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Low Blood Pressure
Cannabis may drop blood pressure by 10 to 20 points and as much as 40 points. this is dose related. If your blood pressure is already as low as 100 or 105, it may drop your blood pressure too low for safe use. Marijuana is contraindicated in those with ischemic heart disease. Their blood pressure is already too low. We like to see blood pressure above 100 !

If pressure is too low, the brain and heart do not receive enough blood and oxygen which may lead to serious problems.

High Heart Rate
Cannabis may increase heart rate as much as 50 to 60 points. This is dose related.
Rapid heart rate
may be worse when combined with other drugs that have anti-cholinergic effects such as the tricyclic antidepressants desipramine, amitriptyline, nortriptyline.

Good Alertness is Required
If you need to be alret e.g. driving, operating machinery or at work. Indica is contraindicated. Indica strains relieve symptoms but will also make you sleepy, some may cause severe sedation.

Sativas are said to be energizing, focusing and inspirational. Choose a blend or hybrid higher in Sativa for daytime use and higher in Indica for sleep.

You are Immunosuppressed
Immunosuppressed patients may be wise to avoid smoking it or risk infection with Aspergillus which is a fungus that may affect lungs or sinuses. The spores are in the air; using filters in growing rooms should prevent it from growing. Large collectives may use forensic microscopes to examine their harvest and they avoid package in cellophane which can cause formaldehyde to form.
To avoid risk of Aspergillus, you may use cannabis under your tongue, swallow it or use it topically in an ointment.
You have Complex Medical Conditions
Consider the potential interactions with multiple medications they use for their medical conditions

There are some Drug interactions
Consider the potential interactions with the current medications you are using.

From Medical CBD – Contraindications
From Medical CBD – Adverse effects
Nancy L. Sajben MD

Drug interactions

Consider the potential interactions with the current medications being used. These are some of the more common interactions between medications and Cannabis. Those patients being treated with a pharmaceutical drug are wise to be mindful of the possible interactions between their use of Cannabis and the drugs they take for their medical condition.

Blood Thinners e.g .Warfarin
CBD reduces the enzymatic degradation of warfarin, thereby increasing its duration of action and effect. A person taking a CBD-rich product should pay close attention to changes in blood levels of warfarin, and adjust dosage accordingly as instructed by their doctor.

Anti-Seizure Medications
Some epileptic patients have encountered issues with how CBD interacts with their anti-seizure medication. Users of clobazam may need to have thier dosages reduced as CBD increases the effect of clobazam by inhibiting it’s breakdown in the body. A May 2015, the study concluded that CBD is a safe and effective treatment of refractory epilepsy in patients receiving [clobazam], though blood levels should be monitored.

Opioid Pain Medications
Cannabis was often prescribed alongside opioid pain medications before both came under regulatory control in the early twentieth century. A patient needs to be cautious, because cannabis can have an additive effect on the opioid which can amplify the creation of drowsiness or the depression of the central nervous system (CNS). The central nervous system controls heart rate and respiration; therefore, this effect can be fatal.

Cannabis can have an additive effect (increases the potency) on many sedatives. This includes many sleeping pills in the class known as cyclopyrrolones, or ‘Z-drugs’. Some American brand names include Sonata, Lunesta and Ambien; in Europe, this drug is known as Zimovane. Z-drugs are similar to benzodiazepines, such as Valium and Ativan.

Examples of these drugs are loratadine (Claritin), fexofenadine (Allegra) and diphenhydramine (Benadryl). Antihistamines have the potential side-effect of causing drowsiness. When combined with Cannabis, this side-effect becomes potentiated – therefore, more likely to occur. Tachycardia is another possible side-effect of mixing these medications with Cannabis.

Metformin – Diabetes
Metformin, known by the brand name Glucophage, also has a potential for interaction with Cannabis. Metformin is used in the treatment of diabetes, as an aid to patients needing help controlling their blood sugar levels. Cannabis has been shown to decrease the effectiveness of metformin, as the effect of lowering blood sugar is opposed by cannabinoids. Diabetic patient who use metformin should be cautious and check their blood sugar levels to know if Cannabis has lessened the efficacy of this medication.

Stimulants and drugs that cause stimulation
Tachycardia (very fast heart rate) is another side-effect that can occur when Cannabis is combined with stimulants. Patients taking cardiovascular medications for hypertension or arrhythmias, or patients with cardiovascular symptoms, would be cautious to monitor their response to a new sample of Cannabis. This caution applies to mixing other stimulants – such as amphetamines, cocaine and even strong coffee – with Cannabis. Tachycardia, palpitations or hypertension may occur. Smoking can, on its own, produce such issues; choosing vaporization or edibles, or indica-dominant strains, may help to prevent such complications.

Mental illness is unfortunately a common complaint in modern civilization – so is the use of medications to treat it. Many patients use tricyclic antidepressants or other drugs (SNRIs) that inhibit the uptake of serotonin and norepinephrine. These drugs can be prescribed for other symptoms, including anxiety disorders, obsessive-compulsive disorder (OCD), attention deficit hyperactivity disorder (ADHD), chronic neuropathic pain and fibromyalgia syndrome (FMS). These drugs can also be prescribed for the relief of menopausal symptoms. Examples are amitriptyline, amoxapine and desipramine. When combined with Cannabis a potentiation of effects related to drowsiness and sedation can occur.

Some of these drugs, however, have a stimulant effect. Their use can bring about symptoms of hypertension and tachycardia, the same as stimulant drugs, when combined with Cannabis. Scientific evidence has been suppressed, but anecdotal evidence abounds for the use of Cannabis for various symptoms of mental illness. Depression and bi-polar symptoms have been reported to have improved with the use of certain strains of Cannabis.

Theophyllines are a group of drugs often used in the treatment of asthma and COPD (chronic obstructive pulmonary disease). These drugs are related to caffeine. Cannabis has been shown to increase the metabolism of these drugs; therefore, the dose or frequency of these medications may require adjustment when combined with Cannabis.




Special Precautions & Warnings:

Pregnancy: Marijuana is UNSAFE when taken by mouth or smoked during pregnancy. Marijuana passes through the placenta and can slow the growth of the fetus. Marijuana use during pregnancy is also associated with childhood leukemia and abnormalities in the fetus.

Breast-feeding: Using marijuana, either by mouth or by inhalation is LIKELY UNSAFE during breast-feeding. The dronabinol (THC) in marijuana passes into breast milk and extensive marijuana use during breast-feeding may result in slowed development in the baby.

Heart disease: Marijuana might cause rapid heartbeat, short-term high blood pressure. It might also increase the risk of a having heart attack.

A weakened immune system: Cannabinoids in marijuana can weaken the immune system, which might make it more difficult for the body to fight infections.

Lung diseases: Long-term use of marijuana can make lung problems worse. Regular, long-term marijuana use has been associated with lung cancer and also with several cases of an unusual type of emphysema, a lung disease.

Seizure disorders: Marijuana might make seizure disorders worse in some people; in other people it might help to control seizures.

Surgery: Marijuana affects the central nervous system. It might slow the central nervous system too much when combined with anesthesia and other medications during and after surgery. Stop using marijuana at least 2 weeks before a scheduled surgery.

From WebMD

=== Interactions =======================

  • Sedative medications (Barbiturates) interacts with MARIJUANA
    Marijuana might cause sleepiness and drowsiness. Medications that cause sleepiness are called sedatives. Taking marijuana along with sedative medications might cause too much sleepiness.
  • Sedative medications (CNS depressants) interacts with MARIJUANA
    Marijuana might cause sleepiness and drowsiness. Medications that cause sleepiness are called sedatives. Taking marijuana along with sedative medications might cause too much sleepiness.Some sedative medications include clonazepam (Klonopin), lorazepam (Ativan), phenobarbital (Donnatal), zolpidem (Ambien), and others.
  • Theophylline interacts with MARIJUANA
    Taking marijuana might decrease the effects of theophylline. But there isn’t enough information to know if this is a big concern.
  • Disulfiram (Antabuse) interacts with MARIJUANA
    Disulfiram (Antabuse) might interact with marijuana. Taking marijuana along with Disulfiram can cause agitation, trouble sleeping, and irritability.
  • Fluoxetine (Prozac) interacts with MARIJUANA
    Taking marijuana with fluoxetine (Prozac) might cause you to feel irritated, nervous, jittery, and excited. Doctors call this hypomania.
  • Warfarin (Coumadin) interacts with MARIJUANA
    Using marijuana might increase the effects of warfarin (Coumadin). Smoking marijuana while taking warfarin (Coumadin) might increase the chance of bruising and bleeding.

From WebMD

Cannabis Allergy
Just like many plants, marijuana plants may trigger allergic reactions in some people, according to a new review of previous studies. Cannabis allergies are rare. People who are allergic to the marijuana plant’s pollen or smoke may get symptoms such as a runny nose, inflammation of the nasal passages, and coughing and sneezing, according to the review. Some people who have touched marijuana have developed hives, and itching and swelling around the eyes. There have also been reports of asthma triggered by exposure to its pollen, according to the review.

For some marijuana users, it is not only the plant itself that may cause an allergic reaction. Pot can become very moldy when it is being stored, and people who are allergic to mold may have reactions, Parikh said.

There has been an increase in allergic reactions in areas where large quantities of marijuana plants are grown due to the pollen.

Avoid if you are allergic to plants of the Cannabaceae family.

From Live Science

A paper published this week by the American College of Allergy, Asthma, and Immunology combines a wealth of research to prove that cannabis allergies are not only real, they’re potentially deadly. The condition, while relatively uncommon, grows increasingly more relevant as the legalization movement in the U.S. continues.

Those allergic to cannabis sativa can present a variety of symptoms ranging from asthma and eczema to conjunctivitis and anaphylaxis. Diagnosis of the allergy, which acts similarly to many others, is generally performed by a skin test.

From The Daily

Marijuana may interfere with the way the body processes certain agents using the liver’s cytochrome P450 enzyme system. As a result, the levels of these agents may be increased in the blood and may cause increased effects or potentially serious adverse reactions. People using any medications should check the package insert and speak with a qualified healthcare professional, including a pharmacist, about possible interactions.

Use cautiously in people who are on estrogen therapy.

Use cautiously in people who have liver disease or those using agents toxic to the liver.

Use cautiously in people who have or are at risk of heart disease. Marijuana may cause abnormal heartbeat, disrupted blood flow to organs (kidney, spleen), heart attack, and heart failure.

From the Mayo Clinic

=== A General Review paper ===============
This review paper ( ) suggests that controlled cannabidiol administration is safe and non-toxic in humans and animals, and doesn’t induce changes on food intake, nor does it affect physiological parameters like the heart rate, body temperature or blood pressure. According to this review, high doses of up to 1,500 mg/day of CBD seem to be well tolerated in humans.

However, the study does mention some potential side effects for cannabidiol, such as the inhibition of hepatic drug metabolism, or the decreased activity of p-glycoprotein. CBD can, indeed, interact with a series of pharmaceuticals, as it inhibits the activity of some liver enzymes called cytochrome P450.

This family of enzymes metabolizes most of the drugs used in humans, so if one uses high doses of CBD, the cannabinoid can temporarily neutralize the activity of P450 enzymes, and thus alter the way drugs are metabolized inside the body.

For sure, this action of CBD can be regarded as a side effect, but it’s not always a negative trait, as the deactivation of P450 enzymes is one of the mechanisms through which CBD neutralizes THC as well. As a side note, grapefruit has a similar effect on the mentioned liver enzymes.

Another reported side effect of CBD administration is an unpleasant dry sensation in the mouth. This effect seems to be caused by the involvement of the endocannabinoid system in the inhibition of saliva secretion. A study published by Argentinian researchers back in 2006 showed that cannabinoid receptors (type 1 and 2) are present in the submandibular glands which are responsible for producing saliva. The activation of these receptors alters the salivary production, leading to mouth dryness (also referred to as “cotton-mouth”).

Early research suggests that CBD taken in high doses may worsen tremor and muscle movement in Parkinson’s disease sufferers. Yet, there are also studies that suggest that cannabidiol is safe and well-tolerated by patients affected by this condition.

This study in full is here in this PDF