Marijuana (Cannabis, Ganja, Hash, Hashish, Hemp, Mary Jane, Pot, Reefer, Weed)
Classes: Analgesics, Herbals
Suggested dosing of Cannabis, Ganja (marijuana)
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
Suggested uses of Cannabis, Ganja (marijuana)
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, several states have adopted individual State Medical Marijuana Laws including: Alaska, California, Colorado, Hawaii, Maine, Maryland, Michigan, Montana, Nevada, New Mexico, Oregon, Rhode Island, Washington, and Vermont
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
Cannabis, Ganja (marijuana) adverse (side) 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 and 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 of Cannabis, Ganja (marijuana)
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)
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
