Major interaction on record — check this product against your medications before combining. Based on 9 of 11 ingredients. Check your meds →
Dietary supplement

Gentle Pathway Ingredients & Drug Interactions

by Energetix

Liquid Category: Botanical
Most serious interaction: Major
The interaction bottom line Most serious interaction: Major

Gentle Pathway is a dietary supplement by Energetix with 11 active ingredients. Its ingredients are commonly taken for chronic pain, nausea and vomiting from chemotherapy, muscle spasticity (e.g., multiple sclerosis).Based on those ingredients, 1,619 medications have a known interaction with it, the most serious rated major. The ingredients most likely to interact are He Shou Wu (Polygonum multifloricum), Huo Ma Ren (Cannabis sativa), Zhi Shi (Citrus aurantium). Use the checker below to test your specific medication, or read the full HelloPharmacist Interaction Report.

HelloPharmacist Scorecard of Gentle Pathway by Energetix

Our pharmacy team’s full take, with four database checks built into the cards below — a summary of what is known, not a grade of the product itself.

From our pharmacy team — supplement deep dive

What’s inside

Low disclosure
Ingredient Transparency · database check
Low

Most active ingredients don't disclose an individual amount — you can't tell how much of each you're getting.

Why this rating?
  • The label discloses an exact amount for 0 of its 11 active ingredients.
  • “Botanical Extract Blend” is a proprietary blend — the label gives one combined amount (0.83 mL) without saying how much of each component you get.

Gentle Pathway contains 11 ingredients, of which 8 are active botanicals from traditional Chinese medicine. The main ones are cannabis (Huo Ma Ren), peony root (Bai Shao), rhubarb root (Da Huang), dong quai (Dang Gui Wei), bitter orange (Zhi Shi), and fo-ti root (He Shou Wu), along with cistanche, perilla seed, and three others we could not fully verify.

The inactive ingredients are purified water, ethanol, and glycerin.

Does it work?

Moderate evidence
Evidence for Intended Use · database check
By FDA rules, dietary supplements can’t claim to treat, cure, or prevent disease — so labels speak in careful marketing language. We discern each product’s intended use from its name, label claims, and label statements, then grade the clinical evidence for that use. How these ratings are computed

This product doesn't appear to be marketed for a specific use, so we graded its ingredients' overall clinical evidence instead.

Moderate

Some clinical evidence supports its ingredients for:

Why this rating?
  • We looked at the product name, claims, and label statements and couldn't find a stated purpose to grade.
  • Since the label doesn't commit to one use, we graded the ingredients' overall clinical evidence instead.
  • On file: Menopausal symptoms — rated "Possibly Effective" (Rhubarb) (Natural Medicines).
  • On file: Multiple sclerosis (MS) — rated "Possibly Effective" (Cannabis) (Natural Medicines).
  • On file: Neuropathic pain — rated "Possibly Effective" (Cannabis) (Natural Medicines).
  • On file: Pancreatitis — rated "Possibly Effective" (Rhubarb) (Natural Medicines).

The evidence for most of these ingredients is limited. Cannabis shows possibly-effective evidence for multiple sclerosis and neuropathic pain, but insufficient evidence for alcohol use disorder, PTSD, and cancer-related appetite loss.

Rhubarb may be possibly effective for pancreatitis and menopausal symptoms. All other active ingredients — peony, dong quai, bitter orange, fo-ti, perilla, and cistanche — lack established evidence; the data we hold rates them as having insufficient reliable evidence to support their use for any of the conditions they're traditionally claimed to address.

None of the ingredients we could verify show strong or probable effectiveness for a specific condition.

How safe is it?

Well-documented data
Safety Information · database check
Well characterized

Adverse-effect, pregnancy, and general safety data are on file for most of these ingredients.

Why this rating?
  • We hold adverse-effect (side-effect) data for 8 of the 9 matched ingredients.
  • Pregnancy & breastfeeding safety ratings cover 9 of 9.
  • General safety write-ups exist for 9 of 9.
  • Remember: this measures how much safety information exists. Thin data is not the same as being safe.

Cannabis is generally well tolerated when used appropriately, but carries serious cautions: it can impair coordination, memory, and reaction time for up to 8 hours; it may cause dizziness, dry mouth, fatigue, nausea, and paranoid thinking; smoking or vaping risks cough and rare cases of collapsed lung; it is unsafe in pregnancy and likely unsafe while breastfeeding. Peony and rhubarb are generally well tolerated orally but may cause gastrointestinal upset — diarrhea (reported in 5% of peony users in one study), cramping, nausea, and abdominal discomfort.

Rhubarb overuse can lead to potassium loss and electrolyte imbalance. Fo-ti carries a caution for liver injury — around 450 cases of hepatitis linked to fo-ti have been documented, ranging from mild to severe.

Dong quai is generally well tolerated but may increase sun sensitivity and cause bleeding. Bitter orange can raise blood pressure and heart rate, especially with caffeine or other stimulants.

Perilla seed has rare reports of anaphylaxis. None of these ingredients should be used during pregnancy — cannabis is unsafe, rhubarb and fo-ti are possibly unsafe, dong quai is possibly unsafe, and peony and perilla lack adequate safety data.

For breastfeeding, cannabis and rhubarb should be avoided; dong quai, peony, fo-ti, and perilla lack sufficient safety data.

Meds to double-check

Major interaction found
Known Interaction Concern · database check
Major identified

At least one ingredient has a documented Major-severity interaction. Check your medications for a personalized result.

Why this rating?
  • 7 of the 9 matched ingredients can interact with medications — Peony, Chinese Cucumber, Rhubarb, Fo-ti, Dong Quai, among others.
  • The most serious interaction on file is rated Major.
  • Some involve high-stakes drug classes: anticoagulant / antiplatelet drugs; immunosuppressants / transplant drugs; diabetes medications; heart-rhythm medications.
  • For scale: 1,620 individual medications appear in the full list. A big number alone doesn't make a product dangerous — what matters is whether YOUR medication is on it, so run yours through the interaction checker on this page.

Check with your pharmacist or doctor before using this product if you take any of the following: blood thinners (warfarin especially); MAO inhibitor antidepressants; the sedative midazolam; blood-pressure, heart-rate, or stimulant medications; blood-sugar drugs; psychiatric medications like clozapine; anesthesia; nervous-system depressants; certain antacids or psychiatric drugs metabolized by the liver; diuretics or corticosteroids; digoxin (a heart medication); or any drug sensitive to laxative effects. No interactions are documented for the three ingredients we could not check.

Check your own medication Run your meds through the checker above

The bottom line

Scorecard at a glanceFormula with limited ingredient disclosure with some supporting evidence behind its ingredients' uses. Major medication interactions have been identified, and safety information is well characterized.

This product is a complex blend with serious drug interaction potential — especially if you take blood thinners, psychiatric medications, heart drugs, or diabetes treatments. Cannabis and bitter orange carry the highest-severity documented interactions.

Multiple ingredients also carry safety concerns: cannabis impairs cognition and coordination, fo-ti has been linked to liver damage, and rhubarb's laxative action can worsen bleeding if you're on anticoagulants. Do not use this product if you're pregnant or breastfeeding.

Talk to your pharmacist about your full medication list before starting.

Educational only — not medical advice; always confirm with your pharmacist. Our editorial policy · How we use AI

Assessment coverage: 9 of 11 active ingredients matched to our full ingredient reviews (monographs). Based on the product label dated Apr 25, 2014.

This Scorecard evaluates available label information, ingredient evidence, and known medication-safety considerations. It does not independently verify product identity, purity, potency, contamination, or manufacturing quality. How these ratings are computed

At a glance

General information

Key facts about Gentle Pathway, straight from the product label.

Brand Energetix
Barcode (UPC) 364578141009
Net contents 2 fl. Oz.; 60 mL
Market status On market
Date entered into DSLD Apr 25, 2014
DSLD ID 32423
Product type Botanical
Supplement form Liquid
Dietary claims / uses All Other
Intended target group(s) Adult (18 - 50 Years), Gluten Free
From the label
Everything in this section is reproduced from the manufacturer’s own product label — it’s the label speaking, not HelloPharmacist. We show it so you can see exactly what the maker states; we don’t verify or endorse those statements.

Supplement Facts

The label details for Gentle Pathway by Energetix, sourced from the NIH Dietary Supplement Label Database.

Supplement Facts

Daily Value (DV) Target Group(s):
Adults and children 4 or more years of age
Minimum serving Sizes:
0.83 mL
Maximum serving Sizes:
0.83 mL
Servings per container
71
UPC/BARCODE
364578141009
IngredientAmount% DV
Botanical Extract Blend0.83 mL--
Huo Ma Ren (Cannabis sativa)0 NP--
Yu Li Ren (Prunus japonica)0 NP--
Bai Shao (Paeonia lactiflora)0 NP--
Da Huang (Rheum palmatum)0 NP--
Dang Gui Wei0 NP--
Gua Lou Zi (Trichosanthes rosthomi)0 NP--
Zi Su Zi (Perilla frutescens)0 NP--
Rou Cong Rong (Cistanche deserticola)0 NP--
Tao Ren (Prunus persica)0 NP--
Zhi Shi (Citrus aurantium)0 NP--
He Shou Wu (Polygonum multifloricum)0 NP--

Other ingredients: purified Water, Ethanol, Glycerin

Tap any ingredient to jump to its full detail below.

Label statements
These statements are the manufacturer’s wording, reproduced from the product label — the label is saying it, not HelloPharmacist. We don’t verify or endorse them.
General Statements

SPAGYRIC CHINESE BOTANICAL

LOT TB182 MFD 06-FEB-12

Tamper-proof.

This formula is based on: Hemp Seed & Rhubarb/Run Chang Wan

Large Intestine

Spagyrically Proccessed

**DV represents Daily Value.

Precautions

Keep out of reach of children.

Do not use if safety seal is broken or missing.

Storage

Store in a cool, dry place out of direct sunlight.

Suggested/Recommended/Usage/Directions

As a dietary supplement, take 30 drops orally (in juice or water, if desired) twice daily or as directed by your healthcare professional. Shake well.

Formulation

Gluten-free

FDA Statement of Identity

Dietary Supplement

Seals/Symbols

Please recycle.

General

r10-11

See for yourself

Gentle Pathway by Energetix label

The label scan from the NIH Dietary Supplement Label Database. Tap to enlarge.

What’s inside

The Ingredients in Gentle Pathway by Energetix

These are the 11 active ingredients this product is made of. Select any to open its full monograph.

Serving size0.83 mL Dosage formLiquid Servings per container71 Amounts shown are per serving.

Most supplement products combine several ingredients, and a medication can interact with the product through any one of them. Each ingredient below shows whether it has known drug interactions.

Other (inactive) ingredients: Purified Water, Ethanol, Glycerin. These complete the product’s ingredient list but are not active constituents.

Interaction report

Gentle Pathway by Energetix Drug Interactions

Want to check YOUR meds against Gentle Pathway?

Ask about interactions with your drugs in plain English — “Can I take it with lisinopril?” — and we find you the answer in seconds, ingredient by ingredient.

Go to the checker
1,619Drugs
12 Major 1,590 Moderate 17 Minor

Each ingredient & the kinds of drugs it affects

For each ingredient in Gentle Pathway with known interactions, here are the types of medications they can affect. Open any type for the detail — or search your exact drug in the checker above.

He Shou Wu (Polygonum multifloricum)17 drug types · 1,257 drugs

Anticoagulant/Antiplatelet Drugs

Fo-ti has been linked to cases of acute liver failure which can decrease clotting factor production and increase the effects of anticoagulants. In one case, a patient who had been stable on warfarin presented with acute hepatitis and an INR elevated to 14.98. The patient had been taking fo-ti for 90 days prior to admission. Discontinuation of warfarin and fo-ti lead to a decrease in the INR and full recovery. Theoretically, concomitant use of fo-ti with anticoagulant or antiplatelet drugs may increase the risk of bleeding in some patients. Until more is known, monitor patients taking fo-ti and drugs that affect bleeding.
Some of these drugs include aspirin, clopidogrel (Plavix), dalteparin (Fragmin), dipyridamole (Persantine), enoxaparin (Lovenox), heparin, ticlopidine (Ticlid), warfarin (Coumadin), and others.

Likelihood Possible Evidence D
Antidiabetes Drugs

Theoretically, fo-ti might increase the risk of hypoglycemia when taken with antidiabetes drugs.
Fo-ti reportedly has hypoglycemic effects.

Likelihood Possible Evidence D
Contraceptive Drugs

Theoretically, taking large amounts of fo-ti might interfere with contraceptive drugs due to competition for estrogen receptors.
In vitro research suggests that fo-ti extract has estrogenic activity.

Likelihood Probable Evidence D
Cytochrome P450 1A2 (Cyp1A2) Substrates

Theoretically, fo-ti might increase or decrease the levels and clinical effects of drugs metabolized by CYP1A2.
In vitro research suggests that fo-ti might inhibit CYP1A2. Additionally, in vitro research suggests that the degree of CYP1A2 inhibition depends on the type of fo-ti extract (i.e., the raw plant leads to greater inhibition than extensively processed extracts). However, in an animal study, an aqueous extract of fo-ti inhibited CYP1A2 while an alcoholic extract of fo-ti induced CYP1A2. Induction or inhibition of CYP1A2 by fo-ti has not been reported in humans.

Likelihood Possible Evidence D
Cytochrome P450 2B6 (Cyp2B6) Substrates

Theoretically, fo-ti might increase the levels and clinical effects of drugs metabolized by CYP2B6.
Animal research suggests that fo-ti might inhibit CYP2B6. One in vitro study suggests that the degree of CYP2B6 inhibition may depend on the type of fo-ti extract (i.e., the raw plant leads to greater inhibition than extensively processed extracts). However, this interaction has not been reported in humans.

Likelihood Possible Evidence D
Cytochrome P450 2C19 (Cyp2C19) Substrates

Theoretically, fo-ti may increase the levels and clinical effects of drugs metabolized by CYP2C19.
Animal and in vitro research suggests that fo-ti may inhibit CYP2C19. An in vitro study suggests that the degree of CYP2C19 inhibition may depend on the type of fo-ti extract (i.e., the raw plant leads to greater inhibition than extensively processed extracts). However, this interaction has not been reported in humans.

Likelihood Possible Evidence D
Cytochrome P450 2C8 (Cyp2C8) Substrates

Theoretically, fo-ti might increase the levels and clinical effects of drugs metabolized by CYP2C8.
In vitro research suggests that fo-ti might inhibit CYP2C8. However, this interaction has not been reported in humans.

Likelihood Possible Evidence D
Cytochrome P450 2C9 (Cyp2C9) Substrates

Theoretically, fo-ti may increase the levels and clinical effects of drugs metabolized by CYP2C9.
Animal and in vitro research suggests that fo-ti may inhibit CYP2C9. However, this interaction has not been reported in humans.

Likelihood Possible Evidence D
Cytochrome P450 2D6 (Cyp2D6) Substrates

Theoretically, fo-ti may increase the levels and clinical effects of drugs metabolized by CYP2D6.
Animal research suggests that fo-ti might inhibit CYP2D6. Additionally, an in vitro study suggests that the degree of CYP2D6 inhibition may depend on the type of fo-ti extract (i.e., the raw plant leads to greater inhibition than extensively processed extracts). However, this interaction has not been reported in humans.

Likelihood Possible Evidence D
Cytochrome P450 3A4 (Cyp3A4) Substrates

Theoretically, fo-ti might increase the levels and clinical effects of drugs metabolized by CYP3A4.
In vitro research suggests that fo-ti might inhibit CYP3A4. One in vitro study suggests that the degree of CYP3A4 inhibition may depend on the type of fo-ti extract (i.e., the raw plant leads to greater inhibition than extensively processed extracts). However, this evidence conflicts with animal research suggesting that fo-ti does not inhibit CYP3A4. This interaction has not been reported in humans.

Likelihood Possible Evidence D
Digoxin (Lanoxin)

Theoretically, fo-ti, particularly raw fo-ti root, might increase the risk of hypokalemia and cardiotoxicity when taken with digoxin.
Raw fo-ti root contains anthraquinone derivatives, which might have stimulant laxative effects. In vitro research shows that fermented and processed fo-ti root have reduced laxative effects compared with raw fo-ti root.

Likelihood Possible Evidence D
Diuretic Drugs

Theoretically, fo-ti, particularly raw fo-ti root, might increase the risk of hypokalemia when taken with diuretic drugs.
Raw fo-ti root contains anthraquinone derivatives, which might have stimulant laxative effects and compound diuretic-induced potassium loss. In vitro research shows that fermented and processed fo-ti root have reduced laxative effects compared with raw fo-ti root.

Likelihood Possible Evidence D
Estrogens

Theoretically, taking large amounts of fo-ti might interfere with hormone replacement therapy through competition for estrogen receptors.
In vitro research suggests that fo-ti extract has estrogenic activity.

Likelihood Probable Evidence D
Hepatotoxic Drugs

Theoretically, fo-ti might increase the risk of liver damage when taken with hepatotoxic drugs.
Fo-ti has been linked to liver damage in many reports.

Likelihood Possible Evidence D
Stimulant Laxatives

Theoretically, fo-ti, particularly raw fo-ti root, might increase the risk of fluid and electrolyte depletion when taken with stimulant laxatives.
Raw fo-ti root contains anthraquinone derivatives, which might have stimulant laxative effects. However, in vitro research shows that fermented and processed fo-ti root have reduced laxative effects compared with raw fo-ti root.

Likelihood Possible Evidence D
Sulindac (Clinoril)

Theoretically, fo-ti might increase or decrease the levels and clinical effects of sulindac.
Animal research suggests that the type of fo-ti extract might affect the levels of sulindac differently; the raw plant may increase levels, but processed parts may decrease levels. Induction or inhibition of CYP1A2 by fo-ti has not been reported in humans.

Likelihood Possible Evidence D
Warfarin (Coumadin)

Theoretically, fo-ti might increase the effects and adverse effects of warfarin.
Fo-ti may have stimulant laxative effects and cause diarrhea, especially when the raw or unprocessed fo-ti root is used. Diarrhea can increase the effects of warfarin, increase international normalized ratio (INR), and increase the risk of bleeding. Also, fo-ti has been linked to cases of acute liver failure which can decrease clotting factor production and increase the effects of warfarin. In one case, a patient who had been stable on warfarin presented with acute hepatitis and an INR elevated to 14.98. The patient had been taking fo-ti for 90 days prior to admission. Discontinuation of warfarin and fo-ti lead to a decrease in the INR and full recovery.

Likelihood Possible Evidence D

Huo Ma Ren (Cannabis sativa)18 drug types · 1,136 drugs

Warfarin (Coumadin)

Concomitant use with cannabis seems to increase the levels and clinical effects of warfarin.
In vitro research shows that the cannabis constituents delta-9-tetrahydrocannabinol (THC), cannabidiol (CBD), and cannabinol inhibit the cytochrome P450 2C9 (CYP2C9)-mediated 7-hydroxylation of S-warfarin in a concentration-dependent manner.
Additionally, there are multiple case reports of patients chronically taking warfarin that developed a spike in international normalized ratio (INR) after using cannabis in various forms, including smoking cannabis, taking medical cannabis orally, or drinking water infused with cannabis flower. One patient smoked 2-2.5 grams in one week and another patient had doubled the amount of THC consumed from 7.5 mg to 14.7 mg daily for one week.

Likelihood Probable Evidence D
Alcohol (Ethanol)

Theoretically, cannabis might have additive effects when used with alcohol.
Cannabis can have CNS depressant effects, similar to synthetic delta-9-tetrahydrocannabinol (THC). Theoretically, concomitant use of alcohol with cannabis can have additive effects including psychomotor impairment, sedation, and changes in mood and behavior.

Likelihood Possible Evidence D
Anesthesia

Cannabis use might alter the safety and clinical effects of various forms of anesthesia.
A small clinical study shows that higher doses of propofol may be needed to achieve relaxation and loss of consciousness in chronic cannabis users compared with nonusers. Another small clinical study shows that use of cannabis within 72 hours prior to undergoing surgery requiring atropine anesthesia may increase the risk of sustained postoperative tachycardia. The exact mechanisms of these interactions are unclear. Obtain a patient's history of cannabis use preoperatively and advise patients to discontinue cannabis use for at least 2 weeks prior to undergoing surgery.

Likelihood Possible Evidence B
Anticoagulant/Antiplatelet Drugs

Theoretically, cannabis might increase the risk of bleeding when used concomitantly with anticoagulant/antiplatelet drugs.
In vitro research shows that the cannabis constituents delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) inhibit platelet aggregation.

Likelihood Possible Evidence D
Barbiturates

Theoretically, cannabis might increase the levels and adverse effects of barbiturates.
Some research shows that synthetic delta-9-tetrahydrocannabinol (THC) increases the elimination half-life of pentobarbital by 4 hours when dosed concomitantly.

Likelihood Possible Evidence D
Cns Depressants

Theoretically, cannabis might have additive effects if used with other CNS depressants.
Cannabis can have CNS depressant effects. Combining cannabis with other CNS depressants might result in additive or synergistic effects. A small clinical trial in healthy adults shows that inhaling a high-grade cannabis (Bedrocan International B.V., Veendam, The Netherlands) 100 mg, containing delta-9-tetrahydrocannabinol 21.8% and cannabinol 0.1%, modestly increases subjective feelings of sedation when compared with cannabis alone.

Likelihood Possible Evidence D
Cytochrome P450 2C19 (Cyp2C19) Substrates

Cannabis may increase levels of drugs metabolized by CYP2C19.
Research shows that cannabidiol (CBD), a constituent of cannabis, inhibits CYP2C19. In clinical studies and case reports, cannabidiol use resulted in significant increases in the serum levels of topiramate, methadone, citalopram, omeprazole, and N-desmethylclobazam, the primary active metabolite of clobazam. These chemicals are metabolized by CYP2C19. Concomitant use of cannabis with CYP2C19 substrates may increase the risk for adverse effects from these substrates.

Likelihood Possible Evidence D
Cytochrome P450 2C9 (Cyp2C9) Inducers

Theoretically, drugs that are CYP2C9 inducers might decrease the effects of cannabis.
Delta-9-tetrahydrocannabinol (THC), an active constituent of cannabis, is a substrate of CYP2C9 enzymes.

Likelihood Possible Evidence D
Cytochrome P450 2C9 (Cyp2C9) Inhibitors

Theoretically, drugs that are CYP2C9 inhibitors might increase the adverse effects of cannabis.
Delta-9-tetrahydrocannabinol (THC), an active constituent of cannabis, is a substrate of CYP2C9 enzymes.

Likelihood Possible Evidence D
Cytochrome P450 2C9 (Cyp2C9) Substrates

Theoretically, cannabis might increase the levels and adverse effects of CYP2C9 substrates.
In vitro research shows that the cannabis constituents delta-9-tetrahydrocannabinol (THC), cannabidiol (CBD), and cannabinol moderately inhibit the CYP2C9-mediated 7-hydroxylation of S-warfarin in a concentration-dependent manner. In vitro research also shows that cannabis extracts modestly inhibit the CYP2C9 metabolism of tolbutamide; extracts providing the specific cannabinoids CBD and cannabigerol (CBG) had stronger inhibitory effects than extracts containing THC and CBD.

Likelihood Possible Evidence D
Cytochrome P450 2E1 (Cyp2E1) Substrates

Theoretically, cannabis might decrease the levels and clinical effects of CYP2E1 substrates.
In vitro research shows that cannabis can induce the activity of CYP2E1, which might increase the metabolism of CYP2E1 substrates.

Likelihood Possible Evidence D
Cytochrome P450 3A4 (Cyp3A4) Inducers

Theoretically, CYP3A4 inducers might reduce the levels and clinical effects of cannabis.
Delta-9-tetrahydrocannabinol (THC), an active constituent of cannabis, is a substrate of CYP3A4 enzymes.

Likelihood Possible Evidence D
Cytochrome P450 3A4 (Cyp3A4) Inhibitors

Theoretically, CYP3A4 inhibitors might increase the levels and adverse effects of cannabis.
Delta-9-tetrahydrocannabinol (THC), an active constituent of cannabis, is a substrate of CYP3A4 enzymes.

Likelihood Possible Evidence D
Cytochrome P450 3A4 (Cyp3A4) Substrates

Theoretically, cannabis may increase the levels and adverse effects of CYP3A4 substrates.
In vitro research shows that cannabis can inhibit the activity of CYP3A4 enzymes, which might decrease the metabolism of CYP3A4 substrates. In vitro research also shows that cannabis extracts modestly inhibit the CYP3A4 metabolism of testosterone; extracts providing the specific cannabinoids CBD and cannabigerol (CBG) had stronger inhibitory effects than extracts containing THC and CBD.

Likelihood Possible Evidence D
P-Glycoprotein Substrates

Theoretically, cannabis might alter levels of drugs that are substrates of P-glycoprotein (P-gp).
Most in vitro research suggests that constituents of cannabis, including cannabidiol (CBD) and delta-9-tetrahydrocannabinol (THC), can inhibit P-gp and increase the accumulation of probe compounds by reducing P-gp mediated drug efflux. In vitro studies in kidney cell lines show that a 1-hour exposure to CBD and THC inhibits P-gp. Cannabis may also alter the expression of P-gp, although this effect appears to vary based on duration of exposure. Some in vitro research in lymphoblastoid leukemia cell lines indicates that a 1-hour exposure to cannabinoids does not affect P-gp expression, while a prolonged 72-hour exposure decreases P-gp expression. Other in vitro research in these cell lines shows that a 4-hour exposure to THC and CBD induces P-gp gene expression, while exposure for longer than 4 hours and up to 48 hours does not induce P-gp gene expression.

Likelihood Possible Evidence D
Theophylline

Smoking cannabis while taking theophylline might reduce the levels and clinical effects of theophylline.
Similar to smoking tobacco, smoking cannabis seems to increase the metabolism of theophylline.

Likelihood Possible Evidence D
Thrombolytic Drugs

Cannabis might augment the effects of thrombolytic drugs and increase the risk of severe bleeding.
A case of cerebral hemorrhage has been reported for a 51-year-old female and chronic cannabis user who had consumed a large amount of cannabis prior to receiving recombinant tissue plasminogen activator (rtPA) for ischemic stroke. Hemorrhage had been ruled out prior to providing the rtPA. The exact mechanism of this interaction is unclear.

Likelihood Possible Evidence D
Antipsychotic Drugs

Cannabis does not seem to affect blood levels or effects of some antipsychotic drugs.
Human research shows that cannabis use does not affect blood levels or clinical effects of amisulpride, aripiprazole, or olanzapine in patients with schizophrenia and related disorders.

Likelihood Unlikely Evidence B

Zhi Shi (Citrus aurantium)13 drug types · 957 drugs

Midazolam (Versed)

Bitter orange might increase blood levels of midazolam.
One small clinical study shows that bitter orange juice can increase midazolam levels, likely through inhibition of cytochrome P450 3A4 (CYP3A4). Theoretically, bitter orange might increase the risk of midazolam-related adverse effects.

Likelihood Probable Evidence B
Monoamine Oxidase Inhibitors (Maois)

Theoretically, taking MAOIs with synephrine-containing bitter orange preparations might increase the hypertensive effects of synephrine, potentially leading to hypertensive crisis.
Bitter orange contains tyramine, octopamine, and synephrine, which are MAO substrates.

Likelihood Probable Evidence D
Antidiabetes Drugs

Theoretically, bitter orange might increase the risk of hypoglycemia when taken with antidiabetes drugs.
Some clinical research shows that drinking a tea containing bitter orange and Indian snakeroot reduces fasting and postprandial glucose levels in patients with type 2 diabetes who are using antidiabetes drugs. However, it is unclear if these effects are due to bitter orange, Indian snakeroot, or the combination. An animal study also shows that p-synephrine in combination with gliclazide , a sulfonylurea, causes an additional 20% to 44% decrease in glucose levels when compared with gliclazide alone.

Likelihood Possible Evidence B
Caffeine

Bitter orange might increase blood pressure and heart rate when taken with caffeine.
Small clinical studies show that taking bitter orange in combination with caffeine can increase blood pressure and heart rate in otherwise healthy normotensive adults. Theoretically, this might increase the risk of serious cardiovascular adverse effects.

Likelihood Possible Evidence B
Colchicine

Bitter orange might affect colchicine levels.
Colchicine is a substrate of P-glycoprotein and cytochrome P450 3A4 (CYP3A4). Bitter orange has been reported to inhibit CYP3A4 and increase levels of CYP3A4 substrates. However, one small clinical study in healthy adults shows that drinking bitter orange juice 240 mL twice daily for 4 days and taking a single dose of colchicine 0.6 mg on the 4th day decreases colchicine peak serum levels by 24%, time to peak serum level by 1 hour, and overall exposure to colchicine by 20%. The clinical significance of this finding is unclear.

Likelihood Possible Evidence B
Cytochrome P450 3A4 (Cyp3A4) Substrates

Bitter orange might increase levels of drugs metabolized by CYP3A4.
Small clinical studies suggest that single or multiple doses of freshly squeezed bitter orange juice 200-240 mL can inhibit CYP3A4 metabolism of drugs, causing increased drug levels and potentially increasing the risk of adverse effects. However, the extent of the effect of bitter orange on CYP3A4-mediated drug interactions is unknown. Some evidence suggests that bitter orange selectively inhibits intestinal CYP3A4, but not hepatic CYP3A4. Its effect on P-glycoprotein, which strongly overlaps with CYP3A4 interactions, is unclear. One small clinical study shows that drinking 8 ounces of freshly squeezed bitter orange juice has no effect on cyclosporine, which seems to be more dependent on hepatic CYP3A4 and P-glycoprotein than intestinal CYP3A4.

Likelihood Possible Evidence B
Dextromethorphan (Robitussin Dm, Others)

Bitter orange might increase blood levels of dextromethorphan.
One small clinical study shows that bitter orange juice increases dextromethorphan levels, likely through cytochrome P450 3A4 (CYP3A4) inhibition. Theoretically, bitter orange might increase the risk for dextromethorphan-related adverse effects.

Likelihood Possible Evidence B
Felodipine (Plendil)

Bitter orange might increase blood levels of felodipine.
One small clinical study shows that bitter orange juice increases felodipine levels, likely through cytochrome P450 3A4 (CYP3A4) inhibition. Theoretically, bitter orange might increase the risk for felodipine-related adverse effects.

Likelihood Probable Evidence B
Indinavir (Crixivan)

Bitter orange might increase blood levels of indinavir.
One small clinical study shows that bitter orange juice slightly increases indinavir levels, but this effect is likely to be clinically insignificant. Bitter orange selectively inhibits intestinal cytochrome P450 3A4 (CYP3A4); however, the metabolism of indinavir seems to be more dependent on hepatic CYP3A4. The effect of bitter orange on other protease inhibitors has not been studied.

Likelihood Possible Evidence B
Qt Interval-Prolonging Drugs

Theoretically, bitter orange might have an additive effect when combined with drugs that prolong the QT interval, potentially increasing the risk of ventricular arrhythmias.
One case report suggests that taking bitter orange in combination with other stimulants such as caffeine might prolong the QT interval in some patients.

Likelihood Possible Evidence D
Sildenafil (Viagra)

Bitter orange juice might increase blood levels of sildenafil.
A small clinical study in healthy adult males shows that drinking freshly squeezed bitter orange juice 250 mL daily for 3 days and taking a single dose of sildenafil 50 mg on the 3rd day increases the peak plasma concentration of sildenafil by 18% and the overall exposure to sildenafil by 44%. Theoretically, this may be due to inhibition of cytochrome P450 3A4 by bitter orange.

Likelihood Probable Evidence B
Stimulant Drugs

Theoretically, bitter orange might increase the risk of hypertension and adverse cardiovascular effects when taken with stimulant drugs.
Bitter orange appears to have stimulant effects.

Likelihood Possible Evidence B
Cytochrome P450 2D6 (Cyp2D6) Substrates

Theoretically, bitter orange might increase levels of drug metabolized by CYP2D6.
In vitro research shows that octopamine, a constituent of bitter orange, weakly inhibits CYP2D6 enzymes. This effect has not been reported in humans.

Likelihood Possible Evidence D

Bai Shao (Paeonia lactiflora)7 drug types · 811 drugs

Anticoagulant/Antiplatelet Drugs

Theoretically, combining peony with anticoagulant or antiplatelet drugs might increase the risk of bleeding.
In vitro research suggests that peony might have antiplatelet, anticoagulant, and antithrombotic effects.

Likelihood Possible Evidence D
Clozapine (Clozaril)

Theoretically, peony might increase the levels and clinical effects of clozapine.
In vitro research shows that peony suppresses the metabolism of clozapine via weak-to-moderate inhibitory effects on cytochromes P450 (CYP) 1A2 and CYP3A4. This effect has not been reported in humans.

Likelihood Possible Evidence D
Contraceptive Drugs

Theoretically, peony might interfere with contraceptive drugs due to competition for estrogen receptors.
In vitro and animal research shows that peony extract has estrogenic activity. Concomitant use might also increase the risk for estrogen-related adverse effects.

Likelihood Possible Evidence D
Cytochrome P450 1A2 (Cyp1A2) Substrates

Theoretically, use of peony may increase the levels and clinical effects of drugs metabolized by CYP1A2.
In vitro research shows that peony suppresses the metabolism of clozapine via weak-to-moderate inhibitory effects on CYP1A2 and CYP3A4. This effect has not been reported in humans.

Likelihood Possible Evidence D
Cytochrome P450 3A4 (Cyp3A4) Substrates

Theoretically, use of peony may increase the levels and clinical effects of drugs metabolized by CYP3A4.
In vitro research shows that peony suppresses the metabolism of clozapine via weak-to-moderate inhibitory effects on CYP1A2 and CYP3A4. This effect has not been reported in humans.

Likelihood Possible Evidence D
Estrogens

Theoretically, concomitant use of large amounts of peony might interfere with hormone replacement therapy and/or increase the risk for estrogen-related adverse effects.
In vitro and animal research shows that peony extract has estrogenic activity. Theoretically, peony might compete for estrogen receptors and/or cause additive estrogenic effects.

Likelihood Possible Evidence D
Phenytoin (Dilantin)

Theoretically, peony might reduce the levels and clinical effects of phenytoin.
Animal research shows that taking peony root reduces levels of phenytoin. Some researchers suggest that peony root might affect cytochrome P450 (CYP) 2C9, which metabolizes phenytoin. However, preliminary research in humans shows that peony root does not alter levels of losartan (Cozaar), which is also metabolized by CYP2C9.

Likelihood Probable Evidence D

Da Huang (Rheum palmatum)8 drug types · 658 drugs

Corticosteroids

Theoretically, frequent and high doses of rhubarb might increase the risk of hypokalemia when taken with corticosteroids.
Rhubarb has stimulant laxative effects. Overuse of rhubarb might compound corticosteroid-induced potassium loss.

Likelihood Possible Evidence D
Cyclosporine (Neoral, Sandimmune)

Theoretically, taking rhubarb with cyclosporine might reduce cyclosporine levels.
Animal research shows that co-administration of rhubarb decoction 0.25 or 1 gram/kg with cyclosporine 2.5 mg/kg, decreases cyclosporine maximum plasma concentration and overall exposure levels when compared with taking cyclosporine alone. The authors theorize that rhubarb might reduce cyclosporine bioavailability by inducing of P-glycoprotein and/or cytochrome P450 3A4. However, since rhubarb was administered as a single oral dose and enzyme induction usually occurs after multiple doses, it is possible that cyclosporine absorption was actually reduced via rhubarb's stimulant laxative effects. Also, the composition of the rhubarb decoction was not described.

Likelihood Possible Evidence D
Digoxin (Lanoxin)

Theoretically, overuse of rhubarb might increase the risk of adverse effects when taken with digoxin.
Rhubarb has stimulant laxative effects. Overuse of rhubarb might cause potassium depletion, increasing the risk of digoxin toxicity.

Likelihood Possible Evidence D
Diuretic Drugs

Theoretically, frequent and high doses of rhubarb might increase the risk of hypokalemia.
Rhubarb has stimulant laxative effects. Overuse of rhubarb might cause potassium depletion and compound diuretic-induced potassium loss.

Likelihood Possible Evidence D
Hepatotoxic Drugs

Theoretically, concomitant use of rhubarb with potentially hepatotoxic drugs might increase the risk of developing liver damage.
Some animal research suggests that anthraquinones in rhubarb might have hepatotoxic effects. Also, rhubarb use has been linked to at least 24 cases of liver injury, although details on the dose of rhubarb and duration of use in these cases is unclear.

Likelihood Possible Evidence D
Nephrotoxic Drugs

Theoretically, long-term use of anthraquinones from rhubarb might increase the risk of nephrotoxicity when used with nephrotoxic drugs.
The anthraquinone constituents of rhubarb have been shown to induce nephrotoxicity in animal research. Additionally, in a case report, a 23-year old female presented with kidney failure after taking 6 tablets of a proprietary slimming agent (found to contain the anthraquinones emodin and aloe-emodin from rhubarb) daily for 6 weeks and then adding diclofenac 25 mg 4 times daily for 2 days. The authors postulate that the anthraquinone constituents of rhubarb contributed to the renal dysfunction, and the addition of diclofenac, a nephrotoxic drug, led to renal failure. Until more is known, advise patients to avoid taking rhubarb if they are taking other potentially nephrotoxic drugs.

Likelihood Possible Evidence D
Stimulant Laxatives

Theoretically, rhubarb might increase the risk for fluid and electrolyte loss when taken with other stimulant laxatives.
Rhubarb has stimulant laxative effects. Concomitant use with stimulant laxatives might compound fluid and electrolyte loss.

Likelihood Possible Evidence D
Warfarin (Coumadin)

Theoretically, excessive use of rhubarb might increase the risk of bleeding when taken with warfarin.
Rhubarb has stimulant laxative effects and can cause diarrhea. Diarrhea can increase the effects of warfarin, increase international normalized ratio (INR), and increase the risk of bleeding. Advise patients who take warfarin not to take excessive amounts of rhubarb.

Likelihood Possible Evidence D

Dang Gui Wei3 drug types · 163 drugs

Warfarin (Coumadin)

Dong quai may increase the risk of bleeding when used with warfarin.
Case reports suggest that concomitant use of dong quai with warfarin can increase the anticoagulant effects of warfarin and increase the risk of bleeding. In one case, after 4 weeks of taking dong quai 565 mg once or twice daily, the international normalized ratio (INR) increased to 4.9. The INR normalized 4 weeks after discontinuation of dong quai.

Likelihood Probable Evidence D
Anticoagulant/Antiplatelet Drugs

Theoretically, dong quai may increase the risk of bleeding when used with anticoagulant or antiplatelet drugs; however, research is conflicting.
Animal studies suggest that dong quai has antithrombin activity and inhibits platelet aggregation due to its coumarin components. Additionally, some case reports in humans suggest that dong quai can increase the anticoagulant effects of warfarin. However, clinical research in healthy adults shows that taking 1 gram of dong quai root daily for 3 weeks does not significantly inhibit platelet aggregation or cause bleeding. Until more is known, use dong quai with caution in patients taking antiplatelet/anticoagulant drugs.

Likelihood Possible Evidence D
Estrogens

Theoretically, dong quai may reduce the effects of estrogens.
Dong quai has estrogenic effects. Theoretically, concomitant use of large amounts of dong quai might interfere with hormone replacement therapy due to competition for estrogen receptors.

Likelihood Possible Evidence D

Gua Lou Zi (Trichosanthes rosthomi)1 drug type · 86 drugs

Antidiabetes Drugs

Theoretically, concomitant use of Chinese cucumber with antidiabetic drugs may have additive effects and adverse effects. Monitor blood glucose levels closely, dose adjustment may be needed.

Likelihood Possible Evidence D
The maker

Brand information

Manufacturer and brand details for Gentle Pathway, from the product label.

Energetix

See all Energetix products
Name
Energetix
Street Address
209 W. Deerfield Lane
City
Dahlonega
State
GA
ZipCode
30533
Phone Number
800.990.7085
Web Address
www.goenergetix.com
Pharmacist Counseling Corner

Gentle Pathway by Energetix: Common Questions

Does Gentle Pathway by Energetix interact with any medications?
Yes. Based on its ingredients, Gentle Pathway has a known interaction with 1,619 medications, including 12 rated major. Use the checker to see how it interacts with a specific drug.
How can one product interact with so many drugs?
Gentle Pathway contains 11 active ingredients, and an interaction can come from any of them. We check every ingredient, combine the results into one list per medication, and show which ingredient and mechanism is responsible.
Where does this information come from?
The product label data comes from the NIH Dietary Supplement Label Database (DSLD); the interaction data is built on the Natural Medicines database and reviewed by HelloPharmacist pharmacists.
Does this product actually work for anything?
Based on the evidence we hold, cannabis in this blend shows possibly-effective evidence for multiple sclerosis and neuropathic pain. Rhubarb may be possibly effective for pancreatitis and menopausal symptoms. All other ingredients lack established evidence — they're traditional remedies, but their effectiveness isn't proven by the data available to us.
Can I take this if I'm on blood thinners like warfarin?
No — at least three ingredients in this product (cannabis, dong quai, and rhubarb) interact with warfarin and can increase your bleeding risk. You must talk to your doctor or pharmacist before considering this product.
What are the most likely side effects?
Cannabis can cause dizziness, dry mouth, fatigue, nausea, and impaired coordination or memory for up to 8 hours. Peony and rhubarb may cause diarrhea, cramping, nausea, or abdominal discomfort. Bitter orange can raise blood pressure and heart rate. Fo-ti carries a documented risk of liver injury.
Is it safe during pregnancy or while breastfeeding?
No. Cannabis is unsafe in pregnancy and likely unsafe while breastfeeding. Rhubarb and fo-ti are possibly unsafe in pregnancy. Dong quai is possibly unsafe in pregnancy. Peony, perilla, and cistanche lack enough safety data — talk to your doctor before using any of this product in pregnancy or while nursing.
What's in this liquid that makes up the 11 ingredients?
Eight are active botanicals from traditional Chinese medicine: cannabis, peony root, rhubarb root, dong quai, bitter orange, fo-ti root, cistanche, and perilla seed, plus three others we couldn't fully check. The inactive ingredients are purified water, ethanol, and glycerin.
I take several medications. How do I know if this is safe for me?
Use the medication checker on this page to search your exact drugs against the ingredients. If you take blood thinners, antidepressants, psychiatric drugs, heart medications, diabetes drugs, or diuretics, there is a real risk — discuss this product with your pharmacist before starting.

Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy

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Label information is sourced from the NIH Dietary Supplement Label Database and reflects the product version on file; always read your actual product label. This page is for education only and is not a substitute for professional medical advice. Confirm with your pharmacist or doctor before combining supplements and medications.

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Go deeper

The Full Monographs Behind Gentle Pathway’s Ingredients

Every ingredient we hold a full HelloPharmacist monograph for — uses, evidence, safety, and the complete interaction list.

Herb & supplement monograph

Cannabis

Interacts with 1,136 drugs

Cannabis contains many active compounds, mainly THC (which causes a 'high') and CBD (which does not). Some uses, such as chemotherapy-related nausea, certain seizure disorders, and muscle sp...

Read the full Cannabis monograph →
Herb & supplement monograph

Peony

Interacts with 811 drugs

Peony root is a traditional Chinese medicine herb often used for menstrual problems, cramps, and inflammation, frequently as part of combination formulas. Human evidence for most uses is lim...

Read the full Peony monograph →
Herb & supplement monograph

Rhubarb

Interacts with 658 drugs

Rhubarb root has a long history of use as a laxative and in traditional Chinese medicine, and its edible stalks are a common food. Most medicinal claims are backed by limited or low-quality...

Read the full Rhubarb monograph →
Herb & supplement monograph

Dong Quai

Interacts with 163 drugs

Dong Quai is a traditional Chinese herb often called "female ginseng" and is mostly used for menstrual and menopausal complaints. High-quality scientific evidence that it works for these use...

Read the full Dong Quai monograph →
Herb & supplement monograph

Chinese Cucumber

Interacts with 86 drugs

Chinese cucumber (Trichosanthes kirilowii) is a plant used in traditional Chinese medicine, and a protein from its root called trichosanthin (Compound Q) has been studied as an injectable dr...

Read the full Chinese Cucumber monograph →
Herb & supplement monograph

Perilla

Perilla is an Asian mint-family plant used in cooking and traditional medicine, mainly for allergy, breathing, and digestive complaints. Most human evidence is limited or preliminary, so it...

Read the full Perilla monograph →
Herb & supplement monograph

Cistanche Deserticola

Cistanche deserticola is a parasitic desert plant long used in traditional Chinese medicine as a tonic for energy, sexual health, and constipation. Modern evidence in humans is very limited,...

Read the full Cistanche Deserticola monograph →
Herb & supplement monograph

Bitter Orange

Interacts with 957 drugs

Bitter orange is a citrus fruit whose extracts contain synephrine, a mild stimulant often added to weight-loss and energy supplements. Evidence that it works for weight loss or performance i...

Read the full Bitter Orange monograph →
Herb & supplement monograph

Fo-ti

Interacts with 1,257 drugs

Fo-ti (He Shou Wu) is a root used in traditional Chinese medicine, often promoted for healthy aging and hair. High-quality human evidence for these benefits is limited, and processed Fo-ti h...

Read the full Fo-ti monograph →
Sources

Sources & How We Checked

Gentle Pathway's label data comes from the NIH Dietary Supplement Label Database; the ingredient interaction data is from the Natural Medicines database, reviewed by our pharmacists.

Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.

The 400 references behind this product’s interaction data

Every citation that drives the interaction findings for this product’s ingredients, from the evidence-graded Natural Medicines (TRC Healthcare) database. Open an ingredient to browse its citations — links open the study on PubMed or the publisher’s site.

Cannabis 261 references
  1. Robbers JE, Speedie MK, Tyler VE. Pharmacognosy and Pharmacobiotechnology. Baltimore, MD: Williams & Wilkins, 1996.
  2. Gruenwald J, Brendler T, Jaenicke C. PDR for Herbal Medicines. 1st ed. Montvale, NJ: Medical Economics Company, Inc., 1998.
  3. Johnson MA, Robin P, Smith RP, Morrisona D, et al. Large lung bullae in marijuana smokers. Thorax 2000;55:340-2.. PubMed
  4. Hebel SK, ed. Drug Facts and Comparisons. 52nd ed. St. Louis: Facts and Comparisons, 1998.
  5. Tyrey L. Delta 9-Tetrahydrocannabinol: a potent inhibitor of episodic luteinizing hormone secretion. J Pharmacol Exp Ther 1980;213:306-8. DOI
  6. Briggs GB, Freeman RK, Yaffe SJ. Drugs in Pregnancy and Lactation. 5th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 1998.
  7. Solowij N, Stephens RS, Roffman RA, et al. Cognitive functioning of long-term heavy cannabis users seeking treatment. JAMA 2002;287:1123-31.. PubMed
  8. Marinol Prescribing Information. Solvay Pharmaceuticals, Rev March 2008. Available at: http://www.solvaypharmaceuticals-us.com/static/wma/pdf/1/3/2/5/0/004InsertText500012RevMar2008.pdf (Accessed 2 July 2009).
  9. Yamreudeewong W, Wong HK, Brausch LM, Pulley KR. Probable interaction between warfarin and marijuana smoking. Ann Pharmacother 2009;43:1347-53. PubMed
  10. Ware MA, Wang T, Shapiro S, et al. Smoked cannabis for chronic neuropathic pain: a randomized controlled trial. CMAJ 2010;182:e694-e701. PubMed
  11. Pellinen, P., Honkakoski, P., Stenback, F., Niemitz, M., Alhava, E., Pelkonen, O., Lang, M. A., and Pasanen, M. Cocaine N-demethylation and the metabolism-related hepatotoxicity can be prevented by cytochrome P450 3A inhibitors. Eur.J Pharmacol 1-3-1994;2 PubMed
  12. Johnson, E. M. Substance abuse and women's health. Public Health Rep. 1987;102(4 Suppl):42-48.
  13. Astley, S. J. and Little, R. E. Maternal marijuana use during lactation and infant development at one year. Neurotoxicol.Teratol. 1990;12(2):161-168. PubMed
  14. Levy, R., Schurr, A., Nathan, I., Dvilanski, A., and Livne, A. Impairment of ADP-induced platelet aggregation by hashish components. Thromb.Haemost. 12-31-1976;36(3):634-640. DOI
  15. Payne, R. J. and Brand, S. N. The toxicity of intravenously used marihuana. JAMA 7-28-1975;233(4):351-354. DOI
  16. Sheweita, S. A. Narcotic drugs change the expression of cytochrome P450 2E1 and 2C6 and other activities of carcinogen-metabolizing enzymes in the liver of male mice. Toxicology 9-30-2003;191(2-3):133-142. PubMed
  17. Rog, D. J., Nurmikko, T. J., Friede, T., and Young, C. A. Randomized, controlled trial of cannabis-based medicine in central pain in multiple sclerosis. Neurology 9-27-2005;65(6):812-819. PubMed
  18. Perras, C. Sativex for the management of multiple sclerosis symptoms. Issues Emerg.Health Technol. 2005;(72):1-4.
  19. Zhu, H. J., Wang, J. S., Markowitz, J. S., Donovan, J. L., Gibson, B. B., Gefroh, H. A., and Devane, C. L. Characterization of P-glycoprotein inhibition by major cannabinoids from marijuana. J Pharmacol Exp.Ther. 2006;317(2):850-857. PubMed
  20. Holland, M. L., Panetta, J. A., Hoskins, J. M., Bebawy, M., Roufogalis, B. D., Allen, J. D., and Arnold, J. C. The effects of cannabinoids on P-glycoprotein transport and expression in multidrug resistant cells. Biochem.Pharmacol 4-14-2006;71(8):1146-115 PubMed
  21. Tetrault, J. M., Crothers, K., Moore, B. A., Mehra, R., Concato, J., and Fiellin, D. A. Effects of marijuana smoking on pulmonary function and respiratory complications: a systematic review. Arch.Intern.Med. 2-12-2007;167(3):221-228. PubMed
  22. Moore, T. H., Zammit, S., Lingford-Hughes, A., Barnes, T. R., Jones, P. B., Burke, M., and Lewis, G. Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review. Lancet 7-28-2007;370(9584):319-328. PubMed
  23. Aldington, S., Williams, M., Nowitz, M., Weatherall, M., Pritchard, A., McNaughton, A., Robinson, G., and Beasley, R. Effects of cannabis on pulmonary structure, function and symptoms. Thorax 2007;62(12):1058-1063. PubMed
  24. Ben Amar, M. and Potvin, S. Cannabis and psychosis: what is the link? J Psychoactive Drugs 2007;39(2):131-142. PubMed
  25. Vidal, C., Fuente, R., Iglesias, A., and Saez, A. Bronchial asthma due to Cannabis sativa seed. Allergy 1991;46(8):647-649.
  26. Beshay, M., Kaiser, H., Niedhart, D., Reymond, M. A., and Schmid, R. A. Emphysema and secondary pneumothorax in young adults smoking cannabis. Eur.J Cardiothorac.Surg. 2007;32(6):834-838. PubMed
  27. Rog, D. J., Nurmikko, T. J., and Young, C. A. Oromucosal delta9-tetrahydrocannabinol/cannabidiol for neuropathic pain associated with multiple sclerosis: an uncontrolled, open-label, 2-year extension trial. Clin Ther. 2007;29(9):2068-2079.
  28. Aldington, S., Harwood, M., Cox, B., Weatherall, M., Beckert, L., Hansell, A., Pritchard, A., Robinson, G., and Beasley, R. Cannabis use and risk of lung cancer: a case-control study. Eur.Respir.J 2008;31(2):280-286. PubMed
  29. Noel, B., Ruf, I., and Panizzon, R. G. Cannabis arteritis. J Am.Acad.Dermatol. 2008;58(5 Suppl 1):S65-S67.
  30. Cappelli, F., Lazzeri, C., Gensini, G. F., and Valente, S. Cannabis: a trigger for acute myocardial infarction? A case report. J Cardiovasc.Med.(Hagerstown.) 2008;9(7):725-728. PubMed
  31. Indlekofer, F., Piechatzek, M., Daamen, M., Glasmacher, C., Lieb, R., Pfister, H., Tucha, O., Lange, K. W., Wittchen, H. U., and Schutz, C. G. Reduced memory and attention performance in a population-based sample of young adults with a moderate lifetime
  32. Mushtaq, F., Mondelli, V., and Pariante, C. M. The metabolic implications of long term cannabis use in patients with psychosis. Epidemiol.Psichiatr.Soc. 2008;17(3):221-226. PubMed
  33. Zammit, S., Moore, T. H., Lingford-Hughes, A., Barnes, T. R., Jones, P. B., Burke, M., and Lewis, G. Effects of cannabis use on outcomes of psychotic disorders: systematic review. Br.J Psychiatry 2008;193(5):357-363. PubMed
  34. Tucker, P. Substance misuse and early psychosis. Australas.Psychiatry 2009;17(4):291-294. PubMed
  35. Reece, A. S. Chronic toxicology of cannabis. Clin Toxicol.(Phila) 2009;47(6):517-524. PubMed
  36. Grotenhermen, F. Cannabis-associated arteritis. Vasa 2010;39(1):43-53. PubMed
  37. McGrath, J., Welham, J., Scott, J., Varghese, D., Degenhardt, L., Hayatbakhsh, M. R., Alati, R., Williams, G. M., Bor, W., and Najman, J. M. Association between cannabis use and psychosis-related outcomes using sibling pair analysis in a cohort of young
  38. Genetic Risk and Outcome in Psychosis (GROUP) Investigators. Evidence that familial liability for psychosis is expressed as differential sensitivity to cannabis: an analysis of patient-sibling and sibling-control pairs. Arch.Gen.Psychiatry 2011;68(2):138 PubMed
  39. Le Guen, P. Y., Gestin, S., Plat, E., Quehe, P., and Bressollette, L. [Renal and spleen infarction after massive consumption of cannabis and cocaine in a young man]. J.Mal Vasc. 2011;36(1):41-44.
  40. Large, M., Sharma, S., Compton, M. T., Slade, T., and Nielssen, O. Cannabis use and earlier onset of psychosis: a systematic meta-analysis. Arch.Gen.Psychiatry 2011;68(6):555-561. PubMed
  41. Lynch, M. E. and Campbell, F. Cannabinoids for treatment of chronic non-cancer pain; a systematic review of randomized trials. Br.J.Clin.Pharmacol. 2011;72(5):735-744. PubMed
  42. Li, M. C., Brady, J. E., DiMaggio, C. J., Lusardi, A. R., Tzong, K. Y., and Li, G. Marijuana use and motor vehicle crashes. Epidemiol.Rev. 2012;34(1):65-72. PubMed
  43. Richards, B. L., Whittle, S. L., and Buchbinder, R. Neuromodulators for pain management in rheumatoid arthritis. Cochrane.Database.Syst.Rev. 2012;1:CD008921. PubMed
  44. Asbridge, M., Hayden, J. A., and Cartwright, J. L. Acute cannabis consumption and motor vehicle collision risk: systematic review of observational studies and meta-analysis. BMJ 2012;344:e536. PubMed
  45. Fajardo, L. L. Association of spontaneous pneumomediastinum with substance abuse. West J Med 1990;152(3):301-304.
  46. Formukong, E. A., Evans, A. T., and Evans, F. J. The inhibitory effects of cannabinoids, the active constituents of Cannabis sativa L. on human and rabbit platelet aggregation. J.Pharm.Pharmacol. 1989;41(10):705-709.
  47. Hollister, L. E. Interactions of cannabis with other drugs in man. NIDA Res.Monogr 1986;68:110-116. DOI
  48. Harvey DJ. Absorption, distribution, and biotransformation of the cannabinoids. Marijuana and Medicine. 1999;91-103. DOI
  49. Bornheim LM, Everhart ET, Li J, Correia MA. Characterization of cannabidiol-mediated cytochrome P450 inactivation. Biochem Pharmacol 1993;45(6):1323-31. PubMed
  50. Mittleman MA, Lewis RA, Maclure M, Sherwood JB, Muller JE. Triggering myocardial infarction by marijuana. Circulation. 2001;103(23):2805-9. PubMed
  51. Combemale P, Consort T, Denis-Thelis L, et al. Cannabis arteritis. Br J Dermatol. 2005;152(1):166-9.
  52. Gibbs M, Winsper C, Marwaha S, et al. Cannabis use and mania symptoms: a systematic review and meta-analysis. J Affect Disord. 2015;171:39-47. PubMed
  53. Hackam DG. Cannabis and stroke: systematic appraisal of case reports. Stroke. 2015;46(3):852-6.
  54. Hancock-Allen JB, Barker L, VanDyke M, Holmes DB. Notes from the Field: Death Following Ingestion of an Edible Marijuana Product--Colorado, March 2014. MMWR Morb Mortal Wkly Rep. 2015;64(28):771-2. PubMed
  55. Ince B, Benbir G, Yuksel O, et al. Both hemorrhagic and ischemic stroke following high doses of cannabis consumption. Presse Med. 2015;44(1):106-7. PubMed
  56. Lev-Ran S, Roerecke M, Le Foll B, et al. The association between cannabis use and depression: a systematic review and meta-analysis of longitudinal studies. Psychol Med. 2014;44(4):797-810. PubMed
  57. Ozyurt S, Muderrisoglu F, Ermete M, Afsar F. Cannabis-induced erythema multiforme-like recurrent drug eruption. Int J Dermatol. 2014;53(1):e22-3. PubMed
  58. Jouanjus E, Lapeyre-Mestre M, Micallef J; French Association of the Regional Abuse and Dependence Monitoring Centres (CEIP-A) Working Group on Cannabis Complications. Cannabis use: signal of increasing risk of serious cardiovascular disorders. J Am Heart PubMed
  59. Westover AN, McBride S, Haley RW. Stroke in young adults who abuse amphetamines or cocaine: a population-based study of hospitalized patients. Arch Gen Psychiatry. 2007 Apr;64(4):495-502. PubMed
  60. Barber PA, Pridmore HM, Krishnamurthy V, et al. Cannabis, ischemic stroke, and transient ischemic attack: a case-control study. Stroke. 2013 Aug;44(8):2327-9. PubMed
  61. Clark SC, Greene C, Karr GW, MacCannell KL, Milstein SL. Cardiovascular effects of marihuana in man. Can J Physiol Pharmacol. 1974 Jun;52(3):706-19. PubMed
  62. Beaconsfield P, Ginsburg J, Rainsbury R. Marihuana smoking. Cardiovascular effects in man and possible mechanisms. N Engl J Med. 1972 Aug 3;287(5):209-12.
  63. Clark SC. Marihuana and the cardiovascular system. Pharmacol Biochem Behavior. 1975;3(2):299-306. PubMed
  64. Sidney S. Cardiovascular Consequences of Marijuana Use. J Clin Pharmacol. 2002;42(11 Suppl):64S-70S. PubMed
  65. Greenberg I, Kuehnle J, Mendelson JH, Bernstein JG. Effects of Marihuana use on body weight and caloric intake in humans. Psychopharmacol. 1976;49:79-84. PubMed
  66. Sansone RA, Sansone LA. Marijuana and body weight. Innov Clin Neurosci. 2014;11(7-8):50-4.
  67. Reece AS. Severe multisystem dysfunction in a case of high level exposure to smoked cannabis. BMJ Case Rep. 2009;2009. pii: bcr08.2008.0798. PubMed
  68. Huson HB, Granados TM, Rasko Y. Surgical considerations of marijuana use in elective procedures. Heliyon. 2018;4(9):e00779. PubMed
  69. Goyal H, Awad HH, Ghali JK. Role of cannabis in cardiovascular disorders. J Thorac Dis. 2017;9(7):2079-2092. PubMed
  70. Wilsey B, Marcotte TD, Deutsch R, Zhao H, Prasad H, Phan A. An exploratory human laboratory experiment evaluating vaporized cannabis in the treatment of neuropathic pain from spinal cord injury and disease. J Pain. 2016;17(9):982-1000. PubMed
  71. Gunn JK, Rosales CB, Center KE, et al. Prenatal exposure to cannabis and maternal and child health outcomes: a systematic review and meta-analysis. BMJ Open. 2016;6(4):e009986. PubMed
  72. Marconi A, Di Forti M, Lewis CM, Murray RM, Vassos E. Meta-analysis of the association between the level of cannabis use and risk of psychosis. Schizophr Bull. 2016;42(5):1262-9. PubMed
  73. Schoeler T, Monk A, Sami MB, et al. Continued versus discontinued cannabis use in patients with psychosis: a systematic review and meta-analysis. Lancet Psychiatry. 2016;3(3):215-25. PubMed
  74. Whiting PF, Wolff RF, Deshpande S, et al. Cannabinoids for medical use: A systematic review and meta-analysis. JAMA. 2015;313(24):2456-73. PubMed
  75. Kedzior KK, Laeber LT. A positive association between anxiety disorders and cannabis use or cannabis use disorders in the general population--a meta-analysis of 31 studies. BMC Psychiatry. 2014;14:136. PubMed
  76. Ocampo TL, Rans TS. Cannabis sativa: the unconventional "weed" allergen. Ann Allergy Asthma Immunol. 2015;114(3):187-92. PubMed
  77. Shere A, Goyal H. Cannabis can augment thrombolytic properties of rtPA: Intracranial hemorrhage in a heavy cannabis user. Am J Emerg Med. 2017;35(12):1988.e1-1988.e2. PubMed
  78. Atchaneeyasakul K, Torres LF, Malik AM. Large amount of cannabis ingestion resulting in spontaneous intracerebral hemorrhage: A case report. J Stroke Cerebrovasc Dis. 2017;26(7):e138-e139. PubMed
  79. Lotan I, Treves TA, Roditi Y, Djaldetti R. Cannabis (medical marijuana) treatment for motor and non-motor symptoms of Parkinson disease: an open-label observational study. Clin Neuropharmacol. 2014;37(2):41-4. PubMed
  80. Duran M, Pérez E, Abanades S, et al. Preliminary efficacy and safety of an oromucosal standardized cannabis extract in chemotherapy-induced nausea and vomiting. Br J Clin Pharmacol. 2010;70(5):656-63. PubMed
  81. Gaston TE, Bebin EM, Cutter GR, Liu Y, Szaflarski JP; UAB CBD Program. Interactions between cannabidiol and commonly used antiepileptic drugs. Epilepsia. 2017 Sep;58(9):1586-92. PubMed
  82. Devinsky O, Marsh E, Friedman D, et la. Cannabidiol in patients with treatment-resistant epilepsy: an open-label interventional trial. Lancet Neurol. 2016 Mar;15(3):270-8.
  83. Geffrey AL, Pollack SF, Bruno PL, Thiele EA. Drug-drug interaction between clobazam and cannabidiol in children with refractory epilepsy. Epilepsia. 2015 Aug;56(8):1246-51. PubMed
  84. Akturk HK, Taylor DD, Camsari UM, Rewers A, Kinney GL, Shah VN. Association Between Cannabis Use and Risk for Diabetic Ketoacidosis in Adults With Type 1 Diabetes. JAMA Intern Med. 2018. PubMed
  85. Bahorik AL, Sterling SA, Campbell CI, Weisner C, Ramo D, Satre DD. Medical and non-medical marijuana use in depression: Longitudinal associations with suicidal ideation, everyday functioning, and psychiatry service utilization. J Affect Disord. 2018;241:8 PubMed
  86. Bonnet U, Preuss UW. The cannabis withdrawal syndrome: current insights. Subst Abuse Rehabil. 2017;8:9-37. PubMed
  87. Cadman PE. Hypophosphatemia in Users of Cannabis. Am J Kidney Dis. 2017;69(1):152-155. PubMed
  88. Damkier P, Lassen D, Christensen MMH, Madsen KG, Hellfritzsch M, Pottegård A. Interaction between warfarin and cannabis. Basic Clin Pharmacol Toxicol. 2019;124(1):28-31. PubMed
  89. Fogang YF, Camara M, Mbonda PC, Toffa D, Touré K. Late onset epilepsy associated with marijuana abuse: a case report with MRI findings. Pan Afr Med J. 2014;17:158. PubMed
  90. Ghasemiesfe M, Ravi D, Vali M, et al. Marijuana Use, Respiratory Symptoms, and Pulmonary Function: A Systematic Review and Meta-analysis. Ann Intern Med. 2018;169(2):106-115. PubMed
  91. Howaizi M, Chahine M, Haydar F, Jemaa Y, Lapoile E. Cannabis-induced recurrent acute pancreatitis. Acta Gastroenterol Belg. 2012;75(4):446-7.
  92. Lawn W, Freeman TP, Pope RA, et al. Acute and chronic effects of cannabinoids on effort-related decision-making and reward learning: an evaluation of the cannabis 'amotivational' hypotheses. Psychopharmacology (Berl). 2016;233(19-20):3537-52. PubMed
  93. Matta A, Tandra PK, Berim L. Priapism in a patient with sickle cell trait using marijuana. BMJ Case Rep. 2014;2014. PubMed
  94. Nourbakhsh M, Miller A, Gofton J, Jones G, Adeagbo B. Cannabinoid Hyperemesis Syndrome: Reports of Fatal Cases. J Forensic Sci. 2019;64(1):270-274. PubMed
  95. Toce MS, Farias M, Powell AJ, Daly KP, Vargas SO, Burns MM. Myocardial Infarct After Marijuana Inhalation in a 16-year-old Adolescent Boy. Pediatr Dev Pathol. 2019;22(1):80-86. PubMed
  96. Zhang LR, Morgenstern H, Greenland S, et al. Cannabis smoking and lung cancer risk: Pooled analysis in the International Lung Cancer Consortium. Int J Cancer. 2015;136(4):894-903.
  97. Product information for Marinol. AbbVie. North Chicago, IL 60064. August 2017. Available at: https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/018651s029lbl.pdf.
  98. Hogendorf AM, Fendler W, Sieroslawski J, et al. Breaking the Taboo: Illicit Drug Use among Adolescents with Type 1 Diabetes Mellitus. J Diabetes Res. 2016;2016:4153278. Epub 2015 Dec 29. PubMed
  99. Lee P, Greenfield JR, Gilbert K, Campbell LV. Recreational drug use in type 1 diabetes: an invisible accomplice to poor glycaemic control? Intern Med J. 2012 Feb;42(2):198-202. PubMed
  100. Winhusen T, Theobald J, Kaelber D, Tlimat A, Lewis D. Using big data to evaluate the association between substance use disorders (SUDS) and T2DM-complications. Journal of General Internal Medicine. 2018;33(2):S382. Abstract Only.
  101. Thurheimer-Cacciotti JL, Sereika SM, Schmitt P, et al. The effect of risk-taking behaviors on hemoglobin A1c in women with type 1 diabetes. Diabetes. 2017;66:A226. Abstract Only.
  102. van de Donk T, Niesters M, Kowal MA, Olofsen E, Dahan A, van Velzen M. An experimental randomized study on the analgesic effects of pharmaceutical-grade cannabis in chronic pain patients with fibromyalgia. Pain. 2019 Apr;160(4):860-869. PubMed
  103. Chocron Y, Zuber JP, Vaucher J. Cannabinoid hyperemesis syndrome. BMJ. 2019 Jul 19;366:l4336. PubMed
  104. Kheifets M, Karniel E, Landa D, Vons SA, Meridor K, Charach G. Resolution of Cannabinoid Hyperemesis Syndrome with Benzodiazepines: A Case Series. Isr Med Assoc J. 2019 Jun;21(6):404-407.
  105. Corsi DJ, Walsh L, Weiss D, et al. Association Between Self-reported Prenatal Cannabis Use and Maternal, Perinatal, and Neonatal Outcomes. JAMA. 2019 Jul 9;322(2):145-152. PubMed
  106. Di Forti M, Quattrone D, Freeman TP, et al. The contribution of cannabis use to variation in the incidence of psychotic disorder across Europe (EU-GEI): a multicentre case-control study. Lancet Psychiatry. 2019 May;6(5):427-436.
  107. Ogeil RP, Cheetham A, Mooney A, et al. Early adolescent drinking and cannabis use predicts later sleep-quality problems. Psychol Addict Behav. 2019 May;33(3):266-273. PubMed
  108. Ghasemiesfe M, Barrow B, Leonard S, Keyhani S, Korenstein D. Association between marijuana use and risk of cancer: a systematic review and meta-analysis. JAMA Netw Open. 2019 Nov 1;2(11):e1916318. PubMed
  109. Rodriguez CE, Sheeder J, Allshouse AA, et al. Marijuana use in young mothers and adverse pregnancy outcomes: a retrospective cohort study. BJOG. 2019 Nov;126(12):1491-1497. PubMed
  110. Smid MC. Marijuana use among young pregnant women: more common and more harmful than we think. BJOG. 2019 Nov;126(12):1498. PubMed
  111. Brar BK, Patil PS, Jackson DN, Gardner MO, Alexander JM, Doyle NM. Effect of intrauterine marijuana exposure on fetal growth patterns and placental vascular resistance. J Matern Fetal Neonatal Med. 2019 Nov 11:1-5. PubMed
  112. Adejumo AC, Flanagan R, Kuo B, Staller K. Relationship Between Recreational Marijuana Use and Bowel Function in a Nationwide Cohort Study. Am J Gastroenterol. 2019 Nov 22. PubMed
  113. Qian ZJ, Alyono JC. An association between marijuana use and tinnitus. Am J Otolaryngol. 2020 Jan - Feb;41(1):102314. PubMed
  114. Lovell ME, Akhurst J, Padgett C, Garry MI, Matthews A. Cognitive outcomes associated with long-term, regular, recreational cannabis use in adults: A meta-analysis. Exp Clin Psychopharmacol. 2019 Oct 31. PubMed
  115. Alshaarawy O, Anthony JC. Are cannabis users less likely to gain weight? Results from a national 3-year prospective study. Int J Epidemiol. 2019 Oct 1;48(5):1695-1700. PubMed
  116. Budney AJ, Roffman R, Stephens R, Walker D. Marijuana dependence and its treatment. Addict Sci Clin Pract. 2007;4(1):4-16. PubMed
  117. Zehra A, Burns J, Liu CK, et al. Cannabis Addiction and the Brain: a Review. J Neuroimmune Pharmacol. 2018;13(4):438-52. PubMed
  118. Bahji A, Stephenson C, Tyo R, Hawken ER, Seitz DP. Prevalence of Cannabis Withdrawal Symptoms Among People With Regular or Dependent Use of Cannabinoids: A Systematic Review and Meta-analysis. JAMA Netw Open. 2020;3(4):e202370. PubMed
  119. Madden K, Tanco K, Bruera E. Clinically Significant Drug-Drug Interaction Between Methadone and Cannabidiol. Pediatrics. 2020;e20193256. PubMed
  120. Baltz JW, Le LT. Serotonin Syndrome versus Cannabis Toxicity in the Emergency Department. Clin Pract Cases Emerg Med. 2020;4(2):171-173. PubMed
  121. Bucchino L, Monzani A, Fracon S, Genoni G, Cena T, Bellone S. Cannabis-Related Diffuse Alveolar Hemorrhage in a 16-Year-Old Patient: A Case Report. Front Pediatr. 2019;7:468. PubMed
  122. Hindley G, Beck K, Borgan F, et al. Psychiatric symptoms caused by cannabis constituents: a systematic review and meta-analysis. Lancet Psychiatry. 2020;7(4):344-353. PubMed
  123. Santaella-Tenorio J, Wheeler-Martin K, DiMaggio CJ, et al. Association of Recreational Cannabis Laws in Colorado and Washington State With Changes in Traffic Fatalities, 2005-2017. JAMA Intern Med. 2020. PubMed
  124. Kloft L, Otgaar H, Blokland A, Garbaciak A, Monds LA, Ramaekers JG. False memory formation in cannabis users: a field study. Psychopharmacology (Berl). 2019;236(12):3439-3450. PubMed
  125. Rosekind MR, Ehsani JP, Michael JP. Reducing Impaired Driving Fatalities: Data Need to Drive Testing, Enforcement, and Policy. JAMA Intern Med. 2020. PubMed
  126. Parekh T, Pemmasani S, Desai R. Marijuana Use Among Young Adults (18-44 Years of Age) and Risk of Stroke: A Behavioral Risk Factor Surveillance System Survey Analysis. Stroke. 2020;51(1):308-310. PubMed
  127. Ramphul K, Joynauth J. Cardiac Arrhythmias Among Teenagers Using Cannabis in the United States. Am J Cardiol. 2019;124(12):1966. PubMed
  128. Kamer RS, Warshafsky S, Kamer GC. Change in Traffic Fatality Rates in the First 4 States to Legalize Recreational Marijuana. JAMA Intern Med. 2020. PubMed
  129. Zaidi SR, Khan ZH, Mukhtar K, Ahmed MM, Syed SH. A Case of Intussusception in a Patient with Marijuana Use: Coincidence or Possible Correlation? Cureus. 2020;12(3):e7493. PubMed
  130. Paul SP, Hatoum AS, Fine JD, et al. Associations between prenatal cannabis exposure and childhood outcomes: results from the ABCD Study. JAMA Psychiatry. 2020;e202902. PubMed
  131. Ammerman SD, Ryan SA, Adelman WP, et al. The impact of marijuana policies on youth: clinical, research, and legal update. Pediatrics. 2015;135(3):584-7. DOI
  132. Emoto J, Weeks K, Kallail KJ. Accidental Acute Cannabis Intoxication Presenting as Seizure in Pediatrics Patients. Kans J Med. 2020;13: 129-130. DOI
  133. Hines LA, Freeman TP, Gage SH, et al. Association of High-Potency Cannabis Use With Mental Health and Substance Use in Adolescence. JAMA Psychiatry. 2020;77(10):1044-1051. PubMed
  134. Monte AA, K Shelton SK, Mills E., Acute Illness Associated With Cannabis Use, by Route of Exposure: An Observational Study. Ann Intern Med. 2019 Apr 16;170(8):531-537. PubMed
  135. San Luis CV, Nobleza COS, Shekhar S, et al. Association between recent cannabinoid use and acute ischemic stroke. Neurol Clin Pract. 2020;10(4):333-339. PubMed
  136. Arkell TR, Vinckenbosch F, Kevin RC, Theunissen EL, McGregor IS, Ramaekers JG. Effect of Cannabidiol and ?9-Tetrahydrocannabinol on Driving Performance: A Randomized Clinical Trial. JAMA. 2020;324(21):2177-2186.
  137. Brown GW, Bellnier TJ, Janda M, Miskowitz K. ?-9-tetrahydrocannabinol dose increase leads to warfarin drug interaction and elevated INR. J Am Pharm Assoc (2003). 2021;61(1):e57-e60. PubMed
  138. Cole TB, Saitz R. Cannabis and Impaired Driving. JAMA. 2020;324(21):2163-2164. PubMed
  139. Corsi DJ, Donelle J, Sucha E, et al. Maternal cannabis use in pregnancy and child neurodevelopmental outcomes. Nat Med. 2020;26(10):1536-1540. PubMed
  140. Dellazizzo L, Potvin S, Dou BY, et al. Association Between the Use of Cannabis and Physical Violence in Youths: A Meta-Analytical Investigation. Am J Psychiatry. 2020;177(7):619-626. PubMed
  141. Faustino ISP, González-Arriagada WA, Cordero-Torres K, Lopes MA. Candidiasis of the tongue in cannabis users: a report of 2 cases. Gen Dent. 2020;68(5):66-68.
  142. Gorfinkel LR, Stohl M, Hasin D. Association of Depression With Past-Month Cannabis Use Among US Adults Aged 20 to 59 Years, 2005 to 2016. JAMA Netw Open. 2020;3(8):e2013802. PubMed
  143. Grzeskowiak LE, Grieger JA, Andraweera P, et al. The deleterious effects of cannabis during pregnancy on neonatal outcomes. Med J Aust. 2020;212(11):519-524. PubMed
  144. Lawin D, Lawrenz T, Tego A, Stellbrink C. Cannabis-induced recurrent myocardial infarction in a 21-year-old man: a case report. Eur Heart J Case Rep. 2020;4(3):1-5. PubMed
  145. Lewis B, Fleeger T, Judge B, Riley B, Jones JS. Acute toxicity associated with cannabis edibles following decriminalization of marijuana in Michigan. Am J Emerg Med. 2020:S0735-6757(20)30872-X. PubMed
  146. Manning T, Bartow C, McNaughton M, Reynolds E, Chen Z. Vaping Cannabis Oil: A Case of Catatonia Associated With Use of High-Potency Cannabis. Psychosomatics. 2020;61(6):745-751. PubMed
  147. Mekala H, Malik Z, Lone J, Shah K, Ishaq M. Cannabis-Induced Catatonia: A Case Series. Cureus. 2020;12(6):e8603. PubMed
  148. Tournier N, Lucie Chevillard L, Megarbane B, et al. Interaction of drugs of abuse and maintenance treatments with human P-glycoprotein (ABCB1) and breast cancer resistance protein (ABCG2). Int J Neuropsychopharmacol. 2010;13(7):905-15. PubMed
  149. Arnold JC, Hone P, Holland ML, Allen JD. CB2 and TRPV1 receptors mediate cannabinoid actions on MDR1 expression in multidrug resistant cells. Pharmacol Rep. 2012;64(3):751-7. PubMed
  150. Wymore EM, Palmer C, Wang GS, et al. Persistence of ?-9-Tetrahydrocannabinol in Human Breast Milk JAMA Pediatr. 2021. doi: 10.1001/jamapediatrics.2020.6098. PubMed
  151. Anderson LL, Doohan PT, Oldfield L, et al. Citalopram and Cannabidiol: In Vitro and In Vivo Evidence of Pharmacokinetic Interactions Relevant to the Treatment of Anxiety Disorders in Young People. J Clin Psychopharmacol. 2021. PubMed
  152. Nasrin S, Watson CJW, Perez-Paramo YX, Lazarus P. Cannabinoid Metabolites as Inhibitors of Major Hepatic CYP450 Enzymes, with Implications for Cannabis-Drug Interactions. Drug Metab Dispos 2021;49(12):1070-1080. PubMed
  153. Noori A, Miroshnychenko A, Shergill Y, et al. Opioid-sparing effects of medical cannabis or cannabinoids for chronic pain: a systematic review and meta-analysis of randomised and observational studies. BMJ Open 2021;11(7):e047717. PubMed
  154. Puri C, Rhee K, Harish VK, Slack D. Marijuana induced spontaneous pneumomediastinum. J Community Hosp Intern Med Perspect 2021;11(4):516-517. PubMed
  155. Rao SJ, Kirse DJ, Shetty AK. Cannabis induced thermal epiglottitis in a pediatric patient. Am J Emerg Med 2021;49:114-116. PubMed
  156. Sheikh B, Hirachan T, Gandhi K, Desai S, Arif R, Isakov O. Cannabis-Induced Malignant Catatonia: A Medical Emergency and Review of Prior Case Series. Cureus 2021;13(8):e17490. PubMed
  157. Malviya A, Khan SA, Gupta A, Mishra A. Chronic Marijuana Consumption Leading to High-Grade Atrioventricular Block in a Young Male. Cureus 2021;13(7):e16202. PubMed
  158. Sly M, Clark K, Karaghossian G, Narang VK, Gill M, Ragland AS. Cannabis-Induced Pancreatitis in a Young Adult Male. J Investig Med High Impact Case Rep 2021;9:23247096211035238. PubMed
  159. Kiburi SK, Molebatsi K, Ntlantsana V, Lynskey MT. Cannabis use in adolescence and risk of psychosis: Are there factors that moderate this relationship? A systematic review and meta-analysis. Subst Abus 2021;42(4):527-542. PubMed
  160. Kasuda S, Kondo T, Terazawa I, Morimoto M, Yuui K, Kudo R. Cardiac sudden death in a young cannabis user. Leg Med (Tokyo) 2021;53:101955. PubMed
  161. Singh BO, Panda PK, Walia R. Recreational cannabis use causing non-ischaemic cardiomyopathy and cardioembolism in a young adult. BMJ Case Rep 2021;14(6):e243193. PubMed
  162. Matta A, Elenizi K, Elbaz M, Roncalli J. Left main coronary artery thrombus after cannabis consumption: a case report. Eur Heart J Case Rep 2021;5(6):ytab179. PubMed
  163. Onorato A, Shapiro J, Griffin L, Aldulescu M, Arva NC, Shah A. Chronic cough and weight loss in an adolescent marijuana smoker. SAGE Open Med Case Rep 2022;10:2050313X221085779. PubMed
  164. Farouji I, Chan KH, Battah A, et al. A rare case of marijuana associated with ascending aorta thrombosis complicated with stroke and bilateral renal infarcts. Radiol Case Rep 2021;17(1):119-123. PubMed
  165. Banana Y, Bashir H, Boukabous S, Rezziki A, Benzirar A, El Mahi O. Cannabis arteritis: A case report and brief review of the literature. Ann Med Surg (Lond) 2022;76:103523. PubMed
  166. Busse JW, Vankrunkelsven P, Zeng L, et al. Medical cannabis or cannabinoids for chronic pain: a clinical practice guideline. BMJ 2021;374:n2040. PubMed
  167. Marchand G, Masoud AT, Govindan M, et al. Birth Outcomes of Neonates Exposed to Marijuana in Utero: A Systematic Review and Meta-analysis. JAMA Netw Open 2022;5(1):e2145653. PubMed
  168. Ramos B, Santos Martins AF, Lima Osório ES. Psychotic cannabis withdrawal: A clinical case. Cureus 2022;14(11):e31465. PubMed
  169. Robinson T, Ali MU, Easterbrook B, et al. Identifying risk-thresholds for the association between frequency of cannabis use and development of cannabis use disorder: A systematic review and meta-analysis. Drug Alcohol Depend 2022;238:109582. PubMed
  170. Fresán A, Dionisio-García DM, González-Castro TB, et al. Cannabis smoking increases the risk of suicide ideation and suicide attempt in young individuals of 11-21 years: A systematic review and meta-analysis. J Psychiatr Res 2022;153:90-98. PubMed
  171. Maharaj N, Swarath S, Seecheran R, Seecheran V, Seecheran NA. Suspected cannabis vaping-induced pericardial effusion. J Investig Med High Impact Case Rep 2022;10:23247096221140251. PubMed
  172. Alirezaei T, Mohammadi MKA, Irilouzadian R, Zarinparsa H. Marijuana-induced myocarditis in a 24-year-old man. Arch Clin Cases 2022;9(2):69-74. PubMed
  173. Kothadia JP, Dash A, Verma R, Kreitman K, Snell PD, Ismail MK. Adult intussusception in chronic marijuana users. Gastroenterology Res 2022;15(5):278-283. PubMed
  174. Abosheaishaa H, Nassar M, Haseeb Ul Rasool M, Makhoul K, Abdelwahed M. Marijuana-induced acute hepatitis: A case report. Cureus 2022;14(10):e30273. PubMed
  175. Jain A, Ashiq A, Ahmed R, Rane RP, Hussain KM. A case of pneumothorax secondary to marijuana use disorder. Cureus 2022;14(7):e26634. PubMed
  176. Prota C, Ravera A, Caleo O, Campanile A. Marijuana-induced toxic myocarditis: a case report and a review of the literature. J Cardiovasc Med (Hagerstown) 2022;23(12):814-818. PubMed
  177. Idris I, Diez JR, Assoku BA, Beker S. Accidental ingestion of tetrahydrocannabinol-laced gummies causing bradycardia and first-degree atrioventricular block in a pediatric patient: A case report. Cureus 2022;14(7):e26826. PubMed
  178. Simonsen SK, Rittig NF, Poulsen PL, Svart MV. Hypokalemic paresis in a 26-year-old man after recreational cannabis use. Am J Case Rep 2022;23:e936008. PubMed
  179. Chabot C, Gouat F. Rare finding of acute eosinophilic pneumonia associated with heavy cannabis use: A case-report. Radiol Case Rep 2022;17(9):3040-3042. PubMed
  180. Gayá García-Manso I, Martínez García MÁ, Pérez Pérez JL. Acute eosinophilic pneumonia associated with marijuana smoking for chronic pain management. Med Clin (Barc) 2022;159(6):e41-e42. DOI
  181. Englund A, Oliver D, Chesney E, et al. Does cannabidiol make cannabis safer? A randomised, double-blind, cross-over trial of cannabis with four different CBD:THC ratios. Neuropsychopharmacology 2022. PubMed
  182. Hutten NRPW, Arkell TR, Vinckenbosch F, et al. Cannabis containing equivalent concentrations of delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) induces less state anxiety than THC-dominant cannabis. Psychopharmacology (Berl) 2022;239(11):3731-374 PubMed
  183. Bell AD, MacCallum C, Margolese S, et al. Clinical Practice Guidelines for cannabis and cannabinoid-based medicines in the management of chronic pain and co-occurring conditions. Cannabis Cannabinoid Res. 2023. PubMed
  184. Graves JM, Dilley JA, Klein T, Liebelt E. Suspected suicidal cannabis exposures reported to US Poison Centers, 2009-2021. JAMA Netw Open. 2023;6(4):e239044. PubMed
  185. Moussa MK, Hall MAK, Akwe J. Cannabis-induced acute encephalopathy in a 94-year-old woman due to family administration of cannabidiol (CBD) products: A case report. Cureus 2023;15(4):e37927.
  186. Le Q, Dangol G, Bhandari A. A rare case of diffuse alveolar hemorrhage caused by fentanyl-laced marijuana. Cureus 2023;15(5):e38523. PubMed
  187. Mankgele M, Hlawe D, Tsabedze N. Cannabis-associated myocardial infarction with non-obstructive coronary arteries in a young patient with underlying myocardial bridge. Am J Case Rep 2023;24:e938175. PubMed
  188. Khan MA, Khan FH, Khan HB, Brabham D. Marijuana as a cause of diffuse coronary vasospasm leading to cardiac arrest. Cureus 2023;15(4):e38026. PubMed
  189. Alisauskiene R, Johnsen E, Gjestad R, et al. Does drug use affect the efficacy of amisulpride, aripiprazole and olanzapine in patients with schizophrenia spectrum disorders? Results from a pragmatic, randomised study. Gen Hosp Psychiatry 2023;83:185-193. PubMed
  190. Nana Sede Mbakop R, Kesiena O, Greene TE, Amakye D. Cannabinoid hyperemesis syndrome in a 23-year-old woman with uncontrolled type 1 diabetes mellitus. Am J Case Rep 2023;24:e938418. PubMed
  191. Johnson GA, Guerra L, Oxner A. A case of panic attacks developing after 10 years of chronic cannabis use in a patient with no prior psychiatric history. Cureus 2023;15(1):e34197. PubMed
  192. Li J, Miller M, Abu Khalaf S, Nelson TB. Weeding out the culprit: Cannabinoid-associated Stevens-Johnson Syndrome. Cureus 2023;15(5):e39454. PubMed
  193. Osagie E, Mirza O. Recurrent severe burns due to cannabinoid hyperemesis syndrome. Cureus 2023;15(2):e34552. PubMed
  194. Ploucher S, Koilpillai S, Iyyani M, Carlan S. A case of near-fatal bradycardia caused by accidental cannabis intoxication. Cureus 2023;15(4):e37430. PubMed
  195. Gauthier T, Prakash PB, Keopple D, Vardis R. Cannabis-induced catatonia in a 15-year-old male: A case report. WMJ 2023;122(2):131-133.
  196. Pilitsi E, Kennamer B, Trepanowski N, et al. Cannabis arteritis presenting with Raynaud's and digital ulcerations: a case-based review of a controversial thromboangiitis obliterans-like condition. Clin Rheumatol 2023;42(7):1981-1985. PubMed
  197. Luke ND, Vefali B, Chow P, Miller R. Acute recreational cannabis-induced hypersensitivity pneumonitis: A case report. Cureus 2023;15(4):e37312. PubMed
  198. Rahman A, Alqaisi S. Myopericarditis associated with marijuana intake: A case report and literature review. Cureus 2023;15(5):e39413. PubMed
  199. Patel M, Sathiya Narayanan R, Peela AS. A case of a patient with cannabis hyperemesis syndrome along with recurrent nephrolithiasis. Cureus 2023;15(4):e37182. PubMed
  200. Zamarripa CA, Spindle TR, Surujunarain R, et al. Assessment of orally administered ?9-tetrahydrocannabinol when coadministered with cannabidiol on ?9-tetrahydrocannabinol pharmacokinetics and pharmacodynamics in healthy adults: A randomized clinical trial PubMed
  201. Phan AT, Hu J, Ghantarchyan HH, Nguyen VP, Hasan M. Marijuana-induced lung injury: A case report and a review of the literature. Cureus 2023;15(2):e34635. PubMed
  202. van Dam CJ, van der Schrier R, van Velzen M, et al. Inhaled Delta(9)-tetrahydrocannabinol does not enhance oxycodone-induced respiratory depression: randomised controlled trial in healthy volunteers. Br J Anaesth 2023;130(4):485-493.
  203. Hjorthøj C, Compton W, Starzer M, et al. Association between cannabis use disorder and schizophrenia stronger in young males than in females. Psychol Med. 2023;1-7. PubMed
  204. Treyer A, Reinhardt JK, Eigenmann DE, Oufir M, Hamburger M. Phytochemical comparison of medicinal cannabis extracts and study of their CYP-mediated interactions with coumarinic oral anticoagulants. Med Cannabis Cannabinoids. 2023;6(1):21-31. PubMed
  205. Nadeem Z, Wu C, Burke S, Parker S. Serotonin syndrome and cannabis: A case report. Australas Psychiatry. 2024;32(1):100-101. PubMed
  206. Arshad H, Mousa A, Oudah B, Kakhktsyan T, Abu-Abaa M, Kass R. Cannabis-Induced ST-Segment Elevation Myocardial Infarction With Possible Coronary Artery Dissection: A Case Report. Cureus. 2023;15(5):e39594. PubMed
  207. Licciardi M, Utzeri E, Marchetti MF, Nissardi V, Cecchetto G, Montisci M, Montisci R. Syncope and Cannabis: hypervagotonia from chronic abuse? A case report and literature review. BMC Cardiovasc Disord. 2023;23(1):518. PubMed
  208. Oudah B, Al-Ameri N, Mousa A, Arshad H, Abu-Abaa M, Park S. Variant Angina and Cannabis-Induced Myocarditis: A Rare Presentation of Myocardial Inflammation. Cureus. 2023;15(6):e41196. PubMed
  209. Fontane Hoyos CN, Boos J, Goldminz AM. Airborne allergic contact dermatitis to medical marijuana. Contact Dermatitis. 2024;90(1):89-91. PubMed
  210. Alduraibi RK, Altowayan YF, AlMharwal BT. Unexpected cause of recurrent diabetic ketoacidosis in type 1 diabetes: a case report. BMC Endocr Disord. 2023;23(1):137. PubMed
  211. Singh A, Apostolatos A, Iyer A, Bescobedo B, Middlemas M. Cannabis Use: An Uncommon Cause of Hypokalemia-Induced Acute Paralysis. Cureus. 2023;15(8):e44393. PubMed
  212. Moshfeghinia R, Oji B, Hosseinzadeh M, Pourfridoni M, Ahmadi J. Early onset frontotemporal dementia following cannabis abuse: a case report. BMC Psychiatry. 2023;23(1):484. PubMed
  213. Sharma A, Sharma V. A Case of Cannabis-Induced Catatonia and Management With Electroconvulsive Therapy. Cureus. 2023;15(8):e43478. PubMed
  214. Leczycki M, Zaki P, Espiridion ED. Moon Rock Cannabis-Induced Psychosis and New-Onset Seizures in a 20-Year-Old Male. Cureus. 2023;15(7):e42752. PubMed
  215. Ahmad Z, Mukherjee A, Garcia A, Asif H. Spontaneous Pneumomediastinum in Marijuana Users. Cureus. 2023;15(9):e45033. PubMed
  216. Oladunjoye AF, Li E, Aneni K, Onigu-Otite E. Cannabis use disorder, suicide attempts, and self-harm among adolescents: A national inpatient study across the United States. PLoS One. 2023;18(10):e0292922. Erratum in: PLoS One. 2023 Nov 30;18(11):e0294303. PubMed
  217. Chhabra M, Ben-Eltriki M, Paul A, Lê ML, Herbert A, Oberoi S, Bradford N, Bowers A, Rassekh SR, Kelly LE. Cannabinoids for symptom management in children with cancer: A systematic review and meta-analysis. Cancer. 2023 Nov 15;129(22):3656-3670. doi: 10.10 PubMed
  218. Delker E, Hayes S, Kelly AE, Jones KL, Chambers C, Bandoli G. Prenatal Exposure to Cannabis and Risk of Major Structural Birth Defects: A Systematic Review and Meta-analysis. Obstet Gynecol. 2023;142(2):269-283. PubMed
  219. Reis MG, Ferreira AJF, Sohouli MH, Taimeirão DR, Vieira RAL, Guimarães NS. Effect of cannabis and subproducts on anthropometric measures: a systematic review and meta-analysis. Int J Obes (Lond). 2024;48(1):44-54. PubMed
  220. Bansal S, Zamarripa CA, Spindle TR, et al. Evaluation of Cytochrome P450-Mediated Cannabinoid-Drug Interactions in Healthy Adult Participants. Clin Pharmacol Ther 2023.
  221. Jeffers AM, Glantz S, Byers AL, Keyhani S. Association of Cannabis Use With Cardiovascular Outcomes Among US Adults. J Am Heart Assoc. 2024 Mar 5;13(5):e030178. PubMed
  222. Elnagar A, Kgomo M, Mokone M, Yousif B. Cannabinoid hyperemesis syndrome. BMJ Case Rep 2024;17(4):e256921. PubMed
  223. Braun IM, Bohlke K, Abrams DI, et al. Cannabis and Cannabinoids in Adults With Cancer: ASCO Guideline. J Clin Oncol 2024;42(13):1575-1593. PubMed
  224. Mensah DN, Livingston J, Maddukuri V. Cannabis-Associated Pneumothorax: A Case Report. Cureus 2023;15(12):e50825. PubMed
  225. Crichton M, Dissanayaka T, Marx W, et al. Does medicinal cannabis affect depression, anxiety, and stress in people with cancer? A systematic review and meta-analysis of intervention studies. Maturitas 2024;184:107941. PubMed
  226. Tadesse AW, Dachew BA, Ayano G, Betts K, Alati R. Prenatal cannabis use and the risk of attention deficit hyperactivity disorder and autism spectrum disorder in offspring: A systematic review and meta-analysis. J Psychiatr Res 2024;171:142-151. PubMed
  227. Oliveira Gracini CL, Nascimento GG, Vidigal MTC, et al. Suicide ideation and psychotropic recreational drug use by adolescents: a systematic review and meta-analysis. Sao Paulo Med J 2024;142(4):e2022641. PubMed
  228. Tadesse AW, Ayano G, Dachew BA, et al. The association between prenatal cannabis use and congenital birth defects in offspring: A cumulative meta-analysis. Neurotoxicol Teratol 2024;102:107340. PubMed
  229. Lowe DJE, Sorkhou M, George TP. Cannabis use in adolescents and anxiety symptoms and disorders: a systematic review and meta-analysis. Am J Drug Alcohol Abuse 2024;50(2):150-161. PubMed
  230. Dawson D, Stjepanovic D, Lorenzetti V, Cheung C, Hall W, Leung J. The prevalence of cannabis use disorders in people who use medicinal cannabis: A systematic review and meta-analysis. Drug Alcohol Depend 2024;257:111263. PubMed
  231. Shukla R, Shukla N. Cannabis-induced obsessive-compulsive disorder: Is it a paradox?. Indian J Psychiatry 2023;65(11):1200-1201. PubMed
  232. Hutchinson J, Sall S, Stevens L. The Effect of Cannabis Use on Depression. Cureus 2024;16(1):e51803. PubMed
  233. Yang G, Li F, Wang Q, Liu Y, Guo J, Yue C. Association between history of cannabis use and outcomes after total hip or knee arthroplasty: a systematic review and meta-analysis. Front Public Health 2024;12:1377688. PubMed
  234. Moshfeghinia R, Hosseinzadeh M, Mostafavi S, et al. Recurrent cannabis-induced catatonia: a case report and comprehensive systematic literature review. Front Psychiatry 2024;15:1332310. PubMed
  235. Zafrullah F, Raheela F, Ali F, et al. Spontaneous Coronary Artery Dissection in the Setting of Marijuana: A Case Report. Cureus 2024;16(4):e59284. PubMed
  236. Shehataa MS, Abdelfattah AH, Selim AN. A Case Report of Acute Respiratory Distress Syndrome From Cannabis and Amphetamine Use. Cureus 2023;15(12):e50003. PubMed
  237. Khalili MR, Hosseini S, Shirvani M. Bilateral Optic Neuropathy Associated with Acute Inhaled Marijuana Use: Case Report and Review of the Literature. Neuroophthalmology 2024;48(3):186-192. PubMed
  238. Kaplan EF, Link CN, Schmalzried S, Rosenblatt A, Kellams A, Holland E. Association of Cannabis with Apneic Episodes in a Breastfed Infant: A Case Study. Breastfeed Med 2024;19(6):490-493. PubMed
  239. Solanki NN, Thill CA, Chaker M, Messina Alvarez AA, Manasrah N, Chaudhary AJ. Recurrent Spontaneous Pneumothorax Secondary to Marijuana and Tobacco Abuse. Cureus 2024;16(1):e52391. PubMed
  240. Velez Oquendo G, Balaji N, Ignatowicz A, Qutob H. Vanishing Lung Syndrome in a Young Male With Chronic Marijuana Use: A Case Report. Cureus 2023;15(12):e51223. PubMed
  241. Heyne S, Steininger J, Bauer A. Occupational allergic contact dermatitis to marijuana. Contact Dermatitis 2024. PubMed
  242. Acharya P, Mishra A, Kuikel S, et al. Severe and rapidly changing hypophosphatemia in cannabinoid hyperemesis syndrome: a case report. Oxf Med Case Reports 2024;2024(6):omae055. PubMed
  243. Moy M, Truonghuynh A, Villarreal E, Neal D. Antepartum Psychosis in the Setting of Preeclampsia With Severe Features: A Case Report. Cureus 2023;15(11):e49678. PubMed
  244. Park JB, Lee D, Adebagbo OD, et al. Impact of marijuana on masculinization top surgery postoperative complications: Single-surgeon single-institutional experience. J Plast Reconstr Aesthet Surg 2024;93:302-304. PubMed
  245. Zebbakh H, Imrani K, Benbrahim F, Moatassim Billah N, Nassar I. Acute toxic hippocampal encephalopathy in heavy cannabis users: A case report. Radiol Case Rep 2024;19(5):1913-1916. PubMed
  246. Bhana M, Perner Y. Can cannabinoids contribute to cholecystitis - a case of gangrenous acalculous cholecystitis. S Afr J Surg 2024;62(2):71. DOI
  247. Salmerón S, Ochandiano I, Andreu H, et al. Cannabis withdrawal and manic episodes: Three cases of an unknown trigger for bipolar disorder. Bipolar Disord 2024;26(3):296-299. PubMed
  248. Colling M, Souri Y, Reifsnyder T. Tetrahydrocannabinol vape-associated cannabis arteritis in a patient with minimal tobacco exposure. J Vasc Surg Cases Innov Tech 2024;11(1):101673. PubMed
  249. Bennasser A, Oudrhiri Safiani M, El Mostarchid A, Zhim M, Jiddane M, Touarsa F. Posterior reversible encephalopathy syndrome (PRES) following cannabis consumption: A rare association. Radiol Case Rep 2024;20(1):59-63. PubMed
  250. de Andrade Silva S, Velozo C, de Almeida Souto Montenegro L, et al. Effect of Preoperative Oral Cannabidiol-Rich Cannabis Extract on Anxiety and Postoperative Pain after Endodontic Treatment: A Double-Blind Randomized Clinical Trial. J Endod 2024;50(12):1 PubMed
  251. Ricci V, De Berardis D, Martinotti G, Maina G. New insight in psychotic cannabis withdrawal: case series and brief overview. Riv Psichiatr 2024;59(6):316-321. PubMed
  252. Grimison P, Mersiades A, Kirby A, et al. Oral Cannabis Extract for Secondary Prevention of Chemotherapy-Induced Nausea and Vomiting: Final Results of a Randomized, Placebo-Controlled, Phase II/III Trial. J Clin Oncol 2024;42(34):4040-4050. PubMed
  253. Udomuksorn W, Saowaneepitak N, Dolthammasiri P, et al. Unveiling the impact of water-boiled cannabis on warfarin: A case report of atrial fibrillation patients after cannabis legalization in Thailand. Toxicol Rep 2024;13:101838. PubMed
  254. Munroe M, Shah Z, Setya A. Wernicke encephalopathy in a pediatric patient with cannabinoid hyperemesis: A novel case report. JPGN Rep 2024;5(3):411-413. PubMed
  255. Storck W, Elbaz M, Vindis C, et al. Cardiovascular risk associated with the use of cannabis and cannabinoids: a systematic review and meta-analysis. Heart. 2025:heartjnl-2024-325429. PubMed
  256. Dogra R, Dogra V, Badyal H, Avasthi S. Hot Dab Associated Pneumonitis - a case report. BMC Pulm Med 2024;24(1):449. PubMed
  257. Ei Sherif Y, Gouher S, Abualhab MM, El-Khoury J. Cannabis Hyperemesis Syndrome in a Recently Abstinent Chronic User: Assessment and Intervention. Consort Psychiatr 2024;5(1):27-32. PubMed
  258. Knight HE, Singla A, Smerina M, et al. A Rare Complication of Cannabinoid Hyperemesis Syndrome. Am J Case Rep 2024;25:e945106. PubMed
  259. Wasik J, Likonska A, Kurowski M. IgE-Mediated Allergy and Asymptomatic Sensitization to Cannabis Allergens-Review of Current Knowledge and Presentation of Six Cases. Medicina (Kaunas) 2024;60(6):954. PubMed
  260. Strickler L, Baker A, DeGonza H, Alkhouri R. Intussusception in an Infant Chronically Ingesting Marijuana Via Breastfeeding. Breastfeed Med. 2025;20(6):450-452. PubMed
  261. Daoudi I, Mabchour A, Rasquin F, Van Bol L, Demols P. Retinal arterial macroaneurysm rupture in a 17-year-old: Could cannabis consumption be a risk factor? J Fr Ophtalmol. 2025:S0181-5512(25)00141-X. PubMed

See these in context on the Cannabis monograph →

Peony 15 references
  1. Chen LC, Chou MH, Lin MF, Yang LL. Effects of Paeoniae Radix, a traditional Chinese medicine, on the pharmacokinetics of phenytoin. J Clin Pharm Ther 2001;26:271-8. PubMed
  2. Guo TL, Zhou XW. [Clinical observations on the treatment of the gestational hypertension syndrome with Angelica and Paeonia powder]. Zhong Xi Yi Jie He Za Zhi 1986;6:714-6, 707.
  3. Xie HJ, Yasar U, Sandberg M, Rane A. Paeoniae Radix, a traditional Chinese medicine, and CYP2C9 activity. J Clin Pharm Ther 2002;27:229-30. . PubMed
  4. Harada M, Suzuki M, Ozaki Y. Effect of Japanese Angelica root and peony root on uterine contraction in the rabbit in situ. J Pharmacobiodyn 1984;7:304-11. PubMed
  5. Anon. Monograph. Peony (Paeonia spp). Alt Med Rev 2001;6:495-9.
  6. Bruynzeel DP. Contact Dermatitis Due to Paeonia (Peony). Contact Dermatitis 1989; 20:152-3..
  7. Bian, X., Xu, Y., Zhu, L., Gao, P., Liu, X., Liu, S., Qian, M., Gai, M., Yang, J., and Wu, Y. Prevention of maternal-fetal blood group incompatibility with traditional Chinese herbal medicine. Chin Med J (Engl.) 1998;111(7):585-587.
  8. Wong, A. L. and Chan, T. Y. Interaction between warfarin and the herbal product quilinggao. Ann Pharmacother 2003;37(6):836-838.
  9. Cai Y, Yuan Q, Xu K, et al. Assessment of the therapeutic effect of total glycosides of peony for juvenile idiopathic arthritis: a systematic review and meta-analysis. Evid Based Complement Alternat Med 2016;2016:8292486.
  10. Koo YK, Kim JM, Koo JY, et al. Platelet anti-aggregatory and blood anti-coagulant effects of compounds isolated from Paeonia lactiflora and Paeonia suffruticosa. Pharmazie 2010;65(8):624-8.
  11. Wang W, Tian DD, Zheng B, et al. Peony-glycyrrhiza decoction, an herbal preparation, inhibits clozapine metabolism via cytochrome P450s, but not flavin-containing monooxygenase in in vitro models. Drug Metab Dispos 2015;43(7):1147-53. PubMed
  12. Zhou Y, Jin L, Kong F, et al. Clinical and immunological consequences of total glucosides of paeony treatment in Sjögren's syndrome: A randomized controlled pilot trial. Int Immunopharmacol. 2016 Oct;39:314-319. doi: 10.1016/j.intimp.2016.08.006. PubMed
  13. Zhu Q, Qi X, Wu Y, Wang K. Clinical study of total glucosides of paeony for the treatment of diabetic kidney disease in patients with diabetes mellitus. Int Urol Nephrol. 2016 Nov;48(11):1873-1880. doi: 10.1007/s11255-016-1345-5. PubMed
  14. Xu Y, Li X, Chen T, et al. Radix Paeoniae Alba increases serum estrogen level and up-regulates estrogen receptor expression in uterus and vagina of immature/ovariectomized mice. Phytother Res. 2019;33(1):117-29. [RETRACTED].
  15. Liu X, Li X, Li X, et al. The efficacy and safety of total glucosides of peony in the treatment of primary Sjögren's syndrome: a multi-center, randomized, double-blinded, placebo-controlled clinical trial. Clin Rheumatol. 2019;38(3):657-64. Erratum i

See these in context on the Peony monograph →

Rhubarb 20 references
  1. Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Trans. S. Klein. Boston, MA: American Botanical Council, 1998.
  2. McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products Association's Botanical Safety Handbook. Boca Raton, FL: CRC Press, LLC 1997.
  3. Gruenwald J, Brendler T, Jaenicke C. PDR for Herbal Medicines. 1st ed. Montvale, NJ: Medical Economics Company, Inc., 1998.
  4. Brinker F. Herb Contraindications and Drug Interactions. 2nd ed. Sandy, OR: Eclectic Medical Publications, 1998.
  5. Nusko G, Schneider B, Schneider I, et al. Anthranoid laxative use is not a risk factor for colorectal neoplasia: results of a prospective case control study. Gut 2000;46:651-5. PubMed
  6. Kwan TH, Tong MK, Leung KT, et al. Acute renal failure associated with prolonged intake of slimming pills containing anthraquinones. Hong Kong Med J 2006;12:394-7.
  7. Fairbairn JW. The anthraquinone laxatives. Biological assay and its relation to chemical structure. Pharmacology 1976;14:48-61. PubMed
  8. Siegers, C. P., Hertzberg-Lottin, E., Otte, M., and Schneider, B. Anthranoid laxative abuse--a risk for colorectal cancer? Gut 1993;34(8):1099-1101. PubMed
  9. Fan, J. G. Evaluating the efficacy and safety of Danning Pian in the short-term treatment of patients with non-alcoholic fatty liver disease: a multicenter clinical trial. Hepatobiliary.Pancreat.Dis.Int 2004;3(3):375-380.
  10. Yan, M., Zhang, L. Y., Sun, L. X., Jiang, Z. Z., and Xiao, X. H. Nephrotoxicity study of total rhubarb anthraquinones on Sprague Dawley rats using DNA microarrays. J Ethnopharmacol. 4-15-2006; PubMed
  11. Zhang, J. H., Li, L. S., and Zhang, M. Clinical effects of rheum and captopril on preventing progression of chronic renal failure. Chin Med J (Engl.) 1990;103(10):788-793.
  12. Mitsuma, T., Yokozawa, T., Oura, H., and Terasawa, K. [Rhubarb therapy in patients with chronic renal failure (Part 2)]. Nippon Jinzo Gakkai Shi 1987;29(2):195-207.
  13. Wu, C. X. [A preliminary study on the effect of a single Rheum officinale in heavy doses in the treatment of acute icteric hepatitis]. Zhong.Xi.Yi.Jie.He.Za Zhi.(Chinese Journal of Modern Developments in Traditional Medicine) 1984;4(2):88-89.
  14. Jiao, D. H. [Clinical research on the hemostatic effect of rhubarb on peptic ulcer with acute bleeding]. Zhong.Xi.Yi.Jie.He.Za Zhi.(Chinese Journal of Modern Developments in Traditional Medicine) 1984;4(10):597-600, 579.
  15. Jiao, D. H., Ma, Y. H., Chen, S. J., Liu, C. T., Shu, H. N., and Chu, C. M. Resume of 400 cases of acute upper digestive tract bleeding treated by rhubarb alone. Pharmacology 1980;20 Suppl 1:128-130.
  16. Zhang, JH, Yao, XD, Song, Y, and et al. [Long-term treating effects of rhubarb and captopril in delaying the progression of renal failure]. Chinese Kidney Disease Journal 1993;9(4):197-201.
  17. Rehman H, Begum W, Anjum F, Tabasum H, Zahid S. Effect of rhubarb (Rheum emodi) in primary dysmenorrhoea: a single-blind randomized controlled trial. J Complement Integr Med. 2015 Mar;12(1):61-9.
  18. Yu CP, Lin HJ, Lin SP, Shia CS, Chang PH, Hou YC, Hsieh YW. Rhubarb decreased the systemic exposure of cyclosporine, a probe substrate of P-glycoprotein and CYP 3A. Xenobiotica. 2016 Aug;46(8):677-82. PubMed
  19. Byeon JH, Kil JH, Ahn YC, Son CG. Systematic review of published data on herb induced liver injury. J Ethnopharmacol 2019;233:190-6. PubMed
  20. Zhao D, Feng SX, Zhang HJ, et al. Pharmacokinetics, tissue distribution and excretion of five rhubarb anthraquinones in rats after oral administration of effective fraction of anthraquinones from rheum officinale. Xenobiotica. 2021;51(8):916-925. PubMed

See these in context on the Rhubarb monograph →

Dong Quai 19 references
  1. Hirata JD, Swiersz LM, Zell B, et al. Does dong quai have estrogenic effects in postmenopausal women? A double-blind, placebo-controlled trial. Fertil Steril 1997;68:981-6. PubMed
  2. Page RL II, Lawrence JD. Potentiation of warfarin by dong quai. Pharmacotherapy 1999;19:870-6. PubMed
  3. Heck AM, DeWitt BA, Lukes AL. Potential interactions between alternative therapies and warfarin. Am J Health Syst Pharm 2000;57:1221-7. DOI
  4. Eagon PK, Elm MS, Hunter DS, et al. Medicinal herbs: modulation of estrogen action. Era of Hope Mtg, Dept Defense; Breast Cancer Res Prog, Atlanta, GA 2000;Jun 8-11.
  5. Dr. Duke's Phytochemical and Ethnobotanical Databases. Available at: http://www.ars-grin.gov/duke/.
  6. Amato P, Christophe S, Mellon PL. Estrogenic activity of herbs commonly used as remedies for menopausal symptoms. Menopause 2002;9:145-50. PubMed
  7. Shi M, Chang L, He G. [Stimulating action of Carthamus tinctorius L., Angelica sinensis (Oliv.) Diels and Leonurus sibiricus L. on the uterus]. Zhongguo Zhong Yao Za Zhi 1995;20:173-5, 192.
  8. Hoult JR, Paya M. Pharmacological and biochemical actions of simple coumarins: natural products with therapeutic potential. Gen Pharmacol 1996;27:713-22.. PubMed
  9. Cheong JL, Bucknall R. Retinal vein thrombosis associated with a herbal phytoestrogen preparation in a susceptible patient. Postgrad Med J 2005;81:266-7.. PubMed
  10. Chang CJ, Chiu JH, Tseng LM, et al. Modulation of HER2 expression by ferulic acid on human breast cancer MCF7 cells. Eur J Clin Invest 2006;36:588-96. PubMed
  11. Chuang CH, Doyle P, Wang JD, et al. Herbal medicines used during the first trimester and major congenital malformations: an analysis of data from a pregnancy cohort study. Drug Saf 2006;29:537-48. PubMed
  12. Lau CBS, Ho TCY, Chan TWL, Kim SCF. Use of dong quai (Angelica sinensis) to treat peri- and postmenopausal symptoms in women with breast cancer: is it appropriate? Menopause 2005;12:734-40.
  13. Ellis GR, Stephens MR. Untitled (photograph and a brief case report). BMJ 1999;319:650.
  14. Nambiar, S., Schwartz, R. H., and Constantino, A. Hypertension in mother and baby linked to ingestion of Chinese herbal medicine. West J Med 1999;171(3):152.
  15. Lee, S. K., Cho, H. K., Cho, S. H., Kim, S. S., Nahm, D. H., and Park, H. S. Occupational asthma and rhinitis caused by multiple herbal agents in a pharmacist. Ann.Allergy Asthma Immunol. 2001;86(4):469-474. PubMed
  16. Xu, J. and Li, G. [Observation on short-term effects of Angelica injection on chronic obstructive pulmonary disease patients with pulmonary hypertension]. Zhongguo Zhong Xi Yi Jie He Za Zhi 2000;20(3):187-189.
  17. Scott, G. N. and Elmer, G. W. Update on natural product--drug interactions. Am J Health Syst.Pharm 2-15-2002;59(4):339-347. PubMed
  18. Circosta, C., Pasquale, R. D., Palumbo, D. R., Samperi, S., and Occhiuto, F. Estrogenic activity of standardized extract of Angelica sinensis. Phytother.Res. 2006;20(8):665-669.
  19. Fung FY, Wong WH, Ang SK, et al. A randomized, double-blind, placebo- controlled study on the anti-haemostatic effects of Curcuma longa, Angelica sinensis and Panax ginseng. Phytomedicine. 2017;32:88-96. PubMed

See these in context on the Dong Quai monograph →

Chinese Cucumber 4 references
  1. The Review of Natural Products by Facts and Comparisons. St. Louis, MO: Wolters Kluwer Co., 1999.
  2. McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products Association's Botanical Safety Handbook. Boca Raton, FL: CRC Press, LLC 1997.
  3. Hikino H, Yoshizawa M, Suzuki Y, et al. Isolation and hypoglycemic activity of trichosans A, B, C, D, and E: glycans of Trichosanthes kirilowii roots. Planta Med 1989;55:349-50.
  4. Jung YB, Roh KJ, Jung JA, et al. Effect of SKI 306X, a new herbal anti-arthritic agent, in patients with osteoarthritis of the knee: a double-blind placebo controlled study. Am J Chin Med. 2001;29(3-4):485-91. PubMed

See these in context on the Chinese Cucumber monograph →

Perilla 4 references
  1. The Review of Natural Products by Facts and Comparisons. St. Louis, MO: Wolters Kluwer Co., 1999.
  2. Kanzaki, T. and Kimura, S. Occupational allergic contact dermatitis from Perilla frutescens (shiso). Contact Dermatitis 1992;26(1):55-56.
  3. Yu H, Qiu JF, Ma LJ, Hu YJ, Li P, Wan JB. Phytochemical and phytopharmacological review of Perilla frutescens L. (Labiatae), a traditional edible-medicinal herb in China. Food Chem Toxicol 2017;108(Pt B):375-91. PubMed
  4. Jeong K, Lee SY, Jeon SA, et al. Clinical and immunological characterization of perilla seed allergy in children. J Investig Allergol Clin Immunol 2021. PubMed

See these in context on the Perilla monograph →

Cistanche Deserticola 2 references
  1. Herbs at a Glance — NIH NCCIH Source
  2. Herbs and Supplements — MedlinePlus Source

See these in context on the Cistanche Deserticola monograph →

Bitter Orange 47 references
  1. Penzak SR, Jann MW, Cold JA, et al. Seville (sour) orange juice: synephrine content and cardiovascular effects in normotensive adults. J Clin Pharmacol 2001;41:1059-63. PubMed
  2. Electronic Code of Federal Regulations. Title 21. Part 182 -- Substances Generally Recognized As Safe. Available at: https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?CFRPart=182
  3. Calapai G, Firenzuoli F, Saitta A, et al. Antiobesity and cardiovascular toxic effects of Citrus aurantium extracts in the rat: A preliminary report. Fitoterapia 1999;70:586-92. DOI
  4. Keogh AM, Baron DW. Sympathomimetic abuse and coronary artery spasm. Br Med J 1985;291:940.
  5. Malhotra S, Bailey DG, Paine MF, Watkins PB. Seville orange juice-felodipine interaction: comparison with dilute grapefruit juice and involvement of furocoumarins. Clin Pharmacol Ther 2001;69:14-23. PubMed
  6. Pellati F, Benvenuti S, Melegari M, Firenzuoli F. Determination of adrenergic agonists from extracts and herbal products of Citrus aurantium L. var. amara by LC. J Pharm Biomed Anal 2002;29:1113-9. . PubMed
  7. Colker CM, Kalman DS, Torina GC, et al. Effects of Citrus aurantium extract, caffeine, and St. John's wort on body fat loss, lipid levels, and mood states in overweight healthy adults. Curr Ther Res 1999;60:145-153. DOI
  8. Penzak SR, Acosta EP, Turner M, et al. Effect of Seville orange juice and grapefruit juice on indinavir pharmacokinetics. J Clin Pharmacol 2002;42:1165-70. PubMed
  9. Edwards DJ, Fitzsimmons ME, Schuetz EG, et al. 6',7'-Dihydroxybergamottin in grapefruit juice and Seville orange juice: effects on cyclosporine disposition, enterocyte CYP3A4, and P-glycoprotein. Clin Pharmacol Ther 1999;65:237-44. PubMed
  10. Di Marco MP, Edwards DJ, Wainer IW, Ducharme MP. The effect of grapefruit juice and seville orange juice on the pharmacokinetics of dextromethorphan: the role of gut CYP3A and P-glycoprotein. Life Sci 2002;71:1149-60. PubMed
  11. Visentin V, Morin N, Fontana E, et al. Dual action of octopamine on glucose transport into adipocytes: inhibition via beta3-adrenoceptor activation and stimulation via oxidation by amine oxidases. J Pharmacol Exp Ther 2001;299:96-104.
  12. Nykamp DL, Fackih MN, Compton AL. Possible association of acute lateral-wall myocardial infarction and bitter orange supplement. Ann Pharmacother 2004;38:812-6. PubMed
  13. Fugh-Berman A, Myers A. Citrus aurantium, an ingredient of dietary supplements marketed for weight loss: Current status of clinical and basic Research. Exp Biol Med 2004;229:698-704.
  14. Suzuki O, Matsumoto T, Oya M, Katsumata Y. Oxidation of synephrine by type A and type B monoamine oxidase. Experientia 1979;35:1283-4. PubMed
  15. Nasir JM, Durning SJ, Ferguson M, et al. Exercise-induced syncope associated with QT prolongation and ephedra-free Xenadrine. Mayo Clin Proc 2004;79:1059-62.. PubMed
  16. Firenzuoli F, Gori L, Galapai C. Adverse reaction to an adrenergic herbal extract (Citrus aurantium). Phytomedicine 2005;12:247-8. PubMed
  17. Bouchard NC, Howland MA, Greller HA, et al. Ischemic stroke associated with use of an ephedra-free dietary supplement containing synephrine. Mayo Clin Proc 2005;80:541-5. PubMed
  18. Haller CA, Benowitz NL, Jacob P 3rd. Hemodynamic effects of ephedra-free weight-loss supplements in humans. Am J Med 2005;118:998-1003.. PubMed
  19. Bui LT, Nguyen DT, Ambrose PJ. Blood pressure and heart rate effects following a single dose of bitter orange. Ann Pharmacother 2006;40:53-7. PubMed
  20. Min B, Cios D, Kluger J, White CM. Absence of QTc-interval-prolonging or hemodynamic effects of a single dose of bitter-orange extract in healthy subjects. Pharmacotherapy 2005;25:1719-24. PubMed
  21. Gange CA, Madias C, Felix-Getzik EM, et al. Variant angina associated with bitter orange in a dietary supplement. Mayo Clin Proc 2006;81:545-8. PubMed
  22. Jordan S, Murty M, Pilon K. Products containing bitter orange or synephrine: suspected cardiovascular adverse reactions. Canadian Adverse Reaction Newsletter 2004;14:3-4.
  23. Burke J, Seda G, Allen D, Knee TS. A case of severe exercise-induced rhabdomyolysis associated with a weight loss dietary supplement. Mil Med 2007;172:656-8. PubMed
  24. Gray, S. and Woolf, A. D. Citrus aurantium used for weight loss by an adolescent with anorexia nervosa. J Adolesc.Health 2005;37(5):414-415. PubMed
  25. Haller, C. A., Duan, M., Jacob, P., III, and Benowitz, N. Human pharmacology of a performance-enhancing dietary supplement under resting and exercise conditions. Br J Clin Pharmacol 2008;65(6):833-840. PubMed
  26. Thomas, J. E., Munir, J. A., McIntyre, P. Z., and Ferguson, M. A. STEMI in a 24-year-old man after use of a synephrine-containing dietary supplement: a case report and review of the literature. Tex.Heart Inst.J 2009;36(6):586-590.
  27. Campbell-Tofte, J. I., Molgaard, P., Josefsen, K., Abdallah, Z., Hansen, S. H., Cornett, C., Mu, H., Richter, E. A., Petersen, H. W., Norregaard, J. C., and Winther, K. Randomized and double-blinded pilot clinical study of the safety and anti-diabetic ef
  28. Seifert, J. G., Nelson, A., Devonish, J., Burke, E. R., and Stohs, S. J. Effect of acute administration of an herbal preparation on blood pressure and heart rate in humans. Int J Med Sci 2011;8(3):192-197. PubMed
  29. Stohs, S. J., Preuss, H. G., Keith, S. C., Keith, P. L., Miller, H., and Kaats, G. R. Effects of p-synephrine alone and in combination with selected bioflavonoids on resting metabolism, blood pressure, heart rate and self-reported mood changes. Int J Med
  30. Wason, S., DiGiacinto, J. L., and Davis, M. W. Effects of grapefruit and Seville orange juices on the pharmacokinetic properties of colchicine in healthy subjects. Clin Ther 2012;34(10):2161-2173. PubMed
  31. Kaats, G. R., Miller, H., Preuss, H. G., and Stohs, S. J. A 60day double-blind, placebo-controlled safety study involving Citrus aurantium (bitter orange) extract. Food Chem Toxicol. 2013;55:358-362.
  32. Calapai, G., Firenzuoli, F., Saitta, A., Squadrito, F. R., Arlotta, M., Costantino, G., and Inferrera, G. Antiobesity and cardiovascular toxic effects of Citrus aurantium extracts in the rat: a preliminary report. Fitoterapia 12-1-1999;70(6):586-592. DOI
  33. Colker, C., Kalman, D., and Torina, G. Effects of Citrus aurantium extract, caffeine, and St. John's Wort on body fat loss, lipid levels, and mood states in overweight healthy adults. Curr Ther Res 1999;60:145-153. DOI
  34. Shara M, Stohs SJ. Safety evaluation of Bitter orange extract (p-synephrine) in healthy volunteers. J.Amer.Coll.Nutr. 2011;30:358.
  35. Lynch B. Review of the safety of p-synephrine and caffeine. Intertek-Cantox Report, 2013;1-20.
  36. Smith TB, Staub BA, Natarajan GM, et al. Acute myocardial infarction associated with dietary supplements containing 1,3-dimethylamylamine and Citrus aurantium. Tex Heart Inst J 2014;41(1):70-2. PubMed
  37. Shara M, Stohs SJ, Mukattash TL. Cardiovascular safety of oral p-synephrine (bitter orange) in healthy subjects: a randomized placebo-controlled cross-over clinical trial. Phytother Res. 2016;30(5):842-7.
  38. Liu Y, Santillo MF. Cytochrome P450 2D6 and 3A4 enzyme inhibition by amine stimulants in dietary supplements. Drug Test Anal. 2016;8(3-4):307-10. PubMed
  39. Abdelkawy KS, Donia AM, Turner RB, Elbarbry F. Effects of Lemon and Seville Orange Juices on the Pharmacokinetic Properties of Sildenafil in Healthy Subjects. Drugs R D. 2016 Sep;16(3):271-278. PubMed
  40. Gutiérrez-Hellín J, Salinero JJ, Abían-Vicen J, Areces F, Lara B, Gallo C, et al. Acute consumption of p-synephrine does not enhance performance in sprint athletes.J. Appl Physiol Nutr Metab. 2016;41(1):63-9. doi: 10.1139/apnm-2015-0299.
  41. Jung YP, Earnest CP, Koozehchian M, et al. Effects of ingesting a pre-workout dietary supplement with and without synephrine for 8 weeks on training adaptations in resistance-trained males. J Int Soc Sports Nutr. 2017;3;14:1. doi: 10.1186/s12970-016-0158- PubMed
  42. Jung YP, Earnest CP, Koozehchian M, et al. Effects of acute ingestion of a pre-workout dietary supplement with and without synephrine on resting energy expenditure, cognitive function and exercise performance. J Int Soc Sports Nutr. 2017;14:3. doi: 10.118
  43. Vatsavai LK, Kilari EK. Interaction of p-synephrine on the pharmacodynamic and pharmacokinetics of gliclazide in animal models. J Ayurveda Integr Med 2017; S0975-9476(16)30487-9. doi: 10.1016/j.jaim.2017.04.010.
  44. Ratamess NA, Bush JA, Stohs SJ, et al. Acute cardiovascular effects of bitter orange extract (p-synephrine) consumed alone and in combination with caffeine in human subjects: A placebo-controlled, double-blind study. Phytother Res. 2018;32(1):94-102.
  45. Gutiérrez-Hellín J, Ruiz-Moreno C, Del Coso J. Acute p-synephrine ingestion increases whole-body fat oxidation during 1-h of cycling at Fatmax. Eur J Nutr. 2019 Nov 5. PubMed
  46. Karimzadeh Z, Azizzadeh Forouzi M, Tajadini H, Ahmadinejad M, Roy C, Dehghan M. Effects of lavender and Citrus aurantium on pain of conscious intensive care unit patients: a parallel randomized placebo-controlled trial. J Integr Med 2021:S2095-4964(21)000 PubMed
  47. Koncz D, Tóth B, Bahar MA, Roza O, Csupor D. The Safety and Efficacy of Citrus aurantium (Bitter Orange) Extracts and p-Synephrine: A Systematic Review and Meta-Analysis. Nutrients 2022;14(19):4019. PubMed

See these in context on the Bitter Orange monograph →

Fo-ti 28 references
  1. Foster S, Tyler VE. Tyler's Honest Herbal: A Sensible Guide to the Use of Herbs and Related Remedies. 3rd ed., Binghamton, NY: Haworth Herbal Press, 1993.
  2. McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products Association's Botanical Safety Handbook. Boca Raton, FL: CRC Press, LLC 1997.
  3. Brinker F. Herb Contraindications and Drug Interactions. 2nd ed. Sandy, OR: Eclectic Medical Publications, 1998.
  4. Covington TR, et al. Handbook of Nonprescription Drugs. 11th ed. Washington, DC: American Pharmaceutical Association, 1996.
  5. Park GJ, Mann SP, Ngu MC. Acute hepatitis induced by Shou-Wu-Pian, a herbal product derived from Polygonum multiflorum. J Gastroenterol Hepatol 2001;16:115-7.
  6. But PP, Tomlinson B, Lee KL. Hepatitis related to the Chinese medicine Shou-wu-pian manufactured from Polygonum multiflorum. Vet Hum Toxicol 1996;38:280-2.
  7. Oerter Klein KO, Janfaza M, Wong JA, Chang RJ. Estrogen bioactivity in Fo-Ti and other herbs used for their estrogen-like effects as determined by a recombinant cell bioassay. J Clin Endocrinol Metab 2003;88:4077-9.. PubMed
  8. Unger M, Frank A. Simultaneous determination of the inhibitory potency of herbal extracts on the activity of six major cytochrome P450 enzymes using liquid chromatography/mass spectrometry and automated online extraction. Rapid Commun Mass Spectrom 2004;1 PubMed
  9. UK Medicines and Healthcare Products Regulatory Agency. Polygonum multiflorum and liver reactions. April 2006. Available at: www.mhra.gov.uk/home/idcplg?IdcService= SS_GET_PAGE&useSecondary=true&ssDocName= CON2023590&ssTargetNodeId= 833 (Accessed 10 May 2
  10. Panis B, Wong DR, Hooymans PM, De Smet PA, Rosias PP. Recurrent toxic hepatitis in a Caucasian girl related to the use of Shou-Wu-Pian, a Chinese herbal preparation. J Pediatr Gastroenterol Nutr 2005;41:256-8. PubMed
  11. Mazzanti G, Battinelli L, Daniele C, et al. New case of acute hepatitis following the consumption of Shou Wu Pian, a Chinese herbal product derived from Polygonum multiflorum. Ann Intern Med 2004;140:E589-90.
  12. Cardenas A, Restrepo JC, Sierra F, Correa G. Acute hepatitis due to shen-min: a herbal product derived from Polygonum multiflorum. J Clin Gastroenterol 2006;40:629-32. PubMed
  13. Zhang CZ, Wang SX, Zhang Y, et al. In vitro estrogenic activities of Chinese medicinal plants traditionally used for the management of menopausal symptoms. J Ethnopharmacol 2005;98:295-300. PubMed
  14. Laird AR, Ramchandani N, deGoma EM, et al. Acute hepatitis associated with the use of an herbal supplement (Polygonum multiflorum) mimicking iron-overload syndrome. J Clin Gastroenterol 2008;42:861-2. PubMed
  15. Jung KA, Min HJ, Yoo SS, et al. Drug-Induced Liver Injury: Twenty Five Cases of Acute Hepatitis Following Ingestion of Polygonum multiflorum Thunb. Gut Liver 2011;5(4):493-9. PubMed
  16. Kang, S. C., Lee, C. M., Choi, H., Lee, J. H., Oh, J. S., Kwak, J. H., and Zee, O. P. Evaluation of oriental medicinal herbs for estrogenic and antiproliferative activities. Phytother Res 2006;20(11):1017-1019. PubMed
  17. Yuen, M. F., Tam, S., Fung, J., Wong, D. K., Wong, B. C., and Lai, C. L. Traditional Chinese medicine causing hepatotoxicity in patients with chronic hepatitis B infection: a 1-year prospective study. Aliment.Pharmacol.Ther 10-15-2006;24(8):1179-1186. PubMed
  18. Zhang, L., Yang, X., Sun, Z., and Qu, Y. [Retrospective study of adverse events of Polygonum multiflorum and risk control]. Zhongguo Zhong.Yao Za Zhi. 2009;34(13):1724-1729.
  19. Bae, S. H., Kim, D. H., Bae, Y. S., Lee, K. J., Kim, D. W., Yoon, J. B., Hong, J. H., and Kim, S. H. [Toxic hepatitis associated with Polygoni multiflori]. Korean J.Hepatol. 2010;16(2):182-186. PubMed
  20. Furukawa, M., Kasajima, S., Nakamura, Y., Shouzushima, M., Nagatani, N., Takinishi, A., Taguchi, A., Fujita, M., Niimi, A., Misaka, R., and Nagahara, H. Toxic hepatitis induced by show-wu-pian, a Chinese herbal preparation. Intern.Med. 2010;49(15):1537-1 PubMed
  21. McGuffin, M., Hobbs, C., Upton, R., and Goldberg, A. American Herbal Products Association's Botanical Safety Handbook. Boca Raton, FL: CRC Press, LLC;1997.
  22. Dong H, Slain D, Cheng J, Ma W, Liang W. Eighteen cases of liver injury following ingestion of Polygonum multiflorum. Complement Ther Med 2014;22(1):70-4. PubMed
  23. Lei X, Chen J, Ren J, et al. Liver damage associated with Polygonum multiflorum Thunb.: a systematic review of case reports and case series. Evid Based Complement Alternat Med 2015;2015:459749.
  24. Ma KF, Zhang XG, Jia HY. CYP1A2 polymorphism in Chinese patients with acute liver injury induced by Polygonum multiflorum. Genet Mol Res 2014;13(3):5637-43. PubMed
  25. Zhang Y, Ding T, Diao T, Deng M, Chen S. Effects of Polygonum multiflorum on the activity of cytochrome P450 isoforms in rats. Pharmazie 2015;70(1):47-54. DOI
  26. Yu J, Xie J, Mao XJ, et al. Comparison of laxative and antioxidant activities of raw, processed and fermented Polygoni multiflori radix. Chin J Nat Med 2012;10(1):63-7. DOI
  27. Shao YL, Ma CM, Wu JM, Guo FC, Zhang SC. Concurrent severe hepatotoxicity and agranulocytosis induced by Polygonum multiflorum: A case report. World J Clin Cases 2022;10(27):9921-9928.
  28. Xing Y, Yu Q, Zhou L, et al. Cytochrome P450-mediated herb-drug interaction (HDI) of Polygonum multiflorum Thunb. based on pharmacokinetic studies and in vitro inhibition assays. Phytomedicine 2023;112:154710. PubMed

See these in context on the Fo-ti monograph →

Parts of this content are provided by the Therapeutic Research Center, LLC.

DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.

© 2021 Therapeutic Research Center, LLC

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