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NERVOUS SYSTEM › ANALGESICS › OTHER ANALGESICS AND ANTIPYRETICS › Other analgesics and antipyretics
cannabinoids
N02BG10
Forms & Strengths
- Oral solution: 25 mg/mL (Epidiolex)
- Oromucosal spray: 2.7 mg THC / 2.5 mg CBD per actuation (Sativex/Nabiximols)
- Oral capsule: 2.5 mg, 5 mg, 10 mg (Dronabinol)
- Oral solution: 1 mg/mL (Dronabinol)
Adult Dosing
- Dronabinol (CINV): 5 mg/m² surface area 1-3 hours prior to chemo, then q2-4h after
- Dronabinol (AIDS anorexia): 2.5 mg PO BID before lunch and dinner
- Cannabidiol (Seizures): Initial 5 mg/kg/PO BID, titrate to 10-20 mg/kg/day
- Nabiximols (MS spasticity): 1-12 actuations/day Oromucosal spray
Pediatric Dosing
- Cannabidiol (Lennox-Gastaut/Dravet syndrome, >=1 year): Start 5 mg/kg/day PO divided BID; increase by 5 mg/kg/day weekly to max 20 mg/kg/day
- CINV (Dronabinol): Safety and efficacy not established in pediatric patients
Indications
- Nausea and vomiting associated with cancer chemotherapy (Dronabinol)
- Anorexia associated with weight loss in AIDS patients (Dronabinol)
- Seizures associated with Lennox-Gastaut syndrome or Dravet syndrome (Cannabidiol)
- Tuberous sclerosis complex-associated seizures (Cannabidiol)
- Spasticity due to multiple sclerosis (Nabiximols)
Mechanism of Action
- Agonist at CB1 and CB2 cannabinoid receptors in neural tissues (Dronabinol/Nabiximols)
- Modulates transient receptor potential (TRP) vanilloid channels and intracellular calcium (Cannabidiol)
- Reduces excitatory neurotransmitter release in the central nervous system
Contraindications
- Hypersensitivity to cannabinoids, sesame oil (specific formulations), or any component
- History of schizophrenia or psychotic disorders (for psychotomimetic THC derivatives)
- Severe hepatic impairment (dose adjustment required)
Adverse Reactions
- Somnolence, sedation, and fatigue
- Dizziness, vertigo, and ataxia
- Euphoria, paranoia, hallucinations, and mood alterations
- Dry mouth and increased appetite
- Elevated serum transaminases (ALT/AST)
- Hypotension and tachycardia
Drug Interactions
- Strong CYP3A4 and CYP2C19 inhibitors/inducers alter cannabinoid plasma concentrations
- CNS depressants (alcohol, opioids, benzodiazepines) increase sedation and respiratory depression risk
- Valproic acid co-administration increases risk of hepatocellular injury (transaminase elevations)
- Inhibition or induction of CYP450 enzymes by CBD may alter levels of concomitantly administered drugs (e.g., clobazam, warfarin)
Curated Content: Needs Vetting Before Put to Clinical Use