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Sizes Available

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Print Medical Document
For Clinicians

Print medical document using the button on the top right of this page. Fill out the medical document for your patient and fax to one of the sellers listed below. See module "How to Fill Out Medical Document" on the Education page for additional guidance. Alternatively, you can refer your patient to our partnered clinic in the Book Appointment page.

Fax patient's medical document to:
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Available Online: {{ getPlaceToPurchaseOnlineProvinces(place_to_purchase) }}In Person: {{ getPlaceToPurchaseInPersonLocation(place_to_purchase) }}
For Patients

Once your clinician faxes your medical document to one of the sellers listed below, you can register on the seller's website. The seller will approve your registration, and from there you will be able to purchase products.

Registration links:
{{ place_to_purchase.company_name }}: Register herePlease register on their website
Administration

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Product Description

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Terpenes removed
Terpenes unknown

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Caution

Many terpenes can become biphasic when taken in higher doses, which may cause opposite effects to occur. It is always recommended to start with a low dose and titrate up while monitoring effects.

This section includes possible interactions and contraindications for cannabis. While we strive to maintain an up to date list of possible interactions, this list may not be comprehensive. It is advised that the healthcare practitioner does their own due diligence when prescribing medical cannabis to their patients. Additionally, the items listed here may not be applicable to all patients.

General
  • Use of high % THC (12-20%) before age 18 may cause cognitive function loss
  • Cannabis should be avoided by pregnant and nursing women
  • Patients with high blood pressure should monitor increases with cannabis use
  • Relative contraindications for the following conditions: severe cardiovascular conditions, immunodeficiencies, liver diseases, kidney diseases
Drug Interactions
  • CYP1A2 inducer- decreases serum concentrations of Duloxetine
  • Potent inhibitor of CYP3A4 and CYP2D6. May increase serum concentrations of:
    • Macrolides
      • Azithromycin, Clarithromycin, Fidaxomicin, Erythromycin
    • Benzodiazepines
    • Calcium channel blockers
      • Amlodipin, Bepridil, Diltiazem, Felodipine, Nicardipine, Nifedipine, Nisoldipine, Verapamil, Caduet-a
    • Beta blockers
      • Acebutolol, Atenolol, Bisoprolol, Carteolol, Esmolol, Metoprolol, Nadolol, Nebivolol, Propranolol
    • Cyclosporine
    • Tricyclic antidepressants
      • Amitriptyline, Clomipramine, Doxepin, Imipramine, Trimipramine, Amoxapine, Desipramine, Nortriptyline, and Protriptyline
    • Some statins prescribed for high cholesterol
      • Atorvastatin and Simvastatin
  • Methylphenidate reacts significantly with high % THC, and can cause increased strain on the heart
  • Potent inhibitor of CYP3A4 and CYP2D6. May increase serum concentrations of:
    • Benzodiazepines
      • Chlordiazepoxide
  • Potent inhibitor of CYP3A4 and CYP2D6. May increase serum concentrations of:
    • Antihistamines
      • Prescription antihistamines include: Azelastine eye drops, Azelastine nasal sprays, Carbinoxamine, Cyproheptadine, Desloratadine, Emedastine eye drops, Hydroxyzine, Levocabastine eye drops, Levocetirizine oral
      • OTC antihistamines include: Brompheniramine, Cetirizine, Chlorpheniramine, Clemastine, Diphenhydramine, Fexofenadine, Loratadine
  • Potent inhibitor of CYP3A4 and CYP2D6. May increase serum concentrations of:
    • Benzodiazepines
      • Midazolam, Lorazepam, and Diazepam
  • CYP1A2 inducer. Decreases serum concentrations of:
    • Duloxetine
    • Clozapine
    • Olanzapine, Haloperidol, and Chlorpromazine
  • Potent inhibitor of CYP3A4 and CYP2D6. May increase serum concentrations of:
    • Benzodiazepines
      • Alprazolam, Chlordiazepoxide, Clorazepate, Diazepam, Lorazepam, and Midazolam
    • Haloperidol
    • SSRIs
      • Citalopram, Escitalopram, Fluoxetine, Paroxetine, Sertraline
    • Antipsychotics
      • Haloperidol, Loxapine, Thioridazine, Molindone, Thiothixene, Fluphenazine, Mesoridazine, Trifluoperazine, Perphenazine, Chlorpromazine, Aripiprazole, Clozapine, Ziprasidone, Risperidone, Quetiapine, Olanzapine
    • Tricyclic antidepressants
      • Amitriptyline, Clomipramine, Doxepin, Imipramine, Trimipramine, Amoxapine, Desipramine, Nortriptyline, and Protriptyline

Caution with:

  • CBD and benzodiazepines: Alprazolam, Chlordiazepoxide, Clonazepam, Diazepam, Lorazepam may cause increased sedation
  • CBD and SSRIs: Escitalopram, Fluoxetine, Paroxetine, Sertraline
  • CBD and Tricyclic antidepressants: Clomipramine, Imipramine
    • Some patients are able to tolerate CBD/Cannabis and tricyclic antidepressants and others might have a possibly severe reaction.
  • MAOIs and cannabis use: Tranylcypromine, Phenelzine, Isocarboxazid
  • Cannabis use and CBD with Maprotiline

Possible interactions with chemotherapy agents:

  • Alkylating Agents
    • Busulfan, Cyclophosphamide, Temozolomide
  • Antimetabolites
    • 5-Fluorouracil, 6-Mercaptopurine, Capecitabine, and Gemcitabine
  • Anti-Tumor Antibiotics
    • Dactinomycin, Bleomycin, Daunorubicin, Doxorubicin
  • Topoisomerase Inhibitors
    • Etoposide, Irinotecan, Topotecan
  • Mitotic Inhibitors
    • Docetaxel, Eribulin, Ixabepilone, Paclitaxel, Vinblastine
  • CYP1A2 inducer. Decreases serum concentrations of:
    • Duloxetine
    • Clozapine
    • Olanzapine, Haloperidol, and Chlorpromazine
  • Potent inhibitor of CYP3A4 and CYP2D6. May increase serum concentrations of:
    • Haloperidol
    • SSRIs
      • Citalopram, Escitalopram, Fluoxetine, Paroxetine, Sertraline
    • Antipsychotics
      • Haloperidol, Loxapine, Thioridazine, Molindone, Thiothixene, Fluphenazine, Mesoridazine, Trifluoperazine, Perphenazine, Chlorpromazine, Aripiprazole, Clozapine, Ziprasidone, Risperidone, Quetiapine, Olanzapine
    • Tricyclic antidepressants
      • Amitriptyline, Clomipramine, Doxepin, Imipramine, Trimipramine, Amoxapine, Desipramine, Nortriptyline, and Protriptyline

Caution with:

  • CBD and SSRIs: Sertraline, Fluoxetine, Citalopram, Escitalopram, Paroxetine, Fluvoxamine
  • CBD and Tricyclic antidepressants: Amitriptyline, Amoxapine, Clomipramine, Desipramine, Doxepin, Imipramine, Nortriptyline, Protriptyline, Trimipramine
  • Cannabis use and CBD with Maprotiline
  • CBD and Clobazam may lead to an increase (up to five‐fold) in its less potent metabolite, N‐Desmethylclobazam. A toxic Benzodiazepine level may manifest as fatigue, somnolence, ataxia, a decrease in cognitive function or behavioral changes.
  • Cannabis may significantly change serum levels of Clobazam, Fufinamide, Topiramate, Zonisamide, and Eslicarbazepine. Patients taking concomitant Divalproex Sodium, Valproate Sodium, and Valproic Acid could experience abnormal liver function. It is important to monitor serum antiepileptic drugs levels and test liver function during treatment with CBD.
  • Potent inhibitor of CYP3A4 and CYP2D6. May increase serum concentrations of:
    • PDE5 inhibitors
      • Sildenafil, Avanafil, Tadalafil, Vardenafil
  • Potent inhibitor of CYP3A4 and CYP2D6. May increase serum concentrations of:
    • Prescriptions for HIV/AIDS, including:
      • Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs): Abacavir/ABC, Didanosine/ddl, Emtricitabine/FTC, Lamivudine/3TC (Epivir), Stavudine/d4T, Tenofovir Alafenamide/TAF, Tenofovir Disoproxil Fumarate/TDF, Zidovudine/ZDV
      • Non-nucleoside Reverse TranscriptaseInhibitors (NNRTIs): Cabotegravir/rilpivirine, Delavirdine/DLV, Doravirine/DOR, Efavirenz/EFV, Etravirine/ETR, Nevirapine/NVP, Rilpivirine/RPV
      • Protease Inhibitors (PIs): Atazanavir/ATV, Darunavir/DRV, Fosamprenavir/ FPV, Indinavir/IDV, Lopinavir + Ritonavir or LPV/r, Nelfinavir/NFV, Ritonavir/RTV, Saquinavir/SQV, Tipranavir/TPV
      • Integrase Inhibitors: Bictegravir/BIC (combined with other drugs as Biktarvy), Dolutegravir/DTG, Elvitegravir/EVG, Raltegravir/ RAL
      • Fusion Inhibitors: Enfuvirtide/ ENF/T-20
      • gp120 Attachment Inhibitor: fostemsavir
      • CCR5 Antagonist: Maraviroc/ MVC
      • Ibalizumab-uiyk
  • Caution with CBD and commonly prescribed Immunosuppressant drugs: Cyclosporine, Azathioprine, Mercaptopurine and Methotrexate. Can cause increased risk of liver damage.
  • CBD oil with Infliximab (TNF-alpha) inhibitors, Natalizumab, and Monoclonal Antibody can increase the risk of: liver damage.
  • CBD oil with Ciprofloxacin & Metronidazole may increase the risk of experiencing the following side effects: drowsiness; diarrhea; decreased appetite; and liver problems.
  • Potent inhibitor of CYP3A4 and CYP2D6. May increase serum concentrations of:
    • Benzodiazepines
      • Estazolam, Flurazepam, Quazepam, Temazepam, and Triazolam may cause insomnia or trouble sleeping
      • Alprazolam, Clonazepam, Diazepam, Estazolam, Lorazepam, and Temazepam may interact with CBD causing alterations in drug metabolism

Caution with:

  • Mirtazapine, Trazodone, and Quetiapine: may cause increased drowsiness
  • Carbamazepine, Gabapentin Enacarbil, Pregabalin, Valproate and Gabapentin CBD: may cause alteration in drug metabolism
  • Hypnotics - Eszopiclone, Zaleplon, and Zolpidem: may cause excessive drowsiness
  • Caution with commonly prescribed tricyclic antidepressants:
    • Imipramine, Desipramine or Nortriptyline
  • Caution with commonly prescribed SSRI antidepressants:
    • Fluoxetine or Paroxetine

Caution in:

  • Patients treated with Valproic Acid, Divalproex Sodium and Valproate Sodium: proceed with caution. Recommend regular liver function testing.
  • Possible drug interactions for: Warfarin, Tricyclic antidepressants, Sildenafil, SSRIs, Corticosteroids, Sedatives, and Anticholinergics.
  • Interactions with disease modifying treatments: increased hepatotoxicity with CBD in patients who have been treated with Alemtuzumab, Cladribine, S1Ps, Interferons, Natalizumab, and Teriflunomide.
  • Caution: Smoked cannabis can increase dysrhythmia and is found to coincide with S1Ps, a reduced efficacy and increased toxicity in conjunction with Cladribine, and increased toxicity in conjunction with Teriflunomide and Siponimod.
  • CYP1A2 inducer- decreases serum concentrations of:
    • Cyclobenzaprine
  • Potent inhibitor of CYP3A4 and CYP2D6. May increase serum concentrations of:
    • Benzodiazepines
      • Diazepam
  • Check for possible interactions with: Citalopram, Escitalopram, Fluoxetine, Paroxetine, Sertraline
  • Interactions between CBD and Methadone may increase methadone levels
  • CYP1A2 inducer- decreases serum concentrations of:
    • Naproxen

Caution with:

  • CBD and Sertraline, Paroxetine, Fluoxetine, Venlafaxine
  • Hydrocortisone and Prednisolone both inhibit the cytochrome P450 enzyme CYP3A, but CBD is a potent inhibitor of CYP3A, so concomitant use may decrease glucocorticoid clearance and increase risk of systemic [corticosteroid] side effects
  • CBD also is known to inhibit the cytochrome P450 isozymes CYP2C9, CYP2D6, CYP2C19, CYP3A4, and CYP1A2, which, alone or in combination, are involved in the metabolization of Naproxen, NSAID and Tramadol
  • Opioid analgesic, Amitriptyline, Tricyclic antidepressant, Tofacitinib, Janus Kinase inhibitors
  • Potent inhibitor of CYP3A4 and CYP2D6. May increase serum concentrations of:
    • Benzodiazepines
      • Clonazepam, Clorazepate, Lorazepam, Clobazam, and Diazepam

Caution with:

  • CBD and Fluphenazine, Haloperidol, Risperidone and Pimozide
  • High % THC and Methylphenidate and medications containing Dextroamphetamine, possibility of heart strain
  • CBD and antidepressants:
    • Fluoxetine
  • CBD and antiseizure medications:
    • Topiramate
Psychiatric Conditions
  • Cannabis should be avoided by patients with acute psychosis and unstable psychiatric conditions
  • Caution with myrcene and THC for patients with a history of psychosis, bipolar, schizophrenia (myrcene can increase the psychoactivity of THC)
Liver Dysfunction
  • Edibles are metabolised through the liver and usually in a higher concentration.
  • Strong caution should be taken for patients or any with liver dysfunction/failure for both edibles or any compound being metabolised by the liver
  • Even high CBD concentrated oil could be problematic
Immunocompromised
  • Smoking is not recommended
  • Due to possible fungal contamination, smoked cannabis could cause respiratory infections in immunocompromised
  • Smoked cannabis may increase risk of pneumonia, especially in immunocompromised patients
Heart Conditions
  • Cannabis may worsen arrhythmias
  • Cannabis can increase risk of angina
  • CBD & THC increase Warfarin levels/INR

How To Purchase This Product:

Once your clinician faxes your medical document to one of the sellers listed below, you can register on the seller's website. The seller will approve your registration, and from there you will be able to purchase products.

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Available Online: {{ getPlaceToPurchaseOnlineProvinces(place_to_purchase) }}In Person: {{ getPlaceToPurchaseInPersonLocation(place_to_purchase) }} Register here to shop {{ place_to_purchase.company_name }}Shop This Product

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Dosing Suggestions

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Recommended Use

Recommended Use

Where to Purchase This Product

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