Medical Marijuana-Induced Tacrolimus Toxicity

Moadel, Daniel; Chism, Keira

doi:10.1016/j.psym.2019.01.009

Cited by 15 publications

(8 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Specifically, concerns about a patient’s transplant candidacy, as well as pharmacologic interactions between cannabis and various immunosuppressive medications, such as tacrolimus, were not addressed. 27 , 28 , 29 This survey was also limited in assessing respondents’ preferences for cannabis formulations with varying THC and cannabidiol compositions, as well as specific preferences for various vendors and distributors. However, the results of this survey demonstrate that only a small minority of respondents had established specific practice preferences.…”

Section: Discussionmentioning

confidence: 99%

Therapeutic Cannabis Use in Kidney Disease: A Survey of Canadian Nephrologists

et al. 2022

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

Therapeutic Cannabis Use in Kidney Disease: A Survey of Canadian Nephrologists

et al. 2022

View full text Add to dashboard Cite

“…Furthermore, how MJ interacts with the pharmacology, physiology, and psychology of the LT population remains unclear. MJ is increasingly potent in terms of the level of tetrahydrocannabinol (THC) it contains and case reports exist regarding interactions between cannabinoids and immunosuppressants 3,19–21 . Furthermore, MJ products have been contaminated with fungal spores, heavy metals, pesticides, opioids, glass beads, phencyclidine, and tobacco 16,22–26 .…”

Section: Discussionmentioning

confidence: 99%

“…MJ is increasingly potent in terms of the level of tetrahydrocannabinol (THC) it contains and case reports exist regarding interactions between cannabinoids and immunosuppressants. 3,[19][20][21] Furthermore, MJ products have been contaminated with fungal spores, heavy metals, pesticides, opioids, glass beads, phencyclidine, and tobacco. 16,[22][23][24][25][26] Occasional and low-level MJ use has not been associated with worsening pulmonary function or development of lung cancer.…”

Section: Ta B L E 1 (Continued)mentioning

confidence: 99%

Marijuana use among adult liver transplant candidates and recipients

Likhitsup

Saeed

Winder

et al. 2021

Clinical Transplantation

View full text Add to dashboard Cite

Marijuana (MJ) is the most commonly used illicit drug in the UnitedStates with an estimated 10% of US adults reporting active MJ use in the past month. 1 The prevalence of MJ use in the US has significantly increased over the past 15 years. 1 Touted clinical uses of MJ include the treatment of pain, muscle spasticity, refractory epilepsy, and nausea. 2 However, MJ use has also been associated with various adverse effects including infection, cardiopulmonary disease, neuropsychiatric, and behavioral problems. 3 More than 50% of LT candidates have substance use disorder (SUD) including alcohol-related liver disease (ALD) and injection drug use associated with viral hepatitis. 4 MJ use among solid organ transplant patients is an area of little policy uniformity. Many studies have demonstrated adverse effects of tobacco use in LT candidates and recipients resulting in many US programs prohibiting tobacco use in their LT candidates. [5][6][7] Only a few studies have investigated the potential harm of MJ use in LT candidates and recipients and risks remain largely unknown. As such, national MJ-related policies and procedures for the evaluation and listing of transplant patients remain highly variable. 8,9

show abstract

“…In addition, there are case reports of drug interactions resulting in tacrolimus toxicity in patients using MJ ( 16,17 ) and CBD, ( 18 ) which likely occurs through inhibition of cytochrome P‐450 3A by cannabinoids. ( 19 ) That cannabinoid use is so prevalent in our population suggests that its use should be screened for and accounted for when monitoring immunosuppression levels in our posttransplant patients.…”

Section: Discussionmentioning

confidence: 99%

“…(14) Currently, there is no uniform regulatory approach to ensure the quality and consistency of CBD products on the market, despite concerns about possible hepatotoxicity at higher doses, possible interactions with other drugs such as acetaminophen, and mechanistic concerns linking it to fatty liver, all of which are very relevant to our posttransplant population. (15) In addition, there are case reports of drug interactions resulting in tacrolimus toxicity in patients using MJ (16,17) and CBD, (18) which likely occurs through inhibition of cytochrome P-450 3A by cannabinoids. (19) That cannabinoid use is so prevalent in our population suggests that its use should be screened for and accounted for when monitoring immunosuppression levels in our posttransplant patients.…”

Section: Original Article | 1629mentioning

confidence: 99%

Cannabinoid Use Among Liver Transplant Recipients

Yan

Forman

2021

Liver Transpl.

View full text Add to dashboard Cite

The effect of cannabinoids on liver transplant outcomes is an area of active research. We aimed to investigate marijuana (MJ) and cannabidiol (CBD) use among liver transplant recipients at the University of Colorado Hospital (UCH), specifically prevalence, habits, and predictors of use. Liver transplant recipients followed at UCH with valid email addresses were sent an informed consent postcard and survey invitation. This exploratory survey was conducted using REDCap. IBM SPSS Statistics software was used for statistical analysis. Of 1227 recipients who were sent surveys, 538 people responded. On average, respondents were 59 years old, with 63.7% male and 81.7% White. Hepatitis C virus (HCV; 30.4%) and alcohol use (17.7%) were the most common etiologies of liver disease. Among respondents, 23.8% reported current MJ use. Methods of use included smoking (72.4%), ingestion (55.3%), and vaporization (31.7%). Top reasons for MJ use were recreation (56.5%), anxiety (54.8%), and pain (53.2%). Among respondents, 21.0% currently used CBD, usually in the form of creams or lotions (58.9%) and to relieve pain (84.9%) and anxiety (31.1%). In multivariable analysis, age (odds ratio [OR], 0.941; 95% confidence interval [CI], 0.923-0.959; P < 0.001), diabetes mellitus (OR, 0.357; 95% CI, 0.171-0.746; P = 0.01), HCV cirrhosis (OR, 3.949; 95% CI, 2.281-6.835; P < 0.001), alcohol-related cirrhosis (OR, 2.101; 95% CI, 1.202-3.671; P = 0.01), and current tobacco use (OR, 2.918; 95% CI, 1.065-7.990; P = 0.04) were significant predictors of MJ use. Our study shows that cannabinoid use after liver transplant is common. MJ use is associated with decreasing age, alcohol-related and HCV cirrhosis, and tobacco use. Anxiety, pain, and recreation were top reasons for its use. Transplant teams should address reasons why their patients use MJ and CBD and develop programs to mitigate anxiety and pain after transplant. Further studies are needed to examine effects of cannabinoids on liver transplant outcomes.

show abstract

Medical Marijuana-Induced Tacrolimus Toxicity

Cited by 15 publications

References 14 publications

Therapeutic Cannabis Use in Kidney Disease: A Survey of Canadian Nephrologists

Therapeutic Cannabis Use in Kidney Disease: A Survey of Canadian Nephrologists

Marijuana use among adult liver transplant candidates and recipients

Cannabinoid Use Among Liver Transplant Recipients

Contact Info

Product

Resources

About