PDI Medical What is Neuropathy Acquired Neuropathy Causes SymptomsSubtypes Mainstream Treatments Pain Relievers OTC medications Opioids Antiseizure medications gabapentin Neurotin pregabalin Lyrica ID: 774775
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Slide1
Cannabis and Neuropathy
Dr. Nick Salamie PharmD, RPhPDI Medical
Slide2What is Neuropathy?
Slide3Acquired Neuropathy Causes
Slide4Symptoms/Subtypes
Slide5Mainstream Treatments
Pain RelieversOTC medicationsOpioidsAnti-seizure medicationsgabapentin (Neurotin)pregabalin (Lyrica)Topical TreatmentsCapsaicinLidocaineAntidepressantsTricyclic antidepressantsduloxetine (Cymbalta)venlafaxine (Effexor)
Slide6Mainstream Treatments: Side Effects
Tramadol
Constipation (24-46%)Nausea (24-40%)Headache (18-32%)GabapentinDizziness (16-20%)Fatigue (11-15%)Somnolence (16-20%)Duloxetine (Cymbalta)Nausea (23-25%)Fatigue (10-11%)Somnolence (10-12%)
Slide7Endocannabinoid System
Found in all animalsCB1 and CB2 receptorsLocated all over bodyAnandamide and 2-AGBalance In the bodyPain ModulationPhytocannabinoids as treatmentTHCCBD
Slide8THC
One of the major therapeutic cannabinoidsBeyond the psychoactivityAnti-inflammatoryAnalgesicNeuroprotectiveIncreased Potency via Gastrointestinal absorptionSide EffectsAnxietyDizzinessRapid Heartbeat
Slide9CBD
Second most prevalent therapeutic cannabinoidNo prevalent psychoactivityEliminates some of THC’s adverse effectsSedationHungerTherapeutic valueAnti-inflammatoryAnti-convulsantAnxiolyticSide effectsHeadacheDiarrheaAgitationSedation CBD more effective with THC: “Power Couple”Hemp vs. Whole Plant CBD
Slide10Cannabis Treatment Approaches
Slide11Meeting the Patient
Start Low, Go Slow
Drug InteractionsProduct selection and initial strategyMinimum Effective DoseFollow Up
Slide12Dosage Forms
Inhalation
Combustion
Vaporization
Ingestible
Edibles
Oils (RSO)
Tablets/Capsules
Sublingual/Buccal/
Oromucosal
Topical
Transdermal
Slide13Cannabis Oils/RSOs
Best medical dosage form
Whole Plant/Full Spectrum Extract/Herbal Shotgun
Varying Cannabinoid Profiles
Different CBD:THC ratios
Acidic Cannabinoids: THCa, CBDa, CBGa“Varin” Cannabinoids: THCV, CBDVLess abundant Cannabinoids: CBN, CBG, CBCTerpenes CapturedBeta-Caryophyllene
Slide14Beyond THC and CBD for Neuropathy
Slide15Getting Your Cannabis Card
Formal Diagnosis of 1 of the 41 qualifying conditions
Conditions that Cause NeuropathyHIV/AIDSCancerFibromyalgiaLupusRACompletion of Physician Written Certification Form by Licensed PhysicianFingerprint/Background CheckCompletion of Forms and PaymentProvisional Registration
Slide16References
Backes, Michael, et al.
Cannabis Pharmacy: the Practical Guide to Medical Marijuana
. Black Dog & Leventhal Publishers, 2017.
Bersten
,
Melani
PharmD,
RPh
. “Advanced Medical Cannabis: Dispensing and Dosing Considerations.”
Powerpoint
File.
Duloxetine. Adverse Effects. Medscape Mobile App. WebMD, LLC.
Gabapentin. Adverse Effects. Medscape Mobile App. WebMD, LLC.
Goldstrich
, Joe D MD, FACC. “Unleashing the Full Potential of Cannabis’ Antineoplastic Benefits: Reimagining the Concept of Full Extract.”
Powerpoing
File.
“Neuropathy.”
Cleveland Clinic
, my.clevelandclinic.org/health/diseases/14737-neuropathy.
“Neuropathy Management and Treatment.”
Cleveland Clinic
, my.clevelandclinic.org/health/diseases/14737-neuropathy/management-and-treatment.
“Peripheral Neuropathy.”
Mayo Clinic
, Mayo Foundation for Medical Education and Research, 9 Aug. 2017,
www.mayoclinic.org/diseases-conditions/peripheral-neuropathy/diagnosis-treatment/drc-20352067
.
Russo, Ethan B., and Jahan
Marcu
. “Cannabis Pharmacology: The Usual Suspects and a Few Promising Leads.”
Cannabinoid Pharmacology Advances in Pharmacology
, 2017, pp. 67–134., doi:10.1016/bs.apha.2017.03.004.
Tramadol. Adverse Effects. Medscape Mobile App. WebMD, LLC.
Slide17Questions?
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