Ketamine induces endogenous cannabinoid release (Pacheco et al. 2019; Ferreira et al. 2018), which may partially explain its role in anti-nociception. The psychomotor side effects of ketamine are enhanced with CBD administration, but no adverse behavioural or cardiovascular effects have been noted (Hallak et al. 2011).
Cannabinol is metabolised via CYP2C9 and CYP3A4, with no evidence cytochrome P450 interactions (Zendulka et al. 2016).
Ether anaesthesia is prolonged in mice and rats by cannabidiol, d8THC and d9THC (Chesher et al. 1974). Halothane anaesthesia is prolonged and dose requirements reduced in dogs after THC administration (Stoelting et al. 1973), with similar effects noted in mice with isoflurane administration (Schuster et al. 2002). Little is known about the interaction between cannabinoids and modern inhalational anaesthetics.
A variety of National and Governmental organisations have provided reviews on the use of CBMs, producing recommendations with a varying hierarchy of evidence (Department of Health and Social Care 2018; Ghebreyesus 2019; Therapeutic Goods Administration 2017; Health Products Regualtory Authority 2017; National Academies of Sciences Engineering and Medicine 2017). Here, we review the commoner indications for CBMs.
The actual, social and economic legitimisation of cannabis and its medicinal derivatives makes it likely increasing numbers of patients will present on this class of medicines. Perioperative physicians will require a sound understanding of their pharmacology and evidence base, and may wish to exploit this group of compounds for therapeutic purposes in the perioperative period.
Effects of cannabinoids on dosing of volatile and intravenous anaesthetic agents is equivocal, with evidence limited to animal studies, case reports and two limited human studies.
Cannabinoids are endogenous in humans, animals and plants, or synthetically produced, acting as ligands at the cannabinoid receptors. Cannabinoids can be psychoactive, for example delta-9-tetrahydrocannabinol (d9THC), delta-8-tetrahydrocannabinol (d8THC), cannabinol (CBN) or non-psychoactive, for example cannabidiol (CBD). Table 2 lists their classification, as well as examples of currently available CBMs (Pertwee 2015; Beaulieu et al. 2016; Zendulka et al. 2016; Yeon Kong et al. 2018; Hauser et al. 2018a; Barnes 2018; National Institute for Health and Care Excellence 2014; Rice and Cameron 2017; Krcevski-Skvarc et al. 2018).
Q: What should I do if the oral syringe is not completely dry before use?
Marketed by : Greenwich Biosciences, Inc., Carlsbad, CA 92008 USA. Revised: Oct 2020
Do not wash the oral syringe in the dishwasher.
Tuberous Sclerosis Complex
Coadministration of EPIDIOLEX (750 or 1500 mg) with a high-fat/high-calorie meal increased Cmax by 5-fold, AUC by 4-fold, and reduced the total variability, compared with the fasted state in healthy volunteers [see DOSAGE AND ADMINISTRATION]. Coadministration of EPIDIOLEX with a low-fat/lowcalorie meal increased Cmax and AUC by 4-fold and 3-fold, respectively. Furthermore, coadministration of EPIDIOLEX with bovine milk increased exposure by approximately 3-fold for Cmax and 2.5-fold for AUC. Coadministration of EPIDIOLEX with alcohol also caused increased exposure to cannabidiol, with 93% increased Cmax and 63% greater AUC.
No effects on the exposures of cannabidiol or metabolite exposures were observed following administration of a single dose of EPIDIOLEX 200 mg in patients with mild (Child-Pugh A) hepatic impairment. Patients with moderate (Child-Pugh B) or severe (Child-Pugh C) hepatic impairment had an approximately 2.5 to 5.2-fold higher AUC, compared with healthy volunteers with normal hepatic function [see DOSAGE AND ADMINISTRATION, WARNINGS AND PRECAUTIONS, Use In Specific Populations].
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
Table 3: Adverse Reactions in Patients Treated with EPIDIOLEX in Controlled Trials of LGS and DS (Studies 1, 2, and 3)
We encourage where possible, all our patients to attend the surgery to see a doctor. Home visits are only for patients who are housebound, terminally ill or frail and there is a medical need. Transportation issues are not a reason for a home visit.
We have access to Routine appointments and repeat prescriptions though our online Patient Access Portal. Please see reception for set up with an online login and password as well as instructions to help you.
If you require urgent medical assistance, which cannotwait until the surgery re-opens, you should call 111. Calls to the NHS 111service are free from both landlines and mobiles. You will be assessed, givenadvice and directed straightaway to the local service that can help you best.
Over 75 – if you have not seen a doctor or nurse in the last year-book a routine appointment for a health review.
Requests for new medications or medications prescribed by an external provider may require a Medication Review and therefore may take longer to collect.