4 Prescription Drugs That Contain THC or CBD
Article written by
Dipak HemrajHead of Research and Education
Content reviewed by
Dr. Lewis JasseyMedical Director - Pediatric Medicine
Despite cannabis being a Schedule I substance and therefore considered to have “no therapeutic value,” there are three cannabinoid-based prescription medications available in the United States:
- Dronabinol
- Nabilone
- Cannabidiol (CBD) in the form of Epidiolex
In the U.K., France, Spain, Italy, Czech Republic, Germany, Denmark, Sweden, Austria, Poland, and Canada, nabiximols (Sativex) is also available for prescription.
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Dronabinol
Dronabinol is a synthetic form of delta-9-tetrahydrocannabinol (THC). Its trade names are Marinol and Syndros. Marinol is an oral capsule, and Syndros is an oral solution.
Dronabinol is a Schedule II drug.
Cannabinoids
Dronabinol contains synthetic delta-9-THC and no other cannabinoids, making it a synthetic cannabinoid.
Purpose and Uses
Dronabinol is prescribed to treat anorexia in adults with AIDS who have lost weight (cachexia) and experience chemotherapy-induced nausea and vomiting. Chemotherapy is usually recommended to treat cancer but is occasionally used for treating bone marrow diseases and immune system disorders like lupus, multiple sclerosis (MS), and rheumatoid arthritis. Cannabinoids may help manage symptoms associated with these conditions as well.
Potential Health Benefits
- Stimulates appetite, which can help reduce weight and muscle loss.
- Reduces episodes of nausea and vomiting in those undergoing chemotherapy.
Potential Risks and Drawbacks
Dronabinol can cause:
- Weakness
- Stomach pain
- Nausea
- Vomiting
- Memory loss
- Anxiety
- Confusion
- Sleepiness
Although dronabinol is relatively well-tolerated, the lack of other cannabinoids may reduce its anti-inflammatory properties as there is no entourage effect. The lack of other cannabinoids and terpenes may also decrease dronabinol’s tolerability, as they can reduce some of THC’s psychoactivity and negative impact on memory.
Nabilone
Nabilone is also a synthetic form of delta-9-THC but is considered to be more potent compared to dronabinol. Nabilone is sold under the trade names Cesamet and Canemes. It is often administered orally in tablet form up to a maximum of 6 mg daily.
Nabilone is a Schedule II substance.
Cannabinoids
Nabilone is a synthetic cannabinoid that mimics the action of THC. Synthetic THC is the only cannabinoid in nabilone.
Purpose and Uses
Nabilone is most often prescribed for managing nausea and vomiting in people undergoing chemotherapy. Nabilone may also be prescribed for managing treatment-resistant chronic pain and neuropathic (nerve) pain and as an appetite stimulant for patients with AIDS or cancer.
Although not approved for use yet in the US, nabilone is shown to be effective for managing symptoms associated with the following conditions:
- Parkinson’s disease, where nabilone may be used for improving sleep and reducing anxiety.
- Neuropathic pain and spasticity as a result of multiple sclerosis (MS).
- Inflammatory bowel disease (IBD), in particular ulcerative colitis.
- Post-traumatic stress disorder (PTSD) and may help reduce the occurrence and severity of nightmares.
Potential Health Benefits
- Nabilone is a well-tolerated medication with analgesic (pain-relieving) and anti-emetic (nausea- and vomiting-relieving) effects.
- Stimulates appetite.
- Can help manage insomnia, spasticity, and movement problems in patients with Parkinson’s, PTSD, and MS.
- Can help reduce anxiety and inflammation in those with IBD.
Potential Risks and Drawbacks
Side-effects of nabilone include:
- Headache
- Dizziness
- Unsteady walking
- Drowsiness
- Sleep problems
- Weakness
- Dry mouth
- Changes in appetite
- Nabilone may increase the sensation of postoperative pain when combined with morphine
Epidiolex
Epidiolex is a CBD-based medication for treating epilepsy in those two or older, particularly Dravet syndrome and Lennox-Gastaut syndrome. Epidiolex is an oral solution containing highly purified CBD derived from cannabis.
Epidiolex is a Schedule V drug.
Cannabinoids
Epidiolex only contains CBD. There are no other cannabinoids in Epidiolex.
Purpose and Uses
Epidiolex is approved to treat seizures associated with three conditions:
- Lennox-Gastaut syndrome
- Dravet syndrome
- Tuberous sclerosis complex (TSC)
Potential Health Benefits
- CBD is shown to be effective in reducing the occurrence of seizures in those with epilepsy.
- Although it has not been approved for such conditions, CBD may be useful for managing chronic pain, muscle spasms, anxiety, depression, insomnia, nerve pain, and psychosis.
- CBD has been shown to have anti-inflammatory, neuroprotective, and antioxidative properties, which can help those suffering from various neurological conditions.
Potential Risks and Drawbacks
CBD has the following potential side effects:
- Somnolence (drowsiness, sleepiness).
- Decreased appetite.
- Diarrhea.
- Transaminase elevations, which can cause liver injury.
- Fatigue, malaise, and asthenia (lack of energy).
- Rash.
- Insomnia.
- CBD desensitizes the liver enzyme cytochrome P450 (CYP450), which can interfere with metabolizing other drugs, particularly benzodiazepines, antidepressants, and other drugs with sedative properties.
Despite being well-tolerated and potentially beneficial for many different conditions, Epidiolex is only available for a limited number of conditions. Those who require high-quality, cannabis-based CBD products will need to get certified for cannabis and apply for a medical marijuana card.
Nabiximols
Nabiximols is a cannabis extract containing a 1:1 THC:CBD ratio, and it is sold under the trade name Sativex. Sativex/nabiximols is an oromucosal spray.
As nabiximols is not approved for use for any condition in the U.S., it is not available on prescription and is considered a Schedule I drug.
Cannabinoids
Nabiximols contains an equal ratio (or nearly equal ratio) of both THC and CBD, and it is, therefore, a 1:1 THC:CBD product.
Purpose and Uses
Outside of the U.S., nabiximols is prescribed for treating:
- Neuropathic pain, spasticity, overactive bladder, and other symptoms of multiple sclerosis.
- Chronic pain resistant to other methods of control, usually as part of a clinical trial.
- Managing pain, nausea, vomiting, and appetite loss associated with chemotherapy.
Potential Health Benefits
- CBD and THC (as well as other cannabinoids) combined may have increased anti-inflammatory effects.
- CBD can counteract some of THC’s psychoactive and negative effects on memory.
- Nabiximols is a well-tolerated medication. The likelihood of a deadly overdose on nabiximols alone is more of a theoretical rather than a practical possibility.
Potential Risks and Drawbacks
Side effects of nabiximols include:
- Feeling sick
- Feeling sleepy
- Dizziness
- Tiredness
- Diarrhea
- Headaches
- Dry mouth
In addition, CBD desensitizes the liver enzyme cytochrome P450 (CYP450), which interferes with metabolizing some classes of drugs, including benzodiazepines, antidepressants, and blood thinners like warfarin and aspirin.
THC also has sedative effects that can negatively interact with opioid-based painkillers, benzodiazepines, and other central nervous system (CNS) depressants.
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