Potential Pharmacokinetic Drug-Drug Interactions between Cannabinoids and Drugs Used for Chronic Pain

Table 1

Effect of cannabinoids on CYP450 isoenzymes, UGTs, and efflux transporters.

Cannabinoids	CYP P450 isoenzymes	UGTs	Modulation of efflux transporter expression
CBD	Inhibition of CYP1A1, CYP1A2, CYP2C9, CYP2C19, CYP2B6, CYP3A4, and CYP2D6	Inhibition of UGT1A9 and 2B7	Deregulation of Pgp, BCRP, and MRP1-4 transporter expression
THC	Inhibition of CYP3A4, CYP2D6, and CYP2C9	THC-OH, THC-COOH (metabolites) can compete with glucuronidation pathways
CBN	Inhibition of CYP3A4, CYP2D6, and CYP2C9	Inhibition of UGT1A7, 1A8, and 1A9

BCRP: breast cancer resistance proteins; CBD: cannabidiol; CBN: cannabinol; CYP: cytochrome; MRP: multidrug resistance proteins; Pgp: glycoprotein P; THC: Δ⁹-tetrahydrocannabinol; THC-OH: 11-hydroxy-tetrahydrocannabinol; THC-COOH: 11-nor-9-carboxy-tetrahydrocannabinol; UGTs: UDP glucuronosyltransferases.