Meta Information
ID:cannabis
Name:
Schema Version:AIM-2.0
Interactions
Target id:
/class/cns-depressants
Target name:
CNS Depressants (Alcohol, Opioids, Benzodiazepines)
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Cannabis has CNS depressant effects that are additive with other depressants, leading to excessive drowsiness, dizziness, and severely impaired motor coordination and judgment.
Actionable advice:
Avoid combining cannabis with alcohol, opioids, benzodiazepines, or other sedating medications.
Target id:
/intervention/warfarin
Target name:
Warfarin
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Cannabis, particularly CBD, strongly inhibits the CYP2C9 enzyme responsible for metabolizing warfarin, which can lead to dangerously high warfarin levels and an increased risk of severe bleeding.
Actionable advice:
Avoid using cannabis with warfarin; if use is unavoidable, frequent and vigilant blood monitoring (INR) is essential.
Target id:
/class/immunosuppressants
Target name:
Calcineurin Inhibitors (Tacrolimus, Cyclosporine)
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Cannabis, especially CBD, inhibits the CYP3A4 enzyme, which can dangerously increase blood levels of narrow-therapeutic-index drugs like tacrolimus, raising the risk of toxicity.
Actionable advice:
Avoid concurrent use unless under the direct supervision of a specialist with therapeutic drug monitoring.
Target id:
/condition/pregnancy
Target name:
Pregnancy
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Cannabis use during pregnancy is associated with significant risks to the fetus, including low birth weight and potential for long-term adverse neurodevelopmental outcomes.
Actionable advice:
Avoid cannabis completely during pregnancy.
Target id:
/condition/lactation
Target name:
Breastfeeding (Lactation)
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Cannabinoids are excreted into breast milk and can be consumed by the infant, with unknown but potentially harmful effects on brain development.
Actionable advice:
Avoid cannabis completely while breastfeeding.
Target id:
/condition/psychosis-history
Target name:
History of Psychosis or Schizophrenia
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
THC can induce psychosis in vulnerable individuals and worsen symptoms in those with a pre-existing psychotic disorder like schizophrenia.
Actionable advice:
Avoid all THC-containing cannabis products if you have a personal or strong family history of psychosis.
Target id:
/class/antipsychotics
Target name:
Antipsychotic Medications
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
The psychoactive properties of THC can directly counteract the therapeutic effects of antipsychotic medications and may exacerbate the underlying symptoms of psychosis.
Actionable advice:
Avoid using THC-containing cannabis if you are taking antipsychotic medication.
Target id:
/condition/cardiovascular-disease
Target name:
Unstable Cardiovascular Disease
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Cannabis can cause temporary increases in heart rate and fluctuations in blood pressure, which may pose a significant risk to individuals with unstable angina, severe arrhythmias, or a recent heart attack.
Actionable advice:
Avoid cannabis if you have unstable cardiovascular disease; consult a cardiologist if considering use.
Target id:
/condition/hepatic-impairment
Target name:
Hepatic Impairment
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Since cannabis is extensively metabolized by the liver, severe liver disease impairs its clearance, leading to much higher blood concentrations and a prolonged duration of effects.
Actionable advice:
Use only with extreme caution under medical supervision, starting with very low doses.
Target id:
/class/cyp3a4-strong-inhibitors
Target name:
Strong CYP3A4 Inhibitors
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Strong CYP3A4 inhibitors (e.g., ketoconazole, ritonavir) block the primary metabolic pathway for THC and CBD, leading to significantly higher blood concentrations and increased risk of toxicity.
Actionable advice:
Avoid concurrent use, or use cannabis only under strict medical supervision with significant dose reduction.
Target id:
/intervention/clobazam
Target name:
Clobazam
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
CBD inhibits the enzyme that metabolizes clobazam's active metabolite, leading to a significant increase in its levels and associated sedation, which requires careful dose management.
Actionable advice:
Dose reduction of clobazam is often required when co-administered with CBD under medical supervision.
Target id:
/class/cyp3a4-moderate-inhibitors
Target name:
Moderate CYP3A4 Inhibitors
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Moderate CYP3A4 inhibitors (e.g., fluconazole, diltiazem) slow the metabolism of THC and CBD, increasing their levels and potential for adverse effects like dizziness and cognitive impairment.
Actionable advice:
Use with caution and consider a lower cannabis dose; monitor for increased side effects.
Target id:
/class/cyp2c9-inhibitors
Target name:
CYP2C9 Inhibitors
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
These drugs (e.g., amiodarone, fluconazole) inhibit the CYP2C9 enzyme, a key pathway for THC metabolism, which can lead to elevated THC levels and increased psychoactive effects.
Actionable advice:
Use with caution, especially with THC-dominant products, and consider dose reduction.
Target id:
/class/broad-spectrum-inducers
Target name:
Broad-Spectrum Metabolic Enzyme Inducers
Severity:
moderate
Interaction type:
diminishing
Nature:
absolute
Temporal spacing:
null
Description:
These agents (e.g., rifampin, carbamazepine) speed up the metabolic breakdown of THC and CBD by inducing CYP enzymes, potentially reducing the therapeutic effects of cannabis.
Actionable advice:
Be aware that the effects of cannabis may be significantly reduced; dose adjustments may be necessary.
Target id:
/intervention/saint-johns-wort
Target name:
Saint John's Wort
Severity:
moderate
Interaction type:
diminishing
Nature:
absolute
Temporal spacing:
null
Description:
St. John's Wort induces CYP3A4, accelerating the metabolism of THC and CBD and potentially decreasing their effectiveness.
Actionable advice:
Avoid using together if consistent cannabis effects are desired.
Target id:
/class/antihypertensives
Target name:
Antihypertensive Medications
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Cannabis can cause a drop in blood pressure upon standing (orthostatic hypotension), which can be enhanced by antihypertensive medications, increasing the risk of dizziness and falls.
Actionable advice:
Use with caution, rise slowly from sitting or lying positions, and monitor blood pressure.
Target id:
/class/antidiabetic-medications
Target name:
Diabetes Medications
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Cannabis can alter blood glucose levels and appetite ('the munchies'), potentially complicating glycemic control for individuals on diabetes medications.
Actionable advice:
Monitor blood glucose levels closely when initiating or changing cannabis use.
Target id:
/class/cyp3a4-substrates
Target name:
CYP3A4 Substrates
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Cannabis can inhibit CYP3A4, potentially increasing concentrations of many common medications like certain statins (atorvastatin, simvastatin), calcium channel blockers, and sildenafil.
Actionable advice:
Monitor for increased side effects of drugs metabolized by CYP3A4 when using cannabis.
Target id:
/class/cyp2c9-substrates
Target name:
Drugs Metabolized by CYP2C9
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Cannabis (especially CBD) inhibits the CYP2C9 enzyme, which can increase the levels of other drugs metabolized by this pathway, such as some NSAIDs (celecoxib) and antidiabetic agents (glipizide).
Actionable advice:
Use with caution and monitor for increased side effects of the co-administered drug.
Target id:
/condition/geriatric
Target name:
Geriatric (Older Adults)
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Older adults are more sensitive to the psychoactive effects of cannabis and are at a higher risk for adverse events like confusion, dizziness, falls, and orthostatic hypotension.
Actionable advice:
If using, start with a very low dose and increase slowly ('start low, go slow') under medical guidance.
Target id:
/circadian/sleep
Target name:
Going to Sleep
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
While THC may decrease the time it takes to fall asleep, chronic use suppresses REM sleep, which is crucial for memory consolidation and emotional regulation, thereby reducing overall sleep quality.
Actionable advice:
Avoid chronic, nightly use of THC-containing cannabis for sleep to preserve healthy sleep architecture.
Target id:
/intervention/theophylline
Target name:
Theophylline
Severity:
moderate
Interaction type:
diminishing
Nature:
absolute
Temporal spacing:
null
Description:
The combustion products in smoked cannabis induce the CYP1A2 enzyme, which accelerates the metabolism of theophylline, reducing its effectiveness. This does not apply to oral or vaporized cannabis.
Actionable advice:
If smoking cannabis, monitor for reduced theophylline efficacy; consider alternative consumption methods.
Target id:
/dietary/high-fat-meal
Target name:
High-Fat Meal
Severity:
moderate
Interaction type:
synergistic
Nature:
temporal
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Consuming oral cannabis products with a high-fat meal can increase the absorption and bioavailability of cannabinoids like THC and CBD by up to four-fold.
Actionable advice:
For consistent effects with oral cannabis, take it at the same time as a meal containing some fat.
Target id:
/class/serotonergic-agents
Target name:
Serotonergic Medications (SSRIs, SNRIs, TCAs, Triptans)
Severity:
minor
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
There is a theoretical risk of additive serotonergic effects when combining cannabis with SSRIs or other serotonergic drugs, though the clinical significance is generally low.
Actionable advice:
Be aware of the theoretical risk and monitor for symptoms like agitation or confusion.
Target id:
/class/cyp1a2-substrates
Target name:
CYP1A2 Substrates
Severity:
minor
Interaction type:
diminishing
Nature:
absolute
Temporal spacing:
null
Description:
Polycyclic aromatic hydrocarbons from smoking cannabis (not vaping or edibles) can induce CYP1A2, potentially decreasing levels of drugs like caffeine and clozapine.
Actionable advice:
Be aware of potentially reduced effects of CYP1A2 substrate drugs if smoking cannabis.
Target id:
/intervention/cbd
Target name:
CBD
Severity:
minor
Interaction type:
synergistic
Nature:
absolute
Temporal spacing:
null
Description:
CBD can modulate or reduce some of the unwanted psychoactive effects of THC, such as anxiety and paranoia, a phenomenon known as the 'entourage effect'.
Actionable advice:
Consider using products with a balanced THC:CBD ratio to mitigate potential THC-induced anxiety.