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Rare vegetative side effects: Can increased blood pressure, headache, chills, nausea, and belly ache be ascribed to cannabis use?

Franjo Grotenhermen

Cannabis exerts manifold effects on the vegetative nervous system, among them increased heart rate, dry mouth, slowdown of intestinal movements, changes of blood pressure (decrease and increase). These effects are usually mild and well tolerated. Their intensity varies from person to person. In some subjects an unusual intensity of these side effects and unusual kinds of vegetative side effects have been observed, Among them strong increase of heart rate, strong increase of blood pressure, shivering and chills, bellyache, headache, nausea and vomiting.
The following experiences were told to me by recreational users: A young man who had used cannabis for many years without relevant side effects experienced strong headache after the use of LSD which made him to attend a hospital. A high blood pressure (systolic pressure of 190 mmHg) was measured. Later every use of cannabis also resulted in headache and significant increase of blood pressure. Another user reported signficant and frightening increase of heart rate (140 beats per minute) lasting for more than one hour occuring sometimes after use of the drug. Two cannabis users reported of bellyache within a few minutes after smoking of whom one experienced flatulences. Another user experienced chills and shivering every time he used the drug. In the internet (http://rxmarijuana.com) I found the report of a man who complained of several symptoms, significant increase of heart rate, anxiety, painful belching, and chills.

Unimed Pharmaceuticals

Adverse experiences information summarized in the tables below was derived from well-controlled clinical trials conducted in the US and US territories involving 474 patients exposed to Marinol (dronabinol). Studies of AIDS related weight loss included 157 patients receiving dronabinol at a dose of 2.5 mg twice daily and 67 receiving placebo. Studies of nausea and vomiting related to cancer chemotherapy included 317 patients receiving dronabinol and 68 receiving placebo. A cannabinoid dose-related "high" (easy laughing, elation and heightened awareness) has been reported by patients receiving Marinol in both the antiemetic (24%) and the lower dose appetite stimulant clinical trials (8%).
The most frequently reported adverse experiences in patients with AIDS during placebo-controlled trials involved the CNS [central nervous system] and were reported by 33% of patients receiving Marinol. About 25% of patients reported a minor CNS adverse event during the first 2 weeks and about 4% reported such an event each week for the next 6 weeks thereafter.

PROBABLY CAUSALY RELATED: Incidence greater than 1%.
Rates derived from clinical trials in AIDS-related anorexia [appetite loss] (N=157) and chemotherapy-related nausea (N=317). Rates were generally higher in the anti-emetic use (given in parenthesis). [Explanation of technical terms in square brackets].
Body as a whole: Asthenia [loss or lack of strength or energy].
Cardiovascular [related to heart and circulation]: Palpitation [uneasy awareness of the heart beat], tachycardia [fast heart rate], vasodilation/facial flash.
Digestive [related to digestion]: Abdominal pain, nausea, vomiting.
Nervous system: (Amnesia), anxiety/nervousness, (ataxia [disturbance of muscle coordination]), confusion, depersonalization, dizziness, euphoria, (hallucination), paranoid reaction, somnolence, thinking abnormal.

PROBABLY CAUSALY RELATED: Incidence less than 1%.
Event rates derived from clinical trials in AIDS-related anorexia (N=157) and chemotherapy-related nausea (N=317).
Cardiovascular: Conjunctivitis [reddening of the eye], hypotension.
Digestive: Diarrhea, fecal incontinence.
Musculosceletal: Myalgia [pain in the muscles].
Nervous system: Depression, nightmares, speech difficulties, tinnitus [ear noise].
Skin and Appendages [hair and nails]: Flushing.
Special senses: Vision difficulties.

The clinical significance of the association of these events with Marinol treatment is unknown, but they are reported as alerting information for the clinician.
Body as a whole: Chills, headache, malaise.
Digestive: Anorexia, hepatic enzyme elevation.
Respiratory: Cough, rhinitis, sinusitis.
Skin and Appendages: Sweating.

Source: Information on Marinol (dronabinol, THC), Unimed Pharmaceuticals, Inc., January 2001, www.marinol.com (physicians information).

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