Medicinal use of Cannabis: Adverse events as a balanced perspective

Summary points - Medicinal Cannabis is generally safe and well tolerated in clinical practice. - Adverse events associated with medicinal Cannabis are reported more frequently by women. - Children treated with medicinal Cannabis may experience irritability, euphoria, drowsiness, dizziness, exaggerated increased or loss of appetite, diarrhea and vomiting, accidental overdose, and temporary treatment failure. - In elderly, the treatment with medicinal Cannabis was significantly associated with all-cause treatment-related adverse events, but not to serious ones. - Patients using medicinal Cannabis may experience mental confusion, depression and suicidal ideation, hallucination, anxiety, altered perception, and panic attacks. - Central nervous system adverse events are usually reversible and self-limiting. - Even in patients without cardiovascular complications, medicinal Cannabis may cause acute myocardial infarction, arrhythmias, stroke, peripheral arteriopathy, stress cardiomyopathy, and sudden death. - Prescribers should consider medicinal Cannabis as a cause of nausea and vomiting, particularly in chronic users and in patients treated with oral Cannabis preparations containing high doses of active compounds. - Considering the pharmacological properties of medicinal Cannabis and the metabolism of its active compounds, healthcare professionals must familiarize with potential drug-drug interactions in subjects receiving concomitant medications. - Postmarketing surveillance is needed to quantify the longer-term adverse events associated with medicinal Cannabis use in the real-world setting.