The <scp>P</scp>harmacologic and <scp>C</scp>linical <scp>E</scp>ffects of <scp>M</scp>edical <scp>C</scp>annabis

Pharmacotherapy - Tập 33 Số 2 - Trang 195-209 - 2013
Laura M. Borgelt1, Kari L. Franson2, Abraham M. Nussbaum3, George S. Wang4
1Departments of Clinical Pharmacy (L.M. Borgelt and K.L. Franson) and Family Medicine (L.M. Borgelt); University of Colorado; Aurora; Colorado
2Department of Clinical Pharmacy, University of Colorado, Aurora, Colorado
3Department of Psychiatry; Denver Health, Behavioral Health; University of Colorado(A.M. Nussbaum),; Aurora; Colorado
4Rocky Mountain Drug and Poison Center Denver Health Hospitals Aurora Colorado (G.S. Wang)

Tóm tắt

Cannabis, or marijuana, has been used for medicinal purposes for many years. Several types of cannabinoid medicines are available in the United States and Canada. Dronabinol (schedule III), nabilone (schedule II), and nabiximols (not U.S. Food and Drug Administration approved) are cannabis‐derived pharmaceuticals. Medical cannabis or medical marijuana, a leafy plant cultivated for the production of its leaves and flowering tops, is a schedule I drug, but patients obtain it through cannabis dispensaries and statewide programs. The effect that cannabinoid compounds have on the cannabinoid receptors (CB1 and CB2) found in the brain can create varying pharmacologic responses based on formulation and patient characteristics. The cannabinoid Δ9‐tetrahydrocannabinol has been determined to have the primary psychoactive effects; the effects of several other key cannabinoid compounds have yet to be fully elucidated. Dronabinol and nabilone are indicated for the treatment of nausea and vomiting associated with cancer chemotherapy and of anorexia associated with weight loss in patients with acquired immune deficiency syndrome. However, pain and muscle spasms are the most common reasons that medical cannabis is being recommended. Studies of medical cannabis show significant improvement in various types of pain and muscle spasticity. Reported adverse effects are typically not serious, with the most common being dizziness. Safety concerns regarding cannabis include the increased risk of developing schizophrenia with adolescent use, impairments in memory and cognition, accidental pediatric ingestions, and lack of safety packaging for medical cannabis formulations. This article will describe the pharmacology of cannabis, effects of various dosage formulations, therapeutics benefits and risks of cannabis for pain and muscle spasm, and safety concerns of medical cannabis use.

Từ khóa


Tài liệu tham khảo

Hi HL, 1974, An archaeological and historical account of cannabis in China, Econ Bot, 28, 437

10.5055/jom.2009.0016

1851, The pharmacopoeia of the United States of America

2009, Cesamet (nabilone) package insert

Food and Drug Administration, Label and approval history: marinol

2004, Marinol (dronabinol): package insert

2010, Sativex (nabiximols) package insert (Canada)

NY Daily News, 2012, Marijuana‐based drug Sativex may get FDA approval?

2011, A study of Sativex® for relieving persistent pain in patients with advanced cancer

2011, Sativex® for relieving persistent pain in patients with advanced cancer (SPRAY III)

2011, Effects of sativex and oral THC on attention, affect, working memory, reversal learning, physiology and brain activation

2012, 18 legal medical marijuana states and DC: laws, fees, and possession limits

10.1038/sj.bjp.0706406

10.1021/ja01062a046

10.1124/pr.110.003004

10.1002/j.1552-4604.2002.tb05998.x

10.1038/clpt.1983.179

Agurell S, 1986, Pharmacokinetics and metabolism of delta 1‐tetrahydrocannabinol and other cannabinoids with emphasis on man, Pharmacol Rev, 38, 21

10.1177/0269881108089870

10.1080/02791072.2011.587700

10.1038/sj.clpt.6100200

10.1038/clpt.1980.181

10.1016/0041-008X(81)90122-8

10.1111/j.1365-2125.2008.03329.x

10.1016/j.yhbeh.2009.10.005

10.1016/j.drugalcdep.2009.01.023

10.2146/ajhp060471

Joy J, 1999, Marijuana and medicine: assessing the science base, 267

Colorado Department of Public Health and Environment.The Colorado Medical Marijuana Registry.2011. Available fromhttp://www.cdphe.state.co.us/hs/medicalmarijuana/statistics.html. Accessed June 20 2012.

Arizona Department of Health Services, 2012, Arizona medical marijuana program

10.1111/j.1468-1331.2010.03328.x

10.1177/1352458510367462

10.1517/14656560903413534

10.3122/jabfm.2011.04.100280

10.1016/j.critrevonc.2011.09.008

10.1111/j.1526-4637.2009.00703.x

10.1371/journal.pone.0014433

10.1097/01.anes.0000286986.92475.b7

10.1212/01.wnl.0000253187.66183.9c

10.1016/j.jpain.2007.12.010

10.1371/journal.pone.0018440

10.1503/cmaj.091414

10.1038/npp.2008.120

10.1093/rheumatology/kei183

10.1016/j.pain.2007.08.028

10.1212/01.wnl.0000176753.45410.8b

10.1016/j.clinthera.2007.09.013

10.1016/S0304-3959(03)00331-2

10.1111/j.1365-2044.1997.139-az0132.x

10.1016/S0304-3959(03)00163-5

10.1002/cpt197518184

10.1002/j.1552-4604.1975.tb02348.x

10.1136/bmj.38149.566979.AE

10.1016/j.jpain.2007.09.002

10.1007/BF03022793

10.3310/hta7400

10.1038/35003583

10.1191/1352458504ms1082oa

10.1111/j.1468-1331.2006.01639.x

10.1191/0269215503cr581oa

10.1191/1352458504ms1048oa

10.1136/jnnp.2005.070136

10.1016/S0140-6736(03)14738-1

10.1300/J251v07n01_04

10.1016/j.apmr.2009.12.025

10.1503/cmaj.071178

Dronabinol, 2012, DRUGDEX® system

10.1093/alcalc/agh110

10.1007/s00213-001-0946-5

10.1080/09595230310001613976

10.1016/j.schres.2011.04.017

10.1152/physrev.00004.2003

10.1111/j.1476-5381.2010.00721.x

10.1016/j.jpsychires.2011.01.004

10.1017/S146114571100068X

10.1111/j.1360-0443.2010.02959.x

10.1111/j.1465-3362.2009.00132.x

10.1176/appi.ajp.2010.09020189

10.1016/j.eurpsy.2011.04.010

10.2174/1874473710801010081

10.1016/j.cell.2012.01.037

10.1001/archpsyc.65.6.694

10.1212/WNL.0b013e318212ab0c

10.1186/1745-0179-3-25

10.1176/appi.ajp.2011.10121769

Substance Abuse and Mental Health Services Administration, 2010, Office of applied studies

10.1016/S0140-6736(09)61037-0

United States Department of Health and Human Services.Substance Abuse and Mental Health Services Administration. Office of Applied Studies. Treatment Episode Data Set – Admissions (TEDS‐A) 2008 [Computer file]. ICPSR27241‐v2.Ann Arbor MI:Inter‐university Consortium for Political and Social Research [distributor] 2010‐03‐31. doi:10.3886/ICPSR27241.

National Poison Data System, Marijuana human exposure data 2000–2010

McGuigan M, 2011, Goldfrank's toxicologic emergencies

Carstairs SD, 2011, Prolonged coma in a child due to hashish ingestion with quantitation of THC metabolites in urine, J Emerg Med, 41, e69

10.1097/00006565-198912000-00010

10.1542/peds.71.5.848

10.1016/j.chiabu.2011.03.012

10.1007/s11606-011-1840-4

Thông tin
Thông tin xuất bản

Pharmacotherapy

Tập 33 Số 2

195-209

Thông tin tác giả