dantrolene
dantrolene and marijuana both increase sedation. Use Caution/Monitor.
- darifenacin
marijuana will increase the level or effect of darifenacin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- darunavir
marijuana will increase the level or effect of darunavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
darunavir will increase the level or effect of marijuana by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. - dasatinib
marijuana will increase the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- desipramine
marijuana will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
desipramine and marijuana both increase sedation. Use Caution/Monitor. - dexamethasone
marijuana will increase the level or effect of dexamethasone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- dexchlorpheniramine
dexchlorpheniramine and marijuana both increase sedation. Use Caution/Monitor.
- dexfenfluramine
marijuana increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dexmedetomidine
dexmedetomidine and marijuana both increase sedation. Use Caution/Monitor.
- dexmethylphenidate
marijuana increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dextroamphetamine
marijuana increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dextromoramide
dextromoramide and marijuana both increase sedation. Use Caution/Monitor.
- diamorphine
diamorphine and marijuana both increase sedation. Use Caution/Monitor.
- diazepam
marijuana will increase the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
diazepam and marijuana both increase sedation. Use Caution/Monitor. - diethylpropion
marijuana increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- difenoxin hcl
difenoxin hcl and marijuana both increase sedation. Use Caution/Monitor.
- diltiazem
diltiazem will increase the level or effect of marijuana by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- dimenhydrinate
dimenhydrinate and marijuana both increase sedation. Use Caution/Monitor.
- diphenhydramine
diphenhydramine and marijuana both increase sedation. Use Caution/Monitor.
- diphenoxylate hcl
diphenoxylate hcl and marijuana both increase sedation. Use Caution/Monitor.
- dipipanone
dipipanone and marijuana both increase sedation. Use Caution/Monitor.
- dobutamine
marijuana increases and dobutamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dopamine
marijuana increases and dopamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dopexamine
marijuana increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- doxepin
doxepin and marijuana both increase sedation. Use Caution/Monitor.
- doxylamine
doxylamine and marijuana both increase sedation. Use Caution/Monitor.
- droperidol
droperidol and marijuana both increase sedation. Use Caution/Monitor.
- duloxetine
marijuana will increase the level or effect of duloxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- efavirenz
efavirenz will decrease the level or effect of marijuana by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- eletriptan
marijuana will increase the level or effect of eletriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- encorafenib
encorafenib, marijuana. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Encorafenib both inhibits and induces CYP3A4 at clinically relevant plasma concentrations. Coadministration of encorafenib with sensitive CYP3A4 substrates may result in increased toxicity or decreased efficacy of these agents.
- ephedrine
marijuana increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- epinephrine
marijuana increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- epinephrine racemic
marijuana increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- erlotinib
marijuana will increase the level or effect of erlotinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- estazolam
estazolam and marijuana both increase sedation. Use Caution/Monitor.
- estradiol
marijuana will increase the level or effect of estradiol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- estrogens conjugated synthetic
marijuana will increase the level or effect of estrogens conjugated synthetic by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- estropipate
marijuana will increase the level or effect of estropipate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- ethanol
ethanol and marijuana both increase sedation. Use Caution/Monitor.
- etonogestrel
marijuana will increase the level or effect of etonogestrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- etravirine
marijuana will increase the level or effect of etravirine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- fedratinib
fedratinib will increase the level or effect of marijuana by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP3A4 substrates as necessary.
- felodipine
marijuana will increase the level or effect of felodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- fenfluramine
marijuana increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- fesoterodine
marijuana will increase the level or effect of fesoterodine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- flecainide
marijuana will increase the level or effect of flecainide by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- fludrocortisone
marijuana will increase the level or effect of fludrocortisone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- fluphenazine
fluphenazine and marijuana both increase sedation. Use Caution/Monitor.
- flurazepam
flurazepam and marijuana both increase sedation. Use Caution/Monitor.
- formoterol
marijuana increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- fosamprenavir
marijuana will increase the level or effect of fosamprenavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- fosphenytoin
fosphenytoin will decrease the level or effect of marijuana by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- glimepiride
marijuana decreases effects of glimepiride by pharmacodynamic antagonism. Use Caution/Monitor.
- glipizide
marijuana decreases effects of glipizide by pharmacodynamic antagonism. Use Caution/Monitor.
- glyburide
marijuana decreases effects of glyburide by pharmacodynamic antagonism. Use Caution/Monitor.
- haloperidol
marijuana will increase the level or effect of haloperidol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
haloperidol and marijuana both increase sedation. Use Caution/Monitor. - hydrocodone
marijuana will increase the level or effect of hydrocodone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Hydromorphone (<3% of the circulating parent hydrocodone) is mainly formed by CYP2D6 mediated O-demethylation of hydrocodone. Hydromorphone may contribute to the total analgesic effect of hydrocodone.
- hydrocortisone
marijuana will increase the level or effect of hydrocortisone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- hydromorphone
marijuana will increase the level or effect of hydromorphone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
hydromorphone and marijuana both increase sedation. Use Caution/Monitor. - hydroxyprogesterone caproate
marijuana will increase the level or effect of hydroxyprogesterone caproate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- hydroxyzine
hydroxyzine and marijuana both increase sedation. Use Caution/Monitor.
- idelalisib
idelalisib will increase the level or effect of marijuana by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- iloperidone
marijuana will increase the level or effect of iloperidone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
marijuana will increase the level or effect of iloperidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
iloperidone and marijuana both increase sedation. Use Caution/Monitor. - imipramine
marijuana will increase the level or effect of imipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
imipramine and marijuana both increase sedation. Use Caution/Monitor. - indinavir
marijuana will increase the level or effect of indinavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
indinavir will increase the level or effect of marijuana by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. - insulin aspart
marijuana decreases effects of insulin aspart by pharmacodynamic antagonism. Use Caution/Monitor.
- insulin detemir
marijuana decreases effects of insulin detemir by pharmacodynamic antagonism. Use Caution/Monitor.
- insulin glargine
marijuana decreases effects of insulin glargine by pharmacodynamic antagonism. Use Caution/Monitor.
- insulin glulisine
marijuana decreases effects of insulin glulisine by pharmacodynamic antagonism. Use Caution/Monitor.
- insulin lispro
marijuana decreases effects of insulin lispro by pharmacodynamic antagonism. Use Caution/Monitor.
- insulin NPH
marijuana decreases effects of insulin NPH by pharmacodynamic antagonism. Use Caution/Monitor.
- insulin regular human
marijuana decreases effects of insulin regular human by pharmacodynamic antagonism. Use Caution/Monitor.
- isoproterenol
marijuana increases and isoproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- istradefylline
istradefylline will increase the level or effect of marijuana by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. This effect was not observed with istradefylline 20 mg/day. Consider dose reduction of sensitive CYP3A4 substrates.
- itraconazole
itraconazole will increase the level or effect of marijuana by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- ixabepilone
marijuana will increase the level or effect of ixabepilone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- ketoconazole
ketoconazole will increase the level or effect of marijuana by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- ketotifen, ophthalmic
ketotifen, ophthalmic and marijuana both increase sedation. Use Caution/Monitor.
- lapatinib
marijuana will increase the level or effect of lapatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- levalbuterol
marijuana increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- levorphanol
levorphanol and marijuana both increase sedation. Use Caution/Monitor.
- lisdexamfetamine
marijuana increases and lisdexamfetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- lofepramine
marijuana will increase the level or effect of lofepramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
lofepramine and marijuana both increase sedation. Use Caution/Monitor. - lofexidine
lofexidine and marijuana both increase sedation. Use Caution/Monitor.
- lopinavir
marijuana will increase the level or effect of lopinavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
lopinavir will increase the level or effect of marijuana by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. - loprazolam
loprazolam and marijuana both increase sedation. Use Caution/Monitor.
- loratadine
marijuana will increase the level or effect of loratadine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- lorazepam
lorazepam and marijuana both increase sedation. Use Caution/Monitor.
- lorlatinib
lorlatinib will decrease the level or effect of marijuana by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- lormetazepam
lormetazepam and marijuana both increase sedation. Use Caution/Monitor.
- loxapine
loxapine and marijuana both increase sedation. Use Caution/Monitor.
- loxapine inhaled
loxapine inhaled and marijuana both increase sedation. Use Caution/Monitor.
- lumefantrine
marijuana will increase the level or effect of lumefantrine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- maprotiline
maprotiline and marijuana both increase sedation. Use Caution/Monitor.
- maraviroc
marijuana will increase the level or effect of maraviroc by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- melatonin
marijuana and melatonin both increase sedation. Use Caution/Monitor.
- meperidine
meperidine and marijuana both increase sedation. Use Caution/Monitor.
- meprobamate
marijuana and meprobamate both increase sedation. Use Caution/Monitor.
- mestranol
marijuana will increase the level or effect of mestranol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- metaproterenol
marijuana increases and metaproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- metaxalone
metaxalone and marijuana both increase sedation. Use Caution/Monitor.
- metformin
marijuana decreases effects of metformin by pharmacodynamic antagonism. Use Caution/Monitor.
- methadone
marijuana will increase the level or effect of methadone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
methadone and marijuana both increase sedation. Use Caution/Monitor. - methamphetamine
marijuana will increase the level or effect of methamphetamine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
marijuana increases and methamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. - methocarbamol
methocarbamol and marijuana both increase sedation. Use Caution/Monitor.
- methylenedioxymethamphetamine
marijuana increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- methylprednisolone
marijuana will increase the level or effect of methylprednisolone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- metoprolol
marijuana will increase the level or effect of metoprolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- mexiletine
marijuana will increase the level or effect of mexiletine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- midazolam
marijuana will increase the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
midazolam and marijuana both increase sedation. Use Caution/Monitor. - midodrine
marijuana increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- miglitol
marijuana decreases effects of miglitol by pharmacodynamic antagonism. Use Caution/Monitor.
- mirtazapine
marijuana and mirtazapine both increase sedation. Use Caution/Monitor.
- mitotane
mitotane will decrease the level or effect of marijuana by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- modafinil
marijuana increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- morphine
marijuana will increase the level or effect of morphine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
morphine and marijuana both increase sedation. Use Caution/Monitor. - motherwort
marijuana and motherwort both increase sedation. Use Caution/Monitor.
- moxonidine
marijuana and moxonidine both increase sedation. Use Caution/Monitor.
- nabilone
marijuana and nabilone both increase sedation. Use Caution/Monitor.
- nafcillin
nafcillin will decrease the level or effect of marijuana by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- nalbuphine
nalbuphine and marijuana both increase sedation. Use Caution/Monitor.
- nateglinide
marijuana decreases effects of nateglinide by pharmacodynamic antagonism. Use Caution/Monitor.
- nebivolol
marijuana will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- nefazodone
nefazodone will increase the level or effect of marijuana by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- nelfinavir
marijuana will increase the level or effect of nelfinavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
nelfinavir will increase the level or effect of marijuana by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. - nicardipine
marijuana will increase the level or effect of nicardipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- nilotinib
marijuana will increase the level or effect of nilotinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- nisoldipine
marijuana will increase the level or effect of nisoldipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- norepinephrine
marijuana increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- nortriptyline
marijuana will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
nortriptyline and marijuana both increase sedation. Use Caution/Monitor. - olanzapine
olanzapine and marijuana both increase sedation. Use Caution/Monitor.
- opium tincture
opium tincture and marijuana both increase sedation. Use Caution/Monitor.
- orphenadrine
orphenadrine and marijuana both increase sedation. Use Caution/Monitor.
- ospemifene
marijuana, ospemifene. Either increases levels of the other by plasma protein binding competition. Modify Therapy/Monitor Closely.
- oxazepam
oxazepam and marijuana both increase sedation. Use Caution/Monitor.
- oxycodone
marijuana will increase the level or effect of oxycodone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
oxycodone and marijuana both increase sedation. Use Caution/Monitor. - oxymorphone
marijuana will increase the level or effect of oxymorphone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
oxymorphone and marijuana both increase sedation. Use Caution/Monitor. - paliperidone
paliperidone and marijuana both increase sedation. Use Caution/Monitor.
- papaveretum
papaveretum and marijuana both increase sedation. Use Caution/Monitor.
- papaverine
marijuana and papaverine both increase sedation. Use Caution/Monitor.
- pazopanib
marijuana will increase the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Avoid coadministration of pazopanib with strong CYP3A4 inhibitors if possible; if must coadminister, decrease pazopanib dose to 400 mg/day
- pentazocine
pentazocine and marijuana both increase sedation. Use Caution/Monitor.
- pentobarbital
pentobarbital and marijuana both increase sedation. Use Caution/Monitor.
- perphenazine
perphenazine and marijuana both increase sedation. Use Caution/Monitor.
- phendimetrazine
marijuana increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- phenobarbital
phenobarbital and marijuana both increase sedation. Use Caution/Monitor.
phenobarbital will decrease the level or effect of marijuana by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. - phentermine
marijuana increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- phenylephrine
marijuana increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- phenylephrine PO
marijuana increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .
- phenytoin
phenytoin will decrease the level or effect of marijuana by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- pholcodine
marijuana and pholcodine both increase sedation. Use Caution/Monitor.
- pimozide
pimozide and marijuana both increase sedation. Use Caution/Monitor.
- pioglitazone
marijuana decreases effects of pioglitazone by pharmacodynamic antagonism. Use Caution/Monitor.
- pirbuterol
marijuana increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- posaconazole
posaconazole will increase the level or effect of marijuana by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- prednisolone
marijuana will increase the level or effect of prednisolone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- prednisone
marijuana will increase the level or effect of prednisone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- primidone
primidone and marijuana both increase sedation. Use Caution/Monitor.
primidone will decrease the level or effect of marijuana by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. - prochlorperazine
prochlorperazine and marijuana both increase sedation. Use Caution/Monitor.
- promethazine
promethazine and marijuana both increase sedation. Use Caution/Monitor.
- propafenone
marijuana will increase the level or effect of propafenone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- propranolol
marijuana will increase the level or effect of propranolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- propylhexedrine
marijuana increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- protriptyline
protriptyline and marijuana both increase sedation. Use Caution/Monitor.
- quazepam
quazepam and marijuana both increase sedation. Use Caution/Monitor.
- quetiapine
marijuana will increase the level or effect of quetiapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
quetiapine and marijuana both increase sedation. Use Caution/Monitor. - quinidine
marijuana will increase the level or effect of quinidine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- ramelteon
marijuana and ramelteon both increase sedation. Use Caution/Monitor.
- repaglinide
marijuana will increase the level or effect of repaglinide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
marijuana decreases effects of repaglinide by pharmacodynamic antagonism. Use Caution/Monitor. - ribociclib
ribociclib will increase the level or effect of marijuana by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- rifampin
rifampin will decrease the level or effect of marijuana by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- rifapentine
rifapentine will decrease the level or effect of marijuana by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- risperidone
risperidone and marijuana both increase sedation. Use Caution/Monitor.
- ritonavir
marijuana will increase the level or effect of ritonavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
ritonavir will increase the level or effect of marijuana by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. - rosiglitazone
marijuana decreases effects of rosiglitazone by pharmacodynamic antagonism. Use Caution/Monitor.
- rucaparib
rucaparib will increase the level or effect of marijuana by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP3A4 substrates, if clinically indicated.
- salmeterol
marijuana increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- saquinavir
marijuana will increase the level or effect of saquinavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
saquinavir will increase the level or effect of marijuana by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. - saxagliptin
marijuana decreases effects of saxagliptin by pharmacodynamic antagonism. Use Caution/Monitor.
- scullcap
marijuana and scullcap both increase sedation. Use Caution/Monitor.
- secobarbital
secobarbital and marijuana both increase sedation. Use Caution/Monitor.
- shepherd's purse
marijuana and shepherd's purse both increase sedation. Use Caution/Monitor.
- sitagliptin
marijuana decreases effects of sitagliptin by pharmacodynamic antagonism. Use Caution/Monitor.
- solifenacin
marijuana will increase the level or effect of solifenacin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- stiripentol
stiripentol, marijuana. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP3A4 inhibitor and inducer. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. CYP3A4 substrates may require dosage adjustment.
stiripentol, marijuana. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence. - sufentanil
sufentanil and marijuana both increase sedation. Use Caution/Monitor.
- sunitinib
marijuana will increase the level or effect of sunitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- tacrolimus
marijuana will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- tadalafil
marijuana will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- tapentadol
tapentadol and marijuana both increase sedation. Use Caution/Monitor.
- tazemetostat
tazemetostat will decrease the level or effect of marijuana by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- temazepam
temazepam and marijuana both increase sedation. Use Caution/Monitor.
- temsirolimus
marijuana will increase the level or effect of temsirolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- terbutaline
marijuana increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- theophylline
marijuana will increase the level or effect of theophylline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- thioridazine
thioridazine and marijuana both increase sedation. Use Caution/Monitor.
- thiothixene
thiothixene and marijuana both increase sedation. Use Caution/Monitor.
- timolol
marijuana will increase the level or effect of timolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- tipranavir
marijuana will increase the level or effect of tipranavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- tolazamide
marijuana decreases effects of tolazamide by pharmacodynamic antagonism. Use Caution/Monitor.
- tolbutamide
marijuana decreases effects of tolbutamide by pharmacodynamic antagonism. Use Caution/Monitor.
- tolterodine
marijuana will increase the level or effect of tolterodine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- topiramate
marijuana and topiramate both increase sedation. Modify Therapy/Monitor Closely.
- tramadol
tramadol and marijuana both increase sedation. Use Caution/Monitor.
- trazodone
marijuana will increase the level or effect of trazodone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
trazodone and marijuana both increase sedation. Use Caution/Monitor. - triamcinolone acetonide injectable suspension
marijuana will increase the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- triazolam
marijuana will increase the level or effect of triazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
triazolam and marijuana both increase sedation. Use Caution/Monitor. - triclofos
triclofos and marijuana both increase sedation. Use Caution/Monitor.
- trifluoperazine
trifluoperazine and marijuana both increase sedation. Use Caution/Monitor.
- trimipramine
trimipramine and marijuana both increase sedation. Use Caution/Monitor.
- triprolidine
triprolidine and marijuana both increase sedation. Use Caution/Monitor.
- vardenafil
marijuana will increase the level or effect of vardenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- verapamil
marijuana will increase the level or effect of verapamil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- vildagliptin
marijuana decreases effects of vildagliptin by pharmacodynamic antagonism. Use Caution/Monitor.
- voriconazole
voriconazole will increase the level or effect of marijuana by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- warfarin
marijuana will increase the level or effect of warfarin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- xylometazoline
marijuana increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- yohimbine
marijuana increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ziconotide
marijuana and ziconotide both increase sedation. Use Caution/Monitor.
- ziprasidone
ziprasidone and marijuana both increase sedation. Use Caution/Monitor.
Minor (75)
- alfentanil
marijuana will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- alfuzosin
marijuana will increase the level or effect of alfuzosin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- alosetron
marijuana will increase the level or effect of alosetron by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- amitriptyline
marijuana will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- aripiprazole
marijuana will increase the level or effect of aripiprazole by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
- armodafinil
marijuana will increase the level or effect of armodafinil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- atazanavir
marijuana will increase the level or effect of atazanavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- bosentan
marijuana will increase the level or effect of bosentan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- cevimeline
marijuana will increase the level or effect of cevimeline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- chlorpromazine
marijuana will increase the level or effect of chlorpromazine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
- clarithromycin
marijuana will increase the level or effect of clarithromycin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- clomipramine
marijuana will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- codeine
marijuana will increase the level or effect of codeine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
- dapsone
marijuana will increase the level or effect of dapsone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- desipramine
marijuana will increase the level or effect of desipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- dexfenfluramine
marijuana will increase the level or effect of dexfenfluramine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
- dextroamphetamine
marijuana will increase the level or effect of dextroamphetamine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
- dextromethorphan
marijuana will increase the level or effect of dextromethorphan by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
- disopyramide
marijuana will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- docetaxel
marijuana will increase the level or effect of docetaxel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- donepezil
marijuana will increase the level or effect of donepezil by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
marijuana will increase the level or effect of donepezil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown. - doxepin
marijuana will increase the level or effect of doxepin by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
- dutasteride
marijuana will increase the level or effect of dutasteride by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- efavirenz
marijuana will increase the level or effect of efavirenz by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- encainide
marijuana will increase the level or effect of encainide by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
- eplerenone
marijuana will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- eucalyptus
marijuana will increase the level or effect of eucalyptus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
eucalyptus and marijuana both increase sedation. Minor/Significance Unknown. - fesoterodine
marijuana will increase the level or effect of fesoterodine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
- finasteride
marijuana will increase the level or effect of finasteride by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- fluoxetine
marijuana will increase the level or effect of fluoxetine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
- fluphenazine
marijuana will increase the level or effect of fluphenazine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
- galantamine
marijuana will increase the level or effect of galantamine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
marijuana will increase the level or effect of galantamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown. - imatinib
marijuana will increase the level or effect of imatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- imipramine
marijuana will increase the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- isradipine
marijuana will increase the level or effect of isradipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- itraconazole
marijuana will increase the level or effect of itraconazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- ketoconazole
marijuana will increase the level or effect of ketoconazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- loratadine
marijuana will increase the level or effect of loratadine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
- montelukast
marijuana will increase the level or effect of montelukast by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- nifedipine
marijuana will increase the level or effect of nifedipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- nimodipine
marijuana will increase the level or effect of nimodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- nitrendipine
marijuana will increase the level or effect of nitrendipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- oxybutynin
marijuana will increase the level or effect of oxybutynin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- paclitaxel
marijuana will increase the level or effect of paclitaxel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- paclitaxel protein bound
marijuana will increase the level or effect of paclitaxel protein bound by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- parecoxib
marijuana will increase the level or effect of parecoxib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- paroxetine
marijuana will increase the level or effect of paroxetine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
- perhexiline
marijuana will increase the level or effect of perhexiline by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
- perphenazine
marijuana will increase the level or effect of perphenazine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
- pimozide
marijuana will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- pioglitazone
marijuana will increase the level or effect of pioglitazone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- prochlorperazine
marijuana will increase the level or effect of prochlorperazine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
- promazine
marijuana will increase the level or effect of promazine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
- promethazine
marijuana will increase the level or effect of promethazine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
- propafenone
marijuana will increase the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- quinine
marijuana will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- rabeprazole
marijuana will increase the level or effect of rabeprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- ramelteon
marijuana will increase the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- risperidone
marijuana will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
- sage
marijuana and sage both increase sedation. Minor/Significance Unknown.
- saxagliptin
marijuana will increase the level or effect of saxagliptin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- sufentanil
marijuana will increase the level or effect of sufentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- tamoxifen
marijuana will increase the level or effect of tamoxifen by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- tolterodine
marijuana will increase the level or effect of tolterodine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
- tramadol
marijuana will increase the level or effect of tramadol by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
- trifluoperazine
marijuana will increase the level or effect of trifluoperazine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
- tropisetron
marijuana will increase the level or effect of tropisetron by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
- vinblastine
marijuana will increase the level or effect of vinblastine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- vincristine
marijuana will increase the level or effect of vincristine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- vincristine liposomal
marijuana will increase the level or effect of vincristine liposomal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- vinorelbine
marijuana will increase the level or effect of vinorelbine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- zaleplon
marijuana will increase the level or effect of zaleplon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- ziprasidone
marijuana will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- zolpidem
marijuana will increase the level or effect of zolpidem by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- zonisamide
marijuana will increase the level or effect of zonisamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
Adverse Effects
Frequency Not Defined
Tolerance
Psychological or physical dependence
Withdrawal symptoms
Altered sensorium
Dizziness
Somnolence
Fatigue
Reduced coordination
Cognitive impairment
Impaired balance
Euphoria
Paranoia
Hallucinations
Mood alterations
Panic
Anxiety
Hypotension
Hypertension
Tachycardia
Flushing
Syncope
Xerostomia
Nausea
Vomiting
Dysgeusia
Tooth discoloration
Anorexia
Increased appetite
Oral candidiasis
Diarrhea
Constipation
Urinary retention
Skin rash
Dry eyes
Blurred vision
Allergy
Cough
Pharyngitis
Warnings
Contraindications
Hypersensitivity
Coadministration with dronabinol (Cannabis derivative)
Cautions
History of substance abuse or mental illness
Hepatic disease
Cardiovascular disease
Seizure disorders
Nonpharmaceutical preparations contaminated with the fungus which may be hazardous to patients with compromised immune systems
Geriatric patients
Operating machinery or driving
Drug interactions
- May potenitate CNS depression w/ concomitant use with CNS depressants (eg, barbiturates, ethanol, anxiolytics, sedatives, and hypnotics, sedating H1-blockers, SSRIs, TCAs)
- Use of marijuana with sedating anticholinergics may result in additive tachycardia and drowsiness
- Other: cocaine, disulfiram, ethanol, protease inhibitors, sildenafil, theophylline, cyclophosphamide, doxorubicin
- Cannabidiol, an inactive constituent of cannabis, may weakly inhibit cytochrome P450 enzymes (CYP1A2, 2C19, 2D6, & 3A4)
- Cannabis is also a minor substrate for CYP2C9, 2C19, 2D6, 3A4
Pregnancy & Lactation
Pregnancy
FDA pregnancy category not available; insufficient data regarding safety to fetus, avoid use
Case-control study reported maternal use and childhood acute nonlymphoblastic leukemia (ANLL); Children’s Cancer Study Group report 10-fold increase of ANLL w/ maternal use (Robison et al, 1989; Briggs, 1998)
Some sources found increased risk for low birth weight w/ maternal use
Lactation
THC found in Marijuana is reported to be concentrated and secreted into breast milk
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Mechanism of Action
Tetrahydrocannabinol (THC), a component of marijuana, acts both centrally and peripherally on endogenous cannabinoid receptors; activation of cannabinoid receptors affects serotonin release, increases catecholamines, inhibits parasympathetic activity, and inhibits prostaglandin biosynthesis
Pharmacokinetics
Absorption: 10-20% (inhaled); 1-10% (PO)
Onset of action: 6-12 min (inhaled); 30-120 min (PO)
Peak effect: 20-30 min (inhaled); 2-3 hrs (PO)
Toxic dose (THC): 15 mg/kg; Lethal dose: 30 mg/kg
Duration of effect: 2-6 hrs
Vd: 10 L/kg (increases with chronic use)
Protein Bound: 97-99%
Metabolism: Hepatic hydroxylation to active and inactive metabolites, then further metabolized by alcohol dehydrogenase or alternatively, metabolites can be further oxidized to more polar compounds and glucuronide conjugates
Excretion: Feces 30-50%; 10-16% excreted in the urine as metabolites
Half-life: 28 hr (56 hr chronic use)
