{"guncelleme":"2026-10-21","aciklama":"Evidence summary; not a personal dose recommendation. The 'doz' fields are only the doses used in studies or in drug approvals. kanit_duzeyi applies to pure CBD; products containing THC are in the kanit_duzeyi_thc_icerenler field. urun_turu: saf_cbd | thc_iceren | cbd_zengin_thc_belirsiz | cbn_diger | karma. kanit_yonu: yarar_gosterildi | olasi_kucuk_yarar | celiskili | yarar_gosterilmedi | olasi_zarar | veri_yok.","konular":[{"id":"dravet-syndrome","baslik":"Epilepsy: Dravet syndrome","grup":"Epilepsy","grup_kodu":"epilepsi","tr_id":"epilepsi-dravet","kanit_duzeyi":"guclu","kanit_yonu":"yarar_gosterildi","kanit_ozet":"In two double-blind RCTs (GWPCARE1 and GWPCARE2), prescription pure CBD added to existing medicines reduced convulsive seizures more than placebo over 14 weeks. 10 and 20 mg/kg/day had a similar effect; 10 mg/kg/day was better tolerated. Complete seizure freedom was rare (5% vs. 0% in GWPCARE1), and seizures also decreased in the placebo group. In a dose-ranging safety RCT with 5–20 mg/kg/day in 34 children aged 4–10, CBD levels rose in proportion to the dose, clobazam's active metabolite rose, and liver enzymes rose in 6 patients taking valproate (all returned to normal). The efficacy studies were all 14 weeks long, add-on treatment and manufacturer-funded; the EMA writes that efficacy has not been proven in patients not taking clobazam. The Stockings 2018 review in the table found CBD superior to placebo for a reduction in seizures of at least half, but rated the certainty of the evidence as low (GRADE); this assessment was based on a search up to October 2017 and, for this outcome, on two RCTs (291 patients). Later meta-analyses combining four RCTs (Lattanzi 2018; Lattanzi 2020, clobazam status) and the meta-analysis combining the three RCTs in Dravet only (Lattanzi 2020, Dravet meta-analysis: seizure reduction of at least half RR 1.69; 95% CI 1.21–2.36; stopping treatment 9.0% vs. 2.3%) gave results in the same direction; the guide's \"strong\" assessment rests on this whole body of evidence. The latest version of the Cochrane review of medicines in Dravet (2017) predates the CBD studies, so it does not include CBD. In analyses that split the same four RCTs by clobazam use, CBD was better than placebo in patients not taking clobazam too. The reduction in seizure count was smaller in patients without clobazam (both conditions and both doses combined, the ratio of seizure frequency vs. placebo was 0.59 with clobazam and 0.85 without clobazam; looking at the two doses separately, the difference was not significant without clobazam; manufacturer analysis, Devinsky 2020); in the share of patients whose seizures fell by at least half, the difference from placebo was similar in the two groups (RR 1.85 and 1.80 in an independent meta-analysis; Lattanzi 2020, clobazam status). In 89 patients with Dravet taking both stiripentol and clobazam, CBD's effect was numerically favorable but not significant (Devinsky 2020). Because whether patients took these medicines was not decided at random, these comparisons are not conclusive. In two network meta-analyses comparing Dravet medicines (there are no studies comparing the medicines directly; the comparisons are indirect), the share of patients whose seizures fell by at least half was lower with CBD than with fenfluramine and stiripentol (vs. fenfluramine OR 0.20; 95% CI 0.07–0.54; Lattanzi 2023); the result was the same when looking only at patients using it together with clobazam (Guerrini 2024). The certainty of these comparisons is limited: stiripentol rests on two small studies (64 children) done an estimated 15–20 years ago, 33–49% of patients in the CBD studies were already taking stiripentol, and one of the analyses was funded by the maker of stiripentol. The picture for side effects is different: in one analysis, the share of patients with side effects was lower with CBD than with fenfluramine and stiripentol, while stopping treatment was more common with CBD than with stiripentol (Lattanzi 2023). In the open-label extension of the two RCTs, the median reduction in convulsive seizures in 315 patients stayed between 45% and 74% in 12-week periods up to 156 weeks; according to the final results on ClinicalTrials.gov (registry, not a peer-reviewed publication), 170 of the patients completed the study and the median reduction in the last 12 weeks was 40%; liver enzymes rose markedly in 22% of patients, 84% of whom were taking valproate (Scheffer 2021). In everyday-practice studies, mostly from Europe, the share of patients with Dravet whose seizures fell by at least half ranged from 22% to 51%; in a study in adults in England, seizures fell by more than 30% in only 3 of 17 patients, and in the 15 patients using it without clobazam the rate was 13–21%; these studies have no comparison group, and in most of them some authors have financial ties to the manufacturer. There is no controlled study of unapproved cannabis products in Dravet. October 2026 search (PubMed, Cochrane, ClinicalTrials.gov): 3 placebo-controlled RCTs with cannabinoids on this topic (one a dose study mainly measuring safety and drug levels) and 6 systematic reviews (2 of them indirect comparisons with other Dravet medicines) were found; these are in the table below together with a manufacturer-supported pooled analysis of the same studies, 10 studies without randomized comparison (long-term extension, access programs, everyday practice, and unapproved or THC-containing products) and 3 drug-level studies measuring drug interactions (two placebo-controlled in patients with epilepsy, one in healthy volunteers). No controlled study with THC-containing products in Dravet was found.","kanit_duzeyi_metin":"Strong (double-blind, placebo-controlled RCTs + meta-analyses)","kanit_duzeyi_thc_icerenler":"yetersiz","kanit_duzeyi_thc_icerenler_metin":"Insufficient: no controlled study with a THC-containing product in Dravet; there is only one small open-label study of 20 children with no comparison group","kaynak_dosya":"epilepsi.md","saf_cbd_sonuc":"Approved, purified medicinal CBD (Epidiolex/Epidyolex) was found effective as an add-on treatment in Dravet syndrome (two double-blind RCTs and meta-analyses; strong evidence); the effect continued in long-term follow-up with no comparison group, and in indirect comparisons with limited certainty against the other medicines approved for Dravet (fenfluramine, stiripentol), its effect on reducing seizures looked smaller; this result cannot be applied to CBD oils whose content and dose are unknown.","thc_icerenler_sonuc":"There is no controlled study with THC-containing products in Dravet syndrome. In the only prospective study specific to Dravet, a cannabis oil also containing a small amount of THC (CBD:THC 50:1) was tried in 20 children for 20 weeks and seizures decreased (median 70.6% for motor seizures); but because there was no placebo group and the contribution of THC could not be separated from that of CBD, this result does not show a benefit of THC. The study was largely funded by the company that makes the product.","ruhsat":"FDA (≥1 year, no clobazam requirement): start at 2.5 mg/kg twice daily (5 mg/kg/day); after 1 week, maintenance dose 5 mg/kg twice daily (10 mg/kg/day). If further seizure reduction is needed, increase weekly by 2.5 mg/kg twice daily up to a maximum of 10 mg/kg twice daily (20 mg/kg/day); for faster titration, increase no more often than every other day. Label: 20 mg/kg/day gives somewhat greater seizure reduction but more side effects. EMA (≥2 years, add-on treatment only together with clobazam): 5 mg/kg/day for 1 week, then maintenance 10 mg/kg/day; increases above 10 mg/kg/day based on individual benefit-risk and with the full monitoring schedule, maximum 20 mg/kg/day. Hepatic impairment: moderate (Child-Pugh B) start at 1.25 mg/kg twice daily, severe (Child-Pugh C) 0.5 mg/kg twice daily. Stopping is done gradually. Source: FDA label (05/2026) §2.1–2.2, §2.5–2.6; EMA product information §4.1–4.2 (last updated in the EPAR on August 20, 2026). Turkey: Epidyolex/cannabidiol is not on the TİTCK (Turkish Medicines and Medical Devices Agency) list of approved products (October 16, 2026); on the TİTCK Foreign Active Ingredient List (September 28, 2026), cannabidiol oral solution (YDN02BG1099) is listed as a red-prescription drug and among the medicines that cannot be imported without TİTCK's written approval.","doz_araligi_ozet":"10–20 mg/kg/day in the labeling and RCTs (divided into two equal doses); up to a ceiling of 25–50 mg/kg/day in the open-label expanded access program; at most 30 mg/kg/day (mean 22 mg/kg/day) in the open-label extension study; in everyday-practice studies in Europe, the median or mean dose was mostly 11–16 mg/kg/day","titrasyon_ozet":"Labeling: start at 5 mg/kg/day, 10 mg/kg/day after 1 week; if needed, increase by 5 mg/kg/day weekly up to a maximum of 20 mg/kg/day. In the RCTs, a 2-week titration (10 mg/kg/day reached in 7 days, 20 mg/kg/day in 11 days), followed by 12 weeks of maintenance","yan_etkiler":["Sleepiness/sedation: Epidiolex (LGS/Dravet) 32% (10 mg/kg/day 27%, 20 mg/kg/day 34%), placebo 11%","Diarrhea, decreased appetite, vomiting, fever, tiredness (common in RCTs)","Liver enzyme (ALT) >3×ULN: in controlled studies, LGS/Dravet 13%, TSC 12% (placebo 1%); 17% at 20 mg/kg/day, 1% at 10 mg/kg/day; >20×ULN <1%","ALT >3×ULN with valproate: valproate+clobazam 30%, valproate alone 21%, clobazam alone 4%, neither 3% (FDA)","Sleepiness/sedation with clobazam 46% (without clobazam 16%)","Stopping due to side effects 8.9% vs. 1.8% (Lattanzi 2018 meta-analysis)","Labeling warnings: suicidal thoughts and behavior (class warning for all antiseizure medicines), hypersensitivity (including to sesame oil), increased seizures on sudden stopping; EMA: seizure frequency may increase, weight loss/failure to gain weight","Postmarketing: cholestatic/mixed-type liver injury and (mostly in people taking valproate/clobazam) elevated ammonia were reported (FDA)","Long term (Dravet extension study GWPCARE5, median 444 days): side effects 97%, stopping due to side effects 9%, transaminases >3×ULN 22% (84% of whom were taking valproate); in the final results in the registry, serious side effects 42% (Scheffer 2021; NCT02224573)","Weight loss: in the LGS/Dravet controlled studies, a decrease of at least 5% in measured weight from baseline occurred in 16% of people taking CBD and 8% on placebo; the decrease appeared dose-related (18% at 20 mg/kg/day, 9% at 10 mg/kg/day). Weight loss reported as a side effect: 3% at 10 mg/kg/day, 5% at 20 mg/kg/day, 1% on placebo. In the TSC study (25 mg/kg/day), weight loss of at least 5% was 31% vs. 8% (FDA, product information 05/2026)"],"izlem":["Before starting: ALT, AST and total bilirubin (FDA and EMA)","Liver tests at months 1, 3 and 6, then periodically or as clinically needed","FDA: within 1 month after a dose change or after adding a medicine that affects the liver; EMA: the monitoring schedule starts over when going above 10 mg/kg/day or when a medicine that affects the liver is changed","People using valproate and those with high baseline ALT/AST: per the EMA, at week 2 and months 1, 2, 3 and 6, then periodically","Stopping rule (FDA and EMA): CBD is stopped if transaminases are >3×ULN and bilirubin >2×ULN, or if transaminases are persistently >5×ULN","If liver symptoms occur (unexplained nausea, vomiting, right upper abdominal pain, tiredness, loss of appetite, jaundice, dark urine), check ALT/AST/bilirubin right away","Blood levels and side effects of co-administered antiseizure medicines (Gaston 2017, PMID 28782097)"],"dikkat":["Epilepsy treatment is started, changed and stopped by a neurologist's decision; antiseizure medicines are not stopped on one's own","CBD is stopped by tapering the dose gradually; stopping suddenly carries a risk of increased seizures and status epilepticus (FDA §2.5, §5.5). EMA: in studies, stopping was done over ~10 days, reducing by ~10% per day","In moderate (Child-Pugh B) and severe (Child-Pugh C) hepatic impairment, the labeling specifies lower starting and maintenance doses; no adjustment is needed in mild impairment","Hypersensitivity to sesame oil is a contraindication (Epidyolex contains 736 mg of refined sesame oil and 79 mg of ethanol per ml)","People using valproate or clobazam need more frequent monitoring for liver effects and sedation","Age: FDA ≥1 year, EMA ≥2 years","The medicine is always taken the same way in relation to food; with a high-fat meal, Cmax rises 5-fold and AUC 4-fold. Measure with a calibrated syringe; a household spoon is not suitable","Unregulated (artisanal) CBD/cannabis oils are not a substitute for the approved medicine: the label is unreliable, they may contain THC and contaminants, and there are reports of increased seizures","In Turkey, fenfluramine (Fintepla, 2025) is approved for Dravet; medicinal CBD, however, is not approved (TİTCK, the Turkish Medicines and Medical Devices Agency, October 16, 2026)"],"ilac_etkilesim_notlari":["Clobazam: CBD raises the active metabolite N-desmethylclobazam ~3-fold (FDA) / 3–4-fold (EMA) (total exposure 2.6-fold in a placebo-controlled study in patients with epilepsy taking clobazam, VanLandingham 2020; 3.4-fold in healthy volunteers, Morrison 2019; this increase was not seen in 4 children with Dravet also taking stiripentol, Devinsky 2018); clobazam also raises 7-OH-CBD (AUC 47%). If sleepiness occurs, reducing the clobazam dose is considered","Valproate: raised liver enzymes increase markedly; diarrhea and decreased appetite also increase (EMA). If enzymes rise, CBD and/or valproate is reduced or stopped","Stiripentol: in healthy volunteers, Cmax 28%, AUC 55% (Morrison 2019); in a placebo-controlled study in patients with epilepsy, Cmax up 17%, AUC up 30% (Ben-Menachem 2020). Side effects are closely monitored","Everolimus: exposure rises ~2.5-fold; levels are monitored, and in patients using CBD, everolimus is started at a lower dose","Topiramate, rufinamide, zonisamide, eslicarbazepine: in an open-label study, serum levels rose as the CBD dose increased (most stayed within the therapeutic range)","Sirolimus, tacrolimus, digoxin (oral P-gp substrates): exposure may rise; level monitoring and dose reduction are considered","Strong CYP3A4/CYP2C19 inducers (rifampin; EMA: carbamazepine, enzalutamide, mitotane, St. John's wort): rifampin lowered CBD by ~32% and 7-OH-CBD by ~63% (FDA); FDA (05/2026): with a strong inducer, increasing the Epidiolex dose up to at most 2-fold may be considered based on response and tolerability","CYP1A2 substrates (theophylline, tizanidine, caffeine): caffeine AUC rose 95%; dose reduction is considered for narrow-range medicines","CYP2C19 prodrugs such as clopidogrel: the active metabolite may decrease","Alcohol and other CNS depressants: sleepiness and sedation increase; alcohol also increases CBD exposure (Cmax 93%, AUC 63%)"],"dogrulanamayan":["The full texts of GWPCARE1, GWPCARE3 (NEJM) and GWPCARE4 (Lancet) could not be accessed; design, titration and results were verified with the ClinicalTrials.gov record and results, the PubMed abstract and the EMA product information. For Laux 2019, only the abstract was read","No official source was found on whether the route of importing for personal treatment with a doctor's report (TİTCK permission) has been used for Epidyolex in Turkey","Difference in efficacy: the expert opinion section of a fenfluramine review says CBD's efficacy appears 'lower' than fenfluramine's and 'similar' to stiripentol's (Schoonjans and Ceulemans 2021; PMID 33455486). This is not a direct comparison; the full text is paywalled, and only the abstract was read. In two network meta-analyses found in the October 2026 search (in the table; Lattanzi 2023, Guerrini 2024), the response rate with CBD was lower than with fenfluramine and stiripentol, so the 'similar to stiripentol' view does not agree with these analyses; but stiripentol rests on two small studies (64 children in total) done an estimated 15–20 years ago, the confidence intervals are very wide, and there is no study comparing the medicines directly","Of the studies added in the October 2026 search, only the PubMed abstract could be read for Scheffer 2021, Lattanzi 2020 (Dravet meta-analysis), Nabbout 2023, Silvennoinen 2021, Lelli 2026 and Press 2015. The centers of the three everyday-practice studies in Italy (Cerulli Irelli 2025, Perulli 2025, Lelli 2026) partly overlap; how many of the patients overlap is unknown. Some numbers do not add up within the articles themselves: D'Onofrio 2020 gives the Dravet subgroup as 22 patients, but the percentages it reports appear to be calculated on 23 patients; Lattanzi 2020 (Dravet meta-analysis) and Lattanzi 2023 give the number of patients taking CBD as 228, but the CBD arms of the same three studies add up to 221. The numbers were taken as given in the articles"],"calismalar":[{"ad":"Devinsky 2017 (GWPCARE1)","tasarim":"Double-blind, placebo-controlled RCT","n":"120","populasyon":"Dravet syndrome, aged 2–18 (CT.gov eligibility criterion)","urun":"Oral CBD solution (GW; pure CBD)","urun_turu":"saf_cbd","doz":"20 mg/kg/day","titrasyon":"2 weeks (20 mg/kg/day reached in 11 days), then 12 weeks of maintenance; preceded by a 4-week drug-free baseline observation (CT.gov NCT02091375; EMA product information §5.1)","sure":"14 weeks","sonuc":"Median monthly convulsive seizures 12.4 → 5.9 (placebo 14.9 → 14.1); adjusted median difference −22.8 points (p=0.01). ≥50% response 43% vs. 27% (p=0.08); seizure-free 5% vs. 0% (p=0.08). No significant reduction in non-convulsive seizures","yan_etki":"Diarrhea, vomiting, tiredness, fever, sleepiness, abnormal liver tests; more study discontinuations in the CBD arm","pmid":"28538134","doi":"10.1056/NEJMoa1611618","diger_kaynak":"NCT02091375. Combined post hoc analyses of GWPCARE1 and GWPCARE2 (manufacturer-supported): Madan Cohen 2021, Epilepsia 62:2218–27 (PMID 34265088): the difference from placebo emerged during titration, on day 12 at 20 mg/kg/day (nominal p = 0.02) and on day 13 at 10 mg/kg/day (p = 0.03); most of the most common side effects (sleepiness, decreased appetite, diarrhea) resolved within 4 weeks. Devinsky 2024, Epilepsy Behav 156:109805 (PMID 38677101; funded by the manufacturer): in 124 placebo patients, seizure counts fell from baseline, but seizure-free days and the caregiver's global impression barely changed"},{"ad":"Miller 2020 (GWPCARE2)","tasarim":"Double-blind, placebo-controlled, dose-comparison RCT","n":"199 randomized (198 eligible)","populasyon":"Dravet syndrome, aged 2–18","urun":"Pharmaceutical CBD solution (pure CBD)","urun_turu":"saf_cbd","doz":"10 or 20 mg/kg/day, 2 equal doses","titrasyon":"2 weeks: started at 2.5 mg/kg/day; increased to 10 mg/kg/day on day 7 and to 20 mg/kg/day on day 11","sure":"14 weeks","sonuc":"Reduction in convulsive seizures 48.7% (10 mg) and 45.7% (20 mg), placebo 26.9%; vs. placebo 29.8% (95% CI 8.4–46.2; p=0.01) and 25.7% (95% CI 2.9–43.2; p=0.03). ≥50% reduction 43.9% and 49.3%, placebo 26.2% (OR 2.21 and 2.74); convulsive seizure-free throughout treatment: 2 patients at 10 mg, 2 at 20 mg, 1 on placebo. No clear difference between groups in sleep, daytime sleepiness, quality of life, adaptive behavior or cognitive function (few patients completed these measures). The manufacturer (GW Research) funded and ran it; all 10 authors have ties to the manufacturer (3 are employees)","yan_etki":"Decreased appetite, diarrhea, sleepiness, fever, tiredness. Raised transaminases in 13 patients at 20 mg and 3 at 10 mg; all were using valproate. 5 discontinuations in the 20 mg arm","pmid":"32119035","doi":"10.1001/jamaneurol.2020.0073","diger_kaynak":"NCT02224703. The correction to the publication (PMID 32391881) only corrects the name of one investigator"},{"ad":"Devinsky 2018 (dose-ranging safety study)","tasarim":"Multicenter, double-blind, placebo-controlled dose-ranging RCT (4:1)","n":"34 (5 mg/kg 10, 10 mg/kg 8, 20 mg/kg 9, placebo 7)","populasyon":"Children aged 4–10 with Dravet syndrome","urun":"Pharmaceutical-grade pure CBD (GWP42003-P)","urun_turu":"saf_cbd","doz":"5, 10 or 20 mg/kg/day, divided into 2 doses a day","titrasyon":"3 weeks of treatment including titration, tapering over 10 days","sure":"3 weeks","sonuc":"Safety and pharmacokinetics study: CBD and its metabolites rose in proportion to the dose; clobazam's active metabolite (N-desmethylclobazam) rose (except in those taking stiripentol); levels of other antiseizure medicines did not change","yan_etki":"Most common fever, sleepiness, decreased appetite, sedation, vomiting, balance problems, behavior change; liver enzymes rose in 6 patients taking valproate, and all returned to normal","pmid":"29540584","doi":"10.1212/WNL.0000000000005254","diger_kaynak":"ClinicalTrials.gov NCT02091206"},{"ad":"Lattanzi 2018","tasarim":"Systematic review and meta-analysis (4 RCTs)","n":"550","populasyon":"LGS and Dravet syndrome","urun":"Medicinal CBD (pure)","urun_turu":"saf_cbd","doz":"10 and 20 mg/kg/day","titrasyon":null,"sure":null,"sonuc":"Difference in seizure frequency vs. placebo 19.5 points (10 mg/kg/day) and 19.9 points (20 mg/kg/day). ≥50% reduction in all seizures 37.2% vs. 21.2% (20 mg; RR 1.76)","yan_etki":"Stopping because of side effects 8.9% vs. 1.8% (RR 5.59); RR 6.89 at 20 mg, not significant at 10 mg","pmid":"30390221","doi":"10.1007/s40265-018-0992-5","diger_kaynak":null},{"ad":"Lattanzi 2020 (clobazam status)","tasarim":"Systematic review and meta-analysis (4 RCTs)","n":"714","populasyon":"LGS and Dravet syndrome","urun":"Medicinal CBD (pure)","urun_turu":"saf_cbd","doz":"not reported","titrasyon":null,"sure":null,"sonuc":"≥50% response: without clobazam 29.1% vs. 15.7% (RR 1.80); with clobazam 52.9% vs. 27.8% (RR 1.85). Clobazam was not randomized; the authors caution about this","yan_etki":null,"pmid":"32452532","doi":"10.1111/epi.16546","diger_kaynak":null},{"ad":"Stockings 2018","tasarim":"Systematic review (6 RCTs + 30 observational studies)","n":"not reported","populasyon":"Drug-resistant epilepsy; mean age 16.1","urun":"Medicinal CBD (RCTs) + various products in observational studies","urun_turu":"karma","doz":"20 mg/kg/day (RCT)","titrasyon":null,"sure":null,"sonuc":"≥50% seizure reduction RR 1.74 (NNT 8); GRADE: low","yan_etki":"Side effects RR 1.24; serious side effects RR 2.55","pmid":"29511052","doi":"10.1136/jnnp-2017-317168","diger_kaynak":null},{"ad":"Lattanzi 2020 (Dravet meta-analysis)","tasarim":"Systematic review and meta-analysis (3 RCTs, Dravet only)","n":"359 (CBD 228, placebo 131; numbers from the abstract, see source note)","populasyon":"Dravet syndrome","urun":"Medicinal CBD (plant-derived purified oral solution)","urun_turu":"saf_cbd","doz":"not reported (in the abstract)","titrasyon":null,"sure":null,"sonuc":"A reduction of at least half in convulsive seizures was more common with CBD than with placebo: RR 1.69 (95% CI 1.21–2.36; p=0.002). No difference in the risk of any side effect (RR 1.06; 95% CI 0.87–1.28); side effects significantly linked to CBD were sleepiness, decreased appetite, diarrhea and raised liver enzymes. A pooling of the same three RCTs; no new patient data.","yan_etki":"Stopping treatment 9.0% with CBD, 2.3% with placebo (RR 3.12; 95% CI 1.07–9.10)","pmid":"32040850","doi":"10.1007/s40263-020-00708-6","diger_kaynak":null},{"ad":"Lattanzi 2023 (network meta-analysis)","tasarim":"Systematic review and network meta-analysis (8 placebo-controlled RCTs in Dravet: stiripentol 2, CBD 3, fenfluramine 2, soticlestat 1)","n":"680 (according to the article's text: CBD 228, fenfluramine 122, stiripentol 33, soticlestat 26, placebo 271); when the arms in the article's patient table are added up, CBD 221, total 673","populasyon":"Dravet syndrome","urun":"Pharmaceutical-grade CBD; comparators stiripentol, fenfluramine and soticlestat","urun_turu":"saf_cbd","doz":"CBD 10 and 20 mg/kg/day (5–20 in the dose-ranging study)","titrasyon":null,"sure":"Search up to the last week of January 2023; studies 8–20 weeks","sonuc":"All the medicines were better than placebo for a reduction of at least half in convulsive seizures. In the indirect comparison, this rate was lower with CBD than with fenfluramine (OR 0.20; 95% CI 0.07–0.54) and higher with stiripentol than with CBD (OR 14.07; 95% CI 2.57–76.87; the stiripentol estimate rests on two small studies, and the confidence interval is very wide). No significant difference between the medicines for seizure freedom; the only medicine that significantly increased seizure freedom vs. placebo was stiripentol. There are no studies comparing the medicines directly. Of the 10 authors, 4 report receiving payments or support from the CBD manufacturer (GW), 1 from the maker of fenfluramine, Zogenix, and 5 from UCB, Zogenix's current owner (the people overlap; most are stated as unrelated to the study); the university paid the open-access fee.","yan_etki":"With CBD, stopping treatment for any reason (OR 3.49; 95% CI 1.11–10.95) and stopping because of side effects (OR 5.18; 1.15–23.23) more common than with placebo; stopping treatment for any reason less common with stiripentol than with CBD (OR 0.08; 0.01–0.61 in the Results; the abstract says 0.45; 0.04–5.69). Any side effect less common with CBD than with fenfluramine (OR 0.22; 0.06–0.78) and stiripentol (stiripentol vs. CBD OR 75.72; 3.59–1598.58); no difference between the medicines in serious side effects","pmid":"37695433","doi":"10.1007/s40265-023-01936-y","diger_kaynak":null},{"ad":"Guerrini 2024 (network meta-analysis, approved doses)","tasarim":"Systematic review and network meta-analysis (two placebo-controlled RCTs each for stiripentol, fenfluramine and CBD; approved doses and, for CBD, clobazam subgroups)","n":"6 RCTs; the arms in the article's data table add up to 559 patients (64 in the stiripentol studies, 177 fenfluramine, 318 CBD)","populasyon":"Dravet syndrome (as the first add-on medicine)","urun":"Pharmaceutical-grade CBD (GWPCARE1, GWPCARE2); comparators stiripentol and fenfluramine","urun_turu":"saf_cbd","doz":"CBD 10 and 20 mg/kg/day (all patients and those taking clobazam separately)","titrasyon":null,"sure":"Studies 8–14 weeks","sonuc":"For a reduction of at least half in convulsive seizures, the absolute difference vs. placebo was 64% for stiripentol, 62% for fenfluramine 0.7 mg/kg/day, 19% for CBD 20 mg/kg/day (25% in those taking clobazam) and 16% for CBD 10 mg/kg/day (18% in those taking clobazam, not significant); both stiripentol and fenfluramine were significantly superior to the approved doses of CBD on this measure and for a 75% reduction. For seizure freedom, stiripentol was superior to fenfluramine and CBD. The stiripentol studies were done 15–20 years ago, were shorter, and one was stopped early because a clear benefit was seen at an interim analysis; 33–49% of patients in the CBD studies were already taking stiripentol; the comparisons are indirect. The maker of stiripentol (Biocodex) funded it; 1 of the 5 authors is a Biocodex employee; 2 are executives of consulting firms working for Biocodex and former employees of the maker of fenfluramine (Zogenix/UCB); 2 sit on advisory boards of companies including Biocodex and the CBD manufacturer and were investigators in the stiripentol studies.","yan_etki":"No significant difference between the medicines in serious side effects; an increase in serious side effects vs. placebo only with CBD 20 mg/kg/day (RR 1.90; 95% CI 1.03–3.50). Stopping because of side effects lowest with stiripentol (the stiripentol studies were shorter)","pmid":"38427284","doi":"10.1002/epi4.12923","diger_kaynak":null},{"ad":"Devinsky 2020 (clobazam subgroups)","tasarim":"Post hoc analysis in which the manufacturer split the 4 RCTs (GWPCARE1–4) by clobazam use and combined them (stratified meta-analysis)","n":"714 (318 Dravet, 396 LGS); CBD 429 (240 with clobazam, 189 without clobazam), placebo 285","populasyon":"Dravet (aged 2–18) and LGS; in the Dravet studies, 64% of patients were taking clobazam and about 38% stiripentol","urun":"Epidiolex/Epidyolex (100 mg/mL oral solution, purified CBD)","urun_turu":"saf_cbd","doz":"10 and 20 mg/kg/day","titrasyon":null,"sure":"14 weeks","sonuc":"With both doses and both conditions combined, the ratio of seizure frequency vs. placebo was 0.59 (95% CI 0.52–0.68) with clobazam and 0.85 (0.73–0.98; p=0.023) without clobazam: on this measure, the effect is smaller without clobazam and the dose groups are not significant individually. The OR for a reduction of at least half, however, is similar in the two groups: 2.51 (1.69–3.71) with clobazam, 2.40 (1.38–4.16) without clobazam. In 89 patients taking both stiripentol and clobazam (all from the Dravet studies; 58 CBD, 31 placebo), CBD's effect vs. placebo was numerically favorable but not significant (ratio 0.81; 0.57–1.17; OR 1.51; 0.36–6.41). Clobazam use was not randomized; about two-thirds of those not taking clobazam had tried and stopped clobazam before. All the authors (7/7) are employees (5) or consultants and investigators (2) of the manufacturer; the manufacturer funded it.","yan_etki":"Sleepiness, rash, pneumonia and aggression more common together with clobazam; stopping because of side effects at 20 mg/kg/day 13.0% with clobazam, 8.0% without clobazam","pmid":"32592183","doi":"10.1111/ane.13305","diger_kaynak":"Gunning 2021, Acta Neurol Scand 143:154–63 (PMID 32969022): manufacturer-supported clobazam subgroup analysis of the same 4 RCTs; in Dravet, ratio of convulsive seizures vs. placebo 0.71 (95% CI 0.60–0.83) in all patients, 0.63 (0.52–0.77) with clobazam; OR for a reduction of at least half 2.34 (1.51–3.63) and 2.78 (1.62–4.77); 3 of the 7 authors are employees of the manufacturer, 4 are consultants or investigators for the manufacturer"},{"ad":"Scheffer 2021 (GWPCARE5, Dravet)","tasarim":"Open-label extension study (those who completed GWPCARE1 and GWPCARE2); no control group","n":"315 (95% of the 330 patients who completed the RCTs)","populasyon":"Dravet syndrome (children and young people from the RCTs)","urun":"Epidiolex/Epidyolex (100 mg/mL oral solution, purified CBD)","urun_turu":"saf_cbd","doz":"Target 20 mg/kg/day; could be reduced or increased to at most 30 mg/kg/day based on response and tolerability; mean most frequently used dose 22 mg/kg/day","titrasyon":"From 2.5 to 20 mg/kg/day over 2 weeks","sure":"Median 444 days (18–1535 days); efficacy up to 156 weeks","sonuc":"In patients from GWPCARE1 and GWPCARE2, median reduction in convulsive seizures 45–74% and in total seizures 49–84% in 12-week periods up to 156 weeks; in each period, at least 83% of patients or caregivers reported improvement in overall condition. According to the final results on ClinicalTrials.gov (not a peer-reviewed publication), 170 of 315 patients completed the study (of those who left, 62 at the patient's or family's request, 26 because of side effects, 23 by investigator decision, 20 for lack of effect); median reduction in convulsive seizures in the last 12 weeks 40% (IQR −77.8 to +6.7). No control group, and only those who completed the first study and continued were included. Run by the manufacturer (GW Research); 2 of the 11 authors are employees of the manufacturer, and the conflict-of-interest statements of the others could not be read (in the interim analysis of the same study, all 7 authors had ties to the manufacturer).","yan_etki":"Side effects 97% (mild 23%, moderate 50%, severe 25%); most common diarrhea 43%, fever 39%, decreased appetite 31%, sleepiness 28%. Stopping because of side effects 28 patients (9%). Liver enzymes (transaminases) >3×ULN in 69 patients (22%); 84% of them were taking valproate. In the final results in the registry, serious side effects in 133 patients (42%), 6 deaths (relationship to the drug not stated in the registry)","pmid":"34406656","doi":"10.1111/epi.17036","diger_kaynak":"NCT02224573 (681 patients with LGS and Dravet together; separate results for Dravet in the registry, posted in February 2022). Interim analysis: Devinsky 2019, Epilepsia 60:294–302 (PMID 30582156): 264 patients with data as of November 2016, median 274 days; transaminases ≥3×ULN in 22 of 128 patients (17.2%) from GWPCARE1, all taking valproate; stopping because of side effects 6.4%; median reduction in convulsive seizures 38–44% up to week 48"},{"ad":"Laux 2019","tasarim":"Open-label expanded access program (EAP), LGS/Dravet subgroup","n":"152 (58 Dravet, 94 LGS)","populasyon":"LGS and Dravet syndrome","urun":"Epidiolex 100 mg/ml (pure CBD)","urun_turu":"saf_cbd","doz":"Start at 2–10 mg/kg/day → ceiling of 25–50 mg/kg/day; median 21–25 mg/kg/day in weeks 12–96","titrasyon":"Varied by center","sure":"Median 78.3 weeks","sonuc":"At week 12, major motor seizures reduced by 50% and all seizures by 44%; consistent up to 96 weeks (no control group; results given for LGS and Dravet together, no separate result for Dravet in the abstract)","yan_etki":"Sleepiness 30%, diarrhea 24%; 28% stopped (mostly for lack of effect, 20%)","pmid":"31022635","doi":"10.1016/j.eplepsyres.2019.03.015","diger_kaynak":null},{"ad":"Ben-Menachem 2020 (stiripentol and valproate interaction, in patients)","tasarim":"Phase 2, double-blind, placebo-controlled, randomized (4:1), two-arm drug interaction study; not designed to measure efficacy","n":"35 randomized: stiripentol arm 14 (12 CBD, 2 placebo), valproate arm 21 (1 left before taking the drug; 16 CBD, 4 placebo); 15 in the drug-level analysis in the valproate arm","populasyon":"Patients with epilepsy aged 16–55 taking a stable dose of stiripentol or valproate (Europe; mean age 29.5); syndrome not specified","urun":"Epidyolex/Epidiolex (100 mg/mL oral solution, purified CBD) or placebo","urun_turu":"saf_cbd","doz":"CBD 20 mg/kg/day","titrasyon":"To 20 mg/kg/day over 10 days","sure":"26 days (10 days of titration, 20 mg/kg/day on days 12–26)","sonuc":"CBD raised stiripentol levels somewhat: peak level 1.17-fold (90% CI 1.03–1.33), total exposure 1.30-fold (1.09–1.55); the authors recommend monitoring side effects in people using them together. There was no important change in the levels of valproate and its breakdown product 4-ene-VPA (valproate 0.87- and 0.83-fold; 4-ene-VPA 0.77- and 0.70-fold). Few patients, very small placebo groups (2 and 4 people), and efficacy was not measured. The manufacturer's study; 6 of the 10 authors are employees of the manufacturer, 4 are investigators for the manufacturer (3 of whom also received consulting fees).","yan_etki":"In the stiripentol arm, side effects in 8 of 14 patients (all in the CBD group), most common diarrhea and tiredness; 1 patient stopped because of a serious rash, and liver enzymes rose in 2 patients. In the valproate arm, side effects 88% on CBD, 25% on placebo; 1 patient stopped because of seriously raised liver enzymes (ALT 5.5×ULN), 1 patient left because of diarrhea and nausea. Diarrhea in 42–69% of those taking CBD","pmid":"32350749","doi":"10.1007/s40263-020-00726-4","diger_kaynak":"NCT02607891 (no results in the registry); its open-label extension NCT02607904"},{"ad":"VanLandingham 2020 (clobazam interaction, in patients)","tasarim":"Phase 2, double-blind, placebo-controlled, randomized (4:1) drug interaction study; not designed to measure efficacy","n":"20 randomized (16 CBD, 4 placebo); 13 in the drug-level analysis (10 CBD, 3 placebo)","populasyon":"Patients with epilepsy aged 18–65 whose seizures were not controlled and who were taking a stable dose of clobazam (at most 20 mg a day); syndrome not specified","urun":"Epidiolex (100 mg/mL oral solution, purified CBD) or placebo, added to clobazam","urun_turu":"saf_cbd","doz":"CBD 20 mg/kg/day, 2 equal doses; clobazam 5–20 mg a day (not changed)","titrasyon":"To 20 mg/kg/day over 10 days","sure":"33 days (10 days of titration, 21 days at a stable dose)","sonuc":"CBD did not change the level of clobazam itself (total exposure ratio 1.1; 90% CI 0.9–1.2); the peak level of clobazam's active breakdown product N-desmethylclobazam rose 2.2-fold (90% CI 1.4–3.5) and total exposure 2.6-fold (2.0–3.6); it did not change in those taking placebo (1.2 and 1.0). Few patients, and efficacy was not measured. The manufacturer's study; all 4 authors are employees of the manufacturer (one during the study).","yan_etki":"Side effects in 13 of 16 patients on CBD and 2 of 4 on placebo; most common diarrhea (6/16), nausea and vomiting (3/16), sleepiness, lightheadedness and skin inflammation; 1 patient was withdrawn because of a serious side effect (seizure cluster), 1 patient left because of side effects; no deaths","pmid":"32652616","doi":"10.1002/jcph.1634","diger_kaynak":"NCT02565108 (results in the registry)"},{"ad":"Morrison 2019 (clobazam, stiripentol and valproate interaction)","tasarim":"Phase 1, open-label, fixed-sequence drug interaction study (in the same person, first the single drug, then with CBD)","n":"78 enrolled; 77 people took the drug, 70 completed (12 people in the group adding CBD to clobazam; the article's results section says 13)","populasyon":"Healthy adult volunteers (aged 18–55), Netherlands","urun":"Epidiolex (100 mg/mL oral solution) + clobazam, stiripentol or valproate","urun_turu":"saf_cbd","doz":"CBD 750 mg twice daily (equivalent to the highest dose in the phase 3 studies); clobazam 5 mg, stiripentol 750 mg, valproate 500 mg twice daily","titrasyon":"After cases of rash, a 3–10-day titration was added to the protocol","sure":"Co-administration for 7–21 days depending on the group","sonuc":"CBD raised stiripentol exposure 1.3–1.6-fold; it raised the peak level and total exposure of clobazam's active breakdown product N-desmethylclobazam about 3.4-fold (clobazam itself 1.2-fold); valproate levels did not change. Clobazam raised CBD's active breakdown product 7-OH-CBD 1.5–1.7-fold; stiripentol, in contrast, lowered 7-OH-CBD by 29%. No placebo group. The manufacturer's study; 2 of the 4 authors are employees of the manufacturer and 2 are consultants to the manufacturer.","yan_etki":"6 people were withdrawn because of side effects (3 when clobazam was added, 3 when valproate was added); the study was temporarily halted because of cases of rash, and no link to the drug could be established; no serious side effects and no deaths","pmid":"30791225","doi":"10.1002/cpdd.665","diger_kaynak":null},{"ad":"D'Onofrio 2020 (France, slow titration)","tasarim":"Prospective, open-label, multicenter study (7 rare epilepsy centers in France; under a temporary use authorization); no control group","n":"125 (48 Dravet, 62 LGS, 5 TSC, 10 other)","populasyon":"Children aged 2–18 with drug-resistant epilepsy","urun":"Purified CBD oral solution (Epidyolex; under a temporary use authorization)","urun_turu":"saf_cbd","doz":"Target 10 mg/kg/day over at least 1 month, then at most 20 mg/kg/day; median 10, 14 and 15.5 mg/kg/day at months 1, 2 and 6 (higher in Dravet than in LGS)","titrasyon":"Started at 2.5 mg/kg/day and increased by 2.5 mg/kg/day per week (10 mg/kg/day in 4 weeks)","sure":"6 months","sonuc":"At month 6, total seizure frequency fell by a mean of 41% (SD 37.5) in the whole group. In patients with Dravet (those with month-6 data; the article says 22 patients, but the percentages it reports appear to be calculated on 23 patients), seizures fell by a mean of 43.9% (SD 37.2); by at least half in 34.8% (8 patients) and by at least 90% in 8.7% (2 patients). One Dravet patient was seizure-free from month 1 on, and another at month 6. Efficacy and side effects did not differ between Dravet and LGS or between those taking and not taking clobazam. No control group; the conclusion that slow titration was better tolerated rests on an indirect comparison with earlier studies. The manufacturer is not in the funding section; 2 of the 16 authors report receiving meeting fees from the manufacturer. Two of the centers (Paris Necker, Lyon) are also in Nabbout 2023; patients may partly overlap.","yan_etki":"Side effects 48.8% (sleepiness 26, fatigue 20, behavior problems 16 patients); no difference between Dravet and LGS; transaminase elevation ≥3-fold in 11 patients, all of whom were taking valproate and clobazam together; 26 patients (20.8%) stopped (mostly for lack of effect); sudden unexpected death in epilepsy in a 2-year-old child with Dravet 1 month after starting CBD","pmid":"32903409","doi":"10.3389/fneur.2020.00829","diger_kaynak":null},{"ad":"Nabbout 2023 (use without clobazam)","tasarim":"Retrospective chart review (the manufacturer's study GWEP20052), European early access program; no control group","n":"114 enrolled; 107 analyzed (15 Dravet, 92 LGS)","populasyon":"Dravet and LGS, aged ≥2; those who used CBD for at least 3 months without taking clobazam (mean age 10.5 in Dravet); based on the authors' institutions, the centers are in France, England, Italy and Spain","urun":"Epidyolex (100 mg/mL oral solution)","urun_turu":"saf_cbd","doz":"Time-weighted mean dose 11.56 mg/kg/day in Dravet, 13.54 mg/kg/day in LGS","titrasyon":null,"sure":"Up to 12 months","sonuc":"In Dravet, median change in 28-day seizure frequency in 3-month periods between 0% and −16.7%; reduction of at least half in convulsive seizures 21% (14 patients) at month 3, 13% (8 patients) at month 12. In LGS, this rate for drop seizures was 19% at month 3, 30% at month 12. Rates of staying on CBD without clobazam (LGS and Dravet together) at months 3, 6, 9 and 12 were 94%, 80%, 69% and 63%. The Dravet group is very small; no control group. Manufacturer-supported; 2 of the 12 authors are employees of the manufacturer (Jazz), and 7 report receiving consulting fees, speaker fees or travel support from the manufacturer. Some of the French centers are also in D'Onofrio 2020; patients may partly overlap.","yan_etki":"Side effects 31% (most common sleepiness, seizures, diarrhea, decreased appetite); 2 patients stopped because of side effects; raised liver enzymes in 4 patients (all LGS)","pmid":"37331197","doi":"10.1016/j.seizure.2023.05.003","diger_kaynak":null},{"ad":"Cerulli Irelli 2025 (real world, SCN1A/Dravet subgroup)","tasarim":"Retrospective, multicenter real-world study (27 centers, mostly in Europe, including Argentina); no control group","n":"266 patients with monogenic epilepsy; 86 with a change in the SCN1A gene (a Dravet diagnosis also in 86 patients)","populasyon":"Monogenic drug-resistant epilepsy; median age 12 when starting CBD","urun":"Epidiolex (Europe) or Convupidiol (Argentina); >99% purified CBD","urun_turu":"saf_cbd","doz":"Not given separately for Dravet","titrasyon":null,"sure":"Median 17 months of follow-up (IQR 12–24); at least 3 months of CBD","sonuc":"At last follow-up, compared with baseline: in 86 patients with SCN1A, mean reduction in seizures 37.6% (SD 33), ≥50% response 50.6%, improvement on the doctor's assessment (CGI-I) 63.9%. There was no difference between diagnostic groups (Lennox–Gastaut, Dravet, TSC, other encephalopathies) in mean reduction, response rate, improvement or staying on the medicine (p > 0.4). Because only those who took CBD for at least 3 months were included, those who stopped early were left out; retrospective and uncontrolled. No funding statement was found in the text; 7 of the 40 authors report receiving payments or support unrelated to the study from the CBD manufacturer (Jazz). Three of the Italian centers (Rome Gemelli, Ancona Salesi, Bologna) are also in Perulli 2025 and Lelli 2026; patients may partly overlap.","yan_etki":"Not given separately for Dravet; in the whole group, side effects during follow-up 38.5% (21.8% at last follow-up; most common sleepiness 12.9%)","pmid":"40126049","doi":"10.1111/epi.18378","diger_kaynak":null},{"ad":"Perulli 2025 (real world, Italy)","tasarim":"Retrospective, two-center observational study (Rome Gemelli and Ancona Salesi); no control group","n":"107 (18 Dravet, 59 LGS, 9 TSC, 21 other encephalopathies)","populasyon":"Developmental and epileptic encephalopathies; median age 12.8 when starting CBD","urun":"Epidyolex (purified CBD)","urun_turu":"saf_cbd","doz":"At last follow-up, median 16.4 mg/kg/day (IQR 11.6–19.5); at most 25 mg/kg/day","titrasyon":"Started at 2.5 mg/kg/day and increased by 2.5 mg/kg/day per week","sure":"Median 20 months (IQR 11–27); at least 3 months of CBD","sonuc":"At last follow-up, seizures fell by at least half in 49 of 107 patients (46%) (the article gives this rate as 69% based on the 71 patients who continued CBD). Response in Dravet was lower than in the other groups: reduction of at least half in 7 of 18 patients (39%; 72% in the others, p=0.007) at month 3 and in 4 (22%; 51% in the others, p=0.028) at last follow-up; staying on the medicine 8/18 (44%) in Dravet, 71% in the others. Use together with valproate was linked to lower efficacy (p=0.006); clobazam had no effect. The Dravet group is small, and the study is uncontrolled and retrospective; a 27-center study published the same year (Cerulli Irelli 2025) found no difference between syndromes. No company support was received for the study; 4 of the 9 authors report receiving consulting or meeting fees unrelated to the study from the manufacturer (Jazz). Both centers (Rome Gemelli, Ancona Salesi) are also in Lelli 2026 and Cerulli Irelli 2025; patients may partly overlap.","yan_etki":"Side effects 33.6%, mostly mild and temporary; 9% stopped because of side effects","pmid":"41165013","doi":"10.1002/epi4.70149","diger_kaynak":null},{"ad":"Silvennoinen 2021 (adult Dravet, England)","tasarim":"Retrospective, two-center follow-up study (England; the manufacturer's early access program); no control group","n":"18 (17 for efficacy)","populasyon":"Adults with genetically confirmed Dravet syndrome (median age 27.5; 20–51)","urun":"Purified CBD (the manufacturer's early access program)","urun_turu":"saf_cbd","doz":"Up to 20 mg/kg/day as tolerated","titrasyon":"Increased up to 20 mg/kg/day (details not in the abstract)","sure":"Median 176 days","sonuc":"Convulsive seizures fell by more than 30% in 3 of 17 patients (17.6%) (in these three patients, the reduction was 87.5–100%); CBD was stopped for lack of effect in 7 patients, and at last follow-up 8 of the 18 patients were still on treatment. Improvement in overall condition 41.2% according to doctors, 47.1% according to families. Only 17.6% reached the seizure reduction required for the medicine to be reimbursed in England. Small, uncontrolled, two centers; conflict-of-interest statement and funding are not in the PubMed record.","yan_etki":"Side effects in everyone; most common raised liver enzymes (52.9%). 3 patients (16.7%) stopped because of behavioral side effects, one of whom was seizure-free. Doses of other medicines had to be closely monitored and adjusted","pmid":"34052628","doi":"10.1016/j.seizure.2021.05.014","diger_kaynak":null},{"ad":"Lelli 2026 (status epilepticus, Italy)","tasarim":"Retrospective, multicenter cohort (Italy); the link between exposure to new medicines and status epilepticus, with models adjusted for age and follow-up time","n":"61 patients, 1033 episodes of status epilepticus","populasyon":"Genetically confirmed Dravet syndrome (median age 13)","urun":"CBD (among 'newly approved medicines' in the abstract; no product name), examined together with stiripentol and fenfluramine","urun_turu":"saf_cbd","doz":"not reported (in the abstract)","titrasyon":null,"sure":"not reported (in the abstract)","sonuc":"Fenfluramine use was linked to a decrease in the frequency of status epilepticus (IRR 0.19; p<0.001); the decrease with stiripentol was not significant (IRR 0.75; p=0.286). Stiripentol was linked to shorter episode duration (−5.0 min; p=0.003); CBD's link with episode duration was not significant (−2.7 min; p=0.506); CBD's link with episode frequency is not given separately in the abstract. Each additional new medicine was linked to an additional decrease in episode frequency and duration. Observational and retrospective, not randomized. The authors report no conflicts of interest. The centers (Ancona, Rome, Bologna) partly overlap with Perulli 2025 and Cerulli Irelli 2025.","yan_etki":"not reported (in the abstract)","pmid":"42636610","doi":"10.1016/j.seizure.2026.08.011","diger_kaynak":null},{"ad":"Press 2015 (unapproved cannabis extracts)","tasarim":"Retrospective chart review (single center, Colorado); based on parent reports; no control group","n":"75 (number of patients with Dravet not given in the abstract)","populasyon":"Children and adolescents with drug-resistant epilepsy (Dravet, Doose, LGS and others)","urun":"Oral cannabis extracts (unapproved, CBD-rich; content and THC ratio not verified)","urun_turu":"cbd_zengin_thc_belirsiz","doz":"not reported (in the abstract)","titrasyon":null,"sure":"not reported (in the abstract)","sonuc":"In the whole group, 33% of families reported a reduction in seizures of more than half; in Dravet, this rate was 23% (LGS 88.9%, Doose 0%). Response was 47% in families who moved to Colorado for this treatment and 22% in those already living there. No improvement was seen on the EEG of responders. No control group, product content unknown; the authors point to confounding factors and call for controlled studies.","yan_etki":"Side effects 44%: increased seizures 13%, sleepiness/tiredness 12%; developmental regression, abnormal movements, status epilepticus requiring intubation and death were reported rarely","pmid":"25845492","doi":"10.1016/j.yebeh.2015.02.043","diger_kaynak":"Overlapping cohort from the same center: Treat 2017, Epilepsia 58:123–7 (PMID 27859038): 71% of 119 patients stopped the product (mean use 11.7 months); a Dravet diagnosis was linked to shorter use (p=0.02); per parent report, response 24%, side effects 19%"},{"ad":"McCoy 2018 (THC-containing cannabis oil)","tasarim":"Prospective, open-label, single-center study (Toronto); no control group and no blinding","n":"20 (19 completed; 1 child died of sudden unexpected death in epilepsy during the study and was excluded from the analysis)","populasyon":"Children with drug-resistant Dravet syndrome (aged 2.1–17.8; mean 10.2); 70% were taking clobazam, 60% valproate, 50% stiripentol","urun":"TIL-TC150 (Tilray): 100 mg CBD and 2 mg THC per mL (50:1), in grapeseed oil; Health Canada-approved investigational product","urun_turu":"thc_iceren","doz":"Target 16 mg/kg/day CBD (0.32 mg/kg/day THC); mean reached 13.3 mg/kg/day CBD (7–16) and 0.27 mg/kg/day THC (0.14–0.32); mean 9.3 mg THC per day (2.4–16.8)","titrasyon":"Titration over 8 weeks; 8 of 19 patients reached the target dose (the others did not because of sleepiness, loss of appetite, diarrhea or weight loss)","sure":"20 weeks (including 8 weeks of dose titration)","sonuc":"Comparing baseline with weeks 17–20, median reduction in motor seizures 70.6% (p=0.006); ≥50% reduction 63%, 2 children seizure-free, seizures increased in 4 children. Seizure-free days and quality-of-life scores increased, and spike activity on EEG decreased. After week 20, 14 of the 19 children continued follow-up; the 5 families who stopped reported seeing no benefit. No control group and no blinding, 20 children; THC's contribution cannot be separated from CBD's. The company that makes the product (Tilray) funded most of the study; the researchers report receiving no payment from the company.","yan_etki":"Side effects in 18 of 19 patients (95%), mostly during titration and temporary; most common sleepiness (17 patients), loss of appetite, diarrhea. Temporary raised liver enzymes in 8 patients (5 of whom also had high valproate levels), mild and temporary low platelets in 8 patients; resolved when the valproate or oil dose was adjusted. Weight loss of more than 5% in 5 patients (26%). No one stopped because of side effects; the dose was reduced in 6 of the 8 patients who reached the target dose. 1 child died of sudden unexpected death in epilepsy (SUDEP); the authors judged it unrelated to the product","pmid":"30250864","doi":"10.1002/acn3.621","diger_kaynak":"NCT02983695 (completed; no results in the registry)"}],"ilgili_ilaclar":["klobazam","valproat","stiripentol","topiramat","rufinamid","zonisamid","eslikarbazepin","karbamazepin"],"son_inceleme":"2026-10-28","arastirma_gecmisi":[{"tarih":"2026-10-19","not":"Page published. This first assessment reviewed 6 studies."},{"tarih":"2026-10-21","not":"The full texts of the studies were reread and the information on the page was checked against its sources. Corrected: dose titration and participant details in the study table; drug interaction notes; the approved medicine's dosing schedule; the starting and titration summary; the \"Who should be careful\" list. Points that could not be verified from the full text went down from 4 items to 3. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-21","not":"PubMed and ClinicalTrials.gov were searched for newly published and previously missed clinical studies. Study added: Devinsky 2018 (dose-ranging safety study). The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-22","not":"The names of the finding labels were simplified: the \"Proven to work\" label on this page became \"Proven effect\". The assessment did not change."},{"tarih":"2026-10-27","not":"The Turkey line was corrected: the active ingredient of the approved CBD medicine (cannabidiol oral solution) is on the Foreign Active Ingredient List of TİTCK (the Turkish Medicines and Medical Devices Agency) and can be brought in from abroad with the agency's written approval; unsourced information about the SGK (Social Security Institution) list was removed. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-27","not":"The reason for the difference between one table review's (Stockings 2018) 'low certainty' rating and the guide's 'strong' rating was added to the evidence summary: the review was based on two studies up to 2017, and later meta-analyses point in the same direction. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-28","not":"In October 2026, PubMed, Cochrane and ClinicalTrials.gov were systematically searched again (1295 PubMed and 46 ClinicalTrials.gov records reviewed; findings were reread from primary sources in an independent check). Studies added: a meta-analysis combining Dravet only (Lattanzi 2020), two network meta-analyses indirectly comparing Dravet medicines (Lattanzi 2023, Guerrini 2024), a manufacturer analysis by clobazam use (Devinsky 2020), the three-year extension of the two RCTs (Scheffer 2021), three drug-level studies measuring interactions with stiripentol, valproate and clobazam (Ben-Menachem 2020 and VanLandingham 2020 in patients, Morrison 2019 in healthy volunteers), everyday-practice studies from France, Italy and England (D'Onofrio 2020, Cerulli Irelli 2025, Perulli 2025, Lelli 2026; in adults, Silvennoinen 2021), use without clobazam (Nabbout 2023), unapproved cannabis extracts (Press 2015) and a THC-containing cannabis oil (McCoy 2018). Added to the evidence summary: that Cochrane's Dravet review does not include CBD, the clobazam and stiripentol subgroups, indirect comparisons with limited certainty against other Dravet medicines, long-term and everyday-practice data, and a sentence describing the search itself; the box and strength of evidence for THC-containing products were written for the first time (Insufficient). The two Lattanzi 2020 reviews in the table were distinguished by name; response rates, outcomes with no difference and company ties were added to the GWPCARE2 row. No new efficacy RCT was found. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-28","not":"On October 28, 2026, two sources found for this page during the searches for other topics were read from their primary sources. Weight loss numbers from the US product information of the approved CBD medicine were added to the side effects list: in the Dravet and Lennox–Gastaut controlled studies, the share of patients whose weight fell by at least 5% from baseline was 16% in the CBD group and 8% in the placebo group; this share was higher at the high dose. The 2021 position paper of the Brazilian Academy of Neurology was reviewed; it was not added to the page because it brought no new data and reported study results differently from their sources. The registry results of the extension study in the table were checked again against ClinicalTrials.gov and found correct. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-30","not":"The last sentence of the page's short summary was rewritten in a calmer, more guiding tone: instead of \"Talk to your doctor before you start.\", it now says whom you can talk with, and about what, if you are considering CBD. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-31","not":"The evidence level text now uses the same level name as the top of the page; the level and the result did not change."}]},{"id":"lennox-gastaut-syndrome","baslik":"Epilepsy: Lennox–Gastaut syndrome","grup":"Epilepsy","grup_kodu":"epilepsi","tr_id":"epilepsi-lennox-gastaut","kanit_duzeyi":"guclu","kanit_yonu":"yarar_gosterildi","kanit_ozet":"In two double-blind RCTs (GWPCARE3 and GWPCARE4), prescription pure CBD added to existing medicines reduced drop seizures more than placebo over 14 weeks (about 37–44% vs. 17–22%). Because seizures also decreased in the placebo group, the absolute difference is about 17–25 points. Some patients see clear benefit and some see none. The EMA writes that efficacy has not been proven in patients not taking clobazam and restricts the approval to use with clobazam. In analyses that separated the same four RCTs by clobazam use, CBD was also better than placebo in patients not taking clobazam. For the reduction in the number of seizures, the effect was smaller in patients without clobazam (with both diseases and both doses combined, the ratio of seizure frequency vs. placebo was 0.59 with clobazam and 0.85 without; when the two doses were looked at separately, the difference was not significant in those without clobazam; manufacturer analysis, Devinsky 2020); for the proportion of patients whose seizures were at least halved, the difference from placebo was similar in the two groups (RR 1.80 and 1.85 in an independent meta-analysis; Lattanzi 2020). Because whether patients took clobazam was not decided by chance, these comparisons are not conclusive. In everyday-practice data on 92 LGS patients taking CBD without clobazam, the proportion of patients whose drop seizures were at least halved was 19% at month 3 and 30% at month 12 (Nabbout 2023; no control group, manufacturer-supported). The Stockings 2018 review in the table found CBD superior to placebo for at least halving seizures but rated the certainty of the evidence as low (GRADE); this rating was based on a search up to October 2017 and, for this outcome, on two RCTs (291 patients). Later meta-analyses combining four RCTs (Lattanzi 2018 LGS and Dravet, Lattanzi 2020) gave results in the same direction; the guide's 'Strong' rating is based on this whole body of evidence. The Cochrane review of medicines in LGS (Brigo 2021) included the two CBD studies. Because the information in the two studies' publications was not enough to calculate the response rate for all seizure types (the studies' main outcome was drop seizures), the review remained uncertain about whether CBD reduces all seizures; it did, however, find with high certainty that stopping because of side effects was more common with CBD (RR 6.62). This uncertainty comes not from a result pointing the other way but from this outcome not being reported in the studies; the guide's rating is based on drop seizures, the studies' main outcome. In a network meta-analysis comparing LGS treatments, CBD's effect on drop seizures was not significantly different from other LGS medicines such as clobazam, rufinamide and fenfluramine; high-dose clobazam was ahead in the ranking, but there are no studies comparing the medicines directly, and the comparisons are indirect (Zhu 2025). In the open-label extension of the two RCTs, the median reduction in drop seizures in 366 patients stayed between 48% and 71% for up to 156 weeks; according to the final results on ClinicalTrials.gov (a registry, not a peer-reviewed publication), 243 of the patients completed the study, and the median reduction in drop seizures over each patient's last 12 weeks in the study, including those who left early, was 59%; liver enzymes rose markedly in 15% of patients, most of whom were taking valproate (Patel 2021). Everyday-practice studies from France and Germany and two studies in adults with LGS in England point in the same direction, while in a small study of children from Korea the response decreased at month 6; these have no comparison group, and most have manufacturer funding or authors with financial ties to the manufacturer. There is no controlled study of unlicensed cannabis products in LGS. October 2026 search (PubMed, Cochrane, ClinicalTrials.gov): 2 controlled treatment studies with cannabinoids and 7 systematic reviews (one of them Cochrane) were found on this topic; these appear in the table below, together with a manufacturer-supported pooled analysis of the same studies, 10 studies without a comparison group (long-term extension, access programs, everyday practice, and unlicensed or THC-containing products), and 2 drug-level studies measuring drug interactions, mainly with clobazam (one placebo-controlled in patients with epilepsy, one in healthy volunteers). No controlled study of THC-containing products in LGS was found.","kanit_duzeyi_metin":"Strong (double-blind, placebo-controlled RCTs + meta-analyses)","kanit_duzeyi_thc_icerenler":"yetersiz","kanit_duzeyi_thc_icerenler_metin":"Insufficient: there is no controlled study of a THC-containing product in LGS; there is only a small observational study without a comparison group that included 11 LGS patients","kaynak_dosya":"epilepsi.md","saf_cbd_sonuc":"The approved, purified pharmaceutical CBD reduced drop seizures as an add-on treatment in Lennox–Gastaut syndrome; this evidence does not apply to unregulated CBD oils.","thc_icerenler_sonuc":"There is no controlled study of THC-containing products in Lennox–Gastaut syndrome. The only data come from a small observational study: in 29 people (11 with LGS) followed for at least 24 weeks on two CBD-rich, low-THC cannabis products (at most 6 mg of THC a day), no significant change in seizure frequency was seen.","ruhsat":"FDA (≥1 year, no clobazam requirement): start at 2.5 mg/kg twice daily (5 mg/kg/day); after 1 week, the maintenance dose is 5 mg/kg twice daily (10 mg/kg/day). If further seizure reduction is needed, increase weekly by 2.5 mg/kg twice daily up to a maximum of 10 mg/kg twice daily (20 mg/kg/day); for faster titration, increases no more often than every other day. Label: 20 mg/kg/day gives slightly more seizure reduction but more side effects. EMA (≥2 years, add-on treatment only together with clobazam): 5 mg/kg/day for 1 week, then maintenance 10 mg/kg/day; increases above 10 mg/kg/day only with an individual benefit–risk assessment and a full monitoring schedule, maximum 20 mg/kg/day. Liver impairment: moderate (Child-Pugh B) start at 1.25 mg/kg twice daily, severe (Child-Pugh C) 0.5 mg/kg twice daily. Stopping is done gradually. Source: FDA label (05/2026) §2.1–2.2, §2.5–2.6; EMA product information §4.1–4.2 (last updated in the EPAR on August 20, 2026). Turkey: Epidyolex/cannabidiol is not on the list of licensed products of TİTCK (Turkish Medicines and Medical Devices Agency) (October 16, 2026); however, on TİTCK's Foreign Active Substance List (September 28, 2026), cannabidiol oral solution (YDN02BG1099) is listed as a red-prescription medicine among those that cannot be imported without TİTCK's written approval.","doz_araligi_ozet":"In the labeling and RCTs, 10–20 mg/kg/day (split into two equal doses); in the open-label expanded access program, up to a ceiling of 25–50 mg/kg/day; in the open-label extension study, at most 30 mg/kg/day (mean 24 mg/kg/day); in everyday-practice studies in Europe and England, the median dose was mostly 10–15 mg/kg/day","titrasyon_ozet":"Labeling: start at 5 mg/kg/day, then 10 mg/kg/day after 1 week; if needed, increase weekly by 5 mg/kg/day up to a maximum of 20 mg/kg/day. In the RCTs, a 2-week titration (to 10 mg/kg/day in 7 days, to 20 mg/kg/day in 11 days), followed by 12 weeks of maintenance","yan_etkiler":["Drowsiness/sedation: Epidiolex (LGS/Dravet) 32% (10 mg/kg/day 27%, 20 mg/kg/day 34%), placebo 11%","Diarrhea, decreased appetite, vomiting, fever, fatigue (common in RCTs)","Liver enzyme (ALT) >3×ULN: in controlled studies, LGS/Dravet 13%, TSC 12% (placebo 1%); 17% at 20 mg/kg/day, 1% at 10 mg/kg/day; >20×ULN <1%","ALT >3×ULN with valproate: valproate+clobazam 30%, valproate alone 21%, clobazam alone 4%, neither 3% (FDA)","Drowsiness/sedation with clobazam 46% (without clobazam 16%)","Discontinuation due to side effects 8.9% vs. 1.8% (Lattanzi 2018, LGS and Dravet meta-analysis)","Labeling warnings: suicidal thoughts and behavior (class warning for all antiepileptic drugs), hypersensitivity (including to sesame oil), increased seizures on sudden discontinuation; EMA: seizure frequency may increase, weight loss/failure to gain weight","Postmarketing: cholestatic/mixed-type liver injury and (mostly in those taking valproate/clobazam) elevated ammonia have been reported (FDA)","Long term (LGS extension study GWPCARE5, median 1,090 days): side effects 96%, serious side effects 42%, discontinuation due to side effects 12%; transaminases >3×ULN 15%, 73% of whom were taking valproate (Patel 2021)","Weight loss: in the LGS/Dravet controlled studies, a decrease in measured weight of at least 5% from baseline was seen in 16% of those taking CBD and 8% with placebo; the decrease appeared to be dose-related (18% at 20 mg/kg/day, 9% at 10 mg/kg/day). Weight loss reported as a side effect was 3% at 10 mg/kg/day, 5% at 20 mg/kg/day and 1% with placebo. In the TSC study (25 mg/kg/day), weight loss of at least 5% was 31% vs. 8% (FDA, product information 05/2026)"],"izlem":["ALT, AST, and total bilirubin before starting (FDA and EMA)","Liver tests at months 1, 3, and 6, then periodically or as clinically needed","FDA: within 1 month after a dose change or after adding a medicine that affects the liver; EMA: the monitoring schedule starts over when the dose goes above 10 mg/kg/day or when a medicine that affects the liver is changed","People taking valproate and those with high baseline ALT/AST: per the EMA, at week 2 and at months 1, 2, 3, and 6, then periodically","Stopping rule (FDA and EMA): CBD is stopped if transaminases are >3×ULN and bilirubin is >2×ULN, or if transaminases are persistently >5×ULN","If liver symptoms occur (unexplained nausea, vomiting, right upper abdominal pain, fatigue, loss of appetite, jaundice, dark urine), check ALT/AST/bilirubin right away","Blood levels and side effects of concomitant antiepileptic drugs (Gaston 2017, PMID 28782097)"],"dikkat":["Epilepsy treatment is started, changed and stopped by a neurologist's decision; antiepileptic drugs should not be stopped on one's own","CBD is stopped by gradually lowering the dose; stopping suddenly carries a risk of increased seizures and status epilepticus (FDA §2.5, §5.5). EMA: in the studies, stopping was done over ~10 days, reducing by ~10% a day","In moderate (Child-Pugh B) and severe (Child-Pugh C) liver impairment, the labeling specifies lower starting and maintenance doses; no adjustment is needed in mild impairment","Hypersensitivity to sesame oil is a contraindication (Epidyolex contains 736 mg of refined sesame oil and 79 mg of ethanol per mL)","People taking valproate or clobazam need more frequent monitoring for liver effects and sedation","Age: FDA ≥1 year, EMA ≥2 years","The medicine is always taken the same way in relation to meals; with a high-fat meal, Cmax increases 5-fold and AUC 4-fold. It is measured with a calibrated syringe; a household spoon is not suitable","Unregulated (artisanal) CBD/cannabis oils do not replace the approved medicine: labels are unreliable, they may contain THC and contaminants, and there are reports of increased seizures"],"ilac_etkilesim_notlari":["Clobazam: CBD increases the active metabolite N-desmethylclobazam ~3-fold (FDA) / 3–4-fold (EMA) (total exposure 2.6-fold in a placebo-controlled study in epilepsy patients taking clobazam, VanLandingham 2020; 3.4-fold in healthy volunteers, Morrison 2019); clobazam also increases 7-OH-CBD (AUC 47%). If drowsiness occurs, lowering the clobazam dose is considered","Valproate: liver enzyme elevations increase markedly; diarrhea and decreased appetite also increase (EMA). If enzymes rise, CBD and/or valproate is reduced or stopped","Stiripentol: in healthy volunteers, Cmax increased 28% and AUC 55%; in patients, Cmax increased 17% and AUC 30%. Side effects are monitored closely","Everolimus: exposure increases ~2.5-fold; levels are monitored, and in a patient taking CBD, everolimus is started at a lower dose","Topiramate, rufinamide, zonisamide, eslicarbazepine: in an open-label study, serum levels rose as the CBD dose increased (most stayed within the therapeutic range)","Sirolimus, tacrolimus, digoxin (oral P-gp substrates): exposure may increase; level monitoring and dose reduction are considered","Strong CYP3A4/CYP2C19 inducers (rifampin; EMA: carbamazepine, enzalutamide, mitotane, St. John's wort): rifampin reduced CBD by ~32% and 7-OH-CBD by ~63% (FDA); FDA (05/2026): with a strong inducer, increasing the Epidiolex dose up to at most 2-fold may be considered based on response and tolerability","CYP1A2 substrates (theophylline, tizanidine, caffeine): caffeine AUC increased 95%; dose reduction is considered for narrow-range medicines","CYP2C19 prodrugs such as clopidogrel: the active metabolite may decrease","Alcohol and other CNS depressants: drowsiness and sedation increase; alcohol also increases CBD exposure (Cmax 93%, AUC 63%)"],"dogrulanamayan":["The full texts of GWPCARE1, GWPCARE3 (NEJM) and GWPCARE4 (Lancet) could not be opened; the design, titration and results were verified using the ClinicalTrials.gov record and results, the PubMed abstract and the EMA product information. For Laux 2019, only the abstract was read","Whether the route of importing a medicine from abroad for personal treatment with a doctor's report (TİTCK permission) has been used for Epidyolex in Turkey could not be found in an official source","Of the studies added in the October 2026 search, only the PubMed abstract could be read for Patel 2021, Lattanzi 2018 (LGS meta-analysis), de Oliveira 2026, Nabbout 2023, Elbadri 2024 and Press 2015; for the Cochrane review in LGS (Brigo 2021), only the abstract and plain language summary are open. The PubMed and PMC (later edited) versions of this Cochrane abstract give different numbers for stopping because of side effects with CBD (RR 4.90 and 6.62); the table uses the edited version, and the current version in the Cochrane Library could not be checked because access was blocked."],"calismalar":[{"ad":"Devinsky 2018 (GWPCARE3)","tasarim":"Double-blind, placebo-controlled RCT, 30 centers","n":"225","populasyon":"Lennox–Gastaut syndrome, aged 2–55","urun":"CBD oral solution (pure CBD)","urun_turu":"saf_cbd","doz":"10 or 20 mg/kg/day, 2 equal doses","titrasyon":"2 weeks (reached 10 mg/kg/day in 7 days and 20 mg/kg/day in 11 days; CT.gov NCT02224560)","sure":"14 weeks","sonuc":"Reduction in drop seizures 41.9% (20 mg) and 37.2% (10 mg), placebo 17.2%; p=0.005 and p=0.002","yan_etki":"Sleepiness, decreased appetite, diarrhea (more common at the higher dose). Discontinuation due to side effects: 6 at 20 mg, 1 at 10 mg. Transaminase elevation in 14 (9%) of those taking CBD","pmid":"29768152","doi":"10.1056/NEJMoa1714631","diger_kaynak":"NCT02224560. Post hoc analyses of GWPCARE3 and GWPCARE4 together: Privitera 2021, Epilepsia 62:1130–40 (PMID 33797076; the authors include employees of the manufacturer): the difference from placebo appeared on day 6 (nominal p = 0.008); Auvin 2023, Epilepsia 64:1812–20 (PMID 37052803): difference vs. placebo in drop seizure-free days per 28 days 2.83 at 10 mg/kg/day (95% CI 0.98–4.68) and 3.64 at 20 mg/kg/day (2.18–5.10); Specchio 2025, CNS Drugs 39:1025–36 (PMID 40775196; funded by the manufacturer): the threshold at which caregivers said 'slightly improved' was about a 31% reduction in drop seizures"},{"ad":"Thiele 2018 (GWPCARE4)","tasarim":"Double-blind, placebo-controlled phase 3 RCT, 24 centers","n":"171","populasyon":"Lennox–Gastaut syndrome, aged 2–55","urun":"Oral CBD (pure CBD)","urun_turu":"saf_cbd","doz":"20 mg/kg/day","titrasyon":"2 weeks (reached 20 mg/kg/day in 11 days; CT.gov NCT02224690)","sure":"14 weeks","sonuc":"Median reduction in drop seizures 43.9% (placebo 21.8%); estimated median difference −17.21 (p=0.0135)","yan_etki":"Side effects 86% vs. 69%: diarrhea, sleepiness, fever, decreased appetite, vomiting. Discontinuation due to side effects 14% vs. 1%. 1 death (judged unrelated to the drug)","pmid":"29395273","doi":"10.1016/S0140-6736(18)30136-3","diger_kaynak":"NCT02224690"},{"ad":"Lattanzi 2018 (LGS and Dravet)","tasarim":"Systematic review and meta-analysis (4 RCTs)","n":"550","populasyon":"LGS and Dravet syndrome","urun":"Pharmaceutical CBD (pure)","urun_turu":"saf_cbd","doz":"10 and 20 mg/kg/day","titrasyon":null,"sure":null,"sonuc":"Difference in seizure frequency vs. placebo 19.5 points (10 mg/kg/day) and 19.9 points (20 mg/kg/day). ≥50% reduction in all seizures 37.2% vs. 21.2% (20 mg; RR 1.76)","yan_etki":"Discontinuation due to side effects 8.9% vs. 1.8% (RR 5.59); RR 6.89 at 20 mg, not significant at 10 mg","pmid":"30390221","doi":"10.1007/s40265-018-0992-5","diger_kaynak":null},{"ad":"Lattanzi 2020","tasarim":"Systematic review and meta-analysis (4 RCTs)","n":"714","populasyon":"LGS and Dravet syndrome","urun":"Pharmaceutical CBD (pure)","urun_turu":"saf_cbd","doz":"not reported","titrasyon":null,"sure":null,"sonuc":"≥50% response: without clobazam 29.1% vs. 15.7% (RR 1.80); with clobazam 52.9% vs. 27.8% (RR 1.85). Clobazam was not randomized; the authors warn about this","yan_etki":null,"pmid":"32452532","doi":"10.1111/epi.16546","diger_kaynak":null},{"ad":"Stockings 2018","tasarim":"Systematic review (6 RCTs + 30 observational studies)","n":"not reported","populasyon":"Drug-resistant epilepsy; mean age 16.1","urun":"Pharmaceutical CBD (RCTs) + various products in observational studies","urun_turu":"karma","doz":"20 mg/kg/day (RCT)","titrasyon":null,"sure":null,"sonuc":"≥50% seizure reduction RR 1.74 (NNT 8); GRADE: low","yan_etki":"Side effects RR 1.24; serious side effects RR 2.55","pmid":"29511052","doi":"10.1136/jnnp-2017-317168","diger_kaynak":null},{"ad":"Brigo 2021 (Cochrane)","tasarim":"Cochrane systematic review and meta-analysis (all seizure medicines in LGS; 11 RCTs, 2 of them CBD)","n":"1,277 in the review; CBD comparison 2 RCTs, 396 patients","populasyon":"Lennox–Gastaut syndrome; children, adolescents and adults","urun":"Purified CBD oral solution (GWPCARE3 and GWPCARE4)","urun_turu":"saf_cbd","doz":"10 and 20 mg/kg/day","titrasyon":null,"sure":"Search up to March 2020; CBD studies 14 weeks","sonuc":"The response rate for all seizure types, which the review looked at, could not be calculated because the information in the two CBD studies' publications was not enough (the two studies' own main outcome was drop seizures); in its plain language summary, the review writes that it is uncertain whether CBD reduces all seizure types. Withdrawal from the study because of side effects was more common with CBD than placebo: RR 6.62 (95% CI 1.56–28.15; 82 more per 1,000 patients), high certainty of evidence (GRADE). There are no studies comparing LGS medicines directly. The review authors have no reported ties to the CBD manufacturer.","yan_etki":"Discontinuation due to side effects RR 6.62 (95% CI 1.56–28.15; high certainty)","pmid":"33825230","doi":"10.1002/14651858.CD003277.pub4","diger_kaynak":"Update of the 2013 Cochrane review; Cochrane summary and commentary PMID 35322410"},{"ad":"Lattanzi 2018 (LGS meta-analysis)","tasarim":"Systematic review and meta-analysis (2 RCTs, LGS only)","n":"396","populasyon":"Lennox–Gastaut syndrome","urun":"Pharmaceutical CBD (pure)","urun_turu":"saf_cbd","doz":"10 and 20 mg/kg/day","titrasyon":null,"sure":"14 weeks (studies)","sonuc":"At least a halving of drop seizures in 40.0% with CBD and 19.3% with placebo (RR 2.12; 95% CI 1.48–3.03; p<0.001). At least a halving of non-drop seizures 49.4% vs. 30.4% (RR 1.62; 95% CI 1.09–2.43; p=0.018). A pooling of the same two RCTs; no new patient data.","yan_etki":"Any side effect RR 1.24 (95% CI 1.11–1.38); stopping the drug RR 4.93 (95% CI 1.50–16.22). Significantly associated with CBD: sleepiness, decreased appetite, diarrhea, liver enzyme elevation","pmid":"30132269","doi":"10.1007/s40263-018-0558-9","diger_kaynak":null},{"ad":"Devinsky 2020 (clobazam subgroups)","tasarim":"The manufacturer's post hoc analysis separating 4 RCTs (GWPCARE1–4) by clobazam use and pooling them (stratified meta-analysis)","n":"714 (396 LGS, 318 Dravet); CBD 429 (240 with clobazam, 189 without clobazam), placebo 285","populasyon":"LGS (aged 2–55) and Dravet syndrome; in the LGS studies, 49% of patients were taking clobazam","urun":"Epidiolex/Epidyolex (100 mg/mL oral solution, purified CBD)","urun_turu":"saf_cbd","doz":"10 and 20 mg/kg/day","titrasyon":null,"sure":"14 weeks","sonuc":"With both doses and both diseases combined, the ratio of seizure frequency vs. placebo was 0.59 with clobazam (95% CI 0.52–0.68) and 0.85 without clobazam (95% CI 0.73–0.98; p=0.023): on this measure, the effect was smaller without clobazam, and the dose groups were not significant individually. The OR for at least a halving, however, was similar in the two groups: 2.51 (1.69–3.71) with clobazam and 2.40 (1.38–4.16) without clobazam. In LGS, in the 20 mg/kg/day group without clobazam, seizure counts increased in more patients than with placebo. Clobazam use was not decided by chance; about two thirds of those not taking clobazam had tried and stopped clobazam before, and the authors write that this may have affected the result. All authors (7/7) were employees (5) or consultants and investigators (2) of the manufacturer; the manufacturer funded it.","yan_etki":"Sleepiness, rash, pneumonia and aggression were more common together with clobazam; discontinuation due to side effects at 20 mg/kg/day was 13.0% with clobazam and 8.0% without","pmid":"32592183","doi":"10.1111/ane.13305","diger_kaynak":"Gunning 2021, Acta Neurol Scand 143:154–63 (PMID 32969022): a manufacturer-supported clobazam subgroup analysis of the same 4 RCTs; in LGS, the ratio of drop seizures vs. placebo was 0.70 in all patients (95% CI 0.62–0.80) and 0.56 with clobazam (0.47–0.67); OR for at least a halving 3.14 (2.04–4.81) and 3.48 (1.96–6.17); 3 of 7 authors are employees of the manufacturer, and 4 are consultants or investigators of the manufacturer"},{"ad":"Zhu 2025 (network meta-analysis)","tasarim":"Systematic review and network meta-analysis (drug and non-drug treatments in LGS; 12 RCTs)","n":"1,445 (CBD 235 patients, 2 RCTs)","populasyon":"Lennox–Gastaut syndrome","urun":"Purified CBD (GWPCARE3 and GWPCARE4); comparators were fenfluramine, clobazam, rufinamide, felbamate, lamotrigine, topiramate, deep brain stimulation and corpus callosotomy","urun_turu":"saf_cbd","doz":"CBD 10 and 20 mg/kg/day","titrasyon":null,"sure":null,"sonuc":"At least a halving of drop seizures, compared with usual treatment: CBD 10 mg/kg/day OR 2.8 (95% CI 1.4–5.7), 20 mg/kg/day OR 3.1 (1.9–5.2); clobazam 1 mg/kg/day OR 7.8, rufinamide OR 4.6, fenfluramine OR 3.0–3.5. At the top of the ranking were clobazam 1 mg/kg/day, corpus callosotomy and rufinamide; the comparisons are indirect (there are no studies comparing the medicines directly), and the authors ask that the ranking be read with caution. The authors report no conflicts of interest.","yan_etki":"In the ranking for likelihood of side effects, CBD 20 mg/kg/day was first, followed by fenfluramine 0.7 mg/kg/day; for serious side effects, CBD 10 mg/kg/day came after lamotrigine","pmid":"40078280","doi":"10.3389/fphar.2025.1522543","diger_kaynak":null},{"ad":"de Oliveira 2026 (meta-analysis by syndrome and age)","tasarim":"Systematic review and meta-analysis (developmental and epileptic encephalopathies; 5 RCTs + 41 non-randomized studies); prespecified subgroups by age and syndrome","n":"2,592","populasyon":"Developmental and epileptic encephalopathies (LGS, Dravet, Doose, CDKL5 and others); children, adults and mixed age groups","urun":"Pharmaceutical-grade (approved) CBD","urun_turu":"saf_cbd","doz":"Varied by study (no details in the abstract)","titrasyon":null,"sure":"Search up to October 12, 2025","sonuc":"Across all studies, the pooled rate of at least a halving was 49.9% (95% CI 44.9–55.0), at least a 75% reduction 26.7% (22.0–32.0), and seizure freedom 5.7% (4.0–8.0). Age (child, adult), syndrome (including LGS), dose, clobazam use and length of follow-up did not consistently change the effect; some subgroup differences that were significant rest on small groups and do not meet credibility criteria. Because most studies were uncontrolled, the pooled rates are not differences from placebo; an LGS-specific rate is not in the abstract. The authors report no conflicts of interest.","yan_etki":"Sleepiness, decreased appetite, diarrhea, fatigue and behavior changes; liver enzyme elevation mostly together with valproate, and it resolved when the dose was lowered or the drug stopped","pmid":"42185726","doi":"10.1007/s40263-026-01301-z","diger_kaynak":null},{"ad":"Patel 2021 (GWPCARE5, LGS)","tasarim":"Open-label extension study (those who completed GWPCARE3 and GWPCARE4); no control group","n":"366 (99.5% of the 368 patients who completed the RCTs)","populasyon":"Lennox–Gastaut syndrome (children and adults)","urun":"Epidiolex/Epidyolex (100 mg/mL oral solution, plant-derived purified CBD)","urun_turu":"saf_cbd","doz":"Target maintenance 20 mg/kg/day; could be lowered or raised to at most 30 mg/kg/day based on response and tolerability; mean modal dose 24 mg/kg/day","titrasyon":"To 20 mg/kg/day over 2 weeks","sure":"Median 1,090 days, mean 826 days (3–1,421 days); efficacy up to 156 weeks","sonuc":"Over 12-week periods up to 156 weeks, the median reduction was 48–71% for drop seizures and 48–68% for total seizures. In every period, at least 87% of patients or caregivers reported improvement in overall condition. According to the final results on ClinicalTrials.gov (a registry, not a peer-reviewed publication), 243 of 366 patients completed the study (of the 123 who left, 48 at the patient's or family's request, 38 because of side effects, 12 for lack of efficacy, 11 by investigator decision); over each patient's last 12 weeks in the study (regardless of when they left; 363 patients), the median reduction was 59.4% for drop seizures (IQR −87.1 to −15.4) and 51.9% for total seizures (IQR −84.7 to −13.3). No control group, and only those who completed the first study and continued were included. Conducted by the manufacturer (GW Research); 2 of 13 authors are employees of the manufacturer, and the conflict of interest statements of the others could not be read (in the interim analysis of the same study, all 8 authors had ties to the manufacturer).","yan_etki":"Side effects 96%, serious side effects 42%, discontinuation due to side effects 12%. Most common: seizures (39%), diarrhea (38%), fever (34%), sleepiness (29%). Liver enzymes (transaminases) >3×ULN in 55 patients (15%); 40 of them (73%) were taking valproate. In the final results in the registry, serious side effects in 157 patients (42.9%), 12 deaths (the registry does not state whether they were related to the drug)","pmid":"34287833","doi":"10.1111/epi.17000","diger_kaynak":"NCT02224573 (681 patients with LGS and Dravet together; separate final results for LGS in the registry, posted on February 3, 2022). Interim analysis: Thiele 2019, Epilepsia 60:419–28 (PMID 30740695): with November 2016 data, median 38 weeks; transaminase elevation 10.1% (29 of 37 patients were taking valproate), discontinuation due to side effects 9.6%"},{"ad":"Laux 2019","tasarim":"Open-label expanded access program (EAP), LGS/Dravet subgroup","n":"152 (58 Dravet, 94 LGS)","populasyon":"LGS and Dravet syndrome","urun":"Epidiolex 100 mg/ml (pure CBD)","urun_turu":"saf_cbd","doz":"2–10 mg/kg/day starting → 25–50 mg/kg/day ceiling; median 21–25 mg/kg/day in weeks 12–96","titrasyon":"By center","sure":"Median 78.3 weeks","sonuc":"At week 12, a 50% reduction in major motor seizures and 44% in all seizures; consistent up to 96 weeks (no control group)","yan_etki":"Sleepiness 30%, diarrhea 24%; 28% stopped (mostly for lack of efficacy, 20%)","pmid":"31022635","doi":"10.1016/j.eplepsyres.2019.03.015","diger_kaynak":null},{"ad":"VanLandingham 2020 (clobazam interaction, in patients)","tasarim":"Phase 2, double-blind, placebo-controlled, randomized (4:1) drug interaction study; not designed to measure efficacy","n":"20 randomized (16 CBD, 4 placebo); 13 in the drug-level analysis (10 CBD, 3 placebo)","populasyon":"Epilepsy patients aged 18–65 with uncontrolled seizures taking a stable dose of clobazam (at most 20 mg a day); syndrome not specified","urun":"Epidiolex (100 mg/mL oral solution, purified CBD) or placebo, added to clobazam","urun_turu":"saf_cbd","doz":"CBD 20 mg/kg/day, 2 equal doses; clobazam 5–20 mg a day (unchanged)","titrasyon":"To 20 mg/kg/day over 10 days","sure":"33 days (10-day dose increase, 21 days at a fixed dose)","sonuc":"CBD did not change the level of clobazam itself (total exposure ratio 1.1; 90% CI 0.9–1.2); the peak level of clobazam's active breakdown product N-desmethylclobazam rose 2.2-fold (90% CI 1.4–3.5) and its total exposure 2.6-fold (2.0–3.6); it did not change in those taking placebo (1.2 and 1.0). Few patients, and efficacy was not measured. The manufacturer's study; all 4 authors were employees of the manufacturer (one at the time of the study).","yan_etki":"Side effects in 13 of 16 patients with CBD and 2 of 4 with placebo; most common were diarrhea (6/16), nausea and vomiting (3/16), sleepiness, lightheadedness and skin inflammation; 1 patient was withdrawn because of a serious side effect (seizure cluster), 1 patient left because of side effects; no deaths","pmid":"32652616","doi":"10.1002/jcph.1634","diger_kaynak":"NCT02565108 (results in the registry)"},{"ad":"Morrison 2019 (clobazam, stiripentol and valproate interaction)","tasarim":"Phase 1, open-label, fixed-sequence drug interaction study (in the same person, first the single drug, then with CBD)","n":"78 enrolled; 77 received a drug, 70 completed (12 people in the group adding CBD to clobazam; the article's results section says 13)","populasyon":"Healthy adult volunteers (aged 18–55), the Netherlands","urun":"Epidiolex (100 mg/mL oral solution) + clobazam, stiripentol or valproate","urun_turu":"saf_cbd","doz":"CBD 750 mg twice daily (equivalent to the highest dose in the phase 3 studies); clobazam 5 mg, stiripentol 750 mg, valproate 500 mg twice daily","titrasyon":"After cases of rash, a 3–10-day dose increase was added to the protocol","sure":"Co-administration for 7–21 days depending on the group","sonuc":"CBD increased the peak level and total exposure of clobazam's active breakdown product N-desmethylclobazam about 3.4-fold (in everyone in the group); clobazam itself increased 1.2-fold. Stiripentol exposure increased 1.3–1.6-fold; the valproate level did not change. Clobazam increased CBD's active breakdown product 7-OH-CBD 1.5–1.7-fold. No placebo group. The manufacturer's study; 2 of 4 authors are employees of the manufacturer and 2 are consultants to the manufacturer.","yan_etki":"6 people were withdrawn because of side effects (3 when clobazam was added, 3 when valproate was added); the study was temporarily paused because of cases of rash, and no link to the drug could be established; no serious side effects or deaths","pmid":"30791225","doi":"10.1002/cpdd.665","diger_kaynak":null},{"ad":"D'Onofrio 2020 (France, slow dose increase)","tasarim":"Prospective, open-label, multicenter study (7 rare epilepsy centers in France; under a temporary authorization for use); no control group","n":"125 (62 LGS, 48 Dravet, 5 TSC, 10 other)","populasyon":"Children aged 2–18 with drug-resistant epilepsy","urun":"Purified CBD oral solution (Epidyolex; under a temporary authorization for use)","urun_turu":"saf_cbd","doz":"Target of 10 mg/kg/day over at least 1 month, then at most 20 mg/kg/day; median 10, 14 and 15.5 mg/kg/day at months 1, 2 and 6","titrasyon":"Started at 2.5 mg/kg/day and increased by 2.5 mg/kg/day each week (10 mg/kg/day in 4 weeks)","sure":"6 months","sonuc":"At month 6, total seizure frequency decreased by a mean of 41% (SD 37.5); at least a halving in 28 patients (37.8%). In patients with LGS (41 patients with month 6 data), seizures decreased by a mean of 42.1% and were at least halved in 43.9%; efficacy and side effects did not differ between LGS and Dravet or between those taking and not taking clobazam. No control group; the conclusion that slow titration was better tolerated rests on an indirect comparison with earlier studies. The manufacturer is not in the funding section; 2 of 16 authors report receiving meeting fees from the manufacturer. Two of the centers (Paris Necker, Lyon) are also in Nabbout 2023; patients may partly overlap.","yan_etki":"Side effects 48.8% (sleepiness in 26, weakness/fatigue in 20, behavior problems in 16 patients); transaminase elevation ≥3-fold in 11 patients, all taking valproate and clobazam together; 26 patients (20.8%) stopped (mostly for lack of efficacy); 1 sudden unexpected death in epilepsy","pmid":"32903409","doi":"10.3389/fneur.2020.00829","diger_kaynak":null},{"ad":"Nabbout 2023 (use without clobazam)","tasarim":"Retrospective chart review (the manufacturer's study GWEP20052), European early access program; no control group","n":"114 enrolled; 107 analyzed (92 LGS, 15 Dravet)","populasyon":"LGS and Dravet, age ≥2; people who used CBD for at least 3 months without taking clobazam (mean age 14.5 in LGS); based on the authors' institutions, the centers were in France, England, Italy and Spain","urun":"Epidyolex (100 mg/mL oral solution)","urun_turu":"saf_cbd","doz":"Time-weighted mean dose 13.54 mg/kg/day in LGS","titrasyon":null,"sure":"Up to 12 months","sonuc":"In LGS, the median change in 28-day seizure frequency over 3-month periods ranged from −6.2% to −20.9%; at least a halving of drop seizures in 19% at month 3 (69 patients) and 30% at month 12 (53 patients). The proportion staying on CBD without clobazam (LGS and Dravet together) was 94%, 80%, 69% and 63% at months 3, 6, 9 and 12. No control group. Manufacturer-supported; 2 of 12 authors are employees of the manufacturer (Jazz), and 7 more report receiving consulting fees, speaker fees or travel support from the manufacturer. Some of the French centers are also in D'Onofrio 2020; patients may partly overlap.","yan_etki":"Side effects 31% (most commonly sleepiness, seizures, diarrhea, decreased appetite); 2 patients stopped because of side effects; liver enzyme elevation in 4 LGS patients","pmid":"37331197","doi":"10.1016/j.seizure.2023.05.003","diger_kaynak":null},{"ad":"Strzelczyk 2025 (Germany, real-world)","tasarim":"Retrospective, multicenter chart review (6 epilepsy centers in Germany); no control group","n":"202 (159 LGS, 34 Dravet, 9 TSC)","populasyon":"LGS, Dravet and TSC; median age 18 (0.3–72); a median of 6 earlier medicines; 64.2% of those with LGS were taking clobazam","urun":"Epidyolex (100 mg/mL oral solution); through early access or by prescription (2019–2023)","urun_turu":"saf_cbd","doz":"Median target dose 11.1 mg/kg/day (<6 years 17.6; 6–17 years 15.2; ≥18 years 9.9)","titrasyon":null,"sure":"Up to 12 months","sonuc":"At least a halving of total seizures in 43.3% at month 3 (194 patients) and 44.0% at month 12 (168 patients); 37.0–52.5% across age groups. Improvement in 62% by the doctor's assessment. Staying on CBD for one year (Kaplan–Meier) was 61.0% in LGS; no difference by age, syndrome or clobazam use. Seizure results are not given separately by syndrome; no control group. Funded by the manufacturer (GW/Jazz); 9 of 11 authors report receiving fees or support from the manufacturer.","yan_etki":"Side effects 41.6%: sleepiness/apathy 20.3%, diarrhea 13.4%; liver enzyme elevation 1.0%","pmid":"40650804","doi":"10.1007/s40120-025-00788-w","diger_kaynak":"Subanalysis of the same study in those using it together with clobazam: Strzelczyk 2025, Epilepsy Behav 166:110302 (PMID 40073826; 126 patients, 102 with LGS)"},{"ad":"Elbadri 2024 (adult LGS, Birmingham)","tasarim":"Retrospective, single-center follow-up study (England); no control group","n":"50","populasyon":"Adults aged 16 and over with LGS","urun":"Approved purified CBD (together with clobazam, per the NICE recommendation)","urun_turu":"saf_cbd","doz":"From 1 mg/kg/day up to 10 mg/kg/day","titrasyon":"Slow increase (from 1 to 10 mg/kg/day)","sure":"6–24 months","sonuc":"At least a halving of focal and generalized seizures in 76% of patients; no one became seizure-free. At last follow-up, 94% were still on the medicine. No control group, single center. 2 of 8 authors report receiving speaker fees from the manufacturer (Jazz).","yan_etki":"The abstract says 'well tolerated'; side effect rates are not in the abstract","pmid":"38908033","doi":"10.1016/j.yebeh.2024.109904","diger_kaynak":null},{"ad":"Aung 2026 (adult LGS, London)","tasarim":"Retrospective, single-center follow-up study (King's College Hospital, London); no control group","n":"79","populasyon":"Adults with LGS (median age 29); together with clobazam, per NICE","urun":"Approved purified CBD oral solution","urun_turu":"saf_cbd","doz":"Median 2.4 mg/kg twice daily at the start; median 5.1 at month 6 and 7.4 mg/kg twice daily at last follow-up","titrasyon":"Per the doctor","sure":"Median 41 months","sonuc":"At least a halving across all seizure types in 59.5% at month 6 and 67.1% at last follow-up; in 78 patients with drop seizures, 50% at month 6 and 61.5% at last follow-up. Seizure-free days per month rose from 5.7 to 12.5; seizure-related hospital admissions and injuries decreased. At last follow-up, 86% were still on the medicine. Based on caregiver diaries, no control group. The first author's research fellowship was paid by the manufacturer (Jazz), which also reviewed the article; 6 of 10 authors report financial ties to the manufacturer.","yan_etki":"Sleepiness in 33, diarrhea in 24, abnormal liver tests in 12 patients (10/39 of those taking valproate, 2/40 of those not; none led to stopping), worsening behavior in 11; doses of other medicines were adjusted in 51 patients; 4 deaths (judged unrelated to CBD)","pmid":"42798297","doi":"10.1111/ene.70760","diger_kaynak":null},{"ad":"Koo 2020 (Korea)","tasarim":"Retrospective, single-center observational study (Severance Children's Hospital, Seoul); no control group","n":"44 (34 LGS, 10 Dravet)","populasyon":"Children with LGS and Dravet (aged 1.2–15.8; mean 5.1); 81.8% were taking valproate","urun":"Epidiolex (purified CBD)","urun_turu":"saf_cbd","doz":"Started at 5 mg/kg/day and maintained at 10 mg/kg/day","titrasyon":null,"sure":"6 months","sonuc":"In the LGS group at month 3, seizures decreased in 52.9% of patients and were at least halved in 32.3% (23.5% seizure-free); at month 6, these figures fell to 29.4% and 20.6%. Based on caregiver report, no control group. The authors report no conflicts of interest.","yan_etki":"Side effects 36.3%, most commonly gastrointestinal complaints (15.9%; mild liver enzyme elevation in 1 patient) and behavior changes (11.4%); no life-threatening side effects","pmid":"33372424","doi":"10.3346/jkms.2020.35.e427","diger_kaynak":"Prospective study from the same center: Kim 2022, J Clin Neurol 18:547–52 (PMID 36062772; NCT04611438; 30 LGS + 11 Dravet): at least a halving in 26.8% at month 6; quality of life score did not change, motor skill score fell. According to the correction (PMID 36854341), the dose was started at 2.5–5 mg/kg/day and raised to 10 mg/kg/day over 2 weeks, and could be increased up to 20 if needed. The periods overlap (March–October 2019 and May 2019–December 2020), and the first author of Koo 2020 is also an author of Kim 2022; some patients are most likely shared"},{"ad":"Press 2015 (unlicensed cannabis extracts)","tasarim":"Retrospective chart review (single center, Colorado); based on parent report; no control group","n":"75 (number of patients with LGS not in the abstract)","populasyon":"Children and adolescents with drug-resistant epilepsy (Dravet, Doose, LGS and others)","urun":"Oral cannabis extracts (unlicensed, CBD-rich; content and THC ratio not verified)","urun_turu":"cbd_zengin_thc_belirsiz","doz":"not reported (in the abstract)","titrasyon":null,"sure":"not reported (in the abstract)","sonuc":"In the whole group, 33% of families reported a more than 50% reduction in seizures; in LGS this figure was 88.9% (Dravet 23%, Doose 0%). Response was 47% in families who had moved to Colorado for this treatment and 22% in those already living there. No improvement was seen on the EEGs of responders. No control group, product content unknown; the authors point to confounding factors and call for controlled studies.","yan_etki":"Side effects 44%: increased seizures 13%, sleepiness/fatigue 12%; developmental regression, abnormal movements, status epilepticus requiring intubation and death were reported rarely","pmid":"25845492","doi":"10.1016/j.yebeh.2015.02.043","diger_kaynak":null},{"ad":"Devinsky 2022 (THC-containing medical cannabis)","tasarim":"Prospective observational study (structured monitoring in a residential care center); no control group or blinding","n":"29 (11 LGS)","populasyon":"People aged 12–46 with drug-resistant epilepsy (11 LGS, 15 focal or multifocal, 3 generalized epilepsy)","urun":"Medical cannabis tablets, THC:CBD 1:20 and/or 1:50 (Columbia Care)","urun_turu":"thc_iceren","doz":"At most 6 mg THC a day; at the highest dose, a mean of 5.9 mg THC and 117.2 mg CBD a day (0.11 and 2.3 mg/kg/day)","titrasyon":"Up to a predefined highest dose; if the response was inadequate, patients were switched to the 1:50 product","sure":"At least 24 weeks","sonuc":"At the stable highest dose, convulsive seizure frequency, seizure duration, post-seizure time and rescue medicine use did not change significantly from baseline; in patients with LGS, the result was no different from the other syndromes. No difference in behavior or sleep duration. The CBD doses were much lower than in the approved medicine's studies. The company that makes the product (Columbia Care) partly funded the study.","yan_etki":"10 side effects in 6 patients (including vomiting, gum or nose bleeding and 1 status epilepticus), all temporary and most unrelated to the drug; 16 serious side effects in 7 patients (5 of them pneumonia), all judged unrelated to the drug; 2 patients were withdrawn from the study because of serious side effects (one for increased seizures, one for increased behavior problems)","pmid":"35267245","doi":"10.1002/acn3.51537","diger_kaynak":null}],"ilgili_ilaclar":["klobazam","valproat","stiripentol","topiramat","rufinamid","zonisamid","eslikarbazepin","karbamazepin"],"son_inceleme":"2026-10-28","arastirma_gecmisi":[{"tarih":"2026-10-19","not":"Page published. This first review examined 6 studies."},{"tarih":"2026-10-21","not":"The full texts of the studies were reread, and the information on the page was checked against its sources. Corrected: the dose increase details in the study table; the drug interaction notes; the approved medicine's dosing schedule; the starting and titration summary. The points that could not be verified from the full text went down from 3 items to 2. The conclusion and strength of evidence did not change."},{"tarih":"2026-10-22","not":"The names of the finding labels were simplified: the label \"Effect proven\" on this page became \"Proven effect\". The assessment did not change."},{"tarih":"2026-10-27","not":"The Turkey row was corrected: the active substance of the approved CBD medicine (cannabidiol oral solution) is on the Foreign Active Substance List of TİTCK (Turkish Medicines and Medical Devices Agency) and can be imported from abroad with the agency's written approval; unsourced information about the SGK (Turkey's Social Security Institution) list was removed. The conclusion and strength of evidence did not change."},{"tarih":"2026-10-27","not":"The reason for the difference between the 'low certainty' rating of a review in the table (Stockings 2018) and the guide's 'Strong' rating was added to the evidence summary: the review was based on two studies up to 2017, and later meta-analyses point in the same direction. The conclusion and strength of evidence did not change."},{"tarih":"2026-10-27","not":"In October 2026, PubMed, Cochrane and ClinicalTrials.gov were systematically searched again (878 PubMed and 24 ClinicalTrials.gov records were reviewed; the findings were reread from primary sources in an independent check). Studies added: the Cochrane review of LGS medicines (Brigo 2021), a meta-analysis combining LGS only (Lattanzi 2018), a network meta-analysis comparing LGS treatments (Zhu 2025), a meta-analysis broken down by age and syndrome (de Oliveira 2026), a manufacturer analysis by clobazam use (Devinsky 2020), the three-year extension of the two studies (Patel 2021), two drug-level studies measuring the clobazam interaction (VanLandingham 2020, in patients; Morrison 2019, in healthy volunteers), everyday-practice studies from France, Germany and Korea (D'Onofrio 2020, Strzelczyk 2025, Koo 2020), use without clobazam (Nabbout 2023), adult LGS studies (Elbadri 2024, Aung 2026), unlicensed cannabis extracts (Press 2015) and a THC-containing product (Devinsky 2022). Added to the evidence summary: that the Cochrane review could not calculate the effect on all seizures because of insufficient data, that in patients not taking clobazam the reduction in the number of seizures was smaller and the response rate similar (the comparison was not made by chance assignment), and long-term liver data; for THC-containing products, the box and the strength of evidence were written for the first time ('Insufficient'). The two Lattanzi 2018 reviews in the table were distinguished by name. No third controlled treatment study was found. The conclusion and strength of evidence did not change."},{"tarih":"2026-10-28","not":"On October 28, 2026, four sources found for this page during the searches for other topics were read from their primary sources. The separate final Lennox–Gastaut results on ClinicalTrials.gov for the extension study lasting up to three years (Patel 2021) were added to the table and the evidence summary: 243 of 366 patients completed the study; the median reduction in drop seizures over each patient's last 12 weeks, including those who left early, was 59%; serious side effects occurred in 157 patients, and 12 deaths were recorded (the registry does not state whether the deaths were related to the medicine). These results come from a study without a comparison group and are not a peer-reviewed publication. Weight loss figures from the US product information for the approved CBD medicine were added to the side effects list: in controlled studies, the proportion of patients whose weight decreased by at least 5% was 16% in the CBD group and 8% in the placebo group. A small, uncontrolled series of 12 patients with a Lennox–Gastaut-like picture in 15q duplication syndrome (in the same direction as the larger studies in the table) and a 2021 position paper of the Brazilian Academy of Neurology (which brings no new data and reports study results differently from their sources) were reviewed and not added to the page. The conclusion and strength of evidence did not change."},{"tarih":"2026-10-30","not":"The last sentence of the page's short summary was rewritten in a calmer, more guiding tone: instead of \"Talk to your doctor before you start.\", it now says whom you can talk with, and about what, if you are considering CBD. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-31","not":"The evidence level text now uses the same level name as the top of the page; the level and the result did not change."}]},{"id":"tuberous-sclerosis","baslik":"Epilepsy: Tuberous sclerosis complex (TSC)","grup":"Epilepsy","grup_kodu":"epilepsi","tr_id":"epilepsi-tuberoz-skleroz","kanit_duzeyi":"orta","kanit_yonu":"yarar_gosterildi","kanit_ozet":"In a single double-blind RCT (GWPCARE6), prescription pure CBD reduced TSC-associated seizures more than placebo over 16 weeks (48.6% vs. 26.5%). For the prespecified key secondary endpoint, the share of patients whose seizures were at least halved, the difference was not statistically significant (36% vs. 22.4%; p = 0.0692; European product information). 50 mg/kg/day showed no additional benefit over 25 mg/kg/day, but side effects increased. People taking oral mTOR inhibitors (everolimus, sirolimus) were not included in the study; data on use with these medicines come only from uncontrolled and observational studies. In the open-label extension of the same study (199 patients, mean 27 mg/kg/day), the reduction in seizures persisted for 48 weeks (median 54–68%); because there was no control group, this part shows durability rather than efficacy; liver enzyme increases occurred in 9%, mostly in those taking valproate; in the final results on ClinicalTrials.gov (follow-up of up to 4 years, no peer-reviewed publication), ≥50% response was 106/199 and discontinuation due to side effects was 18/199. Other data without a comparison group point in the same direction: in 34 TSC patients in the expanded access program, the median reduction in total seizures over 12-week periods stayed between 44% and 87% for 144 weeks (36–74% when those who stopped were counted with their last values; Weinstock 2024); in a 27-center retrospective real-world study, among patients who took CBD for at least 3 months, the share whose seizures were at least halved was 55.9% in the group of 36 patients with a change in the TSC2 gene and 2/5 in the 5 patients with a change in TSC1 (Cerulli Irelli 2025). These studies show durability and results in everyday practice, not efficacy; because those who stopped the medicine early were not included in the analysis or in later periods, the results may be skewed in a favorable direction. In a small retrospective series, 6 of 7 renal angiomyolipomas and 3 of 3 subependymal giant cell tumors grew during CBD treatment; there was no comparison group (Barnett 2020). Meta-analyses add no new data for TSC; their TSC estimates are again based on GWPCARE6 (Talwar 2023: OR 1.99 for ≥50% response; 95% CI 1.06–3.76). This estimate most likely combines the two dose groups; the approved dose alone was not significant on this measure. The evidence rests on a single RCT, and doses below 25 mg/kg/day have not been studied in TSC (FDA). October 2026 search (PubMed, Cochrane, ClinicalTrials.gov): 1 controlled study and 3 reviews (2 of them meta-analyses) of cannabinoids on this topic were found; these are in the table below, together with 2 long-term studies without a comparison group, 1 drug interaction study in healthy volunteers, and 4 observational studies. There is no Cochrane review covering TSC. No study with published results in TSC was found for a product known to contain THC; a retrospective cohort from Israel also includes \"CBD-based products\" with unstated THC content (Shlomovitz 2021), and a placebo-controlled study of full-spectrum cannabis extract is ongoing in Spain (THC content not stated in the registry; NCT07403266).","kanit_duzeyi_metin":"Moderate (a single pivotal RCT; no second controlled study)","kanit_duzeyi_thc_icerenler":"yetersiz","kanit_duzeyi_thc_icerenler_metin":"THC-containing: Insufficient; no controlled study with results","kaynak_dosya":"epilepsi.md","saf_cbd_sonuc":"The approved, purified pharmaceutical CBD reduced seizures in TSC as an add-on treatment; this result cannot be applied to unregulated CBD products.","thc_icerenler_sonuc":"There is no controlled study with published results using THC-containing products in tuberous sclerosis (October 2026 search). In a retrospective patient cohort from Israel, a response of about 30–40% was reported with CBD-based products whose THC content was not stated; these data without a comparison group do not show an effect. A placebo-controlled study of full-spectrum cannabis extract is ongoing in Spain (NCT07403266).","ruhsat":"FDA (≥1 year): start at 2.5 mg/kg twice daily (5 mg/kg/day); increase weekly by 2.5 mg/kg twice daily (5 mg/kg/day) as tolerated; for faster titration, no more often than every other day. Recommended maintenance 12.5 mg/kg twice daily (25 mg/kg/day); the efficacy of doses below 25 mg/kg/day has not been studied in TSC. EMA (≥2 years, add-on treatment, no clobazam requirement): 5 mg/kg/day for 1 week, 10 mg/kg/day in week 2 (response and tolerability are assessed), then weekly increases of 5 mg/kg/day; above 10 mg/kg/day only with a benefit–risk assessment and full monitoring, maximum 25 mg/kg/day. In moderate liver impairment, 6.25 mg/kg twice daily for TSC; in severe impairment, 2.5 mg/kg twice daily (the maintenance dose in the FDA label, the maximum dose in the EMA label). Source: FDA label (05/2026) §2.3, §2.6; EMA product information §4.2, Table 2 (last updated in the EPAR on August 20, 2026). Turkey: Epidyolex/cannabidiol is not on the list of licensed products of TİTCK (Turkish Medicines and Medical Devices Agency) (October 16, 2026); however, on TİTCK's Foreign Active Substance List (September 28, 2026), cannabidiol oral solution (YDN02BG1099) is listed as a red-prescription medicine among those that cannot be imported without TİTCK's written approval.","doz_araligi_ozet":"25 or 50 mg/kg/day in the RCT; recommended maintenance in the labeling 25 mg/kg/day","titrasyon_ozet":"Labeling: start at 5 mg/kg/day, increase by 5 mg/kg/day weekly to a maintenance dose of 25 mg/kg/day; 4-week titration in the RCT (25 mg/kg/day reached in 9 days)","yan_etkiler":["Drowsiness/sedation: Epidiolex (LGS/Dravet) 32% (10 mg/kg/day 27%, 20 mg/kg/day 34%), placebo 11%","Diarrhea, decreased appetite, vomiting, fever, fatigue (common in RCTs)","Liver enzyme (ALT) >3×ULN: in controlled studies, LGS/Dravet 13%, TSC 12% (placebo 1%, controlled studies of the three diseases combined; FDA label, increase to more than 3 times normal — in the Thiele 2021 full text, transaminase (ALT or AST) >3×ULN: 12% at 25 mg/kg/day, 26% at 50 mg/kg/day, 0 with placebo; 22 of the 28 affected patients were taking valproate); 17% at 20 mg/kg/day, 1% at 10 mg/kg/day; >20×ULN <1%","ALT >3×ULN with valproate (TSC study, 25 mg/kg/day): valproate+clobazam 20%, valproate alone 25%, clobazam alone 0%, neither 6% (FDA)","Drowsiness/sedation in the TSC study 19% (placebo 17%); 33% in those taking clobazam, 14% in those not taking it (FDA)","Discontinuation due to side effects: in the TSC study, 8/75 (11%) at 25 mg/kg/day, 10/73 (14%) at 50 mg/kg/day, 2/76 (3%) with placebo (Thiele 2021); 8.9% vs. 1.8% in a Dravet/LGS meta-analysis (Lattanzi 2018, PMID 30390221)","Labeling warnings: suicidal thoughts and behavior (class warning for all antiepileptic drugs), hypersensitivity (including to sesame oil), increased seizures on sudden discontinuation; EMA: seizure frequency may increase, weight loss/failure to gain weight","Postmarketing: cholestatic/mixed-type liver injury and (mostly in those taking valproate/clobazam) elevated ammonia have been reported (FDA)","Weight loss: in the TSC study (25 mg/kg/day), a decrease in measured weight of at least 5% from baseline was seen in 31% of those taking CBD and 8% with placebo; weight loss reported as a side effect was 7% vs. 0%. In the LGS/Dravet controlled studies (10 and 20 mg/kg/day), weight loss of at least 5% was 16% vs. 8% (FDA, product information 05/2026)"],"izlem":["ALT, AST, and total bilirubin before starting (FDA and EMA)","Liver tests at months 1, 3, and 6, then periodically or as clinically needed","FDA: within 1 month after a dose change or after adding a medicine that affects the liver; EMA: the monitoring schedule starts over when the dose goes above 10 mg/kg/day or when a medicine that affects the liver is changed","People taking valproate and those with high baseline ALT/AST: per the EMA, at week 2 and at months 1, 2, 3, and 6, then periodically","Stopping rule (FDA and EMA): CBD is stopped if transaminases are >3×ULN and bilirubin is >2×ULN, or if transaminases are persistently >5×ULN","If liver symptoms occur (unexplained nausea, vomiting, right upper abdominal pain, fatigue, loss of appetite, jaundice, dark urine), check ALT/AST/bilirubin right away","Blood levels and side effects of concomitant antiepileptic drugs (Gaston 2017, PMID 28782097)"],"dikkat":["Epilepsy treatment is started, changed, and stopped by a neurologist's decision; antiepileptic medicines are not stopped on your own","CBD is stopped by gradually lowering the dose; stopping suddenly carries a risk of increased seizures and status epilepticus (FDA §2.5, §5.5). EMA: in studies, tapering was done over ~10 days, reducing the dose by ~10% a day","In moderate (Child-Pugh B) and severe (Child-Pugh C) liver impairment, the labeling specifies lower starting and maintenance doses; no adjustment is needed in mild impairment","Hypersensitivity to sesame oil is a contraindication (Epidyolex contains 736 mg of refined sesame oil and 79 mg of ethanol per mL)","People taking valproate or clobazam need more frequent monitoring for liver effects and sedation","Age: FDA ≥1 year, EMA ≥2 years","The medicine is always taken the same way in relation to food; a high-fat meal increases Cmax 5-fold and AUC 4-fold. Doses are measured with a calibrated syringe; a household spoon is not suitable","Unregulated (artisanal) CBD/cannabis oils are not a substitute for the approved medicine: labels are unreliable, they may contain THC and contaminants, and there are reports of increased seizures"],"ilac_etkilesim_notlari":["Clobazam: CBD increases the active metabolite N-desmethylclobazam ~3-fold (FDA) / 3–4-fold (EMA); clobazam also increases 7-OH-CBD (AUC 47%). If drowsiness occurs, lowering the clobazam dose is considered","Valproate: liver enzyme elevations increase markedly; diarrhea and decreased appetite also increase (EMA). If enzymes rise, CBD and/or valproate is reduced or stopped","Stiripentol: in healthy volunteers, Cmax increased 28% and AUC 55%; in patients, Cmax increased 17% and AUC 30%. Side effects are monitored closely","Everolimus: exposure increases ~2.5-fold (in healthy volunteers, CBD 25 mg/kg a day with a single dose of everolimus; Wray 2023); levels are monitored, and in a patient taking CBD, everolimus is started at a lower dose","Topiramate, rufinamide, zonisamide, eslicarbazepine: in an open-label study, serum levels rose as the CBD dose increased (most stayed within the therapeutic range)","Sirolimus, tacrolimus, digoxin (oral P-gp substrates): exposure may increase; level monitoring and dose reduction are considered","Strong CYP3A4/CYP2C19 inducers (rifampin; EMA: carbamazepine, enzalutamide, mitotane, St. John's wort): rifampin reduced CBD by ~32% and 7-OH-CBD by ~63% (FDA); FDA (05/2026): with a strong inducer, increasing the Epidiolex dose up to 2-fold may be considered based on response and tolerability","CYP1A2 substrates (theophylline, tizanidine, caffeine): caffeine AUC increased 95%; dose reduction is considered for drugs with a narrow therapeutic range","CYP2C19 prodrugs such as clopidogrel: the active metabolite may decrease","Alcohol and other CNS depressants: drowsiness and sedation increase; alcohol also increases CBD exposure (Cmax 93%, AUC 63%)","mTOR inhibitors in TSC: in an observational study (n=25), everolimus/sirolimus levels rose in 76% of patients; median +9.8 ng/mL (everolimus), +5.1 ng/mL (sirolimus), 2–3-fold in some (Ebrahimi-Fakhari 2020, PMID 31924480)"],"dogrulanamayan":["No official source was found on whether the route of importing a medicine for personal treatment with a doctor's report (TİTCK permission) has been used for Epidyolex in Turkey"],"calismalar":[{"ad":"Thiele 2021 (GWPCARE6)","tasarim":"Double-blind, placebo-controlled RCT, 46 centers","n":"224 randomized; 201 completed","populasyon":"Tuberous sclerosis complex, ages 1–65 (median 11.4); people taking oral mTOR inhibitors (everolimus, sirolimus) were not included","urun":"Epidiolex/Epidyolex (100 mg/mL oral solution, plant-derived purified CBD)","urun_turu":"saf_cbd","doz":"25 or 50 mg/kg/day","titrasyon":"4 weeks: started at 5 mg/kg/day; 25 mg/kg/day reached on day 9 and 50 mg/kg/day on day 29; then 12 weeks of maintenance","sure":"16 weeks","sonuc":"Reduction in TSC seizures 48.6% (25 mg) and 47.5% (50 mg), placebo 26.5%; vs. placebo 30.1% (p<0.001) and 28.5% (nominal p=0.002); ≥50% response 36% (25 mg) and 40% (50 mg), placebo 22%; difference not significant for 25 mg (p=0.0692, EMA)","yan_etki":"Diarrhea 31% / 56% (placebo 25%); drowsiness 13% / 26% (placebo 9%). Discontinuation 8 / 10 (placebo 2). Transaminase increase to more than 3 times normal 9/75 (12%) at 25 mg, 19/73 (26%) at 50 mg, 0 with placebo (18.9% for the two doses combined); 22 of the 28 affected patients were taking valproate, most began within the first 30 days, none met Hy's law criteria (full text). 25 mg is safer","pmid":"33346789","doi":"10.1001/jamaneurol.2020.4607","diger_kaynak":"NCT02544763; post hoc analysis: Wu 2022, Epilepsia 63:1189–99 (PMID 35175622): the difference from placebo began on day 6 (15 mg/kg/day) and became nominally significant on day 10"},{"ad":"Thiele 2022 (GWPCARE6 open-label extension)","tasarim":"Open-label extension (those who completed GWPCARE6); interim analysis","n":"199","populasyon":"Seizures due to TSC (ages 1–57, mean 13); in the extension, 9 patients took everolimus and 25 took sirolimus, mTOR inhibitors that had been prohibited in the double-blind phase; the interaction was not assessed","urun":"Epidiolex/Epidyolex (100 mg/mL oral solution)","urun_turu":"saf_cbd","doz":"Target 25 mg/kg/day, up to 50 mg/kg/day depending on response; mean 27 mg/kg/day","titrasyon":"Reduction, or increase up to 50 mg/kg/day, based on response and tolerability","sure":"Median 267 days (18–910); efficacy 48 weeks","sonuc":"In 12-week periods, median seizure reduction 54–68%; ≥50% response 53–61%; at week 26, 87% of patients/caregivers reported improvement; no control group. This is an interim analysis (February 2019 data); in the final results on ClinicalTrials.gov (up to 4 years, no peer-reviewed publication), median reduction in TSC seizures was 56% (those who received CBD in the double-blind phase, 124 patients) and 47% (those who received placebo, 75 patients), ≥50% response 106/199; according to the registry, 34 of the 199 patients completed the extension (for most of those who left, the reason was 'other')","yan_etki":"Side effects 92% (diarrhea 42%, seizures 22%, decreased appetite 20%); discontinuation due to side effects 6%; liver enzyme increases 9% (12 of the 17 patients were taking valproate). Final results (ClinicalTrials.gov, up to 4 years): side effects 192/199, serious side effects 56/199, permanent discontinuation due to side effects 18/199, 1 death","pmid":"34957550","doi":"10.1111/epi.17150","diger_kaynak":"ClinicalTrials.gov NCT02544750 (final results entered in the registry in July 2022; no peer-reviewed publication, 3-year results only as a conference abstract: American Epilepsy Society 2022)"},{"ad":"Weinstock 2024 (expanded access program)","tasarim":"Open-label, uncontrolled expanded access program (35 centers in the US); pooled analysis of the TSC subgroup","n":"34 (same for safety and efficacy analysis)","populasyon":"TSC and drug-resistant epilepsy; ages 1.8–31.2 years (mean 12.4); median 3 antiepileptic drugs at baseline (clobazam 59%, valproate 18%)","urun":"Epidiolex (100 mg/mL oral solution, plant-derived purified CBD)","urun_turu":"saf_cbd","doz":"Up to 25–50 mg/kg/day depending on the center; median 25–28 mg/kg/day in the first 36 weeks, then 20–50 mg/kg/day; median highest dose 40 mg/kg/day, 62% of patients went above 25 mg/kg/day","titrasyon":"Started at 2–10 mg/kg/day and increased as tolerated","sure":"Median 1,102 days of CBD; efficacy up to 144 weeks, safety up to 233 weeks","sonuc":"In 12-week periods, up to 144 weeks: median reduction in total seizures 44–87% (convulsive 44–81%, focal 51–87%); ≥50% response for total seizures 46–79%, seizure freedom 0–13%. When those who stopped were counted with their last values (LOCF), reduction in total seizures 36–74%. 8 patients (24%) stopped, most commonly for lack of effect (4 patients). No control group, and the number of patients decreases in later periods; supported by the manufacturer (GW Research/Jazz).","yan_etki":"Side effects 94% (drowsiness 32%, diarrhea 29%); serious side effects 47% (unrelated to treatment according to the investigator; status epilepticus, vomiting, viral infection, and seizures in 3 patients each); treatment-related side effects 68% (full text; 71% in the abstract); discontinuation due to side effects 2 patients; liver-related side effect 1 patient (was taking valproate, resolved without changing medicines); no deaths","pmid":"39088193","doi":"10.1002/epi4.13013","diger_kaynak":"Hess 2016, Epilepsia 57:1617–24 (PMID 27696387): single-center (Massachusetts General Hospital) interim analysis of the same program, 18 TSC patients (included among these 34 patients); at month 3, median reduction in weekly seizures 48.8%, ≥50% response 50%"},{"ad":"Wray 2023 (everolimus interaction)","tasarim":"Phase 1, single-center, open-label, fixed-sequence drug interaction study (everolimus alone and with CBD in the same person)","n":"not reported (in the abstract)","populasyon":"Healthy adult volunteers","urun":"Epidiolex (100 mg/mL oral solution) + single dose of everolimus 5 mg","urun_turu":"saf_cbd","doz":"CBD 12.5 mg/kg morning and evening (25 mg/kg/day), after a standard meal; everolimus 5 mg on days 1 and 13","titrasyon":null,"sure":"17 days (everolimus on day 1, 7 days of washout, CBD on days 9–17)","sonuc":"At steady-state CBD levels, everolimus peak blood level and total exposure (AUC) increased about 2.5-fold; half-life did not change markedly. The authors recommend monitoring everolimus blood levels and reducing the dose when they are used together. The authors are employees of the manufacturer.","yan_etki":"The single dose of everolimus was well tolerated with CBD (abstract); no details in the abstract","pmid":"37132402","doi":"10.1002/cpdd.1262","diger_kaynak":null},{"ad":"Talwar 2023 (meta-analysis)","tasarim":"Systematic review and meta-analysis; subgroup analysis by syndrome","n":"6 RCTs (Dravet, Lennox–Gastaut, TSC); the TSC subgroup is likely based on GWPCARE6 (224 patients), the only TSC RCT found in this search (full text could not be read)","populasyon":"Drug-resistant epilepsy due to Dravet syndrome, Lennox–Gastaut syndrome, and TSC","urun":"Epidiolex (purified CBD, oral)","urun_turu":"saf_cbd","doz":"10–50 mg/kg/day in the studies","titrasyon":null,"sure":"Up to 16 weeks in the studies","sonuc":"In the TSC subgroup, the likelihood of patients having their seizures at least halved was higher with CBD than with placebo (OR 1.99; 95% CI 1.06–3.76). This estimate most likely combines the two dose groups of GWPCARE6; in the same study, the approved dose alone was not significantly different from placebo on this measure (p = 0.0692). Across all studies, OR 2.45 (1.81–3.32). According to the authors, dose and concomitant clobazam use were associated with both the effect and side effects.","yan_etki":"Across all studies, side effects OR 1.81 (1.33–2.46), serious side effects OR 2.86 (1.63–5.05); diarrhea, drowsiness, sedation","pmid":"36206805","doi":"10.1016/j.expneurol.2022.114238","diger_kaynak":null},{"ad":"Tong 2024 (network meta-analysis)","tasarim":"Systematic review and network meta-analysis (6 newer antiepileptic drugs; indirect comparison)","n":"20 RCTs, 5,516 patients (all epilepsy types)","populasyon":"Adults with focal epilepsy; patients with Dravet, Lennox–Gastaut, and TSC (the abstract says 'adolescents'; the CBD study in TSC, GWPCARE6, covered ages 1–65)","urun":"Purified CBD (oral); everolimus among the drugs compared","urun_turu":"saf_cbd","doz":"not reported (in the abstract)","titrasyon":null,"sure":"not reported (in the abstract)","sonuc":"In the indirect comparison for ≥50% response in TSC, everolimus targeting high blood levels ranked ahead of CBD (SUCRA 89.7%). There is no study directly comparing CBD with everolimus; this kind of ranking does not show definite superiority. The authors state that the findings need to be confirmed.","yan_etki":"Not given separately for TSC (in the abstract); serious side effect and discontinuation rates were compared between drugs","pmid":"38277848","doi":"10.1016/j.yebeh.2024.109653","diger_kaynak":null},{"ad":"Samanta 2022 (scoping review)","tasarim":"Scoping review, TSC only","n":"not reported (in the abstract)","populasyon":"Seizures due to TSC","urun":"Approved, purified CBD","urun_turu":"saf_cbd","doz":"not reported (in the abstract)","titrasyon":null,"sure":"not applicable (review)","sonuc":"States that the evidence for short-term efficacy and safety rests on a single pivotal RCT. Data are lacking on which patients and which seizure types respond better, its place in the treatment sequence, use with other medicines, early treatment in infants, seizure severity, and cognitive/behavioral effects. No new numerical results.","yan_etki":"No separate figures; interactions with other antiepileptic drugs are discussed (abstract)","pmid":"35151190","doi":"10.1016/j.yebeh.2022.108577","diger_kaynak":"Commentary: Brigo 2022 (PMID 35581136); author reply: Samanta 2022 (PMID 35500511)"},{"ad":"Cerulli Irelli 2025 (real-world, TSC subgroup)","tasarim":"Retrospective, multicenter real-world study (27 centers, most in Europe, including Argentina); no control group","n":"266 patients with single-gene epilepsy; 41 with TSC epilepsy (36 with a change in the TSC2 gene, 5 in TSC1)","populasyon":"Single-gene drug-resistant epilepsy; median age 12 years when starting CBD","urun":"Epidiolex (Europe) or Convupidiol (Argentina); >99% purified CBD","urun_turu":"saf_cbd","doz":"Mean initial target dose 8.5 mg/kg/day for the whole group; not given separately for TSC","titrasyon":null,"sure":"Median follow-up 17 months (IQR 12–24); at least 3 months of CBD","sonuc":"At last follow-up, compared with baseline: in the group of 36 patients with a change in the TSC2 gene, mean seizure reduction 48.4%, ≥50% response 55.9% (rate in the table; number of patients assessed not stated), improvement on doctor assessment (CGI-I) 83.3%; in the 5 patients with TSC1, mean reduction 21.4%, ≥50% response 2/5. There was no difference in results between diagnostic groups (Lennox–Gastaut, Dravet, TSC, other encephalopathies) (unadjusted p > 0.4; p = 0.83 after accounting for the degree of intellectual disability and the longest seizure-free period before CBD). Because only those who took CBD for at least 3 months were included, those who stopped early were left out; retrospective and uncontrolled.","yan_etki":"Not given separately for TSC; in the whole group, side effects 38.5% during follow-up (21.8% at last follow-up; most common drowsiness 12.9%, digestive complaints 5.3%)","pmid":"40126049","doi":"10.1111/epi.18378","diger_kaynak":null},{"ad":"Ebrahimi-Fakhari 2020 (mTOR inhibitor levels)","tasarim":"Retrospective records review; comparison before and after CBD in the same patients","n":"25 (18 everolimus, 7 sirolimus)","populasyon":"TSC patients who had CBD added while taking an mTOR inhibitor (everolimus or sirolimus) (US, Cincinnati Children's Hospital); age not stated in the abstract","urun":"CBD (product name not stated in the abstract)","urun_turu":"cbd_zengin_thc_belirsiz","doz":"not reported (in the abstract)","titrasyon":null,"sure":"not reported (in the abstract)","sonuc":"After CBD was added, the trough blood level of the mTOR inhibitor rose significantly in 76% of patients (p = 0.0003); median increase +9.8 ng/mL for everolimus, +5.1 ng/mL for sirolimus. In some patients, the level rose 2–3-fold; some had clinical toxicity and laboratory abnormalities. The authors recommend level monitoring and an upfront dose reduction in patients prone to toxicity.","yan_etki":"Side effects 40% (most common diarrhea, 3 patients); no severe side effects","pmid":"31924480","doi":"10.1016/j.pediatrneurol.2019.11.017","diger_kaynak":null},{"ad":"Barnett 2020 (tumor volume)","tasarim":"Retrospective records review, single center (Massachusetts General Hospital); no control group","n":"Number of patients not in the abstract; 7 dominant renal angiomyolipomas and 3 subependymal giant cell tumors were measured","populasyon":"TSC patients taking CBD for epilepsy who had renal angiomyolipomas or subependymal giant cell tumors; those taking mTOR inhibitors and those who had surgery for these tumors were excluded","urun":"Epidiolex (plant-derived purified CBD, oral solution)","urun_turu":"saf_cbd","doz":"not reported (in the abstract)","titrasyon":null,"sure":"not reported (in the abstract)","sonuc":"During CBD treatment, 6 of 7 kidney tumors and 3 of 3 brain tumors grew; the 1 tumor that shrank was not considered significant. According to the authors, unlike mTOR inhibitors, CBD does not shrink these tumors. Because there was no comparison group, it is not known whether the growth differed from the natural course of the disease. Very small, uncontrolled series.","yan_etki":"not reported (in the abstract)","pmid":"32409220","doi":"10.1016/j.jocn.2020.05.030","diger_kaynak":null},{"ad":"Shlomovitz 2021 (Israeli TSC cohort)","tasarim":"Retrospective, single-center cohort (2008–2018); results of CBD-based products, vagus nerve stimulation, and the ketogenic diet side by side; no randomization or placebo","n":"91 TSC patients; number of patients taking CBD-based products not reported (in the abstract)","populasyon":"Tuberous sclerosis complex, children and adults; median age 15.6 years at last follow-up (Israel, single center)","urun":"\"CBD-based products\" (product name and THC content not stated in the abstract)","urun_turu":"cbd_zengin_thc_belirsiz","doz":"not reported (in the abstract)","titrasyon":null,"sure":"Mean follow-up about 2.5 years (0–9.5 years; abstract)","sonuc":"No difference in efficacy was found between CBD-based products, vagus nerve stimulation, and the ketogenic diet; the response rate was about 30–40% for all three. The definition of response and the number of patients taking CBD are not in the abstract; retrospective, uncontrolled.","yan_etki":"not reported (in the abstract)","pmid":"34491422","doi":"10.1007/s00381-021-05348-9","diger_kaynak":null}],"ilgili_ilaclar":["klobazam","valproat","stiripentol","topiramat","rufinamid","zonisamid","eslikarbazepin","karbamazepin","everolimus","sirolimus"],"son_inceleme":"2026-10-28","arastirma_gecmisi":[{"tarih":"2026-10-19","not":"Page published. This first assessment reviewed 1 study."},{"tarih":"2026-10-21","not":"The full texts of the studies were reread and the information on the page was checked against its sources. Corrected: the dose titration information in the study table; drug interaction notes; the approved medicine's dosing schedule; the starting and titration summary; reported side effects. Points that could not be confirmed from the full text went down from 3 items to 1 item. The definition used to measure liver enzyme elevation was clarified. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-21","not":"Newly published and previously missed clinical studies were searched for in PubMed and ClinicalTrials.gov. Study added: Thiele 2022 (GWPCARE6 open-label extension). The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-22","not":"The names of the conclusion labels were simplified: the \"Benefit shown\" label on this page became \"Proven effect\". The assessment did not change."},{"tarih":"2026-10-27","not":"The European product information of the approved medicine was reread. Added: the difference from placebo in the share of patients whose seizures were at least halved was not statistically significant. The Turkey row was corrected: cannabidiol oral solution is on the Foreign Active Substance List of TİTCK (Turkish Medicines and Medical Devices Agency), and the unsourced information about the SGK (Social Security Institution) list was removed. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-27","not":"The plain label and plain summary were rewritten to show clearly that the result rests on a single controlled study for now ('Effect shown (single controlled study)'). The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-27","not":"In October 2026, PubMed, Cochrane, and ClinicalTrials.gov were systematically searched again (390 PubMed and 10 ClinicalTrials.gov records were reviewed). Studies added: Weinstock 2024 (34 patients in the expanded access program, follow-up of up to three years), Wray 2023 (everolimus interaction in healthy volunteers), Talwar 2023 and Tong 2024 (meta-analyses), Samanta 2022 (review), Cerulli Irelli 2025 (real-world data), Ebrahimi-Fakhari 2020 (everolimus and sirolimus levels), Barnett 2020 (tumor volume), and Shlomovitz 2021 (tuberous sclerosis cohort from Israel). Corrected: the definition of liver enzyme elevation in the main study and its rates by dose were added from the full text; it was noted that the 1% placebo rate in the US prescribing information is the combined figure from the studies of three diseases; the rate of discontinuation due to side effects was given using the tuberous sclerosis study's own data; it was noted that people taking everolimus or sirolimus were not included in the main study; the final results of the open-label extension on ClinicalTrials.gov were added; the absence of controlled studies with results for THC-containing products, and the strength of evidence for this area (insufficient), were stated for the first time. No second controlled study was found. The evidence level text was aligned with the badge ('Moderate' instead of 'Moderate–high'); the conclusion and the strength of evidence in the badge did not change."},{"tarih":"2026-10-28","not":"On October 28, 2026, three sources found for this page during the searches for other topics were read in their primary sources. Weight loss figures from the US prescribing information of the approved CBD medicine were added to the side effects list: in the tuberous sclerosis study, the share of patients whose weight dropped by at least 5% from baseline was 31% in the CBD group and 8% in the placebo group. The 9 tuberous sclerosis patients in a real-world study from Germany were not added to the page because their seizure results were not reported separately, and the Brazilian Academy of Neurology's 2021 position paper was not added because it brought no new data for tuberous sclerosis. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-29","not":"The plain label changed from \"Effect shown (single controlled study)\" to \"Proven effect\", the same as the result label used elsewhere on the site. The result and the strength of evidence (moderate) did not change."},{"tarih":"2026-10-31","not":"The last sentence of the page's short summary was rewritten in a calmer, more guiding tone: instead of \"Talk to your doctor before you start.\", it now says whom you can talk with, and about what, if you are considering CBD. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-31","not":"The evidence level text now uses the same level name as the top of the page; the level and the result did not change."}]},{"id":"drug-resistant-epilepsy","baslik":"Epilepsy: Other drug-resistant epilepsies and unregulated CBD oils","grup":"Epilepsy","grup_kodu":"epilepsi","tr_id":"epilepsi-diger","kanit_duzeyi":"zayif","kanit_yonu":"celiskili","kanit_ozet":"In adults with drug-resistant focal epilepsy, a synthetic CBD gel applied to the skin (a daily total of 195 or 390 mg, divided into two applications) did not change seizure frequency differently from placebo in a 188-person double-blind RCT. In a small 27-person controlled study in frontal lobe epilepsy, liposomal CBD by mouth (up to 210 mg/day) was reported to improve seizures; however, the change in seizure frequency over time was not statistically different between the two groups (p = 0.187), the difference in the proportion of patients who improved at week 8 was also not significant (p = 0.069), at baseline the CBD group's monthly seizure count was about 2.5 times that of the control group (86.5 vs. 34.0), and the publication is not clear about whether the control group received placebo. An expanded access program reported seizure reductions for up to 144 weeks in 140 patients with focal epilepsy, but there is no control group. In other drug-resistant epilepsies such as CDKL5 deficiency, Aicardi, Dup15q and Doose, there are only open-label data without a placebo arm; seizure reductions were reported, but because reductions of 13–27% were also seen in the placebo arms of the approved medicine's RCTs, these findings cannot be counted as a drug effect. There is no approval for these epilepsies. Data on unregulated CBD/cannabis oils are mostly retrospective parent reports; in a prospective study that recorded seizures for 4 weeks before treatment, the response rate was at placebo level, and increased seizures have been reported. The manufacturer's studies in epilepsy with myoclonic-atonic seizures (NCT05288283; 2 patients randomized, ended by a business decision) and in children under 2 years (NCT04485104; 3 patients, ended due to low enrollment) produced no interpretable efficacy data. In a pilot study in infantile spasms (9 babies, 40 mg/kg/day, 2 weeks), the spasms did not stop in any baby; the randomized phase was not started. In a double-blind RCT in 162 adults with focal seizures using CBDV, a plant compound closely related to CBD, seizures fell similarly in both groups (40.5% vs. 37.7%; p = 0.648; manufacturer funding). Old controlled trials of pure CBD by mouth are very small: the 15-patient placebo-controlled study from 1980 has no statistical comparison; together with three small trials from the same period, one published as a letter to the editor and one as a conference abstract (48 patients in total), a Cochrane review (search 2013) wrote that no reliable conclusions can be drawn from these reports. In childhood absence epilepsy, in an uncontrolled study of 20 children by the maker of a synthetic CBD (results only on ClinicalTrials.gov, no peer-reviewed publication), the mean change in absence seizures counted on EEG, one of the primary outcomes, was not in the direction of a decrease (+41% and +35% in the two dose groups; highly variable from patient to patient), while the other primary outcome, time to first absence with hyperventilation, became longer; because the two outcomes pointed in different directions, the result is unclear. In real-world studies (Germany, France, Denmark, Colombia), the proportion of patients with off-label diagnoses whose seizures fell by at least half was reported as between 22% and 69%; in the comparisons in Germany and France, this rate was close to that in approved diagnoses, while in the Danish study it was clearly lower (22% vs. 70% at month 3). None of these studies has a control group; seizure outcomes rely on doctors' notes, seizure diaries and family reports, and some of those who stopped early are left out of the analysis. Two systematic reviews pooling epilepsies other than Dravet syndrome and LGS (2021 and 2026; the second was funded by the manufacturer) found only open-label data apart from TSC; 33 of the 57 studies in the 2026 review were case reports or small series. The UK's national guideline (NICE 2019) made no practice recommendation for cannabis-based products in these epilepsies, nor a recommendation against their use; it called for research into the efficacy of CBD in these epilepsies and into the effect of adding THC to CBD compared with CBD alone and with placebo. There are no controlled studies of CBD-rich products that contain THC or have an unknown THC content: in the only structured study, which prospectively followed 29 patients on a low-THC product, seizures did not change; the high response rates reported in open-label series in Israel and Colombia and the improvement reported in a national cohort in Thailand have no comparison group (evidence for THC is very weak). In unregulated products: in a pooled analysis of observational studies comparing CBD-rich extracts with purified CBD, the proportion of patients whose seizures fell by at least half was similar in both groups (37% vs. 42%; uncontrolled studies, and all three authors of the analysis had ties to cannabis companies); in product analyses, content often differed from the label, and THC, solvents, heavy metals and pesticides were found; in spontaneous side effect reports in Europe, in about 39% of serious reports involving unlicensed CBD, the product was being used for epilepsy. October 2026 search (PubMed, Cochrane, ClinicalTrials.gov): 4 controlled studies with cannabinoids on this topic (one with CBDV instead of CBD) and more than 30 systematic reviews of cannabinoid use in epilepsy were found (most rely on studies in Dravet syndrome, LGS and TSC); all the controlled studies, the 4 reviews most relevant to these epilepsies (including Cochrane) and the UK's national guideline are in the table below. The three small trials from 1978–1990 in the Cochrane review are not separate rows; they are mentioned in the review's row. The other studies in the table are open-label or observational studies without a comparison group, and product analyses; later publications from the same programs and studies with overlapping patients are in the other sources section of the relevant row.","kanit_duzeyi_metin":"Weak (mostly uncontrolled, open-label; Class III); in adult focal epilepsy, two large RCTs (CBD applied to the skin and CBDV, a compound closely related to CBD) were negative; in real-world studies, response rates reported in off-label diagnoses were mostly close to those in approved diagnoses (clearly lower in one study), but all are uncontrolled. Unregulated ('artisanal') CBD/cannabis oils: Very low","kanit_duzeyi_thc_icerenler":"cok_zayif","kanit_duzeyi_thc_icerenler_metin":"Very weak (no controlled studies; no effect was seen in the only prospective structured study, and the other data come from uncontrolled series and unregulated oils)","kaynak_dosya":"epilepsi.md","saf_cbd_sonuc":"Purified medicinal CBD has mostly been tested in uncontrolled studies in other drug-resistant epilepsies; in adult focal epilepsy, CBD applied to the skin in a 188-person RCT, and CBDV, a compound closely related to CBD, in a 162-person RCT, were no different from placebo; in real-world studies, seizures fell by at least half in 22% to 69% of patients using it off-label, but none of these studies has a comparison group; with unregulated CBD oils, the effect stayed at placebo level, and dose and content are unreliable.","thc_icerenler_sonuc":"Some unregulated products contain THC; the effect of THC-containing cannabis extracts has not been shown in controlled studies: in the only structured study, which prospectively followed 29 patients taking low-THC tablets, seizures did not change; the high response rates reported in open-label series in Israel and Colombia with CBD-rich oils containing small amounts of THC have no comparison group. In Australia, families believed CBD was dominant in most of the extracts they used, but THC or the raw form of THC (THCA) was found in 98% of the samples.","ruhsat":"Not approved. CBD's approval as a medicine covers only seizures in Dravet syndrome, Lennox–Gastaut syndrome and TSC, and covers only purified, standard-dose medicinal CBD (Epidiolex/Epidyolex, 100 mg/ml). In Turkey, medicinal CBD is not approved (list of TİTCK, the Turkish Medicines and Medical Devices Agency, October 16, 2026). On the TİTCK Foreign Active Ingredient List (September 28, 2026), cannabidiol oral solution (YDN02BG1099) is listed as a red-prescription medicine and among the medicines that cannot be imported without TİTCK's written approval.","doz_araligi_ozet":"In open-label studies, starting at 2–10 mg/kg/day, up to a ceiling of 25–50 mg/kg/day; in children using unregulated oils, median highest dose 0.9 mg/kg/day; CBD gel on the skin, a daily total of 195 or 390 mg, divided into two applications (focal epilepsy RCT); in frontal lobe epilepsy, 70–210 mg/day by mouth; CBDV in focal seizures up to 1,600 mg per day (RCT); synthetic CBD in childhood absence epilepsy 20 or 30 mg/kg/day","titrasyon_ozet":"In open-label studies, gradual increase varying by center; no common schedule reported","yan_etkiler":["Devinsky 2016: side effects 79% (sleepiness 25%, decreased appetite 19%, diarrhea 19%, tiredness 13%, convulsion 11%); serious side effects 30%, status epilepticus 6%","Szaflarski 2018: diarrhea 29%, sleepiness 22%","Unregulated oils: increased seizures 13% (Press 2015) and early discontinuation 14% (Knupp 2019)","Liver enzyme (ALT) >3×ULN: in controlled studies, LGS/Dravet 13%, TSC 12% (placebo 1%); 17% at 20 mg/kg/day, 1% at 10 mg/kg/day; >20×ULN <1%","ALT >3×ULN with valproate: valproate+clobazam 30%, valproate alone 21%, clobazam alone 4%, neither 3% (FDA)"],"izlem":["Before starting: ALT, AST and total bilirubin (FDA and EMA)","Liver tests at months 1, 3 and 6, then periodically or as clinically needed","FDA: within 1 month after a dose change or after adding a medicine that affects the liver; EMA: the monitoring schedule restarts when the dose goes above 10 mg/kg/day or when a medicine affecting the liver is changed","People taking valproate and those with high baseline ALT/AST: per EMA, at week 2 and months 1, 2, 3 and 6, then periodically","Stopping rule (FDA and EMA): CBD is stopped if transaminases are >3×ULN and bilirubin >2×ULN, or if transaminases stay >5×ULN","If liver symptoms occur (unexplained nausea, vomiting, upper right abdominal pain, tiredness, loss of appetite, jaundice, dark urine), check ALT/AST/bilirubin right away","Blood levels and side effects of antiseizure medicines used at the same time (Gaston 2017)"],"dikkat":["Epilepsy treatment is started, changed and stopped by the neurologist's decision; antiseizure medicines are not stopped on one's own","CBD is stopped by gradually reducing the dose; stopping suddenly carries a risk of increased seizures and status epilepticus (FDA §2.5, §5.5). EMA: in the studies, CBD was stopped over ~10 days, reducing by ~10% per day","In moderate (Child-Pugh B) and severe (Child-Pugh C) liver impairment, the label specifies lower starting and maintenance doses; no adjustment is needed in mild impairment","Hypersensitivity to sesame oil is a contraindication (Epidyolex contains 736 mg refined sesame oil and 79 mg ethanol per ml)","People taking valproate or clobazam need more frequent monitoring for liver effects and sedation","Age: FDA ≥1 year, EMA ≥2 years","The medicine is always taken the same way in relation to food; with a high-fat meal, Cmax rises 5-fold and AUC 4-fold. Doses are measured with a calibrated syringe; a household spoon is not suitable","Unregulated (artisanal) CBD/cannabis oils do not replace the approved medicine: labels are unreliable, they may contain THC and contaminants, and increased seizures have been reported","The approval covers only Dravet syndrome, LGS and TSC; use in other epilepsies is the doctor's decision","In unregulated products, CBD may be lower than the label (ineffective dose) or higher (unexpected side effects and clobazam/valproate interaction), and they may contain THC"],"ilac_etkilesim_notlari":["Clobazam: CBD increases the active metabolite N-desmethylclobazam ~3-fold (FDA) / 3–4-fold (EMA); clobazam also increases 7-OH-CBD (AUC 47%). If sleepiness occurs, reducing the clobazam dose is considered","Valproate: raised liver enzymes increase markedly; diarrhea and decreased appetite also increase (EMA). If enzymes rise, CBD and/or valproate is reduced or stopped","Stiripentol: in healthy volunteers, Cmax up 28%, AUC 55%; in patients, Cmax up 17%, AUC 30%. Side effects are monitored closely","Everolimus: exposure increases ~2.5-fold; levels are monitored, and in patients taking CBD, everolimus is started at a lower dose","Topiramate, rufinamide, zonisamide, eslicarbazepine: in an open-label study, serum levels rose as the CBD dose increased (most stayed within the therapeutic range)","Sirolimus, tacrolimus, digoxin (oral P-gp substrates): exposure may increase; level monitoring and dose reduction are considered","Strong CYP3A4/CYP2C19 inducers (rifampin; EMA: carbamazepine, enzalutamide, mitotane, St. John's wort): rifampin lowered CBD by ~32% and 7-OH-CBD by ~63% (FDA); FDA (05/2026): with a strong inducer, increasing the Epidiolex dose up to at most 2-fold may be considered, based on response and tolerability","CYP1A2 substrates (theophylline, tizanidine, caffeine): caffeine AUC rose 95%; dose reduction is considered for narrow-range medicines","CYP2C19 prodrugs such as clopidogrel: the active metabolite may decrease","Alcohol and other CNS depressants: sleepiness and sedation increase; alcohol also increases CBD exposure (Cmax 93%, AUC 63%)"],"dogrulanamayan":["For Devinsky 2016, Devinsky 2018 (CDKL5/Aicardi/Dup15q/Doose) and Gaston 2021, only the PubMed abstract was read; the values match the abstract","No official source was found on whether the route of importing from abroad for personal treatment with a doctor's report (permission from TİTCK, the Turkish Medicines and Medical Devices Agency) has been used for Epidyolex in Turkey","A study of switching from unregulated CBD to Epidiolex (NCT06924827; Toronto, 25 children planned) is not yet recruiting; estimated start January 2027, no results (ClinicalTrials.gov, last updated September 11, 2026)","Ebadi 2023: the abstract says the control group took only their existing medicines, while the methods section says placebo was given; what the control group received remains unclear","Controlled studies with unknown results (ClinicalTrials.gov, October 28, 2026): there are no results in the registry or peer-reviewed publications for a placebo-controlled study of CBD in children and adolescents in Brazil (NCT02783092; 126 patients planned, status unknown), a crossover study of the approved CBD in electrical status epilepticus in sleep (NCT04721691; completed in January 2024), and a placebo-controlled study of CBD+THC in adults (NCT03808935; terminated with 17 patients).","Ongoing or planned placebo-controlled studies (ClinicalTrials.gov, October 28, 2026): studies by the maker of the approved CBD, a phase 3 study with oral CBD solution in developmental and epileptic encephalopathies (NCT07723976; not yet recruiting) and a phase 2/3 study with a capsule form of the same active ingredient in juvenile myoclonic epilepsy (NCT07723963; recruiting); a Canadian study that will compare pure CBD and a CBD-rich plant extract that also contains a small amount of THC with placebo (NCT07023744; not yet recruiting); individualized crossover studies in children in the Netherlands with a full-spectrum cannabis extract that also contains a small amount of THC (NCT07668856; recruiting). None had results as of this date.","The original texts of the 1978, 1986 and 1990 trials in the Cochrane review could not be read (one is only a conference abstract); the details of these trials could not be verified from the primary source."],"calismalar":[{"ad":"O'Brien 2022 (STAR 1)","tasarim":"Multicenter, double-blind, placebo-controlled RCT, 3 arms","n":"188 (195 mg 63, 390 mg 62, placebo 63)","populasyon":"Adults with drug-resistant focal epilepsy (Australia, New Zealand)","urun":"Synthetic CBD gel, applied to the skin (transdermal); pharmaceutical grade","urun_turu":"saf_cbd","doz":"Daily total of 195 mg or 390 mg, divided into two applications (per the journal's correction)","titrasyon":null,"sure":"12 weeks (followed by an open-label extension of up to 2 years)","sonuc":"Seizure frequency no different from placebo at either dose (2.51 and 2.59 vs. 2.49 per 28 days); ≥50% reduction in 60.8% at month 6 of the open-label extension (uncontrolled)","yan_etki":"Treatment-related side effects 33.9% at 390 mg, 17.5% at 195 mg, 12.7% with placebo; stopped because of side effects 3–5%","pmid":"35802375","doi":"10.1001/jamanetworkopen.2022.20189","diger_kaynak":"ACTRN12616000510448"},{"ad":"Ebadi 2023","tasarim":"Triple-blind, controlled study (Iran)","n":"27 (12 CBD / 15 control)","populasyon":"Drug-resistant frontal lobe epilepsy (adults)","urun":"Liposomal pure CBD (99.95%, contains no THC), oral solution (40 mg/mL)","urun_turu":"saf_cbd","doz":"70 mg/day (week 1) → 140 mg/day (week 2) → 210 mg/day, once daily","titrasyon":"Weekly increase: 70 → 140 → 210 mg/day","sure":"8 weeks","sonuc":"At week 4, seizure improvement 66.7% with CBD and 20% in controls (difference not significant at week 8, p = 0.069); the between-group difference in the change in seizure frequency over time was not significant (p = 0.187); baseline monthly seizure count 86.5 with CBD and 34.0 in controls; seizure severity did not change; at week 8, more patients improved in quality of life with CBD","yan_etki":"Found to be safe; side effect numbers not in the publication","pmid":"37470002","doi":"10.3389/fneur.2023.1143783","diger_kaynak":"IRCT20210608051515N1"},{"ad":"Devinsky 2016","tasarim":"Open-label, uncontrolled; 11 US centers","n":"214 enrolled; 162 safety, 137 efficacy analysis","populasyon":"Mixed drug-resistant epilepsies, ages 1–30","urun":"Oral CBD (pure CBD)","urun_turu":"saf_cbd","doz":"Starting at 2–5 mg/kg/day, up to intolerance or a ceiling of 25 or 50 mg/kg/day","titrasyon":"By center","sure":"12 weeks","sonuc":"Median motor seizures 30.0 → 15.8/month; median reduction 36.5% (no control group)","yan_etki":"Side effects 79%: sleepiness 25%, decreased appetite 19%, diarrhea 19%, tiredness 13%, convulsion 11%. Serious side effects 30%; severe events possibly related to the medicine 12% (most often status epilepticus, 6%). 1 SUDEP (unrelated)","pmid":"26724101","doi":"10.1016/S1474-4422(15)00379-8","diger_kaynak":"Single-center reports from centers that took part in the same program (some patients shared): Sands 2019, CNS Drugs 33:47–60 (PMID 30460546; UCSF, 26 children under individual patient and expanded access permits between April 2013 and December 2014, mean 21 months): at month 24, 9 of the 26 children were still on treatment, and 7 (26.9%) had a lasting reduction of more than half in motor seizures; 57.7% stopped due to insufficient effect; side effects 80.8%, serious side effects 23.1% (3 status epilepticus, 2 catatonia). Patel 2021, Epilepsia 62:1594–603 (PMID 34050682; MGH, 54 patients, median 45.5 months): responder rate similar at year 1 and at the last visit (41.7–42.6%); no control group"},{"ad":"Szaflarski 2018","tasarim":"Interim analysis of an open-label expanded access program, 25 US centers","n":"607 (safety)","populasyon":"Drug-resistant epilepsies; mean age 13 (0.4–62)","urun":"Oral CBD (pure CBD)","urun_turu":"saf_cbd","doz":"Starting at 2–10 mg/kg/day → ceiling of 25–50 mg/kg/day; median 25 mg/kg/day","titrasyon":"By center","sure":"Median 48 weeks","sonuc":"At week 12, 51% reduction in convulsive seizures and 48% in all seizures; similar up to 96 weeks. ≥50% / ≥75% / 100% response: 52% / 31% / 11% (no control group)","yan_etki":"Diarrhea 29%, sleepiness 22%. 24% stopped (lack of effect 15%, side effects 5%)","pmid":"29998598","doi":"10.1111/epi.14477","diger_kaynak":"Final pooled analysis of the same program: Szaflarski 2023, Epilepsia 64:619–29 (PMID 36537757; 35 US centers, 892 patients, up to January 2019, median 694 days): 36% stopped (insufficient effect 19%, side effects 7%); median reduction in convulsive seizures 50–67%, at least 50% reduction 51–59%; side effects 88%, serious side effects 41%; 20 deaths judged by investigators as unrelated to treatment; no control group. Funding also includes GW/Jazz and Alabama's Carly's Law fund, so the UAB patients in Gaston 2021 may be included in this pool; the correction note (PMID 38420790) could not be read. Analysis of the same pool by seizure type: Flamini 2023, Epilepsia 64:e156–63 (PMID 37243404): median reduction 50–100% in focal, absence and myoclonic seizures and epileptic spasms, at least 50% reduction in about half of patients; the correction note (PMID 38572913) could not be read"},{"ad":"Patel 2025 (expanded access, focal epilepsies)","tasarim":"Subanalysis of an open-label expanded access program (the same program as Devinsky 2016 and Szaflarski 2018; no control group)","n":"140 efficacy (TSC 33, other focal epilepsies 107); 148 safety","populasyon":"Drug-resistant focal epilepsies (ages 2–73)","urun":"Epidiolex (100 mg/mL oral solution)","urun_turu":"saf_cbd","doz":"Starting at 2–10 mg/kg/day, up to a ceiling of 25–50 mg/kg/day; median 23–25 mg/kg/day","titrasyon":"Gradual increase up to the level the patient tolerated","sure":"Up to 144 weeks","sonuc":"In focal epilepsies other than TSC, median reduction in focal seizures 46–75%; 38% stopped (lack of effect 18%, side effects 9%); no control group","yan_etki":"Side effects 95% (most often diarrhea 48%); serious side effects 40%; stopped because of side effects 8%","pmid":"40673944","doi":"10.1111/epi.18496","diger_kaynak":null},{"ad":"Devinsky 2018 (CDKL5, Aicardi, Dup15q, Doose)","tasarim":"Open-label, compassionate use/EAP","n":"55 safety (CDKL5 20, Aicardi 19, Dup15q 8, Doose 8)","populasyon":"Ages 1–30","urun":"Epidiolex (pure CBD)","urun_turu":"saf_cbd","doz":"Not reported (in the abstract)","titrasyon":"not reported","sure":"48 weeks (efficacy)","sonuc":"Convulsive seizure reduction: week 12 51.4% (n=35), week 48 59.1% (n=27). Authors: Class III evidence; RCTs needed","yan_etki":"27% stopped by week 144 (4 side effects, 9 lack of effect)","pmid":"30006259","doi":"10.1016/j.yebeh.2018.05.013","diger_kaynak":null},{"ad":"Gaston 2021","tasarim":"Open-label (UAB EAP), 2 years","n":"169 (89 children, 80 adults)","populasyon":"Drug-resistant epilepsy","urun":"Epidiolex 100 mg/ml (pure CBD)","urun_turu":"saf_cbd","doz":"Starting at 5 mg/kg/day → ceiling of 50 mg/kg/day","titrasyon":"According to seizure control and tolerability","sure":"Up to 2 years","sonuc":"Seizure reduction in children 52% (month 1), 51% (year 1), 75% (year 2); in adults 60%, 81%, 85% (no control group)","yan_etki":"Diarrhea, sedation, decreased appetite","pmid":"33667843","doi":"10.1016/j.yebeh.2021.107862","diger_kaynak":"Drug interaction analyses from the same UAB program: Gaston 2017, Epilepsia 58:1586–92 (PMID 28782097; 39 adults, 42 children): as the CBD dose increased, topiramate, rufinamide and N-desmethylclobazam levels rose and the clobazam level fell; in adults, zonisamide and eslicarbazepine levels also rose; changes other than clobazam and its metabolite stayed within the therapeutic range; AST/ALT were higher in those taking valproate. Final analysis Gaston 2023, Epilepsia Open 8:1405–12 (PMID 37593907; 169 people, 80 adults): with CBD dose, levels of clobazam, N-desmethylclobazam, free valproate, felbamate and topiramate rose (levetiracetam in children only, perampanel in adults only); according to the authors, the clinical importance is probably small. The program was funded by the state of Alabama (Carly's Law), and the medicine was donated by GW. This UAB program is the Alabama arm of the US expanded access program in row 1768 (Carly's Law funding); some patients are very likely also counted in that row"},{"ad":"Knupp 2019","tasarim":"Prospective observation","n":"21 (32 consented; 11 excluded from the analysis)","populasyon":"Children with epilepsy using unregulated oral cannabis extracts","urun":"Unregulated cannabis extract (CBD and THC-COOH measured)","urun_turu":"cbd_zengin_thc_belirsiz","doz":"Median highest CBD dose used 0.9 mg/kg/day","titrasyon":"not reported","sure":"12 weeks (after a 4-week baseline observation)","sonuc":"Response rate 24%; according to the authors, similar to the placebo rates in RCTs of medicinal CBD. Blood CBD/THC-COOH levels were not related to response","yan_etki":"Stopped early in 3 children (14%) because of perceived increase in seizures","pmid":"31550641","doi":"10.1016/j.seizure.2019.09.007","diger_kaynak":null},{"ad":"Press 2015","tasarim":"Retrospective parent report (Colorado)","n":"75","populasyon":"Children with drug-resistant epilepsy","urun":"Oral cannabis extracts (unregulated)","urun_turu":"cbd_zengin_thc_belirsiz","doz":"not reported","titrasyon":"not reported","sure":"not reported","sonuc":"33% reported ≥50% reduction; 47% among families who moved to Colorado for this treatment and 22% among those who already lived there (a sign of an expectation effect). No improvement in EEG background","yan_etki":"Side effects 44%; increased seizures 13%, sleepiness/tiredness 12%. Rare: developmental regression, abnormal movements, status epilepticus requiring intubation, death","pmid":"25845492","doi":"10.1016/j.yebeh.2015.02.043","diger_kaynak":"Overlapping cohort from the same center: Treat 2017, Epilepsia 58:123–7 (PMID 27859038): 71% of 119 patients stopped the product (mean use 11.7 months); moving to Colorado was associated with perceived benefit (65% vs. 38%, p = 0.01) but was not independently associated with longer use; a Dravet diagnosis was associated with shorter use (p = 0.02); according to parent reports, response 24%, side effects 19% (most often sleepiness and increased seizures)"},{"ad":"Porcari 2018","tasarim":"Retrospective","n":"108","populasyon":"Children with epilepsy","urun":"Unregulated (artisanal) CBD preparations; content not verified","urun_turu":"cbd_zengin_thc_belirsiz","doz":"not reported","titrasyon":"not reported","sure":"not reported","sonuc":"≥50% seizure reduction reported in 39% and seizure freedom in 10%; uncontrolled and open to bias","yan_etki":"The most commonly reported side effect was sedation (<4%; all were also taking clobazam)","pmid":"29429908","doi":"10.1016/j.yebeh.2018.01.026","diger_kaynak":null},{"ad":"Sulak 2017","tasarim":"Retrospective patient data (Washington and California) and 4 case reports; no control group","n":"272","populasyon":"Patients with epilepsy","urun":"Unregulated (artisanal) cannabis products; content not verified","urun_turu":"cbd_zengin_thc_belirsiz","doz":"not reported","titrasyon":"not reported","sure":"not reported","sonuc":"Among 272 patients from Washington and California, more than 50% seizure reduction was reported in 146 (54%), complete response in 26 (10%) and no effect in 37 (14%) (two percentages in the abstract do not match the numbers; the numbers were used); most patients used CBD-rich handmade formulations, and some used products with added THC or THCA; uncontrolled, retrospective and open to bias","yan_etki":"According to the authors, mild and infrequent","pmid":"28254350","doi":"10.1016/j.yebeh.2016.12.032","diger_kaynak":null},{"ad":"Suraev 2022 (PELICAN subanalysis)","tasarim":"Product analysis (contaminant screening)","n":"78 samples (tested for solvents in 58, heavy metals in 51, pesticides in 31 samples)","populasyon":"Unregulated cannabis products used in children with epilepsy in Australia","urun":"Unregulated cannabis products","urun_turu":"cbd_zengin_thc_belirsiz","doz":null,"titrasyon":null,"sure":null,"sonuc":"Ethanol or isopropanol above the accepted limit (5000 ppm) in 17/58 samples (29%); bifenthrin (a pesticide) at 4.9 times the limit in one sample. No samples exceeded heavy metal limits (51 samples). Most pesticide tests were inconclusive","yan_etki":null,"pmid":"34954507","doi":"10.1016/j.yebeh.2021.108496","diger_kaynak":"Epilepsy Behav 2022;127:108496 (online December 2021). Earlier study in which the samples were collected (same research group; Suraev 2022 describes its samples as collected in an earlier study; 78 samples in 2022, 61 in 2018): Suraev 2018, Sci Rep 8:10154 (PMID 29977078; the author correction PMID 30068968 concerns only the interviewers' names). 65 families were interviewed in June 2016–December 2017; 61 samples from 38 families (51 extracts when combined) were analyzed. Families believed CBD was the main component in 71% of the extracts, but 98% of the samples contained THC and/or its raw form THCA; CBD was the dominant cannabinoid in only 23%, was absent in 4 samples, and only 3 extracts (6%) came close to the lowest CBD dose in studies (10 mg/kg/day). Families rated 75% of the extracts as effective; the cannabinoid content of extracts rated effective and ineffective did not differ. No control group; results rely on family reports"},{"ad":"GWPCARE7 pilot + extension (infantile spasms)","tasarim":"Open-label pilot phase and open-label extension (uncontrolled); results from the ClinicalTrials.gov record","n":"9","populasyon":"Infantile spasms, 1–24 months","urun":"Oral CBD solution (GW; pure CBD)","urun_turu":"saf_cbd","doz":"Target 40 mg/kg/day","titrasyon":"not reported","sure":"Pilot 2 weeks; extension up to 12 months","sonuc":"In the pilot, spasms did not stop and hypsarrhythmia did not resolve in any of the 9 babies; the study met the no-go criterion. In the extension, at the day 379 measurement in the registry, 3 of the 7 babies who could be assessed had no spasms and their hypsarrhythmia had resolved; however, only 2 of the 9 babies completed the extension (3 left due to lack of effect), this measurement may also include babies who stopped treatment; no control group","yan_etki":"In the pilot, 1 status epilepticus (serious). In the extension, serious side effects in 2 of 9; 3 babies stopped due to lack of effect","pmid":null,"doi":null,"diger_kaynak":"NCT02953548; NCT02954887 (clinicaltrials.gov)"},{"ad":"Cunha 1980","tasarim":"Double-blind, placebo-controlled randomized study (phase 2; phase 1 in healthy volunteers)","n":"15 patients (CBD 8, placebo 7; the wording in the abstract can also be read as a placebo group of 8 patients); also 16 healthy volunteers in phase 1","populasyon":"Epilepsy with secondary generalization from a temporal focus that could not be controlled with medicines","urun":"Pure CBD by mouth (capsules)","urun_turu":"saf_cbd","doz":"200–300 mg/day","titrasyon":"not reported (in the abstract)","sure":"Up to 4.5 months","sonuc":"Of the 8 patients taking CBD, 4 had almost no major seizures throughout the study, 3 had partial improvement and 1 showed no effect; in the placebo group, 1 patient had clear improvement and the others had no change. The abstract has no statistical comparison, and the size of the placebo group is inconsistent (15 patients were divided into two groups, the CBD group 8; for placebo it says 'no change in 7 patients, improvement in 1 patient'). No randomization details are given; the Cochrane review (Gloss 2014) rated this report as low quality. Patients continued their previous epilepsy medicines.","yan_etki":"No serious side effects or signs of toxicity were reported (monitored with physical exams, blood and urine tests, EEG and ECG)","pmid":"7413719","doi":"10.1159/000137430","diger_kaynak":"A review that also describes the same trial: Carlini and Cunha 1981, J Clin Pharmacol 21:417S–427S (PMID 7028792; improvement in 7 of the 8 patients taking CBD and in 1 patient taking placebo)"},{"ad":"Brodie 2021 (CBDV, focal seizures)","tasarim":"Phase 2, multicenter, double-blind, placebo-controlled randomized study (centers in Czechia, Hungary, Poland, Spain and the UK)","n":"162 randomized (CBDV 81, placebo 81); 162 analyzed","populasyon":"Adults (aged 18–65; mean age 36) with at least 1 focal seizure per week despite at least 2 medicines","urun":"Cannabidivarin (CBDV; GWP42006), oral solution 50 mg/mL","urun_turu":"cbn_diger","doz":"400 mg twice a day (week 1) → 600 mg twice a day (week 2) → 800 mg twice a day (1,600 mg per day) for 6 weeks; mean daily dose 1,480 mg","titrasyon":"Weekly increase: 400 → 600 → 800 mg, twice a day","sure":"4 weeks of baseline observation, 8 weeks of treatment (2 weeks of dose increase + 6 weeks at a fixed dose), followed by 12 days of dose reduction","sonuc":"Focal seizure frequency fell by 40.5% in the CBDV group and 37.7% in the placebo group; the difference was not significant (treatment ratio 0.95; 95% CI 0.78–1.17; p = 0.648). At least 50% reduction: 36% with CBDV, 33% with placebo. No difference in any seizure type or in secondary outcomes (seizure-free days, rescue medication use, doctor and patient global impression, cognitive tests). The authors note that the placebo response was higher than in previous epilepsy studies. Funded by the manufacturer (GW Research); 3 of the 8 authors are GW employees and hold share options.","yan_etki":"Side effects 73% with CBDV, 48% with placebo (most often diarrhea 25% vs. 7%, sleepiness 15% vs. 3%); stopped because of side effects 14% vs. 3%; serious side effects 4% vs. 1% (in the CBDV group, one patient with a picture of severe drug toxicity and one with kidney failure together with diarrhea; both resolved when the medicine was stopped). Liver enzymes (ALT or AST) >3×ULN in 3 patients with CBDV (2 stopped) and 1 patient with placebo; all were also taking another medicine that can affect the liver","pmid":"33998885","doi":"10.1089/can.2020.0075","diger_kaynak":"NCT02365610 (no results on ClinicalTrials.gov). The same program's 32-person pharmacokinetic part NCT02369471 (ended November 2015; no results in the registry or PubMed). The journal added a correction note for Figure 2 (April 15, 2021)"},{"ad":"Gloss 2014 (Cochrane)","tasarim":"Cochrane systematic review (randomized studies only)","n":"4 randomized studies, 48 patients in total","populasyon":"Any type of epilepsy (add-on treatment or monotherapy); before the approved CBD medicine's Dravet and LGS studies","urun":"Pure CBD, by mouth (in all four trials)","urun_turu":"saf_cbd","doz":"200–300 mg/day","titrasyon":null,"sure":"Search up to September 9, 2013; the trials were short","sonuc":"All four reports provided data only on the side effect question; the review's main outcome (seizure freedom for at least one year) and the response rate could not be measured in any of them. The review wrote that no reliable conclusion can be drawn on whether cannabinoids are effective in epilepsy. All the reports were of low quality: one is only a conference abstract and one a letter to the editor; none gives randomization details, and whether the groups were similar at baseline was not checked. Because the search was done in September 2013, it does not include the later studies of the approved CBD medicine; there is no newer version on PubMed. The authors have no known conflicts of interest.","yan_etki":"According to the review, no side effects were reported in patients taking CBD; because 200–300 mg/day of CBD was given to a small number of patients for a short time, long-term safety could not be assessed","pmid":"24595491","doi":"10.1002/14651858.CD009270.pub3","diger_kaynak":"2012 version: PMID 22696383 (same conclusion). Trials in the review: Mechoulam 1978 (PMID 351429), Cunha 1980 (PMID 7413719; a separate row in the table), Ames 1986 (PMID 3941934, letter to the editor), Trembly 1990 (conference abstract only)"},{"ad":"Lattanzi 2021 (epilepsies other than Dravet and LGS)","tasarim":"Systematic review (no meta-analysis); 42 studies: 3 RCTs (one an efficacy study in TSC, GWPCARE6, two drug interaction studies), open-label studies and their subanalyses, retrospective chart reviews, clinical series and case reports","n":"42 studies; pooled number of patients not given","populasyon":"Epilepsies other than Dravet and LGS (including TSC); children and adults","urun":"Only the approved medicinal CBD (plant-derived purified, >98%, oral solution in sesame oil)","urun_turu":"saf_cbd","doz":"Up to 50 mg/kg/day","titrasyon":null,"sure":"Search up to October 2020","sonuc":"Placebo-controlled evidence exists only for TSC (GWPCARE6); data for other conditions are open-label and uncontrolled. 18 of the 42 studies report results separately by condition (CDKL5, Aicardi, Doose, Dup15q, epilepsy with myoclonic absences, Sturge–Weber, SYNGAP1, migrating focal seizures, SCN8A, epileptic spasms, cortical dysplasia, FIRES, status epilepticus), and 24 report drug-resistant epilepsies of mixed causes together. In infantile spasms, the placebo-controlled study met the 'no-go' criterion in its pilot phase and was stopped. The authors write that open-label studies provide Class III (weak) evidence, that the lack of a control group and expectations create bias, and that the results cannot be applied to other cannabis products. 3 of the 7 authors received fees or research support from the CBD manufacturer GW; the review had no funding.","yan_etki":"Most often sleepiness (more common with clobazam), decreased appetite, diarrhea and raised liver enzymes (mostly in those taking valproate); one center reported low platelets together with valproate","pmid":"33754312","doi":"10.1007/s40263-021-00807-y","diger_kaynak":null},{"ad":"Coppola 2026 (DEE and complex drug-resistant epilepsies)","tasarim":"Systematic review (narrative synthesis; no meta-analysis)","n":"57 studies reporting seizure outcomes, 37 different epilepsy types, 971 patients; 33 of the studies were case reports or small series","populasyon":"Developmental and epileptic encephalopathies and complex drug-resistant epilepsies other than Dravet, LGS and TSC; most often focal/multifocal epilepsy (401 patients) and Angelman syndrome (188 patients)","urun":"Approved medicinal CBD (plant-derived purified oral solution)","urun_turu":"saf_cbd","doz":"not reported (in the abstract)","titrasyon":null,"sure":"Search up to March 2024","sonuc":"47 of 57 studies reported a seizure reduction in at least one patient; definitions of reduction differed from study to study (reduction in 20–100% of patients; mean or median reduction 12–99%). In 22 studies, at least one patient was seizure-free for 48 days or longer. The authors write that CBD may reduce seizures in these epilepsies and support new studies; most of the data come from small series without a control group. The review was funded by the manufacturer (Jazz Pharmaceuticals); 2 of the 4 authors are Jazz employees and shareholders, and 2 have received consulting fees or research support from Jazz.","yan_etki":"Mostly mild or moderate; most often digestive: diarrhea 17–50%, decreased appetite 7–45%, vomiting 5–86% (by study)","pmid":"41558068","doi":"10.1016/j.eplepsyres.2026.107731","diger_kaynak":"Correction notice PMID 41820159 (April 2026; content not on PubMed, could not be read). Non-seizure outcomes from the same systematic search: Samanta 2026, Epilepsy Res 227:107873 (PMID 42520581; 32 studies, 1,343 patients; most studies reporting improvements in cognitive function, behavior, communication and quality of life were observational and at moderate-to-high risk of bias; same authors and same company ties)"},{"ad":"Pamplona 2018 (CBD-rich extracts and pure CBD)","tasarim":"Meta-analysis of observational studies (11 studies; categorical comparison with Fisher's test)","n":"670 patients (11 studies: 5 pure CBD, 6 CBD-rich cannabis extract)","populasyon":"Drug-resistant epilepsy (mostly children; mixed, including Dravet and LGS)","urun":"Purified CBD and CBD-rich cannabis extracts","urun_turu":"karma","doz":"1–50 mg/kg/day; mean 25.3 for pure CBD and 6.0 mg/kg/day for extracts (CBD equivalent)","titrasyon":null,"sure":"Search February and December 2017; treatment durations 3–12 months (mean 6.2 months)","sonuc":"Reports of 'any improvement' were 71% (318/447) with extracts and 46% (81/175; p < 0.0001) with pure CBD; on the standard outcome of at least 50% reduction, there was no difference: 37% (122/330) with extracts and 42% (94/223; p = 0.52) with pure CBD; response rate across all patients 39%. None of the studies had a control group; the authors write that the placebo effect could not be measured and that the interpretation that extracts may be more effective needs to be confirmed in a controlled study. All the extract studies were family surveys or retrospective chart reviews (two publications from the same Colorado cohort, Press 2015 and Treat 2017, were counted separately); the pure CBD studies were prospective drug programs. All 3 authors have ties to cannabis product companies (2 to Entourage Phytolab, 1 to Bedrocan). Numbers are per the journal's correction.","yan_etki":"Mild side effects reported in 76% (158/216) of pure CBD studies and 33% (148/447) of extract studies; severe side effects 26% (41/155) and 7% (23/328) (p < 0.0001); side effects were recorded in different ways in studies with different designs","pmid":"30258398","doi":"10.3389/fneur.2018.00759","diger_kaynak":"Correction: Front Neurol 2018;9:1050 (PMID 30687209, PMC6335388; numbers in Tables 2 and 4 and the abstract were corrected; according to the authors, the conclusion did not change)"},{"ad":"NICE 2019 (NG144 guideline)","tasarim":"National guideline (based on an evidence review)","n":"Evidence review D: 4 RCTs (2 Dravet, 2 LGS; as indirect evidence) + 11 single-arm observational studies (8 prospective, 2 retrospective, 1 unclear)","populasyon":"Severe, drug-resistant epilepsy (children and adults); United Kingdom","urun":"Cannabis-based medicinal products: pure CBD and THC:CBD extracts","urun_turu":"karma","doz":null,"titrasyon":null,"sure":"Search December 19, 2018 – January 21, 2019; guideline November 2019 (last updated on the page March 22, 2021)","sonuc":"No practice recommendation was made for cannabis-based products other than approved CBD: the committee stated that the observational evidence was of very low quality (all single-arm, at high risk of bias) and that, because the disease mechanisms differ, Dravet/LGS studies cannot serve as a basis for recommendations in other epilepsies. No recommendation against use was made either: this would have stopped treatment for patients thought to be benefiting and would have blocked research; the committee was also concerned that a recommendation against might steer families toward products without a prescription (online or over the counter). It asked that people seeking treatment for severe epilepsy be told there is no clear evidence on the safety and efficacy of these products. The committee wrote that the amounts of CBD and THC may vary in products that are not pharmaceutical grade, especially whole-plant extracts. Research recommendations: the efficacy of CBD in different epilepsies and the effect of adding THC compared with CBD alone and with placebo. For approved CBD, the guideline refers to the technology appraisals for Dravet, LGS and TSC.","yan_etki":"In the observational studies, side effects were reported in up to 98% of patients; because there was no control group, how much was due to the product could not be determined","pmid":"31909928","doi":null,"diger_kaynak":"Evidence review D: epilepsy (NICE, November 2019; NCBI Bookshelf PMID 35107910, NBK577085). Guideline: nice.org.uk/guidance/ng144"},{"ad":"Absence epilepsy, synthetic CBD (NCT03336242)","tasarim":"Phase 2, open-label, non-randomized dose-finding study (two dose groups); results from the ClinicalTrials.gov record, no peer-reviewed publication","n":"20 (10 + 10); 19 completed (1 patient left because of side effects); EEG absence count analyzed in 19 patients, hyperventilation outcome in 17","populasyon":"Drug-resistant childhood absence epilepsy with at least 2 medicines tried; ages 3–17 (mean 8.4), 11 centers in the US","urun":"Synthetic (not plant-derived) pharmaceutical-grade CBD oral solution; manufacturer INSYS Therapeutics (current sponsor in the registry Radius Pharmaceuticals)","urun_turu":"saf_cbd","doz":"20 mg/kg/day or 30 mg/kg/day, divided into two doses per day; the planned 10 mg/kg/day group was not opened","titrasyon":"In the 30 mg/kg/day group, started at 20 mg/kg/day for 5 days","sure":"4 weeks of treatment (after a 5–10-day dose increase); up to about 54 weeks in the extension study","sonuc":"On one of the primary outcomes, the mean change in the number of absence seizures on 4-hour video-EEG pointed toward an increase, not a decrease: +40.7% (SD 180.9; 10 patients) in the 20 mg/kg/day group and +35.1% (SD 121.5; 9 patients) in the 30 mg/kg/day group; in the registry, a negative value means improvement. The standard deviations are several times the mean: the response is highly variable from patient to patient; the median and how many patients had a reduction are not in the registry. On the other primary outcome, time to first absence with hyperventilation lengthened by a mean of 162% (SD 344; 9 patients) and 65% (SD 116; 8 patients); a longer time is read as improvement, meaning the two outcomes point in different directions. Seizure-free at week 4 according to diaries: 1 of 10 patients and 0 of 9 patients. Family and doctor global impression scores averaged 2.9 and 3.1 (1–7 scale; 3 = minimally improved). According to the sponsor's rationale, more patients showed a clinically meaningful reduction in seizure count in the 20 mg/kg/day group than in the 30 mg/kg/day group, and the planned third group (10 mg/kg/day) was not opened; the extension study was terminated because the manufacturer filed for bankruptcy protection. No control group, no statistical comparison was made.","yan_etki":"Side effects in 6 of 10 patients in the 20 mg/kg/day group and 7 of 10 patients in the 30 mg/kg/day group; no serious side effects. In the 30 mg/kg/day group, 1 patient left because of side effects; in the same group, raised liver enzymes were recorded once each under four separate terms (ALT, AST, liver enzyme, liver test) (whether it was the same patient is not stated); seizures were recorded as a side effect in 2 patients. In the extension (11 patients), no serious side effects; 3 patients left due to lack of effect","pmid":null,"doi":null,"diger_kaynak":"NCT03336242 (results entered in the registry on July 21, 2023); extension NCT03355300 (11 patients; results June 18, 2023). No peer-reviewed publication of this study was found in PubMed (October 28, 2026)"},{"ad":"Scheffer 2021 (CBD gel on the skin, developmental and epileptic encephalopathy)","tasarim":"Open-label, two-center, non-randomized before-and-after study (Melbourne and Wellington); no control group","n":"48 (seizure analysis 46; 33 patients with focal impaired awareness and tonic-clonic seizures analyzed separately)","populasyon":"Children and adolescents aged 3–18 with developmental and epileptic encephalopathy (8 Dravet, 5 Lennox–Gastaut, 6 myoclonic-atonic epilepsy, 3 West, 26 other); they were taking 1–4 seizure medicines","urun":"Synthetic CBD gel, applied to the skin (4.2%; ZYN002, Zynerba)","urun_turu":"saf_cbd","doz":"Applied twice a day, total 250–1000 mg/day (by weight)","titrasyon":"Start 250 mg/day (≤25 kg) or 500 mg/day (>25 kg); could be increased to 500/750 at month 1 and to 750/1000 mg/day at month 2.5","sure":"6.5 months (1 month baseline observation, 1 month dose increase, 5.5 months maintenance at a flexible dose)","sonuc":"Median reduction in all countable seizures over 6.5 months was only 12.3% (IQR −18.6 to 46.3). Focal impaired awareness and tonic-clonic seizures, where the best response was seen, were analyzed separately afterward: in these 33 patients, median reduction 43.5% (IQR −23.8 to 57.5), 57.7% at month 5; at least 50% reduction 42.4% at month 2 and 62.5% at month 5. Improvement was smaller in those taking clobazam (26.8% vs. 45.5%). Sleep scale scores improved. No control group; the authors note that dropout of non-responders, expectation effects and regression to the mean may have affected the result. In the controlled study in adult focal epilepsy (O'Brien 2022), the same gel was no different from placebo. The study was designed and funded by the manufacturer (Zynerba); 7 of the 9 authors have ties to the company (2 are employees and hold patents and shares).","yan_etki":"Any side effect 96% (29% in the baseline observation month); treatment-related side effects 60% (29/48), 96% mild-moderate: dryness and pain at the application site, sleepiness (8% each; all 4 patients with sleepiness were taking clobazam); treatment-related diarrhea in 1 patient. 15 serious side effects in 10 patients (21%) (10 infections, 4 seizure-related); 2 may be drug-related: nonconvulsive status epilepticus and lower respiratory tract infection. 8 patients (17%) stopped (7 lack of effect, 1 skin reaction)","pmid":"34477852","doi":"10.1001/jamanetworkopen.2021.23930","diger_kaynak":"ACTRN12618000516280"},{"ad":"Kaplan 2017 (Sturge-Weber syndrome)","tasarim":"Open-label expanded access study (under an FDA investigational permit, single center, Kennedy Krieger); no control group; 8-week baseline observation","n":"5 started; data for 4 patients at week 14 (according to the registry, 1 patient was withdrawn at week 9 due to lack of effect)","populasyon":"Patients with Sturge-Weber syndrome with brain involvement and drug-resistant epilepsy; according to the registry, mean age 8.8 (4 under 18, 1 adult)","urun":"Epidiolex (purified CBD, oral solution)","urun_turu":"saf_cbd","doz":"According to the registry, at most 25 mg/kg/day","titrasyon":"According to the registry, started at 2 mg/kg/day; after 7 days, increased by 3 mg/kg/day to 5 mg/kg/day, then increased by 5 mg/kg/day each week up to at most 25 mg/kg/day","sure":"Week 14 assessment; those remaining were on CBD for 63–80 weeks","sonuc":"Motor seizures fell by more than half in 2 of 4 patients at week 14 and in 3 patients (those with brain involvement on both sides) at the last check; these patients reported improved quality of life. In the registry, the seizure reductions of the 4 patients at the last check were 12%, 100%, 83% and 64%. One of the 4 patients in the analysis first left due to lack of effect and then restarted at a lower dose; according to the registry, the fifth patient was withdrawn at week 9 due to lack of effect (side effects are also mentioned in one place) and was not included in the analysis. Very small and uncontrolled; the medicine's manufacturer (today Jazz) is a collaborator in the registry.","yan_etki":"According to the article, mild drug-related side effects in 3 patients. In the registry, serious events in 3 of 5 patients (eye twitching, pneumonia, facial skin infection; relationship to the medicine not stated); temporary increase in seizures 3, behavior problems 2, raised AST 1 patient","pmid":"28454984","doi":"10.1016/j.pediatrneurol.2017.02.009","diger_kaynak":"NCT02332655 (results in the registry; collaborators Jazz Pharmaceuticals and the Faneca 66 Foundation). Later study by the same team: Smegal 2023, Pediatr Neurol 139:24–34 (PMID 36508880; NCT04447846): approved CBD at 5–20 mg/kg/day for 6 months in 10 Sturge-Weber patients whose seizures were under control and who had cognitive difficulties; no seizures were seen, and improvements in neurological score, quality of life and anxiety were reported; on the working memory test, the registry's primary outcome, the mean T score changed from 37.1 to 39.1 in 7 patients (no statistics given); 1 patient stopped because of a moderate side effect; open-label and uncontrolled"},{"ad":"Gofshteyn 2017 (FIRES)","tasarim":"Multicenter case series; open-label use under emergency or expanded access protocols (5 centers); no control group","n":"7","populasyon":"Children with febrile infection-related epilepsy syndrome (FIRES) who had not responded to medicines and other treatments; in the acute (non-stop seizures) or chronic phase of the disease","urun":"Epidiolex (purified CBD)","urun_turu":"saf_cbd","doz":"Not reported (in the abstract)","titrasyon":"not reported","sure":"Not reported (in the abstract)","sonuc":"After CBD was started, the frequency and duration of seizures fell in 6 of 7 children; on average, 4 seizure medicines could be stopped. At the latest assessment, 5 children could walk, 1 walked with help and 4 could talk. Because other treatments were given at the same time and there was no control group, it is impossible to know how much of the improvement came from CBD; the authors also stress that this is an open-label case series.","yan_etki":"1 child died of multiple organ failure related to isoflurane anesthesia (not attributed to CBD); other side effects not in the abstract","pmid":"27655472","doi":"10.1177/0883073816669450","diger_kaynak":null},{"ad":"Kühne 2023 (Germany, 16 centers)","tasarim":"Retrospective, multicenter real-world study (Germany, 16 epilepsy centers, December 2015–December 2021); no control group","n":"311 (235 children, 76 adults); 206 outside LGS, Dravet and TSC","populasyon":"Children and adults with epilepsy from various causes (structural, genetic, unknown; including syndromes such as Angelman and Rett); 74.9% drug-resistant. 91.3% of treatment was off-label (epilepsy type, age, use without clobazam or above the approved dose)","urun":"Purified CBD: approved oral solution (70.7%) or a standard 100 mg/mL CBD solution prepared in pharmacies in Germany (NRF 22.10; 29.3%)","urun_turu":"saf_cbd","doz":"Median starting dose 3.2 mg/kg/day; median final dose 17.8 mg/kg/day (children 19.0, adults 13.3; at most 45 mg/kg/day)","titrasyon":"Slower than recommended: median increase of 2.8 mg/kg per week","sure":"Median follow-up 15.8 months (3 days–5.9 years)","sonuc":"At the last follow-up, 6.4% of patients were seizure-free, 30.5% had more than 50% seizure reduction, 31.2% had a smaller reduction, 23.2% had no change and 8.7% had an increase. The authors give seizure freedom or more than 50% reduction as 40.8% in LGS/Dravet/TSC and 36.9% in other epilepsies and do not find the difference significant; however, 36.9% also appears in the article as the rate for the whole group (115 of 311 patients): if 40.8% of the 105 patients with approved diagnoses is taken, the rate in the other 206 patients comes out at about 35% (the detailed supplementary table could not be read). Use together with clobazam did not improve the result. In 21.5% of those who benefited in the first 3 months, the effect later decreased. No control group; retrospective, and seizure outcomes rely on doctors' notes, seizure diaries and family reports. GW Pharma paid the salary of the doctor who collected data in the study; 10 of the 32 authors reported consulting, speaker fees or institutional support from GW","yan_etki":"Side effects 46.9%: sleepiness and reduced attention 24.1%, digestive complaints 25.1% (diarrhea in 38 patients), psychiatric symptoms 6.1%, raised liver enzymes 1.6% (4 of the 5 patients were taking valproate). Stopped because of side effects 9.3%, stopped because of insufficient effect 19.6%","pmid":"36693811","doi":"10.1002/epi4.12699","diger_kaynak":"Later off-label use study from some of the same centers (some patients may be shared): Hollander 2025, Neurol Res Pract 7:49 (PMID 40696489; 6 centers in Germany, 2019–2023; the Frankfurt, Freiburg, Greifswald and Lingen centers and 5 of the 10 authors are also in Kühne 2023; LGS, Dravet and TSC patients were not included): 108 patients (74 focal onset, 14 genetic generalized, 20 other epilepsies; 76 adults); at month 3, seizures fell by at least half in 42 of the 108 patients who started (38.9%); retention 61% at month 12; side effects 38%, discontinuation in which side effects played a role 19.5%; seizure counts rely on diaries kept by caregivers, no control group; the study was not funded, and 9 of the 10 authors reported fees from pharmaceutical companies, including Jazz, the maker of the approved medicine"},{"ad":"Calonge 2024 (Paris, adults)","tasarim":"Retrospective, single center (Paris, Pitié-Salpêtrière; 2018–2024); approved-indication and off-label groups compared; no control group without CBD","n":"91 (32 approved indication: 21 LGS, 8 Dravet, 3 TSC; 59 off-label)","populasyon":"Adults with drug-resistant epilepsy (mean age about 30). In the off-label group, genetic or chromosomal (24), brain malformation (7), other causes such as lack of oxygen at birth, post-encephalitis and FIRES (12), and unknown (16) causes","urun":"Approved purified CBD (oral solution)","urun_turu":"saf_cbd","doz":"Highest dose median 11.1 mg/kg/day (off-label) and 10.7 mg/kg/day (approved)","titrasyon":"not reported","sure":"At least 1 year; median follow-up 24 months","sonuc":"More than 50% seizure reduction 35.6% (21/59) in the off-label group and 31.3% (10/32) in the approved group; the difference was not significant (p = 0.85). Retention at 1 year 74.6% and 75.0%. In the off-label group, clobazam was used more often among responders (71.4% vs. 28.9%; p = 0.002). No control group; response relies on categories in doctors' notes. Jazz supported data collection; 4 of the 8 authors reported fees from Jazz","yan_etki":"In the off-label and approved groups: any side effect 40.7% and 62.5%; sleepiness 22.0% and 50.0% (p = 0.01); increased seizures 8.5% and 6.3%; abnormal liver tests 1.7% and 6.3%. Of the 23 patients who stopped in the first year, 13 stopped due to insufficient effect, 4 due to increased seizures and 6 due to tolerability problems","pmid":"39501537","doi":"10.1002/brb3.70122","diger_kaynak":null},{"ad":"Espinosa-Jovel 2023 (Colombia, other than LGS, Dravet and TSC)","tasarim":"Retrospective, multicenter (Bogotá, Colombia); no control group","n":"78","populasyon":"Drug-resistant epilepsies other than LGS, Dravet and TSC (mostly structural and genetic causes), over age 2; median age 24, median 3 medicines, median 30 seizures per month at baseline","urun":"Purified CBD (product name not in the abstract)","urun_turu":"saf_cbd","doz":"not reported (in the abstract)","titrasyon":"not reported (in the abstract)","sure":"Median treatment duration 14 months (IQR 10–17)","sonuc":"At the last visit, mean seizure reduction 67.8%; at least 50% reduction in 68.8%, 11.5% seizure-free. Use together with clobazam did not change efficacy or safety. Retention 78.2%. The abstract does not say whom the analysis covered at the last visit or how early dropouts were counted. No control group; retrospective. The authors reported no conflicts of interest","yan_etki":"CBD-related side effects 28.2% (22 patients); types not in the abstract","pmid":"37769547","doi":"10.1016/j.seizure.2023.09.015","diger_kaynak":null},{"ad":"Zilmer 2021 (Denmark)","tasarim":"Retrospective cohort, single center (Filadelfia Epilepsy Hospital, Denmark; December 2016–December 2019); no control group","n":"78 (seizure effect in 77; numerical analysis in the 51 patients who kept a seizure diary); 15 Dravet/LGS, 62 other epilepsies","populasyon":"Children and young adults over age 2 with various epilepsies and at least one severe seizure per week (most with motor seizures)","urun":"Pharmacy-prepared (compounded) CBD oil, 300 mg/mL; derived from cannabis, contains no THC","urun_turu":"saf_cbd","doz":"Starting at 5 mg/kg/day, at most 20 mg/kg/day","titrasyon":"Increase of 5 mg/kg/day every 3–5 days (faster schedule after 2018)","sure":"Median follow-up 15.2 months (3–36)","sonuc":"In the 51 patients who kept a seizure diary (15 had no pre-treatment measurement, and the first month of treatment was used as the baseline), at least 50% reduction was 31.4% at month 3, 28.1% at month 12 and 20.0% at month 24. At month 3, 70% in Dravet/LGS and 22% in other epilepsies (p < 0.05; subgroup numbers not in the text); according to the authors, the rate in other epilepsies is not higher than some of the placebo groups in the approved medicine's studies. Response tended to be higher in those using it together with clobazam (40% vs. 25.8% at month 3; not significant); the clobazam dose was reduced in 67.9% of those taking clobazam. In the 26 patients without a diary, families reported benefit at a rate of 53.8% at month 3 and 11.8% at month 12. No control group; no funding, and the authors reported no conflicts of interest","yan_etki":"Most often tiredness (especially during dose increases); increased seizures more common at 10 mg/kg/day and above; treatment stopped in 2 patients (2.6%) because of status epilepticus attributed to CBD. Discontinuation 38.8% in year 1, 66.7% in year 2","pmid":"33913416","doi":null,"diger_kaynak":"Dan Med J 2021;68(5):A07200527"},{"ad":"Cerulli Irelli 2026 (15q duplication and Angelman syndrome)","tasarim":"Retrospective, multicenter (9 centers in Europe); no control group","n":"22 (12 15q duplication syndrome, 10 Angelman syndrome)","populasyon":"Drug-resistant epilepsy due to 15q11.2-q13.1 duplication or deletion; median age 14.5 at the start of CBD; all patients with 15q duplication and 2 patients with Angelman had a Lennox–Gastaut-like picture","urun":"Epidyolex (purified CBD)","urun_turu":"saf_cbd","doz":"Initial maintenance dose median 10 mg/kg/day (IQR 10–14); 14.5 mg/kg/day (11–18) at the last check","titrasyon":null,"sure":"Median 21 months of follow-up (IQR 14–33); those with at least 6 months of follow-up were included","sonuc":"At the last check, mean seizure reduction 55.7% (95% CI 38.7–72.7); in 14 of 22 patients (63.6%), at least 50% reduction, more than 75% reduction in 9, and 4 (18.2%) seizure-free. There was no difference between Angelman and 15q duplication (p > 0.2). Tonic seizures fell by a median of 60% and myoclonic seizures by 70%; there was no reduction in spasms (median 0%). There was no relationship between dose and response. In the doctors' assessment, 16/22 improved, and 2 Angelman patients got worse (behavior; in one, myoclonic seizures became more severe). Retrospective, small and uncontrolled; it shares the same ethics approval as the same team's monogenic epilepsy study (Cerulli Irelli 2025). No funding for the study; 5 of the 15 authors report receiving fees or support from the manufacturer (Jazz) unrelated to the study.","yan_etki":"Side effects in 6 patients (27.3%): sleepiness/sedation 5, digestive complaints 3, raised liver enzymes 1, skin finding 1; still present in 2 at the last check. 4 patients stopped due to lack of effect (retention 18/22)","pmid":"41992447","doi":"10.1002/epi4.70241","diger_kaynak":null},{"ad":"Vignoli 2025 (typical Rett syndrome and CDKL5 deficiency)","tasarim":"Retrospective, multicenter (Italian national study group); no control group","n":"27 (14 Rett/MECP2, 13 CDKL5)","populasyon":"Genetically confirmed typical Rett syndrome or CDKL5 deficiency with drug-resistant seizures, median age 10.5 (26 girls)","urun":"Epidiolex (purified CBD)","urun_turu":"saf_cbd","doz":"From 5 to 20 mg/kg/day; median 15 mg/kg/day at the last check (IQR 11.1–18.8)","titrasyon":"From 5 to 20 mg/kg/day according to tolerability and response","sure":"Median 14 months (IQR 8.5–20); those who took CBD for at least 6 months were included","sonuc":"Seizures fell by at least half in 18 of 27 patients (66.6%; 95% CI 46.0–83.5) and by more than 75% in 7 (25.9%); they did not change in 9. Rett 9/14, CDKL5 9/13 (no difference, p = 1.0). No increase in seizures was seen. 12 families (44.4%) reported improvement in attention and responsiveness. The authors write in the abstract that the effect did not reach statistical significance (the text has no corresponding test for a single-arm study). Because the requirement of having taken CBD for at least 6 months leaves out those who stopped early, the rates may look high; in a study partly from the same centers with a requirement of at least 3 months of CBD, the response in patients with CDKL5 and MECP2 was much lower (other source). Retrospective and uncontrolled. Supported by government research funding; 2 of the 23 authors report consulting or advisory board ties with the manufacturer (GW).","yan_etki":"Sleepiness 3, restlessness/agitation 2, loss of appetite 2, insomnia 1 patient; 2 patients stopped because of side effects","pmid":"40543048","doi":"10.1002/epi4.70078","diger_kaynak":"Monogenic epilepsy study partly from the same centers (6 shared centers and authors; periods overlap): Cerulli Irelli 2025, Epilepsia 66:2253–67 (PMID 40126049; 27 centers, at least 3 months of CBD): in the CDKL5 (12 patients) and MECP2 (12 patients) groups, the proportion of patients whose seizures fell by at least half was 33.3%; some of the patients are very likely shared with those in this row. The same study is a separate row in the Dravet and TSC tables"},{"ad":"Caraballo 2023 (epilepsy with myoclonic-atonic seizures)","tasarim":"Retrospective, multicenter (first author's center Buenos Aires, Garrahan Hospital; other centers not in the abstract); no control group","n":"26 (22 epilepsy with myoclonic-atonic seizures, 4 Sturge-Weber syndrome with myoclonic-atonic seizures)","populasyon":"Children with drug-resistant epilepsy with myoclonic-atonic seizures (Doose syndrome)","urun":"CBD; product type (purified CBD or CBD-rich cannabis oil) not stated in the abstract","urun_turu":"cbd_zengin_thc_belirsiz","doz":"8–40 mg/kg/day","titrasyon":"not reported","sure":"Mean 19 months of follow-up","sonuc":"In 15 of 26 patients (57.7%), seizures fell by more than half, and 3 (11.5%) became seizure-free; a 25–50% reduction was reported in the remaining 11 (42.3%). Drop seizures, atypical absences and nonconvulsive status epilepticus responded well. In 3 of the patients with Sturge-Weber, focal seizures fell by 30%. Retrospective and uncontrolled; the authors report no company ties.","yan_etki":"Mild; CBD was not stopped in any patient","pmid":"37182500","doi":"10.1016/j.yebeh.2023.109245","diger_kaynak":null},{"ad":"González-Alguacil 2026 (epileptic spasms over age 2)","tasarim":"Retrospective, single-center (Madrid, Niño Jesús Hospital, 2020–2024); no control group","n":"53","populasyon":"Children older than 2 years with drug-resistant epilepsy whose main seizure type is epileptic spasms","urun":"Epidyolex (purified CBD)","urun_turu":"saf_cbd","doz":"Not reported (in the abstract)","titrasyon":"not reported","sure":"Not reported (in the abstract)","sonuc":"In 58.5% of 53 patients, spasms fell by at least half; according to the abstract, spasms stopped completely in 15% of these. The highest response was seen in those with malformations of cortical development and Down syndrome. 77.3% of patients were also taking clobazam. CBD was stopped in 17% due to lack of effect. Retrospective, single-center and uncontrolled. All 6 of the 6 authors report receiving research or educational support from pharmaceutical companies, including the manufacturer (Jazz).","yan_etki":"Side effects 62.2%: most often sleepiness, high blood ammonia and behavior disorders; 11.3% stopped because of side effects","pmid":"41197417","doi":"10.1016/j.pediatrneurol.2025.10.013","diger_kaynak":null},{"ad":"Devinsky 2022 (medical cannabis containing THC)","tasarim":"Prospective observational study (structured follow-up in a residential care center, New York); no control group and no blinding","n":"29 (15 focal or multifocal, 3 generalized, 11 LGS)","populasyon":"People aged 12–46 with drug-resistant epilepsy that began in childhood (an average of 10 medicines tried)","urun":"Medical cannabis tablets, THC:CBD 1:20 and/or 1:50 (Columbia Care)","urun_turu":"thc_iceren","doz":"At most 6 mg THC per day; at the highest dose, a mean of 5.9 mg THC and 117.2 mg CBD per day (0.11 and 2.3 mg/kg/day)","titrasyon":"THC increased by 2 mg per week (1:20 tablet); if the response was inadequate, patients switched to the 1:50 product","sure":"At least 24 weeks (at most 9 months) after a 90-day baseline period","sonuc":"At the stable highest dose, convulsive seizure frequency did not change significantly from baseline (median −5.3%; p = 0.99); more than 50% reduction in 6 patients (21%) (4 of whom had no convulsive seizures during this period), at least 50% increase in 4 patients (13.8%); the authors write that the change in individual patients could not be told apart from spontaneous fluctuation. No difference between the focal/multifocal, generalized and LGS groups in seizure frequency, seizure duration or post-seizure time; a trend toward shorter post-seizure time in the focal and generalized epilepsy groups (trend only). Rescue medication, behavior and sleep did not change. The CBD dose was much lower than in the approved medicine's studies. The company that makes the product (Columbia Care) partly funded the study; the researchers did not receive payment from the company.","yan_etki":"10 side effects in 6 patients (vomiting, gum or nose bleeding, respiratory infection, tiredness, dizziness and 1 status epilepticus), all temporary and most unrelated to the medicine; 16 serious side effects in 7 patients (5 of them pneumonia), all judged unrelated to the medicine; 2 patients were withdrawn from the study because of serious side effects (one for increased seizures, one for increased behavior problems; the authors discuss that the behavior increase may have been due to THC, and behavior returned to its previous level when the medicine was stopped)","pmid":"35267245","doi":"10.1002/acn3.51537","diger_kaynak":null},{"ad":"Navarro 2023 (adult focal epilepsy, compounded CBD+THC)","tasarim":"Open-label, prospective, single-center cohort (Bogotá, Colombia); no control group","n":"44 (followed for at least 3 months; 38.6% of those enrolled)","populasyon":"Adults with drug-resistant focal epilepsy","urun":"Cannabis-based compounded (pharmacy-prepared) formula: 100 mg CBD and less than 1.9 mg THC per mL, sublingual","urun_turu":"thc_iceren","doz":"Median 200 mg CBD and 4 mg THC per day (CBD 3.7 mg/kg/day)","titrasyon":"Started at 0.1 mL twice a day, with weekly increases","sure":"August 2020–July 2022; primary outcome at week 12","sonuc":"At week 12, more than 50% seizure reduction in 79.5% of patients; median monthly seizures fell from 11 to 2.5 (p < 0.001; median reduction 84.1%). Only 38.6% of those enrolled could be followed for 3 months, and the analysis covers only them; no control group; single-author study, and the author also works in a medical cannabis and drug-resistant epilepsy program.","yan_etki":"Drug-related adverse effects reported in 5 patients (type not given in the abstract)","pmid":"36129615","doi":"10.1007/s10072-022-06393-1","diger_kaynak":null},{"ad":"Uliel-Sibony 2021 (Israel, 20:1 oil, tolerance)","tasarim":"Prospective, single-center follow-up of consecutive patients (Tel Aviv Sourasky, Dana-Dwek Children's Hospital); no control group","n":"92 (tolerance analysis 84)","populasyon":"Children and adults aged 1–37 with treatment-resistant epilepsy (mean age 11.8)","urun":"Cannabis oil extract, CBD:THC 20:1","urun_turu":"thc_iceren","doz":"Mean CBD 11.3 mg/kg/day (4–38)","titrasyon":"not reported (in the abstract)","sure":"Mean 19.8 ± 12.5 months (3–45 months)","sonuc":"More than 50% seizure reduction 54%, seizure freedom 9% (8 patients); seizure counts reported by patients or families at monthly visits. Tolerance developed in 25% of patients (21 of 84) after a mean of 7.3 months (the dose had to be raised by at least 30% for the same effect, or seizures increased by at least 30%); tolerance decreased as epilepsy duration increased (p = 0.038). 31% stopped due to lack of effect or side effects. No control group.","yan_etki":"Side effects in 47 of 87 patients (51%); one of the reasons for stopping","pmid":"32713661","doi":"10.1016/j.braindev.2020.06.018","diger_kaynak":"Earlier study from the same center: Hausman-Kedem 2018, Brain Dev 40:544–551 (PMID 29674131; 20:1 oil, 57 patients, 46 in the efficacy analysis, mean CBD 11.4 mg/kg/day, median follow-up 18 months; side effects 46% and the main reason for stopping; better response in children under 10 years of age and with doses above 11 mg/kg/day; the response rate sentence in the abstract ('26 patients (56%) ≤50% reduction') is unclear). Retrospective study of 5 Israeli pediatric neurology clinics, including this center: Tzadok 2016, Seizure 35:41–4 (PMID 26800377; 74 children, 20:1 CBD:THC oil, CBD 1–20 mg/kg/day, mean 6 months; according to family reports, more than 50% seizure reduction in 38 children (52%), stopped in 5 children (7%) due to increased seizures; one of the authors works at a cannabis company and one at the Ministry of Health's medical cannabis unit). Some of the patients in the three studies are very likely shared"},{"ad":"Lusawat 2025 (Thailand, CBD-rich oil)","tasarim":"Prospective observational study, 19 public hospitals (Thailand); no control group","n":"101","populasyon":"Children with drug-resistant epilepsy from various causes (median age 10; an average of 7 medicines tried; median 75 seizures per month)","urun":"Medical-grade CBD-rich oil made in Thailand (THC ratio not in the abstract)","urun_turu":"cbd_zengin_thc_belirsiz","doz":"Median CBD 6 mg/kg/day; effective dose in the range of 1–15 mg/kg/day","titrasyon":"not reported (in the abstract)","sure":"Median 15 months of follow-up (2021–2023)","sonuc":"The rate of more than 50% seizure reduction and the median reduction in monthly seizure count pointed toward improvement at months 3, 6, 9 and 12 and at the last visit (rates not in the abstract); seizure types other than complex motor seizures responded. 33 patients stopped (57% due to side effects, 30% due to lack of effect, 12% due to non-adherence). No control group; because response rates are not given in the abstract, the size of the effect is unknown.","yan_etki":"Side effects in 92% of patients, most (95%) mild: sleepiness, raised liver enzymes, loss of appetite, restlessness","pmid":"40460512","doi":"10.1016/j.pediatrneurol.2025.04.015","diger_kaynak":null},{"ad":"Lyu 2026 (Minnesota medical cannabis program)","tasarim":"Dispensing records and per-visit patient reports from a state medical cannabis program (retrospective registry analysis); no control group","n":"1,940 (1,284 certified for seizures only)","populasyon":"People in Minnesota certified for medical cannabis because of seizures (68.4% adults)","urun":"Cannabis products dispensed in the state program; 86.8% of patients were given products containing both CBD and THC","urun_turu":"thc_iceren","doz":"Median CBD 2.5 mg/kg/day (about 75% lower than the approved medicine's maintenance dose); in regular users, CBD 0.001–33.1 and THC 0.002–12.6 mg/kg/day; 87% high CBD:THC ratio products","titrasyon":"not reported (in the abstract)","sure":"July 2015–December 2023","sonuc":"According to patient reports, seizure frequency improved during follow-up in 67.6%; at the last visit, 76.2% were also using at least one epilepsy medicine. Doses varied widely; people aged 60 and over reported side effects more often. Patients found the product helpful but expensive and mostly chose products containing THC. Reports are self-reported; no control group.","yan_etki":"No rate in the abstract; side effects more common at age 60 and over","pmid":"42612572","doi":"10.1016/j.yebeh.2026.111230","diger_kaynak":null},{"ad":"Ríos-Pohl 2024 (Chile, product analysis)","tasarim":"Product analysis (high-performance liquid chromatography of samples sent in voluntarily by families)","n":"35 samples (27 homemade, 6 unlicensed commercial, 2 products equivalent to the approved medicine)","populasyon":"CBD oils given to children with epilepsy in Chile to treat seizures","urun":"Homemade oils, unlicensed commercial CBD products and bioequivalent CBD products","urun_turu":"karma","doz":null,"titrasyon":null,"sure":"March 2020–September 2021","sonuc":"The CBD in the two products bioequivalent to the approved medicine was close to the labeled 100 mg/mL (88.3 and 90 mg/mL), and THC was below the limit (0 and 0.03 mg/mL). In unlicensed commercial products, CBD ranged from 0.1 to 78.5 mg/mL (mean 25.4); 4 of 6 products were far below the labeled amount (25–100 mg/mL on the label, 0.1–3.3 mg/mL measured); of the two samples with high CBD (two batches of the same brand: 67 and 78.5 mg/mL), one exceeded the THC limit (2.43 mg/mL). In homemade oils, CBD was 0–6.6 mg/mL, far below treatment levels; THC ranged from 0 to 388 mg/mL and was above the 0.2% (2 mg/mL) limit in 11 of 27 samples (in two, 6.3 and 388 mg/mL, at a level the authors wrote carries a risk of poisoning); the solvent was unknown in two thirds of the homemade samples. The samples came from families who responded to a call on social media; patients' diagnoses, seizures and side effects were not asked about.","yan_etki":null,"pmid":"39503571","doi":"10.1002/epi4.13081","diger_kaynak":null},{"ad":"Gidal 2024 (US commercial CBD products)","tasarim":"Product analysis (label accuracy and contaminant screening; accredited laboratory, one sample per product)","n":"202 products (100 drops/tinctures, 48 gummies, 34 vaping products, 20 topical)","populasyon":"CBD products sold over the counter in the US (not FDA-approved); bought from brand websites and online marketplaces","urun":"Unlicensed commercial CBD products (full-spectrum, broad-spectrum, isolate or type not stated)","urun_turu":"cbd_zengin_thc_belirsiz","doz":null,"titrasyon":null,"sure":"Products bought October–December 2021","sonuc":"In 74% of products, the amount of CBD deviated from the label by at least 10%: 46% contained more than the label and 28% less; one product contained 565% of the labeled CBD; no CBD was detected in 5 products. The share of products that did not match the product type stated on the label (full-spectrum, broad-spectrum, isolate) was 26% in the abstract and 32–43% by type in the findings; 3 broad-spectrum products that should have been THC-free contained THC, 2 of them above 0.3%. Heavy metals were found in 44 products (most often lead; 5 products exceeded the limit), solvent residues in 181 products and pesticides in 30 products; there were 53 violations of regulatory limits in total. The study was funded by the maker of the approved CBD medicine (Jazz), which took part in the design, analysis and writing; all 7 of the 7 authors had ties to the company (2 employees, 1 former employee, 4 consultants or company-funded researchers).","yan_etki":null,"pmid":"38562466","doi":"10.3389/fphar.2024.1335441","diger_kaynak":null},{"ad":"Calapai 2024 (unlicensed CBD, European side effect reports)","tasarim":"Pharmacovigilance analysis: spontaneous side effect reports in the European Medicines Agency's EudraVigilance database","n":"not reported (in the abstract)","populasyon":"People in Europe with a side effect reported after using an unlicensed CBD product","urun":"Unlicensed CBD products (not approved as medicines)","urun_turu":"cbd_zengin_thc_belirsiz","doz":null,"titrasyon":null,"sure":"not reported (in the abstract)","sonuc":"18.9% of side effect reports involving unlicensed CBD were serious; serious reports were more common in males and adults, and less common in children aged 3–11. In 38.8% of reports, the product had been used to treat epilepsy. The most common serious side effects were psychiatric disorders, liver disorders and worsening of existing epilepsy; the medicines most often seen together with the side effects were clobazam and valproic acid, followed by marijuana. Based on spontaneous reports; causality and frequency cannot be calculated.","yan_etki":null,"pmid":"37800192","doi":"10.1002/ptr.8028","diger_kaynak":null}],"ilgili_ilaclar":["klobazam","valproat","stiripentol","topiramat","rufinamid","zonisamid","eslikarbazepin","karbamazepin"],"son_inceleme":"2026-10-28","arastirma_gecmisi":[{"tarih":"2026-10-19","not":"Page published. This first review examined 9 studies."},{"tarih":"2026-10-21","not":"The full texts of the studies were reread, and the information on the page was checked against its sources. Corrected: participant numbers, side effects, results and duration in the study table; drug interaction notes; the approved medicine schedule; the evidence summary. Study added: GWPCARE7 pilot + extension (infantile spasms). Points that could not be verified from the full text went down from 6 items to 3. The year of one publication named on the page was corrected to the journal's print year instead of the online publication year. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-21","not":"PubMed and ClinicalTrials.gov were searched for newly published and previously missed clinical studies. 3 studies added: O'Brien 2022 (STAR 1), Ebadi 2023 and Patel 2025 (expanded access, focal epilepsies). In the 188-person randomized study testing CBD applied to the skin (O'Brien 2022), seizures did not fall differently from placebo; the text was updated accordingly. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-27","not":"The studies' sources were reread. Corrected: the dose of the CBD gel applied to the skin was written as a daily total (the journal's correction); the lower bound of seizure reduction in people taking placebo in the approved medicine's studies was corrected (13%); it was added that the between-group difference in the frontal lobe study was not statistically significant and that the groups were unbalanced at baseline; the denominator of the rate in the infantile spasms extension was corrected and the limitation of this measurement was added; the description of the prospective study with unregulated oils as the 'only' one was corrected; information on Turkey's list of medicines from abroad was added. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-28","not":"In October 2026, PubMed, Cochrane and ClinicalTrials.gov were systematically searched again (3,670 PubMed and 119 ClinicalTrials.gov records were screened; findings were reread from primary sources in an independent check). 27 studies added: a placebo-controlled study in focal seizures with CBDV, a compound closely related to CBD (Brodie 2021; seizures fell similarly to placebo), and the small 1980 CBD study (Cunha 1980); the Cochrane review (Gloss 2014), two systematic reviews specific to these epilepsies (Lattanzi 2021, Coppola 2026), a meta-analysis comparing CBD-rich extracts with pure CBD (Pamplona 2018) and the UK's national guideline (NICE 2019); childhood absence epilepsy (a study with results only in the registry), epileptic spasms over 2 years of age, CDKL5 deficiency and Rett, epilepsy with myoclonic-atonic seizures, 15q duplication and Angelman, Sturge–Weber and FIRES series, and CBD gel on the skin in developmental and epileptic encephalopathies; real-world data on off-label use from Germany, France, Denmark and Colombia; studies with THC-containing or CBD-rich products from the US (a prospective study and a state program), Israel, Colombia and Thailand; product content analyses from Chile and the US, and European side effect reports. Later publications from the same programs or studies with overlapping patients were added to the 'other sources' section of the relevant rows; one row's result was written out with numbers. A sentence describing the search itself was added to the evidence summary. No new efficacy RCT with purified oral CBD was found in these epilepsies. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-31","not":"The last sentence of the page's short summary was rewritten in a calmer, more guiding tone: instead of \"Talk to your doctor before you start.\", it now says whom you can talk with, and about what, if you are considering CBD. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-31","not":"The evidence level text now uses the same level name as the top of the page; the level and the result did not change."}]},{"id":"autism","baslik":"Autism spectrum disorder (ASD)","grup":"Neurodevelopmental","grup_kodu":"norogelisimsel","tr_id":"otizm","kanit_duzeyi":"zayif","kanit_yonu":"yarar_gosterilmedi","kanit_ozet":"There are 6 small placebo-controlled studies (n 29–150, 8–12 weeks), and the products vary widely: pure CBD, 20:1 and 9:1 CBD:THC extracts, and a full-spectrum extract with a THC ratio <0.3%. The two RCTs with pure CBD were not clearly different from placebo on the primary outcomes; positive findings were seen on secondary measures or in a manufacturer-supported study. For sleep, two RCTs showed no advantage over placebo; there are no controlled data in adults or in epilepsy occurring alongside ASD. The placebo effect is strong, and most uncontrolled studies rely on parent reports. The \"No effect found\" label is based on the evidence for pure CBD (on this site, the CBD label is given for pure CBD, and products that also contain THC are rated separately): in the two controlled studies of pure CBD in autism, the primary outcomes were negative (the fragile X study was not used as a basis for the label because it was done in a different condition); positive findings were seen with extracts that also contain more or less THC (20:1 and 9:1 CBD:THC extracts, and a full-spectrum extract with a THC ratio below 0.3%) and mostly on secondary measures; the only study that was positive on a primary measure was manufacturer-supported. In fragile X syndrome, the 212-child RCT with pure CBD gel applied to the skin (CONNECT-FX) was negative on the primary outcome; a difference was seen only in an exploratory subgroup analysis that was not in the study's original plan, and the results of the second, 257-person RCT in this subgroup (RECONNECT) had not been published as of October 2026, either in the registry or in a peer-reviewed journal. October 2026 search (PubMed, Cochrane, ClinicalTrials.gov): 7 controlled studies with cannabinoids in autism (6 treatment studies, one with results only in the registry; one single-dose brain imaging study in adults; one sub-analysis was not counted separately and is mentioned in the main study's row), 1 controlled study in fragile X syndrome, 1 small controlled study in intellectual disability and severe behavior problems (8 children; feasibility study) and 4 systematic reviews were found; all are in the table below. There is no Cochrane review assessing cannabinoids. There are three more controlled studies with unpublished results: 86 children with pure CBD in autism (CASCADE), 257 people in fragile X (RECONNECT) and 132 children with pure CBD in intellectual disability (Australia; ended in August 2025). Publications from the same Israeli group of children were combined in a single row in the table (Hacohen 2022). In an additional search in October 2026 (intellectual disability and severe behavior problems only; PubMed, Cochrane, ClinicalTrials.gov, Europe PMC), the only controlled study on this question to be included in the table was the 8-child pilot study (Efron 2021; all the children in the CBD group were autistic, so there is no separate result for intellectual disability without autism). The results of a 20-person uncontrolled pilot study with nabilone in adults with intellectual disability (ended in August 2025) and of single-patient crossover trials for behavior problems in rare genetic conditions (tuberous sclerosis, MPS III, fragile X) that began in the Netherlands in 2025 had not been published as of October 2026.","kanit_duzeyi_metin":"Pure CBD: Weak (in autism, only two controlled studies, 39 and 103 children, 8–12 weeks, one with results only in the registry; in both, the primary outcomes were negative; positive findings come from small studies without a control group). The studies of gel applied to the skin in fragile X syndrome were not used as a basis for this level because they were done in a different condition, and neither was the 8-child pilot study in intellectual disability, because it was not designed to measure the effect (feasibility study; the groups were not compared statistically). The results of CBD-rich products that also contain THC or have an unclear THC amount were assessed under the THC evidence","kanit_duzeyi_thc_icerenler":"zayif","kanit_duzeyi_thc_icerenler_metin":"Weak (four short RCTs in 34–150 children with CBD-rich extracts that also contain THC or have an unclear THC amount: one positive on the main measure but manufacturer-funded and analyzed only in completers, one positive on one of two main measures, one positive only on the authors' interview form, one negative on the main measure; low certainty in meta-analyses; uncontrolled studies are low-level evidence)","kaynak_dosya":"otizm.md","saf_cbd_sonuc":"In the two controlled studies with pure CBD (Trauner 2026: 39 boys aged 7–14, crossover; NCT04745026: 103 children, results only in the registry), no advantage over placebo was seen on the primary outcomes for behavior problems; the single-dose brain imaging study in adults (Pretzsch 2019) did not measure clinical effect. Two small studies without a control group (23 and 20 children) reported improvement. In fragile X syndrome, pure CBD gel applied to the skin was no different from placebo on the primary outcome in a controlled study of 212 children (CONNECT-FX); the difference in a subgroup analysis that was not in the original plan is exploratory and has not yet been confirmed. In children with intellectual disability and severe behavior problems, pure CBD has been compared with placebo only in an 8-child feasibility study (Efron 2021; the authors reported a signal in favor of CBD, but the number of children is far too small for a conclusion, and all the children in the CBD group were autistic); the result of the large 132-child study had not been published as of October 2026.","thc_icerenler_sonuc":"There are four controlled studies with CBD-rich extracts that also contain more or less THC or have an unclear THC amount, and their results are not consistent. In a 150-child study with a 20:1 CBD:THC extract (Aran 2021), only one of the two main measures, the doctor's overall assessment, was better than placebo (clear improvement in 49% versus 21%); the other main measure was negative. In a 60-child study with a 9:1 CBD:THC extract (Silva 2024), there was no difference on standard scales; only some symptoms improved on an interview form prepared by the authors. In a 34-child crossover study with a CBD oil reported to contain at most 1 mg THC per milliliter (Parrella 2026), the main measure was negative and some secondary measures were positive. In a manufacturer-funded study of 61 children with a full-spectrum extract containing very little THC and made up mainly of CBDA, the acid form of CBD (Keating 2026), the main measure (overall illness severity) was positive; the analysis included only the 54 children who completed the study. A meta-analysis pooling two of these studies found a small effect (Köck 2024); a 2026 meta-analysis pooling all cannabinoid products also saw a small reduction in autistic traits; this result rests on 2 studies done with products containing both THC and CBD, with low certainty of evidence (Wilson 2026). Studies and registries without a control group from Israel, Brazil, Turkey and the UK reported improvement; in Israel's national data, only about a quarter of children continued treatment for a year. Cases of psychosis and mania were reported in some young people with THC-containing products.","ruhsat":null,"doz_araligi_ozet":"In the studies, target 5–20 mg/kg/day for pure CBD or low-THC products; 7.5–10 mg/kg/day CBD for THC-containing 20:1 extracts (THC ceiling 0.375–0.5 mg/kg/day); averages reached 0.7–5.9 mg/kg/day (in studies where the dose was adjusted for each person, most with extracts that also contained THC; in the two controlled studies with pure CBD, the dose was the same for everyone, 10 or 20 mg/kg/day); in fragile X, pure CBD gel applied to the skin at 250 or 500 mg a day depending on weight (125–750 mg in the extension)","titrasyon_ozet":"In the studies, the dose was started low (e.g. 1 mg/kg/day or 5 mg/kg/day, 1–6 drops a day) and raised at rates ranging from +1 mg/kg every other day to +5 mg/kg a week; reaching the target took 2 weeks to 2 months; the total dose was split into 2–3 a day; when stopping, it was tapered over 1–2 weeks","yan_etkiler":["Sleepiness: 28% (20:1 extract) / 23% (pure) / 8% (placebo) (Aran 2021)","Reduced appetite: 25% / 21% / 15% (Aran 2021); BMI decreased in the cannabinoid arms","Sleep disturbance/insomnia, irritability, restlessness (Aran 2019; Bar-Lev Schleider 2019; Fortini 2025)","Vomiting (NCT04745026: 7 versus 4); gastrointestinal complaints (Parrella 2026; Keating 2026)","With pure CBD, longer sleep 39%, sedation 26%, increased saliva 30%, polyuria 22% (Lawson 2026)","Worsening behavior: in Fleury-Teixeira 2019, 3/18 stopped early; in Hacohen 2022, 12/110 stopped because of side effects; in Trauner 2026, 4 children got worse after CBD was stopped","Serious THC-related psychiatric events: a psychotic event in a girl in Aran 2019; mania or psychosis in three young adult men using CBD+THC in Al-Soleiti 2021 (PMID 34505186)","1 serious side effect in the pure CBD arm: suicidal thoughts (NCT04745026)","Raised liver enzymes with 20 mg/kg/day pure CBD led to dose changes (Trauner 2026; 3 events during the CBD period)","QTc prolongation on ECG: >450 ms 7/49 versus 4/54, >500 ms 1 versus 0 (NCT04745026)","With pure CBD gel applied to the skin (fragile X): application-site pain 6.4% versus 1.0% on placebo, no serious side effects (Berry-Kravis 2022); in an open extension averaging 28 months, treatment-related side effects 12.9%, ALT above 3 times normal in 3 of 240 people (Berry-Kravis 2025)"],"izlem":["At the start, liver and kidney function, complete blood count and fasting blood sugar (Silva 2024)","Every two weeks, complete blood count, comprehensive metabolic panel, cannabinoid levels and ECG (Trauner 2026)","At the start and at month 3, complete blood count, liver enzymes, kidney, lipids, thyroid and prolactin (interim safety analysis of the Hacohen 2022 cohort: Stolar 2022, PMID 36249785)","Safety blood tests at the start and at weeks 4, 8 and 16 (Keating 2026)","Asking about side effects with a structured scale or by phone every 2 weeks (Aran 2021; Barchel 2018; Hacohen 2022)","With CBD gel applied to the skin, a skin examination of the application site at every visit; also ECG, safety blood tests and screening for suicidal thoughts (Berry-Kravis 2022)"],"dikkat":["History of psychosis or psychosis in the family: excluded from studies (Hacohen 2022); Barchel 2018 considers a history of psychotic episodes a contraindication; cases of psychosis and mania have been reported with THC-containing products","Bipolar disorder, active major depression, history of suicidal behavior (NCT04745026 exclusion criteria)","Liver dysfunction: NCT04745026 excluded those with ALT/AST >2×ULN, and Trauner 2026 excluded those with liver disease","People taking valproate or clobazam were excluded because of interactions (Trauner 2026)","Pregnancy and breastfeeding (Hacohen 2022 and NCT04745026 exclusion criteria)","Allergy to product ingredients, e.g. sesame oil (Trauner 2026; NCT04745026)","History of substance misuse (NCT04745026; Hacohen 2022)","Children taking antipsychotics or multiple medicines: close monitoring; current medicines should not be stopped suddenly (Fleury-Teixeira 2019)","Israeli context: a prescription requires two FDA-approved antipsychotics to have been tried first; in Clalit data, this was documented in only 28% of prescriptions, and 4.3% were written for children under 5 (Sadeh 2026, PMID 41334706)"],"ilac_etkilesim_notlari":["Antiepileptics (epilepsy cohort, not specific to ASD): as the CBD dose went up, N-desmethylclobazam, topiramate and rufinamide levels rose and the clobazam level fell; in adults, zonisamide and eslicarbazepine rose; with valproate, AST/ALT were high (Gaston 2017, PMID 28782097)","CYP: CBD is broken down by CYP2C19 and CYP3A4, THC by CYP2C9 and CYP3A4; ketoconazole raised CBD and THC levels with the THC/CBD mouth spray; rifampin lowered exposure to approved oral CBD by ~32% (FDA label), and with low-dose THC/CBD mouth spray the drop was ~50–60% (Stott 2013, PMID 23750331)","Barchel 2018 discussion (not its own data; citing a review in the context of products that also contain THC): phenytoin levels may rise; possible interaction with SSRIs, tricyclic antidepressants and CNS depressants. For pure CBD, the EMA product information states that no dose adjustment is needed for CYP2C9 substrates such as phenytoin","CBD blood levels were lower on average in those taking antipsychotics, SSRIs, alpha-2 agonists, stimulants or mood stabilizers (Trauner 2026)","All 3 patients who had serious side effects were taking multiple medicines, including antipsychotics; in two, the antipsychotic had been stopped suddenly without supervision (Fleury-Teixeira 2019)","Barchel 2018, based on animal studies, reports that THC may reverse the effect of risperidone","Sleepiness was more common in those taking chronic medication (Aran 2021)","CNS depressants and anticholinergics: effects such as drowsiness and ataxia may add up (Campos 2024, PMID 38794183)","NCT04745026 excluded people taking these medicines (not evidence of interaction; a sponsor safety limit): clobazam; omeprazole, lansoprazole; tolbutamide; warfarin; sirolimus, everolimus, temsirolimus, tacrolimus; repaglinide, pioglitazone, rosiglitazone; montelukast, bupropion, efavirenz"],"dogrulanamayan":["The full text of Aran 2019 is not open access; dose and duration are taken from the Bilge 2021 review (Aran 2021 also confirms the 20:1 ratio)","CASCADE (NCT04520685; 86 people, pure CBD 10 mg/kg/day, primary data collection ended in January 2024): status in the registry is 'unknown' (last updated May 2024), no results posted, only a methods paper; risk of publication bias","The full text of Parrella 2026 could not be read (publisher access blocked); the starting dose and titration are not in the abstract or the registration; THC content only as reported by the Riera 2025 review (≤1 mg/mL)","That David 2025 (PMID 39047052) comes from the same group of children as Hacohen 2022 was inferred from the author team and the description in the abstract; the full text could not be read","RECONNECT (NCT04977986; pure CBD gel applied to the skin in fragile X, 257 people, ended in August 2025): as of October 2026, the results had not been published either in the study registry or in a peer-reviewed journal. A page of FRAXA, the fragile X patient association, reports that the company running the study announced on September 24, 2025 that there was no difference from placebo on the main measure; this is a secondhand report, contains no numbers and could not be verified (both the company's own announcement and the association's page gave an access block on a second reading). For this reason, it is not stated as a result on the page.","The Australian study comparing pure CBD with placebo in 132 children with intellectual disability and severe behavior problems (NCT04821856; 10 mg of pure CBD per kilogram of body weight a day, 8 weeks; children with autism are not excluded) ended in August 2025; as of October 2026, there are no results in the registry and no publication. The same team's 8-child pilot study (Efron 2021) is now in the table; its full text could not be read: the efficacy figures are not in the abstract, and the children's diagnoses (all children in the CBD group were autistic, 1 in 4 in the placebo group) and side effects were taken from a review in which the team took part (Rice 2024).","A 20-person pilot study without a comparison group with nabilone, a synthetic THC-like drug, for severe behavior problems (aggression) in adults with intellectual disability (NCT05273320, Canada; protocol: Lin 2023, PMID 37043511) was completed in August 2025; as of October 2026, there are no results or publication in the registry. In the Netherlands, single-patient crossover trials with pure CBD in 30 patients for severe behavior problems in tuberous sclerosis, MPS III and fragile X syndrome began in January 2025 (protocol: Müller 2024, PMID 38177999; EudraCT 2021-003250-23); in the EU clinical trials register in October 2026 the status was 'ongoing', with no results; no results publication was found on PubMed."],"calismalar":[{"ad":"Aran 2021","tasarim":"Double-blind, placebo-controlled RCT, 3 arms, prespecified crossover (efficacy from period 1 only)","n":"150","populasyon":"ASD, aged 5–21 (mean 11.8)","urun":"(1) Whole-plant extract CBD:THC 20:1; (2) pure CBD + pure THC 20:1. 167 mg/ml CBD, 8.35 mg/ml THC","urun_turu":"thc_iceren","doz":"Started at 1 mg/kg/day CBD (+0.05 mg/kg/day THC). Target: for 20–40 kg, 10 mg/kg/day CBD (+0.5 THC); for >40 kg, 7.5 (+0.375). Upper limit 420 mg CBD and 21 mg THC/day. Actual mean 5.7±2.6 (extract) and 5.9±2.7 (pure) mg/kg/day","titrasyon":"+1 mg/kg/day every other day; dose split into 3 a day; tapered over 2 weeks at the end of each period","sure":"12 weeks + 4-week washout + 12 weeks","sonuc":"HSQ-ASD (co-primary): no difference. Much/very much improvement on CGI-I: 49% with the extract, 21% with placebo (p=0.005); 38% in the pure arm (p=0.08). SRS-2 (secondary): median improvement of 14.9 points with the extract, 3.6 with placebo (p=0.009). No difference on APSI. Sleep (CSHQ): not better than placebo (Schnapp 2022)","yan_etki":"Sleepiness 28% extract / 23% pure / 8% placebo; reduced appetite 25% / 21% / 15%. No serious treatment-related side effects. BMI decreased with cannabinoids","pmid":"33536055","doi":"10.1186/s13229-021-00420-2","diger_kaynak":"Sleep analysis: Schnapp 2022, PMID 35884990, DOI 10.3390/biomedicines10071685; registration NCT02956226; placebo response analysis: Aran 2023, PMID 37176538 (the families of 67 of the 88 children who received placebo took part in a survey; improvement on placebo was linked to the child understanding the purpose of the treatment, p = 0.037, and not to the family's expectations)"},{"ad":"Silva 2024","tasarim":"Double-blind, placebo-controlled RCT","n":"60 (31 active / 29 placebo)","populasyon":"ASD, aged 5–11; refractory epilepsy excluded","urun":"CBD-rich cannabis extract (ABRACE), CBD:THC 9:1; the methods say '0.5% (5 mg/mL)', the discussion '2.5 mg/mL' (the paper's own inconsistency; the same team's 2026 sub-analysis says 0.5%)","urun_turu":"thc_iceren","doz":"Started at 6 drops a day (3 drops every 12 hours); not reported in mg/kg; maximum 70 drops/day; actual mean 47.4 drops (≈12 mg CBD/day according to the same team's sub-analysis)","titrasyon":"+2 drops/day twice a week; at least 1 hour apart from psychotropic medicines","sure":"12 weeks","sonuc":"Improvement versus placebo in a semi-structured interview: social interaction, anxiety, psychomotor agitation, number of meals. No significant difference on ATEC or CARS. In a post hoc sub-analysis of 19 children who could complete the social cognition tests (11 active / 8 placebo; ASD level 1–2), improvement in facial expression recognition and verbal theory of mind was statistically significant compared with baseline only in the active group, and the total theory of mind score improved in both groups; at the end of treatment, there was no difference between the groups on any of them (p = 0.527; 0.901; 0.967; Medeiros 2026). According to the authors, the findings do not show an effect of CBD on social cognition","yan_etki":"According to the text, side effects in the active group 9.7% (3/31): dizziness, insomnia, colic, weight gain; in Table 2, side effects 4/31 active, 5/29 placebo","pmid":"35617670","doi":"10.47626/2237-6089-2021-0396","diger_kaynak":"Post hoc sub-analysis: Medeiros 2026 (Autism Res, PMID 42644517, PMC13674367; 19 children who could complete the social cognition tests). Registration: ReBEC (registration no. 10743 in Silva 2024, RBR-5wr2cqq in Medeiros 2026; the same ethics approval number in both publications)"},{"ad":"Trauner 2026","tasarim":"Double-blind, placebo-controlled crossover RCT (phase 2)","n":"39 analyzed (completers: the paper says 30 in one place and 31 in another)","populasyon":"Boys only, aged 7–14, severe behavior problems; epilepsy excluded","urun":"Pure CBD (Epidiolex); no THC, no THC detected in plasma","urun_turu":"saf_cbd","doz":"5 mg/kg/day (week 1) → target 20 mg/kg/day","titrasyon":"5 → 10 → 20 mg/kg/day (weekly); 2 doses a day, with a fatty meal","sure":"8 weeks + 4-week washout + 8 weeks","sonuc":"No advantage over placebo on the primary outcomes (RBS-R, CBCL, ADOS-2); a marked placebo effect. Blinded clinicians correctly guessed the CBD period in 21 of the 31 children who completed (68%) (based on observed improvement; chance level in a two-period crossover design is 50%); this is not a primary outcome but a clinician impression","yan_etki":"118 side effects: 59 on CBD, 49 on placebo, 10 during washout. No serious treatment-related side effects. During the CBD period, 3 events of raised liver tests were recorded and led to dose changes (how many children were affected is not stated); 5 events of diarrhea and 3 of loose stools (1 of diarrhea on placebo). 4 children whose behavior worsened after CBD was stopped withdrew from the study","pmid":"40410546","doi":"10.1007/s10803-025-06884-y","diger_kaynak":"EEG secondary analysis: Cazares 2026, PMID 41611664; registration NCT04517799"},{"ad":"NCT04745026 (Jazz/GW, GWP42003-P)","tasarim":"Double-blind, placebo-controlled parallel RCT (phase 2); no peer-reviewed publication as of October 2026, results from the ClinicalTrials.gov registration (March 30, 2025)","n":"103 (49 CBD / 54 placebo)","populasyon":"ASD, aged 6–17, IQ ≥70","urun":"Pure CBD oral solution, 100 mg/mL","urun_turu":"saf_cbd","doz":"5 mg/kg/day (1 week) → 10 mg/kg/day","titrasyon":"5 for 1 week, then 10 mg/kg/day; 2 doses a day; tapered over 1 week at the end","sure":"12 weeks","sonuc":"None of the primary outcomes was significant. ABC irritability p=0.085 (numerically in favor of placebo). CGI-I response 35% versus 32% (p=0.71). Vineland-3 p=0.85. CGI-S p=0.61","yan_etki":"Any side effect 27/49 versus 24/54; vomiting 7 versus 4; serious side effects 2 versus 1, with 1 case of suicidal thoughts in the CBD arm; withdrawal because of side effects 2 versus 2; QTc on ECG >450 ms 7/49 versus 4/54, >500 ms 1 versus 0","pmid":null,"doi":null,"diger_kaynak":"NCT04745026 (clinicaltrials.gov/study/NCT04745026)"},{"ad":"Parrella 2026","tasarim":"Double-blind, placebo-controlled crossover pilot RCT","n":"34 randomized, 29 completed","populasyon":"ASD, aged 5–12","urun":"CBD oil containing terpenes (Medigrowth CBD100): 100 mg/mL CBD, THC ≤1 mg/mL (as reported by the Riera 2025 review; full text could not be read)","urun_turu":"cbd_zengin_thc_belirsiz","doz":"Target 10 mg/kg/day; starting dose not reported (abstract)","titrasyon":"Not reported (abstract)","sure":"2 × 12 weeks, with an 8-week washout in between","sonuc":"Primary SRS-2: no difference (p=0.125). Secondary: DBC-2 social relating (p=0.024), DBC-2 anxiety (p=0.002) and parental stress APSI (p=0.044) improved. No difference on Vineland-3","yan_etki":"Gastrointestinal discomfort in 2 children; no other side effects reported in the abstract","pmid":"41452412","doi":"10.1002/aur.70159","diger_kaynak":"Correction: PMID 42861636, DOI 10.1002/aur.70380; registration ACTRN12622000437763"},{"ad":"Keating 2026 (NTI164, Harmony)","tasarim":"Double-blind, placebo-controlled RCT (phase II/III) + 8 weeks open-label; funded by the manufacturing companies (sponsor in the registration Fenix Innovation Group, partner Neurotech International); 3 of the 6 authors, including the corresponding author, work at Fenix and declared financial support from Fenix (one is also a Neurotech shareholder), 1 is a Neurotech consultant; 3 of the 4 authors who designed the trial have ties to the companies; according to the paper, the sponsors had no role in data collection or analysis; simple randomization","n":"61 randomized, 54 completed","populasyon":"ASD Level II/III, aged 8–17","urun":"Full-spectrum extract (NTI164): mainly CBDA, plus CBD, CBGA, CBDV and very little THC and THCA (THC <0.3% in the paper, <0.08% in the registration)","urun_turu":"thc_iceren","doz":"Started at 5 mg/kg/day → 20 mg/kg/day or the highest tolerated dose; actually reached 10–20 mg/kg/day","titrasyon":"+5 mg/kg/day each week; 20 reached in week 4; 2 doses a day","sure":"8 weeks","sonuc":"Primary CGI-S: difference −1.65 (95% CI −2.29 to −1.01; p<0.001; only the 54 people who completed the double-blind period were analyzed). Improvement in all Vineland-3 domains; improvement in some ADAMS and ASC-ASD-P subscales. SRS-2 total p=0.055. Sleep (SDSC total) p=0.214, no difference","yan_etki":"41 side effects in 26 participants, all mild: nausea 21.9%, headache 19.5%, abdominal pain 17.1% (percentage of side effects); similar between groups. No serious side effects; no clinically significant laboratory changes","pmid":"42561512","doi":"10.1016/j.neurot.2026.e01033","diger_kaynak":"NCT05626959 (NTIASD2; 54 participants in the registration, no results posted)"},{"ad":"Pretzsch 2019 (mechanism)","tasarim":"Double-blind, placebo-controlled, single-dose, crossover","n":"34 adult men (17 with ASD, 17 neurotypical)","populasyon":"Adult men","urun":"Pure CBD","urun_turu":"saf_cbd","doz":"600 mg single dose","titrasyon":null,"sure":"Single dose","sonuc":"Changes in glutamate and GABA on MRS; the GABA response differed in the ASD group. The authors state that it does not show effectiveness","yan_etki":"Not reported (the full text says health checks were done, but gives no results)","pmid":"30758329","doi":"10.1038/s41386-019-0333-8","diger_kaynak":"Other publications from the same trial (NCT03537950; 600 mg CBD, 600 mg CBDV and placebo, in random order): CBD with fMRI, Pretzsch 2019, PMID 31237191 (CBD changed activity and connectivity in the cerebellum and fusiform region, especially in the ASD group); CBDV with MRS, Pretzsch 2019, PMID 31748505 (glutamate rose in the basal ganglia) and fMRI, Pretzsch 2021, PMID 34210360 (in ASD, striatal connectivity moved closer to neurotypical levels). All single-dose mechanism studies; clinical effect was not measured"},{"ad":"Efron 2021","tasarim":"Double-blind, placebo-controlled parallel pilot RCT (feasibility study; not powered for efficacy); intellectual disability","n":"8 randomized (1:1); all 8 completed","populasyon":"Children and adolescents aged 8–16 with intellectual disability and severe behavior problems (Melbourne, Australia); according to a review that included members of the team, all children in the CBD group and 1 of the 4 children in the placebo group were autistic (Rice 2024, secondary source)","urun":"98% pure CBD oil (Tilray, Canada), by mouth","urun_turu":"saf_cbd","doz":"Increased over 9 days to 20 mg per kilogram per day, split into 2 doses a day; upper limit 500 mg twice a day","titrasyon":"Gradual increase over 9 days","sure":"8 weeks","sonuc":"The feasibility goals were met: all 8 children completed the study; attendance at visits and medication adherence were 100%, blood tests 92% and questionnaires 88%. The authors reported a ‘signal of efficacy’ in favor of CBD on the main behavior scale (Aberrant Behavior Checklist irritability subscale; according to Rice 2024); the numbers are not in the abstract; the behavior scales were completed for only 3 children in the CBD group and 4 in the placebo group (Rice 2024), and the groups were not compared statistically; the sample was too small to assess significance. Because all the children in the CBD group were autistic (1 in 4 in the placebo group), the result cannot be carried over to intellectual disability without autism. The full text could not be read","yan_etki":"No serious side effects and no dropouts; mild side effects in both groups (abdominal pain, constipation, ringing in the ears, restlessness, sleepiness; as reported by Rice 2024)","pmid":"32478863","doi":"10.1111/bcp.14399","diger_kaynak":"ACTRN12618001852246; protocol: Efron 2020, PMID 32152170; its large study NCT04821856 (132 children; ended in August 2025, no results); for details, Rice 2024, PMID 36864363 (PMC10869397; Efron is among the authors)"},{"ad":"Lawson 2026","tasarim":"Open-label phase 2, Bayesian dose-finding","n":"23","populasyon":"ASD, aged 7.8–17.8, IQ ≥80","urun":"Pure CBD (Epidiolex, ≥98%)","urun_turu":"saf_cbd","doz":"3, 6 or 9 mg/kg/day (fixed-dose arms)","titrasyon":"Not reported (abstract)","sure":"6 weeks","sonuc":"Highest response 62% at 9 mg/kg/day (n=8); overall response 10/23; no response in the only child who chose sleep as the target symptom (no control group)","yan_etki":"Related side effects: longer sleep 39%, more dreams 35%, increased saliva 30%, sedation 26%, polyuria 22%. Liver tests and blood counts were not affected","pmid":"42204954","doi":"10.1177/10445463261452514","diger_kaynak":"NCT03900923"},{"ad":"Hacohen 2022","tasarim":"Prospective, open-label","n":"110 started, 82 completed","populasyon":"ASD, aged 5–25 (mean 9.2)","urun":"Whole-plant extract CBD:THC 20:1 (Nitzan Spectrum, MCT oil); 5.7 mg CBD + 0.3 mg THC per drop","urun_turu":"thc_iceren","doz":"Started at 1 drop a day; ≤10 mg/kg/day CBD (≤400 mg/day), THC ≤0.5 mg/kg/day (≤20 mg/day)","titrasyon":"Parents increased gradually until improvement was seen (individual)","sure":"6 months","sonuc":"Improvement in social communication on ADOS, SRS and Vineland; no change in cognitive scores (no control group). A 6-month additional analysis by the same team (David 2025, 65 children) reported reductions in anxiety and repetitive behaviors; in a secondary analysis (Treves 2026; 81 completers out of 109 children), there was no difference in safety, effectiveness or CBD blood levels between those taking cannabis oil alone (51) and those taking it in addition to other medicines (30)","yan_etki":"12/110 (11%) stopped because of side effects. In an interim safety analysis of the same cohort (Stolar 2022, 59 children), no clinically significant changes in blood counts, liver enzymes, kidney, thyroid or prolactin values at month 3","pmid":"36085294","doi":"10.1038/s41398-022-02104-8","diger_kaynak":"Additional analysis: David 2025, PMID 39047052; 10.1089/can.2024.0001; other publications from the same cohort (Shamir Medical Center, November 2019–May 2021), not separate studies: Stolar 2022, PMID 36249785, DOI 10.3389/fphar.2022.977484 (interim biochemical safety analysis in 59 children); Treves 2026, PMID 40613426, DOI 10.1177/02698811251332841 (comparison of single-drug and add-on treatment in 109 children); David 2025b, PMID 41153555 (family accommodation; 44 of 87 families analyzed); Barchel 2026, PMID 41503912 (ADHD symptoms on a teacher scale in 53 of 109 children)"},{"ad":"Barchel 2018","tasarim":"Prospective, parent-reported; children were drawn from the licensed patient registry of the company that prepared the product (Tikun Olam), and 1 of the 8 authors works at this company; according to the paper, the company did not fund the study, and the authors declared no conflicts of interest. Some patients may overlap with Bar-Lev Schleider 2019 (both are patients of the same company)","n":"53","populasyon":"ASD, aged 4–22 (median 11)","urun":"30% oil, CBD:THC 20:1","urun_turu":"thc_iceren","doz":"Recommended 16 mg/kg CBD (at most 600 mg/day), THC 0.8 mg/kg (at most 40 mg/day); median actually reached 90 mg/day CBD and 7 mg/day THC","titrasyon":"Not reported (not in the full text either)","sure":"Median 66 days (30–588)","sonuc":"Improvement according to parent reports: self-injury/meltdowns 67.6%, hyperactivity 68.4%, sleep 71.4%, anxiety 47.1%; worsening of anxiety 23.5%","yan_etki":"Sleepiness 12/53, reduced appetite 6/53, increased appetite 4/53; all transient","pmid":"30687090","doi":"10.3389/fphar.2018.01521","diger_kaynak":null},{"ad":"Bar-Lev Schleider 2019","tasarim":"Prospective treatment program data: all autistic patients who received products in 2015–2017 from Tikun Olam, Israel's largest medical cannabis provider; the study was supported by the company, 2 of the 5 authors are company employees and 1 is a paid member of the company's scientific board. Some patients may overlap with Barchel 2018","n":"188","populasyon":"ASD, mean age 12.9±7.0 years","urun":"Oil, THC:CBD 1:20 (30% CBD, 1.5% THC); 15 mg CBD + 0.75 mg THC per drop; for insomnia (46 patients), an evening oil with 3% THC was added (mean +5.0±4.5 mg/day THC)","urun_turu":"thc_iceren","doz":"From 1 drop 3 times a day to 20 drops 3 times a day; mean 79.5±61.5 mg CBD and 4.0±3.0 mg THC, 3 times a day; mg/kg not reported","titrasyon":"Individual; finding the right dose can take up to 2 months","sure":"6 months","sonuc":"Of the 93 patients assessed at month 6, marked improvement in 28 (30.1%) and moderate improvement in 50 (53.7%); survey response rate 60%","yan_etki":"At least one side effect 25.2%: restlessness 6.6%, sleepiness 3.2%, psychoactive effect 3.2%; 5 people stopped because of side effects","pmid":"30655581","doi":"10.1038/s41598-018-37570-y","diger_kaynak":null},{"ad":"Fleury-Teixeira 2019","tasarim":"Observational (compassionate use)","n":"18","populasyon":"ASD, aged 7–18; active epilepsy in 5 patients","urun":"CBD-rich extract, CBD:THC 75:1","urun_turu":"thc_iceren","doz":"Starting mean ~2.90 (2.30–3.60), target mean 4.55 (3.75–6.45) mg/kg/day CBD; THC mean 0.06 mg/kg/day","titrasyon":"Individual titration","sure":"6–9 months","sonuc":"Improvement in at least one area in 14 of 15 adherent patients; of the 5 patients with epilepsy, seizures fell by 50% in 3 and disappeared in 2 (no control)","yan_etki":"3/18 (17%) stopped within the first month because of side effects; all were taking multiple medicines, including antipsychotics. In the others, sleepiness and irritability (3 cases each)","pmid":"31736860","doi":"10.3389/fneur.2019.01145","diger_kaynak":null},{"ad":"Fortini 2025 / 2026","tasarim":"Prospective before-and-after, add-on treatment","n":"20 (13 patients completed long-term follow-up)","populasyon":"Severe ASD + intellectual disability, aged 3–18","urun":"Pure CBD","urun_turu":"saf_cbd","doz":"Median total 363.5 mg/day (100–700); mg/kg not reported","titrasyon":"Not reported (abstract)","sure":"Median 11 months; long-term follow-up mean 27.6±1.3 months","sonuc":"Improvement in at least one parent-selected symptom in 18/20 patients; about 30% improvement in irritability, social withdrawal and hyperactivity; concomitant medicines could be reduced in 40% (no control)","yan_etki":"Side effects in 65% (13/20): increased irritability, reduced appetite; mild or moderate, transient","pmid":"39965749","doi":"10.1016/j.pbb.2025.173971","diger_kaynak":"Long-term follow-up: PMID 42248366, DOI 10.1016/j.pbb.2026.174220"},{"ad":"Erridge 2022; Aggarwal 2026 (UK Medical Cannabis Registry)","tasarim":"Uncontrolled case series (registry)","n":"74; 130","populasyon":"Adults with ASD (mean age 32.7)","urun":"Mostly THC-dominant dried flower and oils","urun_turu":"thc_iceren","doz":"CBD median 8.50 mg/day, THC median 20 mg/day (2026); at month 18, THC median 192.25 mg/day, CBD 26.25 mg/day; in the 2022 cohort, THC median 112.5 mg/day","titrasyon":"Titration by a specialist physician","sure":"6 months; 18 months","sonuc":"Linked to improvement in GAD-7, sleep and EQ-5D-5L; no control group. In the 2026 cohort, the effect wanes after month 3; the authors discuss THC tolerance. Note on interests: according to the journal's correction, most authors of the 2026 publication work at a private medical cannabis clinic","yan_etki":"180 side effects in 14/74 people (2022). 232 side effects in 25/130 people; 42 severe, 3 life-threatening or disabling (2026)","pmid":"36159065","doi":"10.1177/20451253221116240","diger_kaynak":"Aggarwal 2026: PMID 42387975, DOI 10.1002/npr2.70146"},{"ad":"Aran 2019","tasarim":"Retrospective","n":"60","populasyon":"ASD, aged 5–17.5","urun":"CBD-rich cannabis, CBD:THC 20:1 (Bilge 2021 review; Aran 2021 writes that it took the same ratio from earlier open studies)","urun_turu":"thc_iceren","doz":"According to the Bilge 2021 review: in those taking 3 doses a day (n=44), mean 3.8±2.6 CBD and 0.29±0.22 THC mg/kg/day; in those taking 2 doses a day (n=16), 1.8±1.6 CBD and 0.22±0.14 THC mg/kg/day","titrasyon":"According to the review, 2–4 weeks","sure":"According to the review, mean follow-up 10.9±2.3 months","sonuc":"Much/very much improvement in behavioral outbreaks 61% (caregiver global impression)","yan_etki":"Sleep disturbance 14%, irritability 9%, loss of appetite 9%. In a 13-year-old girl taking more THC (6.5 mg/kg/day CBD; when THC rose to 0.72 mg/kg/day), a transient, serious psychotic event; an antipsychotic was needed (as reported by Bilge 2021)","pmid":"30382443","doi":"10.1007/s10803-018-3808-2","diger_kaynak":null},{"ad":"Bilge & Ekici 2021 (Turkey)","tasarim":"Retrospective, single center","n":"33","populasyon":"ASD, mean age 7.7±5.5 years; all were taking antipsychotics","urun":"Full-spectrum CBD, trace THC (CBDistillery, CBDodgamax; 500/1000/2500 mg/30 mL drops); ratio not reported. The abstract gives THC as '<3%', the methods as the maximum allowed in Turkey, 0.3%","urun_turu":"thc_iceren","doz":"Started at 1 drop twice a day (according to body weight); mean 0.7 (0.3–2) mg/kg/day; daily maintenance CBD did not exceed 40 mg in any patient","titrasyon":"+1 drop every 3 days","sure":"Median 6.5 months (3–28)","sonuc":"Parent reports: 32.2% reduction in behavior problems, 22.5% increase in expressive language; the antipsychotic could be stopped in only 1 patient","yan_etki":"Restlessness 7/31 (22%), which subsided when the dose was lowered; a generalized seizure in a 13-year-old boy after 5 mg CBD (the drug was stopped); stopped in week 2 in one child because of increased stereotypy; no laboratory changes","pmid":"34911567","doi":"10.1186/s42238-021-00108-7","diger_kaynak":null},{"ad":"Wilson 2026","tasarim":"Systematic review and meta-analysis (54 RCTs in mental disorders)","n":"54 RCTs; 2,477 participants (all mental disorders); 2 RCTs in the ASD analysis (from the journal correction)","populasyon":"Mental disorders (ASD sub-analysis)","urun":"Various cannabinoids; both ASD studies used THC and CBD together","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"In ASD, reduction in autistic traits SMD −0.36 (−0.66 to −0.07; 2 RCTs, both with products containing THC and CBD together); quality of evidence generally low. The correction published in the journal (June 16, 2026) corrected the number and type of the ASD studies; the result did not change","yan_etki":"Risk of any side effect increased: OR 1.75 (NNTH=7); serious side effects did not increase","pmid":"41856154","doi":"10.1016/S2215-0366(26)00015-5","diger_kaynak":"Correction: Lancet Psychiatry 2026;13(8):e11, PMID 42302809 (June 16, 2026; the axis of a figure and the study counts in the table were corrected, results unchanged); PROSPERO CRD42023392718"},{"ad":"Vasconcelos 2026","tasarim":"Systematic review (GRADE); 4 RCTs + 8 non-RCTs","n":"not reported","populasyon":"ASD in children and adolescents","urun":"Various cannabinoid products","urun_turu":"karma","doz":"Titration generally up to ~10 mg/kg/day","titrasyon":null,"sure":null,"sonuc":"In a single RCT (20:1 extract), improvement in CGI and social communication; the other standard measures were negative; no difference in sleep or overall severity; non-RCT studies at very low certainty","yan_etki":null,"pmid":"41974303","doi":"10.1016/j.pnpbp.2026.111697","diger_kaynak":null},{"ad":"Riera 2025","tasarim":"Systematic review (Cochrane methods); 11 studies: 4 completed RCTs, 7 ongoing","n":"351 (4 completed RCTs)","populasyon":"ASD","urun":"Various cannabis derivatives","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"Certainty very low to low; no study measured quality of life","yan_etki":null,"pmid":"40605143","doi":"10.1002/jcph.70068","diger_kaynak":null},{"ad":"Köck 2024","tasarim":"Systematic review and meta-analysis of RCTs","n":"8 RCTs, 474 participants (ASD: 2 RCTs)","populasyon":"Psychiatric disorders in young people","urun":"Various cannabinoids","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"ASD: g=0.264 (0.107–0.421; 2 RCTs: Aran 2021, Silva 2024); across all disorders, CBD dose was not related to effect size (ρ=−0.014)","yan_etki":null,"pmid":"39696457","doi":"10.1186/s13034-024-00846-5","diger_kaynak":null},{"ad":"Berry-Kravis 2022 (CONNECT-FX)","tasarim":"Double-blind, placebo-controlled RCT (phase 3; 21 centers: US, Australia, New Zealand); 2-week single-blind placebo run-in; fragile X syndrome. Funded by the manufacturer (Zynerba); all 14 authors declared ties to the manufacturer (research funding, consulting; 3 employees, 1 former employee)","n":"212 randomized (110 CBD, 102 placebo); 211 in the safety analysis, 210 in the efficacy analysis","populasyon":"Fragile X syndrome (FMR1 full mutation), aged 3–17 (mean 9.7), 75% male; high social avoidance or irritability scores; at most 2 add-on psychiatric medicines","urun":"ZYN002: laboratory-made (not plant-derived) CBD gel applied to the skin; contains no THC","urun_turu":"saf_cbd","doz":"250 mg CBD a day for those weighing ≤35 kg, 500 mg for those >35 kg (split into two doses, on the skin)","titrasyon":"None; fixed dose by weight","sure":"12 weeks","sonuc":"Primary outcome (ABC-CFXS social avoidance, week 12) showed no difference: mean change −2.68 versus −2.29 on placebo (p = 0.321). Key secondary outcomes also showed no difference: irritability p = 0.149, social unresponsiveness p = 0.607, any improvement on CGI-I 46.8% versus 40.5% (p = 0.376). In a subgroup analysis that the paper calls 'ad hoc' and that was not in the original analysis plan (according to the registration, defined before unblinding), the difference in social avoidance in 169 children with at least 90% methylation of the FMR1 gene was −1.00 (nominal p = 0.020; no correction for multiple comparisons); in the small group with methylation below 90%, the effect went in the opposite direction. This finding is exploratory and does not count as proof of effect. The second RCT testing this subgroup as its main measure (RECONNECT, NCT04977986, 257 people) ended in August 2025; as of October 2026, its results are not in the registry or in a peer-reviewed journal","yan_etki":"Any side effect 57.8% versus 50.0% on placebo; all mild or moderate; no serious side effects; the most common treatment-related side effect was application-site pain (6.4% versus 1.0%)","pmid":"36434514","doi":"10.1186/s11689-022-09466-6","diger_kaynak":"NCT03614663 (results in the registry); confirmatory study RECONNECT, NCT04977986 (257 people, ended August 29, 2025; as of October 2026, no results in the registry and no peer-reviewed publication)"},{"ad":"Heussler 2019 (FAB-C)","tasarim":"Open-label phase 1/2, multicenter (Australia); no control group; fragile X syndrome. Funded by the manufacturer (Zynerba), which took part in the design and interpretation; 5 of the 8 authors are linked to the manufacturer (3 employees, 1 former employee, 1 consultant)","n":"20 started, 18 completed","populasyon":"Fragile X syndrome, aged 6–17 (mean 10.4), 75% male; high anxiety scores","urun":"ZYN002, synthetic CBD gel applied to the skin","urun_turu":"saf_cbd","doz":"Started at 50 mg a day, at most 250 mg; of the 18 who completed, 16 received 250 mg and 2 received 100 mg","titrasyon":"50 → 100 → 250 mg/day over 6 weeks (at the investigator's discretion)","sure":"12 weeks (6 weeks of dose adjustment + 6 weeks at a fixed dose); 13 people moved to the 24-month extension","sonuc":"The primary ADAMS total score (anxiety, mood, behavior) fell from an average of 32.1 to 18.1 (p < 0.001); improvement also in anxiety (PARS-R), ABC-CFXS subscales and quality of life; no significant change in depressed mood. No control group","yan_etki":"At least one side effect in 17 of 20 people (85%), 70% of them mild; no serious side effects; side effects possibly related to treatment in 6 people (dryness or rash at the application site, hyperactivity, stereotypy, nightmares); most common were gastroenteritis 25% and vomiting 10%; 1 person stopped because of worsening eczema","pmid":"31370779","doi":"10.1186/s11689-019-9277-x","diger_kaynak":"ACTRN12617000150347"},{"ad":"Berry-Kravis 2025 (fragile X extension)","tasarim":"Interim analysis of an open-label extension study (ZYN2-CL-017; data cutoff January 31, 2024); primary aim safety; no control group. Funded by the manufacturer (Harmony Biosciences); all 15 authors declared ties to the manufacturer (6 employees)","n":"240 (10 from FAB-C, 197 who completed CONNECT-FX, 33 who could not be enrolled in CONNECT-FX); 196 in the efficacy analysis","populasyon":"Fragile X syndrome, aged 3–17 at entry (mean 9.7), 76% male","urun":"ZYN002, synthetic CBD gel applied to the skin","urun_turu":"saf_cbd","doz":"250 mg a day (≤35 kg) or 500 mg (>35 kg); after month 1, between 125 and 750 mg at the investigator's discretion","titrasyon":"Individual (increase or decrease with the approval of the investigator and medical monitor)","sure":"Average 28 months including the earlier studies; at the data cutoff, 75 people were continuing and 165 had left","sonuc":"Safety (primary): treatment-related side effects 12.9%; serious side effects 4.6% (none considered drug-related); stopping because of side effects 3.3%. Secondary: compared with the CONNECT-FX baseline, the social avoidance score fell by −3.37 at month 1 in the group continuing the gel and by −3.36 at month 3 in the group switching from placebo, and was maintained in the following months. No control group; the dropout rate is high (165 of 240 people), and according to the authors, good responders staying in the study may make the result look optimistic","yan_etki":"At least one side effect in 68.3% of 240 people (98% mild to moderate); most common were upper respiratory infection 20%, COVID-19 12.5%, vomiting 7.9%, fever 7.1%, application-site pain 6.7%; ALT above 3 times normal in 3 people (1.3%); events leading to stopping include aggression, behavior disorder, irritability, suicidal thoughts and fatty liver","pmid":"41254489","doi":"10.1186/s11689-025-09657-x","diger_kaynak":"NCT03802799 (476 people in the registry; no results as of October 2026)"},{"ad":"Treves 2025 (Israeli national data)","tasarim":"Retrospective national cohort (Israeli Medical Cannabis Agency data, 2018–2022) and data from the Shamir Medical Center open-label study (the same group of children as Hacohen 2022; 59 children in the methods, 110 in the flow chart); aim: staying on treatment. The authors declared no conflicts of interest","n":"1,341 children under 12; 751 with ASD (367 children with ASD in the one-year follow-up analysis)","populasyon":"Children under 12 receiving medical cannabis oil (ASD, epilepsy, Tourette syndrome, cancer); adolescents and young adults for comparison","urun":"Licensed medical cannabis oils; most children with ASD received a CBD-rich product that also contained THC (THC:CBD mostly 1:10 or lower; in older children, the THC ratio rose over time)","urun_turu":"thc_iceren","doz":"No mg/kg in the national data (amount dispensed per month)","titrasyon":"Each month during treatment, 15–25% of patients changed the amount and 10–20% changed the THC:CBD ratio","sure":"First 3 months; 12 months in ASD","sonuc":"In children with ASD, the share who continued treatment for one year was about 26% both in the national data and in the open-label study; in the national data, 48% completed 6 months (about 75% in the open-label study). In the open-label study, the main reasons for stopping were side effects and lack of effect, and in the long term also bureaucratic and logistical difficulties. Effectiveness was not measured; no control group","yan_etki":"In the open-label study, the main reasons for dose reductions were psychiatric, neurological and general side effects (tiredness, restlessness, sleep problems, aggression; the reports also include suicidal thoughts); in one third of reductions, no reason was recorded","pmid":"41357860","doi":"10.3389/fphar.2025.1646560","diger_kaynak":null}],"ilgili_ilaclar":["risperidon","antipsikotik","klobazam","valproat","topiramat","rufinamid","zonisamid","eslikarbazepin"],"son_inceleme":"2026-10-31","arastirma_gecmisi":[{"tarih":"2026-10-19","not":"Page published. This first review examined 23 studies."},{"tarih":"2026-10-21","not":"The full texts of the studies were re-read and the information on the page was checked against its sources. Corrected: side effect, dose, product and participant number information in the study table; drug interaction notes; the dose range in the studies; reported side effects. Points that could not be verified from full texts went down from 5 items to 3. A technical phrase (\"failed to beat placebo\") was replaced with a clearer one (\"was not clearly different from placebo\"). The year of 4 publications named on the page was corrected to the journal's print year instead of the online publication year. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-21","not":"Newly published and previously missed clinical studies were searched in PubMed and ClinicalTrials.gov. A new publication from the Hacohen 2022 study team (David 2025) was not counted as a separate study; it was added as a note to that study's row. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-27","not":"The year of a controlled study with pure CBD was corrected to the journal's print year (Trauner 2026), and a note was added that the clinician impression in this study was not a primary outcome; the authors' declaration of interests was added to the UK registry study. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-27","not":"Where the 'Mixed results' label comes from was written into the plain summary and the evidence summary: in the controlled studies of pure CBD, the main outcomes were negative, and the positive findings came with products that also contain THC and mostly on secondary measures. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-28","not":"In October 2026, PubMed (835 records), Cochrane and ClinicalTrials.gov (87 records) were systematically searched again. The scope was widened and a fragile X syndrome section was added to the page: a 212-child controlled study with pure CBD gel applied to the skin (no different from placebo on the primary outcome; a difference only in an exploratory subgroup analysis added afterward), a 20-child open-label study and a 240-child long-term open extension study. A second large controlled study in this subgroup has ended, but its results have not been published; because the company's announcement about this study could not be verified, it was mentioned only under unverifiable points. A real-world study from Israel's national data was also added (share of children who continued treatment for a year about 26%). The result for THC-containing products was rewritten to describe all four controlled studies. Corrected: the upper limit of the average doses reached in the studies (5.9, not 7.88 mg/kg/day) and that in the controlled studies with pure CBD the dose was fixed at 10–20 mg/kg/day; two publications from the same Israeli group of children were not counted as separate studies and were moved to the row of the main study (Hacohen 2022); the other publications of the single-dose brain imaging study were added; a study's company ties, confidence interval and number of children analyzed; a meta-analysis's number of participants and correction notice; a publication's year. The strength of evidence did not change."},{"tarih":"2026-10-28","not":"Evidence changed: The finding for CBD in autism was changed from \"Mixed results\" to \"No effect found\"; the strength of evidence (Weak) and the strength of evidence for THC-containing products (Weak) did not change. On this site, the CBD label is given according to the evidence for pure CBD. In the two controlled studies with pure CBD in autism (39 and 103 children; the results of the second only in the ClinicalTrials.gov registration), the main measures of behavior problems were no different from placebo. The positive controlled findings that gave the \"mixed\" impression came from extracts that also contain THC or have an unclear THC amount, and mostly from secondary measures; these are now described under the evidence for THC-containing products. Positive results for pure CBD were seen only in small studies without a control group. The fragile X syndrome studies are described in a separate section and were not used as a basis for this label. Because the studies are few, small and short, the evidence is weak."},{"tarih":"2026-10-28","not":"October 2026 additional review: sources found for this page during searches for other topics were read and added to the page. A later sub-analysis (Medeiros 2026) of the 60-child controlled study in Brazil (Silva 2024) had been listed as a separate row in the table; because it is a second publication of the same trial, it is no longer a separate row, and its finding (no difference from placebo in facial expression recognition and theory of mind in 19 children who completed the social cognition tests) was moved to the main study's row. The number of controlled studies did not change; the conclusion and the strength of evidence did not change."},{"tarih":"2026-10-30","not":"The correction to the Wilson 2026 meta-analysis published in the journal was read: the results did not change. According to the corrected table, the meta-analysis's autism result rests on 2 studies done with products containing both THC and CBD; there is no study done with CBD alone. This information was added to the page."},{"tarih":"2026-10-30","not":"The last sentence of the page's short summary was rewritten in calmer, more guiding language: instead of \"Talk to your doctor before you start.\", it now says who you can talk with, and about what, if you are considering CBD. The result and the strength of evidence did not change."},{"tarih":"2026-10-31","not":"A separate section was added to the page for children with intellectual disability and severe behavior problems. The only controlled study testing pure CBD on this question is an 8-child pilot study (Efron 2021): its aim was to test whether such a study is feasible; the authors reported a signal in favor of CBD, but the number of children was far too small for a conclusion, and all the children taking CBD were autistic. There is no controlled study giving a separate result for intellectual disability without autism. The results of the large 132-child study and of a 20-person pilot study with nabilone in adults had not been published as of October 2026. In autism, the result and the strength of evidence did not change."}]},{"id":"chemotherapy-nausea","baslik":"Cancer: nausea and vomiting caused by chemotherapy and radiotherapy","grup":"Cancer","grup_kodu":"kanser","tr_id":"kanser-bulanti-kusma","kanit_duzeyi":"yetersiz","kanit_yonu":"veri_yok","kanit_ozet":"No RCT of pure CBD in chemotherapy nausea was found. Current evidence comes from THC-containing products given in addition to standard treatment in patients whose nausea continued despite standard anti-nausea medicines: a 1:1 THC:CBD capsule raised the complete response from 8% to 24%. In gynecologic cancer, a 1:1 THC:CBD oil (very low dose) reduced the nausea score slightly more than placebo (54-person crossover RCT; 2.11 vs. 2.99); two-thirds of the patients had dizziness and sleepiness. The table includes 26 controlled studies done between 1975 and 1995 with dronabinol (synthetic THC) and nabilone (a synthetic THC-like cannabinoid) whose results can be read in their abstracts; 7 had a placebo group, and 19 compared only with the anti-nausea medicines of that era (prochlorperazine, metoclopramide, domperidone, etc.). Four controlled chemotherapy studies done in the same period with levonantradol, an experimental synthetic cannabinoid that was never approved, are not in the table under the site's rule and are mentioned here only as background: levonantradol was more effective than an anti-nausea medicine of that era (chlorpromazine, metoclopramide) in two studies, similar to prochlorperazine in one, and more effective than placebo in one; side effects such as low mood, sleepiness and a drop in blood pressure were common (Hutcheon 1983, PMID 6352278; Heim 1984, PMID 6467496; Sheidler 1984, PMID 6373843; Stambaugh 1984, PMID 6392353). According to reviews pooling the studies of this period, these medicines were better than placebo and similar to or slightly better than the anti-nausea medicines of that era; side effects and stopping because of side effects were more common (Tramèr 2001, 30 studies: complete control of nausea vs. the medicines of that era RR 1.38; Smith 2015 Cochrane: complete absence of nausea and vomiting vs. placebo RR 2.9, no difference vs. prochlorperazine; Chow 2025: vs. placebo RR 2.65, no difference vs. active medicines). The most recent review, examining 32 RCTs up to June 2024, rated no study as high quality and considered the evidence insufficient to recommend cannabinoids (Kemmner 2026). Compared with the strongest regimen of that era, high-dose metoclopramide plus dexamethasone, the nabilone regimen was less effective (Cunningham 1988); dronabinol added to an intensive anti-nausea regimen before bone marrow transplant gave no extra benefit (Gilbert 1995). Comparisons with today's medicines are few: dronabinol gave results similar to ondansetron for delayed nausea (Meiri 2007, 61 people, manufacturer-supported); with dronabinol added to palonosetron and dexamethasone, complete protection in the registry record was 35% vs. 16% (NCT00553059, 62 people; no statistical analysis and no peer-reviewed publication). In children there are 4 small RCTs with nabilone and THC; the results are conflicting and side effects are common (Phillips 2016 Cochrane). In radiotherapy nausea: during radiation therapy for head and neck cancer, nabilone did not affect nausea differently from placebo (Côté 2016, 56 people; nausea a secondary outcome, p = 0.71); in 40 patients with nausea during radiotherapy, nabilone was similarly effective to metoclopramide, with more side effects (Priestman 1987, crossover RCT); THC was found \"slightly more helpful\" than prochlorperazine (Ungerleider 1984; number of participants and statistics not in the abstract); levonantradol, an experimental synthetic cannabinoid, did not affect vomiting differently from chlorpromazine in single-session palliative radiation therapy (Lucraft 1982, PMID 6754212; not in the table because it is an experimental synthetic cannabinoid). There is no study of pure CBD in radiotherapy nausea. NICE's evidence review found only one study in radiotherapy nausea (Priestman 1987) and made no recommendation because there were no efficacy data; the MASCC 2022 review also counted only one RCT on this. In a recent RCT examining general symptoms in advanced cancer, pure CBD (MedCan1) did not reduce nausea more than placebo; this study was not designed for chemotherapy nausea. ASCO 2024 writes that THC-containing options may be added only in this refractory situation (weak recommendation). In the 1:1 capsule study, only 10% of patients had received olanzapine, and the study closed early with 151 patients instead of the planned 250. MASCC 2022 found the evidence insufficient to recommend cannabinoids for chemotherapy nausea; as reported by ASCO, the same document says they should not be used for first-line prevention but may be considered in refractory cases in patients not receiving checkpoint inhibitors. The MASCC/ESMO 2023 guideline on chemotherapy and radiotherapy nausea contains no recommendation for cannabinoids; the recommended medicine for nausea that continues despite standard treatment is olanzapine. The UK's national guideline NICE (2019, updated 2021) says nabilone may be considered as add-on treatment in adults for chemotherapy nausea that continues despite optimized standard anti-nausea medicines (NICE uses the word \"consider\" for recommendations where the benefit is less certain); its rationale is limited evidence, mostly from old and low-quality studies. It made no recommendation for other cannabis products or for children, and recommended research. October 2026 search (PubMed, Cochrane, ClinicalTrials.gov): 36 controlled studies with cannabinoids on this topic with readable results were found (35 in chemotherapy nausea, one of them with results only on ClinicalTrials.gov; one a pure CBD study on general symptoms in advanced cancer); all except the 4 with levonantradol are in the table below (one trial appears in two rows, with two separate publications; levonantradol is an experimental synthetic cannabinoid, so under the site's rule it is mentioned only in this text). Of the many systematic reviews examining this question, the 7 most recent and comprehensive (two of them Cochrane) and one observational study in children are also in the table. Eight older controlled studies with no abstract, or with no results in their abstract, could not be included in the table. In the October 2026 completion round, radiotherapy nausea was added to the page: 4 controlled studies with cannabinoids on this question were found; the 3 with THC or nabilone are in the table, and the one with the experimental synthetic cannabinoid levonantradol is only in this text under the site's rule; a comparative study published in Hebrew without an abstract could not be read. There are no cannabinoid registrations on ClinicalTrials.gov for radiotherapy nausea. The NICE guideline is also in the table. A single-arm study looking at the tolerability of dronabinol during chemotherapy in glioma patients (NCT00314808, 33 people) was not included because it had no comparison group and tracked nausea only as a secondary outcome, with a quality-of-life scale and without comparison.","kanit_duzeyi_metin":"Pure CBD: Insufficient; no RCTs in chemotherapy or radiotherapy nausea; in one RCT looking at general symptoms in advanced cancer, no difference from placebo for nausea","kanit_duzeyi_thc_icerenler":"zayif","kanit_duzeyi_thc_icerenler_metin":"Weak (our assessment: most of the studies were done before today's anti-nausea medicines). ASCO 2024 (Recommendation 3.1): quality of evidence moderate for dronabinol and nabilone, low for 1:1 THC:CBD extract; strength of recommendation weak. NICE 2019: nabilone may be considered as add-on treatment in adults only for chemotherapy nausea that continues despite optimized standard treatment. For radiotherapy nausea, very weak (3 controlled studies, two of them from the 1980s; no difference in two; number of participants 56 and 40 in two, not given in the abstract in one)","kaynak_dosya":"kanser-destek.md","saf_cbd_sonuc":"There are no controlled studies of pure CBD oil in chemotherapy or radiotherapy nausea; there is no evidence for CBD oil. In the only pure CBD study looking at general symptoms in advanced cancer (144 people, placebo-controlled), CBD did not reduce any symptom, including nausea, more than placebo; this study was not designed for chemotherapy nausea.","thc_icerenler_sonuc":"A 1:1 THC:CBD capsule, oil or mouth spray added to standard anti-nausea medicines gave better results than placebo for nausea or vomiting in three recent RCTs (two of them in patients whose nausea continued despite standard treatment; the largest had 147 people). According to reviews pooling the controlled studies from 1975–1995, synthetic THC (dronabinol) and the THC-like medicines nabilone and levonantradol were better than placebo and similar to or slightly better than the anti-nausea medicines of that era; dizziness, feeling high and low mood were more common. Comparisons with today's medicines are very few: dronabinol gave results similar to ondansetron for delayed nausea (61 people); the result for dronabinol added to palonosetron and dexamethasone exists only in a ClinicalTrials.gov record, without statistical analysis. When added to an intensive, older-type anti-nausea regimen given before bone marrow transplant, dronabinol gave no additional benefit. For radiation-therapy (radiotherapy) nausea, the evidence is very limited and mostly old: nabilone was no better than placebo (56 people; nausea a secondary outcome) or metoclopramide (40 people), and had more side effects than metoclopramide; THC was found slightly more helpful than prochlorperazine in one study (number of participants and statistics not in the abstract). These results cannot be carried over to CBD oil.","ruhsat":null,"doz_araligi_ozet":"No pure CBD studies in chemotherapy nausea; THC-containing 1:1 capsule from 2.5 mg THC + 2.5 mg CBD 3 times a day up to 10 mg + 10 mg 3 times a day; in older studies, nabilone 1–2 mg 2–4 times a day, dronabinol 5–15 mg/m² 2–6 times a day","titrasyon_ozet":"In the THC:CBD capsule studies, patients adjusted the dose themselves according to nausea and side effects","yan_etkiler":["Moderate/severe sedation 18% vs. 7%, dizziness 10% vs. 0%, temporary anxiety 4% vs. 1% (Grimison 2024, THC-containing)","Moderate/severe cannabinoid side effects in 31%: sedation, dizziness, disorientation (Grimison 2020)","Dysphoria, feeling 'high', dizziness (older dronabinol and nabilone studies, Cochrane 2015)","Dizziness 49% vs. 17%, low/depressed mood 13% vs. 0.3%, hallucinations 6% vs. 0%, paranoia 5% vs. 0%, drop in blood pressure 25% vs. 11%; stopping because of side effects 11% vs. 2% (30 older RCTs, Tramèr 2001; nabilone, dronabinol, levonantradol)","Nabilone in children: sleepiness 20%, dizziness 10%, euphoria 3.6%; stopped because of side effects in 10 of 110 children (Polito 2018, observational); hallucinations in one child in the RCTs (Dalzell 1986)","Cannabis hyperemesis syndrome: recurrent episodes of nausea, vomiting and abdominal pain with long-term, frequent cannabis use; goes away when cannabis is stopped (Sorensen 2017, systematic review, PMID 28000146)"],"izlem":["Prescription CBD label: liver tests at baseline and at months 1, 3 and 6, then periodically; stop if ALT/AST >3×ULN + bilirubin >2×ULN, or if transaminases stay >5×ULN","INR in people taking warfarin","Drug blood levels in people taking everolimus/tacrolimus/sirolimus"],"dikkat":["People with liver disease / liver metastases / on hepatotoxic treatment: with prescription CBD, ALT >3×ULN in 12–13% (placebo 1%), dose-dependent; in moderate/severe hepatic impairment the label specifies a lower starting dose","People taking warfarin or clopidogrel and those at high risk of bleeding: there is an interaction mechanism (CYP2C9, CYP2C19); no clinical data have been reported showing that CBD directly increases bleeding risk","Before surgery/procedures: ASRA 2023 recommends asking about cannabinoid use and including it in the anesthesia plan; the anesthesia team must be told","People on immunotherapy (checkpoint inhibitors): there is an observational signal and a guideline warning","People taking everolimus, tacrolimus, sirolimus or oral targeted drugs: CBD should not be added without consulting the oncologist/pharmacist","Older adults, people taking many medicines, and those on sedatives/opioids: somnolence, dizziness, risk of falls; with THC-containing products, confusion and psychotomimetic effects","Use for 'treating' tumors: uncontrolled case series are not evidence; ASCO strongly recommends against abandoning standard treatment","Pregnancy/breastfeeding, history of psychiatric illness (with THC-containing products): cancer studies excluded these groups","If nausea and vomiting keep coming back in episodes while using cannabis: cannabis hyperemesis syndrome can occur in people who use cannabis frequently over a long period. Recurrent episodes of severe nausea, vomiting and abdominal pain, with temporary relief from hot showers or baths, are typical; in a systematic review, almost all patients used cannabis at least once a week, and the symptoms went away when cannabis was stopped (Sorensen 2017, PMID 28000146; for diagnosis and treatment, American Gastroenterological Association 2024 clinical practice update). Anyone using cannabis during cancer treatment should talk with their care team about whether the nausea and vomiting may be related to cannabis"],"ilac_etkilesim_notlari":["Everolimus: exposure increased ~2.5-fold; label: start everolimus at a lower dose and monitor levels (high, human PK data)","Tacrolimus, sirolimus, digoxin (P-gp substrates): the label states that levels may increase (moderate)","Oral P-gp substrate chemotherapy/targeted drugs (e.g., many tyrosine kinase inhibitors): theoretical; no human data","CYP2C19 substrates and prodrugs (clopidogrel): substrate levels rise, and the active metabolite of prodrugs may decrease; no human data for oncology drugs","Warfarin: case report of INR rise; INR should be monitored","CYP3A4 substrates (taxanes, irinotecan, docetaxel, many TKIs): midazolam unchanged on the label (licensed CBD 750 mg twice daily); a single dose of a CBD-dominant extract (640 mg CBD + 20 mg THC) increased midazolam AUC by 56% (Bansal 2023, PMID 37313955); herbal cannabis tea did not affect irinotecan and docetaxel PK (n=24); nabiximols did not affect temozolomide PK; these results cannot be generalized","Immunotherapy: nivolumab response rate 15.9% vs. 37.5% in cannabis users (mostly THC-containing cannabis) (Taha 2019, PMID 30670598, n=140); in a prospective observational study, time to progression and survival were shorter (Bar-Sela 2020, PMID 32872248, n=102); causality not proven, no data specific to pure CBD","Opioids: in MedCan1, CBD dose was unrelated to opioid use; no opioid-sparing effect shown with THC-containing products; somnolence increases with CNS depressants","Citalopram/escitalopram: citalopram levels rose significantly in 6 patients who added CBD (200–800 mg/day) (Anderson 2021, PMID 34121064)","Valproate and liver-toxic drugs (some chemotherapies, methotrexate): no data on use together with hepatotoxic chemotherapies","Tamoxifen: in one case, endoxifen was found to be low with CBD 40 mg/day (Parihar 2020, PMID 33191836)","No clinical studies reported with direct oral anticoagulants (apixaban, rivaroxaban)"],"dogrulanamayan":["The current version of the NCCN Antiemesis guideline (2025–2026) could not be read because it requires a login; in the 2017 version, dronabinol and nabilone are an option for breakthrough nausea and vomiting, with no separate category (2A under the NCCN rule)","The full text of MASCC 2022 (Alderman) is paywalled; the statement quoted by ASCO 2024, 'may be considered in refractory chemotherapy nausea in patients not receiving checkpoint inhibitors', could not be verified from MASCC's own text (the MASCC abstract contains only 'insufficient evidence to recommend')","The full text of the 2015 Cochrane review could not be read (its pages on Europe PMC and PMC require human verification); the list of the 23 studies included in the review and which drugs it covers could not be verified from the review itself. The product type in the table row is based on the 'nabilone, dronabinol' information already written in the row and on Tramèr 2001, which covers the same period (studies of nabilone, dronabinol and levonantradol).","Eight older studies published between 1981 and 1985 (most comparing nabilone with placebo or prochlorperazine) have no abstract or no results in their abstract; they were not included in the table because their full texts could not be read. A 109-person placebo-controlled study of dronabinol in pancreatic cancer (NCT03984214) was completed in September 2024; its results have not yet been published.","Of the radiotherapy nausea studies, the full texts of Côté 2016, Priestman 1987, Ungerleider 1984 and Lucraft 1982 could not be read: only their abstracts were read, plus, for Priestman 1987, the dose and side-effect figures reported in the NICE evidence review, and for Côté 2016, what the Cochrane 2023 and Ceolin 2024 reviews reported. The number of participants and the design (whether it was randomized) of Ungerleider 1984 are not in the abstract. A comparative study published in Hebrew (Gez 1983) has no abstract on PubMed; it was not included in the table because it could not be read. Which single RCT the MASCC 2022 review counted for radiotherapy nausea could not be determined from the abstract."],"calismalar":[{"ad":"Grimison 2024 (CannabisCINV phase II/III)","tasarim":"Double-blind, placebo-controlled RCT (combined analysis)","n":"151 randomized, 147 treated, 144 in the efficacy analysis (250 planned; closed early because of slow recruitment)","populasyon":"Refractory nausea and vomiting despite moderately/highly emetogenic IV chemotherapy + guideline-consistent prophylaxis","urun":"Capsule: THC 2.5 mg + CBD 2.5 mg (1:1)","urun_turu":"thc_iceren","doz":"1 capsule 3 times a day → 4 capsules 3 times a day (THC 10 mg + CBD 10 mg/dose); median 2 capsules/dose (5 mg THC + 5 mg CBD 3 times a day)","titrasyon":"By the patient, according to nausea and side effects","sure":"Day −1 to day 5 (chemotherapy cycle)","sonuc":"Complete response 8% → 24% (absolute difference 16%; 95% CI 4–28; p=0.01)","yan_etki":"Moderate/severe: sedation 18% vs. 7%, dizziness 10% vs. 0%, anxiety 4% vs. 1%; adverse effects of any severity 74% vs. 38%; no drug-related serious side effects","pmid":"39151115","doi":"10.1200/JCO.23.01836","diger_kaynak":"The phase II part was also published separately: Grimison 2020 (PMID 32801017; separate row in the table; the first 81 participants are also in this combined analysis). Protocol: Mersiades 2018 (PMID 30209152). Registration: ACTRN12616001036404"},{"ad":"Grimison 2020 (phase II, crossover)","tasarim":"Double-blind, placebo-controlled crossover RCT","n":"81 randomized, 72 in the efficacy analysis","populasyon":"Refractory chemotherapy-induced nausea and vomiting","urun":"Capsule: THC 2.5 mg + CBD 2.5 mg (1:1)","urun_turu":"thc_iceren","doz":"1 capsule 3 times a day → 4 capsules 3 times a day","titrasyon":"By the patient","sure":"Day −1 to day 5","sonuc":"Complete response 14% → 25% (RR 1.77; 90% CI 1.12–2.79); 83% of patients preferred cannabis","yan_etki":"Moderate/severe cannabinoid side effects in 31% (sedation, dizziness, disorientation)","pmid":"32801017","doi":"10.1016/j.annonc.2020.07.020","diger_kaynak":"First part of the same phase II/III trial; combined final analysis: Grimison 2024 (PMID 39151115). Registration: ACTRN12616001036404"},{"ad":"Sukpiriyagul 2023","tasarim":"Double-blind, placebo-controlled crossover RCT","n":"54 analyzed (60 enrolled)","populasyon":"Women with gynecologic cancer receiving moderately to highly emetogenic chemotherapy (Thailand)","urun":"THC:CBD 1:1 oil (2.7 mg THC + 2.5 mg CBD per mL), in addition to standard anti-nausea medicines","urun_turu":"thc_iceren","doz":"1 drop under the tongue twice a day (days 1–3), 3 times a day (days 4–5)","titrasyon":null,"sure":"5 days in each chemotherapy cycle (2 cycles)","sonuc":"Nausea score 2.11 with the oil and 2.99 with placebo (p<0.05)","yan_etki":"Dizziness and sleepiness in 36 of 54 people; dry mouth, confusion, anxiety and palpitations similar between groups","pmid":"37608911","doi":"10.2147/IJWH.S401938","diger_kaynak":null},{"ad":"NCT00553059 (MD Anderson, registry results)","tasarim":"Randomized, triple-blind, placebo-controlled parallel study (phase 3)","n":"62 randomized (31 dronabinol, 31 placebo); 59 completed","populasyon":"Adults with solid tumors receiving moderately emetogenic chemotherapy (cyclophosphamide and/or doxorubicin) for the first time (USA)","urun":"Dronabinol (synthetic THC) tablet; both groups received palonosetron and dexamethasone","urun_turu":"thc_iceren","doz":"5 mg 3 times a day for 5 days (first dose 30 minutes before chemotherapy)","titrasyon":null,"sure":"First 5 days of the first chemotherapy cycle","sonuc":"Comparison: placebo; both groups received palonosetron + dexamethasone (a 5-HT3 antagonist and a corticosteroid; no NK1 antagonist or olanzapine was given). The primary outcome, complete protection (no vomiting, no rescue medicine and no nausea over 5 days), was achieved in 11 of 31 people (35%) with dronabinol and 5 of 31 (16%) with placebo; in the first 24 hours, 22 vs. 14. No statistical analysis in the registry; in a secondary outcome with the same definition the numbers differ (14 of 30 vs. 9 of 29), and the numbers for some secondary outcomes are internally inconsistent. No peer-reviewed publication; according to the registry, the co-sponsors were the US National Cancer Institute and the dronabinol manufacturer Solvay","yan_etki":"Dizziness in 14 of 30 people (placebo 7 of 29), insomnia 15 vs. 4, tiredness 17 vs. 11, sleepiness 5 vs. 3; serious side effects in 1 person in each group","pmid":null,"doi":null,"diger_kaynak":"ClinicalTrials.gov NCT00553059 (results in the registry, October 9, 2020; no publication found on PubMed in October 2026)"},{"ad":"Duran 2010","tasarim":"Double-blind, placebo-controlled parallel pilot RCT (phase 2)","n":"16 randomized (7 spray, 9 placebo); all analyzed","populasyon":"Adults with solid tumors with nausea and vomiting lasting more than 24 hours after moderately emetogenic chemotherapy despite standard preventive treatment (Spain, 3 university hospitals)","urun":"Mouth spray containing THC and CBD (Sativex; each spray 2.7 mg THC + 2.5 mg CBD), in addition to standard anti-nausea medicines","urun_turu":"thc_iceren","doz":"On the first day, up to 3 sprays within 2 hours in hospital, then at home up to 8 sprays every 4 hours until day 4; mean 4.8 sprays a day (about 12.9 mg THC + 12 mg CBD)","titrasyon":"By the patient, according to side effects; no target dose","sure":"120 hours after chemotherapy (1 cycle)","sonuc":"Comparison: placebo; both groups received standard anti-nausea medicines (a corticosteroid and a 5-HT3 antagonist or metoclopramide). Complete response over the 120-hour period in 5 of 7 people (71%) with the spray and 2 of 9 (22%) with placebo; difference 49% (95% CI 1–75). The difference came from the delayed phase; in the first 24 hours 5/7 vs. 6/9. Very small pilot study; the primary aim was tolerability","yan_etki":"At least one side effect 86% vs. 67%; most common was sleepiness; 1 patient stopped on the first day because of anxiety, sleepiness, visual hallucinations and confusion (resolved in 3 hours); no serious side effects","pmid":"21039759","doi":"10.1111/j.1365-2125.2010.03743.x","diger_kaynak":null},{"ad":"Meiri 2007","tasarim":"Double-blind, placebo-controlled parallel RCT (4 groups)","n":"64 randomized; 61 in the efficacy analysis","populasyon":"Delayed nausea and vomiting in adults receiving moderately or highly emetogenic chemotherapy","urun":"Dronabinol (synthetic THC) capsule; all groups received dexamethasone 20 mg and ondansetron 16 mg on day 1","urun_turu":"thc_iceren","doz":"Day 1: 2.5 mg before and after chemotherapy; day 2: 10 mg; days 3–5: 10–20 mg","titrasyon":"Flexible dose on days 3–5","sure":"5 days (chemotherapy day and the following 4 days)","sonuc":"Comparison: ondansetron (an anti-nausea medicine still used today), dronabinol + ondansetron, and placebo; on day 1 all groups received ondansetron and dexamethasone, and the comparison was for delayed nausea on days 2–5. Total response (nausea below 5 mm on a 100 mm scale, no vomiting and no rescue medicine) 54% with dronabinol, 58% with ondansetron, 47% with both, and 20% with placebo. No nausea at all in 71%, 64%, 53% and 15%, respectively (all three active groups better than placebo, p<0.05). Dronabinol and ondansetron gave similar results; giving both together gave no added benefit. Because of slow recruitment the groups remained small; according to the authors, this limits interpretation of the results. According to the registry, the sponsor was the dronabinol manufacturer (Solvay)","yan_etki":"Active treatments were well tolerated; side-effect rates not in the abstract","pmid":"17355735","doi":"10.1185/030079907x167525","diger_kaynak":"ClinicalTrials.gov NCT00642512 (same design, 64 people and 2003–2004 period; sponsor Solvay Pharmaceuticals; no results in the registry)"},{"ad":"Sallan 1975","tasarim":"Double-blind, placebo-controlled crossover RCT","n":"22 patients; 20 evaluable","populasyon":"Cancer patients receiving chemotherapy that causes nausea and vomiting","urun":"Oral delta-9-THC (the same substance as today's dronabinol)","urun_turu":"thc_iceren","doz":"Not in the abstract; according to Tramèr 2001, 15 mg or 10 mg/m², 3 doses","titrasyon":null,"sure":"Several chemotherapy cycles (each patient served as their own control)","sonuc":"Comparison: placebo. An anti-nausea effect was seen in 14 of 20 THC courses and in none of 22 placebo courses; among those who completed the study, in 12 of 15 THC courses and none of 14 placebo courses (p<0.001). A very small and old study","yan_etki":"Abstract states only: no patient vomited while feeling high","pmid":"1099449","doi":"10.1056/NEJM197510162931603","diger_kaynak":null},{"ad":"Herman 1979","tasarim":"Two double-blind crossover RCTs (reported together)","n":"113 evaluable patients","populasyon":"Cancer patients experiencing severe nausea and vomiting with chemotherapy","urun":"Nabilone (synthetic THC-like cannabinoid) capsule","urun_turu":"cbn_diger","doz":"Not in the abstract; according to Tramèr 2001, 2 mg 3–4 times a day","titrasyon":null,"sure":"Two consecutive identical chemotherapy cycles","sonuc":"Comparison: prochlorperazine (the standard anti-nausea medicine of that era). Response in 90 of 113 people (80%) with nabilone and 36 (32%) with prochlorperazine (p<0.001); complete resolution of symptoms in only 9 people (8%, nabilone). Nausea (p<0.01) and the number of vomiting episodes (p<0.001) were lower with nabilone; patients preferred nabilone for continued treatment (p<0.001)","yan_etki":"Sleepiness, dry mouth and dizziness similar in type with both medicines, but about twice as common and more severe with nabilone; side effects requiring medical intervention in 4 patients (3%) (hallucinations in 3, drop in blood pressure in 1); euphoria 16% and mild","pmid":"375088","doi":"10.1056/NEJM197906073002302","diger_kaynak":null},{"ad":"Chang 1979","tasarim":"Double-blind, placebo-controlled crossover RCT","n":"15 patients","populasyon":"Patients with bone cancer (osteosarcoma) receiving high-dose methotrexate","urun":"Oral THC; smoked THC (cannabis cigarette) if vomiting occurred","urun_turu":"thc_iceren","doz":"Not in the abstract; according to Tramèr 2001, 10 mg/m² by mouth, 4 doses","titrasyon":null,"sure":"High-dose methotrexate cycles (each patient served as their own control)","sonuc":"Comparison: placebo. Nausea and vomiting decreased with THC in 14 of 15 patients; the number of vomiting and retching episodes, the degree and duration of nausea, and the volume of vomit were significantly lower than with placebo (p<0.001). The rate of nausea and vomiting with placebo was 72%; as blood THC levels rose, the rate of nausea and vomiting fell (44%, 21%, 6%)","yan_etki":"Not in the abstract","pmid":"293141","doi":"10.7326/0003-4819-91-6-819","diger_kaynak":null},{"ad":"Kluin-Neleman 1979","tasarim":"Double-blind, placebo-controlled crossover study (randomization not stated in the abstract)","n":"Not in the abstract; according to Tramèr 2001, 11 patients","populasyon":"Lymphoma patients receiving MOPP chemotherapy","urun":"Oral THC","urun_turu":"thc_iceren","doz":"Not in the abstract; according to Tramèr 2001, 10 mg/m², 2 doses","titrasyon":null,"sure":"MOPP chemotherapy cycles","sonuc":"Comparison: placebo. THC's anti-nausea effect was clear, but the side effects were severe and most patients preferred to put up with nausea and vomiting rather than take THC; no relationship was found between effect or side effects and blood THC levels. Numbers not in the abstract","yan_etki":"Severe (details not in the abstract)","pmid":"516362","doi":null,"diger_kaynak":null},{"ad":"Frytak 1979","tasarim":"Double-blind, placebo-controlled parallel RCT (3 groups)","n":"116 patients","populasyon":"Patients with gastrointestinal cancer receiving 5-fluorouracil and semustine; median age 61","urun":"Oral THC","urun_turu":"thc_iceren","doz":"15 mg 3 times a day","titrasyon":null,"sure":"One chemotherapy cycle","sonuc":"Comparison: prochlorperazine 10 mg 3 times a day (an anti-nausea medicine of that era) and placebo. THC was more effective than placebo but had no advantage over prochlorperazine. In this mostly older patient group, THC treatment was overall a more unpleasant experience than prochlorperazine and placebo. Numbers not in the abstract","yan_etki":"Central nervous system side effects significantly more common and more severe with THC","pmid":"517882","doi":"10.7326/0003-4819-91-6-825","diger_kaynak":null},{"ad":"Ekert 1979 (children)","tasarim":"Two double-blind comparative studies; according to the Cochrane review in children, separate randomization for each chemotherapy course (RCT)","n":"Number of children not in the abstract; according to the Cochrane review in children, 17 vs. 25 chemotherapy courses in the metoclopramide comparison and 18 vs. 18 in the prochlorperazine comparison","populasyon":"Children receiving chemotherapy (various cancers; no cisplatin)","urun":"Oral THC","urun_turu":"thc_iceren","doz":"10 mg/m²; 2 hours before chemotherapy and at hours 4, 8, 16 and 24","titrasyon":null,"sure":"Chemotherapy courses (24 hours)","sonuc":"Comparison: metoclopramide syrup and prochlorperazine tablets (anti-nausea medicines of that era). In both comparisons THC reduced nausea and vomiting significantly more, but it did not work in every child. Numbers not in the abstract; the Cochrane review in children confirms THC's superiority for nausea and vomiting","yan_etki":"Sleepiness significantly more common with THC; feeling high in 2 children; increased appetite in some","pmid":"231736","doi":null,"diger_kaynak":null},{"ad":"Sallan 1980","tasarim":"Double-blind crossover RCT","n":"79 THC and 78 prochlorperazine cycles; number of patients not in the abstract (73 according to Tramèr 2001)","populasyon":"Cancer patients receiving chemotherapy who had not benefited from standard anti-nausea medicines; including children and adolescents","urun":"Oral THC","urun_turu":"thc_iceren","doz":"Not in the abstract; according to Tramèr 2001, 15 mg or 10 mg/m², 3 doses","titrasyon":null,"sure":"Chemotherapy cycles","sonuc":"Comparison: prochlorperazine (an anti-nausea medicine of that era). Complete response in 36 of 79 THC cycles and 16 of 78 prochlorperazine cycles. Of the 25 patients who received both medicines and stated a preference, 20 chose THC (p=0.005). Complete response more common in people younger than 20 (15 of 20 cycles). A feeling of being high was present in 32 of the 36 THC cycles with a complete response","yan_etki":"Feeling high common; food intake increased more with THC (p=0.008)","pmid":"6985702","doi":"10.1056/NEJM198001173020302","diger_kaynak":null},{"ad":"Colls 1980","tasarim":"Double-blind crossover RCT (3 medicines)","n":"Not in the abstract; according to Tramèr 2001, 35 patients","populasyon":"Cancer patients receiving chemotherapy","urun":"Oral THC","urun_turu":"thc_iceren","doz":"Not in the abstract; according to Tramèr 2001, 12 mg/m², 2 doses","titrasyon":null,"sure":"Chemotherapy cycles","sonuc":"Comparison: metoclopramide and thiethylperazine (anti-nausea medicines of that era). There was no significant difference in anti-nausea effect among the three medicines; the authors did not recommend THC at these doses for routine use","yan_etki":"Side effects were significantly more common with THC in both staff and patient records","pmid":"6250106","doi":null,"diger_kaynak":"Report of the same study as a letter: Colls 1980, Lancet (PMID 6104004); Tramèr 2001 counted it twice"},{"ad":"Steele 1980","tasarim":"Double-blind crossover RCT","n":"37 patients","populasyon":"Cancer patients receiving various chemotherapies (high- or low-dose cisplatin, mechlorethamine, streptozocin, actinomycin D, DTIC)","urun":"Nabilone (synthetic THC-like cannabinoid)","urun_turu":"cbn_diger","doz":"2 mg every 12 hours","titrasyon":null,"sure":"Chemotherapy cycles","sonuc":"Comparison: slow-release prochlorperazine 10 mg every 12 hours (an anti-nausea medicine of that era). Symptoms resolved completely or partly in 18 of 37 patients: in 7 with nabilone only, in 3 with prochlorperazine only, and in 8 with both. Nabilone appeared more effective with chemotherapies other than high-dose cisplatin; with high-dose cisplatin the two medicines were equivalent","yan_etki":"Sleepiness and dizziness common with nabilone; dose-limiting in 25% of patients. With prochlorperazine, only mild sleepiness (35%)","pmid":"6250699","doi":null,"diger_kaynak":null},{"ad":"Orr 1980","tasarim":"Double-blind, placebo-controlled crossover RCT (3 treatments)","n":"55 patients","populasyon":"Patients with various cancers who had previously had severe nausea or vomiting with chemotherapy","urun":"Oral THC","urun_turu":"thc_iceren","doz":"Not in the abstract; according to Tramèr 2001, 7 mg/m², 4 doses","titrasyon":null,"sure":"Chemotherapy cycles","sonuc":"Comparison: prochlorperazine (an anti-nausea medicine of that era) and placebo. Patients with no nausea at all: 40 of 55 with THC, 8 with prochlorperazine and 5 with placebo (according to the second publication, p<0.005 between THC and prochlorperazine). THC appeared more effective with cyclophosphamide, 5-FU and doxorubicin, and less effective with mechlorethamine and nitrosoureas","yan_etki":"Not in the abstract","pmid":"6254456","doi":"10.1001/archinte.140.11.1431","diger_kaynak":"Second publication on the same 55 patients: Orr and McKernan 1981, J Clin Pharmacol (PMID 6271846); Tramèr 2001 counted it twice"},{"ad":"Chang 1981","tasarim":"Double-blind, placebo-controlled crossover RCT","n":"8 patients","populasyon":"Patients receiving doxorubicin and cyclophosphamide after surgical removal of a soft tissue sarcoma","urun":"Oral THC; smoked THC (cannabis cigarette) if vomiting occurred","urun_turu":"thc_iceren","doz":"Not in the abstract; according to Tramèr 2001, 10 mg/m² by mouth, 4 doses","titrasyon":null,"sure":"Adjuvant chemotherapy cycles (each patient served as their own control)","sonuc":"Comparison: placebo. THC did not significantly reduce the number of vomiting and retching episodes, the volume of vomit, or the degree and duration of nausea compared with placebo. According to the authors, THC's effect varies with the chemotherapy drug (the same team had found an effect with high-dose methotrexate). Very small study","yan_etki":"Not in the abstract","pmid":"6261926","doi":"10.1002/1097-0142(19810401)47:7<1746::aid-cncr2820470704>3.0.co;2-4","diger_kaynak":null},{"ad":"Neidhart 1981","tasarim":"Double-blind crossover RCT (interim report)","n":"52 evaluable patients (as of October 1980)","populasyon":"Patients receiving chemotherapy causing severe vomiting (cisplatin, nitrogen mustard or doxorubicin) or who had retching with previous chemotherapy","urun":"Oral THC","urun_turu":"thc_iceren","doz":"Not in the abstract; according to Tramèr 2001, mean 10 mg, 4 doses","titrasyon":null,"sure":"2 cycles with one medicine, then 2 cycles with the other","sonuc":"Comparison: haloperidol (an antipsychotic also used as an anti-nausea medicine). The two medicines were equally effective in terms of the number of vomiting episodes, the patient's assessment of effectiveness and preference; vomiting was completely controlled in about 10% of patients, and one-third had fewer than 5 vomiting episodes. In about half of those who did not respond to one medicine, the other provided good control","yan_etki":"THC's side effects were tolerated less well than haloperidol's; no serious side effects in most patients","pmid":"6271838","doi":"10.1002/j.1552-4604.1981.tb02571.x","diger_kaynak":null},{"ad":"Einhorn 1981","tasarim":"Double-blind crossover RCT","n":"80 evaluable patients","populasyon":"Cancer patients receiving combination chemotherapy, mostly cisplatin-containing","urun":"Nabilone (synthetic THC-like cannabinoid)","urun_turu":"cbn_diger","doz":"Not in the abstract; according to Tramèr 2001, 2 mg, 4 doses","titrasyon":null,"sure":"Two consecutive identical chemotherapy cycles","sonuc":"Comparison: prochlorperazine (an anti-nausea medicine of that era). 60 of 80 patients (75%) found nabilone more effective for nausea and vomiting; of these, the 46 who continued chemotherapy kept using nabilone. No statistical comparison between the medicines in the abstract","yan_etki":"Drop in blood pressure and weakness more pronounced with nabilone; side effects did not prevent chemotherapy","pmid":"6271844","doi":"10.1002/j.1552-4604.1981.tb02576.x","diger_kaynak":null},{"ad":"Ungerleider 1982","tasarim":"Double-blind crossover RCT","n":"214 evaluable patients (75% had previously received prochlorperazine)","populasyon":"A wide variety of chemotherapy regimens and cancer types (USA, UCLA)","urun":"Oral THC","urun_turu":"thc_iceren","doz":"7.5–12.5 mg based on body surface area; 1 hour before chemotherapy, then every 4 hours, 4 doses in total","titrasyon":null,"sure":"Chemotherapy cycles","sonuc":"Comparison: prochlorperazine 10 mg (an anti-nausea medicine of that era), on the same schedule. The two medicines reduced nausea and vomiting equally; no difference in appetite or food intake. THC's side effects did not reduce preference for it; patients who correctly guessed their THC period did better with THC (p<0.05)","yan_etki":"With THC, reduced concentration (p<0.01) and reduced social interaction (p<0.05) and activity (p<0.05); drug-related effects more common with THC","pmid":"6284334","doi":"10.1002/1097-0142(19820815)50:4<636::aid-cncr2820500404>3.0.co;2-4","diger_kaynak":"Patient preference analysis of the same study: Ungerleider 1985, Am J Clin Oncol (PMID 3010696; 139 patients; preference was determined mainly by reduction in nausea); Tramèr 2001 counted it twice"},{"ad":"George 1983","tasarim":"Double-blind crossover RCT","n":"20 patients","populasyon":"Women with advanced gynecologic cancer receiving cisplatin-containing chemotherapy","urun":"Nabilone (synthetic THC-like cannabinoid)","urun_turu":"cbn_diger","doz":"According to the abstract, 3 mg 3 times a day, starting the day before cisplatin and ending the day after (1 mg × 3 in the Tramèr 2001 table)","titrasyon":null,"sure":"Cisplatin cycles","sonuc":"Comparison: chlorpromazine 12.5 mg intramuscularly (an anti-nausea medicine of that era). Nabilone did not reduce the number of vomiting episodes significantly more than chlorpromazine. 10 patients preferred nabilone, 5 chlorpromazine, and 3 were undecided","yan_etki":"Similar with both medicines: sleepiness, dry mouth, drop in blood pressure on standing; no intervention needed beyond reassurance","pmid":"6311306","doi":null,"diger_kaynak":null},{"ad":"Ahmedzai 1983","tasarim":"Double-blind crossover comparative study","n":"34 patients","populasyon":"Patients with lung cancer receiving cyclophosphamide, doxorubicin and etoposide","urun":"Nabilone (synthetic THC-like cannabinoid)","urun_turu":"cbn_diger","doz":"Not in the abstract; according to Tramèr 2001, 2 mg twice a day","titrasyon":null,"sure":"3-day chemotherapy cycles","sonuc":"Comparison: prochlorperazine (an anti-nausea medicine of that era). Nausea, retching and vomiting scores were significantly better with nabilone (p<0.05); fewer patients vomited (p=0.05) and there were fewer vomiting episodes (p<0.05); no patient on nabilone needed an extra anti-nausea injection. Most patients preferred nabilone (p<0.005)","yan_etki":"With nabilone, sleepiness 57%, dizziness on standing 35%, lightheadedness 18%, euphoria 14%, feeling drunk 7%; standing systolic blood pressure lower on day 1, a significant problem in only 7%","pmid":"6315040","doi":"10.1038/bjc.1983.247","diger_kaynak":null},{"ad":"Niiranen 1985","tasarim":"Double-blind crossover RCT","n":"24 patients","populasyon":"Patients with lung cancer receiving chemotherapy","urun":"Nabilone (synthetic THC-like cannabinoid)","urun_turu":"cbn_diger","doz":"2 mg every 12 hours, starting the evening before chemotherapy","titrasyon":null,"sure":"Two consecutive identical chemotherapy cycles","sonuc":"Comparison: prochlorperazine 15 mg every 12 hours (an anti-nausea medicine of that era). Nabilone reduced the number of vomiting episodes significantly more; two-thirds of patients preferred nabilone","yan_etki":"Side effects in about half of patients with nabilone (mostly dizziness); 3 patients were withdrawn from the study because of incoordination and hallucinations. With prochlorperazine, only mild sleepiness in 1 patient","pmid":"3002167","doi":"10.1097/00000421-198508000-00013","diger_kaynak":null},{"ad":"Niederle 1986","tasarim":"Randomized crossover study (blinding not stated in the abstract)","n":"20 patients","populasyon":"Young men with non-seminomatous testicular cancer receiving low-dose cisplatin who had not previously received emetogenic chemotherapy","urun":"Nabilone (synthetic THC-like cannabinoid)","urun_turu":"cbn_diger","doz":"2 mg twice a day","titrasyon":null,"sure":"Two chemotherapy cycles","sonuc":"Comparison: alizapride 150 mg 3 times a day (an anti-nausea medicine of that era). With nabilone, fewer vomiting episodes (median 1.1 vs. 2.9; p<0.01); complete absence of nausea more common (median 65% vs. 30%; p<0.01) and shorter duration of nausea (1.3 vs. 5.1 hours; p<0.01)","yan_etki":"More side effects with nabilone","pmid":"3009962","doi":"10.1007/BF01728184","diger_kaynak":null},{"ad":"Crawford 1986","tasarim":"Double-blind crossover RCT","n":"32 patients","populasyon":"Cancer patients receiving cisplatin","urun":"Nabilone (synthetic THC-like cannabinoid), by mouth","urun_turu":"cbn_diger","doz":"1 mg every 8 hours","titrasyon":null,"sure":"4 chemotherapy cycles (medicines in random order)","sonuc":"Comparison: intravenous metoclopramide 1 mg/kg every 3 hours (a strong anti-nausea medicine for cisplatin at that time). Overall, no difference in the frequency and severity of vomiting; in one subgroup, vomiting was clearly reduced with metoclopramide","yan_etki":"Side effects expected from the known effects of the medicines (no details in the abstract)","pmid":"3010011","doi":"10.1007/BF02934575","diger_kaynak":null},{"ad":"Dalzell 1986 (children)","tasarim":"Double-blind crossover RCT","n":"23 eligible children; 18 completed","populasyon":"Children aged 10 months to 17 years receiving repeated identical chemotherapy (various cancers; most high-dose cyclophosphamide)","urun":"Nabilone (synthetic THC-like cannabinoid)","urun_turu":"cbn_diger","doz":"By weight: under 18 kg 0.5 mg twice a day, 18–36 kg 1 mg twice a day, over 36 kg 1 mg 3 times a day","titrasyon":null,"sure":"Repeated identical chemotherapy cycles","sonuc":"Comparison: oral domperidone (an anti-nausea medicine of that era). With nabilone, the number of vomiting episodes and nausea were significantly lower (according to the Cochrane review in children, nausea score on a 0–3 scale 1.5 vs. 2.5; p=0.01); two-thirds of the children preferred nabilone","yan_etki":"Most common were sleepiness and dizziness; distressing hallucinations in 1 child","pmid":"3013104","doi":"10.1136/adc.61.5.502","diger_kaynak":null},{"ad":"Pomeroy 1986","tasarim":"Double-blind, randomized, two-cycle comparative study","n":"38 patients; 32 cycles with nabilone and 33 with domperidone evaluated","populasyon":"Cancer patients receiving highly emetogenic chemotherapy (70% cisplatin-containing)","urun":"Nabilone (synthetic THC-like cannabinoid)","urun_turu":"cbn_diger","doz":"1 mg; the night before chemotherapy and every 8 hours on chemotherapy days","titrasyon":null,"sure":"Two consecutive chemotherapy cycles","sonuc":"Comparison: domperidone 20 mg (an anti-nausea medicine of that era). Mean number of vomiting episodes over both cycles combined 4.53 with nabilone and 10.81 with domperidone (p<0.01); 4.76 vs. 12.95 in the first cycle (p<0.02), difference not significant in the second cycle. No significant difference in nausea or food intake","yan_etki":"More common with nabilone: sleepiness, dizziness, dry mouth, drop in blood pressure on standing","pmid":"3017596","doi":"10.1007/BF00256701","diger_kaynak":null},{"ad":"Chan 1987 (children)","tasarim":"Double-blind crossover RCT","n":"30 children","populasyon":"Children aged 3.5–17.8 who had moderate to severe nausea and vomiting with previous chemotherapy (no cisplatin)","urun":"Nabilone (synthetic THC-like cannabinoid)","urun_turu":"cbn_diger","doz":"By weight, started 8–12 hours before chemotherapy, 2–3 times a day (0.5–2 mg according to the Cochrane review in children)","titrasyon":"A lower dose schedule was adopted during the study","sure":"Two consecutive identical chemotherapy cycles","sonuc":"Comparison: prochlorperazine (an anti-nausea medicine of that era). Overall improvement in retching and vomiting 70% with nabilone and 30% with prochlorperazine (p=0.003); 66% of children preferred nabilone and 17% prochlorperazine (p=0.015). The Cochrane review in children, however, found no difference in complete prevention of vomiting in this study (RR 1.0; 95% CI 0.85–1.17). The study was supported by the company that supplied nabilone (Eli Lilly)","yan_etki":"Significant side effects (dizziness, sleepiness, mood changes) 11% with nabilone and 3% with prochlorperazine; more likely at doses above 60 micrograms per kilogram per day","pmid":"3035479","doi":null,"diger_kaynak":null},{"ad":"Cunningham 1988","tasarim":"Randomized, open-label (unblinded) crossover study","n":"80 patients; 70 completed the crossover","populasyon":"Patients receiving cisplatin- or carboplatin-containing chemotherapy for the first time","urun":"Oral nabilone + prochlorperazine","urun_turu":"cbn_diger","doz":"Nabilone 2 mg + prochlorperazine 5 mg every 12 hours, 4 doses","titrasyon":null,"sure":"First two chemotherapy cycles","sonuc":"Comparison: intravenous high-dose metoclopramide + dexamethasone 20 mg (the strongest anti-nausea regimen of that era). Complete control of nausea and vomiting 32% (24 patients) with metoclopramide + dexamethasone and 19% (14 patients) with nabilone + prochlorperazine; the vomiting score favored metoclopramide + dexamethasone (p=0.02). No overall difference in preference (31 to 26; 13 undecided); those receiving carboplatin preferred the nabilone regimen (16 to 5; p=0.013)","yan_etki":"No details in the abstract","pmid":"2838294","doi":"10.1016/0277-5379(88)90300-8","diger_kaynak":null},{"ad":"McCabe 1988","tasarim":"Randomized comparative crossover study","n":"36 patients","populasyon":"Chemotherapy patients whose vomiting was resistant to standard anti-nausea treatment","urun":"Oral THC","urun_turu":"thc_iceren","doz":"15 mg/m²","titrasyon":null,"sure":"Chemotherapy cycles","sonuc":"Comparison: prochlorperazine 10 mg (an anti-nausea medicine of that era). THC reduced nausea and vomiting in 23 of 36 patients (64%), prochlorperazine in 1. The effect did not vary by type of chemotherapy, age or type of perceptual change","yan_etki":"Temporary perceptual changes in all patients: a pleasant feeling of being high in 19, low mood and restlessness (dysphoria) in 17","pmid":"2847994","doi":"10.1007/BF00175407","diger_kaynak":null},{"ad":"Lane 1991","tasarim":"Double-blind, multicenter parallel RCT (3 groups)","n":"Not in the abstract; according to Tramèr 2001, 54 patients (17, 20, 17)","populasyon":"Cancer patients receiving chemotherapy","urun":"Dronabinol (synthetic THC), by mouth","urun_turu":"thc_iceren","doz":"10 mg every 6 hours","titrasyon":null,"sure":"From 24 hours before chemotherapy to 24 hours after the last dose","sonuc":"Comparison: prochlorperazine 10 mg every 6 hours (an anti-nausea medicine of that era) and the two given together. After chemotherapy, nausea occurred in 29% with the combination, 47% with dronabinol and 60% with prochlorperazine; vomiting in 35%, 41% and 55%, respectively. The combination was significantly more effective than either medicine alone","yan_etki":"Mostly central nervous system side effects; more common with dronabinol alone than with prochlorperazine; adding prochlorperazine reduced dronabinol's dysphoric effect","pmid":"1652611","doi":"10.1016/0885-3924(91)90026-z","diger_kaynak":"Preliminary report of the same trial: Lane 1990, Am J Clin Oncol (PMID 2173391; 19 patients, 17 evaluable); Tramèr 2001 counted it twice"},{"ad":"Gilbert 1995","tasarim":"Double-blind 2×2 factorial RCT (4 groups)","n":"126 randomized; 106 fully evaluable","populasyon":"Patients with solid tumors receiving high-dose cisplatin, cyclophosphamide and carmustine before (autologous) bone marrow transplant","urun":"Dronabinol (synthetic THC) capsule","urun_turu":"thc_iceren","doz":"5 mg/m², 2 doses on the last chemotherapy day before carmustine","titrasyon":null,"sure":"4 days of high-dose chemotherapy","sonuc":"Comparison: placebo; everyone received an intravenous infusion of prochlorperazine or metoclopramide, plus lorazepam and diphenhydramine. On the last chemotherapy day, when dronabinol was given, there was no significant difference in the number of vomiting episodes among the four groups (median: in the metoclopramide group, 2 with dronabinol and 2 without; in the prochlorperazine group, 2.5 vs. 2). Dronabinol gave no added benefit to this intensive regimen","yan_etki":"Side effects requiring dose reduction or discontinuation (diarrhea, arrhythmia, sleepiness, anxiety, akathisia) were reported for the anti-nausea medicines; no dronabinol-specific rate in the abstract","pmid":"8635039","doi":"10.1002/1097-0142(19951201)76:11<2330::aid-cncr2820761122>3.0.co;2-f","diger_kaynak":null},{"ad":"Hardy 2023 (MedCan1-CBD)","tasarim":"Double-blind, placebo-controlled, dose-escalation RCT (phase 2b)","n":"144 randomized; 121 on day 14 (58 CBD, 63 placebo)","populasyon":"Patients with advanced cancer and a high symptom burden receiving palliative care (Australia); not designed for chemotherapy nausea","urun":"Synthetic pure CBD oil (100 mg per mL)","urun_turu":"saf_cbd","doz":"From 0.5 mL once a day to 2 mL 3 times a day (50–600 mg/day); median dose chosen by patients 400 mg/day","titrasyon":"By the patient, according to effect and side effects","sure":"28 days","sonuc":"Comparison: placebo; both groups received specialist palliative care. The primary outcome, total symptom distress score, fell by 3.0 points with CBD and 6.2 points with placebo at day 14; no difference (p=0.24); the proportion of responders was also not different (44.8% vs. 58.7%; p=0.13). All symptoms, including nausea (ESAS), decreased over time in both groups, with no difference between groups; no nausea-specific figure in the abstract (full text could not be read)","yan_etki":"Side effects similar between groups; shortness of breath more common with CBD","pmid":"36409969","doi":"10.1200/JCO.22.01632","diger_kaynak":null},{"ad":"Tramèr 2001","tasarim":"Quantitative systematic review of RCTs (Medline, Embase, Cochrane; up to August 2000)","n":"30 randomized comparisons (1975–1997); 1366 patients","populasyon":"Cancer patients receiving chemotherapy (2 studies in children, 1 in children and adults)","urun":"Oral nabilone (16 studies), oral dronabinol (13) and intramuscular levonantradol (1); smoked cannabis was not tested","urun_turu":"karma","doz":null,"titrasyon":null,"sure":"Follow-up in the studies 24 hours","sonuc":"Comparison: the anti-nausea medicines of that era (prochlorperazine, metoclopramide, chlorpromazine, thiethylperazine, haloperidol, domperidone, alizapride) and placebo. Cannabinoids were slightly more effective than these medicines: complete control of nausea RR 1.38 (95% CI 1.18–1.62; number needed to treat 6), complete control of vomiting RR 1.28 (1.08–1.51; 8); complete control of vomiting vs. placebo RR 1.84 (1.42–2.38). There was no advantage with chemotherapy of very low or very high emetogenicity. In crossover studies, patients preferred the cannabinoid for their next chemotherapy (RR 2.39)","yan_etki":"More common with cannabinoids: dizziness (49% vs. 17%), dysphoria or depressed mood (13% vs. 0.3%), hallucinations (6% vs. 0%), paranoia (5% vs. 0%), drop in blood pressure (25% vs. 11%); stopping because of side effects 11% vs. 2% (RR 4.67)","pmid":"11440936","doi":"10.1136/bmj.323.7303.16","diger_kaynak":null},{"ad":"Smith 2015 (Cochrane)","tasarim":"Systematic review and meta-analysis","n":"23 RCTs (1975–1991)","populasyon":"Adult cancer patients receiving chemotherapy","urun":"Nabilone (synthetic THC-like cannabinoid), dronabinol (synthetic THC) and similar cannabinoid medicines","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"Complete absence of nausea and vomiting vs. placebo RR 2.9 (moderate quality); no difference vs. prochlorperazine; no comparison with newer antiemetics (ondansetron, etc.)","yan_etki":"Increased withdrawal because of side effects, dizziness, dysphoria, feeling 'high'","pmid":"26561338","doi":"10.1002/14651858.CD009464.pub2","diger_kaynak":null},{"ad":"Chow 2025","tasarim":"Systematic review and meta-analysis of RCTs (Medline, Embase, CENTRAL; up to March 2024)","n":"26 studies (1975–2024; 23 before 2000; Lane 1990 and Lane 1991 counted separately, although according to Tramèr 2001 they are two publications of the same trial); studies of 8–147 people; 3 in children","populasyon":"Cancer patients given cannabinoids to prevent chemotherapy nausea","urun":"Nabilone, dronabinol/THC, levonantradol and THC:CBD (mouth spray, capsule)","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"Comparison: placebo and active anti-nausea medicines (mostly old, single-drug regimens). Overall control of nausea and vomiting was better with cannabinoids than placebo (RR 2.65; 95% CI 1.70–4.12; 8 RCTs); compared with active medicines, there was no difference in any outcome. About half of the studies have concerns about bias. Evidence with today's three- and four-drug regimens (including olanzapine) is very limited; only the THC:CBD capsule trial showed added benefit on top of a current regimen","yan_etki":null,"pmid":"39953210","doi":"10.1007/s00520-025-09251-w","diger_kaynak":null},{"ad":"Kemmner 2026","tasarim":"Systematic review of RCTs (no meta-analysis; 5 databases, June 2024)","n":"32 RCTs; 1889 patients (1495 analyzed)","populasyon":"Adult cancer patients receiving chemotherapy","urun":"Nabilone, dronabinol, levonantradol and THC:CBD preparations","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"Comparison: anti-nausea medicines now outdated (22 studies), placebo (9) and today's guideline regimen (1). A cannabinoid benefit was seen in 12 of the 22 studies comparing with older medicines and in 8 of the 9 placebo-controlled studies. The single study testing a cannabinoid in addition to today's guideline regimen (5-HT3 + NK1 antagonist + dexamethasone) showed a benefit, but side effects increased. No study was of high quality; 29 were of low quality. According to the authors, the evidence is insufficient to recommend cannabinoids for chemotherapy nausea","yan_etki":null,"pmid":"40797063","doi":"10.1007/s11764-025-01876-4","diger_kaynak":null},{"ad":"Mücke 2018","tasarim":"Systematic review and meta-analysis (palliative medicine)","n":"9 studies, 1561 participants","populasyon":"Palliative care (cancer subgroup)","urun":"Cannabinoids","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"In cancer patients, no difference from placebo in calorie intake, appetite, nausea and vomiting, pain or sleep problems (low/very low quality)","yan_etki":"In cancer, no difference in dizziness/mental health","pmid":"29400010","doi":"10.1002/jcsm.12273","diger_kaynak":null},{"ad":"Phillips 2016 (Cochrane, children)","tasarim":"Cochrane systematic review (up to December 2014)","n":"34 RCTs of anti-nausea medicines in children; 4 RCTs with cannabinoids","populasyon":"Children and adolescents under 18 receiving chemotherapy","urun":"THC (2 studies) and nabilone (2 studies)","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"Comparison: the anti-nausea medicines of that era (prochlorperazine, metoclopramide, domperidone). Results were conflicting and could not be pooled: in the two Ekert studies THC was superior for nausea and vomiting, in Dalzell 1986 there was less nausea with nabilone, and in the largest study, Chan 1987, there was no difference in complete prevention of vomiting. According to the authors, cannabinoids are probably effective but cause frequent side effects","yan_etki":"With nabilone, dizziness, sleepiness, mood changes; in one child, hallucinations requiring withdrawal from the study; with THC, sleepiness","pmid":"26836199","doi":"10.1002/14651858.CD007786.pub3","diger_kaynak":"Previous version: Phillips 2010, Cochrane (PMID 20824866)"},{"ad":"Chhabra 2023","tasarim":"Systematic review and meta-analysis (PROSPERO CRD42020187433)","n":"19 studies (7 RCTs, 8 retrospective chart reviews, 2 open-label studies, 2 case reports); 1927 children with cancer","populasyon":"Symptom management in children with cancer","urun":"Various cannabinoid products (details not in the abstract)","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"Cannabinoids were used most often for chemotherapy nausea (11 of 19 studies). According to the authors, there is evidence supporting their use for symptom management, but no solid evidence to establish dose, safety and efficacy in children with cancer. No pooled efficacy figure in the abstract (full text could not be read)","yan_etki":"In controlled studies, sleepiness, dizziness, dry mouth and stopping because of side effects were more common with cannabinoids; no study reported a serious cannabinoid-related side effect","pmid":"37635461","doi":"10.1002/cncr.34920","diger_kaynak":null},{"ad":"NICE 2019 (NG144 guideline)","tasarim":"National clinical guideline (United Kingdom; based on a systematic evidence review)","n":"Evidence review A: 28 studies (27 RCTs: 6 parallel, 21 crossover; 1 uncontrolled observational study in children); 27 on chemotherapy nausea, 1 on radiotherapy nausea","populasyon":"Persistent (refractory) nausea and vomiting despite optimized standard anti-nausea medicines; adults and children (United Kingdom)","urun":"Cannabis-based medicinal products; studies in the evidence review used THC (9), THC + prochlorperazine (1), dronabinol (2), dronabinol + prochlorperazine (1) and nabilone (14)","urun_turu":"karma","doz":null,"titrasyon":null,"sure":"Evidence review November 2019; guideline November 11, 2019 (last updated March 22, 2021)","sonuc":"Recommendation 1.1.1: nabilone may be considered as add-on treatment in adults aged 18 and over for chemotherapy-induced nausea and vomiting that persists despite optimized standard anti-nausea medicines (NICE uses the word \"consider\" for recommendations where the benefit is less certain). Recommendation 1.1.2: when considering nabilone, take care with interactions with central nervous system depressants and other centrally acting medicines. Rationale: limited evidence showed complete or partial reduction in nausea and vomiting with nabilone, but most studies were old, of low quality, and compared it with anti-nausea medicines no longer used today (evidence quality low to very low, moderate for some outcomes). No practice recommendation for other cannabis-based products or for children; a research recommendation instead. No recommendation was made for radiotherapy nausea because the only study found (Priestman 1987) provided no efficacy data","yan_etki":"In the evidence review, sleepiness, dizziness and dry mouth were more common with nabilone, especially in children; there were no data on long-term effects such as dependence and mental disorders","pmid":"31909928","doi":null,"diger_kaynak":"Evidence review A: persistent nausea and vomiting (NICE, November 2019; NCBI Bookshelf PMID 35107906, NBK577077). Guideline: nice.org.uk/guidance/ng144"},{"ad":"Polito 2018 (children)","tasarim":"Multicenter retrospective chart review (no control group)","n":"110 children","populasyon":"Children aged 1–18 (median age 14) given nabilone to prevent acute chemotherapy nausea, 2010–2015","urun":"Nabilone (synthetic THC-like cannabinoid); 109 of the 110 children also received a 5-HT3 antagonist","urun_turu":"cbn_diger","doz":"Not in the abstract","titrasyon":null,"sure":"Acute phase of one chemotherapy block (up to 24 hours after the last dose)","sonuc":"No comparison. Complete prevention of vomiting in the acute phase in 42 of 83 children (50.6%) with highly emetogenic chemotherapy and in 14 of 26 children (53.8%) with moderately emetogenic chemotherapy. The authors found control with nabilone-containing regimens inadequate and stressed the importance of guideline-consistent preventive treatment","yan_etki":"Nabilone-related side effects in 34% of children (37/110), all grade 2 or milder: sleepiness 20%, dizziness 10%, euphoria 3.6%; stopped in 10 children because of side effects","pmid":"30051617","doi":"10.1002/pbc.27374","diger_kaynak":null},{"ad":"Côté 2016 (radiotherapy)","tasarim":"Double-blind, placebo-controlled parallel RCT (single center)","n":"56 randomized (28 nabilone, 28 placebo); 24 people left before the end of the study","populasyon":"Patients with squamous cell head and neck cancer (mouth, pharynx, larynx) receiving radiotherapy or chemoradiotherapy (Canada); not selected because of nausea","urun":"Nabilone (synthetic THC-like cannabinoid, by mouth) and placebo; in both groups, only metoclopramide was allowed as an extra anti-nausea medicine","urun_turu":"cbn_diger","doz":"Week 1: 0.5 mg at bedtime; week 2: 0.5 mg twice a day; after week 3, at most 2 mg/day (at most 4 tablets a day)","titrasyon":"Weekly increase; after week 3, the dose was adjusted by the radiation oncologist","sure":"Throughout radiotherapy (about 7 weeks) + 4 weeks of follow-up","sonuc":"Comparison: placebo. The primary outcome was quality of life: time to a 15% deterioration was not prolonged by nabilone (p = 0.43). Nausea, measured with a separate weekly questionnaire, was no different from placebo (p = 0.71); no difference in appetite, weight, pain, mood or sleep either. Nausea-specific numbers are not in the abstract (full text could not be read); the study was not designed for nausea","yan_etki":"No difference from placebo in the frequency of sleepiness (p = 0.32), anxiety or dry mouth (as reported in the Ceolin 2024 review; Cochrane 2023 reports the same for sleepiness; full text could not be read)","pmid":"26503964","doi":"10.1177/0003489415612801","diger_kaynak":"Funding: Canadian public research funds; nabilone and placebo were supplied by the manufacturer; the authors reported no conflicts of interest (as reported in Cochrane 2023)"},{"ad":"Priestman 1987 (radiotherapy)","tasarim":"Double-blind, randomized crossover RCT (two periods)","n":"40 randomized (1 person did not take the medicine); according to NICE, groups of 20 (nabilone) and 19 (metoclopramide)","populasyon":"Patients who developed nausea and vomiting during radiotherapy and had at least 5 sessions remaining (pelvis, abdomen, chest, head and neck and other sites; United Kingdom)","urun":"Nabilone (synthetic THC-like cannabinoid, by mouth); comparison: metoclopramide","urun_turu":"cbn_diger","doz":"Nabilone 1 mg twice a day (with a placebo capsule at midday); metoclopramide 10 mg 3 times a day (as reported in the NICE evidence review)","titrasyon":null,"sure":"Until the end of radiotherapy, 30 days, or treatment failure (whichever came first)","sonuc":"Comparison: metoclopramide (an anti-nausea medicine of that era; in the MASCC/ESMO 2023 recommendations, 5-HT3 antagonists are the core medicines in high- and moderate-risk radiotherapy). No difference between the two medicines in controlling nausea and vomiting (numbers not in the abstract); according to the authors, the frequency and severity of side effects were significantly greater with nabilone (in NICE's recalculation, side effects in 35 vs. 5 per 100 people, but with a wide confidence interval: RR 6.65; 95% CI 0.90–40.09; very low quality). The NICE evidence review could not extract efficacy data from this study and judged the risk of bias high (randomization and washout period unclear; which period the data came from not stated)","yan_etki":"Dizziness 30% vs. 11%, tiredness 25% vs. 5%, disorientation 20% vs. 5%, dry mouth 15% vs. 5%, euphoria 5% vs. 0% (nabilone vs. metoclopramide; as reported in the NICE evidence review, full text could not be read)","pmid":"2822337","doi":"10.1016/s0009-9260(87)80151-4","diger_kaynak":"Dose, group size, side-effect percentages and bias assessment: NICE NG144 evidence review A (November 2019), Appendix E and Appendix H.2. Nabilone was supplied by the manufacturer (Eli Lilly)"},{"ad":"Ungerleider 1984 (radiotherapy)","tasarim":"Comparative clinical study (randomization, blinding and number of participants not stated in the abstract)","n":"Not reported (in the abstract)","populasyon":"Cancer patients receiving radiotherapy and experiencing nausea and vomiting (USA)","urun":"Oral delta-9-THC; comparison: prochlorperazine","urun_turu":"thc_iceren","doz":"Not reported (in the abstract)","titrasyon":null,"sure":"Not reported (in the abstract)","sonuc":"Comparison: prochlorperazine (an anti-nausea medicine of that era). Patients rated the severity of their symptoms, their mood, attention, physical activity and desire for social interaction, and chose the medicine they preferred; according to the authors, THC was \"slightly more beneficial\" than prochlorperazine. Number of participants, numerical results and statistics are not in the abstract; the full text could not be read","yan_etki":"Not reported (in the abstract; patients recorded side effects)","pmid":"6318262","doi":"10.1148/radiology.150.2.6318262","diger_kaynak":"Full text could not be read (publisher site returned 403)"}],"ilgili_ilaclar":["kemoterapi","immunoterapi","tamoksifen","everolimus","varfarin","apiksaban","rivaroksaban"],"son_inceleme":"2026-10-28","arastirma_gecmisi":[{"tarih":"2026-10-19","not":"Page published. In this first assessment, 4 studies were reviewed."},{"tarih":"2026-10-21","not":"The full texts of the studies were reread and the information on the page was checked against its sources. Corrected: participant numbers, side-effect and dose information in the study table; drug interaction notes; evidence summary. Points that could not be verified from full texts went down from 4 items to 2. Our evidence assessment for THC-containing products and the recommendation grade of the ASCO 2024 guideline are now written separately. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-21","not":"PubMed and ClinicalTrials.gov were searched for newly published and previously missed clinical studies. Study added: Sukpiriyagul 2023. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-22","not":"The names of the conclusion labels were simplified: the \"Not enough research\" label on this page became \"Not studied enough\". The assessment did not change."},{"tarih":"2026-10-27","not":"PubMed, Cochrane and ClinicalTrials.gov were systematically searched again in October 2026 (1159 records on PubMed, 39 on ClinicalTrials.gov). 40 studies were added to the table: 30 controlled studies from 1975–1995 with dronabinol, nabilone and levonantradol; two recent studies, one comparing dronabinol with ondansetron and one adding it to palonosetron and dexamethasone (one of them with results only on ClinicalTrials.gov); a pilot study with a mouth spray containing THC and CBD; a recent study with pure CBD in advanced cancer; 5 systematic reviews, including two on children; and a records review of nabilone in children. Corrected: the product type of the Cochrane 2015 row (mixed, because it pooled several types of drugs) and its product description, and the publication date of Sukpiriyagul 2023; the rows now state that the two publications of the CannabisCINV trial are the same trial; the definition of this trial's complete response (no vomiting and no need for extra medicine) was corrected in the text; the statement in the text that “the older studies were not compared with today's anti-nausea medicines” was corrected, and the text now states that dronabinol is THC itself while nabilone is a THC-like medicine. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-28","not":"Display fix: internal working file names left in the text were removed; content and evidence did not change."},{"tarih":"2026-10-28","not":"October 2026 additional review: sources found for this page during the searches for other topics were read and added to the page. The scope was broadened to include nausea during radiation therapy (radiotherapy), and the title was changed accordingly; PubMed and ClinicalTrials.gov were also searched separately for this section. 4 rows were added to the table: 2 studies with nabilone in radiotherapy nausea (one placebo-controlled, one comparing it with metoclopramide) and 1 older comparative study with THC; and the UK's national guideline NICE (2019; nabilone may be considered as add-on treatment in adults for chemotherapy nausea that continues despite standard medicines). A warning about cannabis hyperemesis syndrome was added. The rule that experimental synthetic cannabinoids do not enter the table as rows (October 28, 2026) was also applied to the 4 older chemotherapy studies on this page with levonantradol, which was never approved: the rows were removed from the table, their findings are mentioned in the evidence summary as background, and the numbers were corrected accordingly. A single-arm study looking at the tolerability of dronabinol in glioma patients, with results only on ClinicalTrials.gov (NCT00314808), was not included in the table because it had no comparison group and tracked nausea only as a secondary outcome. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-31","not":"The last sentence of the page's short summary was rewritten in a calmer, more guiding tone: instead of \"Talk to your doctor before you start.\", it now says whom you can talk with, and about what, if you are considering CBD. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-31","not":"The evidence level text now uses the same level name as the top of the page; the level and the result did not change."}]},{"id":"cancer-pain","baslik":"Cancer pain","grup":"Cancer","grup_kodu":"kanser","tr_id":"kanser-agri","kanit_duzeyi":"zayif","kanit_yonu":"yarar_gosterilmedi","kanit_ozet":"In advanced cancer, CBD oil (median 400 mg/day chosen by patients) provided no added benefit to palliative care (low certainty). In large studies with THC-containing nabiximols (Sativex), opioid-refractory cancer pain was no different from placebo (moderate certainty): the positive primary result of the 2010 study and the positive findings of the 2012 study, which were seen only in secondary analyses, were not repeated in three phase 3 studies involving a total of 1,202 patients, and opioid use did not decrease either. The positive measures referred to as 'quality of life' in these studies were global impression and satisfaction questionnaires. The positive results seen in US patients come from post hoc exploratory subgroup analyses; in one study, the result in patients outside the US favored placebo, so these findings do not count as evidence of an effect. In two small studies from the 1970s with single oral doses of THC, high doses reduced pain more than placebo but were not superior to codeine and caused marked drowsiness and mental clouding (low certainty); in two small RCTs with nabilone, a synthetic THC-like drug, pain was no different from placebo (low certainty). With a 1:1 THC:CBD oil, a small pain benefit was seen at the cost of more psychotomimetic side effects (single study, secondary outcome). In chemotherapy-induced neuropathy, in none of four small RCTs with cannabinoids (a THC:CBD spray, two CBD-dominant low-THC capsules, a pure CBD cream applied to the skin) did pain decrease more than with placebo (in one, neuropathy scores in the cannabis arm were worse than with placebo; low certainty); in aromatase inhibitor–related joint pain, pure CBD (up to 200 mg/day) reduced worst pain by ≥2 points in 44% of patients in an uncontrolled phase 2 study; in a 21-person randomized study comparing CBD and THC ointments for the same pain, there was no placebo and the pain results were not given in the abstract. In registries following cancer patients prescribed cannabis (Canada, United Kingdom, Israel, Thailand), pain decreased from baseline over months; but these studies had no comparison group, a large share of patients dropped out of follow-up in the Israeli and Thai registries, the daily amount of THC in the oil used in Thailand (about 0.2 mg) was far below the doses in pain studies, and the improvement in a 2025 meta-analysis pooling this kind of data is not a comparison with placebo (low or very low certainty). In a 6-month open-label spray study in advanced cancer, pain did not change from baseline and more than a third of participants stopped because of adverse events (including disease progression). In a single-arm, open-label dronabinol study in 14 women with breast cancer that had spread to the bone and who were using opioids, according to the authors 4 women reduced their opioid dose by at least 20% by a predefined criterion (according to the paper's table, the reduction in one of them was 19.7%; no control group; very low certainty). In a retrospective chart review of 513 patients receiving oxaliplatin, grade 2–3 nerve damage was less common in those using medical cannabis (15.3% versus 27.9%); the groups were not balanced, product and dose were not recorded, and pain was not measured (very low certainty). ASCO 2024 finds the evidence insufficient to make a recommendation for or against their use in cancer pain; MASCC 2023 recommends against using cannabinoids as add-on painkillers; the BMJ guideline (2021), which covers cancer and non-cancer long-term pain together, gives a weak recommendation for trying non-inhaled (oral or topical) cannabinoids when standard treatment is not enough, but most of the studies it relied on were in non-cancer pain and there was no significant difference in the cancer pain studies. October 2026 search (PubMed, Cochrane, ClinicalTrials.gov): on this topic, 18 randomized studies with cannabinoids (15 of them placebo-controlled; one publication reports two studies together), 1 observational study comparing people taking nabilone with those not taking it, 1 retrospective study comparing the frequency of chemotherapy-related nerve damage between cannabis users and non-users (pain not measured), 3 studies without a control group, 4 systematic reviews and meta-analyses (one of them Cochrane), 3 guidelines and 4 patient registries or cohorts were found; all are in the table below. Not included in the table: two 1970s single-dose studies with experimental synthetic THC analogs (Jochimsen 1978, Staquet 1978; outside the site's scope), two expert documents repeating the same recommendation as the guidelines in the table (European Pain Federation 2018, São Paulo Society of Anesthesiology 2024), a review (2026) that summarizes the three small neuropathy studies in the table without pooling them, an uncontrolled pure CBD study in which pain was measured only together with exercise, and other small studies without a control group. The recommendation on cannabinoids in the ESMO 2018 cancer pain guideline could not be re-verified in this search (see the unverifiable points section).","kanit_duzeyi_metin":"Weak (pure CBD)","kanit_duzeyi_thc_icerenler":"orta","kanit_duzeyi_thc_icerenler_metin":"Moderate, pointing to no effect: in cancer pain that continues despite opioids, a mouth spray containing THC and CBD (nabiximols) is no different from placebo; for single-dose THC, nabilone and other products, the evidence is low","kaynak_dosya":"kanser-destek.md","saf_cbd_sonuc":"Pure CBD oil did not improve symptoms, including pain, more than placebo in advanced cancer (Hardy 2023; Cochrane 2023 interpretation: low certainty); in chemotherapy-induced nerve pain, a CBD cream applied to the skin was also no different from placebo (D'Andre 2024, 40-person pilot). For aromatase inhibitor–related joint pain, there is only a small study of oral pure CBD without a control group (Fleege 2025).","thc_icerenler_sonuc":"In opioid-refractory cancer pain, nabiximols/THC was no different from placebo (Cochrane 2023, moderate certainty); with a 1:1 THC:CBD oil, a small benefit came with more side effects (single study, secondary outcome); opioid needs did not decrease (Creangă-Murariu 2026 meta-analysis, low certainty), and in none of the three small RCTs of THC-containing products in chemotherapy-induced nerve pain did pain decrease more than with placebo (low certainty). In the small single-dose studies of the 1970s, THC was better than placebo but no different from codeine (low certainty).","ruhsat":null,"doz_araligi_ozet":"Pure CBD: 50–600 mg/day (median chosen 400 mg/day), 50–200 mg/day in aromatase inhibitor pain; in chemotherapy neuropathy ~130 mg CBD + 6–11 mg THC/day or at most 300 mg CBD + 15 mg THC/day; THC-containing products: nabiximols 1–16 sprays/day, 1:1 oil from 2.5+2.5 mg up to 30+30 mg/day; in the 1970s single-dose studies, 5–20 mg oral THC (marked side effects at 20 mg); nabilone 0.5–2 mg/day","titrasyon_ozet":"In MedCan1, an increase every 3 days; in the nabiximols studies, 2 weeks of self-titration","yan_etkiler":["Pure CBD (Hardy 2023): no difference between arms; dyspnea more frequent with CBD","THC-containing: somnolence OR 2.69, dizziness OR 1.58 (Boland 2020); confusion, feeling 'high' (Hardy 2025)","THC-containing, long-term use (NCT01337089, 6 months, 660 patients, open-label): 237 people (36%) stopped because of adverse events (including progressing cancer); most common: nausea, vomiting, dizziness, fatigue, drowsiness"],"izlem":["Prescription CBD label: liver tests at baseline and at months 1, 3 and 6, then periodically; stop if ALT/AST >3×ULN + bilirubin >2×ULN, or if transaminases stay >5×ULN","INR in people taking warfarin","Drug blood levels in people taking everolimus/tacrolimus/sirolimus","ASCO 2024 recommendation 3.2: oral CBD ≥300 mg/day is not recommended for symptom burden outside clinical trials (no efficacy; risk of reversible liver enzyme abnormalities)"],"dikkat":["People with liver disease / liver metastases / on hepatotoxic treatment: with prescription CBD, ALT >3×ULN in 12–13% (placebo 1%), dose-dependent; in moderate/severe hepatic impairment the label specifies a lower starting dose","People taking warfarin or clopidogrel and those at high risk of bleeding: there is an interaction mechanism (CYP2C9, CYP2C19); no clinical data have been reported showing that CBD directly increases bleeding risk","Before surgery/procedures: ASRA 2023 recommends asking about cannabinoid use and including it in the anesthesia plan; the anesthesia team must be told","People on immunotherapy (checkpoint inhibitors): there is an observational signal and a guideline warning","People taking everolimus, tacrolimus, sirolimus or oral targeted drugs: CBD should not be added without consulting the oncologist/pharmacist","Older adults, people taking many medicines, and those on sedatives/opioids: somnolence, dizziness, risk of falls; with THC-containing products, confusion and psychotomimetic effects","Use for 'treating' tumors: uncontrolled case series are not evidence; ASCO strongly recommends against abandoning standard treatment","Pregnancy/breastfeeding, history of psychiatric illness (with THC-containing products): cancer studies excluded these groups"],"ilac_etkilesim_notlari":["Everolimus: exposure increased ~2.5-fold; label: start everolimus at a lower dose and monitor levels (high, human PK data)","Tacrolimus, sirolimus, digoxin (P-gp substrates): the label states that levels may increase (moderate)","Oral P-gp substrate chemotherapy/targeted drugs (e.g., many tyrosine kinase inhibitors): theoretical; no human data","CYP2C19 substrates and prodrugs (clopidogrel): substrate levels rise, and the active metabolite of prodrugs may decrease; no human data for oncology drugs","Warfarin: case report of INR rise; INR should be monitored","CYP3A4 substrates (taxanes, irinotecan, docetaxel, many TKIs): midazolam unchanged on the label (licensed CBD 750 mg twice daily); a single dose of a CBD-dominant extract (640 mg CBD + 20 mg THC) increased midazolam AUC by 56% (Bansal 2023, PMID 37313955); herbal cannabis tea did not affect irinotecan and docetaxel PK (n=24); nabiximols did not affect temozolomide PK; these results cannot be generalized","Immunotherapy: nivolumab response rate 15.9% vs. 37.5% in cannabis users (mostly THC-containing cannabis) (Taha 2019, PMID 30670598, n=140); in a prospective observational study, time to progression and survival were shorter (Bar-Sela 2020, PMID 32872248, n=102); causality not proven, no data specific to pure CBD","Opioids: in MedCan1, CBD dose was unrelated to opioid use; no opioid-sparing effect shown with THC-containing products; somnolence increases with CNS depressants","Citalopram/escitalopram: citalopram levels rose significantly in 6 patients who added CBD (200–800 mg/day) (Anderson 2021, PMID 34121064)","Valproate and liver-toxic drugs (some chemotherapies, methotrexate): no data on use together with hepatotoxic chemotherapies","Tamoxifen: in one case, endoxifen was found to be low with CBD 40 mg/day (Parihar 2020, PMID 33191836)","No clinical studies reported with direct oral anticoagulants (apixaban, rivaroxaban)"],"dogrulanamayan":["Studies that were completed but whose results, as of October 2026, had neither been published nor posted to the registry: nabilone in chemotherapy-induced nerve pain (NCT00380965, completed in 2007), a personalized (N-of-1) cannabis oil trial for cancer symptoms (NCT03948074, 91 people, completed in July 2025), dronabinol in pancreatic cancer (NCT03984214, 109 people, completed in September 2024), cannabis during chemoradiotherapy in head and neck cancer (NCT03431363, 30 people, completed in January 2026) and a capsule containing THC, CBD and CBC for advanced cancer pain (NCT06533657, 11 people, completed in April 2026). The status of a planned phase 3 study of a THC:CBD spray for bone metastasis pain (NCT04808531) is unknown in the registry.","ESMO 2018 cancer pain guideline: the site previously stated that this guideline found the added contribution of a mouth spray containing THC and CBD uncertain for pain continuing despite opioids and generally did not recommend it (level of evidence II, grade of recommendation D). In the October 2026 audit, this statement could not be re-verified because the full text of the guideline could not be accessed and the PubMed record has no abstract; it was removed from the evidence summary until it is verified."],"calismalar":[{"ad":"Hardy 2023 (MedCan1-CBD)","tasarim":"Phase IIb, double-blind, placebo-controlled, dose-escalation RCT","n":"144 randomized (58 CBD / 63 placebo in the primary analysis)","populasyon":"Advanced cancer, palliative care, ESAS ≥10/90","urun":"Synthetic CBD oil 100 mg/mL (pure CBD produced by synthesis, not from the plant) and placebo oil","urun_turu":"saf_cbd","doz":"0.5 mL once a day (50 mg/day) at the start → 2 mL 3 times a day (600 mg/day); median chosen by patients 400 mg/day","titrasyon":"Increase every 3 days (ASCO 2024 text)","sure":"28 days (primary: day 14)","sonuc":"At day 14, change in total symptom distress score: CBD −3.0, placebo −6.2 (p=0.24, no difference). Responder rate 44.8% vs. 58.7% (p=0.13). No effect on quality of life, depression and anxiety. For pain, the measure for this topic, no added benefit of CBD was seen either (Cochrane 2023, low certainty): according to the data reported by Cochrane, at day 28 the pain score (0–100) fell from 40 to 38 in the CBD group and from 51 to 44 in the placebo group; according to Cochrane's estimate from baseline and final values, at least a 30% reduction in pain was seen in 26 of 70 people and 29 of 72 people (no statistical test for these comparisons); opioid doses followed a similar course in both groups","yan_etki":"No difference between arms; dyspnea more frequent with CBD","pmid":"36409969","doi":"10.1200/JCO.22.01632","diger_kaynak":"ANZCTR ACTRN12618001220257; protocol: Good 2019, PMID 31810437. Secondary analyses of the same trial: O'Leary 2024 (PMID 38307703), Downs 2026 (PMID 39539239), Scarborough 2026 (PMID 41429435). Funding: Australian government (MRFF); 2 authors received funds on behalf of their institutions from the company that supplied the CBD (Cochrane 2023)"},{"ad":"Häuser 2023 (Cochrane)","tasarim":"Cochrane systematic review and meta-analysis (double-blind RCTs; search January 26, 2023)","n":"14 studies, 1823 participants","populasyon":"Adults with cancer pain","urun":"Nabiximols, THC, nabilone, synthetic THC analogs, CBD oil","urun_turu":"karma","doz":null,"titrasyon":null,"sure":"2–5 weeks (nabiximols RCTs)","sonuc":"In opioid-refractory cancer pain, nabiximols/THC did not reduce average pain differently from placebo (SMD −0.19; 95% CI −0.40 to 0.02; 4 studies; moderate certainty); the small difference in the proportion saying they were 'much or very much improved' was not considered clinically meaningful (risk difference 0.06; 0.01 to 0.12; moderate certainty). Nabilone (2 studies, 89 people) did not reduce pain differently from placebo (low certainty). In the single-dose studies of the 1970s, THC and its analogs were superior to placebo and no different from codeine (low certainty). CBD oil added no value for pain to palliative care (low certainty). No herbal cannabis studies","yan_etki":"No clinically meaningful difference in stopping because of side effects or in serious side effects (moderate certainty); according to the authors, nervous system and psychiatric side effects are common","pmid":"37283486","doi":"10.1002/14651858.CD014915.pub2","diger_kaynak":"Previous review by the same authors: Häuser 2019, PMID 31073761. Two of the 14 studies in the review (Jochimsen 1978, Staquet 1978) were done with experimental synthetic THC analogs and therefore have no separate row in the table"},{"ad":"Boland 2020","tasarim":"Systematic review and meta-analysis","n":"6 RCTs, 1460 participants","populasyon":"Cancer-related pain","urun":"Cannabinoids (mostly nabiximols)","urun_turu":"thc_iceren","doz":null,"titrasyon":null,"sure":null,"sonuc":"No difference in average pain NRS (MD −0.21; −0.02 in the phase III studies)","yan_etki":"Somnolence OR 2.69; dizziness OR 1.58","pmid":"31959586","doi":"10.1136/bmjspcare-2019-002032","diger_kaynak":null},{"ad":"Lichtman 2018","tasarim":"Phase 3, double-blind RCT","n":"397 (199/198)","populasyon":"Advanced cancer with pain NRS 4–8 despite opioids","urun":"Nabiximols spray (THC 27 mg/mL : CBD 25 mg/mL)","urun_turu":"thc_iceren","doz":"At most 10 sprays a day; on average 6.4 sprays/day with the spray and 7.3 with placebo (Cochrane 2023)","titrasyon":"2 weeks of self-titration","sure":"2 + 3 weeks","sonuc":"The primary endpoint was not met: median improvement 10.7% vs. 4.5% (p=0.0854, ITT); in per-protocol patients, 15.5% vs. 6.3% (p = 0.038). Average pain decreased by 0.8 points with the spray and 0.6 with placebo; opioid use did not change in either group (registry). The measures referred to as 'quality of life' in the abstract that favored the spray were, according to the secondary measures in the registry, the patient's and physician's global impression of change and a satisfaction questionnaire. The benefit seen in US patients comes from a post hoc exploratory analysis and was not seen in patients outside the US","yan_etki":"Safety profile consistent with previous studies","pmid":"28923526","doi":"10.1016/j.jpainsymman.2017.09.001","diger_kaynak":"ClinicalTrials.gov NCT01262651 (results in the registry; sponsor GW Pharmaceuticals, which developed the drug, partner Otsuka). According to the author affiliations on PubMed, 6 of the 9 authors are employees of companies that developed or market the drug (5 Otsuka, 1 GW); according to Cochrane 2023, the authors declared no conflicts of interest (the full text of the article could not be read). Long-term open-label extension: NCT01337089 (in this table)"},{"ad":"Fallon 2017","tasarim":"Two phase 3 RCTs","n":"Study 1: 399 randomized (200/199); Study 2: 406 patients entered titration, 206 randomized (103/103)","populasyon":"Advanced cancer, NRS 4–8 despite opioids","urun":"Nabiximols (27:25 mg/mL)","urun_turu":"thc_iceren","doz":"Start with 1 spray in the evening, increase by 1 spray a day; at most 10 sprays/day; in Study 1, average 6.3 sprays/day","titrasyon":"2 weeks, self-titrated","sure":"Study 1: 2 weeks of titration + 3 weeks; Study 2: 2 weeks of single-blind titration + 5-week randomized period","sonuc":"The primary outcome was not met in either study. In Study 1, median improvement in pain was 7.2% with the spray and 9.5% with placebo (p = 0.27). In Study 2, everyone first received the spray, and those whose pain decreased by at least 15% were randomized; pain worsened to the same extent in both groups (difference −0.02; 95% CI −0.42 to 0.38; p = 0.92). The spray had no significant effect on opioid use (total daily dose in Study 1, p = 0.053). In a post hoc exploratory analysis, a difference favoring the spray was seen in US patients younger than 65 in Study 1, and a difference favoring placebo in patients outside the US (p = 0.03); this two-directional finding does not count as evidence of an effect. The measures called 'quality of life' in the abstract that favored the spray were the patient's and physician's global impression of change (patient impression in Study 1, p = 0.022); in Study 2, there was no difference in these measures either","yan_etki":"Consistent with previous studies; no evidence of abuse. In Study 1, 32% of patients with the spray and 21% with placebo left the study; drowsiness 12% vs. 4%. In the first period of Study 2, when everyone received the spray, 17.5% of patients stopped because of side effects; in the randomized period, stopping because of side effects was 13.6% with the spray and 5.8% with placebo. In the randomized period of Study 2, more deaths occurred in the spray group (23 vs. 9; hazard ratio 2.68; p = 0.012); almost all deaths were due to cancer progression, most of the excess was seen in the period after treatment ended (12 vs. 9 during treatment, 11 vs. 0 after treatment); the authors considered none of the deaths treatment-related, and the independent safety board saw no safety issue that would stop development of the medicine, but according to the authors the reason for the difference could not be explained. In Study 1, deaths were slightly more frequent with placebo (25 of 199 patients vs. 20 of 200 patients with the spray)","pmid":"28785408","doi":"10.1177/2049463717710042","diger_kaynak":"ClinicalTrials.gov NCT01361607 (Study 1) and NCT01424566 (Study 2); results in the registry. Funding: Otsuka; 6 of the 9 authors are employees of companies that developed or market the drug (5 Otsuka, 1 GW Pharmaceuticals); in the article, the authors declared no conflicts of interest. Long-term open-label extension: NCT01337089 (in this table)"},{"ad":"Portenoy 2012","tasarim":"Phase 2, dose-group RCT","n":"360 randomized","populasyon":"Opioid-refractory cancer pain","urun":"Nabiximols","urun_turu":"thc_iceren","doz":"Low 1–4, medium 6–10, high 11–16 sprays/day","titrasyon":"By group","sure":"5 weeks","sonuc":"Primary analysis of 30% response not significant (p=0.59); benefit at the low/medium doses in a secondary analysis. In the low-dose group, the score for pain interfering with sleep (secondary outcome) also decreased more than with placebo (−1.5 vs. −0.8 on a 0–10 scale; estimated difference −0.88, 95% CI −1.45 to −0.31; p = 0.003); no difference in sleep at the medium and high doses (p = 0.26 and 0.78)","yan_etki":"Dose-dependent; only the high dose unfavorable compared with placebo","pmid":"22483680","doi":"10.1016/j.jpain.2012.01.003","diger_kaynak":"ClinicalTrials.gov NCT00530764 (results in the registry). Funding: GW Pharmaceuticals and Otsuka (Cochrane 2023)"},{"ad":"Johnson 2010","tasarim":"Double-blind, placebo-controlled RCT","n":"177","populasyon":"Inadequate analgesia despite opioids","urun":"THC:CBD extract vs. THC extract vs. placebo","urun_turu":"thc_iceren","doz":"At most 8 sprays in 3 hours and at most 48 sprays a day (registry); on average THC:CBD 8.8, THC 8.4, placebo 9.1 sprays/day (Cochrane 2023)","titrasyon":"Self-titrated by the patient (registry)","sure":"2 weeks","sonuc":"Primary outcome: average pain (0–10) decreased by 1.37 points with the THC:CBD spray and 0.69 with placebo (difference in the registry −0.67; 95% CI −1.21 to −0.14; p = 0.014); with the THC-only spray, the difference was not significant (p = 0.24). More than 30% reduction in pain in 43% with THC:CBD and 21% with placebo. Opioid and rescue medication use did not change. In the registry's secondary outcomes, appetite (p = 0.016), concentration (p = 0.021) and memory (p = 0.045) were worse with the THC:CBD spray than with placebo. Two-week study","yan_etki":"Most mild/moderate; the nausea-vomiting subscore worsened with THC:CBD","pmid":"19896326","doi":"10.1016/j.jpainsymman.2009.06.008","diger_kaynak":"ClinicalTrials.gov NCT00674609 (results in the registry). Open-label extension: Johnson 2013, PMID 23141881 (43 patients; no comparison group; no new safety problems or loss of effect reported with long-term use; NCT00675948). The sponsor in the registry is the manufacturer; Cochrane 2023 gives the funder as Otsuka"},{"ad":"Hardy 2025 (MedCan2)","tasarim":"Double-blind, placebo-controlled RCT","n":"144 randomized","populasyon":"Advanced cancer, palliative care","urun":"Oil: THC 10 mg + CBD 10 mg/mL (1:1)","urun_turu":"thc_iceren","doz":"0.25 mL/day (2.5 mg THC + 2.5 mg CBD) at the start → 3 mL/day (30 mg + 30 mg); median dose chosen given in the article as '15 mg/day'","titrasyon":"Increase over 14 days based on tolerance/effect","sure":"28 days","sonuc":"No difference in total symptom distress (p=0.76). Small benefit in ESAS pain (−1.42 vs. −0.46; p=0.04), at the cost of more psychotomimetic toxicity. Placebo better for overall well-being. No opioid-sparing effect","yan_etki":"Confusion, feeling 'high' and an exaggerated sense of well-being more common; most grade 1–2","pmid":"40705150","doi":"10.1007/s00520-025-09763-5","diger_kaynak":"ANZCTR ACTRN12619000037101. Funding: Australian government (MRFF) and the Mater Foundation; the manufacturer provided the drug and placebo and had no role in the study. At baseline, more people in the THC:CBD group were using opioids"},{"ad":"Weiss 2025","tasarim":"Double-blind, placebo-controlled RCT (+12 weeks of open follow-up)","n":"46 randomized (43 completed; target 100)","populasyon":"Patients with breast, colorectal, endometrial or ovarian cancer who had finished chemotherapy and had grade 2–3 chemotherapy neuropathy","urun":"Gel capsule: CBD + a little THC (13.9–15.1 mg CBD, 0.67–1.20 mg THC per capsule)","urun_turu":"thc_iceren","doz":"After week 1, 125.3–135.9 mg/day CBD + 6.0–10.8 mg/day THC","titrasyon":"Days 1–3: 1 capsule × 3; days 4–6: 2 × 3; from day 7: 3 × 3","sure":"12 weeks","sonuc":"No difference on the primary outcome (sensory neuropathy score); in a secondary analysis, 10.4 points better than placebo for sensory impairment (p=0.044); no difference in pain (a difference favoring placebo in the impact of pain on daily life disappeared after adjusting for the baseline difference); half the targeted number of participants was reached","yan_etki":"No difference in side effects between groups; no serious side effects","pmid":"41211445","doi":"10.3389/fonc.2025.1590168","diger_kaynak":"ClinicalTrials.gov NCT04398446 (no results in the registry). The cannabis company that provided the active and placebo capsules was among the funders; the authors declared no conflicts of interest"},{"ad":"Haney 2025","tasarim":"Double-blind, placebo-controlled pilot RCT","n":"12 (6/6)","populasyon":"Women with breast cancer with painful taxane-induced neuropathy","urun":"Cannabis capsule (100 mg CBD : 5 mg THC)","urun_turu":"thc_iceren","doz":"100 mg CBD + 5 mg THC 3 times a day (participants reduced the dose; average 2.0 capsules/day)","titrasyon":null,"sure":"8 weeks","sonuc":"Pain and sleep improved over time in both groups; in the cannabis arm, neuropathy scores were worse than with placebo every week, and sleep and the impact of pain on daily life also worsened","yan_etki":"Everyone completed; dose reductions were requested in both groups","pmid":"40611810","doi":"10.1089/can.2025.0028","diger_kaynak":"ClinicalTrials.gov NCT03782402 (terminated with 12 people; results in the registry)"},{"ad":"Fleege 2025","tasarim":"Phase 2, single-arm (no control group)","n":"39 (28 completed; 5 people stopped because of side effects, 6 because they saw no benefit)","populasyon":"Women with stage 0–3, hormone receptor–positive breast cancer with aromatase inhibitor–related joint and muscle pain","urun":"Epidiolex (pure CBD)","urun_turu":"saf_cbd","doz":"25 mg twice a day → 100 mg twice a day","titrasyon":"Increase of 25 mg × 2 every week over 4 weeks","sure":"15 weeks","sonuc":"≥2-point reduction in worst pain in 17/39 (43.6%); average 2.36-point reduction in those who completed; no placebo","yan_etki":"40 side effects in 18 patients, all grade 1–2; 5 people stopped because of side effects","pmid":"40751295","doi":"10.1002/cam4.71117","diger_kaynak":"ClinicalTrials.gov NCT04754399 (results in the registry). Funding: ASCO Foundation (Conquer Cancer), Rising Tide Foundation and the US National Institutes of Health"},{"ad":"Noyes 1975 (THC–codeine comparison)","tasarim":"Double-blind, placebo- and codeine-controlled, single-dose crossover study (randomized according to Cochrane 2023; few method details)","n":"36","populasyon":"Patients with continuous moderate cancer pain who were not taking high-dose opioids (US, single center; most often breast cancer and lymphoma)","urun":"Oral THC (delta-9-THC); comparators codeine and placebo","urun_turu":"thc_iceren","doz":"Single dose of THC 10 mg or 20 mg; codeine 60 mg or 120 mg","titrasyon":"None (fixed single dose)","sure":"Single dose of each drug and 7 hours of observation (previous painkillers stopped 4.5 hours before)","sonuc":"According to the abstract, THC showed a mild analgesic effect; 10 mg was well tolerated. According to the authors, the side effects of 20 mg were at a level that would prevent its use in treatment. Cochrane 2023 pooled this and similar single-dose studies (including studies with experimental synthetic THC analogs that are outside the site's scope) and writes that they reduced pain more than placebo but were not superior to codeine (both low certainty). A small, single-dose study lasting a few hours, from 1975","yan_etki":"At 20 mg, drowsiness, dizziness, impaired balance, blurred vision and 'disturbing' reactions; sedation in 94% with THC 20 mg, 71% with 10 mg, 47–50% with codeine and 29% with placebo (as reported by Cochrane)","pmid":"50159","doi":"10.1002/cpt197518184","diger_kaynak":"Listed as 'Noyes 1975a' in Cochrane 2023. Funding: clinical research center support from the US National Institutes of Health (NIH). The same team's dose–response study: Noyes 1975 (THC dose–response), in this table"},{"ad":"Noyes 1975 (THC dose–response)","tasarim":"Double-blind, placebo-controlled, single-dose crossover preliminary study","n":"10","populasyon":"Patients with continuous moderate cancer pain who were not taking high-dose opioids (US; 5 with breast cancer)","urun":"Oral THC (delta-9-THC) and placebo","urun_turu":"thc_iceren","doz":"Single doses of 5, 10, 15 and 20 mg THC","titrasyon":"None (fixed single doses)","sure":"Single dose for each dose level and same-day observation","sonuc":"15 and 20 mg of THC reduced pain significantly more than placebo; the abstract does not report superiority for the lower doses (5 and 10 mg). Marked drowsiness and mental clouding were seen at the effective doses. A 10-person, single-dose preliminary study from 1975","yan_etki":"Marked drowsiness and mental clouding; reports of nervous system side effects increased with dose (14 at 5 mg, 36 at 20 mg, 21 with placebo; as reported by Cochrane)","pmid":"1091664","doi":"10.1002/j.1552-4604.1975.tb02348.x","diger_kaynak":"Listed as 'Noyes 1975b' in Cochrane 2023. Funding: US National Institutes of Health (NIH)"},{"ad":"Lynch 2014","tasarim":"Double-blind, placebo-controlled, crossover pilot RCT; followed by an open-label extension","n":"16 (abstract); Cochrane 2023 gives 18 participants","populasyon":"Established chemotherapy-induced neuropathic pain (Canada, Halifax)","urun":"THC + CBD mouth spray (nabiximols) and placebo spray","urun_turu":"thc_iceren","doz":"At most 12 sprays a day; on average 8 sprays/day with the active spray and 11 with placebo (Cochrane 2023)","titrasyon":"Self-titrated by the patient","sure":"Two 4-week periods with a 2-week break in between (Cochrane 2023)","sonuc":"On the primary outcome (0–10 pain score), there was no significant difference from placebo in the whole group. Pain decreased by at least 2 points in 5 of 16 people (average 2.6 points; 0.6 with placebo); this responder analysis also did not reach significance (number needed to treat 5). By Cochrane 2023's calculation, at least a 30% reduction in pain occurred in 5 of 18 people with the active spray and 3 with placebo (p = 0.16; low certainty). Pilot study","yan_etki":"Not reported (in the abstract)","pmid":"23742737","doi":"10.1016/j.jpainsymman.2013.02.018","diger_kaynak":"ClinicalTrials.gov NCT00872144 (no results in the registry). According to Cochrane 2023, no funding; the authors declared no conflicts of interest"},{"ad":"Côté 2016","tasarim":"Double-blind, placebo-controlled RCT (single center)","n":"56 randomized (28 nabilone, 28 placebo); 24 people left before the end of the study","populasyon":"Patients with squamous cell head and neck cancer (mouth, pharynx, larynx) receiving radiotherapy (Canada); pain was not an inclusion criterion","urun":"Nabilone (a synthetic THC-like cannabinoid, by mouth) and placebo","urun_turu":"cbn_diger","doz":"Week 1: 0.5 mg at bedtime; week 2: 0.5 mg twice a day; after week 3, adjusted by the radiation oncologist up to at most 4 tablets a day (2 mg/day)","titrasyon":"Fixed increase in the first two weeks, adjusted by the physician after week 3","sure":"Throughout radiotherapy (about 7 weeks) + 4 weeks of follow-up","sonuc":"For pain (visual pain scale), the measure for this topic, nabilone was no different from placebo (p = 0.60). The time to a 15% worsening of quality of life, the primary outcome, was also not prolonged (p = 0.43); no difference in nausea, appetite, weight, mood or sleep either. Baseline pain was not reported (Cochrane 2023)","yan_etki":"No difference from placebo in the frequency of drowsiness (p = 0.32), anxiety and dry mouth as side effects (as reported in the Ceolin 2024 review; Cochrane 2023 gives the same result for drowsiness and anxiety; full text could not be read)","pmid":"26503964","doi":"10.1177/0003489415612801","diger_kaynak":"Funding: Canadian public research funds (CIHR, FRSQ); the manufacturer provided nabilone and placebo (as reported in Cochrane 2023)"},{"ad":"Turcott 2018","tasarim":"Double-blind, placebo-controlled pilot RCT (single center)","n":"47 randomized; 33 analyzed (14 nabilone, 19 placebo)","populasyon":"Advanced non-small cell lung cancer with loss of appetite (Mexico); pain was not an inclusion criterion","urun":"Nabilone (a synthetic THC-like cannabinoid, oral capsule) and placebo","urun_turu":"cbn_diger","doz":"0.5 mg (2 weeks) → 1.0 mg (6 weeks) (wording in the abstract and the registry)","titrasyon":"Dose increase after 2 weeks","sure":"8 weeks","sonuc":"Pain was measured with the pain subscale of the quality-of-life questionnaire (EORTC QLQ-C30): borderline within-group improvement in the nabilone group (p = 0.06), no change in the placebo group; the abstract gives no direct comparison of the two groups. By Cochrane 2023's calculation, at least a 30% reduction in pain occurred in 7 of 14 people with nabilone and 7 of 19 with placebo (p = 0.45; low certainty). The primary aim was appetite and nutrition; the only result reported as significantly different from placebo was carbohydrate intake (p = 0.040). Full text could not be read","yan_etki":"The abstract reported the treatment as safe. According to the Ceolin 2024 review, grade 3 nausea occurred only in the placebo group, and at most grade 2 side effects were reported in the nabilone group at week 8 (as reported in the review; full text could not be read)","pmid":"29550881","doi":"10.1007/s00520-018-4154-9","diger_kaynak":"ClinicalTrials.gov NCT02802540 (no results in the registry). The manufacturer donated nabilone and placebo and had no role in the study (Cochrane 2023)"},{"ad":"Zylla 2021","tasarim":"Randomized pilot study: early start compared with a 3-month delayed start (no placebo, open-label)","n":"30 randomized (15 early, 15 delayed)","populasyon":"Patients with stage 4 cancer using opioids (US, Minnesota)","urun":"Products from the state medical cannabis program, chosen together with the dispensary pharmacist (product type, ratio and route individualized)","urun_turu":"thc_iceren","doz":"Individual; at month 3, estimated average daily THC 34 mg, CBD 17 mg","titrasyon":"Individual, as recommended by the pharmacist","sure":"3-month comparison period","sonuc":"The primary aim was feasibility (36% of eligible patients took part). According to the abstract, the proportion of patients who reduced opioid use and had better pain control was higher in the early-start group; the abstract gives no numbers or statistical test, and the full text could not be read. No placebo, and patients knew they were taking cannabis; Cochrane 2023 did not include it in its review for this reason. Very small pilot","yan_etki":"No serious safety problems reported; high patient satisfaction (abstract)","pmid":"34085149","doi":"10.1007/s00520-021-06301-x","diger_kaynak":"Products were provided free of charge through the state program. 2 of the 13 authors are affiliated with medical cannabis manufacturers in the state (PubMed affiliation information). Letter of criticism in the journal: Davis 2022, PMID 35083541. The same group's pancreatic cancer study: Zylla 2026 (CanPan), in this table"},{"ad":"D'Andre 2024","tasarim":"Double-blind, placebo-controlled, crossover pilot RCT","n":"40 randomized (20 + 20); 36 completed both periods","populasyon":"Chemotherapy-induced peripheral neuropathy with pain or tingling of at least 4/10, in people who had finished chemotherapy and had no evidence of cancer (USA, Mayo Clinic)","urun":"Pure CBD (isolate) cream applied to the skin; placebo cream","urun_turu":"saf_cbd","doz":"Twice a day to the affected areas (the amount of CBD in the cream is not in the abstract or the registry)","titrasyon":null,"sure":"2 × 2 weeks","sonuc":"Neuropathy symptoms (QLQ-CIPN20 sensory subscale) were similar in the CBD and placebo periods; according to the researchers, the results do not support that this CBD cream improves painful neuropathy. Small and short pilot study","yan_etki":"Side-effect scores were similar in both periods; generally well tolerated; no serious side effects (registry)","pmid":"39016024","doi":"10.1089/can.2023.0253","diger_kaynak":"ClinicalTrials.gov NCT05388058 (results in the registry)"},{"ad":"Zylla 2026 (CanPan)","tasarim":"Waitlist-controlled, open-label pilot RCT","n":"34 enrolled; 32 started (16 early, 16 delayed start)","populasyon":"Newly diagnosed locally advanced or metastatic pancreatic cancer, at least one symptom; moderate to severe pain in 77% (US, Minnesota)","urun":"Products chosen for each patient from the state medical cannabis program (THC-dominant, THC:CBD-balanced or CBD-dominant; by mouth, as a spray or inhaled)","urun_turu":"thc_iceren","doz":"Individual; median THC 7.3 mg/day at week 8","titrasyon":null,"sure":"8-week comparison period (16 weeks in total)","sonuc":"The feasibility goals, the primary outcome, were met. At week 8, pain improved in 44% of the early-start group and 20% of the waiting group (p = 0.35; not significant); numerical but non-significant differences in appetite and insomnia as well. No placebo, and patients knew what they were using; very small pilot","yan_etki":"Worsening of cannabis-related complaints such as dry mouth similar in both groups (11% vs. 20%; p = 0.99)","pmid":"41510814","doi":"10.1200/OP-25-01165","diger_kaynak":"ClinicalTrials.gov NCT06605430 (registration given in the second publication); 16-week dose-response analysis: Gupta 2026, PMID 42767994. Products were provided by a cannabis company; funding by donation; no conflicts of interest reported. The same group's stage 4 cancer study: Zylla 2021, in this table"},{"ad":"Zylla 2026 (ointment for joint pain)","tasarim":"Randomized, open-label feasibility study; no placebo (CBD-dominant vs. THC-dominant ointment)","n":"24 registered (ClinicalTrials.gov); 21 women completed the study","populasyon":"Women with stage 1–3 breast cancer taking an aromatase inhibitor, with drug-related joint, muscle and bone pain (AIMSS) (US, Minnesota)","urun":"Ointments provided free of charge by a medical cannabis company: CBD-dominant (2210 mg CBD per jar, THC below 0.3%) or THC-dominant (375 mg THC per jar, CBD below 20 mg); applied to the hands","urun_turu":"thc_iceren","doz":"3 times a day, one scoop (1.25 mL spoon) applied to the back of each hand and spread over the hand, wrist and fingers","titrasyon":null,"sure":"2 weeks randomized + 2-week open extension with the chosen ointment","sonuc":"The primary aim was feasibility: 71% of participants continued into the 2-week extension. In the second week, 86% of participants reported improvement in hand symptoms (M-SACRAH); improvement of more than 50% was reported as 50% in the THC ointment group and 18% in the CBD ointment group, but the two groups were not compared statistically. Results for pain (Brief Pain Inventory), the main measure for this topic, are not in the abstract read (the full text could not be read). There was no placebo and participants knew which ointment they were using; the improvements cannot be interpreted as an effect of the ointment","yan_etki":"Mild skin irritation in 24% of participants; 1 person stopped because of the ointment's greasy texture","pmid":"41467893","doi":"10.1177/25785125251398286","diger_kaynak":"ClinicalTrials.gov NCT05935891 (no results in the registry). Supported by the US National Cancer Institute and NIH; the ointments were provided free of charge by a medical cannabis company; the authors declared no conflicts of interest"},{"ad":"NCT01337089 (nabiximols long-term open-label extension, registry results)","tasarim":"Multicenter, open-label, uncontrolled extension study (phase 3)","n":"660 (patients continuing from three phase 3 studies and newly enrolled patients); 256 completed","populasyon":"Patients with advanced cancer whose pain continued despite opioids","urun":"Nabiximols (THC + CBD mouth spray)","urun_turu":"thc_iceren","doz":"Morning and evening, at most 10 sprays a day (registry)","titrasyon":"1 spray in the evening on the first day; adjusted individually by increasing by 1 spray a day over 14 days, then continued at the same dose (registry)","sure":"6 months (183 days)","sonuc":"The primary aim was safety: 82.9% of participants had at least one adverse event. The average pain score over the last 4 weeks (in those who stopped early, over the last 27 days of treatment) did not change from baseline (0.0; SD 1.8), and sleep disruption also did not change (0.1; SD 1.9). At the last visit, 471 (76%) of the 618 people who answered the satisfaction question reported being at least 'slightly satisfied'. No comparison group; some participants had previously received the spray or placebo, which makes the baseline measurement harder to interpret. No peer-reviewed publication","yan_etki":"404 people did not finish the study; 237 (36%) stopped because of adverse events (including progressing cancer). Serious adverse events in 301 of 660 people (most often cancer progression: 209). Common events: nausea (86 people), vomiting (59), dizziness (51), fatigue (50), loss of appetite (49), drowsiness (38)","pmid":null,"doi":null,"diger_kaynak":"ClinicalTrials.gov NCT01337089 (results in the registry, April 23, 2018; no publication found on PubMed in October 2026). The sponsors in the registry are Jazz Pharmaceuticals, the drug's current owner, and its development partner Otsuka. Main studies: Fallon 2017 and Lichtman 2018 (in this table)"},{"ad":"Segar 2026","tasarim":"Early phase 1, single-arm, open-label pilot study (no control group)","n":"20 consented; 14 evaluated (3 people stopped because of side effects); 17 in the side effect analysis","populasyon":"Women with breast cancer that had spread to the bone who had been using opioids for bone pain for at least 4 weeks (USA)","urun":"Dronabinol (synthetic THC); oral liquid in 11 patients, capsules in 3 (product name in the registry record: Syndros)","urun_turu":"thc_iceren","doz":"5 mg twice a day for 3 days, 10 mg in the morning + 5 mg in the evening for 3 days, then 10 mg twice a day (8 weeks in total)","titrasyon":"Increased over 6 days as tolerated","sure":"8 weeks","sonuc":"According to the authors, the primary outcome (number of patients reducing their opioid dose by at least 20%) was met: 4 of 14 patients (predefined threshold: 4 patients); however, in the article’s per-patient opioid table, the reduction in the fourth patient is 19.7% (from 1,830 to 1,470 mg morphine equivalent). The need for opioids increased in 3 patients; their disease had progressed. According to the authors, pain intensity, the impact of pain on daily life and quality of life improved compared with baseline (before–after comparison); the change in the insomnia score, however, was not significant according to the table (p = 0.19). No control group, open-label and small; the authors note that there may be subjective bias and are planning a placebo-controlled study","yan_etki":"Most often dizziness (6 people) and cognitive impairment (5 people); grade 3 dizziness in 1 person; grade 1 psychosis in 1 person and grade 2 euphoria in 1 person; the dose was reduced in 3 people, and 3 people stopped because of side effects","pmid":"42050177","doi":"10.1093/oncolo/oyag163","diger_kaynak":"ClinicalTrials.gov NCT03661892 (completed April 2021; no results in the registry record). PMC13375633. Funding: US National Cancer Institute and the University of Arizona; the authors reported no conflicts of interest directly related to this study"},{"ad":"To 2023 (MASCC guideline)","tasarim":"Guideline based on a systematic review of RCTs and systematic reviews (MASCC; search up to November 12, 2021; Jadad scoring)","n":"34 systematic reviews and RCTs for cancer pain (7 of them RCTs in cancer pain); 7 publications for harms","populasyon":"Adults with cancer pain; all cancer patients for harms","urun":"Cannabis and cannabinoid products","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"The positive primary results of two of the cancer pain RCTs could not be repeated in studies with a similar design; high-quality meta-analyses found little evidence that cannabinoids are an effective adjuvant drug or painkiller in cancer pain. The guideline's recommendation: cannabinoids should not be used as adjuvant painkillers in cancer pain; the risk of harm and side effects should be weighed carefully, especially in people taking checkpoint inhibitors. Full text could not be read (abstract)","yan_etki":"Evidence on the type and level of harms was found to be inconsistent","pmid":"36872397","doi":"10.1007/s00520-023-07662-1","diger_kaynak":"Correction: PMID 37148393 (only one author's name was corrected; does not affect the results). No funding was received for the guideline (publisher's page). The same society's guideline on anxiety, depression and insomnia in cancer: De Feo 2023, PMID 36809575"},{"ad":"Braun 2024 (ASCO guideline)","tasarim":"Clinical practice guideline; based on a systematic review (13 systematic reviews and 5 primary studies; search January 2023)","n":null,"populasyon":"Adults with cancer","urun":"Cannabis and cannabinoids (pure, synthetic and plant-based)","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"Recommendation 3.3: evidence is insufficient to recommend for or against cannabis or cannabinoids for treatment-related side effects and symptoms, including cancer pain (outside clinical trials). In the guideline table, the quality of evidence for cancer pain is 'moderate' for nabiximols, with no clear evidence of benefit or harm and no recommendation; in the 2021 meta-analysis it relied on, the difference with nabiximols in cancer pain was not significant (−0.10 on a 10 cm scale; 95% CI −0.28 to 0.09). Recommendation 3.2: oral CBD at 300 mg a day or more should not be recommended for symptom burden outside clinical trials (low quality of evidence, weak recommendation). Two of the 15 panel members reported ties with companies in the cannabinoid field (one with stock and consulting in companies in this field, one with consulting for GW Pharmaceuticals, which developed nabiximols); one member also reported an unpaid tie with a cannabinoid research consortium","yan_etki":null,"pmid":"38478773","doi":"10.1200/JCO.23.02596","diger_kaynak":"Q&A summary: Braun 2024, PMID 38478793"},{"ad":"Busse 2021 (BMJ Rapid Recommendation)","tasarim":"Clinical practice guideline (BMJ Rapid Recommendations; GRADE; international panel that included patient representatives)","n":null,"populasyon":"People with chronic pain due to cancer or non-cancer causes","urun":"Non-inhaled (oral or topical) medical cannabis and cannabinoids","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"Weak recommendation for trying non-inhaled medical cannabis or cannabinoids in addition to standard treatment when standard treatment is not enough; because the balance of benefit and harm is close, shared decision-making is needed. In the meta-analysis it relied on (Wang 2021; 32 RCTs, 5,174 people), there was a small improvement in pain (−0.50 cm on a 10 cm scale; moderate certainty), but 28 of the studies were in non-cancer pain; in the nabiximols studies in cancer pain, the difference was not significant (as reported in ASCO 2024: −0.10; 95% CI −0.28 to 0.09)","yan_etki":"According to the underlying meta-analysis, a small increase in the risk of dizziness, drowsiness, nausea, vomiting, impaired attention and temporary cognitive impairment","pmid":"34497062","doi":"10.1136/bmj.n2040","diger_kaynak":"Underlying systematic review: Wang 2021, PMID 34497047 (BMJ). According to Cochrane 2023, the average pain analysis of Wang 2021 included only one cancer pain study"},{"ad":"Creangă-Murariu 2026 (meta-analysis of opioid use)","tasarim":"Systematic review and meta-analysis (randomized and non-randomized studies; search October 24, 2025; GRADE)","n":"15 studies (10 in the meta-analysis); 5 RCTs, 769 people in the total opioid analysis","populasyon":"Adult cancer patients using opioids for pain","urun":"THC-dominant, CBD-dominant and balanced THC:CBD products","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"In placebo-controlled analyses, cannabinoids did not change total opioid use (SMD −0.03; 95% CI −0.17 to 0.12; 5 RCTs, 769 people), the regular opioid dose or extra (rescue) opioid use differently from placebo. In before-and-after analyses, reductions in the regular opioid dose varied by product and came from individual studies; these analyses are not comparisons with placebo. Certainty of evidence low for all outcomes; the authors write that cannabinoids should not be seen as a reliable way to reduce opioids","yan_etki":null,"pmid":"42262611","doi":"10.1007/s00520-026-10856-y","diger_kaynak":"PROSPERO CRD420251175971. Funding: research fund of a Romanian public health program; the authors declared no conflicts of interest"},{"ad":"Creangă-Murariu 2025","tasarim":"Systematic review and meta-analysis (interventional and observational studies; search up to November 4, 2023)","n":"98 publications (all cancer symptoms); 12 single-group studies, 2,591 patients in the pain analysis","populasyon":"Symptom management in cancer patients","urun":"All types of cannabinoids (THC-dominant, CBD-dominant, balanced)","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"Pain was pooled only from single-group studies, as change from baseline: on a 0–10 scale it decreased by an average of 1.22 points (95% CI 0.52 to 1.92; very high inconsistency between studies, I² 100%); this is not a placebo comparison. In the placebo comparison, the small difference seen with nabiximols (mean difference −0.25; 95% CI −0.50 to −0.01) was judged by the authors as a failure to reduce pain. The authors nevertheless conclude that cannabinoids may be useful in cancer pain; this interpretation is based on change from baseline, not on a placebo comparison. Certainty of evidence low or very low for all outcomes; high risk of publication bias for pain","yan_etki":"With THC-dominant products, the risk of psychiatric (OR 10.62; 1.35–83.57) and neurological (OR 2.24; 1.15–4.35) side effects increased","pmid":"40748522","doi":"10.1007/s11912-025-01695-x","diger_kaynak":"PROSPERO CRD42023479375"},{"ad":"Waissengrin 2021","tasarim":"Retrospective chart review (single center, Israel; no randomization: people with a medical cannabis license were compared with those without one; groups were not matched)","n":"513 (248 cannabis: 116 started before oxaliplatin or within the first month, 132 started afterward; 265 not taking cannabis)","populasyon":"Digestive system cancers treated with chemotherapy containing oxaliplatin and 5-FU; people with pre-existing nerve damage excluded","urun":"Medical cannabis (licensed in Israel for reasons such as nausea, loss of appetite and pain; product type, THC/CBD ratio and dose not stated in the records)","urun_turu":"karma","doz":"Not reported (amount and product type not in the records)","titrasyon":null,"sure":"Treatments between October 2015 and January 2018","sonuc":"Moderate or severe (grade 2–3) nerve damage occurred in 15.3% of those taking cannabis and 27.9% of those not taking it (p < 0.001); no nerve damage at all developed in 75% of those who started cannabis before oxaliplatin, 46.2% of those who started afterward and 31.7% of those not taking it. Pain was not measured; nerve damage was graded retrospectively from doctors’ notes. The groups were not balanced: spread (metastatic) disease was more common in the cannabis groups (85% and 79% vs 63%), and the total oxaliplatin dose differed between groups. Observational; it does not show cause and effect; the authors write that a placebo-controlled study is planned","yan_etki":"Not assessed","pmid":"33613702","doi":"10.1177/1758835921990203","diger_kaynak":"PMC7876573. No funding (authors’ statement). The last author reports stock options and consulting at a cannabis company (BOL Pharma)"},{"ad":"Maida 2008","tasarim":"Prospective observational study: patients taking and not taking nabilone were compared after balancing with propensity scores (not randomized or blinded)","n":"112 (47 nabilone, 65 not taking nabilone)","populasyon":"Patients with advanced cancer with pain and other symptoms (Canada)","urun":"Nabilone (a synthetic THC-like cannabinoid, by mouth), added to existing treatment","urun_turu":"cbn_diger","doz":"Not reported (in the abstract)","titrasyon":null,"sure":"30 days","sonuc":"The primary outcomes were pain and opioid use: at day 30, propensity-adjusted pain scores and total morphine-equivalent use were lower in the nabilone group (both p < 0.0001). Nausea, anxiety and total symptom score were also better in the nabilone group; those taking nabilone started fewer other pain and nausea medicines. Nabilone was not given randomly, and the study was not blinded; the groups were balanced with propensity scores","yan_etki":"Not reported (in the abstract)","pmid":"18402303","doi":null,"diger_kaynak":null},{"ad":"Aviram 2022","tasarim":"Prospective observational cohort (multicenter; no comparison group)","n":"324 started; 212, 158 and 126 people responded at months 1, 3 and 6","populasyon":"Oncology patients receiving a medical cannabis license for the first time for cancer symptoms (Israel)","urun":"Licensed medical cannabis: dried flower (smoked or vaporized) or oil extract; at month 6, of those who reported their product, 61% used THC-dominant, 25% mixed and 15% CBD-dominant products","urun_turu":"thc_iceren","doz":"Individual; median 20 g of product per month","titrasyon":null,"sure":"6 months","sonuc":"In those who reached month 6, weekly average pain fell from a median of 7 to 5 (−0.98; 95% CI −1.43 to −0.54), and worst pain from 8 to 6 (−1.78; −2.31 to −1.26); total symptom burden, the primary outcome, decreased by a median of 18%. Of the 74 people using analgesics at baseline, 30 (40%) had stopped by month 6, and 10 people had newly started; very few of those reaching month 6 were using opioids (median morphine equivalent 0). According to the authors, the change in pain was small and the clinical importance of the effect may be limited. No control group; only 39% of those who started responded at month 6","yan_etki":"Side effects were common (20–30%) but most were not serious and stayed stable throughout follow-up","pmid":"35669038","doi":"10.3389/fpain.2022.861037","diger_kaynak":"1-month study by the same group: Aviram 2020, PMID 33265945 (108 patients; pain intensity improved, no difference in pain between THC- and CBD-dominant products; worst and least pain had not changed significantly at month 1). Funding: a charitable foundation; the authors declared no conflicts of interest"},{"ad":"Aprikian 2024 (Quebec Cannabis Registry)","tasarim":"Patient registry analysis (prospective, multicenter registry; no comparison group)","n":"358","populasyon":"Patients starting medical cannabis for cancer pain and other cancer symptoms (Canada, Quebec)","urun":"Medical cannabis: THC-dominant, THC:CBD-balanced or CBD-dominant products","urun_turu":"karma","doz":"Not reported (in the abstract)","titrasyon":null,"sure":"Up to 12 months (measurements at months 3, 6, 9 and 12)","sonuc":"Worst pain (Brief Pain Inventory, 0–10) fell from 5.5 to 3.6 at month 3, and average pain from 4.1 to 2.4; the decrease was significant at months 3, 6 and 9 (p < 0.01). THC:CBD-balanced products were associated with better pain reduction than THC- or CBD-dominant products. Total medication burden decreased at all follow-ups, and the daily morphine-equivalent dose at the first three follow-ups. No control group; the numbers of patients remaining in follow-up are not in the abstract; the authors write that the result needs to be confirmed in placebo-controlled studies. Full text could not be accessed","yan_etki":"15 side effects in 11 patients; 2 serious events (pneumonia and a cardiovascular event) were not considered likely to be related to cannabis","pmid":"37130724","doi":"10.1136/spcare-2022-004003","diger_kaynak":"Analysis of symptoms and sex differences in the same 358 patients: Kasvis 2022, PMID 35723729. One of the authors has served on the clinical advisory boards of several cannabis companies and was research director of a medical cannabis clinic until 2020 (PubMed conflict-of-interest statement)"},{"ad":"Varadpande 2025 (UK Medical Cannabis Registry)","tasarim":"Case series (prospective patient registry; no comparison group)","n":"168","populasyon":"Patients prescribed cannabis-based medicines for cancer pain (United Kingdom)","urun":"Cannabis-based medicines (product breakdown not in the abstract)","urun_turu":"karma","doz":"Not reported (in the abstract)","titrasyon":null,"sure":"6 months (measurements at months 1, 3 and 6)","sonuc":"All pain-specific measures (Brief Pain Inventory, pain visual scale) improved significantly from baseline at months 1, 3 and 6 (p < 0.05; magnitudes not in the abstract); anxiety, sleep quality and quality of life also improved. No control group; the authors state that cause and effect cannot be established. 8 of the 12 authors are affiliated with a private clinic that prescribes cannabis medicines","yan_etki":"29 side effects in 5 patients (3%); most mild or moderate","pmid":"39921589","doi":"10.1080/15360288.2025.2457101","diger_kaynak":"Preliminary 16-patient palliative care report from the same registry: Nimalan 2022, PMID 34980282"},{"ad":"Stienrut 2024 (Thai national cohort)","tasarim":"Prospective observational cohort (30 centers; no comparison group)","n":"21,284 patients, 2,873 with cancer; by week 12, 32% of participants had dropped out of follow-up","populasyon":"Patients prescribed cannabis oil by traditional Thai medicine practitioners for symptoms such as pain, loss of appetite and insomnia (Thailand)","urun":"Cannabis extract in coconut oil produced by the Ministry of Health (about 0.07 mg THC per drop; almost no CBD)","urun_turu":"thc_iceren","doz":"Most often 3 drops a day at bedtime (about 0.2 mg THC/day)","titrasyon":null,"sure":"3 months","sonuc":"In patients with cancer, pain (ESAS, 0–10) decreased by 2.01 points from baseline over 3 months (95% CI 1.87 to 2.16); by 2.75 points in patients without cancer. Quality of life and other symptoms also improved. No control group; the daily THC dose was about 0.2 mg (far below the doses in cancer pain RCTs); the authors write that efficacy needs to be shown in controlled studies","yan_etki":"Side effects at 0.42% of 67,681 visits (most often dry mouth, dizziness, drowsiness)","pmid":"39144529","doi":"10.1159/000540153","diger_kaynak":"Thai Clinical Trials Registry TCTR20191231001. Funding: the Department of Thai Traditional and Alternative Medicine of the Ministry of Health, which also makes the product; the authors declared no conflicts of interest"}],"ilgili_ilaclar":["kemoterapi","immunoterapi","tamoksifen","everolimus","varfarin","apiksaban","rivaroksaban","opioid"],"son_inceleme":"2026-10-30","arastirma_gecmisi":[{"tarih":"2026-10-19","not":"Page published. In this first assessment, 8 studies were reviewed."},{"tarih":"2026-10-21","not":"The full texts of the studies were reread and the information on the page was checked against its sources. Corrected: duration, participant numbers and dose information in the study table; drug interaction notes; evidence summary. No points remain that could not be verified from the full text (previously 3 items). The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-21","not":"PubMed and ClinicalTrials.gov were searched for newly published and previously missed clinical studies. 3 studies added: Weiss 2025, Haney 2025 and Fleege 2025. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-22","not":"The names of the finding labels were simplified: on this page the \"No benefit seen\" label became \"No effect found.\" The assessment did not change."},{"tarih":"2026-10-28","not":"Display fix: internal working file names left in the text were removed; content and evidence did not change."},{"tarih":"2026-10-28","not":"In the October 2026 search (PubMed, Cochrane, ClinicalTrials.gov), 20 studies were added to this topic: 9 randomized studies (two single-dose THC studies from 1975, Lynch 2014, Côté 2016, Turcott 2018, Zylla 2021, D'Andre 2024, Zylla 2026 CanPan and the ointment study in joint pain), the registry results of the 6-month open-label extension study of nabiximols, the MASCC, ASCO and BMJ guidelines, 2 systematic reviews and 5 observational studies. Registry numbers, funding and company ties, and the figures from Cochrane and from the registry results, were added to the rows of the nabiximols studies; the page now states that the measures referred to as 'quality of life' were global impression and satisfaction questionnaires, that the positive subgroup findings in US patients were post hoc and went in both directions, and that more deaths occurred in the spray group during the randomized period of one study (the authors and the independent safety board saw no link with the spray); the pain data reported by Cochrane were added to the MedCan1 row. The sentence based on the ESMO 2018 guideline was removed from the evidence summary and moved to the unverifiable points because the full text of the guideline could not be accessed; completed studies whose results have not been published were also listed under the unverifiable points. The conclusion and the strength of evidence did not change; the scope of the strength of evidence for THC was clarified."},{"tarih":"2026-10-28","not":"October 2026 additional review: a source found for this page during the searches for other topics was read and added to the page. The sleep result in the low-dose group was added to the dose study of the THC and CBD mouth spray in cancer pain not responding to opioids (Portenoy 2012): the score for pain interfering with sleep, a secondary measure, decreased more than with placebo only at the low dose, with no difference at the medium and high doses; on the study's primary outcome, there was also no difference between the spray and placebo. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-30","not":"Two studies that had no comparison group or were retrospective were added: a single-arm study in which 4 of 14 women with breast cancer that had spread to the bone and who were using opioids reduced their opioid dose with synthetic THC (dronabinol), and a retrospective chart review of 513 patients receiving oxaliplatin reporting that chemotherapy-related nerve damage was less common in those using medical cannabis. Because neither was randomized, neither counts as evidence of an effect; both were written up in the table and the text with these limitations. In a large study with a spray containing THC and CBD, the excess of deaths seen in the spray group (23 vs 9) is now described with its context not only in the table but also in the side effects section; the numbers of deaths during and after treatment were added to the row in the table. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-30","not":"The last sentence of the page's short summary was rewritten in a calmer, more guiding tone: instead of \"Talk to your doctor before you start.\", it now says whom you can talk with, and about what, if you are considering CBD. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-31","not":"The evidence level text now uses the same level name as the top of the page; the level and the result did not change."}]},{"id":"cancer-appetite-loss","baslik":"Cancer: loss of appetite and cachexia (weight loss)","grup":"Cancer","grup_kodu":"kanser","tr_id":"kanser-istah-kaseksi","kanit_duzeyi":"yetersiz","kanit_yonu":"yarar_gosterilmedi","kanit_ozet":"No pure CBD RCT that selected patients for loss of appetite and weight loss in cancer was found; in an RCT on symptom burden in advanced cancer (144 patients, 28 days, median 400 mg/day), all ESAS items, including appetite, improved in both groups, with no difference between the groups; in a small non-randomized study, 300 mg/day of CBD during chemotherapy did not change lean body mass and reported improvement in taste discrimination. THC-containing cannabis extract and THC were no different from placebo; dronabinol was worse than megestrol. In a 46-patient pilot RCT in patients with taste and smell disorders, dronabinol improved taste and smell perception, appetite before meals and the share of calories from protein more than placebo; total calorie intake, the primary outcome in the registry, increased in both groups, with no difference between the groups. Nabilone was no different from placebo for appetite and weight during radiotherapy in head and neck cancer; THC:CBD 1:1 oil did not change the appetite score differently from placebo in advanced cancer (p = 0.32); in a waitlist-controlled open pilot study in pancreatic cancer, the difference in appetite improvement was not significant (56% vs. 30%; p = 0.37). In a 177-patient RCT of cancer pain, the appetite score fared worse over 2 weeks with the THC+CBD mouth spray than with placebo (difference 0.83 points; 95% CI 0.16–1.51; p = 0.016), and with the THC-only spray the difference was borderline (p = 0.056); this secondary outcome is not in the publication but in the ClinicalTrials.gov registry (NCT00674609). In lung cancer, nabilone was no different from placebo for appetite and weight in a small pilot RCT; calorie intake increased in the nabilone group, but the abstract does not state whether the difference from placebo was significant, and the only result reported as significantly higher than placebo was carbohydrate intake (47 randomized, 33 analyzed). Uncontrolled studies and patient registries reported improvement in appetite, but there was no comparison group, and in a cohort followed for 6 months average weight did not change; in 2,873 cancer patients in Thailand, the appetite-loss score (0–10) decreased by 1.67 points over 3 months with an oil containing only about 0.2 mg of THC a day (uncontrolled; patients were not selected for appetite loss, baseline score 2.45; the public institution that makes the product funded the study; the authors point to the possible role of the placebo effect). Systematic reviews (Simon 2022, Razmovski-Naumovski 2022, Creangă-Murariu 2025) showed no significant benefit for appetite or weight; certainty low or very low. The ASCO 2020 cachexia guideline had given a weak recommendation against cannabinoids (as reported in ASCO 2024). October 2026 search (PubMed, Cochrane, ClinicalTrials.gov): 9 randomized studies with cannabinoids on this topic and 2 non-randomized studies with a comparison group were found; all are in the table below. 4 of the randomized studies were done in patients with loss of appetite, weight loss or taste disorders; the other 5 were done for symptom burden in advanced cancer, cancer pain or quality of life during radiation therapy and measured appetite as a secondary outcome. The 4 most comprehensive and most recent systematic reviews answering the same question are also in the table; there is no Cochrane review. Although chemotherapy nausea studies measured appetite as a side outcome, they were assessed under the nausea and vomiting topic. A 109-patient phase 3 study comparing dronabinol with placebo for symptoms during chemotherapy in pancreatic cancer (NCT03984214; weight loss and lean body mass among the secondary outcomes) was completed in September 2024; its results have not yet been published.","kanit_duzeyi_metin":"Pure CBD: Insufficient; no RCT for loss of appetite; in 1 RCT on symptom burden, appetite no different from placebo","kanit_duzeyi_thc_icerenler":"cok_zayif","kanit_duzeyi_thc_icerenler_metin":"Very weak","kaynak_dosya":"kanser-destek.md","saf_cbd_sonuc":"There is no pure CBD RCT that selected patients for appetite loss/cachexia in cancer; in a symptom-burden RCT in advanced cancer (144 patients), there was no difference from placebo in the ESAS items, including appetite (secondary outcome); in a small non-randomized study, lean body mass did not change.","thc_icerenler_sonuc":"No benefit for appetite and weight has been shown with THC-containing products and nabilone (low to very low evidence); small studies reported improvement in taste perception and in the intake of some foods.","ruhsat":null,"doz_araligi_ozet":"In the non-randomized study, CBD 300 mg/day (8 days in each chemotherapy cycle); in the symptom-burden RCT, CBD 50–600 mg/day (median 400 mg); in THC-containing products, THC mostly 2.5 mg twice a day (increased up to 20–30 mg/day in some studies), median 15 + 15 mg/day in the THC:CBD 1:1 oil; nabilone 0.5–2 mg/day","titrasyon_ozet":"In most studies, the dose was started low and increased over 1–2 weeks based on response and side effects: dronabinol from 2.5 mg a day, nabilone from 0.5 mg, CBD oil from 50 mg a day, THC:CBD oil from 2.5 + 2.5 mg a day (study doses; not a personal recommendation). In the Israeli capsule study, where side effects were seen at the higher dose, the dose was halved.","yan_etkiler":["Strasser 2006: no difference in toxicity","Jatoi 2002: side effects of dronabinol and megestrol similar","Hardy 2025 (THC:CBD 1:1 oil): mental side effects such as feeling intoxicated more common; stopping before day 14, 22% vs. 10%","Hardy 2023 (CBD oil): side effects similar to placebo; shortness of breath more common in the CBD group","Bar-Sela 2019: fatigue, dizziness, disorientation, anxiety or hallucinations in 3 of 4 patients taking the 10 mg capsule (9.5 mg THC); dose lowered to 5 mg","Brisbois 2011 and Côté 2016: no difference from placebo in side effects"],"izlem":["Prescription CBD label: liver tests at baseline and at months 1, 3 and 6, then periodically; stop if ALT/AST >3×ULN + bilirubin >2×ULN, or if transaminases stay >5×ULN","INR in people taking warfarin","Drug blood levels in people taking everolimus/tacrolimus/sirolimus"],"dikkat":["People with liver disease / liver metastases / on hepatotoxic treatment: with prescription CBD, ALT >3×ULN in 12–13% (placebo 1%), dose-dependent; in moderate/severe hepatic impairment the label specifies a lower starting dose","People taking warfarin or clopidogrel and those at high risk of bleeding: there is an interaction mechanism (CYP2C9, CYP2C19); no clinical data have been reported showing that CBD directly increases bleeding risk","Before surgery/procedures: ASRA 2023 recommends asking about cannabinoid use and including it in the anesthesia plan; the anesthesia team must be told","People on immunotherapy (checkpoint inhibitors): there is an observational signal and a guideline warning","People taking everolimus, tacrolimus, sirolimus or oral targeted drugs: CBD should not be added without consulting the oncologist/pharmacist","Older adults, people taking many medicines, and those on sedatives/opioids: somnolence, dizziness, risk of falls; with THC-containing products, confusion and psychotomimetic effects","Use for 'treating' tumors: uncontrolled case series are not evidence; ASCO strongly recommends against abandoning standard treatment","Pregnancy/breastfeeding, history of psychiatric illness (with THC-containing products): cancer studies excluded these groups","People with loss of appetite or unintended weight loss: CBD has not been shown to increase appetite; on the contrary, it may decrease appetite in some people. In controlled studies in Lennox–Gastaut and Dravet syndromes, appetite decreased in 16–22% of those taking the approved CBD medicine (5% with placebo), and 16% lost at least 5% of their weight (8% with placebo); the effect increased with dose (US product information, FDA). In a review of 11 randomized studies looking at the effect of CBD on appetite and weight, decreased appetite was more common with CBD in 7 studies; 5 of these were done with high doses in patients with severe epilepsy, and the review includes no studies in cancer patients (Pinto 2022, PMID 36180814)."],"ilac_etkilesim_notlari":["Everolimus: exposure increased ~2.5-fold; label: start everolimus at a lower dose and monitor levels (high, human PK data)","Tacrolimus, sirolimus, digoxin (P-gp substrates): the label states that levels may increase (moderate)","Oral P-gp substrate chemotherapy/targeted drugs (e.g., many tyrosine kinase inhibitors): theoretical; no human data","CYP2C19 substrates and prodrugs (clopidogrel): substrate levels rise, and the active metabolite of prodrugs may decrease; no human data for oncology drugs","Warfarin: case report of INR rise; INR should be monitored","CYP3A4 substrates (taxanes, irinotecan, docetaxel, many TKIs): midazolam unchanged on the label (licensed CBD 750 mg twice daily); a single dose of a CBD-dominant extract (640 mg CBD + 20 mg THC) increased midazolam AUC by 56% (Bansal 2023, PMID 37313955); herbal cannabis tea did not affect irinotecan and docetaxel PK (n=24); nabiximols did not affect temozolomide PK; these results cannot be generalized","Immunotherapy: nivolumab response rate 15.9% vs. 37.5% in cannabis users (mostly THC-containing cannabis) (Taha 2019, PMID 30670598, n=140); in a prospective observational study, time to progression and survival were shorter (Bar-Sela 2020, PMID 32872248, n=102); causality not proven, no data specific to pure CBD","Opioids: in MedCan1, CBD dose was unrelated to opioid use; no opioid-sparing effect shown with THC-containing products; somnolence increases with CNS depressants","Citalopram/escitalopram: citalopram levels rose significantly in 6 patients who added CBD (200–800 mg/day) (Anderson 2021, PMID 34121064)","Valproate and liver-toxic drugs (some chemotherapies, methotrexate): no data on use together with hepatotoxic chemotherapies","Tamoxifen: in one case, endoxifen was found to be low with CBD 40 mg/day (Parihar 2020, PMID 33191836)","No clinical studies reported with direct oral anticoagulants (apixaban, rivaroxaban)"],"dogrulanamayan":["The full text of Turcott 2018 (nabilone) is not open access; the information that there was no difference from placebo in appetite and weight and that the analysis was done with 33 patients was taken from the Simon 2022 and Ceolin 2024 reviews and from the ESMO 2021 cachexia guideline; whether the calorie increase differed significantly from placebo is not in the sources read. The appetite result of Johnson 2010 is not in the publication, only in the ClinicalTrials.gov registry (NCT00674609). For Strasser 2006, Jatoi 2002, Brisbois 2011, Côté 2016, Hardy 2023, Johnson 2010, Zylla 2026, Maida 2008, Kasvis 2022 and Razmovski-Naumovski 2022, only the PubMed abstract, the registry entry or the protocol was read (full text behind a paywall)","Studies with unpublished results (October 2026): dronabinol vs. placebo in pancreatic cancer, 109 patients, phase 3 (NCT03984214, Austria; completed in September 2024, no results in the registry); a repeated crossover (N-of-1) study with cannabis oil for cancer symptoms, 91 patients (NCT03948074, Canada; completed in July 2025); a quality-of-life study with cannabis extract in oncology patients (NCT06097533, Germany; terminated early in February 2026); a phase I/IIb study with vaporized inhaled cannabis flower for cancer-related loss of appetite (Australia; only its sub-study based on patient interviews has been published)"],"calismalar":[{"ad":"Strasser 2006 (Cannabis-In-Cachexia-Study-Group)","tasarim":"Phase III, double-blind RCT","n":"243 randomized (95 extract, 100 THC, 48 placebo); 164 completed","populasyon":"Cancer-related anorexia-cachexia","urun":"Cannabis extract (THC 2.5 mg + CBD 1 mg) vs. THC 2.5 mg vs. placebo","urun_turu":"thc_iceren","doz":"Twice a day (fixed)","titrasyon":"None","sure":"6 weeks","sonuc":"No difference between groups in appetite and quality of life (reported increased appetite: extract 73%, THC 58%, placebo 69%); the independent data board recommended stopping enrollment because there was not enough difference between the groups","yan_etki":"No difference in toxicity","pmid":"16849753","doi":"10.1200/JCO.2005.05.1847","diger_kaynak":null},{"ad":"Jatoi 2002 (NCCTG)","tasarim":"RCT","n":"469 evaluable patients randomized (three groups)","populasyon":"Anorexia in advanced cancer","urun":"Dronabinol 2.5 mg × 2 vs. megestrol 800 mg/day vs. both","urun_turu":"thc_iceren","doz":"Dronabinol 2.5 mg twice a day (fixed)","titrasyon":"None","sure":"Not reported (in the abstract)","sonuc":"Megestrol better: improvement in appetite 75% vs. 49% (p = 0.0001), weight gain of at least 10% from baseline 11% vs. 3% (p = 0.02); the combination gave no added benefit. No placebo group","yan_etki":"Similar (more impotence with megestrol)","pmid":"11786587","doi":"10.1200/JCO.2002.20.2.567","diger_kaynak":"IL-6 substudy of the same trial: Jatoi 2002, Support Care Cancer, PMID 11777191 (85 patients; change in IL-6 not different between groups)"},{"ad":"Turcott 2018","tasarim":"Double-blind pilot RCT","n":"47 randomized; 33 analyzed (14 nabilone, 19 placebo)","populasyon":"Advanced non-small cell lung cancer, anorexia","urun":"Nabilone (a synthetic THC-like cannabinoid, oral capsule) and placebo","urun_turu":"cbn_diger","doz":"0.5 mg (2 weeks) → 1.0 mg (6 weeks)","titrasyon":"Fixed increase","sure":"8 weeks","sonuc":"Of the five primary outcomes in the registry, no difference from placebo in appetite and weight (weight change at week 8: −1.4 kg with nabilone, −1.09 kg with placebo; p = 0.724); BMI and nutritional status (SGA) results are not in the sources read. Of the primary outcomes, daily calorie intake increased by 342 kcal in the nabilone group and decreased in the placebo group; the abstract does not state whether the between-group difference was significant. The only result reported as significantly higher than placebo was carbohydrate intake, a secondary outcome (64 g; p = 0.040). Improvement in some quality-of-life domains was shown only within the nabilone group; the ESMO 2021 guideline reports that there was no significant effect on quality of life either. Full text could not be read; appetite, weight and calorie details are from two reviews and ESMO 2021","yan_etki":"According to the Ceolin 2024 review, grade 3 nausea occurred only in the placebo group, and at most grade 2 side effects were reported in the nabilone group at week 8 (as reported in the review; full text could not be read)","pmid":"29550881","doi":"10.1007/s00520-018-4154-9","diger_kaynak":"ClinicalTrials.gov NCT02802540 (78 patients had been planned; no results in the registry)"},{"ad":"Dominiak 2023","tasarim":"Non-randomized, controlled pilot study","n":"32 (22 CBD / 10 control)","populasyon":"Cancer patients receiving oxaliplatin or paclitaxel chemotherapy (Denmark)","urun":"CBD oil made by the hospital pharmacy (THC content not stated in the publication)","urun_turu":"cbd_zengin_thc_belirsiz","doz":"150 mg twice a day (300 mg/day), 8 days in each chemotherapy cycle","titrasyon":null,"sure":"3 chemotherapy cycles","sonuc":"No difference between groups in lean body mass, the primary outcome (numbers not given in the publication); the ability to tell apart the intensity of tastes improved in the CBD group and was lost in the control group. Taste results are within-group comparisons; the control group was enrolled in the months before the CBD group, the sample stayed below the planned 25 people per group, and 21% of taste test questions went unanswered in the CBD group (2.4% in the control group)","yan_etki":"Not reported in this publication (according to the full text, side effects were recorded in CINCAN-2, the study of CBD for preventing neuropathy)","pmid":"37447339","doi":"10.3390/nu15133014","diger_kaynak":"ClinicalTrials.gov NCT04585841 (non-randomized design in the registry as well; no results in the registry)"},{"ad":"Mücke 2018","tasarim":"Systematic review and meta-analysis (palliative medicine)","n":"9 studies, 1561 participants","populasyon":"Palliative care (cancer subgroup)","urun":"Cannabinoids","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"In cancer patients, no difference from placebo in calorie intake, appetite, nausea and vomiting, pain or sleep problems (low/very low quality)","yan_etki":"In cancer, no difference in dizziness/mental health","pmid":"29400010","doi":"10.1002/jcsm.12273","diger_kaynak":null},{"ad":"Brisbois 2011","tasarim":"Double-blind, placebo-controlled, randomized pilot study (phase 2, two centers)","n":"46 randomized (24 dronabinol, 22 placebo); 21 people completed","populasyon":"Patients with advanced cancer with reduced appetite and taste and smell disorders (Canada)","urun":"Dronabinol (synthetic THC, oral capsule) and placebo","urun_turu":"thc_iceren","doz":"2.5 mg; once a day for the first 3 days, then twice a day; if needed, up to 20 mg a day","titrasyon":"Twice a day from day 4; increase up to at most 20 mg/day if the patient wished","sure":"18 days","sonuc":"Total calorie intake, the primary outcome in the registry, increased in both groups; no difference between groups. Quality of life also improved similarly in both groups. In the dronabinol group, improvement (p = 0.026) and enhancement (p < 0.001) of taste and smell perception, food tasting \"better\" (p = 0.04), appetite before meals (p = 0.05) and the share of calories from protein (p = 0.008) increased more than with placebo; sleep quality (p = 0.025) and relaxation (p = 0.045) were better. Very small and short; fewer than half of the patients completed","yan_etki":"No difference in side effects between groups was reported (as reported in a review; full text could not be read)","pmid":"21343383","doi":"10.1093/annonc/mdq727","diger_kaynak":"ClinicalTrials.gov NCT00316563 (primary outcome: total calorie intake; no results in the registry)"},{"ad":"Côté 2016","tasarim":"Double-blind, placebo-controlled RCT (single center)","n":"56 randomized (28 nabilone, 28 placebo); 24 people left before the end of the study","populasyon":"Patients with squamous cell head and neck cancer (mouth, pharynx, larynx) receiving radiotherapy (Canada)","urun":"Nabilone (a synthetic THC-like cannabinoid, by mouth) and placebo","urun_turu":"cbn_diger","doz":"Week 1: 0.5 mg at bedtime; week 2: 0.5 mg twice a day; after week 3, at most 2 mg/day (at most 4 tablets a day)","titrasyon":"Weekly increase; after week 3, dose adjusted by the radiation oncologist (at most 2 mg/day)","sure":"Throughout radiotherapy (about 7 weeks) + 4 weeks of follow-up","sonuc":"Primary outcome: the time to a 15% worsening of quality of life was not prolonged with nabilone (p = 0.43). No difference from placebo in loss of appetite (p = 0.33), weight (p = 0.15), pain (p = 0.60), nausea (p = 0.71), mood or sleep","yan_etki":"No difference from placebo in the frequency of drowsiness (p = 0.32), anxiety and dry mouth as side effects (as reported in the Ceolin 2024 review; Cochrane 2023 gives the same result for drowsiness and anxiety; full text could not be read)","pmid":"26503964","doi":"10.1177/0003489415612801","diger_kaynak":null},{"ad":"Hardy 2023 (MedCan1-CBD)","tasarim":"Double-blind, placebo-controlled, dose-escalation RCT (phase 2b, multicenter)","n":"144 randomized; 121 people in the primary analysis (58 CBD, 63 placebo)","populasyon":"Patients with advanced cancer and a high symptom burden receiving palliative care (Australia); not selected because of loss of appetite","urun":"Synthetic CBD oil 100 mg/mL (CBD produced by synthesis, not from the plant; as described in the MedCan2 publication) and placebo oil","urun_turu":"saf_cbd","doz":"Started at 0.5 mL (50 mg) once a day, up to at most 2 mL 3 times a day (600 mg/day); median dose chosen by patients 400 mg/day","titrasyon":"Increase based on response and side effects in the first 14 days, then 14 days at a fixed dose","sure":"28 days (primary outcome at day 14)","sonuc":"The primary outcome (total symptom burden, day 14) was no different with CBD than with placebo (change −3.0 vs. −6.2; p = 0.24). Appetite was a secondary outcome, as one of the 9 items of the scale (ESAS): all items, including appetite, improved in both groups, with no difference between the groups (no appetite-specific numbers in the abstract; the full text could not be read)","yan_etki":"Side effects did not differ between groups; only shortness of breath was more common in the CBD group","pmid":"36409969","doi":"10.1200/JCO.22.01632","diger_kaynak":"ANZCTR ACTRN12618001220257; protocol: Good 2019, PMID 31810437"},{"ad":"Hardy 2025 (MedCan2)","tasarim":"Double-blind, placebo-controlled, dose-escalation RCT (multicenter)","n":"144 randomized; 121 people in the day-14 analysis (56 THC:CBD, 65 placebo)","populasyon":"Patients with advanced cancer and a high symptom burden receiving palliative care (Australia); not selected because of loss of appetite","urun":"Plant-derived THC:CBD 1:1 oral oil (10 mg THC + 10 mg CBD per mL) and placebo oil","urun_turu":"thc_iceren","doz":"0.25–3 mL a day (between 2.5 + 2.5 mg and 30 + 30 mg THC + CBD); median dose chosen by patients 1.5 mL (15 mg THC + 15 mg CBD/day)","titrasyon":"Increase or decrease over 14 days on a set schedule based on response and side effects","sure":"28 days (primary outcome at day 14)","sonuc":"The primary outcome (total symptom burden, day 14) improved similarly in both groups (−6.30 vs. −6.98; p = 0.76). On the appetite item (0–10; a higher score means worse appetite), the score decreased by 0.19 with THC:CBD and by 0.69 with placebo (improvement in both groups); no difference (p = 0.32; baseline-adjusted p = 0.51). There was a small improvement in pain (p = 0.04); the difference in overall well-being favored placebo","yan_etki":"Mental side effects such as feeling intoxicated more common in the THC:CBD group; stopping before day 14, 22% vs. 10%, and before day 28, 54% vs. 31% (p = 0.007)","pmid":"40705150","doi":"10.1007/s00520-025-09763-5","diger_kaynak":"ANZCTR ACTRN12619000037101; funding: Australian government (MRFF); the manufacturer provided the drug and placebo and had no role in the study"},{"ad":"Zylla 2026 (CanPan)","tasarim":"Waitlist-controlled, open-label pilot RCT","n":"34 enrolled; 32 started (16 early, 16 delayed start)","populasyon":"Newly diagnosed locally advanced or metastatic pancreatic cancer, at least one symptom; moderate to severe loss of appetite in 69% (US, Minnesota)","urun":"Products chosen for each patient from the state medical cannabis program: THC-dominant or THC:CBD-balanced depending on the symptom (balanced products were recommended for loss of appetite and cachexia), CBD-dominant only for anxiety; by mouth, as a spray or inhaled","urun_turu":"thc_iceren","doz":"Individual; median THC 7.3 mg/day at week 8","titrasyon":"Started at a low dose and increased slowly as recommended by the pharmacist and the oncology team","sure":"8-week comparison period (16 weeks in total)","sonuc":"The feasibility goals, the primary outcome, were met. At week 8, appetite improved in 56% of the early-start group and 30% of the waiting group; the difference was not significant (p = 0.37). Numerical but non-significant differences in pain and insomnia as well. No placebo, and patients knew what they were using","yan_etki":"Worsening of cannabis-related complaints such as dry mouth similar in both groups (11% vs. 20%; p = 0.99)","pmid":"41510814","doi":"10.1200/OP-25-01165","diger_kaynak":"ClinicalTrials.gov NCT06605430 (registration given in the second publication); 16-week dose-response analysis: Gupta 2026, PMID 42767994"},{"ad":"Johnson 2010","tasarim":"Double-blind, placebo-controlled, three-arm RCT (multicenter)","n":"177 randomized (60 THC+CBD, 58 THC, 59 placebo); 144 completed; 54, 54 and 56 people in the appetite analysis","populasyon":"Patients with advanced (terminal) cancer whose pain was not adequately reduced despite strong opioids; not selected because of loss of appetite","urun":"THC+CBD mouth spray (nabiximols; 27 mg THC + 25 mg CBD per mL), THC-only cannabis extract spray (27 mg THC per mL) and placebo spray","urun_turu":"thc_iceren","doz":"One spray is 100 µL (2.7 mg THC + 2.5 mg CBD in the THC+CBD spray); at most 8 sprays in 3 hours and 48 sprays a day (at most 130 mg THC + 120 mg CBD a day)","titrasyon":"Patients adjusted the number of sprays themselves (within the upper limits)","sure":"2 weeks","sonuc":"On pain, the primary outcome, the THC+CBD spray was better than placebo (−1.37 vs. −0.69); with THC alone, the difference was not significant. The appetite score, a secondary outcome (0 very good, 10 very bad), worsened by 0.24 points with THC+CBD and by 0.18 points with THC alone over 2 weeks, while it improved by 1.65 points with placebo: the difference between THC+CBD and placebo was significant in favor of placebo (0.83; 95% CI 0.16–1.51; p = 0.016), and borderline for THC alone (0.66; −0.02 to 1.33; p = 0.056). The appetite result is not in the abstract of the publication; it was taken from the results in the ClinicalTrials.gov registry (it could not be verified in a peer-reviewed publication). No difference in sleep and nausea scores; the nausea-vomiting domain of the quality-of-life scale was worse with THC+CBD than with placebo (p = 0.02). The sponsor in the registry is the company that makes the drug","yan_etki":"Serious side effects in 13/60 patients with THC+CBD, 13/58 with THC alone and 7/59 with placebo (registry; relation to the drug not separated); according to the publication, most drug-related side effects were mild or moderate","pmid":"19896326","doi":"10.1016/j.jpainsymman.2009.06.008","diger_kaynak":"ClinicalTrials.gov NCT00674609 (results in the registry; appetite result only in the registry)"},{"ad":"Maida 2008","tasarim":"Prospective observational study: patients taking and not taking nabilone were compared after balancing with propensity scores (not randomized or blinded)","n":"47 nabilone, 65 patients not taking nabilone","populasyon":"Patients with advanced cancer with pain and other symptoms (Canada)","urun":"Nabilone (a synthetic THC-like cannabinoid, by mouth), added to existing treatment","urun_turu":"cbn_diger","doz":"Not reported (in the abstract)","titrasyon":null,"sure":"30 days","sonuc":"The primary outcomes were pain and opioid use (both lower in the nabilone group; p < 0.0001). The improvement in appetite was borderline and not statistically significant (p = 0.0516); nausea, anxiety and total symptom score were better in the nabilone group. Nabilone was not given randomly, and the study was not blinded; the groups were balanced with propensity scores","yan_etki":"Not reported (in the abstract)","pmid":"18402303","doi":null,"diger_kaynak":null},{"ad":"Bar-Sela 2019","tasarim":"Open-label, single-group pilot study (no comparison group)","n":"24 gave consent; 17 started; 11 people used it for more than 2 weeks; 6 people completed 6 months","populasyon":"Patients with advanced cancer with cancer-related anorexia-cachexia (Israel)","urun":"THC-rich cannabis extract capsule (9.5 mg THC + 0.5 mg CBD in the 10 mg capsule; half that in the 5 mg capsule)","urun_turu":"thc_iceren","doz":"Planned 10 mg twice a day; because of side effects, 5 mg once or twice a day in 13 of the 17 patients","titrasyon":"1 capsule a day for the first 2 weeks, then 2 if needed; lowered to the 5 mg capsule if side effects occurred","sure":"6 months (planned)","sonuc":"Primary outcome (weight gain of at least 10% from baseline): in 3 of the 6 patients who completed 6 months (17.6% of the 17 patients who started); in the 6-patient analysis, complaints in the appetite-loss domain of the quality-of-life scale decreased (p = 0.05). No control group, and most of those who started stopped. The study was funded by the company that makes the product; one of the authors is a company employee","yan_etki":"Side effects such as fatigue, dizziness, disorientation, anxiety and hallucinations in 3 of the 4 patients taking the 10 mg capsule; 3 (23%) of those taking 5 mg stopped with similar side effects","pmid":"31595793","doi":"10.1177/1534735419881498","diger_kaynak":"ClinicalTrials.gov NCT02359123 (no results in the registry)"},{"ad":"Simon 2022 (systematic review and meta-analysis)","tasarim":"Systematic review and meta-analysis (RCTs and non-randomized studies; search up to May 2020)","n":"10 studies: 4 RCTs (647 patients) and 6 non-randomized studies (157 patients)","populasyon":"Cancer-related cachexia and loss of appetite","urun":"Dronabinol, nabilone, THC, cannabis extract and medical cannabis","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"In the pooled analysis of 3 RCTs, no difference from placebo in appetite (SMD −0.02; 95% CI −0.51 to 0.46; very low certainty); no benefit for weight in two RCTs; quality of life was slightly worse with cannabinoids than in the control group (SMD −0.25; −0.43 to −0.07; moderate certainty). In non-randomized studies, patients reported improvement in appetite (uncontrolled, very low certainty)","yan_etki":"No significant difference in the number and severity of side effects in RCTs; in most non-randomized studies, most patients reported side effects","pmid":"34881518","doi":"10.1002/jcsm.12861","diger_kaynak":null},{"ad":"Razmovski-Naumovski 2022 (systematic review)","tasarim":"Systematic review (narrative synthesis and meta-analysis; search up to February 2021)","n":"5 RCTs","populasyon":"Appetite-related symptoms in cancer","urun":"Dronabinol, nabilone and cannabis extract (compared with placebo in 4 studies and with megestrol in 1 study)","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"Efficacy was shown in only 1 study (dronabinol): taste and smell perception and some secondary outcomes were better than with placebo. Evidence from RCTs that cannabinoids increase appetite in cancer is limited; measures, results and products vary widely","yan_etki":"Generally well tolerated regardless of product and dose; however, side effects were not measured comprehensively","pmid":"35360989","doi":"10.1177/02692163221083437","diger_kaynak":null},{"ad":"Creangă-Murariu 2025 (systematic review and meta-analysis)","tasarim":"Systematic review and meta-analysis (interventional and observational studies; search up to November 4, 2023)","n":"98 publications (all cancer symptoms); 3 studies in the appetite analysis","populasyon":"Symptom management in cancer patients","urun":"All types of cannabinoids (THC-dominant, CBD-dominant, balanced)","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"There is a trend toward improvement in appetite from baseline, but it is not statistically significant (pooled mean change from baseline −1.88; 95% CI −6.23 to 2.46; 3 single-group studies). Certainty of evidence low or very low for all outcomes; high risk of publication bias for appetite","yan_etki":"With THC-dominant products, the risk of psychiatric (OR 10.62; 1.35–83.57) and neurological (OR 2.24; 1.15–4.35) side effects increased","pmid":"40748522","doi":"10.1007/s11912-025-01695-x","diger_kaynak":"PROSPERO CRD42023479375"},{"ad":"Aviram 2022","tasarim":"Prospective observational cohort (multicenter; no comparison group)","n":"324 started; 212, 158 and 126 people responded at months 1, 3 and 6","populasyon":"Oncology patients receiving a medical cannabis license for the first time for cancer symptoms (Israel)","urun":"Licensed medical cannabis: dried flower (smoked or vaporized) or oil extract; at month 6, of those who reported their product, 61% used THC-dominant, 25% mixed and 15% CBD-dominant products (median 3 g of THC per month)","urun_turu":"thc_iceren","doz":"Individual; median 20 g of product per month","titrasyon":null,"sure":"6 months","sonuc":"At 6 months, total symptom burden decreased by a median of 18% from baseline (−18.98; 95% CI −26.95 to −11.00). Average weight and body mass index did not change (median 70 kg → 70 kg); there was a small but significant decrease in the distribution (−0.96 kg; −1.83 to −0.10). No control group; only 39% of those who started responded at month 6","yan_etki":"Side effects were common, but most were not serious and stayed stable throughout follow-up","pmid":"35669038","doi":"10.3389/fpain.2022.861037","diger_kaynak":"1-month study from the same research group: Aviram 2020, PMID 33265945 (108 patients; average weight did not change significantly)"},{"ad":"Kasvis 2022 (Quebec Cannabis Registry)","tasarim":"Patient registry analysis (prospective registry; no comparison group)","n":"358 (171 men, 187 women)","populasyon":"Patients starting medical cannabis for cancer symptoms (Canada, Quebec)","urun":"Medical cannabis: THC-dominant, THC:CBD-balanced or CBD-dominant products","urun_turu":"karma","doz":"Not reported (in the abstract)","titrasyon":null,"sure":"3 months","sonuc":"At 3 months, the appetite-loss score (ESAS-r, 0–10) decreased only in women (−1.7 ± 0.4; p < 0.001) and did not change significantly in men; CBD-dominant products did not provide significant symptom relief in either sex. No control group; results are patients' self-reports","yan_etki":"Not reported (in the abstract)","pmid":"35723729","doi":"10.1007/s00520-022-07193-1","diger_kaynak":null},{"ad":"Stienrut 2024 (Thai national cohort)","tasarim":"Prospective observational cohort (30 centers; no comparison group)","n":"21,284 patients, 2,873 with cancer; by week 12, 32% of participants had dropped out of follow-up","populasyon":"Patients prescribed cannabis oil by traditional Thai medicine practitioners for symptoms such as pain, loss of appetite and insomnia (Thailand); patients with cancer were not selected because of loss of appetite (mean baseline appetite-loss score 2.45/10)","urun":"Cannabis extract in coconut oil produced by the Ministry of Health (about 0.07 mg THC per drop; almost no CBD)","urun_turu":"thc_iceren","doz":"Most often 3 drops a day at bedtime (about 0.2 mg THC/day)","titrasyon":null,"sure":"3 months","sonuc":"In patients with cancer, the appetite-loss score (ESAS, 0–10) decreased by 1.67 points from baseline over 3 months (95% CI 1.56 to 1.78; baseline 2.45); by 1.12 points in patients without cancer. Weight change was not reported for the cancer subgroup. No control group; patients were not selected because of loss of appetite; the daily amount of THC was about 0.2 mg (far below the doses in the THC studies in the table; the authors write that the placebo effect may have influenced the results), and reasons for dropping out of follow-up were not recorded","yan_etki":"Side effects at 0.42% of 67,681 visits (most often dry mouth, dizziness, drowsiness); decreased appetite at 2 visits","pmid":"39144529","doi":"10.1159/000540153","diger_kaynak":"Thai Clinical Trials Registry TCTR20191231001. Funding: the Department of Thai Traditional and Alternative Medicine of the Ministry of Health, which also makes the product; 9 of the 13 authors work in this department; the authors declared no conflicts of interest"}],"ilgili_ilaclar":["kemoterapi","immunoterapi","tamoksifen","everolimus","varfarin","apiksaban","rivaroksaban"],"son_inceleme":"2026-10-30","arastirma_gecmisi":[{"tarih":"2026-10-19","not":"Page published. In this first assessment, 4 studies were reviewed."},{"tarih":"2026-10-21","not":"The full texts of the studies were reread and the information on the page was checked against its sources. Corrected: drug interaction notes. No points remain that could not be verified from the full text (previously 3 items). The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-21","not":"PubMed and ClinicalTrials.gov were searched for newly published and previously missed clinical studies. Study added: Dominiak 2023. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-22","not":"The names of the finding labels were simplified: on this page the \"No benefit seen\" label became \"No effect found.\" The assessment did not change."},{"tarih":"2026-10-27","not":"In October 2026, PubMed, Cochrane, ClinicalTrials.gov and Europe PMC were searched systematically; 13 studies were added: 6 randomized studies measuring appetite or taste perception in cancer patients (dronabinol, nabilone, pure CBD oil, an oil containing THC and CBD, a mouth spray containing THC and CBD, medical cannabis), 1 comparative observational study with nabilone, 1 open-label study with a THC-rich cannabis extract, 3 systematic reviews and 2 real-world studies. The product type of the nabilone study (Turcott 2018) was corrected; its result was completed to also show that, among the registered primary outcomes, there was no difference from placebo in appetite and weight. Group sizes, the weight result, limitations, the registry number or the second publication of the same trial were added to the Strasser 2006, Jatoi 2002 and Dominiak 2023 rows. It was added to the text that appetite was also measured in a pure CBD study in advanced cancer and was no different from placebo, and that in a study of cancer pain, appetite fared worse with a mouth spray containing THC and CBD than with placebo. Information that CBD may decrease appetite was added to the \"Who should be careful\" section (US product information for approved CBD; a review of 11 randomized studies, Pinto 2022). The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-28","not":"Display fix: internal working file names left in the text were removed; content and evidence did not change."},{"tarih":"2026-10-28","not":"The source of the side-effect information in the Côté 2016 and Turcott 2018 rows is now stated clearly: both are taken from the table of a systematic review (Ceolin 2024); the full texts of the studies could not be read. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-28","not":"October 2026 additional review: sources found for this page during the searches for other topics were read and added to the page. The nabilone dose in the Côté 2016 row was corrected based on the study characteristics table of Cochrane 2023 (after week 3, at most 2 mg/day, at most 4 tablets a day; the previous wording \"at most 1 mg twice a day\" was a review's interpretation). A cohort without a comparison group that followed 2,873 cancer patients in Thailand for 3 months (Stienrut 2024; about 0.2 mg of THC a day) was added; the improvement seen in the appetite-loss score cannot be attributed to the product because the dose was so low and the study was uncontrolled. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-30","not":"The frequently asked questions now explain why the strength of evidence for THC-containing products is “Very weak” on this page and “Weak” on the Loss of Appetite and Weight Loss page: in loss of appetite related to HIV/AIDS, appetite or the amount eaten increased in a few small controlled studies; in two large studies with cancer patients, however, THC did no better than either placebo or the appetite stimulant megestrol, and reviews rated the certainty of this result as low or very low. No new study was added; the conclusion and the strength of evidence did not change."},{"tarih":"2026-10-30","not":"The last sentence of the page's short summary was rewritten in a calmer, more guiding tone: instead of \"Talk to your doctor before you start.\", it now says whom you can talk with, and about what, if you are considering CBD. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-31","not":"The evidence level text now uses the same level name as the top of the page; the level and the result did not change."}]},{"id":"cancer-sleep-anxiety","baslik":"Cancer: sleep, anxiety and quality of life","grup":"Cancer","grup_kodu":"kanser","tr_id":"kanser-uyku-kaygi-yasam-kalitesi","kanit_duzeyi":"zayif","kanit_yonu":"yarar_gosterilmedi","kanit_ozet":"In advanced cancer, CBD oil did not improve total symptom burden, quality of life or anxiety more than placebo (MedCan1). A 1:1 THC:CBD oil also made no difference in total symptom burden. In studies of a THC+CBD spray for cancer pain, the Cochrane 2023 meta-analysis found no difference from placebo in sleep problems (4 RCTs, 1,314 people; SMD −0.06; moderate certainty); a 2022 meta-analysis calculated a 'very small' improvement (−0.19 cm on a 10 cm scale). In two small RCTs of CBD-dominant, low-THC capsules for chemotherapy-induced nerve damage, sleep was no better than placebo; in one, it went worse with cannabis. For anxiety before a scan, a single 400 mg dose of CBD was ineffective on the primary outcome. In patients with brain tumors, 600 mg/day of pure CBD for 3 weeks did not reduce anxiety and depression symptoms more than placebo (a small crossover RCT stopped early). There is no randomized THC study in cancer that targets psychological symptoms as its primary goal; there is only a small placebo-controlled pilot from 1974 in 12 anxious lung cancer patients, with randomization not stated (THC improved night-time sleep but caused tiredness and confusion; its effect on anxiety was not reported in the abstract, and there are no numerical results). In two THC/nabilone RCTs that used quality of life as their main measure (243 and 56 patients), there was no difference from placebo; in a pooled analysis of cachexia RCTs, quality of life improved slightly less with cannabinoids than in those taking placebo or an appetite-stimulating drug (megestrol) (SMD −0.25). For psychological symptoms in cancer, the MASCC 2023 guideline reviewed 15 RCTs and wrote that none of them used these symptoms as the primary outcome and that there is no high-quality evidence sufficient to recommend cannabis; a 2024 meta-analysis also found no clinically meaningful effect on depression, anxiety or stress. Patient registries in Israel, Canada, the US, the UK and Thailand reported improvement from baseline in anxiety, sleep and quality of life; but these studies had no comparison group, in most of them patients mainly used THC products, patients who died or stopped were not included in the analysis, and some were run by authors linked to organizations that make or prescribe cannabis products. In the Thai cohort (2,873 cancer patients; quality of life +0.13, anxiety −1.46 points; sleep not measured separately), the daily amount of THC in the oil used was only about 0.2 mg, and the public agency that makes the product funded the study; the authors also point to the possible share of the placebo effect. October 2026 search (PubMed, Cochrane, ClinicalTrials.gov): 13 studies with cannabinoids that had a comparison group (11 placebo-controlled, 1 waitlist-controlled, 1 comparing two THC:CBD ratios) and 8 systematic reviews were found on this topic; all are in the table below. The table also includes 1 open-label study, 8 observational studies and 2 safety sub-analyses of the same trials. Four cancer pain RCTs that examined sleep only as a secondary measure were not listed one by one; their sleep results are included in pooled form in the Cochrane review in the table.","kanit_duzeyi_metin":"Weak (pure CBD: anxiety and quality of life); there is no pure CBD study that targets sleep as its main goal; all 3 placebo-controlled studies with pure CBD found no difference from placebo on their main measure","kanit_duzeyi_thc_icerenler":"zayif","kanit_duzeyi_thc_icerenler_metin":"Moderate for sleep (effect very small or absent; from cancer pain studies); very low for anxiety and depression (no randomized study used these symptoms as its main measure; studies that looked at them as a secondary measure found no significant difference from placebo); low for quality of life (no benefit or a small negative effect)","kaynak_dosya":"kanser-destek.md","saf_cbd_sonuc":"Pure CBD oil was no different from placebo for anxiety, quality of life or total symptom burden in advanced cancer; in brain tumors, 600 mg/day also did not reduce anxiety; in breast cancer, a single 400 mg dose before imaging was no different from placebo for anxiety on the main measure (in an exploratory comparison, the anxiety level after the dose was lower in the CBD group); there is no pure CBD study that targets sleep as its main goal (in a small open-label study done for joint pain, sleep and anxiety did not change when all participants were analyzed together). In real-world data, sleep and anxiety improved slightly more in those taking higher CBD doses, but most of these patients were using THC-dominant products and there was no comparison group; in one patient registry, CBD-dominant products did not bring clear relief.","thc_icerenler_sonuc":"A 1:1 THC:CBD oil did not change total symptom burden; it was also no different from placebo for anxiety, depression or quality of life (on the quality-of-life scale, only the pain domain favored the THC oil), and general well-being improved more with placebo on day 14. In analyses pooling placebo-controlled studies for cancer pain, there was either no difference in sleep (Cochrane 2023: 4 studies, 1,314 people) or a very small improvement (2022 meta-analysis: −0.19 cm on a 10 cm scale); in two small studies of CBD-dominant, low-THC capsules for nerve damage, sleep was no better than placebo, and in one it was worse. In studies that used quality of life as their main measure, THC, cannabis extract or the THC-like drug nabilone was no different from placebo; in a pooled analysis of cachexia studies, quality of life improved slightly less in those taking cannabinoids than in those taking placebo or an appetite-stimulating drug (megestrol). Real-world registries reported improvement in anxiety, sleep and quality of life, but there was no comparison group.","ruhsat":null,"doz_araligi_ozet":"Pure CBD: 50–600 mg/day (MedCan1, median chosen dose 400 mg/day), 600 mg/day in brain tumors (3 weeks), single dose 400 mg (Nayak 2024), 200 mg/day for joint pain in breast cancer (15 weeks, open-label; Fleege 2025); THC-containing 1:1 oil: from 2.5+2.5 mg up to 30+30 mg/day; THC or cannabis extract (2.5 mg THC, + 1 mg CBD in the extract) 2 times a day (Strasser 2006, Brisbois 2011); nabilone starting at 0.5 mg, up to 2 mg/day (Côté 2016)","titrasyon_ozet":"MedCan1: increased every 3 days; MedCan2: increased over 14 days according to tolerance/effect","yan_etkiler":["Pure CBD: no difference between arms, dyspnea more frequent (Hardy 2023)","THC-containing: confusion, feeling 'high', exaggerated sense of well-being (Hardy 2025)","In the short term (≤600 mg/day, 28 days), no rise in liver enzymes was seen in cancer patients (Scarborough 2026)","THC-dominant products: increased risk of psychiatric side effects (meta-analysis, OR 10.62; wide confidence interval); anxiety events more frequent with high-dose synthetic THC (OR 2.0; very low certainty) (Creangă-Murariu 2025, Crichton 2024)"],"izlem":["Prescription CBD label: liver tests at baseline, at months 1, 3 and 6, then periodically; stop if ALT/AST >3× ULN + bilirubin >2× ULN, or if transaminases stay >5× ULN","INR in people taking warfarin","Drug blood levels in people taking everolimus/tacrolimus/sirolimus"],"dikkat":["Liver disease / liver metastases / hepatotoxic treatment: with prescription CBD, ALT >3× ULN in 12–13% (placebo 1%), dose-related; in moderate/severe hepatic impairment, the label specifies a lower starting dose","People taking warfarin or clopidogrel and those at high risk of bleeding: there is an interaction mechanism (CYP2C9, CYP2C19); no clinical data have been reported showing that CBD directly increases bleeding risk","Before surgery/procedures: ASRA 2023 recommends asking about cannabinoid use and including it in the anesthesia plan; the anesthesia team must be told","People receiving immunotherapy (checkpoint inhibitors): there is an observational signal and a guideline warning","People taking everolimus, tacrolimus, sirolimus or oral targeted drugs: should not be added without consulting the oncologist/pharmacist","Older adults, people taking many medicines, people on sedatives/opioids: risk of somnolence, dizziness and falls; with THC-containing products, confusion and psychotomimetic effects","Use to 'treat' tumors: uncontrolled case series are not evidence; according to ASCO, stopping standard treatment is strongly advised against","Pregnancy/breastfeeding, history of psychiatric illness (for THC-containing products): cancer studies excluded these groups"],"ilac_etkilesim_notlari":["Everolimus: exposure increased ~2.5-fold; label: start everolimus at a lower dose, monitor levels (high; human PK data)","Tacrolimus, sirolimus, digoxin (P-gp substrates): the label states that their levels may rise (moderate)","Oral chemotherapy/targeted drugs that are P-gp substrates (e.g., many tyrosine kinase inhibitors): theoretical; no human data","CYP2C19 substrates and prodrugs (clopidogrel): substrate levels rise, and the active metabolite of prodrugs may fall; no human data for cancer drugs","Warfarin: case report of INR elevation; INR should be monitored","CYP3A4 substrates (taxanes, irinotecan, docetaxel, many TKIs): on the label, midazolam was unchanged (licensed CBD 750 mg twice daily); a single dose of a CBD-dominant extract (640 mg CBD + 20 mg THC) increased midazolam AUC by 56% (Bansal 2023, PMID 37313955); herbal cannabis tea did not affect irinotecan and docetaxel PK (n=24); nabiximols did not affect temozolomide PK; these results cannot be generalized","Immunotherapy: in people using cannabis (mostly THC-containing), the nivolumab response rate was 15.9% versus 37.5% (Taha 2019, PMID 30670598, n=140); in a prospective observational study, time to progression and survival were shorter (Bar-Sela 2020, PMID 32872248, n=102); causation not proven, no data specific to pure CBD","Opioids: in MedCan1, CBD dose was unrelated to opioid use; no opioid-sparing effect was shown with THC-containing products; somnolence increases with CNS depressants","Citalopram/escitalopram: in 6 patients who added CBD (200–800 mg/day), citalopram levels rose significantly (Anderson 2021, PMID 34121064)","Valproate and liver-toxic drugs (some chemotherapies, methotrexate): no data on use together with hepatotoxic chemotherapies","Tamoxifen: in one case, endoxifen was found to be low with 40 mg/day CBD (Parihar 2020, PMID 33191836)","No clinical studies have been reported with direct oral anticoagulants (apixaban, rivaroxaban)"],"dogrulanamayan":["MedCan3 (THC/CBD 1:20) is ongoing: 128 of the target 150 patients have been enrolled (ANZCTR, September 23, 2026), and the last patient is expected to be enrolled in June 2027; no results (protocol PMID 38693590)","Related studies on ClinicalTrials.gov that were completed or ended early but whose results had not been published as of October 2026: a 91-person N-of-1 study of cannabis oil for cancer symptoms (NCT03948074; a symptom scale that also includes sleep and anxiety; finished in July 2025), a phase 3 dronabinol–placebo study in pancreatic cancer (NCT03984214; 109 patients; main measure the symptom score of a quality-of-life scale; finished in September 2024), a quality-of-life study with cannabinoids in Germany (NCT06097533; 79 patients; ended early in February 2026) and a CBD study for anxiety in glioblastoma (NCT05753007; ended with 2 participants). Their results could not be included in the table.","The full text of some studies is not open access: for MedCan1 (Hardy 2023), Strasser 2006, Brisbois 2011, Côté 2016, Turcott 2018, Zylla 2026, Haney 2025, Maida 2008, Kasvis 2022, Bar-Lev Schleider 2018, Varadpande 2025, the MASCC 2023 guideline, Crichton 2024 and AminiLari 2022, only the abstract, the registry entry or reports in reviews were read. For Davies 1974, only the abstract could be read (the full-text file could not be opened because it required human verification). A 1976 publication on the psychological effects of THC in patients with advanced cancer (Noyes 1976) has no abstract on PubMed; because it could not be read, it was not included in the table."],"calismalar":[{"ad":"Hardy 2023 (MedCan1-CBD)","tasarim":"Phase IIb, double-blind, placebo-controlled, dose-escalation RCT","n":"144 randomized (58 CBD / 63 placebo in the primary analysis)","populasyon":"Advanced cancer, palliative care, ESAS ≥10/90","urun":"Synthetic CBD oil 100 mg/mL (CBD made by synthesis, not from the plant; as described in the MedCan2 publication) and placebo oil","urun_turu":"saf_cbd","doz":"Starting at 0.5 mL once a day (50 mg/day) → 2 mL 3 times a day (600 mg/day); median chosen by patients 400 mg/day","titrasyon":"Increased every 3 days (ASCO 2024 text)","sure":"28 days (primary: day 14)","sonuc":"On day 14, the change in total symptom distress score was −3.0 with CBD and −6.2 with placebo (p=0.24, no difference). Responder rate 44.8% vs 58.7% (p=0.13). No effect on quality of life, depression or anxiety (on day 28, change in anxiety CBD −1.10, placebo −0.79; depression −0.50 and −0.63; as reported by Cochrane 2023); sleep was not measured separately. The share of patients who felt better or much better on day 14 was 53% in the CBD group and 65% in the placebo group; on day 28, 70% and 64%","yan_etki":"No difference between arms; dyspnea more frequent with CBD","pmid":"36409969","doi":"10.1200/JCO.22.01632","diger_kaynak":"ANZCTR ACTRN12618001220257; protocol: Good 2019, PMID 31810437. Secondary analyses of the same trial: Downs 2026 and Scarborough 2026 (in this table), O'Leary 2024 (PMID 38307703; disease progression and survival)"},{"ad":"Hardy 2025 (MedCan2)","tasarim":"Double-blind, placebo-controlled RCT","n":"144 randomized; 121 in the day-14 analysis (56 THC:CBD, 65 placebo)","populasyon":"Advanced cancer, palliative care","urun":"Oil: THC 10 mg + CBD 10 mg/mL (1:1)","urun_turu":"thc_iceren","doz":"Starting at 0.25 mL/day (2.5 mg THC + 2.5 mg CBD) → 3 mL/day (30 mg + 30 mg); median dose chosen by patients 1.5 mL (15 mg THC + 15 mg CBD/day)","titrasyon":"Increased over 14 days according to tolerance/effect","sure":"28 days","sonuc":"No difference in total symptom distress (p=0.76). Small benefit in ESAS pain (−1.42 vs −0.46; p=0.04), at the cost of more psychotomimetic toxicity. No difference in anxiety (−1.46 vs −1.17; p = 0.48) or depression (p = 0.21) scores; general well-being improved more in the placebo group on day 14 (baseline-adjusted p = 0.02; no difference left on day 28). On the quality-of-life scale (EORTC QLQ-C15-PAL), only the pain domain favored THC:CBD; no difference on the depression-anxiety-stress scale (DASS). On day 28, the share who felt better was higher in the THC:CBD group (88% vs 66%; p = 0.05), but those who stopped early were not included in this analysis. No opioid-sparing effect","yan_etki":"Confusion, feeling 'high', exaggerated sense of well-being more frequent; most grade 1–2","pmid":"40705150","doi":"10.1007/s00520-025-09763-5","diger_kaynak":"ANZCTR ACTRN12619000037101; funding from the Australian government (MRFF); the manufacturer supplied the drug and placebo and had no role in the study"},{"ad":"Nayak 2024","tasarim":"Phase 2, double-blind, placebo-controlled RCT","n":"50 randomized (25 CBD, 25 placebo)","populasyon":"Women with advanced breast cancer and clinical anxiety","urun":"FDA-approved CBD (oral, pure)","urun_turu":"saf_cbd","doz":"400 mg single dose","titrasyon":"None","sure":"Single dose before a scan (imaging)","sonuc":"The primary outcome (change on the fear subscale from before to 2–4 hours after the dose) did not differ between groups (−19.1 vs −15.0; p = 0.37). In a secondary (exploratory) comparison, the anxiety score 2–4 hours after the dose was lower in the CBD group (51.5 vs 58.0; p = 0.02); this was not the prespecified main outcome","yan_etki":"No grade 3–4 toxicity. Mild or moderate side effects in 2 people in the CBD group: grade 1 nausea in 1 person, grade 2 nausea and pain in 1 person (possibly drug-related according to the authors); in the registry's 1-week side-effect table, 1 nausea and 1 pain in the CBD group and no side effects in the placebo group","pmid":"39680411","doi":"10.1001/jamanetworkopen.2024.50391","diger_kaynak":"ClinicalTrials.gov NCT04482244 (results in the registry). Funding: two foundation grants"},{"ad":"Belgers 2026","tasarim":"Double-blind, placebo-controlled crossover RCT; stopped early because of low enrollment (research letter)","n":"20 randomized (15 completed)","populasyon":"Adults with a primary brain tumor and stable disease who had significant anxiety","urun":"Pure CBD tablet (>99% CBD, <0.1% THC)","urun_turu":"saf_cbd","doz":"600 mg/day","titrasyon":null,"sure":"2 × 3 weeks (at least 2 weeks of washout)","sonuc":"Anxiety and depression symptoms fell more with placebo; the probability that CBD was beneficial was 19% for anxiety and 11% for depression (Bayesian analysis); at the end of 3 weeks, significant anxiety was present in 50% after placebo and 59% after CBD","yan_etki":"Side effects mild and similar (CBD 3 events, one of them grade 3; placebo 6 events); 1 rash during CBD","pmid":"42750778","doi":"10.1093/nop/npag025","diger_kaynak":"Netherlands Trial Register NL9623 (GRASS study). Funding: Anita Veldman Foundation; the authors reported no conflicts of interest"},{"ad":"Davies 1974","tasarim":"Placebo-controlled crossover pilot study (randomization and blinding not stated in the abstract)","n":"12 (two groups of 6)","populasyon":"Anxious patients receiving radiation therapy in hospital for inoperable lung (bronchial) cancer (United Kingdom)","urun":"Oral THC (named Δ1-trans-THC in the publication, Δ9-THC in today's naming) and placebo","urun_turu":"thc_iceren","doz":"10 mg/day, 7 days","titrasyon":"None (fixed dose)","sure":"2 × 7 days (with a 7-day gap between them)","sonuc":"THC caused drowsiness, improved night-time sleep and reduced pain; but on mood scales, tiredness and confusion increased, and cheerfulness and vigor decreased. Whether anxiety changed is not reported in the abstract. According to the authors, caring for stressed patients became easier. The abstract has no numerical results or statistics; a very small study from 1974","yan_etki":"Drowsiness, tiredness, confusion; mild increase in heart rate and drop in blood pressure (also seen during the placebo period)","pmid":"22454883","doi":"10.1111/j.1365-2125.1974.tb00257.x","diger_kaynak":null},{"ad":"Strasser 2006 (Cannabis-In-Cachexia-Study-Group)","tasarim":"Multicenter, double-blind, placebo-controlled phase 3 RCT (3 groups; stopped early on the recommendation of an independent committee)","n":"243 randomized (95 cannabis extract, 100 THC, 48 placebo); 164 completed","populasyon":"Patients with advanced cancer and cancer-related anorexia-cachexia syndrome (at least 5% weight loss in the past 6 months)","urun":"Oral cannabis extract (2.5 mg THC + 1 mg CBD) or THC (2.5 mg) and placebo","urun_turu":"thc_iceren","doz":"2 times a day, 6 weeks","titrasyon":"None (fixed dose)","sure":"6 weeks","sonuc":"No difference among the three groups in the co-primary outcomes of appetite and quality of life (EORTC QLQ-C30 global health and quality-of-life score). In mood measured daily, improvement was reported by 60% with cannabis extract, 46% with THC and 64% with placebo (p = 0.46; as reported by Mücke 2018). Because it became clear that no meaningful difference between groups would emerge, the independent committee recommended stopping enrollment","yan_etki":"No difference between groups in cannabinoid-related side effects","pmid":"16849753","doi":"10.1200/JCO.2005.05.1847","diger_kaynak":null},{"ad":"Brisbois 2011","tasarim":"Double-blind, placebo-controlled, randomized pilot study (phase 2, two centers)","n":"46 randomized (24 dronabinol, 22 placebo); 21 completed","populasyon":"Patients with advanced cancer with reduced appetite and taste and smell disturbances (Canada)","urun":"Dronabinol (synthetic THC, oral capsule) and placebo","urun_turu":"thc_iceren","doz":"2.5 mg; once a day for the first 3 days, then 2 times a day; up to 20 mg a day if needed","titrasyon":"2 times a day from day 4; increase up to 20 mg/day at the patient's request","sure":"18 days","sonuc":"Quality of life, one of the study's aims, improved in both groups; no difference between groups. In the dronabinol group, sleep quality (p = 0.025) and relaxation (p = 0.045) were better than with placebo; taste and smell perception and the enjoyment of food were also rated better. Very small and short; 21 of 46 people completed","yan_etki":"No details in the abstract","pmid":"21343383","doi":"10.1093/annonc/mdq727","diger_kaynak":"ClinicalTrials.gov NCT00316563 (primary outcome: total calorie intake; no results in the registry)"},{"ad":"Côté 2016","tasarim":"Double-blind, placebo-controlled RCT (single center)","n":"56 randomized (28 nabilone, 28 placebo); 24 left before the end of the study","populasyon":"Patients with squamous cell cancer of the head and neck (mouth, pharynx, larynx) receiving radiation therapy (Canada)","urun":"Nabilone (THC-like synthetic cannabinoid, by mouth) and placebo","urun_turu":"cbn_diger","doz":"Week 1: 0.5 mg at bedtime; week 2: 0.5 mg 2 times a day; from week 3: up to 2 mg/day","titrasyon":"Weekly increase; from week 3, dose adjusted by the radiation oncologist","sure":"Throughout radiation therapy (about 7 weeks) + 4 weeks of follow-up","sonuc":"Primary outcome: the time until a 15% worsening of quality of life was not extended by nabilone (p = 0.43). No difference from placebo in mood (p = 0.32), sleep (p = 0.44), pain (p = 0.60), nausea (p = 0.71), appetite (p = 0.33) or weight (p = 0.15). Anxiety was not measured as an efficacy outcome","yan_etki":"No difference from placebo in the frequency of drowsiness (p = 0.32) and anxiety (p = 0.91) as side effects (as reported by Cochrane 2023; the full text could not be read)","pmid":"26503964","doi":"10.1177/0003489415612801","diger_kaynak":"Funding: Canadian public research funds; the manufacturer supplied the nabilone and placebo (as reported by Cochrane 2023)"},{"ad":"Turcott 2018","tasarim":"Double-blind, placebo-controlled RCT (single center)","n":"47 randomized; 33 analyzed (14 nabilone, 19 placebo)","populasyon":"Patients with advanced non-small cell lung cancer and loss of appetite (Mexico)","urun":"Nabilone (THC-like synthetic cannabinoid, oral capsule) and placebo","urun_turu":"cbn_diger","doz":"0.5 mg for 2 weeks, then 1 mg for 6 weeks","titrasyon":"Dose increase after week 2","sure":"8 weeks","sonuc":"Quality of life (one of the study's three aims) was compared only within each group: in the nabilone group, role (p = 0.030), emotional (p = 0.018) and social functioning (p = 0.036) and insomnia (p = 0.020) improved, while in the placebo group they did not change; a direct comparison of the two groups is not in the abstract. The insomnia score (0–100) changed by −40.7 with nabilone and −9.9 with placebo (as reported by Cochrane 2023). No difference from placebo in appetite or weight; the full text could not be read","yan_etki":"The abstract reports that treatment was safe; no details on side effects in the sources read (the full text could not be read)","pmid":"29550881","doi":"10.1007/s00520-018-4154-9","diger_kaynak":"ClinicalTrials.gov NCT02802540 (78 patients had been planned; quality-of-life domains were secondary outcomes; no results in the registry). The manufacturer donated the nabilone and placebo and had no role in the study (as reported by Cochrane 2023)"},{"ad":"Schloss 2021","tasarim":"Double-blind, randomized phase 2 study comparing two THC:CBD ratios (no placebo group; control group from past patient records for secondary outcomes)","n":"88 enrolled; 83 completed at least 4 weeks (41 on 1:1, 42 on 4:1); 61 at week 12","populasyon":"Adults with high-grade glioma (glioblastoma or grade 3 astrocytoma) taking cannabis in addition to standard treatment (Australia)","urun":"Oral whole-plant cannabis oil: 1:1 (4.6 mg THC + 4.8 mg CBD per mL) or 4:1 (15 mg THC + 3.8 mg CBD per mL); single dose at night","urun_turu":"thc_iceren","doz":"Mean tolerated dose 2.25 mL/day of the 1:1 oil (10.4 mg THC + 10.8 mg CBD), 1.8 mL/day of the 4:1 oil (27 mg THC + 6.8 mg CBD)","titrasyon":"Night-time dose adjusted according to side effects","sure":"12 weeks","sonuc":"The primary outcomes were tolerability and quality of life (FACT-Br). Both ratios were well tolerated; the total quality-of-life score did not change clearly with either ratio (1:1: 92.8 → 91.2; 4:1: 93.6 → 87.9; between groups p = 0.90); the sleep item improved in both groups (p = 0.009), and the physical and functional domains were better with the 1:1 ratio. Because there was no placebo group, it cannot be told whether the improvement came from cannabis or from other factors; the abstract's statement that it \"significantly improved quality of life\" is not supported by the total score","yan_etki":"No serious side effects; dry mouth 13%, night-time tiredness 11%, dizziness 10%, drowsiness 7%; at week 8, mild night-time hallucinations, suspiciousness or excessive cheerfulness in 4 people (6%); dose reduced in 3 people","pmid":"34094937","doi":"10.3389/fonc.2021.649555","diger_kaynak":"ANZCTR ACTRN12617001287325. Funding: the company that supplied the product (Bioceuticals); the authors reported no conflicts of interest"},{"ad":"Zylla 2026 (CanPan)","tasarim":"Waitlist-controlled, open-label pilot RCT","n":"34 enrolled; 32 started (16 early start, 16 delayed start)","populasyon":"Newly diagnosed locally advanced or metastatic pancreatic cancer, at least one symptom; moderate-to-severe insomnia in 85% (US, Minnesota)","urun":"Products chosen for each patient from the state medical cannabis program (THC-dominant, balanced THC:CBD or CBD-dominant; by mouth, spray or inhaled)","urun_turu":"thc_iceren","doz":"Individual; median THC at week 8: 7.3 mg/day","titrasyon":"Start at a low dose and increase slowly on the advice of the pharmacist and oncology team","sure":"8-week comparison period (16 weeks in total)","sonuc":"Feasibility goals, the primary outcome, were met. At week 8, improvement in insomnia was 67% in the early-start group and 30% in the waiting group (p = 0.18; not significant); numerical but non-significant differences also in pain and appetite. No placebo; patients knew what they were taking. In a second, 16-week analysis (16 patients with complete data), those with higher daily THC doses had greater improvement in anxiety (r = 0.52; p = 0.038) and insomnia (r = 0.53; p = 0.033); this is an association without a comparison","yan_etki":"Worsening of cannabis-related complaints such as dry mouth was similar in the two groups (11% vs 20%; p = 0.99)","pmid":"41510814","doi":"10.1200/OP-25-01165","diger_kaynak":"ClinicalTrials.gov NCT06605430 (registration given in the second publication); 16-week dose–response analysis: Gupta 2026, PMID 42767994. A cannabis company supplied the products; funding was a donation; no conflicts of interest reported"},{"ad":"Weiss 2025","tasarim":"Double-blind, placebo-controlled RCT (the target of 100 people was not reached)","n":"46 randomized; 43 completed (23 active, 20 placebo)","populasyon":"Patients with non-metastatic breast, colorectal, endometrial or ovarian cancer who had finished chemotherapy and had grade 2–3 chemotherapy-related nerve damage (neuropathy) (88% women; US)","urun":"Oral hemp extract gel capsule, CBD-dominant with a little THC; placebo","urun_turu":"thc_iceren","doz":"After week 1, 125–136 mg CBD + 6–11 mg THC a day","titrasyon":"Days 1–3: 1 capsule 3 times a day; days 4–6: 2 capsules 3 times a day; from day 7: 3 capsules 3 times a day","sure":"12 weeks","sonuc":"The primary outcome was sensory symptoms of neuropathy (no difference in the primary analysis). Of this topic's secondary measures, there was no significant difference between groups in sleep disturbance (PROMIS): at 12 weeks, the placebo group improved slightly more (p = 0.13); in a mixed model adjusted for the baseline difference, the difference favored the active group but was again not significant (−2.6; 95% CI −6.0 to 0.9; p = 0.14). Quality of life (QLQ-C30 summary score p = 0.46; global health p = 0.33) did not differ. Half the targeted number of people was reached","yan_etki":"No difference in side effects between groups; no serious side effects","pmid":"41211445","doi":"10.3389/fonc.2025.1590168","diger_kaynak":"ClinicalTrials.gov NCT04398446 (no results in the registry). The company that supplied the products was among the funders; the authors reported no conflicts of interest"},{"ad":"Haney 2025","tasarim":"Double-blind, placebo-controlled pilot RCT (feasibility)","n":"12 (6 active, 6 placebo); all completed","populasyon":"Women with breast cancer and painful taxane-related nerve damage (neuropathy) (US)","urun":"Oral cannabis capsule (100 mg CBD + 5 mg THC per capsule) and placebo","urun_turu":"thc_iceren","doz":"1 capsule 3 times a day (300 mg CBD + 15 mg THC/day); patients in both groups asked to reduce the dose","titrasyon":"Dose reduction at the patient's request","sure":"8 weeks","sonuc":"Sleep, pain and functional well-being improved over time in both groups; but sleep scores went worse in the cannabis group than with placebo (p < 0.05), and functional well-being was lower in the last 3 weeks (p < 0.02); neuropathy scores were worse than placebo every week. No sign of benefit was seen; a very small feasibility study","yan_etki":"Well tolerated according to the authors; requests for dose reduction in both groups","pmid":"40611810","doi":"10.1089/can.2025.0028","diger_kaynak":"ClinicalTrials.gov NCT03782402 (terminated with 12 people; results in the registry)"},{"ad":"Fleege 2025","tasarim":"Open-label, single-arm phase 2 pilot study (no comparison group)","n":"39 started; 28 completed (5 stopped because of side effects, 6 because they saw no benefit)","populasyon":"Women with stage 0–3 hormone receptor-positive breast cancer and aromatase inhibitor-related joint and muscle pain (US)","urun":"FDA-approved pure CBD medicine (oral solution)","urun_turu":"saf_cbd","doz":"Started at 25 mg 2 times a day and increased over 4 weeks to 100 mg 2 times a day (200 mg/day)","titrasyon":"If tolerated, increased by 25 mg 2 times a day once a week","sure":"15 weeks","sonuc":"The primary outcome was pain (worst pain fell by at least 2 points in 17 of 39 people). In this topic's secondary measures, anxiety and sleep disturbance did not change in the analysis of all participants (38 people); improvement in anxiety, sleep disturbance and fatigue was seen only in the 28 people who completed 15 weeks (completers are a selected group). Participants' average baseline anxiety score was close to that of the general population (PROMIS T score 49.5). No comparison group","yan_etki":"40 side effects in 18 patients (46%), all grade 1–2; 5 people stopped because of side effects","pmid":"40751295","doi":"10.1002/cam4.71117","diger_kaynak":"ClinicalTrials.gov NCT04754399 (results in the registry: at week 15, PROMIS anxiety T score −3.4, depression −1.7). Funding: public and foundation funds"},{"ad":"De Feo 2023 (MASCC guideline)","tasarim":"Systematic review and expert guideline (MASCC; RCTs and systematic reviews; search up to November 12, 2021)","n":"15 RCTs and 2 systematic reviews (of the RCTs, 4 on sleep, 5 on mood, 6 on both)","populasyon":"Anxiety, depression and insomnia in cancer patients","urun":"Cannabis and cannabinoid products (product breakdown not in the abstract)","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"No study in cancer patients used psychological symptoms as the primary outcome. 6 of the 15 RCTs showed a sign of benefit (5 for sleep, 1 for mood); the studies differed greatly in product, comparison, duration and measurement tools. The guideline's conclusion: there is no high-quality evidence sufficient to recommend cannabis for psychological symptoms in cancer","yan_etki":null,"pmid":"36809575","doi":"10.1007/s00520-023-07628-3","diger_kaynak":null},{"ad":"Crichton 2024","tasarim":"Systematic review and meta-analysis of intervention studies (5 databases; up to May 2023; GRADE)","n":"15 studies (11 randomized, 4 non-randomized), 18 interventions, 1,898 participants","populasyon":"Depression, anxiety and stress in cancer patients","urun":"THC (70% synthetic), synthetic CBD (with or without THC) and whole-plant extracts","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"No clinically meaningful effect on the primary outcomes (depression, anxiety, stress); also no effect on emotional functioning, mood changes or quality of life. Anxiety events were more frequent with high-dose synthetic THC than with low doses (OR 2.0; 95% CI 1.4–2.9; very low certainty). The authors concluded that the evidence for efficacy and safety is insufficient","yan_etki":"Side effects, including anxiety, more frequent with high-dose synthetic THC (very low certainty)","pmid":"38430618","doi":"10.1016/j.maturitas.2024.107941","diger_kaynak":null},{"ad":"Creangă-Murariu 2025","tasarim":"Systematic review and meta-analysis (interventional and observational studies; search up to November 4, 2023)","n":"98 publications (all cancer symptoms); 1,039 patients from single-arm studies in the anxiety analysis","populasyon":"Symptom management in cancer patients","urun":"All types of cannabinoids (THC-dominant, CBD-dominant, balanced)","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"Anxiety and insomnia were pooled only from single-arm studies, against baseline: anxiety fell (mean change −1.30; 95% CI −2.22 to −0.39; very high inconsistency between studies, I² 100%), while the improvement in insomnia was not significant (−1.08; −2.48 to 0.33); these are not placebo comparisons. In comparisons with placebo, there was no difference in depression (MD 0.60; −0.65 to 1.86) or overall quality of life (MD 0.16; −0.02 to 0.35). Certainty of evidence was low or very low for all outcomes; risk of publication bias was high for anxiety, insomnia and quality of life","yan_etki":"With THC-dominant products, the risk of psychiatric (OR 10.62; 1.35–83.57) and neurological (OR 2.24; 1.15–4.35) side effects increased","pmid":"40748522","doi":"10.1007/s11912-025-01695-x","diger_kaynak":"PROSPERO CRD42023479375"},{"ad":"Häuser 2023 (Cochrane)","tasarim":"Cochrane systematic review and meta-analysis (double-blind RCTs; search January 26, 2023)","n":"14 RCTs, 1,823 participants; sleep analysis included 4 RCTs, 1,314 people","populasyon":"Adults with cancer pain (sleep problems, depression and anxiety as secondary outcomes)","urun":"Nabiximols (THC+CBD mouth spray), THC, nabilone and other synthetic THC analogs, CBD oil","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"In cancer pain not responding to opioids, THC+CBD spray or THC gave no benefit over placebo for sleep problems (SMD −0.06; 95% CI −0.19 to 0.06; 4 studies, 1,314 people; moderate certainty); a study with a withdrawal design also found no difference. In one study included in the pooled analysis (Portenoy 2012), sleep disruption fell more than with placebo only in the lowest-dose arm (p = 0.003), with no difference at medium and high doses. No difference in depression (single study, 360 people) (low certainty); anxiety was not measured in these spray studies. Of two small studies with nabilone, one found sleep and mood no different from placebo, while in the other the insomnia score improved more with nabilone (−40.7 vs −9.9 on a 0–100 scale; a direct comparison of the two groups was not reported); anxiety was not measured in these two studies (low certainty). In the pure CBD study (MedCan1), changes in anxiety and depression were similar in the two groups; sleep was not measured","yan_etki":"No clinically meaningful difference from placebo in withdrawals due to side effects or in serious side effects (moderate certainty)","pmid":"37283486","doi":"10.1002/14651858.CD014915.pub2","diger_kaynak":null},{"ad":"AminiLari 2022","tasarim":"Systematic review and meta-analysis of RCTs (up to January 2021; GRADE)","n":"39 RCTs, 5,100 patients (33 of the studies in patients with cancer pain or chronic non-cancer pain); 5 RCTs in the cancer pain subgroup (as reported by ASCO 2024)","populasyon":"Patients whose sleep was measured; most with chronic pain (including cancer pain)","urun":"Oral cannabinoids (38 studies) and inhaled cannabis in 1 study","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"A very small improvement in sleep disturbance in cancer pain (weighted mean difference −0.19 cm on a 10 cm scale; 95% CI −0.36 to −0.03; moderate-to-high certainty); improvement was larger in chronic non-cancer pain (interaction p = 0.03). According to the authors, any benefit is small","yan_etki":"Risk of dizziness clearly increased (risk difference 29% in studies with at least 3 months of follow-up); small increases in drowsiness, dry mouth, tiredness and nausea","pmid":"34546363","doi":"10.1093/sleep/zsab234","diger_kaynak":null},{"ad":"Belgers 2023","tasarim":"Meta-analysis of RCTs (search August 2–3, 2021)","n":"17 RCTs (4 in cancer, 13 in central nervous system disease); in the cancer subgroup, quality-of-life analysis included 4 studies, 747 patients","populasyon":"Adults with cancer or chronic neurological disease","urun":"THC (dronabinol, nabilone), THC+CBD (mouth spray, cannabis extract) and CBD","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"No effect on overall health-related quality of life (g = −0.02; 95% CI −0.11 to 0.06) or mental well-being (g = −0.02; −0.16 to 0.13); no difference between the cancer and neurological disease subgroups. In 65% of the studies, a drug company supplied the drug or sponsored the study","yan_etki":null,"pmid":"35861789","doi":"10.1089/can.2021.0187","diger_kaynak":"Brain tumor study by the same research group: Belgers 2026 (in this table)"},{"ad":"Simon 2022","tasarim":"Systematic review and meta-analysis (RCTs and non-randomized studies; search up to May 2020)","n":"10 studies (4 RCTs, 6 non-randomized); quality-of-life analysis included 4 RCTs, 545 patients","populasyon":"Cancer-related cachexia and loss of appetite","urun":"Dronabinol, nabilone, THC, cannabis extract and medical cannabis","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"In the pooled analysis of 4 RCTs, overall quality of life improved slightly less in the cannabinoid groups than in control groups taking placebo or megestrol (an appetite-stimulating drug) (SMD −0.25; 95% CI −0.43 to −0.07; moderate certainty). No benefit for appetite or weight","yan_etki":"No significant difference in the number and severity of side effects in the RCTs","pmid":"34881518","doi":"10.1002/jcsm.12861","diger_kaynak":null},{"ad":"Mücke 2018","tasarim":"Systematic review and meta-analysis (palliative medicine)","n":"9 studies, 1561 participants","populasyon":"Palliative care (cancer subgroup)","urun":"Cannabinoids","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"In cancer patients, no difference from placebo in sleep problems (2 studies, 203 patients; SMD −0.09; 95% CI −0.62 to 0.43) or health-related quality of life (2 studies, 420 patients; SMD 0.10; −0.12 to 0.33); the share of patients developing mental health complaints was similar (3.2% vs 4.1%). No difference in calories, appetite, nausea and vomiting, or pain either; quality of evidence low or very low","yan_etki":"No difference in dizziness/mental health in cancer","pmid":"29400010","doi":"10.1002/jcsm.12273","diger_kaynak":"First German version: Mücke 2016, Schmerz, PMID 26809975 (no difference in quality of life, SMD 0.00)"},{"ad":"Maida 2008","tasarim":"Prospective observational study: patients taking and not taking nabilone were compared after balancing with propensity scores (not randomized or blinded)","n":"112 (47 nabilone, 65 not taking nabilone)","populasyon":"Patients with advanced cancer with pain and other symptoms (Canada)","urun":"Nabilone (THC-like synthetic cannabinoid, by mouth), in addition to existing treatment","urun_turu":"cbn_diger","doz":"Not reported (in the abstract)","titrasyon":null,"sure":"30 days","sonuc":"The primary outcomes were pain and opioid use (both lower in the nabilone group; p < 0.0001). Of this topic's measures, anxiety (p = 0.028) and total symptom distress (ESAS total; p = 0.021) were better in the nabilone group; the scale has no sleep item. Nabilone was not given at random and the study was not blinded; groups were balanced with propensity scores","yan_etki":"Not reported (in the abstract)","pmid":"18402303","doi":null,"diger_kaynak":null},{"ad":"Bar-Lev Schleider 2018","tasarim":"Prospective observational study (data routinely collected in a cannabis company's treatment program; no comparison group)","n":"2,970 cancer patients","populasyon":"Cancer patients granted a medical cannabis license (Israel); 51% stage 4","urun":"The company's cannabis products (product types and THC/CBD ratios not in the abstract)","urun_turu":"karma","doz":"Not reported (in the abstract)","titrasyon":null,"sure":"6 months (2015–2017)","sonuc":"The most common reasons for treatment were sleep problems (78%) and pain (78%). At month 6, 902 patients had died and 682 had stopped treatment; of the 1,211 remaining who responded, 95.9% reported that their condition had improved, 3.7% that it was unchanged and 0.3% that it had worsened. No separate result for sleep and quality of life in the abstract; the full text could not be read. No control group; those who died or stopped were not included in the evaluation. 4 of the 8 authors are from the research department of the company that supplied the product","yan_etki":"No details in the abstract (the authors report it was well tolerated)","pmid":"29482741","doi":"10.1016/j.ejim.2018.01.023","diger_kaynak":null},{"ad":"Aviram 2022","tasarim":"Prospective observational cohort (multicenter; no comparison group)","n":"324 started; 212, 158 and 126 responded at months 1, 3 and 6","populasyon":"Oncology patients receiving a medical cannabis license for the first time for cancer symptoms (Israel)","urun":"Licensed medical cannabis: dried flower (smoked or vaporized) or oil extract; at month 6, of those who reported their product, 61% used THC-dominant, 25% mixed and 15% CBD-dominant products (median monthly THC 3 g)","urun_turu":"thc_iceren","doz":"Individual; median 20 g of product a month","titrasyon":null,"sure":"6 months","sonuc":"At 6 months, compared with baseline, anxiety (GAD-7: 9 → 6; −2.35; 95% CI −3.31 to −1.40), depression (Beck: 19 → 15; −1.97; −3.26 to −0.68), sleep disturbance (Pittsburgh: 12 → 8; −3.07; −3.95 to −2.18) and quality-of-life score (−0.55; −0.83 to −0.27) improved; total symptom burden fell by a median of 18%. In the same group's first 1-month analysis (108 patients), sleep and distress had improved, while anxiety, depression and quality of life had not changed significantly. No control group; at month 6, only 39% of those who started responded","yan_etki":"Side effects were common (20–30%), but most were not serious and stayed stable during follow-up","pmid":"35669038","doi":"10.3389/fpain.2022.861037","diger_kaynak":"1-month study from the same research group: Aviram 2020, PMID 33265945 (108 patients; THC-dominant products were better than CBD-dominant ones only for sleep duration). Funding: a charitable foundation; the authors reported no conflicts of interest"},{"ad":"Reddy 2026 (Minnesota cannabis program)","tasarim":"Retrospective longitudinal analysis (state medical cannabis program records and sales data; no comparison group)","n":"1,962 cancer patients","populasyon":"Cancer patients enrolled in the Minnesota Medical Cannabis Program (US); anxiety and depression were not the reason for enrolling","urun":"Products obtained from the program (75% taken by mouth; median daily THC 17 mg, CBD 3 mg; median THC:CBD ratio 7.2)","urun_turu":"thc_iceren","doz":"Individual; mean daily THC 32 mg, CBD 14 mg","titrasyon":null,"sure":"2015–2023; measurements after the first 30 days in the program","sonuc":"The sleep disturbance score (0–10) was 6.72 at baseline and then fell by a mean of 1.63 points (24%). Compared with the highest CBD band (>14.3 mg/day), the likelihood of meaningful (at least 30%) improvement was 29–35% lower in the second and third bands; there was no consistent link with THC dose or THC:CBD ratio. In the same patients, the anxiety score improved by a mean of 25% and was linked to CBD dose (0.05 points per 5 mg of CBD); improvement in depression was linked only to route of use (Reddy 2025). No control group; dose was estimated from sales records","yan_etki":"Not reported (in these analyses)","pmid":"41120744","doi":"10.1007/s12094-025-04069-8","diger_kaynak":"Anxiety and depression analysis in the same 1,962 patients: Reddy 2025, PMID 41163433; analysis of cancer patients' symptoms over the first 4 months in the same program: Anderson 2019, PMID 30860938. Funding: US National Cancer Institute; the authors reported no conflicts of interest"},{"ad":"Kasvis 2022 (Quebec Cannabis Registry)","tasarim":"Patient registry analysis (prospective registry; no comparison group)","n":"358 (171 men, 187 women)","populasyon":"Patients starting medical cannabis for cancer symptoms (Canada, Quebec)","urun":"Medical cannabis: THC-dominant, balanced THC:CBD or CBD-dominant products","urun_turu":"karma","doz":"Not reported (in the abstract)","titrasyon":null,"sure":"3 months","sonuc":"At 3 months, anxiety (ESAS-r, 0–10; men −1.1, women −1.2) and well-being (men −1.2, women −1.4) improved from baseline in both sexes; the abstract reports no significant improvement for depression (the scale has no sleep item). Balanced THC:CBD products improved anxiety (−1.83) and well-being (−2.01) in men; CBD-dominant products did not give significant relief in either sex. No control group; results are self-reported by patients","yan_etki":"Not reported (in the abstract)","pmid":"35723729","doi":"10.1007/s00520-022-07193-1","diger_kaynak":"Pain analysis of the same 358 patients: Aprikian 2024, PMID 37130724"},{"ad":"Bar-Sela 2013","tasarim":"Prospective observational study (interviews on the day of licensing and 6–8 weeks later; no comparison group)","n":"211 started; 131 attended the second interview (25 had stopped in the first week); 106 evaluated","populasyon":"Cancer patients receiving supportive or palliative care who were granted a medical cannabis license (Israel, single center)","urun":"Licensed cannabis plant (THC 16–27%, CBD 0.5–2%)","urun_turu":"thc_iceren","doz":"Up to 30 g a month; starting with strains under 20% THC was recommended for the first 2 months","titrasyon":"Start with a small amount and increase slowly according to need and side effects","sure":"6–8 weeks","sonuc":"In the 106 patients who continued treatment, all symptoms improved significantly from baseline (p < 0.001): the share of patients without sleep disturbance rose from 20% to 56%, and the share without mood disturbance from 6% to 46%; the distress thermometer score also fell. 50 of those who started (24%) died before the second interview; only those who continued were evaluated (selection bias). No control group; results are patient-reported","yan_etki":"Memory weakening with long-term use was the only significant side effect (p = 0.002)","pmid":"23956774","doi":"10.1155/2013/510392","diger_kaynak":null},{"ad":"Varadpande 2025 (UK Medical Cannabis Registry)","tasarim":"Case series (prospective patient registry; no comparison group)","n":"168","populasyon":"Patients prescribed cannabis-based medicines for cancer pain (United Kingdom)","urun":"Cannabis-based medicines (product breakdown not in the abstract)","urun_turu":"karma","doz":"Not reported (in the abstract)","titrasyon":null,"sure":"6 months (measurements at months 1, 3 and 6)","sonuc":"In addition to pain measures, anxiety (GAD-7), sleep quality (single-item scale) and quality of life (EQ-5D-5L) improved significantly from baseline (p < 0.05; sizes not in the abstract). No control group; the authors state that cause and effect cannot be established. 8 of the 12 authors are linked to a private clinic that prescribes cannabis medicines","yan_etki":"29 side effects in 5 patients (3%); most mild or moderate","pmid":"39921589","doi":"10.1080/15360288.2025.2457101","diger_kaynak":"Preliminary 16-patient palliative care report from the same registry: Nimalan 2022, PMID 34980282"},{"ad":"Stienrut 2024 (Thai national cohort)","tasarim":"Prospective observational cohort (30 centers; no comparison group)","n":"21,284 patients, 2,873 of them with cancer; by week 12, 32% of participants had dropped out of follow-up","populasyon":"Patients prescribed cannabis oil by traditional Thai medicine practitioners for symptoms such as pain, loss of appetite and insomnia (Thailand); patients with cancer were not selected for anxiety or sleep problems (mean anxiety score at baseline 1.96/10)","urun":"Cannabis extract in coconut oil made by the Ministry of Public Health (about 0.07 mg THC per drop; almost no CBD)","urun_turu":"thc_iceren","doz":"Most often 3 drops a day at bedtime (about 0.2 mg THC/day)","titrasyon":null,"sure":"3 months","sonuc":"In patients with cancer, quality of life (EQ-5D-5L; 1 = best health state) rose from 0.79 by a mean of 0.13 points over 3 months (95% CI 0.12–0.14); the anxiety score (ESAS, 0–10) fell by 1.46 points (1.35–1.58), the not-feeling-well score by 1.97 points and the depression score by 0.59 points. Sleep was not measured separately: the authors used ESAS's drowsiness item in place of insomnia. No control group; patients were not selected for these symptoms and baseline scores were low; the daily amount of THC was about 0.2 mg (the authors write that the placebo effect may have influenced the results), and reasons for dropping out were not recorded","yan_etki":"Side effects at 0.42% of 67,681 visits (most often dry mouth, dizziness, drowsiness)","pmid":"39144529","doi":"10.1159/000540153","diger_kaynak":"Thai Clinical Trials Registry TCTR20191231001. Funding: the Department of Thai Traditional and Alternative Medicine of the Ministry of Public Health, which also makes the product; 9 of the 13 authors work in this department; the authors reported no conflicts of interest"},{"ad":"Scarborough 2026 (MedCan1+2 substudy)","tasarim":"Liver enzyme substudy of two RCTs","n":"287","populasyon":"Advanced cancer","urun":"CBD alone or THC/CBD","urun_turu":"karma","doz":"Escalating dose, ≤600 mg CBD/day","titrasyon":"Escalating","sure":"28 days","sonuc":"No significant rise in ALT/AST; no patient had ALT/AST >3× ULN (>5× in liver metastases)","yan_etki":null,"pmid":"41429435","doi":"10.1136/spcare-2025-005837","diger_kaynak":"Main studies: Hardy 2023 (MedCan1) and Hardy 2025 (MedCan2), in this table"},{"ad":"Downs 2026 (MedCan1 secondary analysis)","tasarim":"Surrogate markers of drug interactions in RCT data","n":"MedCan1 participants (number in the analysis not in the abstract; the full text could not be read)","populasyon":"Advanced cancer","urun":"CBD oil (pure)","urun_turu":"saf_cbd","doz":"MedCan1 dose: 50–600 mg/day, chosen by the patient","titrasyon":null,"sure":"28 days (MedCan1 duration)","sonuc":"The chosen CBD dose was unrelated to opioid, benzodiazepine or antipsychotic use; the risk of new side effects did not increase with concomitant medicines","yan_etki":null,"pmid":"39539239","doi":"10.1089/can.2024.0041","diger_kaynak":"Main study: Hardy 2023 (MedCan1), in this table"}],"ilgili_ilaclar":["kemoterapi","immunoterapi","tamoksifen","everolimus","varfarin","apiksaban","rivaroksaban","sitalopram","essitalopram"],"son_inceleme":"2026-10-28","arastirma_gecmisi":[{"tarih":"2026-10-19","not":"Page published. This first review examined 6 studies."},{"tarih":"2026-10-21","not":"The full texts of the studies were reread, and the information on the page was checked against its sources. Corrected: drug interaction notes. Points that could not be verified from the full text went down from 4 items to 1. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-21","not":"PubMed and ClinicalTrials.gov were searched for newly published clinical studies and ones missed earlier. Study added: Belgers 2026. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-22","not":"The names of the finding labels were simplified: this page's \"No benefit seen\" label became \"No effect found\". The assessment did not change."},{"tarih":"2026-10-28","not":"In the October 2026 search (PubMed, Cochrane, ClinicalTrials.gov), 24 studies were added to this topic: 9 studies with a comparison group (7 placebo-controlled: Davies 1974, Strasser 2006, Brisbois 2011, Côté 2016, Turcott 2018, Weiss 2025, Haney 2025; waitlist-controlled Zylla 2026; Schloss 2021, comparing two THC:CBD ratios), 1 open-label study (Fleege 2025), 7 systematic reviews including the MASCC 2023 guideline and Cochrane 2023, and 7 observational studies. The THC result for sleep was updated with the Cochrane analysis of cancer pain studies (no difference or a very small improvement); the negative sleep result of two small RCTs with CBD-dominant products was added. The statement 'there is no THC RCT for anxiety' was corrected: there are RCTs that measured anxiety as a secondary measure, and they found no difference; a small 1974 THC pilot in anxious patients was also added. Quality of life and real-world data were described together with their limits; ASCO 2024's weak recommendation against high-dose CBD for symptom burden was added. Anxiety, depression and quality-of-life results, registration numbers and funding were added to the MedCan rows; an internal file note visible to readers in two places was removed. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-28","not":"October 2026 supplementary review: sources found for this page during the searches for other topics were read and worked into the page. A cohort without a comparison group that followed 2,873 cancer patients in Thailand for 3 months (Stienrut 2024; about 0.2 mg of THC a day) was added: quality of life and anxiety scores improved, but an improvement seen at such a low dose and without controls cannot be attributed to the product; sleep was not measured separately in this study. The side-effect information for the single-dose pre-imaging CBD study in breast cancer (Nayak 2024) was completed from the full text (mild or moderate nausea in 2 people in the CBD group, pain in one of them; no side effects with placebo). The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-30","not":"The last sentence of the page's short summary was rewritten in a calmer, more guiding tone: instead of \"Talk to your doctor before you start.\", it now says whom you can talk with, and about what, if you are considering CBD. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-31","not":"The evidence level text now uses the same level name as the top of the page; the level and the result did not change."}]},{"id":"cancer-treatment-claims","baslik":"Cancer treatment (anti-tumor claims)","grup":"Cancer","grup_kodu":"kanser","tr_id":"kanser-antitumor-iddialar","kanit_duzeyi":"yetersiz","kanit_yonu":"yarar_gosterilmedi","kanit_ozet":"Based on current evidence, CBD does not treat cancer, shrink tumors or boost the effect of chemotherapy. In the secondary analysis of the controlled study with pure CBD oil, disease progression and survival did not change. Lab and animal findings have not been confirmed in humans; uncontrolled case series (of 15 and 119 patients) and published case reports carry no evidential value; 81% of 77 published cases were rated as weak evidence for this claim. In a phase 1 safety study with 600–800 mg/day Epidiolex in 21 patients with biochemical recurrence of prostate cancer, PSA stayed stable in most patients; because there was no control group, an anti-tumor effect cannot be considered shown. ASCO 2024: cannabis/cannabinoids should not be used in place of cancer treatment (strong recommendation) and should not be recommended outside of clinical trials to boost the effect of tumor-directed treatment either. In three of six observational studies examining cannabis use in people receiving immunotherapy, worse response or survival was seen, and in three it was not; these studies do not show cause and effect, but ASCO recommends caution in these patients. In observational studies of people who were using or had previously used cannabis when they were diagnosed with cancer, no clear difference was seen in survival, in cancer coming back or in a second cancer developing (in HPV-related oropharyngeal cancer, 47 patients matched with 47; at the same center, among 513 head and neck cancer patients, a second primary cancer occurred in 2 of 59 cannabis users and 23 of 454 non-users; in the matched analysis of a French cohort of 8,999 patients with lung cancer, HR 0.90, 95% CI 0.68–1.18; in 1,472 patients with bladder cancer that had not spread into the muscle layer, recurrence in the first 2 years, HR 0.87, 95% CI 0.56–1.33 in current users); in lung cancer, people who smoked tobacco along with cannabis were diagnosed at a younger age than those who smoked only tobacco, and aggressive tumor types were more common. These studies are observational, cannabis use relies mostly on self-report and the share of tobacco cannot be fully separated; they do not show cause and effect (very low certainty). October 2026 search (PubMed, Cochrane, ClinicalTrials.gov, Europe PMC): only 2 small studies were found that measured a tumor or survival outcome in humans and randomly compared patients receiving cannabinoids with those not receiving them (one a secondary analysis of a symptom study with pure CBD, the other a 21-person safety study with a spray containing THC and CBD); the result of a third, with 122 patients, has not been published. In addition, 1 randomized study comparing two THC:CBD ratios, 3 uncontrolled trials, 2 case series, 10 observational comparisons, 5 observational studies examining the course of the disease in people who were using or had previously used cannabis when they were diagnosed with cancer, 2 systematic reviews (one Cochrane), 1 review assessing published case reports, 1 narrative review and the ASCO guideline were found; all are in the table below.","kanit_duzeyi_metin":"Insufficient: no RCT measuring anti-tumor effect as the primary outcome; the only placebo-controlled data are a secondary analysis of a symptom study (no difference)","kanit_duzeyi_thc_icerenler":"cok_zayif","kanit_duzeyi_thc_icerenler_metin":"Very weak: the only randomized data comparing with a no-cannabis group are a small subgroup (21 people) of a phase 1b safety study; observational studies are conflicting; no approval/evidence","kaynak_dosya":"kanser-destek.md","saf_cbd_sonuc":"Pure CBD has not been shown to have an anti-tumor effect in humans; in the MedCan1 secondary analysis, progression and survival did not change. The prostate cancer phase 1 study and the two case series reporting positive results (15 and 119 patients) are uncontrolled.","thc_icerenler_sonuc":"Studies measuring tumor response or survival with THC-containing products are small and mostly safety-focused: the nabiximols + temozolomide phase 1b study in glioblastoma (21 people randomized) was not powered for survival; the 88-patient glioma study had no comparison group without cannabis; in chronic lymphocytic leukemia, a single dose of spray slightly reduced cancer cells in the blood for only a few hours. The result of the 122-patient phase II randomized study (ARISTOCRAT) has not been published as of October 2026. Observational findings on cannabis use in people receiving immunotherapy are conflicting: some show worse response and survival, some show no difference.","ruhsat":null,"doz_araligi_ozet":"400–600 mg/day CBD in the uncontrolled glioblastoma series; 600–800 mg/day in the prostate cancer phase 1; up to 12 sprays/day (30 mg CBD + 32.4 mg THC) in the nabiximols phase 1b; median dose chosen by patients 400 mg/day in the pure CBD RCT in advanced cancer; in the glioma study, a single nightly dose averaging about 10 mg THC + 11 mg CBD (1:1) or 27 mg THC + 7 mg CBD (4:1)","titrasyon_ozet":null,"yan_etkiler":["Twelves 2021 (THC-containing): vomiting, dizziness, tiredness, nausea, headache; mostly grade 2–3","Schloss 2021 and Melén 2022 (THC-containing): dry mouth, dizziness, drowsiness; in the glioma study, mild nighttime hallucinations, paranoia or euphoria in 4 people","MedCan1 and Myint 2023 (pure CBD): in advanced cancer, side effects similar to placebo, shortness of breath more common with CBD; in prostate cancer with 600–800 mg/day, diarrhea 55%, nausea 25%, tiredness 20% (grade 1–2)"],"izlem":["Prescription CBD label: liver tests at baseline and at months 1, 3 and 6, then periodically; stop if ALT/AST >3×ULN + bilirubin >2×ULN or transaminases persistently >5×ULN","INR in people using warfarin","Drug blood levels in people using everolimus/tacrolimus/sirolimus"],"dikkat":["CBD should not be used in place of cancer treatment (ASCO 2024, recommendation 2.2, strong recommendation)","Cannabis/cannabinoids are not recommended outside of clinical trials to boost the effect of (tumor-directed) cancer treatment (ASCO 2024, recommendation 2.1, weak recommendation)","People with liver disease / liver metastases / receiving hepatotoxic treatment: with prescription CBD, ALT >3×ULN 12–13% (placebo 1%), dose-related; in moderate/severe hepatic impairment, the label specifies a low starting dose","People using warfarin or clopidogrel and those at high risk of bleeding: an interaction mechanism exists (CYP2C9, CYP2C19); no clinical data have been reported that CBD directly increases bleeding risk","Before surgery/procedures: ASRA 2023 recommends asking about cannabinoid use and including it in the anesthesia plan; the anesthesia team must be told","People receiving immunotherapy (checkpoint inhibitors): observational studies are conflicting (some show worse response and survival); ASCO 2024 recommends caution, and MASCC 2023 recommends particular attention to possible harms in these patients","People using everolimus, tacrolimus, sirolimus or oral targeted drugs: should not add it without consulting the oncologist/pharmacist","Older people, people taking many medicines, those taking sedatives/opioids: somnolence, dizziness, risk of falls; with THC-containing products, confusion and psychotomimetic effects","Use for tumor 'treatment': uncontrolled case series are not evidence; per ASCO, abandoning standard treatment is strongly recommended against","Pregnancy/breastfeeding, history of psychiatric illness (with THC-containing products): cancer studies excluded these groups"],"ilac_etkilesim_notlari":["Everolimus: exposure rose ~2.5-fold; label: start everolimus at a low dose, monitor levels (high, human PK data)","Tacrolimus, sirolimus, digoxin (P-gp substrates): the label states that levels may rise (moderate)","Oral P-gp substrate chemotherapy/targeted drugs (e.g., many tyrosine kinase inhibitors): theoretical; no human data","CYP2C19 substrates and prodrugs (clopidogrel): substrate levels rise, and with prodrugs the active metabolite may decrease; no human data for oncology drugs","Warfarin: case report of raised INR; INR should be monitored","CYP3A4 substrates (taxanes, irinotecan, docetaxel, many TKIs): in the label, midazolam did not change (approved CBD 750 mg twice daily); a single dose of a CBD-dominant extract (640 mg CBD + 20 mg THC) raised midazolam AUC by 56% (Bansal 2023, PMID 37313955); herbal cannabis tea did not affect the PK of irinotecan and docetaxel (n=24); nabiximols did not affect temozolomide PK; these results cannot be generalized","Immunotherapy: in cannabis users (mostly THC-containing), nivolumab response rate 15.9% vs. 37.5% (Taha 2019; in the 116 of 140 patients who lived longer than 2 months); in a prospective observational study, shorter time to progression and survival (Bar-Sela 2020, n=102); shorter survival in 28 patients, most using dronabinol (Hadid 2024); on the other hand, no link with survival was found in 201 lung cancer patients receiving pembrolizumab (Waissengrin 2023), in a pooled trial analysis of 684 patients (Coschi 2025) or in 201 head and neck cancer patients (Alsavaf 2025); in two Israeli studies, most of the p-values in the baseline tables could not be obtained with the test stated in the article in an independent reanalysis, and group differences not reported in the articles were found; the main results could not be recalculated because raw data were not available (Piper 2024); causation has not been proven, and there are no data specific to pure CBD","Opioids: in MedCan1, CBD dose was unrelated to opioid use; no opioid-sparing effect has been shown with THC-containing products; somnolence increases with CNS depressants","Citalopram/escitalopram: in 6 patients who added CBD (200–800 mg/day), citalopram levels rose significantly (Anderson 2021, PMID 34121064)","Valproate and liver-toxic drugs (some chemotherapies, methotrexate): no data on use together with hepatotoxic chemotherapies","Tamoxifen: in one case, endoxifen was found to be low with 40 mg/day CBD (Parihar 2020, PMID 33191836)","No clinical studies have been reported with direct oral anticoagulants (apixaban, rivaroxaban)"],"dogrulanamayan":["ARISTOCRAT (phase II, 122 patients) results are awaited; completion 2027 (ISRCTN April 30, 2027, ClinicalTrials.gov October 7, 2027, estimated); as of October 2026, no results have been published","The phase 1b study in Spain in which a mixture of THC and CBD was tried together with radiotherapy and temozolomide in newly diagnosed glioblastoma (NCT03529448, 33 patients) was completed in November 2025; as of October 2026, its results are neither in the registry nor in a peer-reviewed publication. The records of two registered studies testing pure CBD alone or as an add-on to standard treatment (NCT02255292, NCT03607643) have not been updated since 2014 and 2018; no results.","According to the registries, two small studies measuring the effect on tumors are enrolling patients: a cannabis oil containing THC and CBD in untreatable liver cancer (NCT06518434, Netherlands, 20 patients; record not updated since July 2024) and pure CBD vs. placebo before surgery in breast cancer (NCT06148038, US, 84 patients). As of October 2026, no results.","The full text of the 119-patient synthetic CBD case series (Kenyon 2018) could not be accessed; how response was defined and the dose information were taken from the abstract and from sources assessing this series (ASCO 2024, Guggisberg 2022).","A short report examining the link between cannabis use disorder and death in patients with colon cancer (Cuomo 2025) was published without an abstract, and its full text could not be accessed; because its result could not be read from the primary source, it is not reported on this page. In the same research group's larger study looking at the records of 22,763 cancer patients (Khoyilar 2025), cannabis dependence was not significantly associated with death; but the abstract does not give the number of patients with cannabis dependence or the size of the effect, the authors note that this group was small, and the full text could not be accessed either. For this reason, neither was included in the table as of October 2026."],"calismalar":[{"ad":"O'Leary 2024 (MedCan1 secondary analysis)","tasarim":"Secondary analysis of a double-blind, placebo-controlled RCT (MedCan1); the trial was designed for symptom burden","n":"Records of 135 patients reviewed, 128 analyzed (144 randomized in the main trial)","populasyon":"Advanced cancer","urun":"CBD oil 100 mg/mL (pure CBD)","urun_turu":"saf_cbd","doz":"CBD oil 100 mg/mL; from 0.5 mL (50 mg) once daily up to 2 mL three times daily (600 mg/day); median dose chosen by patients 400 mg/day (main publication)","titrasyon":"Patients increased the dose themselves (the main trial's schedule)","sure":"56 days of follow-up","sonuc":"Progression in 36% of patients at day 28 and 49% at day 56; no difference between CBD and placebo (day 14 p = 0.33; day 28 p = 0.67; day 56 p = 0.50); no difference in survival (p = 0.38). The trial was not designed to measure anti-tumor effect; treatment 28 days, follow-up 56 days","yan_etki":"In the main trial, side effects similar in the two groups; shortness of breath more common with CBD (Hardy 2023)","pmid":"38307703","doi":"10.1136/spcare-2023-004746","diger_kaynak":"Main publication: Hardy 2023, PMID 36409969 (MedCan1); ANZCTR ACTRN12618001220257"},{"ad":"Likar 2021","tasarim":"Retrospective case series, no control group","n":"15","populasyon":"Glioblastoma, added to standard treatment","urun":"Oral CBD","urun_turu":"saf_cbd","doz":"400–600 mg/day in the abstract; 200–600 mg/day in the cases (e.g., from 2×100 mg to 2×300 mg); additional dronabinol (THC) 7.5 mg/day in 2 cases","titrasyon":"No standard schedule; case by case","sure":"Case by case, months to years (no fixed duration)","sonuc":"Mean survival 24.2 months, median 21 months. Uncontrolled; open to selection bias; causation cannot be established. Survival was calculated from diagnosis, while CBD was started months or years after diagnosis in some patients; most patients received standard treatment at the same time. One of the 4 authors reported being a consultant to the European Industrial Hemp Association (EIHA) and several drug companies","yan_etki":"No side effect data in the article","pmid":"35403130","doi":"10.21873/cdp.10011","diger_kaynak":"Earlier publication: Likar 2019, PMID 31570484 (9 patients with brain tumors; the 6 glioblastoma patients here are also in that series)"},{"ad":"Myint 2023","tasarim":"Phase 1, open-label dose escalation and expansion","n":"21 (7 dose escalation + 14 expansion)","populasyon":"Prostate cancer with biochemical recurrence (rising PSA) after local treatment","urun":"Epidiolex (pure CBD)","urun_turu":"saf_cbd","doz":"From 600 mg/day to 800 mg/day (once daily)","titrasyon":"Bayesian dose escalation; tapering over 10 days after 90 days","sure":"90 days","sonuc":"At week 12, PSA stable in 16 of 18 patients, partial decline in 1 (at most 41%), progression in 1; the definition of 'stable' also includes a PSA rise of less than 25%; imaging showed progression in 3 patients (one during the study, two afterward); no control group, no anti-tumor effect shown","yan_etki":"No dose-limiting toxicity; diarrhea 55%, nausea 25%, tiredness 20% (grade 1–2)","pmid":"37173971","doi":"10.3390/cancers15092505","diger_kaynak":"ClinicalTrials.gov NCT04428203 (results in the registry)"},{"ad":"Twelves 2021 (glioblastoma)","tasarim":"Phase 1b; Part 1 open-label, Part 2 randomized placebo-controlled","n":"6 + 21 (12 nabiximols / 9 placebo)","populasyon":"First recurrence of glioblastoma","urun":"Nabiximols + dose-intense temozolomide","urun_turu":"thc_iceren","doz":"1 spray (evening) → 12 sprays/day (30 mg CBD + 32.4 mg THC)","titrasyon":"+1 spray per day","sure":"≤12 months","sonuc":"Safety study. Progression-free at 6 months 33% in both arms. 1-year survival 83% vs. 44% (p=0.042); not powered for survival, 2 early deaths in the placebo arm. Did not affect temozolomide PK. During follow-up in Part 2, 5 of 9 patients in the placebo arm and 2 of 12 patients in the nabiximols arm died. Supported by the manufacturer (GW Research); 3 of the 8 authors are employees of the manufacturer and hold stock options","yan_etki":"Vomiting, dizziness, tiredness, nausea, headache; mostly grade 2–3","pmid":"33623076","doi":"10.1038/s41416-021-01259-3","diger_kaynak":"ClinicalTrials.gov NCT01812603 (Part 1), NCT01812616 (Part 2)"},{"ad":"Guzmán 2006","tasarim":"Phase I pilot","n":"9","populasyon":"Recurrent glioblastoma","urun":"THC into the tumor","urun_turu":"thc_iceren","doz":"THC by catheter into the tumor cavity: 20–40 µg on day 1, increased to 80–180 µg/day over 2–5 days","titrasyon":"Increased over 2–5 days based on psychoactive side effects","sure":"Median cycle 10 days; median total 15 days","sonuc":"Safety-focused; median survival 24 weeks; no control group","yan_etki":"No overt psychoactive effects","pmid":"16804518","doi":"10.1038/sj.bjc.6603236","diger_kaynak":null},{"ad":"ARISTOCRAT (NCT05629702)","tasarim":"Phase II, double-blind, placebo-controlled RCT (2:1): temozolomide ± nabiximols in recurrent glioblastoma (University of Birmingham)","n":"122 enrolled (target 234 in the protocol publication; current target 120 in the ISRCTN registry)","populasyon":"MGMT-methylated recurrent glioblastoma","urun":"Nabiximols + temozolomide","urun_turu":"thc_iceren","doz":"Nabiximols up to 12 sprays/day + temozolomide (cycle 1 150 mg/m², then 200 mg/m², days 1–5)","titrasyon":"Self-titrated by the patient during days 1–14 of cycle 1","sure":"28-day cycles, at most 6 cycles; at least 12 months of follow-up","sonuc":"Enrollment closed on October 7, 2026; completion April 30, 2027 in ISRCTN, primary completion October 7, 2027 on ClinicalTrials.gov (estimated); as of October 2026, no results have been published. The primary outcome is overall survival. The investigator-initiated study is funded by The Brain Tumour Charity; nabiximols and placebo are provided free of charge by the manufacturer (Jazz Pharmaceuticals)","yan_etki":null,"pmid":null,"doi":null,"diger_kaynak":"ClinicalTrials.gov NCT05629702; ISRCTN11460478; protocol: Bhaskaran 2024, PMID 38225549"},{"ad":"Abrams 2021","tasarim":"Review (preclinical and clinical)","n":null,"populasyon":null,"urun":"Cannabinoids","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"Cell and animal studies have not translated into human results","yan_etki":null,"pmid":"34850894","doi":"10.1093/jncimonographs/lgab010","diger_kaynak":null},{"ad":"Schloss 2021","tasarim":"Phase 2, double-blind, randomized; two THC:CBD ratios compared with each other, no placebo (retrospective historical comparison group for secondary outcomes)","n":"88 enrolled (41 in the 1:1 arm and 42 in the 4:1 arm for at least 4 weeks); 61 people completed 12 weeks","populasyon":"Recurrent or inoperable high-grade glioma (90% glioblastoma), added to standard treatment (Australia)","urun":"Whole-plant cannabis oil, THC:CBD 1:1 or 4:1 (by mouth, single nightly dose)","urun_turu":"thc_iceren","doz":"Mean tolerated daily dose: about 10.4 mg THC + 10.8 mg CBD in the 1:1 arm; about 27 mg THC + 6.8 mg CBD in the 4:1 arm","titrasyon":"Starting at 0.2 mL and increasing until tolerated (at most 5 mL in a single dose)","sure":"12 weeks","sonuc":"Primary outcomes tolerability and quality of life: both ratios were tolerated; no difference between ratios in the total quality-of-life score (FACT-Br) (p = 0.90); physical (p = 0.025) and functional (p = 0.014) subscores were better in the 1:1 arm, and sleep improved in both arms. Secondary outcome, tumor (MRI at week 12): shrinkage in 11%, stable disease in 34%, slight increase in 16%, progression in 10%; no difference between the two ratios (the denominators vary between 53 and 61 in the article). The comparison group not taking cannabis comes only from retrospective records (different dexamethasone and surgery rates), and no statistics are given; so no conclusion can be drawn about cannabis's effect on the tumor. The product and funding were provided by FIT-Bioceuticals","yan_etki":"No serious side effects; dry mouth 13%, nighttime tiredness 11%, dizziness 10%, drowsiness 7%; at week 8, mild nighttime hallucinations, paranoia or euphoria in 4 people (6%); dose reduced in 3 people","pmid":"34094937","doi":"10.3389/fonc.2021.649555","diger_kaynak":"ANZCTR ACTRN12617001287325"},{"ad":"Melén 2022","tasarim":"Phase 2, single group, open-label; single dose","n":"23","populasyon":"Asymptomatic, indolent leukemic B-cell lymphoma (including chronic lymphocytic leukemia) (Sweden, Karolinska)","urun":"Mouth spray containing THC and CBD (Sativex), single dose","urun_turu":"thc_iceren","doz":"Single dose; amount not reported in the abstract or in the EU trial registry","titrasyon":null,"sure":"Single dose; 24 hours of follow-up","sonuc":"The primary outcome was a decrease in leukemic B cells in the blood: median 11% decrease within 2 hours (p = 0.014), lasting 6 hours and completely gone by 24 hours; no change in cancer cell death (apoptosis) or proliferation; normal B and T cells also decreased. The researchers concluded that THC/CBD has no therapeutic potential in these lymphomas. No control group","yan_etki":"Grade 1–2 side effects in 91% of patients: dry mouth 78%, dizziness (vertigo) 70%, drowsiness 43%","pmid":"35037561","doi":"10.1080/10428194.2021.2020776","diger_kaynak":"EudraCT 2014-005553-39 (EU Clinical Trials Register: completed, no results section)"},{"ad":"Kenyon 2018","tasarim":"Retrospective case series (routine records of a private clinic), no control group","n":"119","populasyon":"Cancer patients with solid tumors (the authors highlight breast cancer and glioma) (United Kingdom)","urun":"Pharmaceutical-grade synthetic CBD","urun_turu":"saf_cbd","doz":"Not reported in the abstract (full text could not be accessed)","titrasyon":null,"sure":"Records from a four-year period; duration per patient not in the abstract","sonuc":"The authors reported a 'clinical response' in 92% of the 119 cases (in most, a decrease in circulating tumor cells in the blood; in some, shrinkage on scans); how response was defined and how many patients were imaged is not in the abstract. No comparison group. The ASCO 2024 guideline points out that in this series those treated for less than 6 months were excluded and the standard cancer treatment received at the same time by almost all patients was disregarded; therefore it does not show an effect of CBD","yan_etki":"The authors reported that no side effects were seen (how they were collected is not in the abstract)","pmid":"30275207","doi":"10.21873/anticanres.12924","diger_kaynak":"The same author's breast, prostate and glioma follow-up publications are not in PubMed; assessed in the Guggisberg 2022 row"},{"ad":"Braun 2024 (ASCO guideline)","tasarim":"Clinical practice guideline; based on a systematic review (13 systematic reviews and 5 primary studies; search January 2023)","n":null,"populasyon":"Adults with cancer","urun":"Cannabis and cannabinoids (pure, synthetic and plant-based)","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"Recommendation 2.1: cannabis or cannabinoids should not be recommended outside of clinical trials to boost the effect of cancer treatment (very low quality of evidence, weak recommendation). Recommendation 2.2: should not be used in place of cancer treatment (consensus-based; very low quality of evidence, strong recommendation). Evidence on anti-tumor effect was found to be limited; caution is recommended in people receiving immunotherapy because of preliminary observational data reporting poor outcomes with cannabis; the guideline also notes that MASCC 2023 does not recommend cannabinoids for any purpose in people receiving checkpoint inhibitors. 2 of the 15 panel members reported ties to cannabinoid companies; the panel also included authors of two studies the guideline relies on (Bar-Sela 2020, Twelves 2021)","yan_etki":"It states that use for the purpose of cancer treatment can lead to significant clinical (tiredness, mental fogginess, feeling high) and financial harm without proven benefit","pmid":"38478773","doi":"10.1200/JCO.23.02596","diger_kaynak":"Q&A summary: Braun 2024, PMID 38478793"},{"ad":"McBain 2021 (Cochrane, recurrent glioblastoma)","tasarim":"Cochrane systematic review and network meta-analysis (42 studies: 34 RCTs, 8 non-randomized; search December 2019)","n":"5,236 (whole review); cannabinoid part 21","populasyon":"Glioblastoma that progressed or recurred after standard treatment","urun":"The only study with a cannabinoid: mouth spray containing THC and CBD + temozolomide, vs. placebo","urun_turu":"thc_iceren","doz":null,"titrasyon":null,"sure":null,"sonuc":"In the review comparing treatments for recurrent glioblastoma, there was only one small pilot study with a cannabinoid (21 people; only a conference abstract at that time), and it could not be included in the network meta-analysis. According to the abstract data, median survival about 18.3 vs. 12.3 months, 1-year survival 83% vs. 56% (in favor of the spray); the authors consider this not a conclusion but a finding 'worth further investigation'. In the full text of the same study published later, 1-year survival in the placebo arm was 44% (Twelves 2021 row)","yan_etki":null,"pmid":"34559423","doi":"10.1002/14651858.CD013579.pub2","diger_kaynak":null},{"ad":"Rodriguez-Almaraz 2020 (systematic review and meta-analysis)","tasarim":"Systematic review and meta-analysis (search November 2018)","n":"5 studies, 176 patients (2 studies only conference abstracts)","populasyon":"Malignant central nervous system tumors in adults (mostly glioma)","urun":"Cannabis and cannabinoids (THC, THC and CBD spray, cannabis oil, unspecified cannabis)","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"No significant difference in 1-year risk of death between cannabis users and non-users (RR 0.46 in the text; 95% CI 0.16–1.31; different numbers in the abstract: RR 1.07; 95% CI 0.14–8.25). Only one of the five studies is randomized (21 people); one examines the incidence of glioma, not survival. The authors' interpretation in the abstract of 'limited, moderate-quality evidence supporting its use as an adjunct treatment' rests on a non-significant result; the authors state that randomized studies are needed","yan_etki":"In the studies reviewed: dizziness, dry mouth, increased appetite, sleepiness and psychoactive effects","pmid":"32765889","doi":"10.1093/nop/npaa013","diger_kaynak":null},{"ad":"Guggisberg 2022 (assessment of case reports)","tasarim":"Review: all published case reports and clinical data were collected through a PubMed and EBSCO search and graded by strength of evidence","n":"77 cases (9 case reports or series)","populasyon":"Published cases claiming that cannabis treated cancer (breast, brain, prostate, pancreas, etc.)","urun":"Mostly CBD oil; THC in a few cases","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"81% of the cases were rated weak, 5% moderate and 14% (11 cases) strong evidence; three criteria were required for 'strong': active cancer when cannabis was started, response confirmed by lab tests or imaging, and no other cancer treatment at the same time. Most of the cases come from four publications by a single author (only one of them in PubMed: Kenyon 2018); in 29%, cannabis had been used together with standard cancer treatment. The authors state that the published cases do not support the claim that cannabis is a cancer drug and that it should not be used in place of standard treatment outside of clinical trials","yan_etki":null,"pmid":"34370591","doi":"10.1089/can.2021.0045","diger_kaynak":null},{"ad":"Coschi 2025 (CCTG pooled analysis)","tasarim":"Observational analysis with individual patient data from four randomized cancer trials (cannabinoid use was not randomly assigned)","n":"684 (32 people were using cannabinoids at baseline, 65 at any time)","populasyon":"Advanced solid tumors receiving durvalumab + tremelimumab (± chemotherapy) (lung, colorectal, pancreatic and other; most cannabinoid users from the lung and pancreatic trials; Canada)","urun":"In drug records: cannabis oil, marijuana, dronabinol, nabilone; the authors also counted propacetamol (an acetaminophen prodrug, not a cannabis product) as a cannabinoid","urun_turu":"karma","doz":"Not reported (dose and THC/CBD ratio not recorded in the trials)","titrasyon":null,"sure":"Follow-up period of the trials","sonuc":"Cannabinoid use at baseline was not linked to overall survival (p = 0.35), progression-free survival by the standard criteria (p = 0.12) or best response; progression-free survival by immunotherapy-specific criteria (iRECIST) was longer in users (median 10.9 vs. 8.3 months; adjusted p = 0.05). Few users (32 people at baseline). Propacetamol, an acetaminophen prodrug, was also included in the 'cannabinoid' definition; how many users took propacetamol is in the supplementary tables (could not be read). AstraZeneca provided drug and funding support for the trials; 3 of the 14 authors reported ties to drug companies (including Jazz Pharmaceuticals, which also makes cannabinoid medicines)","yan_etki":"No difference in immune-related side effects (grade 1–2 p = 0.96; grade 3–4 p = 0.65)","pmid":"40184324","doi":"10.1080/1750743X.2025.2485012","diger_kaynak":"Trials: CCTG BR.34, CO.26, PA.7, IND.226"},{"ad":"Waissengrin 2023","tasarim":"Retrospective cohort (consecutive patients); mouse experiment in the same article","n":"201 (102 licensed for cannabis, 99 not using it)","populasyon":"Metastatic non-small cell lung cancer receiving first-line pembrolizumab alone (Israel, Tel Aviv)","urun":"Licensed medical cannabis (license in the first month of treatment; product composition not in the abstract)","urun_turu":"karma","doz":"Not reported (in the abstract)","titrasyon":null,"sure":null,"sonuc":"Time to tumor progression similar (5.6 vs. 6.1 months; p = 0.386). Overall survival numerically shorter in cannabis users (23.6 vs. 54.9 months) but not significant (p = 0.08); in multivariate analysis, cannabis was not an independent factor for death. Cannabis users were younger, mostly women and more often had brain metastases; they had been licensed for pain (71%) and loss of appetite (34%). In the mouse experiment in the same article (in animals), THC did not reduce the effect of the PD-1 drug. 5 of the 8 authors reported fees or grants from drug companies, including immunotherapy makers","yan_etki":null,"pmid":"36535195","doi":"10.1016/j.ejca.2022.11.022","diger_kaynak":null},{"ad":"Taha 2019","tasarim":"Retrospective observational cohort (single center)","n":"140 (89 nivolumab alone, 51 nivolumab + cannabis); response analysis in the 116 patients who lived longer than 2 months","populasyon":"Advanced melanoma, non-small cell lung cancer and kidney cancer receiving nivolumab (Israel, Rambam)","urun":"Medical cannabis licensed in Israel (flower, oil or both; THC and CBD ratios variable)","urun_turu":"thc_iceren","doz":"Mostly 20 g per month (the lowest licensed amount)","titrasyon":null,"sure":"Those who started nivolumab between August 2015 and August 2016","sonuc":"Response rate lower in cannabis users: 15.9% vs. 37.5% (in those who lived longer than 2 months; in multivariate analysis, OR about 3.1; 95% CI 1.24–8.1; p = 0.016); in all patients, adjusted OR 2.74 (p = 0.031). No difference in progression-free and overall survival in multivariate analysis (in univariate analysis, overall survival was shorter in cannabis users: HR 1.58; p = 0.045); THC and CBD ratio did not affect response. An independent reanalysis (Piper 2024) showed that cannabis users were significantly younger and that the share of smokers was numerically higher (57% vs. 40%; p = 0.06); the article had stated that the groups were similar","yan_etki":"No difference between groups in immunotherapy side effects","pmid":"30670598","doi":"10.1634/theoncologist.2018-0383","diger_kaynak":"Independent reanalysis: Piper 2024, PMID 38610922"},{"ad":"Bar-Sela 2020","tasarim":"Prospective observational study (consecutive patients, single center)","n":"102 (68 immunotherapy alone, 34 immunotherapy + cannabis); the sample size calculation anticipated 243 patients","populasyon":"Stage 4 cancer starting checkpoint inhibitors (mostly non-small cell lung cancer and melanoma) (Israel, Rambam)","urun":"Medical cannabis licensed in Israel (flower, oil or both), started before immunotherapy","urun_turu":"thc_iceren","doz":"Mostly 20 g per month","titrasyon":null,"sure":"Enrollment September 2016–September 2018; at least 7 months of follow-up","sonuc":"The primary outcome (time to tumor progression) was shorter in cannabis users: median 3.4 vs. 13.1 months (HR adjusted for treatment line 1.95; 95% CI 1.17–3.26); overall survival 6.4 vs. 28.5 months (HR 2.18; 95% CI 1.24–3.82). Enrollment was stopped at an interim analysis of 102 patients instead of the planned 243. Cannabis users more often received immunotherapy as a second or later line (76% vs. 54%); smoking data were not given. The baseline table was corrected in 2022. An independent reanalysis (Piper 2024) reported that of the 22 p-values in the corrected table, only 1 could be obtained with the test stated in the article, 17 could be obtained with another test, and 4 could not be obtained at all; that the difference in treatment line was significant with the appropriate test (p = 0.03); and it found percentage errors; because raw data were not available, the main survival results could not be recalculated. The results should therefore be read with caution","yan_etki":"Immune-related side effects less common in cannabis users (e.g., colitis only in non-users, 9%)","pmid":"32872248","doi":"10.3390/cancers12092447","diger_kaynak":"Correction: PMID 35454955 (April 2022, Table 1); independent reanalysis: Piper 2024, PMID 38610922"},{"ad":"Hadid 2024","tasarim":"Retrospective cohort (single center)","n":"105 (28 using cannabis, 77 not using it)","populasyon":"Solid tumors receiving checkpoint inhibitors (62% lung cancer) (US, Detroit)","urun":"Mostly (82%) dronabinol (synthetic THC); also non-prescription cannabis or CBD","urun_turu":"thc_iceren","doz":"Most users 5–10 mg a day","titrasyon":null,"sure":"Those who received immunotherapy for at least 2 months between August 2014 and August 2018; median follow-up 29.2 months","sonuc":"The primary outcome, overall survival, was shorter in cannabis users: median 6.7 vs. 17.3 months (adjusted HR 2.25; 95% CI 1.25–4.05; p = 0.007); progression-free survival 4.8 vs. 9.7 months (adjusted HR 2.21); disease control 11% vs. 38%. Users were younger and 96% had smoked (74% among non-users); smoking is not in the final survival model. Does not show cause and effect","yan_etki":null,"pmid":"39737331","doi":"10.1177/25151355241309095","diger_kaynak":null},{"ad":"Alsavaf 2025","tasarim":"Retrospective cohort (single center)","n":"201 (47 using marijuana)","populasyon":"Recurrent or metastatic head and neck cancer receiving checkpoint inhibitors (pembrolizumab, nivolumab) (US, Ohio)","urun":"Marijuana use (medical vs. recreational distinction and product not in the abstract)","urun_turu":"thc_iceren","doz":"Not reported (in the abstract)","titrasyon":null,"sure":"Those treated between January 2016 and April 2020","sonuc":"Marijuana use was not linked to overall survival (HR 0.93; 95% CI 0.58–1.49); smoking and alcohol were not linked either. In the whole group, median survival 12 months, response rate 18%. The study examined marijuana as a lifestyle factor together with smoking and alcohol; whether use was medical or recreational, and when and how much was used, is not in the abstract","yan_etki":null,"pmid":"39704258","doi":"10.1111/ajco.14135","diger_kaynak":null},{"ad":"Peleg Hasson 2024","tasarim":"Retrospective cohort (single center)","n":"93 (29 using medical cannabis, 64 not using it)","populasyon":"Ovarian cancer receiving PARP inhibitor maintenance treatment after response to platinum (Israel, Tel Aviv)","urun":"Medical cannabis (product composition not in the abstract)","urun_turu":"karma","doz":"Not reported (in the abstract)","titrasyon":null,"sure":"Those treated between January 2014 and January 2020","sonuc":"Duration of PARP inhibitor use (12.1 and 9.5 months; p = 0.89) and progression-free survival (20 and 21 months; p = 0.83) similar in the two groups. Overall survival longer in cannabis users in the univariate analysis (129.3 vs. 99 months; p = 0.03) but not significant in the multivariate analysis (p = 0.10). The authors' conclusion: cannabis use is not linked to treatment outcomes","yan_etki":null,"pmid":"38242547","doi":"10.1136/ijgc-2023-004953","diger_kaynak":null},{"ad":"Gastmeier 2024","tasarim":"Retrospective multicenter cohort (legally mandated monitoring records)","n":"9,419 (those who lived at least 7 days; subgroup 7,085: those who lived 7–100 days); 310 (3.3%) received THC","populasyon":"Patients receiving specialized palliative home care (Germany, Brandenburg; the title says 'palliative cancer patients', but the distribution of diagnoses is not given)","urun":"Prescription THC (type of preparation not in the abstract)","urun_turu":"thc_iceren","doz":"The last (highest) dose in the records; median 4.7 mg/day","titrasyon":"Started at a low dose and increased based on effect or tolerability","sure":"Patients who died between April 2017 and September 2021","sonuc":"Longer survival in those taking more than 4.7 mg THC a day (median 40 vs. 25 days in the 7–100-day group; in the large group, HR adjusted for age and sex 0.69; 95% CI 0.59–0.81); no difference at lower doses. 62% of the 310 patients receiving THC were from a single palliative care team (11% among those not receiving THC); the models account for the team difference but do not include disease severity or diagnosis. The authors write that they do not discuss an anti-tumor effect and consider it unlikely in this period, and that they cannot rule out that patients in better condition may have received THC; because the dose is the last value in the records, people who lived longer may end up in the higher-dose group. 3 of the 4 authors reported speaker fees or advisory board membership with cannabis companies","yan_etki":"Not recorded","pmid":"38655402","doi":"10.1159/000538311","diger_kaynak":null},{"ad":"Phansila 2022","tasarim":"Retrospective cohort (6 hospitals)","n":"491 (87 medical cannabis, 404 standard palliative pain treatment)","populasyon":"Newly diagnosed advanced bile duct cancer (cholangiocarcinoma) and liver cancer (Thailand, northeast)","urun":"Oral cannabis oil approved in Thailand (dose, composition and duration of use missing from records)","urun_turu":"karma","doz":"Missing from records","titrasyon":null,"sure":"September 2019–June 2021","sonuc":"Median survival after clinic registration 5.7 months in the cannabis group, 0.8 months in the standard group (HR adjusted for age, sex, treatment and time from diagnosis to registration 0.28; 95% CI 0.20–0.37). Stage, performance status and pain data were not available and could not be included in the analysis; patients in the standard group had been referred to the palliative clinic very late in their illness. The authors note that unmeasured confounding factors could explain the result. Third version in a journal with post-publication peer review","yan_etki":null,"pmid":"41113085","doi":"10.12688/f1000research.123250.3","diger_kaynak":"F1000Research first version 2022; version 3 October 3, 2025"},{"ad":"Gallow 2026","tasarim":"Prospective observational comparison (three groups; groups formed by patients' treatment preference, not randomized)","n":"90 (30 in each group: chemotherapy alone, cannabis alone, chemotherapy + cannabis)","populasyon":"Prostate cancer (no hormone therapy given during the study) (South Africa, Eastern Cape)","urun":"Sublingual full-spectrum cannabis oils (THC-dominant, balanced and CBD-dominant)","urun_turu":"thc_iceren","doz":"Median daily 12.5 mg THC and 18 mg CBD","titrasyon":null,"sure":"6 months","sonuc":"The course of PSA differed between groups (p < 0.001): it fell faster in the cannabis groups, but values were similar at month 6. A complete metabolic response on PET/CT was seen only in the cannabis groups (6 patients; chemotherapy + cannabis 16.7%, cannabis alone 3.3%); p = 0.013 in favor of tumor response in the combined group; partial response was the same in the chemotherapy-alone and cannabis-alone groups (30%). Not randomized, groups formed by patients' own preference; the authors also write that the design does not allow conclusions about cause and effect. Cannabis use is based on patients' self-report. 2 of the 5 authors are in the cannabis industry and in a cannabis physicians' association. No independent verification","yan_etki":"Side effects mostly in those receiving chemotherapy; no one left the study","pmid":"41939176","doi":"10.1159/000550792","diger_kaynak":null},{"ad":"Zhang 2019","tasarim":"Observational matched comparison (from a single center’s prospectively collected head and neck cancer database; cannabis users were matched 1 to 1 with non-users by age, sex and clinical stage; no randomization)","n":"94 (47 cannabis users, 47 non-users)","populasyon":"HPV-related (p16-positive) oropharyngeal cancer, treated with curative intent (Hamilton, Canada; diagnosed 2011–2015)","urun":"Cannabis (self-reported use of dried plant at least once a week at diagnosis; form, amount and duration of use not classified; not for treatment)","urun_turu":"thc_iceren","doz":"Not reported (amount, product and duration of use not recorded)","titrasyon":null,"sure":"Mean follow-up of 4.1 years","sonuc":"No difference in overall survival between cannabis users and non-users (90% vs 80% at 2 years, 80% vs 72% at 5 years; p = 0.40); no difference in disease-specific (p = 0.99), disease-free (p = 0.40) or metastasis-free survival (p = 0.38) either. Recurrence in 5 vs 6 patients; 5 deaths in each group. Observational and small; the amount of cannabis was not measured; the authors state that cause and effect cannot be inferred with this design","yan_etki":"Not assessed (cannabis was not given as a treatment)","pmid":"31477184","doi":"10.1186/s40463-019-0365-4","diger_kaynak":"PMC6720071. A separate study from the same center’s same database, looking at second primary cancers in 513 head and neck cancer patients, is in this table: Kim 2020. The authors reported no conflicts of interest"},{"ad":"Couraud 2025 (KBP-2020-CPHG)","tasarim":"Observational analysis of a national prospective cohort (non-academic hospitals in France); cannabis smokers were compared with tobacco-only smokers; for survival, 1-to-1 matching by age, sex, stage, histology and pack-years; no randomization","n":"8,999 newly diagnosed lung cancers; 314 cannabis smokers, 7,372 tobacco-only smokers (data missing in 183); the number of pairs in the survival analysis is not in the abstract","populasyon":"Patients diagnosed with lung cancer in 2020 (France)","urun":"Cannabis (self-reported; at least 20 joints in a lifetime)","urun_turu":"thc_iceren","doz":"Not reported (history of use; not a treatment)","titrasyon":null,"sure":"Not reported (in the abstract)","sonuc":"Cannabis smokers were younger at diagnosis (mean 52.9 vs 67.7 years; in 298 pairs matched by histology, sex and pack-years, median 53.1 vs 64.8 years), and adenocarcinoma and large cell neuroendocrine carcinoma were more common. In the analysis matched by age, sex, stage, histology and pack-years, overall survival did not differ (HR 0.90; 95% CI 0.68–1.18; p = 0.44). Observational; cannabis use was self-reported; the full text could not be read","yan_etki":"Not assessed","pmid":"40393352","doi":"10.1016/j.resmer.2025.101174","diger_kaynak":"The full text could not be read (paywalled; not on Europe PMC); the row is based on the PubMed abstract. In the declaration of interests, the authors report financial relationships; it states that the study’s scientific committee was independent of its industry sponsors"},{"ad":"Pradère 2026","tasarim":"Prospective multicenter observational study (France; consecutive patients; people who smoked cannabis and tobacco, tobacco only, and never smokers were compared; no randomization)","n":"150 enrolled, 148 analyzed (39% cannabis and tobacco, 52% tobacco only, 9% never smokers)","populasyon":"Newly diagnosed lung cancer at age 60 or younger (2021–2023)","urun":"Cannabis (self-reported, confirmed by THC and CBD measurement in hair; all cannabis smokers also smoked tobacco)","urun_turu":"thc_iceren","doz":"Median 26 years, 4 joints a day (history of use; not a treatment)","titrasyon":null,"sure":"Characteristics at diagnosis (follow-up length not in the abstract)","sonuc":"All cannabis smokers also smoked tobacco; their amount of tobacco (pack-years, cotinine in hair) was similar to that of tobacco-only smokers. Compared with tobacco-only smokers, they were younger (median 53 vs 56 years; p = 0.006), more often had chest pain at diagnosis (22% vs 8%), more often had rare and aggressive lung cancer types (17% vs 4%; p = 0.007), more often had emphysema (64% vs 38%; p = 0.003) and had lower lung gas transfer (63% vs 70%). The methods say surgical outcomes were also compared, but the abstract gives no surgical outcomes or survival (the full text could not be read). Observational and small; the authors write that the effect of cannabis independent of tobacco needs further study","yan_etki":"Not assessed","pmid":"41005696","doi":"10.1016/j.chest.2025.09.017","diger_kaynak":"ClinicalTrials.gov NCT05119244 (‘Environment and Lung Cancer’; Centre Chirurgical Marie Lannelongue; 150 people, three groups; recruiting, no results in the registry record); because the article’s full text could not be read, the match with this number could not be verified (the name, center, number of people and groups are the same). Accompanying editorial: Kaye 2026 (PMID 41813296). The full text could not be read (the publisher’s page requires bot verification; a subscription is required on Europe PMC); the row is based on the PubMed abstract. The authors reported no conflicts of interest"},{"ad":"Kwan 2022 (Be-Well)","tasarim":"Prospective cohort (Kaiser Permanente Northern and Southern California; no randomization)","n":"1,472 patients; 363 (24.7%) had used cannabis in their lifetime (121 current, 242 former)","populasyon":"Newly diagnosed non-muscle-invasive bladder cancer (2015–2019; USA)","urun":"Cannabis (self-reported; form of use not asked)","urun_turu":"thc_iceren","doz":"Not reported","titrasyon":null,"sure":"Mean follow-up of 25.9 months","sonuc":"No link was found between cannabis use and the cancer coming back or progressing: compared with never-users, HR 0.87 in current users (95% CI 0.56–1.33) and 1.03 in former users (0.75–1.40) (fully adjusted model; 473 recurrences in total, 89 of them progressions). In the same study, long-term smoking increased the risk of recurrence (40 years or more: HR 2.36; 1.43–3.91). Observational; cannabis use was self-reported and the amount is not in the analysis; results cover only the first 2 years after diagnosis (a limitation noted by the authors)","yan_etki":"Not assessed","pmid":"36449286","doi":"10.1001/jamanetworkopen.2022.44430","diger_kaynak":"PMC9713602. Funding: US National Cancer Institute (NIH)"},{"ad":"Kim 2020","tasarim":"Retrospective cohort (single-center head and neck cancer database with prospectively collected consecutive patients; current use asked by telephone; no randomization)","n":"513 (59 cannabis users, 454 non-users; groups based on last known use)","populasyon":"Newly diagnosed head and neck squamous cell cancer (Hamilton, Canada)","urun":"Cannabis (self-reported; form and amount of use not in the analysis; not for treatment)","urun_turu":"thc_iceren","doz":"Not reported","titrasyon":null,"sure":"Diagnosis 2011–2015; follow-up to November 2018","sonuc":"A second primary cancer of the head and neck or upper aerodigestive tract developed in 2 of 59 cannabis users (3.4%; both also smoked tobacco) and in 23 of 454 non-users (5.1%). Among non-smokers (including former smokers), there were no events in the 45 cannabis users, so the adjusted odds ratio was 0.19 (95% CI 0.01–3.20; p = 0.25); the difference is not significant. In cannabis users, the first cancer was more often in the oropharynx (61% vs 35%). Observational, with very few events; participation in the telephone survey was low (65 of 313 people), and the use of those who could not be reached was assumed to be as recorded","yan_etki":"Not assessed (cannabis was not given as a treatment)","pmid":"33329979","doi":"10.7759/cureus.11483","diger_kaynak":"PMC7735528. From the same center’s same database as Zhang 2019 (Hamilton Region Head and Neck Cancer Database); different sample and question. The authors reported no conflicts of interest"}],"ilgili_ilaclar":["kemoterapi","immunoterapi","tamoksifen","everolimus","varfarin","apiksaban","rivaroksaban"],"son_inceleme":"2026-10-31","arastirma_gecmisi":[{"tarih":"2026-10-19","not":"Page published. This first assessment reviewed 6 studies."},{"tarih":"2026-10-21","not":"The full texts of the studies were reread and the information on the page was checked against its sources. Corrected: duration, dose, dose titration and side effect details in the study table; drug interaction notes; the \"Who should be careful\" list; the evidence summary; the finding for THC-containing products. Points that could not be verified from the full text went down from 4 items to 1. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-21","not":"PubMed and ClinicalTrials.gov were searched for newly published and previously missed clinical studies. Study added: Myint 2023. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-22","not":"The names of the finding labels were simplified: the \"No benefit seen\" label on this page became \"No effect found\". The assessment did not change."},{"tarih":"2026-10-28","not":"In October 2026, PubMed, Cochrane, ClinicalTrials.gov and Europe PMC were systematically searched; 17 studies were added: 2 clinical studies with products containing THC and CBD (glioma and chronic lymphocytic leukemia), a 119-patient pure CBD case series, the ASCO 2024 guideline, 3 reviews (one Cochrane) and 10 observational studies comparing cancer patients who use and do not use cannabis (6 in people receiving immunotherapy; results conflicting). The case series and observational studies reporting positive results were written up together with their methodological limitations and the authors' company ties. Registry numbers, the main publication, doses, death counts and company ties were added to existing rows; ARISTOCRAT's target number of patients was corrected according to verified sources. The texts on immunotherapy were balanced to also show the studies that found no difference, and the warning from the MASCC 2023 guideline was added; statements saying 'no human study' that conflicted with the table were corrected to 'no well-designed human study'; time-dependent statements were written with dates; a transparency sentence was added to the evidence summary. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-28","not":"Display fix: internal working file names left in the text were removed; content and evidence did not change."},{"tarih":"2026-10-31","not":"Five observational studies (head and neck, lung and bladder cancer) looking at the course of the disease in people who were using or had previously used cannabis when they were diagnosed with cancer were added to the table, and a separate paragraph describing them was written in the “What does the research say?” section: no clear difference was seen in survival, in cancer coming back or in a second cancer developing; in lung cancer, aggressive tumor types were more common in people who smoked tobacco along with cannabis. Because these studies are observational, they do not show cause and effect, and the strength of evidence is very weak. For a 2025 publication claiming that there is a “scientific consensus” that cannabis is good for cancer, a question and answer was added explaining what it did and why it does not count as evidence of a treatment. Because the result of a short report on cannabis use disorder and death in colon cancer could not be read, and the abstract of the same research group's larger study gives no figures for cannabis either, both are described under unverifiable items. The result and the strength of evidence did not change."},{"tarih":"2026-10-31","not":"The last sentence of the page's short summary was rewritten in calmer, more guiding language: instead of \"Talk to your doctor before you start.\", it now says who you can talk with, and about what, if you are considering CBD. The result and the strength of evidence did not change."},{"tarih":"2026-10-31","not":"The evidence level text now uses the same level name as the top of the page; the level and the result did not change."}]},{"id":"post-surgical-pain","baslik":"Postoperative and acute pain","grup":"Pain and surgery","grup_kodu":"agri","tr_id":"agri-ameliyat-sonrasi","kanit_duzeyi":"zayif","kanit_yonu":"yarar_gosterilmedi","kanit_ozet":"Most RCTs of pure CBD showed no superiority over placebo: low back pain in the emergency department, ureteroscopy, root canal treatment and total knee replacement (topical). In shoulder arthroscopy there was a difference in pain and satisfaction only on day 1, which then disappeared, and opioid consumption did not change; no difference or harm was seen at 1-year follow-up either. After eye laser surgery (PRK), CBD 50 mg × 2 in 35 patients gave pain control similar to codeine-acetaminophen; this study had no placebo. In emergency dental pain, a single small RCT reported a positive result with very high doses (10–20 mg/kg). In 36 patients who had both knees replaced at once, oral CBD 400 or 800 mg (4 doses around surgery) did not significantly reduce the primary outcome, 72-hour opioid consumption, compared with placebo; the reduction at 400 mg was seen only in a post hoc analysis, and side effects increased at 800 mg. In healthy volunteers given experimental pain, CBD alone (50–1600 mg) did not reduce pain intensity; when given with an opioid, it increased the opioid's effect on some acute pain measures but not on the prespecified primary measure. CBD added to THC also did not increase THC's analgesic effect. In a meta-analysis combining 18 experimental pain studies of cannabis, THC and THC-like drugs, pain threshold and pain tolerance rose slightly, but pain intensity did not decrease. None of the eight placebo-controlled studies of postoperative and acute pain with THC-containing products or the THC-like drug nabilone clearly reduced pain or opioid requirements; these include two knee replacement RCTs published in 2026, with 111 and 163 patients. Because most studies were small and THC doses were low, the evidence for THC is also weak. In an open-label trial of 469 trauma patients, the daily opioid amount was similar in both groups (median 17 and 15 mg morphine equivalents; results only in the registry, no statistical comparison reported). The studies that reported a benefit had no placebo: an open-label trial of 68 patients in coronary bypass surgery, an uncontrolled dose-escalation study and two retrospective comparisons. Meta-analyses of postoperative and acute pain found no clinically meaningful benefit; in the only meta-analysis that found a small benefit, the effect came from a single study of an experimental synthetic cannabinoid (intramuscular levonantradol). The São Paulo Society of Anesthesiology (2024) does not recommend cannabinoids for acute pain; the American (ASRA 2023) and Canadian (PAIN 2021) guidelines focus on perioperative management of patients who use cannabis. Postoperative nausea and vomiting: none of the four controlled studies of nabilone, dronabinol and IV THC (the largest with 340 patients, a single low dose of nabilone) showed superiority over placebo or standard antiemetics; the strength of evidence for nausea is weak, and no study of pure CBD has published results. October 2026 search (PubMed, Cochrane, ClinicalTrials.gov, Europe PMC): 29 controlled studies of cannabinoids on this topic (19 in patients with postoperative or acute pain, 4 in postoperative nausea, 6 in experimental pain in healthy volunteers with CBD-containing products) and 6 systematic reviews were found; all are in the table below. Experimental pain studies in healthy volunteers using only THC or THC-like drugs are not listed individually in the table: those up to 2017 are represented by a meta-analysis, and later ones were not added separately; three postoperative pain studies with selective or experimental synthetic cannabinoids fell outside the site's scope. There is no Cochrane review; a Cochrane protocol for postoperative nausea was published in 2022, but the review itself could not be found in October 2026.","kanit_duzeyi_metin":"Weak; mostly no benefit","kanit_duzeyi_thc_icerenler":"zayif","kanit_duzeyi_thc_icerenler_metin":"Weak, pointing to no effect: no clinically meaningful benefit in eight placebo-controlled studies or in meta-analyses; the studies are small, THC doses were low, and there is no meta-analysis combining the new trials","kaynak_dosya":"agri-ameliyat.md","saf_cbd_sonuc":"In most RCTs, pure CBD was no different from placebo for postoperative and acute pain and did not reduce opioid use. In a 36-patient pilot RCT in bilateral knee replacement, the primary outcome (72-hour opioid consumption) was also no different from placebo; the reduction at 400 mg appeared only in a post hoc analysis. No study of pure CBD for postoperative nausea has published results.","thc_icerenler_sonuc":"In a meta-analysis of cannabinoids after surgery (most containing THC), there was no difference in opioid consumption or pain at 24 hours; at 12 hours there was an increase in pain and a hypotension signal (OR 3.24). In two knee replacement RCTs published in 2026 (111 and 163 patients), dronabinol did not reduce opioid consumption or pain; in a 469-person open-label trial in trauma patients, the daily opioid amount was similar in both groups (results only in the registry, with no statistical comparison). Positive results came only from small studies without placebo or from retrospective studies. For preventing nausea and vomiting, nabilone, dronabinol and IV THC were no better than placebo or standard anti-nausea medicines in four controlled studies.","ruhsat":null,"doz_araligi_ozet":"In pure CBD studies, from 20 mg/day to a 400 mg single dose; in bilateral knee replacement, 4 doses of 400 or 800 mg around surgery; after PRK, 100 mg/day; in experimental pain models, 50–1600 mg single dose; in dental pain, 10–20 mg/kg single dose","titrasyon_ozet":null,"yan_etkiler":["In the dental pain study, sedation, diarrhea and abdominal pain were more common in the CBD groups (Chrepa 2024)","Small drop in blood pressure after a single dose (Arout 2022); hypotension with cannabinoids after surgery OR 3.24 (Abdallah 2020, most containing THC)","With 800 mg CBD (4 doses around surgery), more adverse events and increases in anxiety and depression scores (Sideris 2026, 36 patients)","With IV THC (0.125 mg/kg), clinically important sedation and confusion; the study was stopped early (Kleine-Brueggeney 2015); with nabilone 2 mg, increased postoperative pain scores (Beaulieu 2006); 450 mg CBD increased THC's psychoactive effects and blood levels (Gorbenko 2024)"],"izlem":["Epidiolex label: at 10–20 mg/kg/day, ALT >3× ULN in 13% (placebo 1%); the risk rises markedly with valproate; monitor at baseline, at months 1, 3 and 6, and after dose changes","In healthy adults, at 5 mg/kg/day, ALT/AST >3× ULN in 5.6% (placebo 0%) and eosinophilia (Florian 2025, PMID 40622698); at 1500 mg/day, >5× ULN in 31% (Watkins 2021, PMID 33022751)","Liver enzymes should be monitored when CBD is combined with acetaminophen (paracetamol) and other medicines that burden the liver (Pramhas 2023, PMID 38033459)"],"dikkat":["Before surgery: ASRA 2023 recommends asking all patients about cannabinoid use (grade A); product type, route, amount, frequency and time of last use should be recorded; routine toxicology screening is not recommended (grade D)","ASRA makes no recommendation for or against routinely tapering cannabinoids before surgery (grade I). Patients should be told about the possible risks of continuing use around surgery (B). For non-inhaled routes, risks and benefits should be weighed; there are no data supporting a specific waiting period (I). The guideline states that prescription pure CBD (Epidiolex) should not be stopped abruptly around surgery; there are no safety data for non-prescription CBD products","Frequent users should be told that pain control after surgery may be harder (ASRA, A); regular users should be monitored for withdrawal after surgery with a validated scale (C). The risk of withdrawal is considered lower with CBD-dominant products (>10:1 CBD:THC)","Bleeding: no human data have been reported showing that pure CBD increases surgical bleeding; the risk comes through interactions (INR rise with warfarin, reduced clopidogrel effectiveness). In patients taking anticoagulants/antiplatelets, CBD use should be reported to the surgeon and anesthesia team","Risk of hypotension (meta-analysis of cannabinoids after surgery, mostly THC-containing products)","ASRA recommends considering adjusting anesthetic doses based on time of last use and the clinical picture (C); the supporting studies were in cannabis/THC users. That CBD does not change sevoflurane requirements has been shown only in a rat study; no human study of pure CBD has been reported","Postoperative nausea: the risk is slightly higher in daily cannabis users (relative risk 1.19; observational study of 27,000 patients); the Canadian PAIN consensus (2021) recommends additional antiemetic prophylaxis in patients who use cannabis. Cannabinoids themselves (nabilone, dronabinol, IV THC) were not superior to placebo or standard antiemetics for preventing nausea in controlled studies (weak evidence)"],"ilac_etkilesim_notlari":["Opioids: no increase in side effects with fentanyl + 400–800 mg CBD; 'bad effects' increased with hydromorphone + 200 mg CBD; pain threshold fell with methadone + 1200 mg CBD. An opioid-sparing effect has not been proven; monitor for sedation","CNS depressants (gabapentin, pregabalin, benzodiazepines, alcohol): additive sedation; somnolence 32% vs 11% with Epidiolex. No direct clinical study of CBD + gabapentinoids has been reported","NSAIDs: on the label, no significant change with the CYP2C9 substrate tolbutamide; no direct study of CBD + NSAIDs has been reported; no documented significant interaction","Acetaminophen (paracetamol): in knee OA, enzyme elevations were more common with acetaminophen 3 g + CBD 600 mg; monitor liver enzymes","Warfarin: in a case report, INR rose and the warfarin dose was reduced; monitor INR when starting or stopping CBD","Clopidogrel: antiplatelet effect may be reduced via CYP2C19 (label); consult cardiology","DOACs (apixaban, rivaroxaban): no direct data reported; uncertain, should be reported and monitored","Valproate (liver, high risk) and clobazam (sedation 46% vs 16%)","Tizanidine, theophylline (CYP1A2): the label recommends considering a dose reduction","Tacrolimus, sirolimus, everolimus, digoxin: monitoring or dose reduction (label)","Strong inducers such as rifampin: CBD levels fall by ~32%","Note: label data come from high-dose prescription CBD; the size of interactions may differ with non-prescription products, but the direction should be assumed to be the same"],"dogrulanamayan":["The full text of the following studies could not be obtained, and some fields come only from the abstract: de Andrade Silva 2024 (n, dose, side effects, THC ratio), Haffar 2022 (topical concentration, amount, side effects), Alaia 2022 (THC content), Narang 2023 (side effect details); Schneider 2022, Arout 2022 and two meta-analyses are also from the abstract only. Of those added in October 2026, Sideris 2026, Jennings 2026, Buggy 2003, Seeling 2006 (German), Holdcroft 2006, Raft 1977, Colwill 2020, Gorbenko 2024, Levin 2017, Kleine-Brueggeney 2015, Lewis 1994, Stevens 2017, King 2026, Hickernell 2018, Layeeque 2006 and the ASRA 2023 and PAIN 2021 guidelines were also read from the abstract only (together with the ClinicalTrials.gov record where available); the abstract and funding information for Beaulieu 2006 are from the publisher's page","Studies without a peer-reviewed publication: as of October 2026, the results of NCT03825965 (knee replacement, CBD:THC 25:1, pilot, 37 people) and NCT05820685 (trauma, dronabinol, 484 people) are only on ClinicalTrials.gov, and the registry has no statistical comparison; the table shows only their numbers. NCT00757822 (postoperative nausea, dronabinol vs ondansetron, 216 people) was not published in a peer-reviewed journal either, but its registry record includes comparison tests. A non-peer-reviewed preprint of NCT03825965 appeared in June 2026. The results of NCT04749628 (bilateral knee replacement, CBD 400/800 mg) were published in a peer-reviewed journal in October 2026 (Sideris 2026); NCT05240755 (shoulder arthroscopy, open-label) was completed in August 2024, with no results","Registered studies with no results found or still ongoing (October 2026): pure CBD for postoperative nausea (NCT06137027, Jamaica, 120 people planned), preoperative THC + CBD premedication (NCT02283281, Israel, 200 people planned), nabilone after inflammatory bowel disease surgery (NCT03422861), THC + CBD oil for acute pain due to a herniated lumbar disc (NCT04816994), dronabinol in spinal fusion (NCT04346407), CBD in knee replacement (NCT03675971; NCT06234631, 380 people, ongoing), CBD in shoulder surgery (NCT06381791), CBD for long bone fractures (NCT06448923, 225 people), dronabinol in arthroscopy (NCT05335252), THC in major abdominal surgery (NCT01790555, Netherlands, 40 people planned), and the effect of a CBD + THC tablet on pain and stress responses in healthy volunteers (NCT04226690, 24 people, ended in December 2023). A Cochrane review protocol on cannabis-based medicines for postoperative nausea was published in 2022 (CD014567); the review itself could not be found","The registry record of the tooth extraction pilot study (Abidi 2025) lists 68 participants as 'actual', while the article reports that 8 people were randomized; May 2, 2022, given in the article as the registration date, is according to ClinicalTrials.gov the record's last update date (registration was in February 2020, before the study started). Kleine-Brueggeney 2015 and NCT00695487 (same hospital, same dose and timing, same reason for stopping; the registry shows 320 participants, the article 40) and Jennings 2026 and NCT04298528 (same center, investigator and dose; the registry plans 460 people, with the drug for 4 weeks and a primary outcome of 30-day opioid use, while the article reports 2-week opioid use) are very likely the same studies; this could not be confirmed because the full texts could not be read. Haffar 2022 and NCT04585230 are also from the same center with the same four-arm design, but the registry lists 92 people and 'mineral oil' (the article: 80 people and 'essential oil'); the match could not be confirmed"],"calismalar":[{"ad":"Alaia 2022","tasarim":"Multicenter, double-blind, placebo-controlled RCT","n":"99 (100 randomized)","populasyon":"Arthroscopic rotator cuff repair","urun":"CBD, buccal tablet (absorbed through the cheek); THC not reported","urun_turu":"saf_cbd","doz":"<80 kg: 25 mg 3 times a day; >80 kg: 50 mg 3 times a day (75–150 mg/day)","titrasyon":"None (fixed dose by body weight)","sure":"14 days","sonuc":"Lower VAS on day 1 (4.4 vs 5.7); no difference on days 2, 7 and 14; higher satisfaction on days 1 and 2; no difference in opioid consumption. At 1-year follow-up (83 patients), no difference in pain, shoulder function or satisfaction (Alaia 2024)","yan_etki":"No difference in liver tests; nausea was monitored","pmid":"35905305","doi":"10.1177/03635465221109573","diger_kaynak":"NCT04672252; 1-year follow-up: PMID 38322981; 10.1177/23259671231222265"},{"ad":"Bebee 2021 (CANBACK)","tasarim":"Double-blind, placebo-controlled RCT","n":"100","populasyon":"Acute low back pain in the emergency department","urun":"Synthetic CBD (>99.9%), 400 mg in 4 mL of MCT oil, single oral dose; no THC","urun_turu":"saf_cbd","doz":"400 mg single dose","titrasyon":null,"sure":"Single dose (measured at hour 2)","sonuc":"No difference in pain score at hour 2 (6.2 vs 5.8); similar oxycodone use","yan_etki":"Similar between groups","pmid":"33846971","doi":"10.5694/mja2.51014","diger_kaynak":"ANZCTR ACTRN12618000487213 (prospectively registered)"},{"ad":"Narang 2023","tasarim":"Double-blind, placebo-controlled RCT","n":"90","populasyon":"Ureteroscopy + stent for stones","urun":"Epidiolex (oral solution, pure CBD)","urun_turu":"saf_cbd","doz":"20 mg/day","titrasyon":null,"sure":"3 days","sonuc":"No difference in pain, opioid use or stent symptoms (\"safe but ineffective\"); the registry's primary outcome, peak pain on day 3: 3.6 vs 3.2 (p = 0.5)","yan_etki":"No serious side effects; in the registry, other side effects 24/45 vs 21/45","pmid":"36891837","doi":"10.1097/JU.0000000000003139","diger_kaynak":"ClinicalTrials.gov NCT04387617 (results in the registry)"},{"ad":"de Andrade Silva 2024","tasarim":"Double-blind, placebo-controlled RCT","n":"Not reported (in the abstract)","populasyon":"Root canal treatment patients","urun":"CBD-rich cannabis extract, oral, before the procedure; THC ratio not reported","urun_turu":"cbd_zengin_thc_belirsiz","doz":"Not reported (in the abstract)","titrasyon":null,"sure":"Single session; 7-day follow-up","sonuc":"No difference in postoperative pain or anxiety","yan_etki":"Not reported (in the abstract)","pmid":"39505200","doi":"10.1016/j.joen.2024.10.010","diger_kaynak":null},{"ad":"Chrepa 2024","tasarim":"Phase IIa, placebo-controlled RCT, 3 arms; participants and assessors blinded","n":"61 analyzed (64 enrolled)","populasyon":"Emergency dental pain (moderate to severe)","urun":"Epidiolex (oral solution, pure CBD, 100 mg/mL)","urun_turu":"saf_cbd","doz":"10 mg/kg or 20 mg/kg single dose","titrasyon":null,"sure":"Single dose; 3-hour follow-up, side effect check on day 7","sonuc":"Significant difference from placebo at 10 mg/kg only at minute 180, and at 20 mg/kg at minutes 120 and 180; NNT 3.1 (10 mg/kg) and 2.4 (20 mg/kg)","yan_etki":"Sedation in the first 3 hours 28.5% (10 mg/kg) and 15% (20 mg/kg), 0% with placebo; diarrhea and abdominal pain 20% at 20 mg/kg, 0% with placebo","pmid":"37910667","doi":"10.1177/00220345231200814","diger_kaynak":"J Dent Res 2024;103(3):235–242 (online November 2023); correction PMID 38900211 (does not change the interpretation); ClinicalTrials.gov NCT04642404 (results in the registry)"},{"ad":"Zhou 2026","tasarim":"Randomized, crossover; patients as their own controls (a different drug for each eye); no placebo","n":"35","populasyon":"Adults having PRK (laser correction of vision problems) in both eyes, one after the other","urun":"Oral low-THC CBD; comparator codeine-acetaminophen","urun_turu":"cbd_zengin_thc_belirsiz","doz":"50 mg twice a day (comparator: codeine-acetaminophen 30/300 mg every 4 hours)","titrasyon":null,"sure":"Postoperative recovery period (3-month follow-up)","sonuc":"Average and peak pain no different from codeine-acetaminophen (p=0.538); similar visual recovery; no placebo group","yan_etki":"Few; more perceptual changes in those taking CBD for the first eye","pmid":"42524865","doi":"10.1097/j.jcrs.0000000000002030","diger_kaynak":"ClinicalTrials.gov NCT05477875"},{"ad":"Haffar 2022","tasarim":"Double-blind, placebo-controlled RCT, 4 arms","n":"80 (19 CBD, 21 essential oil, 21 CBD + essential oil, 19 placebo)","populasyon":"Primary total knee replacement","urun":"Topical CBD (± essential oil), around the knee; concentration not reported","urun_turu":"saf_cbd","doz":"Not reported (in the abstract); 3 times a day","titrasyon":null,"sure":"2 weeks","sonuc":"No difference between CBD and placebo in pain, sleep or 42-day opioid use; the only significant difference was against CBD: on day 2 after surgery, pain was higher in the CBD group than in the essential oil group (VAS 69.9 vs 51.0; p = 0.013)","yan_etki":"Not reported (in the abstract)","pmid":"35390457","doi":"10.1016/j.arth.2022.03.081","diger_kaynak":null},{"ad":"Schneider 2022 (CANAB I)","tasarim":"Crossover, double-blind, placebo-controlled RCT","n":"20","populasyon":"Healthy volunteers, electrical experimental pain","urun":"Oral CBD","urun_turu":"saf_cbd","doz":"800 mg single dose","titrasyon":null,"sure":"Single dose","sonuc":"No difference in pain, hyperalgesia or allodynia; low blood levels (median 5.0 µg/L at minute 130)","yan_etki":"Well tolerated","pmid":"34086631","doi":"10.1097/j.pain.0000000000002310","diger_kaynak":"ClinicalTrials.gov NCT03985995"},{"ad":"Dieterle 2022 (CANAB II)","tasarim":"Crossover, double-blind, placebo-controlled RCT","n":"24","populasyon":"Healthy volunteers, remifentanil-induced hyperalgesia","urun":"Oral CBD","urun_turu":"saf_cbd","doz":"1600 mg single dose","titrasyon":null,"sure":"Single dose","sonuc":"No effect on opioid-induced hyperalgesia, allodynia or pain","yan_etki":"Well tolerated","pmid":"35239547","doi":"10.1097/j.pain.0000000000002591","diger_kaynak":"ClinicalTrials.gov NCT04059978"},{"ad":"Arout 2022","tasarim":"Within-subject, double-blind, placebo-controlled","n":"17","populasyon":"Healthy, non-cannabis users","urun":"Oral CBD","urun_turu":"saf_cbd","doz":"200 / 400 / 800 mg single dose","titrasyon":"Fixed-dose arms","sure":"Single dose","sonuc":"No consistent analgesia; pain perception was higher than with placebo at all doses","yan_etki":"Small drop in blood pressure; well tolerated","pmid":"34223660","doi":"10.1111/bcp.14973","diger_kaynak":null},{"ad":"Abdallah 2020","tasarim":"Systematic review and meta-analysis (8 RCTs + 4 observational)","n":"924 patients (8 RCTs) + 4,259 patients (4 observational studies)","populasyon":"Postoperative pain","urun":"Cannabinoids (most containing THC)","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"No difference in opioid consumption or pain at 24 hours; pain at 12 hours +0.83 cm (95% CI 0.04–1.63); 24-hour results could not be pooled, qualitative synthesis","yan_etki":"Hypotension OR 3.24 (95% CI 1.12–9.36)","pmid":"32471924","doi":"10.1136/rapm-2020-101340","diger_kaynak":null},{"ad":"González Cárdenas 2025","tasarim":"Systematic review and meta-analysis (5 studies)","n":null,"populasyon":"Acute postoperative pain","urun":"Cannabinoids","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"Meta-analysis could not be done because of heterogeneity; the evidence is conflicting","yan_etki":null,"pmid":"39878042","doi":"10.1002/ejp.4790","diger_kaynak":null},{"ad":"Sideris 2026","tasarim":"Randomized, triple-blind, placebo-controlled, 3-arm parallel pilot RCT","n":"36 randomized (12 per arm; 37 enrolled in the registry)","populasyon":"Adults having both knees replaced at once (bilateral total knee replacement) (US)","urun":"Epidiolex (oral solution, pure CBD; off-label use); comparator sugar-free syrup","urun_turu":"saf_cbd","doz":"400 mg or 800 mg, 4 doses around surgery","titrasyon":null,"sure":"4 doses around surgery; primary outcome at 72 hours","sonuc":"No significant difference from placebo in the primary outcome, 72-hour opioid consumption: 144 vs 209 MME at 400 mg (p = 0.10), 203 vs 209 MME at 800 mg (p = 0.98; Dunnett test). The difference between 400 mg and placebo was significant only in a post hoc analysis (p = 0.04); the abstract states that pain scores and rescue medicine were lower and NSAID use higher in the 400 mg group (no test of these differences in the abstract). Sleep domains improved in the CBD groups; anxiety and depression scores (especially at 800 mg) and IL-6 were higher. A pilot study not powered for efficacy; the authors' interpretation of a \"possible signal of benefit\" for 400 mg is not based on the primary analysis","yan_etki":"Greater side effect burden at 800 mg (abstract). In the registry, serious side effects placebo 1/12, 400 mg 0/12, 800 mg 1/12; other side effects in 4, 3 and 5 people","pmid":"42913966","doi":"10.1016/j.jpain.2026.106477","diger_kaynak":"ClinicalTrials.gov NCT04749628 (results in the registry, May 26, 2026)"},{"ad":"Abidi 2025 (SWAP)","tasarim":"Randomized, 4-arm pilot study (two CBD concentrations, placebo, standard painkiller); CBD and placebo blinded, standard treatment arm open","n":"8 randomized (2 per arm; the registry says 68)","populasyon":"Adults having a simple tooth extraction (US)","urun":"Oral CBD oil (commercial product with a certificate of analysis; THC content not reported in the article); comparators almond-peppermint oil and ibuprofen + acetaminophen","urun_turu":"cbd_zengin_thc_belirsiz","doz":"0.5 mL (17 or 37 mg/mL; about 8.5 or 18.5 mg per dose), every 4–6 hours as needed","titrasyon":null,"sure":"7 days; pain followed for 72 hours","sonuc":"Because the numbers were very small, results are descriptive only, with no statistical comparison: pain was lowest in the 37 mg/mL group and similar to the standard ibuprofen-acetaminophen group; the 17 mg/mL group overlapped with placebo. The 17 mg/mL group had much lower pain before surgery (4 vs 10), which distorts the comparison. Stopped at 8 people because of the pandemic","yan_etki":"No serious side effects; mild drowsiness and dry mouth were rare","pmid":"41471281","doi":"10.3390/ph18121792","diger_kaynak":"ClinicalTrials.gov NCT04271917 (registered in February 2020, before the study started; the registry lists 68 participants as 'actual', with no results posted; the May 2, 2022 date in the article is the record's last update)"},{"ad":"De Vita 2022","tasarim":"Randomized, crossover, 2 × 2 balanced placebo design (the substance given and what participants were told were varied separately)","n":"15","populasyon":"Healthy young adults (ages 18–30), experimental heat and pressure pain (US)","urun":"Pure CBD derived from hemp (isolate), oil under the tongue","urun_turu":"saf_cbd","doz":"50 mg single dose","titrasyon":null,"sure":"Single dose, 4 sessions","sonuc":"No effect on pain threshold, pain tolerance or pain intensity. How much the pain bothered people decreased compared with the control session both when CBD was given and when no CBD was given but people were told \"you received CBD\"; being told \"you received CBD\" by itself changed some measures of pain modulation (an expectation effect)","yan_etki":"No cannabis-related side effects were detected","pmid":"34251840","doi":"10.1037/pha0000465","diger_kaynak":null},{"ad":"Bergeria 2025","tasarim":"Within-subject, double-blind, double-dummy, placebo-controlled randomized laboratory study","n":"31","populasyon":"Healthy volunteers, laboratory pain models (cold water, heat, pressure, capsaicin)","urun":"Epidiolex (oral pure CBD) together with 4 mg hydromorphone (an opioid)","urun_turu":"saf_cbd","doz":"50, 100 or 200 mg CBD, single dose with 4 mg hydromorphone","titrasyon":"Fixed-dose conditions","sure":"Single-dose sessions (5 sessions)","sonuc":"No effect on the prespecified primary pain measure (cold water tolerance time); on 3 of 10 acute pain measures, at least one CBD dose increased the opioid's analgesic effect (e.g., peak heat pain decreased with 50 mg); no effect in chronic pain models. CBD increased the opioid's subjective \"drug effect\" and reduced psychomotor impairment. NIDA-funded; 2 of 8 authors have ties to cannabis companies (research support or consulting: Canopy Growth, Charlotte's Web)","yan_etki":"Side effects and \"bad effects\" more common with 100 and 200 mg CBD + hydromorphone (drowsiness, nausea, dizziness); no serious side effects","pmid":"40839659","doi":"10.1097/j.pain.0000000000003561","diger_kaynak":"ClinicalTrials.gov NCT04036968"},{"ad":"Gorbenko 2024","tasarim":"Randomized, double-blind, placebo-controlled, 5-way crossover RCT","n":"37","populasyon":"Healthy volunteers, experimental pain test battery","urun":"Oral THC alone or together with CBD; double placebo","urun_turu":"thc_iceren","doz":"THC 9 mg + CBD 0, 10, 30 or 450 mg, single dose","titrasyon":"Fixed-dose conditions","sure":"Single dose, 5 sessions","sonuc":"CBD did not increase THC's analgesic effect at any dose. Instead of reducing them, 450 mg of CBD increased THC's intoxicating effects (feeling \"high\" increased by 60.5%; 95% CI 12.7–128.5) and its psychomotor, cognitive and autonomic effects; it raised THC blood levels 2.2-fold and its active metabolite 11-OH-THC 6.2-fold (with 10 and 30 mg CBD, effects did not differ from THC alone). Supported by the Dutch government research fund (ZonMw); the affiliation of 1 of 7 authors lists two companies (Verdient Science, Tomori Pharmacology); no conflict-of-interest statement in the PubMed record","yan_etki":"With 450 mg CBD + THC, subjective, psychomotor and autonomic effects increased compared with THC","pmid":"39054656","doi":"10.1002/cpt.3381","diger_kaynak":null},{"ad":"NCT03825965 (Busse pilot, registry results)","tasarim":"Multicenter, quadruple-blind, placebo-controlled pilot RCT; primary outcomes were feasibility; results only in the registry (no peer-reviewed publication)","n":"37 randomized (19 drug, 18 placebo); 30 people at month 6","populasyon":"Adults scheduled for total knee replacement (Canada)","urun":"Oral CBD-dominant cannabis oil MPL-001 (CBD:THC 25:1; 50 mg CBD, 2 mg THC per mL); comparator MCT oil","urun_turu":"thc_iceren","doz":"Up to 125 mg CBD + 5 mg THC a day (2.5 mL)","titrasyon":"Increased from 25 mg to 125 mg CBD a day over 2 weeks, then fixed","sure":"Starting 4 weeks before surgery until 6 weeks after; 6-month follow-up","sonuc":"Primary outcomes were feasibility: 2.9 patients enrolled per month; those taking at least 75% of the drug before surgery 13/17 vs 11/17, after surgery 10/16 vs 6/17; completing month-6 follow-up 14/19 vs 16/18. Efficacy measures were descriptive only: persistent pain at month 6 2/14 vs 3/16; pain intensity at month 6 3.5 vs 2.6 (0–10); median time to stopping opioids 32 vs 16 days; return to function at week 2 51.7% vs 61.9% (numbers are drug and placebo, respectively). The registry has no statistical comparison. Per protocol, the drug was not used during the 1–2 days in hospital. Supported by the Canadian Institutes of Health Research and university funds","yan_etki":"Nausea or stomach upset 7/19 vs 2/18; 1 serious side effect in the drug group (bowel inflammation)","pmid":null,"doi":null,"diger_kaynak":"ClinicalTrials.gov NCT03825965 (results in the registry, September 8, 2026); protocol: Busse 2026, PMID 42032682; non-peer-reviewed preprint June 2026 (doi 10.21203/rs.3.rs-9622221/v1)"},{"ad":"Thor 2026","tasarim":"Double-blind, placebo-controlled RCT (research letter)","n":"114 randomized; 111 analyzed (55 dronabinol, 56 placebo)","populasyon":"Unilateral total knee replacement under regional anesthesia; ages 18–70 with no cannabis or long-term opioid use in the past 3 months (US)","urun":"Dronabinol (synthetic THC) capsule; placebo sesame oil capsule","urun_turu":"thc_iceren","doz":"5 mg twice a day, 5 doses in total","titrasyon":null,"sure":"5 doses from the morning of surgery to the morning of day 2; 6-month telephone follow-up","sonuc":"No difference in the primary outcome, opioid consumption at 24–48 hours: mean 17.2 vs 23.9 MME (estimated difference −33%; −73 to +8). No difference in pain, reaching discharge criteria, oxygen desaturation, sleep or other secondary outcomes; blinding was successful. Internal institutional funding; one author receives royalties from a prosthesis company","yan_etki":"No serious or other side effects recorded (0 in both groups in the registry); confusion, dizziness, nausea and vomiting scores did not differ","pmid":"41838938","doi":"10.1097/ALN.0000000000005945","diger_kaynak":"ClinicalTrials.gov NCT04734080 (results in the registry, March 27, 2026)"},{"ad":"Jennings 2026","tasarim":"Randomized, triple-blind, placebo-controlled RCT","n":"163 (81 dronabinol, 82 placebo)","populasyon":"Patients not using cannabis (confirmed by preoperative urine test) having unilateral total knee replacement (US)","urun":"Dronabinol (synthetic THC) pill; placebo pill","urun_turu":"thc_iceren","doz":"2.5 mg twice a day","titrasyon":null,"sure":"Postoperative; 6-week follow-up (drug duration not in the abstract; 4 weeks in the likely registry record)","sonuc":"No difference in the primary outcome, total 2-week opioid consumption: 383.6 ± 309.8 vs 367.6 ± 246.3 MME (p = 0.717); in hospital 40.1 vs 38.8 MME (p = 0.901). No difference in pain, sleep duration or nausea and vomiting at weeks 2 and 4, or in patient-reported outcomes at week 6. Funding source not in the abstract","yan_etki":"No complications attributed to the drug or placebo","pmid":"41967982","doi":"10.1016/j.arth.2026.02.047","diger_kaynak":"Very likely ClinicalTrials.gov NCT04298528 (same center and principal investigator, unilateral knee replacement, preoperative cannabis screening, same dose; the registry plans 460 people, drug for 4 weeks, primary outcome 30-day opioid use, status 'unknown'; no registry number in the abstract, match could not be confirmed)"},{"ad":"NCT05820685 (DOPE, registry results)","tasarim":"Pragmatic, open-label (no blinding) RCT; terminated early because the drug became unavailable; results only in the registry (no peer-reviewed publication)","n":"484 randomized (241 standard care, 243 standard care + dronabinol); 469 analyzed","populasyon":"Adults hospitalized for acute trauma (US, Houston)","urun":"Dronabinol (synthetic THC), added to standard multimodal pain treatment (acetaminophen, naproxen, gabapentin, and oxycodone or tramadol if needed)","urun_turu":"thc_iceren","doz":"10 mg twice a day (the physician could change it if needed)","titrasyon":null,"sure":"Throughout the hospital stay (about 11 days)","sonuc":"Primary outcome, daily opioid amount: median 17 (IQR 10–26) MME/day with dronabinol, 15 (9–25) with standard care; total in-hospital opioids median 99 MME in both; opioid prescription at discharge 144/234 vs 133/235. The registry has no statistical comparison and no pain score data; no blinding","yan_etki":"Serious events 13/234 vs 10/235 (unplanned ICU admission 13 vs 8, unplanned intubation 4 vs 3); among those placed on a ventilator, median ventilator time 6 vs 3 days","pmid":null,"doi":null,"diger_kaynak":"ClinicalTrials.gov NCT05820685 (results in the registry, June 11, 2025; no publication found in PubMed in October 2026)"},{"ad":"Kumar 2024","tasarim":"Randomized, open-label (no placebo or blinding), single-center study; no registry number; ethics approval was obtained for retrospective analysis of anonymized patient data","n":"74 randomized; 68 analyzed (31 dronabinol, 37 control)","populasyon":"Adults having first-time coronary bypass surgery (US); long-term opioid or cannabis users were excluded","urun":"Dronabinol (synthetic THC), added to standard opioid-based pain treatment","urun_turu":"thc_iceren","doz":"30 mg, 3 doses (before surgery, before removal of the breathing tube and on day 1; 90 mg in total)","titrasyon":null,"sure":"Day of surgery and day 1 (3 doses)","sonuc":"Total postoperative opioids were lower in the dronabinol group: 23.7 vs 39.6 MME (p = 0.0037; 40%). No difference in ventilator time, ICU stay or inotrope requirement. Pain scores not reported; because there was no placebo or blinding, opioid decisions may have been influenced; after randomization, 6 patients (long-term opioid or cannabis use) were excluded, and at the analysis stage those receiving circulatory support were also excluded","yan_etki":"No side effects attributed to dronabinol were reported","pmid":"38765405","doi":"10.7759/cureus.58566","diger_kaynak":null},{"ad":"Seeling 2006","tasarim":"Randomized, double-blind, placebo-controlled RCT (article in German)","n":"100 analyzed (number randomized not in the abstract)","populasyon":"Men having radical prostate surgery (retropubic prostatectomy and lymph node removal)","urun":"Oral dronabinol (synthetic THC)","urun_turu":"thc_iceren","doz":"5 mg, 8 doses","titrasyon":null,"sure":"8 doses from the evening before surgery to the morning of day 2; 48-hour follow-up","sonuc":"48-hour patient-controlled opioid (piritramide) consumption did not differ: median 54 mg (IQR 46–88) with dronabinol, 74 mg (44–90) with placebo; the difference was not significant. No synergy or additive effect with the opioid was seen; THC blood levels were measurable in the entire drug group","yan_etki":"Not reported (in the abstract)","pmid":"16389542","doi":"10.1007/s00101-005-0963-6","diger_kaynak":null},{"ad":"Buggy 2003","tasarim":"Randomized, double-blind, placebo-controlled, single-dose RCT","n":"40 (20 + 20)","populasyon":"Women who had uterine surgery (abdominal hysterectomy) and requested pain medicine on day 2 after patient-controlled analgesia was stopped (Ireland)","urun":"Oral THC capsule","urun_turu":"thc_iceren","doz":"5 mg single dose","titrasyon":null,"sure":"Single dose; 6-hour follow-up","sonuc":"No difference in the primary outcome, summed pain intensity difference over 6 hours (SPID): on movement, placebo 7.9, THC 4.3 cm·h (95% CI of the difference −1.8 to 9.0); at rest, 8.8 vs 4.9; time to rescue medicine 217 vs 163 min (no difference)","yan_etki":"Heightened awareness of the surroundings more common with THC (40% vs 5%; p = 0.04); no difference in other side effects","pmid":"14581124","doi":"10.1016/s0304-3959(03)00331-2","diger_kaynak":null},{"ad":"Beaulieu 2006","tasarim":"Randomized, double-blind, placebo-controlled, 4-arm parallel pilot RCT","n":"41 (nabilone 1 mg: 11, 2 mg: 9, ketoprofen: 11, placebo: 10)","populasyon":"Adults receiving morphine patient-controlled analgesia after major surgery (gynecologic 46%, orthopedic 44%) (Canada)","urun":"Oral nabilone (THC-like synthetic cannabinoid); comparators ketoprofen 50 mg and placebo","urun_turu":"cbn_diger","doz":"1 mg or 2 mg, every 8 hours","titrasyon":null,"sure":"24 hours (every 8 hours, 3 doses)","sonuc":"24-hour morphine consumption did not differ among the four groups; in the 2 mg nabilone group, pain scores at rest and on movement were significantly higher than in the other groups. No difference in nausea and vomiting, sleep quality or sedation. Supported by the Canadian Institutes of Health Research and a drug company (Valeant Pharmaceuticals; the product information for nabilone in Canada belongs to this company); single-author pilot study, arms of 9–11 people","yan_etki":"No difference in the number and severity of side effects, euphoria or itching; no serious side effects","pmid":"16873343","doi":"10.1007/BF03022793","diger_kaynak":null},{"ad":"Holdcroft 2006","tasarim":"Multicenter, uncontrolled dose-escalation study (no placebo)","n":"65 (5 mg: 11, 10 mg: 30, 15 mg: 24)","populasyon":"Patients aged 18–75 with at least moderate pain after postoperative patient-controlled analgesia was stopped","urun":"Oral cannabis plant extract (Cannador; contains THC and CBD)","urun_turu":"thc_iceren","doz":"5, 10 or 15 mg single dose (units as given in the abstract)","titrasyon":"Dose escalation between groups","sure":"Single dose; 6-hour follow-up","sonuc":"The number of people requesting rescue pain medicine fell as the dose rose: 11/11 at 5 mg, 15/30 at 10 mg, 6/24 at 15 mg (trend p < 0.001); pain at rest also decreased (p = 0.01). Because there was no placebo, the size of the effect cannot be known (NNTs were calculated relative to 5 mg). The study was stopped at 15 mg because of a serious fainting (vasovagal) event","yan_etki":"Drowsiness (p = 0.03) and side effects (p = 0.002) increased with dose; serious vasovagal event at 15 mg","pmid":"16645457","doi":"10.1097/00000542-200605000-00021","diger_kaynak":null},{"ad":"Raft 1977","tasarim":"Placebo- and diazepam-controlled clinical study (randomization and blinding not stated in the abstract)","n":"10","populasyon":"Healthy volunteers having a tooth extraction","urun":"IV THC; comparators diazepam and lactated Ringer's","urun_turu":"thc_iceren","doz":"0.022 or 0.044 mg/kg (diazepam 0.157 mg/kg)","titrasyon":null,"sure":"Single dose (before tooth extraction)","sonuc":"The analgesic effect measured by pain tolerance was smaller with THC than with diazepam and placebo; at the high dose, pain threshold changed unpredictably. Low-dose THC was better than placebo in only 3 people; 6 people preferred placebo as a painkiller, and in these people surgical pain increased","yan_etki":"Not reported (in the abstract)","pmid":"832447","doi":"10.1002/cpt197721126","diger_kaynak":"Gregg 1976 (PMID 1062533 and 769605), published in the same period with the same design: anxiety, dysphoria, paranoid thinking and tachycardia with IV THC premedication; no superiority of THC over diazepam or placebo (whether it is the same study could not be confirmed)"},{"ad":"Colwill 2020","tasarim":"Randomized, double-blind, placebo-controlled RCT (phase 4)","n":"70 randomized (35 + 35); primary outcome in 66 people","populasyon":"Women having a medication abortion (mifepristone + misoprostol, up to 70 days) (US)","urun":"Dronabinol (synthetic THC) capsule; everyone also took ibuprofen 800 mg","urun_turu":"thc_iceren","doz":"5 mg single dose, 30 min before misoprostol","titrasyon":null,"sure":"Single dose; 24-hour follow-up","sonuc":"No difference in the primary outcome, maximum pain over 24 hours: median 7 vs 7 (p = 0.82); no difference at any time point in pain, maximum anxiety (3.33 vs 3.23) or nausea (2.21 vs 2.72; p = 0.41); satisfaction 76% vs 82%","yan_etki":"In the registry, other side effects 2/35 vs 0/35; no serious side effects","pmid":"32459420","doi":"10.1097/AOG.0000000000003850","diger_kaynak":"ClinicalTrials.gov NCT03604341 (results in the registry)"},{"ad":"Levin 2017","tasarim":"Pragmatic, single-center, randomized, placebo-controlled RCT (quadruple-blind in the registry)","n":"340 (172 nabilone, 168 placebo)","populasyon":"Adults having planned surgery under general anesthesia with a risk of nausea and vomiting above 60% (Canada)","urun":"Oral nabilone (THC-like synthetic cannabinoid); added to other anti-nausea medicines","urun_turu":"cbn_diger","doz":"0.5 mg single dose, before surgery","titrasyon":null,"sure":"Single dose; from the recovery room until discharge","sonuc":"Nausea outcome (primary): no difference in the frequency of postoperative nausea and vomiting, 20.9% vs 21.4% (relative risk 0.98; 95% CI 0.89–1.11; p = 0.99). No difference in pain scores, opioid consumption or speed of recovery either","yan_etki":"No difference in reported side effects","pmid":"28160217","doi":"10.1007/s12630-017-0814-3","diger_kaynak":"ClinicalTrials.gov NCT02115529"},{"ad":"Kleine-Brueggeney 2015","tasarim":"Randomized, double-blind, placebo-controlled RCT; stopped after 40 patients because of lack of efficacy and unacceptable side effects","n":"40","populasyon":"Surgical patients at high risk of nausea and vomiting (Switzerland)","urun":"IV THC","urun_turu":"thc_iceren","doz":"0.125 mg/kg, at the end of surgery before waking","titrasyon":null,"sure":"Single dose; 24-hour follow-up","sonuc":"Nausea outcome (primary, 24 hours): relative risk reduction 12% (95% CI −37 to 43), not significant; OR adjusted for anesthesia duration 0.97 (0.21–4.43; p = 0.97). The authors concluded that it cannot be recommended for prevention in high-risk patients","yan_etki":"Clinically important psychotropic side effects, especially drowsiness and confusion; the effect of anesthesia did not mask them","pmid":"26426861","doi":"10.1213/ANE.0000000000000877","diger_kaynak":"Very likely ClinicalTrials.gov NCT00695487 (same hospital, the registry's study director is an author of the article, same dose and timing; in the registry it was stopped on the grounds that 'no effect was seen at interim analysis', and the participant count shows as 320, versus 40 in the article; no registry number in the abstract)"},{"ad":"Lewis 1994","tasarim":"Randomized, double-blind, active-controlled RCT (no placebo)","n":"60 randomized; 53 analyzed","populasyon":"Women under age 70 having abdominal hysterectomy","urun":"Oral nabilone (THC-like synthetic cannabinoid); comparator metoclopramide 10 mg","urun_turu":"cbn_diger","doz":"2 mg single dose, 90 min before anesthesia","titrasyon":null,"sure":"Single dose; postoperative period","sonuc":"Nausea outcome: the frequency of nausea (73% vs 70%) and vomiting (54% vs 67%) did not differ between nabilone and metoclopramide; because there was no placebo, the effect of either drug on its own cannot be known","yan_etki":"Not reported (in the abstract)","pmid":"7917745","doi":"10.1093/bja/73.2.244","diger_kaynak":null},{"ad":"NCT00757822 (US Veterans Affairs, registry results)","tasarim":"Randomized, triple-blind, active-controlled study (no placebo); results only in the registry (no peer-reviewed publication)","n":"216 enrolled; 180 randomized (92 dronabinol, 88 ondansetron); 121 analyzed (64 + 57)","populasyon":"Veterans at high risk of nausea and vomiting having same-day abdominal surgery lasting at least 1 hour (US)","urun":"Oral dronabinol (synthetic THC); comparator ondansetron 4 mg IV","urun_turu":"thc_iceren","doz":"5 mg single dose, 20–60 min before surgery","titrasyon":null,"sure":"Single dose; 48-hour and 6-week follow-up","sonuc":"Nausea outcome (primary measures): nausea in the recovery room 34.4% vs 29.8% (difference 4.6 points; 95% CI −9.5 to 18.6; p > 0.76), vomiting 12.5% vs 7%; nausea at 24–48 hours 23.4% vs 22.8%. Dronabinol was not better than ondansetron; rescue anti-nausea medicine in the recovery room 25% vs 17%. One third of those randomized were excluded from the analysis","yan_etki":"Serious events (mostly overnight hospital stays) 13/92 vs 10/88","pmid":null,"doi":null,"diger_kaynak":"ClinicalTrials.gov NCT00757822 (results in the registry, May 13, 2016; no publication found in PubMed in October 2026)"},{"ad":"Gazendam 2020","tasarim":"Systematic review and meta-analysis (6 RCTs, 678 patients)","n":"678","populasyon":"Acute pain (mostly postoperative; including tooth extraction)","urun":"Cannabinoids: nabilone (2 studies), oral THC (1; the review classified it as \"cannabis oil extract\"), intramuscular levonantradol and two experimental synthetic drugs (AZD1940, GW842166)","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"Small difference in pain across all comparisons (−0.90 points; 95% CI −1.69 to −0.10; heterogeneity 65%); the difference came only from a single study of the experimental synthetic levonantradol given intramuscularly (−2.98). No difference with oral cannabinoids (−0.21; −0.64 to 0.22). GRADE: low certainty","yan_etki":"Serious side effects 3.7% vs 2.6%","pmid":"33381643","doi":"10.1089/can.2019.0079","diger_kaynak":null},{"ad":"Stevens 2017","tasarim":"Systematic review (7 RCTs, 611 patients; qualitative synthesis)","n":"611","populasyon":"Acute pain","urun":"Cannabinoid medicines (details not in the abstract)","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"Analgesic effect equal to placebo in 5 studies, better than placebo in 1 and worse than placebo in 1; no synergy or additive effect with opioids. The authors' conclusion: cannabinoids have no role in treating acute pain","yan_etki":"In 5 of 7 studies, some side effects were more common with cannabinoids","pmid":"28090652","doi":"10.1111/aas.12851","diger_kaynak":null},{"ad":"De Vita 2018","tasarim":"Systematic review and meta-analysis (18 placebo-controlled studies, 442 people)","n":"442","populasyon":"Healthy adults, experimental pain models","urun":"Cannabis (6 studies), dronabinol or THC capsules (8), nabilone (2), a cannabis extract containing half as much CBD as THC (1) and two synthetic drugs (HU210, AZD1940); no pure CBD studies","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"Cannabinoids slightly increased pain threshold (Hedges g = 0.19; 95% CI 0.05–0.32) and pain tolerance (g = 0.23; 0.02–0.44), and reduced the unpleasantness of ongoing pain (g = 0.29; 0.10–0.47); however, they did not reduce pain intensity (g = 0.02; p = 0.81) or mechanical hyperalgesia (g = 0.09; p = 0.23). They may change the emotional response to pain more than they relieve pain","yan_etki":null,"pmid":"30422266","doi":"10.1001/jamapsychiatry.2018.2503","diger_kaynak":null},{"ad":"King 2026","tasarim":"Narrative review with a systematic search (42 observational studies, last 10 years; data not pooled)","n":"42 studies","populasyon":"Patients who used cannabis before surgery (compared with non-users)","urun":"Cannabis (mostly personal use; product and dose definitions varied)","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"Of the studies reporting pain, 14 found more postoperative pain in cannabis users, 10 no difference and 2 less; opioid requirements were higher in 18, no different in 17 and lower in 3. Increases were more common in mixed patient groups and spine surgery, and \"no difference\" more common in joint replacement. Observational data; confounding and differences in how use was defined limit interpretation","yan_etki":null,"pmid":"41406677","doi":"10.1016/j.jclinane.2025.112097","diger_kaynak":null},{"ad":"Shah 2023 (ASRA guideline)","tasarim":"Consensus guideline (modified Delphi; 9 questions, 100% agreement in the third round)","n":null,"populasyon":"Surgical patients who use cannabis or cannabinoids","urun":"Cannabis and cannabinoids (including CBD)","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"All patients should be asked about cannabinoid use before surgery (A); no recommendation for or against routine tapering before surgery (I); frequent users should be told that pain control after surgery may be harder (A) and should be monitored for withdrawal (C); anesthetic doses may be adjusted based on time of last use (C). Focus: safe management of the patient who uses cannabinoids. 1 of 13 authors declared consulting fees from device and drug companies","yan_etki":null,"pmid":"36596580","doi":"10.1136/rapm-2022-104013","diger_kaynak":null},{"ad":"Ladha 2021 (Canadian PAIN consensus)","tasarim":"Consensus recommendations (modified Delphi; 17 experts, 4 independent reviewers)","n":null,"populasyon":"Surgical patients who use cannabis or cannabinoid medicines","urun":"Cannabis and cannabinoid medicines","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"Asking about a history of cannabis use and quantifying it; considering tapering use around surgery; additional prophylaxis against nausea and vomiting; extra attention to depth of anesthesia; being prepared for an increased need for pain medicine after surgery, and watching for withdrawal. Grades of recommendation strength and conflict-of-interest statements are not in the abstract","yan_etki":null,"pmid":"33129489","doi":"10.1016/j.bja.2020.09.026","diger_kaynak":null},{"ad":"de Barros 2024 (São Paulo Society of Anesthesiology)","tasarim":"Consensus recommendations (narrative review using the Delphi method; at least 60% agreement, about 90% in the second round)","n":null,"populasyon":"Use of cannabinoids in pain treatment (acute, cancer, neuropathic, musculoskeletal and other pain)","urun":"Cannabinoid products","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"The task force does not recommend cannabinoids for acute pain; it cites the acute pain meta-analyses (Gazendam 2020, Abdallah 2020) as its basis. It does not recommend them for cancer pain either; for other pain, established treatments should come first. The authors declared no conflicts of interest","yan_etki":null,"pmid":"38740135","doi":"10.1016/j.bjane.2024.844513","diger_kaynak":null},{"ad":"Hickernell 2018","tasarim":"Retrospective matched cohort (not randomized)","n":"243 (81 dronabinol, 162 matched controls)","populasyon":"Primary hip or knee replacement performed by a single surgeon (US)","urun":"Dronabinol (synthetic THC), added to standard multimodal pain treatment","urun_turu":"thc_iceren","doz":"5 mg twice a day","titrasyon":null,"sure":"Hospital stay","sonuc":"No difference in pain score (VAS), walking distance in physical therapy, or nausea and vomiting. In the dronabinol group, hospital stay was shorter (2.3 vs 3.0 days; p = 0.02) and total opioids were lower (252.5 vs 313.3 mg; p = 0.0088); the difference in daily opioids was not significant. Not randomized; confounding cannot be ruled out","yan_etki":"No side effects attributed to dronabinol were reported","pmid":"30170713","doi":"10.1016/j.arth.2018.07.027","diger_kaynak":null},{"ad":"Schneider-Smith 2020","tasarim":"Retrospective matched cohort (pilot)","n":"66 (33 dronabinol, 33 matched controls)","populasyon":"Adults hospitalized for trauma (US, level 1 trauma center)","urun":"Dronabinol (synthetic THC), added at the physician's discretion, mostly for pain","urun_turu":"thc_iceren","doz":"Mostly 5 or 10 mg twice a day (median 11 mg/day)","titrasyon":null,"sure":"48 hours each before and after dronabinol","sonuc":"In patients started on dronabinol, 48-hour opioid consumption fell by 79 MME, while it did not change in controls (−9 MME); difference between pairs p = 0.02; the effect was more pronounced in cannabis users. Observational and small; who was started on dronabinol, and when, may have been selective","yan_etki":"Side effects were not examined; no patient stopped dronabinol","pmid":"32154376","doi":"10.1136/tsaco-2019-000391","diger_kaynak":"An RCT planned by the same team (NCT03928015; protocol Swartwood 2020, PMID 32178232) was withdrawn before enrolling patients"},{"ad":"Layeeque 2006","tasarim":"Retrospective before-and-after cohort comparison (not randomized)","n":"242 (127 earlier period, 115 later period)","populasyon":"Women having breast surgery under general anesthesia","urun":"Oral dronabinol (synthetic THC) and prochlorperazine suppository, given together","urun_turu":"thc_iceren","doz":"Dronabinol 5 mg + prochlorperazine 25 mg, before surgery","titrasyon":null,"sure":"Postoperative period","sonuc":"Nausea outcome: with the new protocol, nausea and vomiting rates fell from 59% to 15% and from 29% to 3%, respectively (p < 0.0001); the need for additional anti-nausea medicine decreased. Because the two drugs were given together and different time periods were compared, dronabinol's share of the effect cannot be known","yan_etki":"Not reported (in the abstract)","pmid":"16720146","doi":"10.1016/j.amjsurg.2005.07.040","diger_kaynak":null},{"ad":"Suhre 2020","tasarim":"Retrospective cohort, two academic centers; causal analysis with machine learning and external validation","n":"27,388 (validation set 16,245)","populasyon":"ASA 1–3 adults receiving general anesthesia (excluding cardiac and obstetric surgery)","urun":"Cannabis (any form; patient's self-report before anesthesia)","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"Nausea outcome: 10% of patients used cannabis. In daily users, the relative risk of nausea and vomiting in the recovery room was 1.19 (95% CI 1.00–1.45; absolute increase 3.3 points, 0.4–6.4); with non-daily use, 1.07 (0.94–1.21). Observational and based on self-report","yan_etki":null,"pmid":"32423445","doi":"10.1186/s12871-020-01036-4","diger_kaynak":null}],"ilgili_ilaclar":["opioid","metadon","gabapentin","pregabalin","nsaii","parasetamol","tizanidin","varfarin","klopidogrel","apiksaban","rivaroksaban"],"son_inceleme":"2026-10-28","arastirma_gecmisi":[{"tarih":"2026-10-19","not":"Page published. This first review looked at 11 studies."},{"tarih":"2026-10-21","not":"The full texts of the studies were reread and the information on the page was checked against its sources. Corrected: product, duration, registry number and study design details in the study table; the \"Who should be careful\" list. Points that could not be confirmed from the full text dropped from 4 items to 2. The year of 2 publications named on the page was corrected to the journal's print year instead of the online publication year. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-21","not":"PubMed and ClinicalTrials.gov were searched for newly published and previously missed clinical studies. Study added: Zhou 2026. The 1-year follow-up results of the Alaia 2022 study (Alaia 2024) were added to that study's row. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-22","not":"The names of the finding labels were simplified: the \"No benefit seen\" label on this page became \"No effect found\". The assessment did not change."},{"tarih":"2026-10-28","not":"The October 2026 search added 31 studies, and on October 28, 2026 the scope was widened so that postoperative nausea and vomiting joined this page as a separate section. Added: a pilot RCT of pure CBD in bilateral knee replacement (Sideris 2026) and a CBD pilot study in tooth extraction; three experimental pain studies with CBD-containing products; ten controlled studies of THC-containing drugs and nabilone for postoperative and acute pain (including the two knee replacement RCTs published in 2026; the results of two are only on ClinicalTrials.gov) and an uncontrolled dose-escalation study; four controlled studies in postoperative nausea (one only in the registry); two systematic reviews in acute pain and one in experimental pain; a review summarizing postoperative pain in cannabis users; recommendations from the American, Canadian and São Paulo anesthesia societies; four observational studies. Registry numbers, figures and confidence intervals were added to the Bebee, Narang, Chrepa, Haffar, Schneider, Dieterle and Abdallah rows; the single significant difference against CBD in Haffar 2022 was written into its row. The topic text was updated for the new studies, the nausea section and the search counts. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-30","not":"The last sentence of the page's short summary was rewritten in a calmer, more guiding tone: instead of \"Talk to your doctor before you start.\", it now says whom you can talk with, and about what, if you are considering CBD. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-31","not":"The evidence level text now uses the same level name as the top of the page; the level and the result did not change."}]},{"id":"neuropathic-pain","baslik":"Neuropathic (nerve) pain","grup":"Pain and surgery","grup_kodu":"agri","tr_id":"agri-noropatik","kanit_duzeyi":"zayif","kanit_yonu":"celiskili","kanit_ozet":"Low-dose oral pure CBD was not superior to placebo in two RCTs: 5–50 mg/day in various peripheral nerve pains (8 weeks; on one scale the result was worse than placebo) and up to 45 mg/day in nerve pain from MS or spinal cord injury (6 weeks). In a crossover RCT (40 people) in neuropathic pain from spinal cord injury with titration to 800 mg/day, the pain score was 0.54 points (0–10 scale) lower than with placebo; the effect is small and rests on a single small study. There are two small RCTs of CBD applied to the skin: a methodologically weak study (29 people) in lower-extremity peripheral neuropathy reported a positive result; a crossover pilot study of pure CBD cream in chemotherapy-induced neuropathy (40 people, 2 + 2 weeks) found no difference from placebo. In HIV-associated neuropathy, CBDV, a cannabinoid closely related to CBD (400 mg/day, 32 people), was also not superior to placebo. In a series of single-patient crossover trials in 24 people with persistent symptoms due to neurological diseases such as MS and spinal cord injury (Wade 2003; each product for 2 weeks), pain was significantly better with a CBD-rich plant extract than with placebo; the patients were not selected for neuropathic pain, the THC content of the extract was not reported and the abstract gives no effect size, so the finding counts as very weak evidence. There are 28 RCTs of products containing THC: THC:CBD oromucosal spray (nabiximols) showed a small benefit in two 4–5-week studies; in two large 14–15-week studies the difference in mean pain was not significant (in one, the ≥30% responder rate was significantly higher with the spray); the manufacturer’s negative results in diabetic neuropathy (297 people) and spinal cord injury (116 people) are available only on ClinicalTrials.gov. Small studies of inhaled cannabis lasting from a single day to 5 days showed short-term pain reduction (individual patient data meta-analysis of 5 RCTs: NNT 5.6). Dronabinol was beneficial in a small 3-week study in MS and ineffective in a 16-week, 240-person study. A single-center, 100-person, 12-week RCT of a THC-dominant oil (THC:CBD:CBN) applied to the skin in diabetic neuropathy reported a very large benefit; it has not been independently confirmed. Of 3 RCTs with nabilone (15–96 people), one found it worse than dihydrocodeine, and two (one with an enriched design enrolling only initial responders) found it beneficial. Cochrane 2026 (21 RCTs, 2,187 people; only double-blind studies lasting at least 2 weeks): no clear effect on ≥50% relief for any of THC-dominant, balanced THC:CBD or CBD-dominant products (very low certainty); with the balanced product, ≥30% relief and the patient’s global impression may increase slightly (RD 0.07; low certainty); nervous system side effects increased (RD 0.25–0.39; low to very low certainty); two-thirds of the studies were funded by drug companies. Reviews reach different conclusions: a meta-analysis of 8 RCTs reported a moderate-certainty benefit for pain and sleep. Guidelines and expert bodies do not recommend cannabinoids as a first choice for nerve pain; where they differ is on whether they can be tried when other treatments have not been enough. The neuropathic pain special interest group of the International Association for the Study of Pain (NeuPSIG) issued a weak recommendation against using cannabinoids in 2015; cannabinoids are also absent from the first-, second- and third-line treatments recommended in the group’s 2025 update. The German Neurological Society’s 2019 guideline does not recommend cannabinoids because their effect is small and their side effects common; it states that, when other treatments have failed, they may be tried off-label only in individual patients as part of a multimodal treatment plan. A 2022 Canadian primary care guideline (PEER) finds the benefit of cannabinoids in nerve pain uncertain and lists them among options that can be discussed with the patient after treatments with clear benefit have been considered. There are also more favorable views: the Canadian Pain Society recommended cannabinoids as third-line treatment in 2014 (and wrote that they may be considered first-line for pain from spinal cord injury); the European Pain Federation’s 2018 position paper states that, when first- and second-line drugs do not work well enough or are not tolerated, experienced physicians may consider cannabis-based products as part of multimodal treatment, preferably as add-on drugs; and the Brazilian Academy of Neurology in 2020 placed products containing THC and CBD at the third line for central nerve pain, not as monotherapy but as add-on drugs in selected patients who have not responded to other drugs. The same academy’s 2021 position paper, however, states that for peripheral nerve pain the evidence points more toward their being ineffective, and that in some situations without an established evidence-based treatment (nerve pain from spinal cord injury, central post-stroke pain, chemotherapy or trauma) they may be considered as add-on treatment within an individual plan (one of its 49 authors is an executive at a CBD company); in chemotherapy-induced nerve damage, three small controlled studies published after this paper (2024–2025) found that pain or neuropathy symptoms did not improve more than with placebo. October 2026 search (PubMed, Cochrane, ClinicalTrials.gov): 35 controlled studies of cannabinoids in patients with neuropathic pain were found (all randomized; 3 with results only in the registry); all of them are in the table below, together with 6 topic-specific systematic reviews (including the 2018 and 2026 versions of the Cochrane review) and 4 real-world studies (one specific to complex regional pain syndrome). Complex regional pain syndrome was searched separately on October 28, 2026 (PubMed, ClinicalTrials.gov): no controlled study specific to this condition was found; three short studies of inhaled cannabis in mixed nerve pain groups also included patients with this syndrome (in one, most of the patients), but no separate result was given for them; a study comparing a CBD-rich extract with placebo is ongoing according to its registration. There is no separate page for burning mouth syndrome (burning pain inside the mouth that persists without a visible cause); it was searched separately on October 29, 2026 (PubMed, ClinicalTrials.gov): in a single-center, single-blind study comparing full-spectrum CBD oil (THC content not reported) with placebo in 26 patients (Parise 2026), pain decreased more than in the placebo group from the third assessment onward, and oral health–related quality of life also improved in the CBD group; in a 4-week study without a control group in 17 patients using an oil made from cannabis flowers (Gambino 2021), symptoms were reported to decrease over time. Both are very small and the evidence is very weak; the placebo-controlled study is in the table (not added to the neuropathic pain counts above), and the uncontrolled study is mentioned only here and in the research section. Studies in groups not selected for neuropathic pain (except Wade 2003, which also tested a CBD-rich extract: that study is in the table to show every piece of data on the CBD side, but it was not added to the count of controlled studies above), experimental synthetic drugs that target the body’s own cannabinoid system, and three small registry records whose comparative pain results could not be interpreted were not included in the table; completed studies with unpublished results are listed under unverifiable items.","kanit_duzeyi_metin":"Weak; conflicting (oral 45–50 mg/day negative in two RCTs, 800 mg/day small benefit in a single small RCT; Cochrane 2026: no clear effect with CBD-dominant products, very low certainty)","kanit_duzeyi_thc_icerenler":"zayif","kanit_duzeyi_thc_icerenler_metin":"Low to very low certainty (Cochrane 2026): benefit uncertain or small, nervous system side effects more common","kaynak_dosya":"agri-ameliyat.md","saf_cbd_sonuc":"Low-dose pure CBD by mouth (45–50 mg/day) was no better than placebo in two RCTs (in Zubcevic 2023, +1.14 NRS worse on one scale); at a very high dose (800 mg/day), a single small RCT in spinal cord injury showed a small benefit (−0.54/10). In a 40-person crossover pilot RCT (2 + 2 weeks) of pure CBD cream applied to the skin in chemotherapy-related neuropathy, there was no difference. In Cochrane 2026, CBD-dominant products (5 studies, 208 people) showed no clear effect on ≥50% relief (RD −0.08; 95% CI −0.20 to 0.05; very low certainty); the high-dose study was published after this review’s search. In an old 24-person crossover study in people with persistent symptoms due to neurological diseases (Wade 2003), pain decreased significantly more with a CBD-rich plant extract than with placebo; but the patients were not selected for neuropathic pain, each product was tried for only 2 weeks and the THC content of the extract was not reported (very weak evidence).","thc_icerenler_sonuc":"There are 28 RCTs of products containing THC (THC:CBD spray, dronabinol, sublingual THC, sublingual THC:CBD oil, inhaled cannabis, CBD+THC capsules, THC oil applied to the skin; 3 have results only in the registry, and 2 are the THC arms of four-arm CBD studies). In most studies lasting from a single day to 5 weeks, pain decreased slightly more than with placebo; in most studies lasting 6 weeks or longer, there was no clear difference (a single 100-person study with an oil applied to the skin reported a large but unconfirmed benefit). Cochrane 2026: no clear effect on ≥50% relief (THC-dominant RD 0.14, 95% CI −0.07 to 0.37; balanced THC:CBD RD 0.04, 0.00–0.08; very low certainty); with the balanced product, ≥30% relief may increase slightly (RD 0.07; low certainty). Nervous system side effects increased (THC-dominant RD 0.25, low certainty; balanced RD 0.39, very low certainty). There are also 3 RCTs with nabilone (15–96 people).","ruhsat":null,"doz_araligi_ozet":"Oral pure CBD 5–50 mg/day (6–8 weeks) and up to 800 mg/day (6 weeks); topical 250 mg CBD / 3 fl oz oil; pure CBD cream twice a day (amount not reported). For products containing THC: mouth spray up to 12–48 sprays a day (2.5–2.7 mg THC per spray), dronabinol up to 10–15 mg a day, nabilone 1–4 mg/day, inhaled cannabis 1–9.4% THC (mostly single sessions; in one study 0.5–1 mg THC with a metered-dose device), CBD+THC capsules 125–300 mg CBD + 6–15 mg THC a day, THC-dominant oil on the skin 1–6 drops depending on pain intensity (3.2 mg THC per drop)","titrasyon_ozet":"Flexible dosing in Zubcevic 2023; 3-week titration in Hansen 2023; in Robertson 2026, increased by 200 mg every 4 days to 800 mg/day on day 13; in the nabiximols study, patients self-titrated","yan_etkiler":["Nabiximols: nervous system adverse events 61% vs. 29%, psychiatric 17% vs. 5% (Cochrane 2018)","Discontinuation with Sativex 18% vs. 3% (Nurmikko 2007)","High dose (800 mg/day): side effects reported in 68% with CBD, 53% with placebo; most often tiredness/drowsiness, nausea, diarrhea (Robertson 2026)","Cochrane 2026: nervous system side effects with THC-dominant products RD 0.25 (95% CI 0.14–0.37; low certainty), with balanced THC:CBD RD 0.39 (0.23–0.55; very low); discontinuation due to side effects with the balanced product RD 0.05 (0.02–0.09; low); no difference in nervous system or psychiatric side effects with CBD-dominant products (low certainty)","Unpublished manufacturer studies: in diabetic neuropathy, side effects 120/149 vs. 101/148, serious 14 vs. 12 (NCT00710424); in spinal cord injury 46/56 vs. 29/60 (NCT01606202)"],"izlem":["Epidiolex label: at 10–20 mg/kg/day, ALT >3×ULN in 13% (placebo 1%); risk rises markedly with valproate; monitor at baseline, at months 1, 3 and 6, and after dose changes","In healthy adults, 5 mg/kg/day led to ALT/AST >3×ULN in 5.6% (placebo 0%) and eosinophilia (Florian 2025, PMID 40622698); 1,500 mg/day led to >5×ULN in 31% (Watkins 2021, PMID 33022751)","Liver enzymes should be monitored with acetaminophen (paracetamol) and other medicines that strain the liver (Pramhas 2023, PMID 38033459)"],"dikkat":["CBD is not an approved medicine for any type of pain","Use caution with CNS depressants because of the risk of sedation, falls and impaired driving"],"ilac_etkilesim_notlari":["Opioids: no increase in side effects with fentanyl + 400–800 mg CBD; 'bad drug effect' increased with hydromorphone + 200 mg CBD; pain threshold decreased with methadone + 1,200 mg CBD. An opioid-sparing effect has not been proven; monitor for sedation","CNS depressants (gabapentin, pregabalin, benzodiazepines, alcohol): additive sedation; somnolence with Epidiolex 32% vs. 11%. No direct clinical study of CBD + gabapentinoids has been reported","NSAIDs: the label shows no significant change in tolbutamide, a CYP2C9 substrate; no direct study of CBD + NSAIDs has been reported; no documented significant interaction","Acetaminophen (paracetamol): in knee OA, enzyme elevations were more frequent with acetaminophen 3 g + CBD 600 mg; monitor liver enzymes","Warfarin: in a case report, INR rose and the warfarin dose was reduced; monitor INR when starting or stopping CBD","Clopidogrel: antiplatelet effect may be reduced via CYP2C19 (label); consult cardiology","DOACs (apixaban, rivaroxaban): no direct data reported; uncertain, should be disclosed and monitored","Valproate (liver, high risk) and clobazam (sedation 46% vs. 16%)","Tizanidine, theophylline (CYP1A2): the label recommends considering a dose reduction","Tacrolimus, sirolimus, everolimus, digoxin: monitoring or dose reduction (label)","Strong inducers such as rifampin: CBD levels fall by ~32%","Note: label data come from high-dose pharmaceutical CBD; with nonprescription products the size of an interaction may differ, but its direction should be assumed to be the same"],"dogrulanamayan":["Xu 2020 (amount applied, THC) was read only from the abstract; the maximum daily dose in Nurmikko 2007 is contradictory in the registry (NCT00711880: 24 sprays in the intervention description, 48 in the results section), and the full text of the publication could not be read","The full text of the Cochrane 2026 update (which 21 studies, and in particular which 5 CBD-dominant studies, were included) could not be read because of the Cochrane Library’s bot verification; the numbers are from the review’s abstract","The Thai registry page (TCTR20191106004) for the brachial plexus injury study (Kittithamvongs 2025) still returned no content on October 28, 2026; the registered plan could not be compared with the publication (product and dose information was read from the full text of the publication)","There are 5 randomized studies that appear completed on ClinicalTrials.gov but whose results were found neither in the registry nor on PubMed as of October 2026: nabilone in phantom limb pain with 50 people planned (ended in 2011; actual number not in the registry) and in spinal cord injury with 12 people (2015), a metered-dose inhaler in diabetic neuropathy with 122 people (ended June 2026), nabilone and diet in spinal cord injury with 14 people (2024), and CBD/CBDA with 6 people (2026)","Dose information is missing in two studies of products applied to the skin: in the pure CBD cream study (D'Andre 2024), the amount of CBD in the cream is not in the abstract or the registry, and the full text is not open access; in the THC-dominant oil study (Seevathee 2025), the daily frequency of application is not stated in the full text","Of the guidelines in the evidence summary, the 2025 NeuPSIG update and the European Pain Federation’s 2018 position paper were read only from the abstract (the full texts required a subscription or the publisher’s page); for this reason, NeuPSIG 2025’s detailed decision on cannabinoids and the content of its published correction are not known","The full text of Wade 2003 could not be read (paywalled): the THC content of the CBD-rich extract and the size of the effect on pain for each product are not known. The two studies in burning mouth syndrome (Gambino 2021, Parise 2026) were read from the abstract only; for Parise 2026, the THC content of the product, the length of treatment and who was blinded are not in the abstract"],"calismalar":[{"ad":"Zubcevic 2023","tasarim":"Double-blind RCT, 4 arms (CBD / THC / CBD+THC / placebo)","n":"118 randomized (115 ITT)","populasyon":"Polyneuropathy, postherpetic neuralgia, peripheral nerve injury; not responding to at least 1 treatment","urun":"Oral capsules: pure CBD; pure THC; CBD/THC 2:1","urun_turu":"saf_cbd","doz":"CBD 5 mg at start → 50 mg (in the combination 5/2.5 mg → 50/25 mg; THC 25 mg)","titrasyon":"Increased up to 10 capsules/day (CBD 50 mg) over the first 4 weeks, then fixed for 4 weeks; median 10 capsules in the CBD arm at week 8","sure":"8 weeks","sonuc":"No group was superior to placebo; in the CBD group, pain at week 8 was 1.14 points worse than placebo (0–10 scale; 95% CI 0.11–2.19). The difference was 0.38 (−0.65 to 1.4) in the THC group and −0.12 (−1.13 to 0.89) in the CBD+THC group; neither differed from placebo","yan_etki":"Dry mouth slightly more common in all active arms; discontinuation due to side effects 2/27 (7.4%) with CBD, 0 with placebo","pmid":"36571471","doi":"10.1002/ejp.2072","diger_kaynak":"EudraCT 2017-005198-38"},{"ad":"Robertson 2026","tasarim":"Double-blind, placebo-controlled crossover RCT (4-week washout)","n":"40 randomized (38 analyzed)","populasyon":"Neuropathic pain from spinal cord injury lasting at least 3 months (Australia)","urun":"Oral pure CBD capsules (200 mg, 99% purity); no THC detected in the blood","urun_turu":"saf_cbd","doz":"Up to 800 mg/day, with food and divided into 3 doses a day (largest dose 400 mg in the evening)","titrasyon":"200 mg/day (days 1–4) → 400 (days 5–8) → 600 (days 9–12) → 800 mg/day (days 13–42)","sure":"2 × 6 weeks","sonuc":"During the treatment period, pain was 0.54 points lower with CBD than with placebo (0–10 scale; 95% CI −0.88 to −0.21); the effect is small","yan_etki":"Side effects reported in 68.4% with CBD, 52.6% with placebo; most often tiredness/drowsiness (15), nausea (10), diarrhea (7); 1 person stopped because of nausea","pmid":"42256679","doi":"10.1016/j.eclinm.2026.103986","diger_kaynak":"ANZCTR ACTRN12622000634774"},{"ad":"Hansen 2023","tasarim":"Multicenter, double-blind, placebo-controlled, 4-arm parallel RCT (THC / CBD / THC+CBD / placebo)","n":"134 (MS 119, spinal cord injury 15; CBD 31, THC 32, THC+CBD 31, placebo 40)","populasyon":"Neuropathic pain and/or spasticity from MS or spinal cord injury (Denmark)","urun":"Oral capsules: synthetic pure CBD; THC; both together","urun_turu":"saf_cbd","doz":"CBD up to 45 mg/day, THC up to 22.5 mg/day (divided into 3 doses a day, up to 9 capsules)","titrasyon":"Standard escalation over 3 weeks; a lower dose was kept if there was enough effect or side effects","sure":"6 weeks + 1 week tapering","sonuc":"In the pure CBD group, the improvement in neuropathic pain did not differ from placebo (difference 0.45 points; 95% CI −0.47 to 1.38; 0–10 scale, a positive value means less reduction than placebo); there was also no difference in the THC (0.42; −0.54 to 1.38) and THC+CBD (0.16; −0.75 to 1.08) groups; for spasticity too, no group differed from placebo. Only 134 of the target 448 people could be enrolled","yan_etki":"Side effects most common in the THC arms; dry mouth 29% with CBD, 27.5% with placebo; 1 hospitalization in the CBD arm (gallstone attack)","pmid":"37630995","doi":"10.3390/ph16081079","diger_kaynak":"EudraCT 2018-002315-98; protocol: Hansen 2021, PMID 34573231; pharmacokinetic substudy in 23 MS patients: Hansen 2024, PMID 38054364"},{"ad":"Xu 2020","tasarim":"Placebo-controlled RCT (followed by crossover)","n":"29","populasyon":"Lower-extremity peripheral neuropathy","urun":"Topical CBD oil (250 mg CBD / 3 fl oz); THC not reported","urun_turu":"cbd_zengin_thc_belirsiz","doz":"Not reported (in the abstract)","titrasyon":null,"sure":"4 weeks","sonuc":"Significant reductions in intense pain, sharp pain, cold sensations and itching were reported (methodologically weak)","yan_etki":"No adverse events reported","pmid":"31793418","doi":"10.2174/1389201020666191202111534","diger_kaynak":null},{"ad":"D'Andre 2024","tasarim":"Double-blind, placebo-controlled, crossover pilot RCT","n":"40 randomized (20 + 20); 36 completed both periods","populasyon":"Chemotherapy-induced peripheral neuropathy with pain or tingling of at least 4/10, in people who had finished chemotherapy and had no evidence of cancer (USA, Mayo Clinic)","urun":"Pure CBD (isolate) cream applied to the skin; placebo cream","urun_turu":"saf_cbd","doz":"Twice a day to the affected areas (the amount of CBD in the cream is not in the abstract or the registry)","titrasyon":null,"sure":"2 × 2 weeks","sonuc":"Neuropathy symptoms (QLQ-CIPN20 sensory subscale) were similar during the CBD and placebo periods; according to the researchers, the results do not support CBD cream reducing this pain. Small, short pilot study","yan_etki":"Side-effect scores were similar in both periods; generally well tolerated; no serious side effects (registry)","pmid":"39016024","doi":"10.1089/can.2023.0253","diger_kaynak":"ClinicalTrials.gov NCT05388058 (results in the registry)"},{"ad":"Wade 2003","tasarim":"Double-blind, placebo-controlled, randomized series of single-patient crossover trials (each patient tried four products for 2 weeks each)","n":"24 (18 MS, 4 spinal cord injury, 1 brachial plexus injury, 1 limb loss due to neurofibromatosis); 20 people per product in the table of a 2026 review","populasyon":"Patients with neurological symptoms (pain, spasticity, muscle spasm, bladder problems) not responding to standard treatment (UK); patients were not selected for neuropathic pain","urun":"Sublingual spray: CBD-rich, THC-rich and 1:1 THC:CBD plant extracts, and placebo (the THC content of the CBD-rich extract is not in the sources read)","urun_turu":"cbd_zengin_thc_belirsiz","doz":"2.5–120 mg per 24 hours (based on symptoms and unwanted effects)","titrasyon":"Self-titrated by the patient","sure":"2-week periods for each product (four periods)","sonuc":"Pain relief was significantly better than placebo with both the CBD-rich and the THC-rich extract (no effect size or numbers in the abstract). Limitations: very small; each product was tried for only 2 weeks; patients were not selected because their pain was neuropathic, and there is no separate result by type of pain; because it was not reported whether the CBD-rich extract contained THC, it does not count as a pure CBD result; the full text could not be read. In later, larger studies testing low-dose oral pure CBD, pain was no different from placebo (Zubcevic 2023, Hansen 2023). The evidence is very weak for both extracts","yan_etki":"With rapid dose increases of the THC-containing extract, temporary drops in blood pressure and intoxication in 3 patients; unwanted effects were generally well tolerated (abstract)","pmid":"12617376","doi":"10.1191/0269215503cr581oa","diger_kaynak":null},{"ad":"Parise 2026 (burning mouth syndrome)","tasarim":"Single-center, single-blind, placebo-controlled RCT","n":"26 randomized (13 CBD, 13 placebo); 35 people screened","populasyon":"Patients with burning mouth syndrome (96% women, mean age 61.9; Brazil, orofacial pain outpatient clinic)","urun":"Full-spectrum CBD oil (THC content not in the abstract)","urun_turu":"cbd_zengin_thc_belirsiz","doz":"Not reported (in the abstract)","titrasyon":null,"sure":"Not reported (in the abstract)","sonuc":"Pain intensity and impact (VAS) decreased over time in the CBD group and did not change in the placebo group; the difference between groups was significant from the third assessment on (p < 0.001). Oral health-related quality of life (OHIP-14) improved in the CBD group (p = 0.001; no between-group comparison in the abstract). Very small, single-center and single-blind; duration, dose and the product’s THC content are not in the abstract, and the full text could not be read. Burning mouth syndrome is not a group selected by this page’s criterion for neuropathic pain. The authors reported no conflicts of interest. The evidence is very weak","yan_etki":"No serious side effects were seen (abstract)","pmid":"42951760","doi":"10.1016/j.oooo.2026.07.010","diger_kaynak":"A study without a control group in the same condition: Gambino 2021 (PMID 33123730; 17 patients, cannabis flower extract, 4 weeks)"},{"ad":"Nurmikko 2007","tasarim":"Double-blind, placebo-controlled RCT","n":"125","populasyon":"Peripheral neuropathic pain with allodynia","urun":"Sativex (THC:CBD roughly 1:1, oromucosal)","urun_turu":"thc_iceren","doz":"Patients adjusted the dose themselves; the daily upper limit is contradictory in the registry: up to 24 sprays a day (THC 65 mg + CBD 60 mg) in the intervention description, up to 48 sprays a day (THC 130 mg + CBD 120 mg) in all group descriptions in the results section; the full text of the publication could not be read","titrasyon":"Patients self-titrated","sure":"5 weeks","sonuc":"Pain on a 0–10 scale decreased by 1.48 points with the active drug and 0.52 with placebo (difference −0.96; 95% CI −1.59 to −0.32; p = 0.004); allodynia, sleep and the patient’s global impression were also better. 5-week study; sponsor is the drug’s manufacturer","yan_etki":"Sedative and gastrointestinal side effects more common; discontinuation 18% vs. 3%","pmid":"17997224","doi":"10.1016/j.pain.2007.08.028","diger_kaynak":"ClinicalTrials.gov NCT00711880 (results in the registry); a 52-week open-label extension is mentioned in the abstract"},{"ad":"Eibach 2021","tasarim":"Double-blind, placebo-controlled, crossover RCT (3-week washout)","n":"32","populasyon":"HIV-associated neuropathic pain (Germany, Berlin)","urun":"Oral cannabidivarin (CBDV; a cannabinoid found in cannabis that is similar in structure to CBD but is not CBD)","urun_turu":"cbn_diger","doz":"400 mg/day","titrasyon":null,"sure":"2 × 4 weeks","sonuc":"Pain was 0.62 points higher during the CBDV period than with placebo (0–10 scale; 95% CI −0.27 to 1.51; p = 0.16), meaning there was no clear difference; use of additional pain relievers, pain quality and quality of life did not change either","yan_etki":"The frequency of side effects was similar in both periods; there were no unexpected serious side effects","pmid":"32770831","doi":"10.1002/cpt.2016","diger_kaynak":null},{"ad":"Berman 2004","tasarim":"Double-blind, placebo-controlled, three-period crossover RCT","n":"48","populasyon":"Treatment-resistant central neuropathic pain from brachial plexus root avulsion (tearing of the nerve roots of the network of nerves in the arm) (United Kingdom)","urun":"Oromucosal spray: plant extract containing roughly equal amounts of THC and CBD (GW-1000-02, Sativex) and plant extract containing mainly THC (GW-2000-02); placebo spray","urun_turu":"thc_iceren","doz":"2.5 mg THC per spray (plus 2.5 mg CBD in the combined spray); up to 48 sprays a day (registry)","titrasyon":null,"sure":"3 × 2 weeks (preceded by a 2-week baseline period)","sonuc":"The expected 2-point reduction in the primary outcome was not seen. Pain decreased slightly more than with placebo: by 0.58 points with the THC+CBD spray (95% CI 0.18–0.98) and 0.64 points with the THC spray (0.24–1.03) (11-box, 0–10 scale; registry results); sleep measures also improved. Each period lasted 2 weeks; the study was conducted with the drug’s manufacturer","yan_etki":"Side effects reported: THC+CBD 34/46, THC 37/47, placebo 20/48 (registry); mostly mild to moderate, including feeling intoxicated, and resolved on their own","pmid":"15561385","doi":"10.1016/j.pain.2004.09.013","diger_kaynak":"ClinicalTrials.gov NCT01606189 (results in the registry; sponsor is the drug’s manufacturer)"},{"ad":"Rog 2005","tasarim":"Single-center, double-blind, placebo-controlled, parallel RCT","n":"66 randomized (THC+CBD 34, placebo 32); 64 completed","populasyon":"Central pain from MS (burning-tingling pain in 59 people, painful muscle spasms in 7) (United Kingdom, Liverpool)","urun":"Oromucosal spray: THC:CBD roughly 1:1 plant extract (Sativex), added to current pain treatment","urun_turu":"thc_iceren","doz":"2.7 mg THC + 2.5 mg CBD per spray; up to 48 sprays a day; mean 9.6 sprays/day at week 4 (19.1 in the placebo group)","titrasyon":"Patients gradually adjusted the dose themselves","sure":"1-week baseline period + 4 weeks of treatment","sonuc":"Pain intensity decreased by 2.7 points with the active drug and 1.4 with placebo (0–10 scale; between-group p = 0.005; difference in the registry −1.25, 95% CI −2.11 to −0.39); sleep disturbance also decreased more (p = 0.003). Small, 4-week study","yan_etki":"Dizziness, dry mouth and drowsiness more common with the active drug; cognitive side effects limited to long-term memory; side effects reported 30/34 vs. 22/32 (registry)","pmid":"16186518","doi":"10.1212/01.wnl.0000176753.45410.8b","diger_kaynak":"ClinicalTrials.gov NCT01604265 (results in the registry; sponsor is the drug’s manufacturer). Open-label 2-year extension: Rog 2007, PMID 18035205 (63 patients; 28 completed 2 years; at least one drug-related side effect in 58)"},{"ad":"Selvarajah 2010","tasarim":"Double-blind, placebo-controlled, parallel RCT","n":"30 randomized; 29 analyzed","populasyon":"Painful diabetic peripheral neuropathy (United Kingdom, Sheffield)","urun":"Oromucosal spray: THC 27 mg/ml + CBD 25 mg/ml (Sativex), added to current treatment","urun_turu":"thc_iceren","doz":"Under the tongue, in divided doses up to 4 times a day; increased to the highest tolerated dose (amount not reported as a number)","titrasyon":"To the highest tolerated dose over 2 weeks","sure":"2 weeks of dose adjustment + 10 weeks fixed dose","sonuc":"Pain decreased in both groups, but the difference between groups was not significant (total pain score p = 0.40; 95% CI −11.3 to 27.8; 0–100 scale); no difference in quality of life either. People with depression had higher baseline pain and improved regardless of treatment","yan_etki":"6 of 30 people stopped because of side effects (distribution by group not given)","pmid":"19808912","doi":"10.2337/dc09-1029","diger_kaynak":"Registration by the same center and the same funder: ClinicalTrials.gov NCT00238550 (no results in the registry; the publication gives no registration number)"},{"ad":"NCT00710424 (manufacturer’s diabetic neuropathy study, registry results)","tasarim":"Double-blind, placebo-controlled, parallel phase 3 RCT; results only in the registry (no peer-reviewed publication)","n":"297 randomized (149 active, 148 placebo); primary analysis 146 and 148","populasyon":"Painful diabetic neuropathy lasting at least 6 months and not relieved by current treatment (type 1 or type 2 diabetes)","urun":"Oromucosal spray: THC 27 mg/ml + CBD 25 mg/ml (Sativex), added to current treatment","urun_turu":"thc_iceren","doz":"Up to 24 sprays a day (THC 65 mg + CBD 60 mg), no more than 8 in 3 hours","titrasyon":null,"sure":"14 weeks (98 days)","sonuc":"Pain decreased similarly in both groups: by 1.67 points with the active drug and 1.55 with placebo (0–10 scale; difference −0.12, 95% CI −0.60 to 0.36; p = 0.63). At least 30% relief 54/149 vs. 59/148 (p = 0.52); no difference in sleep, quality of life or use of additional pain relievers either. No peer-reviewed publication","yan_etki":"Side effects reported 120/149 vs. 101/148; possibly drug-related side effects 96 vs. 52; serious side effects 14 vs. 12; intoxication score rose with the active drug; did not complete the study 44/149 vs. 23/148 (registry)","pmid":null,"doi":null,"diger_kaynak":"ClinicalTrials.gov NCT00710424 (July 2005–June 2006; results in the registry, July 31, 2012; sponsor is the drug’s manufacturer, and the registry states that publications must be submitted for company review; no publication found on PubMed in October 2026)"},{"ad":"NCT01606202 (manufacturer’s spinal cord injury study, registry results)","tasarim":"Double-blind, placebo-controlled, parallel phase 3 RCT; results only in the registry (no peer-reviewed publication)","n":"116 randomized (56 active, 60 placebo); primary analysis 55 and 59","populasyon":"Central neuropathic pain from spinal cord injury not relieved by current treatment (pain at least 4/10)","urun":"Oromucosal spray: THC 27 mg/ml + CBD 25 mg/ml (GW-1000-02, Sativex), added to current treatment","urun_turu":"thc_iceren","doz":"2.7 mg THC + 2.5 mg CBD per spray; no more than 8 sprays in 3 hours, up to 48 sprays a day","titrasyon":null,"sure":"Up to 51 days (about 7 weeks)","sonuc":"No difference in the primary outcome: pain decreased by 0.74 points with the active drug and 0.69 with placebo (0–10 scale; difference −0.08, 95% CI −0.51 to 0.35; p = 0.71). Among secondary outcomes, those saying their overall condition had improved at least slightly were 30/56 vs. 12/60 (p < 0.001), and the Brief Pain Inventory score was slightly better (p = 0.032); no difference in spasms, sleep or quality of life. No peer-reviewed publication","yan_etki":"Side effects reported 46/56 vs. 29/60; serious side effects 3 vs. 2","pmid":null,"doi":null,"diger_kaynak":"ClinicalTrials.gov NCT01606202 (July 2002–January 2005; results in the registry, September 28, 2012; sponsor is the drug’s manufacturer; in October 2026, mentioned on PubMed only in a scoping review, PMID 33465022)"},{"ad":"Langford 2013","tasarim":"Multicenter, double-blind, placebo-controlled, parallel phase 3 RCT (phase A); followed by 14 weeks open-label + 4 weeks double-blind randomized withdrawal (phase B)","n":"339 randomized (167 active, 172 placebo); 58 in phase B","populasyon":"Central neuropathic pain from MS without adequate relief from current medicines","urun":"Oromucosal spray: THC:CBD (Sativex), added to current treatment","urun_turu":"thc_iceren","doz":"Up to 12 sprays a day (THC 32.5 mg + CBD 30 mg; registry)","titrasyon":null,"sure":"14 weeks (A) + 18 weeks (B)","sonuc":"The primary outcome was not met: at week 14, at least a 30% reduction in pain was 50% with the active drug and 45% with placebo (p = 0.234); difference in mean pain −0.17 points (95% CI −0.62 to 0.29; registry). In the interim analysis at week 10 there was a difference (p = 0.046). In the randomized withdrawal phase (58 people), treatment failure was 57% in those switched to placebo and 24% in those who continued the drug (p = 0.04). The authors found the findings inconsistent between the two phases","yan_etki":"Side effects reported 99/167 vs. 65/172; serious side effects 3 vs. 2 (registry)","pmid":"23180178","doi":"10.1007/s00415-012-6739-4","diger_kaynak":"ClinicalTrials.gov NCT00391079 (results in the registry; sponsor is the drug’s manufacturer)"},{"ad":"Serpell 2014","tasarim":"Multicenter, double-blind, placebo-controlled, parallel RCT","n":"246 randomized (128 active, 118 placebo); 303 people screened","populasyon":"Treatment-resistant peripheral neuropathic pain with pain triggered by touch (allodynia)","urun":"Oromucosal spray: THC:CBD (Sativex), added to current treatment","urun_turu":"thc_iceren","doz":"Up to 24 sprays a day (THC 65 mg + CBD 60 mg), no more than 8 in 3 hours (registry)","titrasyon":null,"sure":"15 weeks","sonuc":"Of the two co-primary outcomes, at least a 30% reduction in pain was significantly more frequent with the active drug (p = 0.034 in the full analysis set; odds ratio CI 1.05–3.70); the reduction in mean pain was numerically greater with the active drug but not significant (difference in the registry −0.34; 95% CI −0.79 to 0.11). Sleep quality (p = 0.007) and the patient’s global impression (p = 0.023) were better","yan_etki":"Side effects reported 109/128 vs. 83/118; serious side effects 10 vs. 6; did not complete the study 49/128 vs. 24/118 (registry); according to the authors, no new safety concerns","pmid":"24420962","doi":"10.1002/j.1532-2149.2013.00445.x","diger_kaynak":"ClinicalTrials.gov NCT00710554 (results in the registry; sponsor is the drug’s manufacturer)"},{"ad":"Lynch 2014","tasarim":"Double-blind, placebo-controlled, crossover pilot RCT; followed by an open-label extension","n":"16","populasyon":"Established chemotherapy-induced neuropathic pain (Canada, Halifax)","urun":"Oromucosal spray: THC:CBD (Sativex)","urun_turu":"thc_iceren","doz":"Starting with 1 spray in the evening, up to a maximum of 12 sprays a day (registry)","titrasyon":"Increased by 1–2 sprays a day until pain relief without side effects (registry)","sure":"Not reported (in the abstract)","sonuc":"In the whole group, there was no significant difference in pain from placebo. In 5 of 16 people, pain decreased by at least 2 points (mean 2.6 points; 0.6 with placebo); this responder analysis also did not reach significance (number needed to treat 5). Pilot study","yan_etki":"Not reported (in the abstract)","pmid":"23742737","doi":"10.1016/j.jpainsymman.2013.02.018","diger_kaynak":"ClinicalTrials.gov NCT00872144 (no results in the registry)"},{"ad":"Svendsen 2004","tasarim":"Double-blind, placebo-controlled, crossover RCT (3-week washout)","n":"24","populasyon":"Central pain from MS, ages 23–55 (Denmark, Aarhus)","urun":"Oral dronabinol (synthetic THC)","urun_turu":"thc_iceren","doz":"Up to 10 mg a day","titrasyon":null,"sure":"2 × 3 weeks (15–21 days)","sonuc":"In the last week, median spontaneous pain was 4.0 with dronabinol and 5.0 with placebo (0–10 scale; p = 0.02); number needed to treat for 50% relief 3.5 (95% CI 1.9–24.8). The authors considered the effect modest; small, short study","yan_etki":"More people had side effects with dronabinol, especially in the first week; most often dizziness. Functional status did not change","pmid":"15258006","doi":"10.1136/bmj.38149.566979.AE","diger_kaynak":"Second publication in Danish: Svendsen 2005, PMID 16014264"},{"ad":"Rintala 2010","tasarim":"Double-blind, active-controlled (diphenhydramine), crossover pilot RCT","n":"7; 5 people completed both drugs","populasyon":"Spinal cord injury and neuropathic pain below the level of injury (USA, Houston)","urun":"Oral dronabinol (synthetic THC); comparator drug diphenhydramine (a sedating allergy medicine, used as an active placebo)","urun_turu":"thc_iceren","doz":"Not reported (in the abstract)","titrasyon":null,"sure":"Not reported (in the abstract)","sonuc":"The change in pain did not differ between the two drugs: +0.20 with dronabinol, −1.80 points with diphenhydramine (0–10 scale; p = 0.10); dronabinol was no better than the comparator. Very small pilot study","yan_etki":"With both drugs, most often dry mouth, constipation, tiredness and drowsiness; 2 people left the study while taking dronabinol, their first drug","pmid":"20855984","doi":"10.1097/PHM.0b013e3181f1c4ec","diger_kaynak":null},{"ad":"Schimrigk 2017","tasarim":"Double-blind, placebo-controlled, parallel phase 3 RCT; followed by a 32-week open-label period","n":"240; 100 people continued treatment for up to 119 weeks","populasyon":"Central neuropathic pain from MS (Germany)","urun":"Oral dronabinol (synthetic THC) solution","urun_turu":"thc_iceren","doz":"Up to 15 mg a day (registry)","titrasyon":null,"sure":"16 weeks double-blind + 32 weeks open-label (some up to 119 weeks in total)","sonuc":"At 16 weeks, pain decreased by 1.92 points with dronabinol and 1.81 with placebo (0–10 scale); there was no difference (p = 0.68). The study was run by the drug’s manufacturer; 4 of the 6 authors are company employees. The authors emphasize that the drug could be used safely over the long term","yan_etki":"Drug-related side effects in 50% with dronabinol, 25.9% with placebo; 26% with long-term use; no signs of abuse, 1 possible dependence","pmid":"29073592","doi":"10.1159/000481089","diger_kaynak":"ClinicalTrials.gov NCT00959218 (sponsor is the drug’s manufacturer; no results in the registry)"},{"ad":"Weizman 2018","tasarim":"Double-blind, placebo-controlled, within-subject two-session single-dose RCT; brain MRI","n":"15","populasyon":"Chronic neuropathic pain radiating from the lower back to the leg (radicular) (Israel, Tel Aviv)","urun":"Sublingual THC oil; placebo oil","urun_turu":"thc_iceren","doz":"Not reported (in the abstract); in the same team’s 2024 publication with the same design, 0.2 mg/kg (mean 15 mg)","titrasyon":null,"sure":"Single dose (two separate sessions)","sonuc":"THC reduced pain significantly more than placebo (numbers not in the abstract); the reduction in pain was associated with reduced connectivity between emotional-cognitive control regions and sensory regions of the brain. Single-dose, very small study","yan_etki":"Not reported (in the abstract)","pmid":"30185448","doi":"10.1212/WNL.0000000000006293","diger_kaynak":"The same team’s 12-male-patient publication with the same design: Weizman 2024, PMID 38597988 (ClinicalTrials.gov NCT02560545; THC 0.2 mg/kg; pain on a 0–100 scale from 53 to 35 with THC and from 52 to 44 with placebo, p < 0.05 vs. placebo). Whether the participants of the two publications are the same is not stated"},{"ad":"Abrams 2007","tasarim":"Randomized, placebo-controlled, parallel study (inpatient)","n":"50 completed (number randomized not in the abstract)","populasyon":"HIV-associated painful sensory neuropathy (USA, San Francisco)","urun":"Smoked cannabis (3.56% THC); placebo cigarettes with the cannabinoids extracted","urun_turu":"thc_iceren","doz":"3 cigarettes a day for 5 days","titrasyon":null,"sure":"5 days","sonuc":"Daily pain decreased by a median of 34% with cannabis and 17% with placebo (p = 0.03); people with more than 30% pain reduction 52% vs. 24% (p = 0.04). Experimentally induced hyperalgesia also decreased. The study lasted 5 days","yan_etki":"No serious side effects reported","pmid":"17296917","doi":"10.1212/01.wnl.0000253187.66183.9c","diger_kaynak":"ClinicalTrials.gov NCT00046722 (no results in the registry)"},{"ad":"Wilsey 2008","tasarim":"Double-blind, placebo-controlled, crossover RCT (single-session laboratory trials)","n":"38","populasyon":"Central or peripheral neuropathic pain (of 38 people, 22 had complex regional pain syndrome type I, 10 central pain from spinal cord injury or MS, and 6 diabetic neuropathy or nerve damage; all had used cannabis before) (USA, California)","urun":"Smoked cannabis: high dose 7% THC, low dose 3.5% THC; placebo","urun_turu":"thc_iceren","doz":"Per session using a standardized smoking procedure (amount not in the abstract)","titrasyon":null,"sure":"3 separate sessions (each a single dose)","sonuc":"Cannabis reduced pain more than placebo (mixed model; numbers not in the abstract); there was no effect on pain evoked by touch or heat. Single-dose, short laboratory study","yan_etki":"Few and tolerable intoxicating effects; at the high dose, short-term cognitive effects, especially on memory","pmid":"18403272","doi":"10.1016/j.jpain.2007.12.010","diger_kaynak":"ClinicalTrials.gov NCT00254761 (no results in the registry)"},{"ad":"Ellis 2009","tasarim":"Double-blind, placebo-controlled, crossover phase 2 RCT (2-week washout)","n":"34 randomized; 28 completed both periods","populasyon":"HIV-associated distal sensory polyneuropathy pain that had not responded to at least two classes of pain relievers (USA, San Diego)","urun":"Smoked cannabis (1–8% THC); placebo","urun_turu":"thc_iceren","doz":"4 times a day for 5 days; THC strength adjusted per person between 1% and 8%","titrasyon":"Dose escalation and adjustment on the first day of each treatment week","sure":"2 × 5 days of treatment","sonuc":"Among completers, pain decreased more with cannabis than with placebo (median difference 3.3 points; effect size 0.60; p = 0.016); people with at least 30% pain reduction 46% vs. 18%. Mood and daily functioning improved similarly in both periods","yan_etki":"Mostly mild and temporary; treatment-limiting side effects in 2 people; difficulty concentrating, tiredness, drowsiness and dry mouth more common with cannabis","pmid":"18688212","doi":"10.1038/npp.2008.120","diger_kaynak":"ClinicalTrials.gov NCT00255580 (no results in the registry); 7-person appetite hormone substudy of the same trial: Riggs 2012 (PMID 22133305; during the cannabis week, plasma ghrelin and leptin rose, PYY fell, and insulin fell similarly to placebo)"},{"ad":"Ware 2010","tasarim":"Double-blind, placebo-controlled, 4-period crossover RCT","n":"23 randomized; 21 completed","populasyon":"Chronic neuropathic pain after trauma or surgery (Canada, Montreal)","urun":"Cannabis smoked in a pipe: 0% (placebo), 2.5%, 6% and 9.4% THC","urun_turu":"thc_iceren","doz":"25 mg of cannabis at a time, 3 times a day, for 5 days","titrasyon":null,"sure":"4 × 14 days (5 days of treatment + 9 days of washout)","sonuc":"In the prespecified comparison, mean daily pain was 5.4 with 9.4% THC and 6.1 with placebo (0–10 scale; difference 0.7; 95% CI 0.02–1.4); the intermediate strengths made no significant difference. Falling asleep and sleep quality improved; no difference in mood or quality of life","yan_etki":"During the 9.4% THC period, most often headache, dry eyes, burning in the painful area, dizziness, numbness and cough","pmid":"20805210","doi":"10.1503/cmaj.091414","diger_kaynak":"ISRCTN68314063"},{"ad":"Wilsey 2013","tasarim":"Double-blind, placebo-controlled, crossover RCT (single-day laboratory trials)","n":"39 (59 people consented, 20 did not take the drug)","populasyon":"Central or peripheral neuropathic pain persisting despite current treatment (of 39 people, 6 had complex regional pain syndrome type I and 2 the type caused by nerve injury; when the type I patients were excluded, the main result did not change noticeably); all had used cannabis before (USA, California)","urun":"Vaporized inhaled cannabis: medium dose 3.53% THC, low dose 1.29% THC; placebo","urun_turu":"thc_iceren","doz":"Two doses per session using a standardized inhalation procedure (cumulative)","titrasyon":null,"sure":"3 separate sessions","sonuc":"With both doses, pain decreased more than with placebo; there was no difference between the two doses (p > 0.7). Number needed to treat for a 30% pain reduction: 3.2 at the low dose, 2.9 at the medium dose. Single-day laboratory study","yan_etki":"Few intoxicating effects; cognitive effects resolved within 1–2 hours","pmid":"23237736","doi":"10.1016/j.jpain.2012.10.009","diger_kaynak":"ClinicalTrials.gov NCT01037088 (results in the registry)"},{"ad":"Wallace 2015","tasarim":"Double-blind, placebo-controlled, 4-period crossover RCT (single-session trials, 2-week washout)","n":"16","populasyon":"Treatment-resistant painful diabetic peripheral neuropathy (USA, San Diego)","urun":"Vaporized inhaled cannabis: 1%, 4% and 7% THC; placebo","urun_turu":"thc_iceren","doz":"A single dose per session (400 mg of cannabis or placebo, with a vaporizer; registry)","titrasyon":null,"sure":"4 separate sessions (each a single dose, 4 hours of follow-up)","sonuc":"Spontaneous pain decreased more than with placebo at all three doses (low p = 0.031, medium p = 0.04, high p < 0.001), and the effect was dose-related; the high dose also reduced evoked pain. Single-dose, very small study","yan_etki":"The high dose impaired performance on 2 of 3 attention tests; euphoria 56% with placebo, 100% with the high dose; drowsiness 38% vs. 73%","pmid":"25843054","doi":"10.1016/j.jpain.2015.03.008","diger_kaynak":"ClinicalTrials.gov NCT00781001 (no results in the registry); secondary analysis: Wallace 2020, PMID 32565122 (blood THC levels and pain)"},{"ad":"Wilsey 2016","tasarim":"Double-blind, placebo-controlled, crossover RCT (8-hour laboratory sessions)","n":"42","populasyon":"Neuropathic pain from spinal cord injury or disease (USA, California)","urun":"Vaporized inhaled cannabis: 2.9% and 6.7% THC; placebo","urun_turu":"thc_iceren","doz":"4 puffs; 3 hours later, 4–8 more puffs at the person’s choice","titrasyon":"For the second dose, the person chose the number of puffs (4–8)","sure":"3 separate sessions","sonuc":"Cannabis reduced pain significantly more than placebo; the two doses did not differ from each other. People with at least 30% pain reduction: 45% with placebo, 70% with the low dose, 88% with the high dose (number needed to treat 4 and 3). Single-day laboratory study","yan_etki":"Intoxication and subjective effects were dose-related; the authors interpreted the low dose as the best balance of benefit and harm","pmid":"27286745","doi":"10.1016/j.jpain.2016.05.010","diger_kaynak":"ClinicalTrials.gov NCT01555983 (results in the registry); blood level analysis of the same trial: Wilsey 2016, PMID 27621666"},{"ad":"Almog 2020","tasarim":"Double-blind, placebo-controlled, three-arm crossover RCT (single-inhalation dose)","n":"27 (21 neuropathic pain, 6 complex regional pain syndrome)","populasyon":"Chronic neuropathic pain or complex regional pain syndrome (Israel, Haifa)","urun":"Cannabis flower vaporized with a metered-dose inhaler (22% THC, less than 0.1% CBD); placebo","urun_turu":"thc_iceren","doz":"0.5 mg or 1 mg of THC in a single inhalation","titrasyon":null,"sure":"3 separate sessions, 150 minutes of follow-up","sonuc":"With both doses, pain decreased from baseline and stayed stable for 150 minutes; a significant difference from placebo was seen only at the 1 mg dose. Single-dose study; supported by the device manufacturer, and 7 of the 8 authors have ties to the company","yan_etki":"Mostly mild and resolved on their own; no consistent impairment of cognitive function was seen","pmid":"32445190","doi":"10.1002/ejp.1605","diger_kaynak":null},{"ad":"NCT02460692 (dronabinol and vaporized cannabis, registry results)","tasarim":"Randomized, triple-blind, placebo-controlled, three-arm parallel phase 2 study (everyone received vapor and capsules); results only in the registry (no peer-reviewed publication)","n":"131 randomized (placebo 44, dronabinol 43, cannabis 44); 91 completed","populasyon":"Chronic low back pain described as related to nerve damage (neuropathic); the registry’s enrollment criteria do not separately require a neuropathic diagnosis (USA, San Diego)","urun":"Vaporized inhaled cannabis (3.7% THC + 5.6% CBD) or oral dronabinol (synthetic THC); placebo","urun_turu":"thc_iceren","doz":"Not reported (in the registry)","titrasyon":null,"sure":"8 weeks","sonuc":"At week 8, pain fell from 6.03 to 5.22 with placebo, from 6.11 to 4.19 with dronabinol and from 6.24 to 4.45 with cannabis (0–10 scale). There was no difference in the main comparison, cannabis vs. dronabinol (p = 0.78); cannabis vs. placebo p = 0.070; exploratory dronabinol vs. placebo comparison p = 0.044. No peer-reviewed publication","yan_etki":"No serious side effects; other side effects reported with placebo 30/44, dronabinol 31/43, cannabis 30/44; 15, 17 and 8 people left the study","pmid":null,"doi":null,"diger_kaynak":"ClinicalTrials.gov NCT02460692 (December 2016–March 2020; results in the registry, September 28, 2023; no publication found on PubMed in October 2026)"},{"ad":"Haney 2025","tasarim":"Double-blind, placebo-controlled, parallel pilot RCT","n":"12 (6 active, 6 placebo); all completed","populasyon":"Women with breast cancer and painful peripheral neuropathy caused by taxane chemotherapy drugs (USA, New York)","urun":"Oral cannabis capsule: CBD 100 mg + THC 5 mg","urun_turu":"thc_iceren","doz":"Target 1 capsule 3 times a day; participants reduced the dose (mean 2.0 capsules/day in the active group, 2.4 with placebo)","titrasyon":null,"sure":"8 weeks","sonuc":"Pain, sleep and well-being improved over time in both groups; however, neuropathy scores in the cannabis group were worse than placebo every week (p < 0.035), and sleep and the impact of pain on daily life also did worse than placebo (p < 0.05). No sign of benefit was seen; very small feasibility study","yan_etki":"Well tolerated according to the authors; requests to reduce the dose in both groups","pmid":"40611810","doi":"10.1089/can.2025.0028","diger_kaynak":"ClinicalTrials.gov NCT03782402 (terminated with 12 people; results in the registry)"},{"ad":"Weiss 2025","tasarim":"Double-blind, placebo-controlled, parallel RCT; followed by a 12-week open-label follow-up","n":"46 randomized (target 100); 43 completed; primary analysis 43 (23 active, 20 placebo)","populasyon":"Patients with non-metastatic breast, colorectal, uterine or ovarian cancer who had finished chemotherapy and had grade 2–3 chemotherapy-induced peripheral neuropathy (88% women) (USA, Pennsylvania)","urun":"Oral hemp extract gel capsules: CBD 13.9–15.1 mg + THC 0.67–1.20 mg per capsule","urun_turu":"thc_iceren","doz":"3 × 3 capsules a day: CBD 125–136 mg + THC 6.0–10.8 mg/day","titrasyon":"Days 1–3: 3 × 1, days 4–6: 3 × 2, from day 7: 3 × 3 capsules","sure":"12 weeks","sonuc":"In the primary analysis, there was no difference between groups in the sensory symptoms of neuropathy (QLQ-CIPN20) or in pain; the difference in the impact of pain on daily life (favoring placebo) disappeared after adjustment for the baseline difference. In a secondary analysis of 46 people who completed at least 8 weeks, sensory symptoms improved more in the active group (−10.4; 95% CI −20.5 to −0.3; p = 0.044). The target number of participants was not reached","yan_etki":"No difference in side effects between groups; raised bilirubin in one person each, raised alkaline phosphatase in one person (did not exceed the withdrawal criterion)","pmid":"41211445","doi":"10.3389/fonc.2025.1590168","diger_kaynak":"ClinicalTrials.gov NCT04398446 (no results in the registry). The company that supplied the products is among the funders; the authors declared no conflicts of interest"},{"ad":"Seevathee 2025","tasarim":"Double-blind, placebo-controlled, parallel phase 3 RCT (single center)","n":"100 randomized (50 + 50); all in the intention-to-treat analysis; 7 people did not complete follow-up","populasyon":"Adults with type 2 diabetes and painful diabetic peripheral neuropathy of the lower extremities who were not taking neuropathic pain medicines (Thailand, Kalasin)","urun":"THC-dominant cannabis oil applied to the skin (per drop THC 3.2 mg, CBD 0.32 mg, CBN 0.65 mg); placebo MCT and coconut oil. The product was supplied by the Department of Thai Traditional and Alternative Medicine of the Thai Ministry of Public Health","urun_turu":"thc_iceren","doz":"1–2, 3–4 or 5–6 drops depending on pain intensity (daily frequency of application not stated in the full text that was read)","titrasyon":null,"sure":"12 weeks","sonuc":"The neuropathic pain symptom score (NPSI-T total) fell from 25.6 to 5.6 with the cannabis oil and from 25.2 to 22.9 with placebo; the between-group difference at week 12 was −17.3 points (p < 0.001). The effect is much larger than in the other diabetic neuropathy studies in the table; this single-center result has not been confirmed by another study, and some numbers in the publication don’t agree (between-group difference at week 4: −5.50 in the table, −8.14 points in the text; at week 8: −12.56 in the table, −14.54 in the text; placebo group score at week 4: 22.22 in the table, 24.86 in the text). 3 of the 9 authors work at the ministry department that supplied the product; the authors declared no conflicts of interest","yan_etki":"Side effects 10% in both groups, all mild (hives, redness, skin pain); resolved by the end of follow-up","pmid":"39720705","doi":"10.1159/000542511","diger_kaynak":"Thai Clinical Trials Registry TCTR20211220008"},{"ad":"Kittithamvongs 2025","tasarim":"Triple-blind, placebo-controlled, two-period crossover RCT (14-day washout)","n":"30 randomized; 28 analyzed","populasyon":"Moderate to severe pain lasting at least 6 months after traumatic injury of the network of nerves in the arm (brachial plexus), ages 20–60 (Thailand, Bangkok)","urun":"Sublingual cannabis oil, THC:CBD 1:1 (27 mg THC and 25 mg CBD per mL; made by the Government Pharmaceutical Organization of Thailand), added to current pain medicines; identical-looking placebo","urun_turu":"thc_iceren","doz":"Starting at 4 × 1 drop a day; up to 4 × 5 drops a day (under 30 mg of THC, according to the authors)","titrasyon":"Increase by 1 drop every 2 days if pain the previous day was 4/10 or higher","sure":"2 × 10 days","sonuc":"Pain decreased 1 point more with the cannabis-based medicine than with placebo (0–10 scale; 99% CI −0.03 to 2.1; p = 0.01); this was below the prespecified clinical importance threshold of 2 points. The neuropathic pain screening test was 75% positive in both periods; sleep quality was 1.5 points better with cannabis (99% CI 0.7–2.4). The authors do not recommend adding this medicine","yan_etki":"Mild dizziness in 4 people (during the cannabis period); all continued treatment","pmid":"39115545","doi":"10.1097/CORR.0000000000003221","diger_kaynak":"Thai Clinical Trials Registry TCTR20191106004 (the registry page returned no content in October 2026); commentary: Hoffmeyer 2025, PMID 39330963"},{"ad":"Frank 2008","tasarim":"Double-blind, active-controlled (dihydrocodeine, a weak opioid), crossover RCT (2-week washout)","n":"96 randomized; 73 in the available-data analysis, 64 in the per-protocol analysis","populasyon":"Chronic neuropathic pain, ages 23–84 (United Kingdom, 3 hospitals)","urun":"Oral nabilone (a THC-like synthetic cannabinoid); comparator drug dihydrocodeine","urun_turu":"cbn_diger","doz":"Nabilone up to 2 mg a day; dihydrocodeine up to 240 mg a day","titrasyon":"The dose was increased gradually in each 6-week period","sure":"2 × 6 weeks (14 weeks in total)","sonuc":"Pain was worse with nabilone than with dihydrocodeine: mean pain 6.0 mm higher (0–100 scale; 95% CI 1.4–10.5); dihydrocodeine provided better pain relief. No placebo group","yan_etki":"Side effects more common with nabilone; no major side effects with either drug","pmid":"18182416","doi":"10.1136/bmj.39429.619653.80","diger_kaynak":"ISRCTN15330757"},{"ad":"Toth 2012","tasarim":"Double-blind, placebo-controlled, flexible-dose RCT with enriched enrollment and randomized withdrawal design (everyone first took single-blind nabilone for 4 weeks)","n":"37 started single-blind nabilone; 26 responders were randomized (13 nabilone, 13 placebo)","populasyon":"Treatment-resistant painful diabetic peripheral neuropathy, pain at least 4/10 (Canada, Calgary)","urun":"Oral nabilone (a THC-like synthetic cannabinoid), added to current medicines","urun_turu":"cbn_diger","doz":"1–4 mg a day (flexible); mean 2.9 mg/day at the end of the study","titrasyon":null,"sure":"4 weeks single-blind + 5 weeks double-blind","sonuc":"Only those who responded to nabilone in the first 4 weeks (at least 30% relief) were randomized; in these people, pain decreased 1.27 points more with nabilone than with placebo (0–10 scale; 95% CI 0.25–2.29; p = 0.02); anxiety, sleep and quality of life also improved. Because non-responders were excluded, the effect may be smaller in the general patient population; in both groups, 62% of participants may have noticed which drug they were taking","yan_etki":"In the single-blind period, 2 of 37 people stopped because of drug-related confusion","pmid":"22921260","doi":"10.1016/j.pain.2012.06.024","diger_kaynak":"A registration by the same institution with the same design, most likely this study: ClinicalTrials.gov NCT01035281 (University of Calgary; 4 weeks single-blind nabilone, responders to the double-blind period; no results in the registry; the publication gives no registration number)"},{"ad":"Turcotte 2015","tasarim":"Double-blind, placebo-controlled, parallel RCT","n":"15","populasyon":"Patients with relapsing-remitting MS and MS-related neuropathic pain without adequate relief despite at least 1,800 mg of gabapentin a day (Canada, Winnipeg)","urun":"Oral nabilone (a THC-like synthetic cannabinoid), added to gabapentin","urun_turu":"cbn_diger","doz":"2 × 1 mg a day","titrasyon":"Increased by 0.5 mg a week over 4 weeks","sure":"9 weeks (4 weeks titration + 5 weeks fixed dose)","sonuc":"In a model adjusted for age, sex, disability, MS duration and baseline pain, pain intensity and the impact of pain on daily life decreased faster with nabilone than with placebo (both p < 0.01). The size of the between-group difference is not in the abstract; very small study","yan_etki":"Most often dizziness and drowsiness; dropout rates did not differ between groups","pmid":"25288189","doi":"10.1111/pme.12569","diger_kaynak":"ClinicalTrials.gov NCT00480181 (same title and institution; no results in the registry; the drug’s marketer Bausch Health is a collaborator in the registry)"},{"ad":"Ateş 2026 (Cochrane)","tasarim":"Systematic review and meta-analysis (Cochrane; update of the 2018 review)","n":"21 RCTs, 2,187 people (6 new studies, 450 people)","populasyon":"Chronic neuropathic pain in adults (5 studies central, 14 studies peripheral, 2 studies both types)","urun":"THC-dominant (7 studies), balanced THC and CBD (9) and CBD-dominant (5) products; herbal, plant-derived and synthetic","urun_turu":"karma","doz":null,"titrasyon":null,"sure":"2–26 weeks","sonuc":"No clear effect on at least 50% pain relief in any product group: THC-dominant RD 0.14 (95% CI −0.07 to 0.37; 7 studies, 534 people), balanced THC:CBD RD 0.04 (0.00–0.08; 8 studies, 746 people), CBD-dominant RD −0.08 (−0.20 to 0.05; 5 studies, 208 people); all very low certainty. With the balanced product, at least 30% relief (RD 0.07; 0.02–0.12) and those saying they were 'much or very much improved' (RD 0.07; 0.02–0.11) may increase slightly (low certainty; the authors did not consider this clinically meaningful). 14 of the studies (two-thirds) were funded by drug companies. The review included only double-blind studies lasting at least 2 weeks; single-session or few-day inhaled cannabis studies were therefore excluded","yan_etki":"Nervous system side effects with THC-dominant RD 0.25 (0.14–0.37; low certainty), with the balanced product RD 0.39 (0.23–0.55; very low); discontinuation due to side effects with the balanced product RD 0.05 (0.02–0.09); no difference in nervous system or psychiatric side effects with CBD-dominant products (low certainty)","pmid":"41548880","doi":"10.1002/14651858.CD012182.pub3","diger_kaynak":"Previous version: Mücke 2018 (Cochrane, in this table)"},{"ad":"Mücke 2018 (Cochrane)","tasarim":"Systematic review and meta-analysis","n":"16 RCTs, 1,750 people","populasyon":"Chronic neuropathic pain","urun":"Mainly THC:CBD spray; nabilone, dronabinol, inhaled cannabis","urun_turu":"karma","doz":null,"titrasyon":null,"sure":"2–26 weeks","sonuc":"≥50% relief 21% vs. 17% (NNTB 20, low quality); 'the potential benefits may be outweighed by potential harms'","yan_etki":"Nervous system adverse events 61% vs. 29% (NNTH 3); psychiatric adverse events 17% vs. 5%","pmid":"29513392","doi":"10.1002/14651858.CD012182.pub2","diger_kaynak":"Update: Ateş 2026 (Cochrane, PMID 41548880; in this table)"},{"ad":"McParland 2023 (meta-analysis)","tasarim":"Systematic review and meta-analysis","n":"8 RCTs (6 studies in the sleep analysis, 8 in the pain analysis)","populasyon":"Chronic neuropathic pain","urun":"Synthetic and natural cannabinoids, compared with placebo","urun_turu":"karma","doz":null,"titrasyon":null,"sure":"Not reported (in the abstract)","sonuc":"Cannabinoids improved sleep quality (SMD 0.40; 95% CI 0.19–0.61) and daily pain (SMD −0.55; −0.69 to −0.19) more than placebo; the authors rated the certainty as moderate. However, heterogeneity between studies was large (I² 82% for pain) and the prediction intervals include zero (pain −1.51 to 0.39; sleep −0.12 to 0.88). This review reaches a more favorable conclusion than Cochrane 2026","yan_etki":"Daytime sleepiness, nausea and dizziness more common","pmid":"36598058","doi":"10.1136/rapm-2021-103431","diger_kaynak":"PROSPERO CRD42017074255"},{"ad":"Andreae 2015 (individual patient data meta-analysis)","tasarim":"Systematic review and individual patient data meta-analysis (Bayesian method)","n":"5 RCTs, 178 people (405 observations)","populasyon":"Neuropathy with chronic pain","urun":"Inhaled cannabis (smoked or vaporized), compared with placebo","urun_turu":"thc_iceren","doz":null,"titrasyon":null,"sure":"Days to a few weeks","sonuc":"In the short term, inhaled cannabis provided additional pain reduction in 1 of every 5–6 patients (number needed to treat 5.6; Bayesian 95% credible interval 3.4–14). The authors write that the result is limited because of the small number of studies and patients, short follow-up, shortcomings in allocation concealment and many dropouts","yan_etki":"Discontinuation due to side effects was rare (full text)","pmid":"26362106","doi":"10.1016/j.jpain.2015.07.009","diger_kaynak":"PROSPERO CRD42011001182; the 5 included studies: Abrams 2007, Ellis 2009, Ware 2010, Wilsey 2008 and Wilsey 2013 (all in this table); 4 of the 12 authors are investigators of these studies"},{"ad":"Sherman 2026 (systematic review)","tasarim":"Systematic review of RCTs (no meta-analysis)","n":"4 RCTs (15,377 records screened)","populasyon":"Painful peripheral neuropathy from diabetes","urun":"Medical cannabis, single cannabinoids and approved cannabinoid medicines (added to treatment)","urun_turu":"karma","doz":null,"titrasyon":null,"sure":"Not reported (in the abstract)","sonuc":"In 3 of four small and differing RCTs, neuropathic pain decreased more than with placebo; in 1 there was no difference. The authors write that no firm conclusion can be drawn because of risk of bias, the small number of studies and the variety of products, and that the doses observed can only guide new studies","yan_etki":"Dizziness and cognitive symptoms common, mostly mild to moderate; discontinuation due to side effects varied across studies","pmid":"41714301","doi":"10.1177/25785125261425444","diger_kaynak":null},{"ad":"Datta 2026 (systematic review)","tasarim":"Systematic review of RCTs (meta-analysis not possible)","n":"3 RCTs, 68 people (plus 3 ongoing studies)","populasyon":"Chemotherapy-induced peripheral neuropathy (treatment or prevention)","urun":"THC:CBD mouth spray; oral capsule (the review classified it as 'oral CBD'; based on participant numbers, most likely a capsule that also contained a small amount of THC alongside CBD); CBD applied to the skin","urun_turu":"karma","doz":null,"titrasyon":null,"sure":"Not reported (in the abstract)","sonuc":"In no study were pain or quality of life better than with placebo (p > 0.05). The authors write that current evidence is insufficient for routine use in chemotherapy-induced neuropathy. The study the review classified as 'oral CBD' is, based on participant numbers, most likely Haney 2025, whose capsule contained 5 mg of THC alongside 100 mg of CBD (the full text of the review could not be read). 2 of the 8 authors work for a clinic chain that prescribes medical cannabis (Curaleaf Clinic, London)","yan_etki":"Mild to moderate; most often tiredness, dizziness and dry mouth","pmid":"42085369","doi":"10.1080/15360288.2026.2664668","diger_kaynak":null},{"ad":"Hoggart 2015","tasarim":"Multicenter, open-label follow-up study (extension of two RCTs); randomized withdrawal phase in a subgroup","n":"380 (234 completed, 62%)","populasyon":"Peripheral neuropathic pain from diabetes or with pain triggered by touch (allodynia); patients who completed the two parent RCTs","urun":"Oromucosal spray: THC:CBD (Sativex), added to current treatment","urun_turu":"thc_iceren","doz":"Up to 24 sprays a day (THC 65 mg + CBD 60 mg; registry)","titrasyon":null,"sure":"38 weeks","sonuc":"No comparison group. Pain fell from 6.9 points at the start of the parent studies to 4.2 at the end of follow-up (0–10 scale); at every assessment, at least half of the patients reported 30% or greater relief; the dose was not increased over time. In the 19-person randomized withdrawal part in the registry, there was no difference in pain between those who continued the drug and those switched to placebo (p = 0.27). 38% did not complete follow-up; the results reflect those who continued. The patients come from two parent RCTs; the registry does not name them, but the patient group, period and dosing rule match the diabetic neuropathy (NCT00710424) and allodynic pain (Serpell 2014) studies in the table, so the patients may largely be from those two studies. Manufacturer-supported","yan_etki":"Serious side effects in 40 of 380 people; non-serious side effects in 295 (registry); according to the authors, no new safety concerns","pmid":"25270679","doi":"10.1007/s00415-014-7502-9","diger_kaynak":"ClinicalTrials.gov NCT00713323 (part A) and NCT00713817 (part B, randomized withdrawal); results in the registry; sponsor is the drug’s manufacturer"},{"ad":"Ueberall 2022 (German Pain e-Registry)","tasarim":"Retrospective, propensity score–matched registry study (comparison of two drugs)","n":"674 (337 THC:CBD spray, 337 dronabinol)","populasyon":"Outpatients with severe neuropathic pain who had not responded adequately to established treatments (Germany)","urun":"THC:CBD oromucosal spray (nabiximols) or oral dronabinol (synthetic THC), added to current treatment","urun_turu":"thc_iceren","doz":"Mean THC: 16.6 mg/day in the spray group, 17.2 mg/day in the dronabinol group","titrasyon":null,"sure":"24 weeks","sonuc":"A composite score of 9 pain- and health-related measures improved by 55.4% in the spray group and 40.5% in the dronabinol group (difference 14.0; 95% CI 12.6–15.4). No placebo group; retrospective registry data. The analysis was funded by a drug company (Almirall); all 4 of the 4 authors have financial ties to this company (one is a full-time employee)","yan_etki":"Drug-related side effects 21.1% vs. 35%; discontinuation due to side effects 5.9% vs. 14.8%","pmid":"35140513","doi":"10.2147/JPR.S340968","diger_kaynak":"Other analyses of the same registry: Ueberall 2019, PMID 31190969 (800 patients, 497 with neuropathic pain; no control group); Ueberall 2022, PMID 34480564 (spray vs. long-acting opioid in neuropathic low back pain, 655 + 655)"},{"ad":"Hjorthøj 2022 (Danish national registry)","tasarim":"Cohort using national registry data; comparison with propensity score–matched controls","n":"1,817 people receiving prescription cannabinoids for neuropathic pain (plus 924 for other pain) and 1 matched control for each","populasyon":"Patients with neuropathic pain who received a prescription in Denmark’s medical cannabis pilot program, which started in 2018","urun":"Prescription cannabinoid medicines and medical cannabis: CBD, THC or CBD + THC (separate analysis by class; distribution not in the abstract)","urun_turu":"karma","doz":"Not reported (in the abstract)","titrasyon":null,"sure":"Not reported (in the abstract)","sonuc":"In neuropathic pain, those taking CBD, THC or both used less gabapentin and spent fewer days in the hospital than controls; those using THC, however, used more opioids than controls. Pain intensity was not measured; observational data, confounding cannot be ruled out. No similar benefit was seen in other types of pain","yan_etki":"The authors found it generally safe; no details in the abstract","pmid":"34624164","doi":"10.1002/ejp.1874","diger_kaynak":"Commentary: PMID 34743399"},{"ad":"Evans 2025 (UK Medical Cannabis Registry, complex regional pain syndrome)","tasarim":"Case series (from a prospective patient registry; no comparison group)","n":"64","populasyon":"Patients treated for complex regional pain syndrome who had entered the registry at least 6 months earlier; 56% were already using cannabis at baseline (United Kingdom, private clinic)","urun":"Prescription cannabis products chosen by the physician: extracts in MCT oil (CBD-dominant and THC-dominant) and THC-dominant dried flower; at baseline, 28 people used oil only, 6 flower only and 30 both","urun_turu":"thc_iceren","doz":"Median prescribed daily amount at baseline THC 12.5 mg and CBD 11 mg; at month 6, THC 117.9 mg and CBD 20 mg","titrasyon":"At the physician’s discretion","sure":"6 months (measurements at baseline and at months 1, 3 and 6)","sonuc":"Pain intensity (BPI, 0–10) fell from 6.69 to 5.85 at month 1 and to 6.05 at month 6 (p < 0.05; missing data imputed with baseline values); a clinically important improvement at month 6 was seen in 28% of patients on the BPI and 41% on the SF-MPQ-2. Improvement from baseline was reported on anxiety, sleep and quality-of-life scales; the patient global impression of change (PGIC) did not change significantly. Because there was no comparison group, it cannot be known how much of the improvement came from the product; this is not evidence of effectiveness. 7 of the 11 authors work for the clinic chain (Curaleaf) that treated the registry patients; the most commonly prescribed oils and flower are also products of the same group of companies","yan_etki":"5 patients (7.8%) reported a total of 50 side effects (20 severe, none life-threatening); most often nausea and headache (4 times each)","pmid":"40898690","doi":"10.1002/brb3.70823","diger_kaynak":"PMC12405601"}],"ilgili_ilaclar":["opioid","metadon","gabapentin","pregabalin","nsaii","parasetamol","tizanidin"],"son_inceleme":"2026-10-30","arastirma_gecmisi":[{"tarih":"2026-10-19","not":"Page published. This first review looked at 4 studies."},{"tarih":"2026-10-21","not":"The full texts of the studies were reread and the information on the page was checked against its sources. Corrected: side-effect and dose-titration information in the study table. Points that could not be verified from the full text went down from 2 items to 1. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-21","not":"Newly published and previously missed clinical studies were searched on PubMed and ClinicalTrials.gov. 2 studies added: Robertson 2026 and Hansen 2023. In a small randomized study of pure CBD, pain eased slightly compared with placebo (Robertson 2026); in another randomized study, no difference was seen (Hansen 2023). With the new studies, the strength of evidence changed from \"Very weak\" to \"Weak\" and the conclusion from \"No effect found\" to \"Mixed results.\""},{"tarih":"2026-10-27","not":"In October 2026, PubMed, Cochrane and ClinicalTrials.gov were searched systematically; 38 studies were added: 24 randomized studies of products containing THC (3 with results only in the trial registry: the drug maker’s diabetic neuropathy and spinal cord injury studies, and a study of dronabinol and inhaled cannabis in nerve-related low back pain; one with a THC-dominant oil applied to the skin in diabetic neuropathy), 1 randomized study with pure CBD cream applied to the skin, 3 with the THC-like drug nabilone, 1 with CBDV, a cannabinoid closely related to CBD, and 1 with a cannabis medicine of unreported composition, 5 systematic reviews including the 2026 Cochrane update, and 3 real-world studies. The 2018 numbers from the Cochrane review were replaced with those from the 2026 update; the conclusion and strength-of-evidence text for products containing THC were rewritten. The phrase 'a single study' for CBD applied to the skin was corrected: there is also a second study with a negative result. For two existing four-arm studies, the results of the THC arms were added; it was noted that the maximum dose of the mouth spray study (Nurmikko 2007) is contradictory in the registry; the product type of the 2018 Cochrane review became 'Multiple product types' and that of the CBD oil applied to the skin became 'CBD-rich extract, THC content unclear'. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-28","not":"October 2026 additional review: sources found for this page during searches for other topics were read and added to the page. The full text of the brachial plexus injury study (Kittithamvongs 2025) was read: the product tested was a cannabis oil containing roughly equal amounts of THC and CBD, dropped under the tongue; the product type changed from 'Other' to 'Contains THC', dose information was added, and the number of randomized studies with products containing THC rose from 27 to 28. Added: the numerical inconsistencies in the publication to the study of an oil applied to the skin in nerve pain from diabetes (Seevathee 2025); the authors’ company ties, and the fact that the study the review counts as 'oral CBD' most likely also contained a small amount of THC, to the review of chemotherapy-induced neuropathy (Datta 2026); and the appetite hormone substudy of the same trial to the HIV-associated neuropathy study (Ellis 2009). A separate search was done for complex regional pain syndrome and a short section was added: there is no controlled study specific to this condition; three short studies in mixed nerve pain groups also included these patients, and their numbers were written in two rows; a 64-patient series with no comparison group from the UK medical cannabis registry was added to the table. The views of guidelines and expert bodies were added to the evidence summary: both those recommending against use and those writing that cannabinoids may be considered when other treatments have not been enough. An uncontrolled CBD study in chemotherapy-induced neuropathy (Vigano 2025) was not added to the table: patients had not been selected for nerve pain, and no pain result was reported for the period when CBD was given alone. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-30","not":"Two studies were added to the table. A small 2003 crossover study in 24 people with persistent symptoms due to neurological diseases that also compared a CBD-rich plant extract with placebo (Wade 2003): pain had decreased more with this extract than with placebo; but because the patients were not selected for neuropathic pain, each product was tried for only 2 weeks and the THC content of the extract is not known, this finding does not count as evidence for pure CBD. No separate page was opened for burning mouth syndrome: a single-center, single-blind study comparing full-spectrum CBD oil with placebo in 26 patients with this condition (Parise 2026) was added to the table, and a 17-person study without a control group was added to the research section; both are very small and the evidence is very weak. The result and the strength of evidence did not change."},{"tarih":"2026-10-30","not":"The last sentence of the page's short summary was rewritten in calmer, more guiding language: instead of \"Talk to your doctor before you start.\", it now says who you can talk with, and about what, if you are considering CBD. The result and the strength of evidence did not change."}]},{"id":"arthritis-osteoarthritis","baslik":"Arthritis and osteoarthritis","grup":"Pain and surgery","grup_kodu":"agri","tr_id":"agri-artrit-osteoartrit","kanit_duzeyi":"orta","kanit_yonu":"yarar_gosterilmedi","kanit_ozet":"Three RCTs found no superiority of oral CBD over placebo: hand osteoarthritis/psoriatic arthritis (20–30 mg, 12 weeks), knee osteoarthritis (600 mg/day, 8 weeks) and knee osteoarthritis (45 mg/day CBD-rich oil, 60 days). In the 600 mg/day study, side effects and raised liver enzymes were more common in the CBD group. Small studies of topical products show conflicting results (see topical CBD). With products containing THC: in rheumatoid arthritis, a single RCT of a THC:CBD mouth spray (58 people, 5 weeks) showed a small improvement in pain and DAS28, with more frequent nervous system side effects (Cochrane: weak evidence, potential harms outweigh the small benefit; GRADE: low certainty; the reviews’ risk-of-bias assessments disagree); in knee osteoarthritis, a single 10 mg dose of dronabinol did not reduce clinical pain more than placebo in two crossover laboratory RCTs (37 and 21 people). A randomized study without placebo comparing three cannabinoid capsules (Kruger 2026) and patient registries (UK, Australia) reported improvement from baseline; with no comparison group, they do not count as evidence of effectiveness. October 2026 search (PubMed, Cochrane, ClinicalTrials.gov, Europe PMC): 8 randomized studies of cannabinoids in this area (7 placebo-controlled), 1 open-label study, 5 reviews (one Cochrane) and 3 observational studies were found; all are in the table below. Not included in the table: a skin gel study announced only as a conference abstract, a non-peer-reviewed 12-person preprint (oral CBD in knee osteoarthritis), completed studies with unpublished results (see unverifiable items) and studies with hemp seed oil (seed oil is not a CBD or THC product; these studies did not report cannabinoid content).","kanit_duzeyi_metin":"Moderate (pointing to no benefit for oral CBD)","kanit_duzeyi_thc_icerenler":"zayif","kanit_duzeyi_thc_icerenler_metin":"Weak (a single small RCT in rheumatoid arthritis; in knee osteoarthritis, only single-dose laboratory studies)","kaynak_dosya":"agri-ameliyat.md","saf_cbd_sonuc":"Oral pure CBD did not reduce pain more than placebo in osteoarthritis and hand arthritis; at high doses, raised liver enzymes were more common. There is no published study comparing pure CBD with placebo in rheumatoid arthritis or ankylosing spondylitis (October 2026); the results of a completed study in rheumatoid arthritis (NCT04911127) have not yet been published.","thc_icerenler_sonuc":"There is a single controlled study lasting several weeks of products containing THC in this area: in rheumatoid arthritis, a mouth spray containing THC and CBD showed slightly more improvement in pain and disease activity than placebo over 5 weeks, but nervous system side effects such as dizziness were also more common (58 people; low-certainty evidence). The Cochrane review wrote that the potential harms seem to outweigh this small benefit. In knee osteoarthritis, a single dose of dronabinol (synthetic THC) did not reduce joint pain more than placebo in two laboratory studies. In patient registries, people using THC-containing products reported improvement in pain, but there was no comparison group. Controlled studies testing THC for weeks in osteoarthritis are ongoing (NCT06878417, NCT04992624).","ruhsat":null,"doz_araligi_ozet":"Oral CBD 20–30 mg/day, 45 mg/day and 600 mg/day; topical 6.2 mg/mL (1 mL twice a day) and 4% gel; with THC: in RA, THC:CBD mouth spray averaging ~14.6 mg THC + 13.5 mg CBD/day; in knee OA, a single 10 mg dose of dronabinol","titrasyon_ozet":"Vela 2022: 10 → 20 → 30 mg/day; Pramhas 2023: 600 mg/day in three equal steps during the first week; Mojoli 2025: fixed 45 mg/day; Blake 2006: started with 1 spray in the evening and increased every 2 days (up to 6)","yan_etkiler":["In knee OA with 600 mg/day, adverse events more frequent (135 vs. 105) and transaminase/GGT elevation 15 vs. 5 (Pramhas 2023)","THC:CBD mouth spray in RA (5 weeks): side effects RR 1.82 (95% CI 1.10–3.00), NNTH 3; dizziness 26%, dry mouth 13%, lightheadedness 10%; no serious side effects or discontinuations due to side effects in the active group (Blake 2006; Richards 2012 Cochrane)"],"izlem":["Epidiolex label: at 10–20 mg/kg/day, ALT >3×ULN in 13% (placebo 1%); risk rises markedly with valproate; monitor at baseline, at months 1, 3 and 6, and after dose changes","In healthy adults, 5 mg/kg/day led to ALT/AST >3×ULN in 5.6% (placebo 0%) and eosinophilia (Florian 2025, PMID 40622698); 1,500 mg/day led to >5×ULN in 31% (Watkins 2021, PMID 33022751)","Liver enzymes should be monitored with acetaminophen (paracetamol) and other medicines that strain the liver (Pramhas 2023)"],"dikkat":["Liver enzymes should be monitored with high-dose CBD taken together with acetaminophen (paracetamol) (Pramhas 2023)","CBD is not an approved medicine for any type of pain"],"ilac_etkilesim_notlari":["Opioids: no increase in side effects with fentanyl + 400–800 mg CBD; 'bad drug effect' increased with hydromorphone + 200 mg CBD; pain threshold decreased with methadone + 1,200 mg CBD. In knee OA, hydromorphone + a single 10 mg dose of dronabinol: no additional analgesia; the feeling of being high increased, and moderate side effects (Campbell 2023) and nausea (Hamilton 2026; compared with hydromorphone alone) were more frequent. An opioid-sparing effect has not been proven; monitor for sedation","CNS depressants (gabapentin, pregabalin, benzodiazepines, alcohol): additive sedation; somnolence with Epidiolex 32% vs. 11%. No direct clinical study of CBD + gabapentinoids has been reported","NSAIDs: the label shows no significant change in tolbutamide, a CYP2C9 substrate; no direct study of CBD + NSAIDs has been reported; no documented significant interaction","Acetaminophen (paracetamol): in knee OA, enzyme elevations were more frequent with acetaminophen 3 g + CBD 600 mg; monitor liver enzymes","Warfarin: in a case report, INR rose and the warfarin dose was reduced; monitor INR when starting or stopping CBD","Clopidogrel: antiplatelet effect may be reduced via CYP2C19 (label); consult cardiology","DOACs (apixaban, rivaroxaban): no direct data reported; uncertain, should be disclosed and monitored","Valproate (liver, high risk) and clobazam (sedation 46% vs. 16%)","Tizanidine, theophylline (CYP1A2): the label recommends considering a dose reduction","Tacrolimus, sirolimus, everolimus, digoxin: monitoring or dose reduction (label)","Strong inducers such as rifampin: CBD levels fall by ~32%","Note: label data come from high-dose pharmaceutical CBD; with nonprescription products the size of an interaction may differ, but its direction should be assumed to be the same"],"dogrulanamayan":["Heineman 2022 was read only from the abstract; for Vela 2022, the accepted author manuscript was read instead of the publisher’s version. Of the studies added in October 2026, Blake 2006, Kruger 2026, Richards 2012 (Cochrane), Dubois 2024, Francis 2024 and Schubert 2023 were read only from the abstract; the numbers for Blake 2006 were taken from reviews, and its funding could not be verified","Ongoing studies (enrolling patients as of October 2026, no results): NCT06878417 (CBD and THC in hip/knee OA, pilot), NCT04992624 (CBD, THC and both together in knee OA), NCT05020028 (orally disintegrating CBD tablet in knee OA), NCT07638189 (CBD on the skin in knee OA; not yet started), NCT06414473 (oral CBD in knee OA; still appears to be enrolling in the registry, its 12-person results were shared in October 2026 as a non-peer-reviewed preprint, not included in the table). Completed but with results unpublished or not found: NCT04911127 (CBD in rheumatoid arthritis, 67 people, December 2023), NCT07445568 (CBD on the skin plus exercise in knee OA, November 2025), ISRCTN29199098 (cannabis cream on the finger joints in rheumatoid arthritis, Canada; end date December 2014), a CBD trial in rheumatoid arthritis and ankylosing spondylitis in Denmark (EudraCT 2017-004226-15; only the protocol was published); NCT04992962 (CBD/CBN and CBD/THC sublingual tablets in knee OA) status unknown","A study of synthetic CBD gel applied to the skin in knee osteoarthritis, announced only as a conference abstract in 2018 (Hunter 2018), could not be found as a full peer-reviewed publication; because the abstract could not be accessed, it was not included in the table"],"calismalar":[{"ad":"Vela 2022","tasarim":"Double-blind, placebo-controlled RCT","n":"136 (129 analyzed)","populasyon":"Hand osteoarthritis and psoriatic arthritis","urun":"Synthetic CBD, oral; no THC","urun_turu":"saf_cbd","doz":"Started at 10 mg/day; 20 mg/day at week 2; 30 mg/day at week 4 if no response","titrasyon":"Stepwise: 10 → 20 → 30 mg/day","sure":"12 weeks","sonuc":"Difference in pain 0.23 mm (0–100 scale; 95% CI −9.4 to 9.9); no difference in sleep, anxiety, depression or pain catastrophizing either","yan_etki":"Adverse events in 33 patients in the CBD group and 26 with placebo (119 events in total); serious events 2 vs. 2, none attributed to the drug","pmid":"34510141","doi":"10.1097/j.pain.0000000000002466","diger_kaynak":"ClinicalTrials.gov NCT03693833 (no results in the registry)"},{"ad":"Pramhas 2023","tasarim":"Double-blind, placebo-controlled, parallel-group RCT","n":"86 randomized (43/43); 84 received the drug, 58 completed; analysis with all randomized patients (missing data imputed)","populasyon":"Painful knee osteoarthritis (in addition to 3 g of acetaminophen [paracetamol] a day)","urun":"Hemp-derived CBD capsules (purity >99.8%), 200 mg/capsule","urun_turu":"saf_cbd","doz":"600 mg/day (200 mg 3 times a day, with food)","titrasyon":"Increased to 600 mg/day in three equal steps during the first week","sure":"8 weeks","sonuc":"Reduction in WOMAC pain (0–10) 2.5 vs. 2.4; difference 0.1 (95% CI −0.8 to 1.0; p=0.80). The study was funded by the company that makes the CBD capsules","yan_etki":"Adverse events more frequent with CBD (135 vs. 105, p=0.008); transaminase/GGT elevation 15 vs. 5 (p=0.02)","pmid":"38033459","doi":"10.1016/j.lanepe.2023.100777","diger_kaynak":"ClinicalTrials.gov NCT04607603 (no results in the registry); letter to the editor Miles 2024 (PMID 38322713) and authors’ reply (PMID 38328411)"},{"ad":"Mojoli 2025 (CANOA)","tasarim":"Double-blind, placebo-controlled RCT","n":"45 randomized (43 analyzed)","populasyon":"Knee osteoarthritis","urun":"Full-spectrum cannabis oil (in MCT), CBD 22.5 mg/mL; THC below the limit of detection (<0.075 mg/mL)","urun_turu":"cbd_zengin_thc_belirsiz","doz":"45 mg CBD/day (morning and evening)","titrasyon":"None (fixed dose)","sure":"60 days","sonuc":"No difference in WOMAC or VAS","yan_etki":"No serious adverse events; no significant change in serum biomarkers","pmid":"41487518","doi":"10.3389/fphar.2025.1657065","diger_kaynak":"ClinicalTrials.gov NCT06588972 (no results in the registry)"},{"ad":"Heineman 2022","tasarim":"Crossover, double-blind RCT","n":"18","populasyon":"Arthritis of the thumb base joint","urun":"Topical CBD 6.2 mg/mL in shea butter (control: shea butter alone)","urun_turu":"saf_cbd","doz":"1 mL twice a day","titrasyon":null,"sure":"2 weeks + 1-week washout + 2 weeks crossover","sonuc":"During the CBD period, greater improvement in VAS pain, DASH and SANE scores than in the control period; grip and pinch strength and range of motion similar. Numbers not in the abstract (full text could not be read); each period 2 weeks, 18 people","yan_etki":"No adverse events","pmid":"35637038","doi":"10.1016/j.jhsa.2022.03.002","diger_kaynak":"ClinicalTrials.gov NCT04611347 (results entered in the registry on July 3, 2025; the primary measures in the registry are grip strength, PROMIS upper extremity, Kapandji and range of motion, not the pain scales highlighted in the article)"},{"ad":"Bawa 2024","tasarim":"Open-label, single-arm, feasibility","n":"18 (15 completed)","populasyon":"Hand osteoarthritis","urun":"Transdermal CBD gel 4%","urun_turu":"saf_cbd","doz":"0.25 mL 3 times a day (~30 mg CBD/day)","titrasyon":null,"sure":"4 weeks","sonuc":"About −1.9 NRS in pain (no control group); returned to baseline during the washout period. The study was co-funded by the company that developed the gel, which also donated the product; four of the authors are employees of this company","yan_etki":"31 reports of mild adverse events and 1 moderate; no THC detected in urine","pmid":"38783008","doi":"10.1038/s41598-024-62428-x","diger_kaynak":"ANZCTR ACTRN12621001512819"},{"ad":"Blake 2006","tasarim":"Double-blind, placebo-controlled, parallel-group RCT","n":"58 randomized (31 active drug, 27 placebo); 75 people screened","populasyon":"Active rheumatoid arthritis; disease-modifying antirheumatic drugs (DMARDs) continued at a stable dose (United Kingdom)","urun":"Mouth spray containing THC and CBD (nabiximols; Sativex); 2.7 mg THC + 2.5 mg CBD per spray","urun_turu":"thc_iceren","doz":"Evenings only; mean 5.4 sprays a day in the last week (about 14.6 mg THC + 13.5 mg CBD/day)","titrasyon":"Started with 1 spray in the evening and increased every 2 days (up to 6); then 3 weeks at a fixed dose","sure":"5 weeks","sonuc":"Compared with placebo, pain on movement (0–10) improved by −0.95 more (p = 0.044), pain at rest by −1.04 (p = 0.018), sleep quality by −1.17 (p = 0.027) and disease activity (DAS28) by −0.76 (p = 0.002); no difference in morning stiffness (baseline scores were low). The authors wrote that the differences were small and varied from person to person; the most recent review (Zintziovas 2026) found the clinical importance of the pain difference of about 1 point unclear. A single, small, short study in rheumatoid arthritis; Cochrane (Richards 2012) found the evidence weak, and the GRADE summary (Schulze-Schiappacasse 2022) rated it low certainty for pain and DAS28. Risk-of-bias assessments conflict: Cochrane, Fitzcharles 2016 and Johal 2020 found it high, the GRADE summary unclear for blinding, and Zintziovas 2026 (RoB 2) low; in Johal 2020’s recalculation, the pain difference was not significant","yan_etki":"Mostly mild to moderate; no serious side effects or discontinuations due to side effects in the active drug group. By Cochrane’s calculation, the risk of side effects was higher than with placebo (RR 1.82; 95% CI 1.10–3.00); most often dizziness 26%, dry mouth 13%, lightheadedness 10%","pmid":"16282192","doi":"10.1093/rheumatology/kei183","diger_kaynak":"Letter: Wright 2006, PMID 16621924"},{"ad":"Campbell 2023","tasarim":"Double-blind, placebo-controlled, within-subject crossover laboratory RCT (a single dose in each session)","n":"37","populasyon":"Knee osteoarthritis, mean pain at least 3/10 (USA; mean age 62, 65% women)","urun":"Dronabinol (synthetic THC) and hydromorphone (an opioid pain reliever), oral capsules; alone, together and placebo","urun_turu":"thc_iceren","doz":"Single dose: dronabinol 10 mg; hydromorphone 4 mg","titrasyon":"None (the first session was always hydromorphone for safety; the order of the next three sessions was random)","sure":"4 sessions at least 7 days apart; measurements for several hours after the dose in each session","sonuc":"No difference in knee pain intensity (0–100) among the four conditions (peak value: placebo 12.6, dronabinol 13.5, hydromorphone 9.3, both together 11.0; p = 0.302); no difference in physical function tests either. In experimental pain tests, dronabinol did not clearly enhance the effect of hydromorphone. Single-dose laboratory study; does not reflect long-term use","yan_etki":"Drug-related side effects in 52 of 148 sessions (35.1%) and in 26 of 37 people; no serious side effects. Hydromorphone + dronabinol increased moderate side effects compared with placebo and with hydromorphone alone; dronabinol raised 'bad drug effect' and 'high' scores above placebo; only hydromorphone impaired cognitive function","pmid":"37202479","doi":"10.1038/s41386-023-01597-1","diger_kaynak":"ClinicalTrials.gov NCT03098563 (results entered in the registry on December 11, 2024; 58 people together with the Hamilton 2026 cohort; in the combined registry result, peak clinical pain (0–100) was 12.8 with dronabinol and 12.8 with placebo)"},{"ad":"Hamilton 2026","tasarim":"Double-blind, placebo-controlled, within-subject crossover laboratory RCT (a single dose in each session)","n":"21 (different people from Campbell 2023)","populasyon":"Knee osteoarthritis (USA, 2021–2023; mean age 63, 57% women)","urun":"Dronabinol (synthetic THC) and low-dose hydromorphone (an opioid pain reliever), oral capsules; alone, together and placebo","urun_turu":"thc_iceren","doz":"Single dose: dronabinol 10 mg; hydromorphone 2 mg","titrasyon":"None (the first session was always hydromorphone for safety; the order of the next three sessions was random)","sure":"4 sessions at least 7 days apart; 4 hours of measurement after the dose","sonuc":"No difference in knee pain intensity (0–100) (placebo 13.1, dronabinol 12.8, hydromorphone 9.5, both together 15.0; p = 0.280); no difference in walking, timed up-and-go or stair tests. In experimental pressure pain, hydromorphone was superior to dronabinol; no added benefit of giving them together was seen. Single-dose laboratory study; does not reflect long-term use","yan_etki":"Drug-related side effects in 24 of 84 sessions (28.6%); no difference between conditions (p = 0.082); no serious side effects. Dronabinol increased the 'high' score more than hydromorphone; when given together, working memory reaction time lengthened and nausea increased compared with hydromorphone","pmid":"41481837","doi":"10.1097/ALN.0000000000005925","diger_kaynak":"ClinicalTrials.gov NCT03098563 (same registration as Campbell 2023; the results in the registry combine both cohorts)"},{"ad":"Kruger 2026","tasarim":"Randomized study without placebo comparing three cannabinoid formulations (a real-world data study, according to the authors); blinding not stated in the abstract","n":"276 enrolled; 164 people who completed the questionnaires and continued the product were analyzed (25 rheumatoid arthritis, 75 knee/hip osteoarthritis, 64 fibromyalgia)","populasyon":"Adults living in California diagnosed with rheumatoid arthritis, knee/hip osteoarthritis or fibromyalgia (USA)","urun":"Oral capsules, three formulations: 1) 12.5 mg CBD + 12.5 mg THC; 2) 10 mg THCA + 10 mg CBDA (the unheated acid forms of THC and CBD) + 5 mg CBG + 3 mg CBC; 3) 10 mg CBD + 10 mg CBDA","urun_turu":"karma","doz":"The amounts above per capsule; number of capsules per day not reported (in the abstract)","titrasyon":"Not reported (in the abstract)","sure":"12 weeks","sonuc":"In the per-protocol analysis, improvement from baseline in all symptoms except cognitive function (small to large effect); most effects did not differ between products or pain types (rheumatoid arthritis, osteoarthritis, fibromyalgia). Because there was no placebo group, it is not known how much of the improvement came from the products; 39% of those enrolled did not complete the questionnaires; arthritis-specific numbers are not in the abstract; four of the six authors are affiliated with a company (MoreBetter), and the authors declared no conflicts of interest","yan_etki":"Not reported (in the abstract)","pmid":"42140793","doi":"10.1016/j.clinthera.2026.04.018","diger_kaynak":null},{"ad":"Richards 2012 (Cochrane)","tasarim":"Cochrane systematic review and meta-analysis (neuromodulators in rheumatoid arthritis; RCTs; search through November 2010)","n":"4 RCTs; 1 RCT with a cannabinoid (58 people)","populasyon":"Adults with rheumatoid arthritis","urun":"In the cannabinoid arm, only a mouth spray containing THC and CBD (Blake 2006); the other drugs were nefopam and capsaicin","urun_turu":"thc_iceren","doz":"As in Blake 2006 (mouth spray in the evening)","titrasyon":null,"sure":null,"sonuc":"Over 5 weeks, the mouth spray was superior to placebo on the 'current pain' score by a small but significant margin (mean difference −0.72; 95% CI −1.31 to −0.13). The authors found the evidence weak (a single, small, low-quality study) and wrote that the potential harms seem to outweigh the small benefit. As of October 2026, there is no update on PubMed","yan_etki":"Risk of side effects higher than with placebo: RR 1.82 (95% CI 1.10–3.00); number needed to harm 3; most often dizziness 26%, dry mouth 13%, lightheadedness 10%","pmid":"22258992","doi":"10.1002/14651858.CD008921.pub2","diger_kaynak":"The same team’s summary on inflammatory joint diseases (J Rheumatol Suppl 2012, PMID 22942326) excluded the cannabis study"},{"ad":"Schulze-Schiappacasse 2022","tasarim":"Structured evidence summary of systematic reviews (Epistemonikos, GRADE)","n":"26 systematic reviews; all rely on the same single RCT (58 people)","populasyon":"Rheumatoid arthritis","urun":"Cannabis, cannabis products and synthetic cannabinoids; the only eligible study was a mouth spray containing THC and CBD","urun_turu":"thc_iceren","doz":"Mean 14.6 mg THC + 13.5 mg CBD/day (Blake 2006)","titrasyon":null,"sure":null,"sonuc":"Disease activity (DAS28) 0.9 points lower than placebo (low certainty); current pain score (0–5) 0.7 lower (low certainty); the authors interpreted this as 'little or no difference' in pain. Certainty was downgraded because the risk of bias from blinding was unclear and the confidence interval was wide. It was emphasized that the evidence rests on a single 5-week study","yan_etki":"Nervous system side effects (dizziness, lightheadedness, sleepiness, headache) 419 vs. 148 per 1,000 people (RR 2.83; 95% CI 1.05–7.65; low certainty); the evidence for serious side effects is very uncertain","pmid":"33859125","doi":"10.1097/RHU.0000000000001745","diger_kaynak":null},{"ad":"Zintziovas 2026","tasarim":"Scoping review (RCTs and observational studies; assessed with RoB 2 and ROBINS-I; search through September 10, 2026)","n":"593 records; 3 studies (1 RCT, 2 observational)","populasyon":"Adults with rheumatoid arthritis","urun":"Cannabinoid products (in the RCT, a mouth spray containing THC and CBD; in the observational studies, CBD or cannabis that people used on their own)","urun_turu":"karma","doz":"Variable","titrasyon":null,"sure":null,"sonuc":"The only RCT of a cannabinoid in rheumatoid arthritis is still Blake 2006; the authors rated it at low risk of bias with RoB 2 (Cochrane and other reviews had found high risk), but found the clinical importance of the pain difference of about 1 point unclear. The risk of bias of the two observational studies is serious or critical. According to the authors, current evidence does not support routine use of cannabinoids for rheumatoid arthritis pain; completed but unpublished studies (e.g., NCT04911127) could not contribute to the evidence","yan_etki":"No long-term safety data","pmid":"42831900","doi":"10.1007/s00296-026-06314-x","diger_kaynak":null},{"ad":"Dubois 2024","tasarim":"Systematic review (2012–2022; GRADE and ROBINS-I; narrative synthesis)","n":"7 studies (2 RCTs, 5 observational)","populasyon":"Adults with osteoarthritis using medical cannabis","urun":"Medical cannabis and cannabinoid products","urun_turu":"karma","doz":"Variable","titrasyon":null,"sure":null,"sonuc":"Of the two RCTs, only one reported an improvement in pain; all 5 observational studies reported improvements in pain, opioid use or function. Risk of bias high, study quality low; the authors found the evidence supporting the use of medical cannabis in place of first-line drug treatment for osteoarthritis to be of low quality","yan_etki":"Not reported (in the abstract)","pmid":"38832841","doi":"10.1080/03007995.2024.2363945","diger_kaynak":"PROSPERO CRD42022354026"},{"ad":"Abafita 2026","tasarim":"Systematic review and meta-analysis (animal and human studies; RoB 2, GRADE; search through April 2024)","n":"6 human studies (5 RCTs, 1 open-label), 606 patients; pain meta-analysis 4 RCTs","populasyon":"Knee and hand osteoarthritis (Denmark, Austria, USA, Australia)","urun":"CBD (oral and on the skin) and dronabinol (synthetic THC)","urun_turu":"karma","doz":"Variable","titrasyon":null,"sure":null,"sonuc":"In the pooled analysis of four RCTs, no significant improvement in pain compared with placebo (standardized mean difference −1.52; 95% CI −4.63 to 1.59). The authors considered the two small hand studies reporting positive results limited because of small samples, lack of a comparison group and high risk of bias. Certainty of evidence low to moderate; positive findings in animal studies were not confirmed in humans","yan_etki":"Side effects generally mild to moderate (nausea, dry mouth, dizziness, sleepiness); insufficient data on long-term safety","pmid":"42515994","doi":"10.1155/prm/3998239","diger_kaynak":"PROSPERO CRD42024539941"},{"ad":"Sajeev 2026 (UK Medical Cannabis Registry)","tasarim":"Prospective patient registry case series (no comparison group)","n":"192 (patients in the registry for at least 24 months)","populasyon":"Chronic pain from inflammatory joint disease (an umbrella term covering rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis; distribution by disease not reported) (United Kingdom; mean age 47; 54% were already using cannabis at baseline)","urun":"Prescription cannabis products (oil, dried flower or both; containing THC and CBD); at month 24, the daily THC dose was about seven times that of CBD","urun_turu":"thc_iceren","doz":"At month 24, median 146 mg THC and 21 mg CBD/day","titrasyon":"Median 20 mg THC/day at baseline; increased from the first month on","sure":"24 months","sonuc":"Pain intensity (BPI, 0–10) fell from 5.95 to 3.98 at month 24; pain, sleep and quality of life were better than baseline at all follow-up points (p < 0.01); anxiety improved only in the first 3 months. At month 24, 62.5% of patients reported a clinically meaningful improvement in pain intensity (in the RCTs the authors cite, 35–65% of chronic pain patients given placebo also report such an improvement). No comparison group and no blinding, and missing questionnaires were filled in statistically; the registry belongs to the private clinic that prescribes the product, and seven of the nine authors are affiliated with this clinic (one is its research director)","yan_etki":"296 side effects in 27 patients (14.1%): 42.6% mild, 44.6% moderate, 12.8% severe; none life-threatening","pmid":"42724108","doi":"10.1177/11795441261480709","diger_kaynak":"Earlier analysis of the same registry: Francis 2025, PMID 38976497 (82 patients, 12 months; the patients most likely overlap)"},{"ad":"Francis 2024 (UK Medical Cannabis Registry)","tasarim":"Prospective patient registry case series (no comparison group)","n":"77","populasyon":"Chronic pain from osteoarthritis (United Kingdom)","urun":"Prescription cannabis products (containing THC and/or CBD; details not in the abstract)","urun_turu":"karma","doz":"Not reported (in the abstract)","titrasyon":"Not reported (in the abstract)","sure":"12 months","sonuc":"Pain intensity and the impact of pain on daily life (BPI) and the McGill pain score were better than baseline at all follow-up points (months 1, 3, 6 and 12) (p = 0.004, 0.005 and 0.017); improvements in quality of life, sleep and anxiety were limited to the first 3–6 months. No comparison group; the authors wrote that causality cannot be inferred; the registry belongs to the private clinic that prescribes the product, and seven of the eight authors are affiliated with this clinic","yan_etki":"218 side effects in 17 patients (22.1%): 76 mild, 104 moderate, 38 severe","pmid":"38669060","doi":"10.1080/15360288.2024.2340076","diger_kaynak":null},{"ad":"Schubert 2023","tasarim":"Interim analysis of a prospective observational study (no comparison group; arthritis subgroup)","n":"Arthritis subgroup 199 (part of a refractory chronic pain cohort)","populasyon":"Patients prescribed medical cannabis for refractory chronic pain; arthritis subgroup (Australia)","urun":"Prescription medical cannabis: CBD-only, balanced CBD:THC and THC-rich products","urun_turu":"karma","doz":"Variable (grouped by THC:CBD ratio)","titrasyon":"Not reported (in the abstract)","sure":"Not reported (in the abstract)","sonuc":"In the arthritis subgroup, pain intensity decreased from baseline (p = 0.005); it also decreased in those using CBD-only (p = 0.018) and balanced CBD:THC products (p = 0.005). In the whole cohort, 22% of patients reported a clinically meaningful reduction in pain. No comparison group; some of the authors are from a private cannabis research company","yan_etki":"51% of the whole chronic pain cohort (364 people) reported at least one side effect: most often dry mouth 24%, sleepiness 19%, tiredness 12%; similar in the arthritis subgroup","pmid":"37057257","doi":"10.1177/20494637221147115","diger_kaynak":null}],"ilgili_ilaclar":["opioid","metadon","gabapentin","pregabalin","nsaii","parasetamol","tizanidin"],"son_inceleme":"2026-10-27","arastirma_gecmisi":[{"tarih":"2026-10-19","not":"Page published. This first review looked at 5 studies."},{"tarih":"2026-10-21","not":"The full texts of the studies were reread and the information on the page was checked against its sources. Corrected: dose, dose titration, side-effect and product information in the study table. Points that could not be verified from the full text went down from 3 items to 2. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-22","not":"The names of the conclusion labels were simplified: the \"No benefit seen\" label on this page became \"No effect found.\" The assessment did not change."},{"tarih":"2026-10-27","not":"In October 2026, PubMed, Cochrane, ClinicalTrials.gov and Europe PMC were searched systematically; 12 studies were added: 3 randomized studies of products containing THC (a mouth spray containing THC and CBD in rheumatoid arthritis, two single-dose dronabinol studies in knee osteoarthritis), a study without placebo comparing three cannabinoid capsules, 5 reviews including Cochrane, and 3 observational studies. A non-peer-reviewed preprint and hemp seed oil studies were not included in the table; the reason is given in the evidence summary. Registration numbers were added to the five existing rows; the number of participants and the result of the knee osteoarthritis study (Pramhas 2023) were given in more detail, a funding note was added to two rows, and a strength-of-evidence note to the thumb-base study (Heineman 2022). The conclusion for products containing THC was rewritten, and the THC strength of evidence, which had been blank, was written for the first time ('Weak'). The conclusion and strength of evidence for CBD did not change."},{"tarih":"2026-10-30","not":"The last sentence of the page's short summary was rewritten in a calmer, more guiding tone: instead of \"Talk to your doctor before you start.\", it now says whom you can talk with, and about what, if you are considering CBD. The conclusion and the strength of evidence did not change."}]},{"id":"chronic-pain","baslik":"Chronic pain (general) and opioid reduction","grup":"Pain and surgery","grup_kodu":"agri","tr_id":"agri-kronik-genel","kanit_duzeyi":"orta","kanit_yonu":"yarar_gosterilmedi","kanit_ozet":"In chronic pain, CBD was not superior to placebo in 15 of 16 RCTs that used pharmaceutical-grade pure CBD (Moore 2024). In the fibromyalgia RCT (50 mg/day, 24 weeks), placebo did better than CBD. In chronic pelvic pain due to endometriosis, a CBD-rich oil (up to 150 mg/day, 10 weeks, 102 people) was no better than placebo, and the study was stopped at an interim analysis; in jaw joint muscle pain, 20 mg/day of CBD oil (3 months, 54 people) also did not change pain. No RCT has been reported showing an opioid-reducing effect of pure CBD in chronic pain. Oral medical cannabis containing THC gave a small to very small improvement in pain (moderate certainty), and the BMJ guideline made this a weak recommendation. IASP (2021) does not support the general use of cannabinoids for pain. According to the 2026 update from the US Agency for Healthcare Research and Quality (AHRQ) (25 RCTs, 2303 people), oral THC and balanced THC:CBD products may reduce pain slightly (low or moderate certainty), while CBD-dominant products may not; according to Stockings 2018, 24 people need to be treated for one person to get meaningful relief, and 1 in every 6 people has an additional side effect. The UK's national guideline (NICE 2019) does not recommend THC-containing products for chronic pain and recommends CBD only in clinical trials; the American College of Physicians (ACP 2025) says that in young adults and adolescents, in people with a substance use disorder or serious mental illness, and in frail patients, the harms most likely outweigh the benefits, and that inhaled cannabis should not be used. A clinical guideline prepared in Canada (Bell 2024), however, summarizes the evidence as 'at least a moderate benefit in most studies' and recommends cannabinoid-based medicines for chronic pain at the level of 'strong recommendation, moderate-quality evidence'; the guideline itself also writes that the strongest evidence is for THC-containing products, not for CBD. This guideline's search ends in 2019, it also counts uncontrolled studies, a cannabis company took part in its funding, and 7 of its 20 authors reported ties to cannabis companies; meta-analyses that pool only placebo-controlled studies, on the other hand, find the benefit small or very small. Small THC RCTs in chronic abdominal pain and sickle cell disease found no difference from placebo; in the safety study in hemodialysis patients, pain was not compared statistically. On the opioid reduction question, opioid dose did not fall in RCTs (Noori 2021, very low certainty); in the only study where cannabis use was assigned by lottery to 87 adults with chronic pain taking opioids, opioid dose and pain at 24 weeks also did not differ from the waiting group (results only in the ClinicalTrials.gov registry). While uncontrolled studies based on patients' own reports describe a clear decrease in opioid use (in the observational studies pooled by Nielsen 2022, the pooled proportion who said they had lowered their dose was 85%; in an uncontrolled series of 1000 patients with chronic low back pain followed for 10 years in Israel, opioid dose fell by 90% among those who completed follow-up, and the authors themselves write that observational bias plays a part in this, Khatib 2026), studies using prescription records or a comparison group show no effect (Campbell 2018, Goedel 2022), a small effect (Nguyen 2023, Slawek 2026) or an effect in the opposite direction (Fontaine 2026: starting long-term opioids was more common in older adults). In a network meta-analysis that indirectly compared cannabis and opioid studies, no difference in pain was seen (low certainty), and fewer people stopped cannabis because of side effects (Jeddi 2024); in a large registry study comparing people who started nabilone with those who started opioids, falls, fractures and deaths were less common, while mental health problems related to substance use were more common (Vozoris 2024). In healthy volunteers, it is inconsistent whether THC increases the painkilling effect of opioids; THC may increase the abuse-related effects of opioids (Nielsen 2022). October 2026 search (PubMed, Cochrane, ClinicalTrials.gov, Europe PMC): 20 randomized controlled trials with cannabinoids on this topic were found (8 with CBD alone; 2 laboratory studies in healthy volunteers done together with an opioid; 3 with results only in the ClinicalTrials.gov registry), along with 11 systematic reviews, 1 publication bias analysis, 5 guidelines or position statements and 12 observational or uncontrolled studies; all are in the table below. Cochrane has no review specific to general chronic pain. Laboratory studies in healthy volunteers that tested CBD together with an opioid are listed one by one in the table; the 5 laboratory studies that tested THC together with an opioid were not listed individually but are summarized through the Nielsen 2022 row. The many small patient registries and uncontrolled studies were also not listed individually; they are summarized through reviews (Nielsen 2022, Noori 2021, Bialas 2022, Zeraatkar 2022).","kanit_duzeyi_metin":"Moderate (no benefit seen with pure CBD; placebo did better in the fibromyalgia RCT); opioid reduction: very low certainty (opioid dose did not fall in RCTs)","kanit_duzeyi_thc_icerenler":"orta","kanit_duzeyi_thc_icerenler_metin":"Moderate certainty, small to very small effect (Wang 2021); AHRQ 2026: low–moderate certainty, small effect; BMJ guideline weak recommendation, NICE (2019) does not recommend","kaynak_dosya":"agri-ameliyat.md","saf_cbd_sonuc":"Pure CBD was not found to be better than placebo in chronic pain (Moore 2024: 15 of 16 RCTs; AHRQ living review: no difference in pain in 4 RCTs of oral pure CBD, moderate certainty), and an opioid-reducing effect has not been shown in RCTs; no conclusions can be drawn from two small CBD studies in patients taking opioids (an RCT that finished with 6 people and an uncontrolled cohort of 97 people).","thc_icerenler_sonuc":"Oral THC-containing cannabinoids give a small improvement in pain (Wang 2021: −0.50 cm VAS; AHRQ 2026: oral THC −0.78, THC:CBD oral spray −0.54 points/10), with increased dizziness, drowsiness and nausea; in chronic low back pain, a THC-dominant full-spectrum extract gave −0.6 NRS versus placebo. In the open-label manufacturer study comparing the same extract with opioids, constipation was less common; the difference in pain was small (0.34 points) and not significant in the confirmatory analysis carried out in the pre-specified order. Small RCTs in chronic abdominal pain and sickle cell disease found no difference from placebo (in the safety study in hemodialysis patients, pain was not compared statistically between groups); NICE (2019) does not recommend them for chronic pain.","ruhsat":null,"doz_araligi_ozet":"Pure CBD in pain RCTs 6–1600 mg (Moore 2024); fibromyalgia 50 mg/day; endometriosis 10–150 mg/day; jaw pain 20 mg/day; 50–1200 mg single doses in laboratory opioid interaction studies; 600 mg/day in patients with radicular pain taking opioids (6 people). In studies of THC-containing or THC-like products: nabilone (a synthetic THC-like cannabinoid) 0.25–1 mg/day, dronabinol 10–20 mg single dose, purified THC up to 24 mg/day (abdominal pain), THC-dominant extract with a dose unit of 2.5 mg THC and at most 13 units a day (low back pain) (study doses; not a personal recommendation)","titrasyon_ozet":"Schedules used in the studies (not a personal recommendation): in most CBD studies the dose was fixed from the start; in the endometriosis study, the CBD-rich oil was raised from 10 mg/day in weekly steps to 150 mg/day by week 9. In studies of THC-containing products, the dose was increased little by little every few days (e.g., every 3 days in the low back pain study), and side effects were seen most often during this increase period","yan_etkiler":["Pure CBD in the fibromyalgia study: side effects mostly mild and similar between groups (Rasmussen 2026)","With 200 mg CBD + hydromorphone, 'bad effects' increased (Bergeria 2025)","THC-containing products: dizziness, drowsiness, nausea (Wang 2021); adverse events 83.3% versus 67.3%, discontinuation due to side effects 17.3% versus 3.5% (VER-01)","With long-term use (observational studies), about a quarter of users reported side effects; serious side effects occurred in fewer than 1 in 20 people (Zeraatkar 2022). In two studies where cannabis use was assigned by lottery, symptoms of cannabis use disorder increased (Gilman 2022; in opioid users, NCT04827992)"],"izlem":["Epidiolex label: at 10–20 mg/kg/day, ALT >3× ULN in 13% (placebo 1%); the risk rises markedly with valproate; monitoring at baseline, at months 1, 3 and 6, and after dose changes","In healthy adults, 5 mg/kg/day gave ALT/AST >3× ULN in 5.6% (placebo 0%) and eosinophilia (Florian 2025, PMID 40622698); 1500 mg/day gave >5× ULN in 31% (Watkins 2021, PMID 33022751)","Liver enzymes should be monitored when combined with acetaminophen (paracetamol) and other medicines that strain the liver (Pramhas 2023, PMID 38033459)"],"dikkat":["CBD is not an approved medicine for any type of pain","In patients taking methadone, high-dose CBD (1200 mg) lowered the pain threshold (Costa 2026)","The expectation that CBD reduces opioid use is not supported by RCTs; the opioid dose should not be reduced on one's own","In non-prescription products, the content on the label may not match the actual content (Moore 2024)","When THC-containing products were taken together with opioids, laboratory studies in healthy volunteers found that the opioid's 'liking' and abuse-related effects could increase (Nielsen 2022)"],"ilac_etkilesim_notlari":["Opioids: fentanyl + 400–800 mg CBD, no increase in side effects; hydromorphone + 200 mg CBD, 'bad effects' increased; methadone + 1200 mg CBD, pain threshold fell. Inhaled cannabis did not significantly change total blood levels of morphine and oxycodone (Abrams 2011); in laboratory studies in healthy volunteers, THC could increase the abuse-related effects of opioids (Nielsen 2022). An opioid-reducing effect has not been proven; sedation should be monitored","CNS depressants (gabapentin, pregabalin, benzodiazepines, alcohol): additive sedation; with Epidiolex, somnolence 32% versus 11%. No direct clinical study of CBD + gabapentinoids has been reported","NSAIDs: on the label, no significant change in the CYP2C9 substrate tolbutamide; no direct study of CBD + NSAIDs has been reported; no documented significant interaction","Acetaminophen (paracetamol): in knee OA, enzyme elevations were more common with acetaminophen 3 g + CBD 600 mg; liver enzymes should be monitored","Warfarin: in a case report, INR rose and the warfarin dose was reduced; INR should be monitored when CBD is started or stopped","Clopidogrel: the antiplatelet effect may be reduced via CYP2C19 (label); cardiology should be consulted","DOACs (apixaban, rivaroxaban): no direct data reported; uncertain, should be disclosed and monitored","Valproate (liver, high risk) and clobazam (sedation 46% versus 16%)","Tizanidine, theophylline (CYP1A2): the label recommends considering a dose reduction","Tacrolimus, sirolimus, everolimus, digoxin: monitoring or dose reduction (label)","Strong inducers such as rifampin: CBD levels fall by ~32%","Note: label data come from high-dose pharmaceutical CBD; with non-prescription products the size of an interaction may differ, but its direction should be assumed to be the same"],"dogrulanamayan":["Rasmussen 2026 (titration, THC content) was read from the abstract only. Of the studies added in the October 2026 search, Notcutt 2004, Pinsger 2006 (in German), Narang 2008, de Vries 2016, de Vries 2017, Abrams 2011, Chesterman 2025, Capano 2020, Ware 2015, Fontaine 2026 and Vozoris 2024, the Chou 2026, Stockings 2018 and Bialas 2022 reviews, and the ACP 2025 recommendation were read from the abstract only; the full text of the AHRQ 2025 report was not read; the results of NCT04527003, NCT04760613 and NCT04827992 were read only from the ClinicalTrials.gov registry; Khatib 2026 was read from the abstract only (the full text requires a subscription; the product, dose and THC content used are not in the abstract; the abstract gives the enrollment period as 2015–2024 while stating that 638 patients completed 10 years of follow-up, so how the follow-up period was calculated could not be verified); the full text of CADTH's 2024 nabilone review could not be opened (bot verification), and its description comes from its abstract on PubMed","Studies completed as of October 2026 but whose results have not been published or posted to the registry: a dose–response study of a THC-dominant extract in chronic low back pain (NCT06475001, 652 people, finished in July 2025), a study comparing cannabis with oxycodone in back and neck pain (NCT02892591, 33 people, 2023), THC and CBD in chronic widespread pain (NCT03215940, 53 people, 2024), CBD in chronic pain (NCT04044729, 24 people, 2024), an RCT of discounted cannabis coupons in opioid users (NCT04495725, 270 people, 2024; sponsored by a cannabis company), a pilot RCT of CBD and THC + CBD oil in chronic pain (NCT05351905, 51 people, January 2026), and a 161-person cannabis oil RCT that the sponsor stopped in 2019 (NCT03337503)","Ongoing studies as of October 2026: CBD in US veterans (NCT06213233, 468 people), dronabinol (NCT05519111) and CBD (NCT06930703) in sickle cell disease, oral cannabis in spinal pain (NCT05052541), dronabinol in low back pain (NCT06454669), a THC-dominant extract in radicular pain from the lower back (NCT06956014), CBD in endometriosis and gynecological pain (NCT06477406, NCT07728695)","In the CBD study in patients with radicular pain taking opioids (NCT04760613), the registry does not say whether the product was pure CBD or an extract; in Capano 2020 the CBD dose, THC content and funding could not be read; the registry results of Meissner 2025 and Karst 2025 have not been posted to ClinicalTrials.gov"],"calismalar":[{"ad":"Rasmussen 2026","tasarim":"Double-blind, placebo-controlled, single-center RCT","n":"200 (100/100)","populasyon":"Fibromyalgia","urun":"Plant-derived CBD tablets (CBD as the only active ingredient; THC content not reported in the abstract or the registry)","urun_turu":"saf_cbd","doz":"50 mg/day","titrasyon":"According to the registry plan, it was to start at 10 mg/day and be increased every 3 days to reach 50 mg/day in 2 weeks (the full text of the article could not be read; the schedule actually used could not be verified)","sure":"24 weeks","sonuc":"Change in pain −0.4 with CBD, −1.1 with placebo; difference in favor of placebo (−0.7; p=0.0028)","yan_etki":"Mostly mild; similar between groups","pmid":"40846590","doi":"10.1016/j.ard.2025.07.008","diger_kaynak":"ClinicalTrials.gov NCT04729179 (CANNFIB; no results in the registry)"},{"ad":"Bergeria 2025","tasarim":"Within-subject, double-blind, double-dummy RCT","n":"31","populasyon":"Healthy volunteers, laboratory pain model","urun":"Oral CBD + 4 mg hydromorphone","urun_turu":"saf_cbd","doz":"50–200 mg","titrasyon":"Fixed-dose conditions","sure":"Single sessions","sonuc":"Opioid analgesia increased on some acute pain measures; no effect in chronic pain models","yan_etki":"At 200 mg, 'bad effects' and adverse events increased; CBD reduced psychomotor impairment","pmid":"40839659","doi":"10.1097/j.pain.0000000000003561","diger_kaynak":null},{"ad":"Costa 2026","tasarim":"Crossover, double-blind, placebo-controlled RCT","n":"23","populasyon":"Opioid use disorder on methadone treatment + chronic pain","urun":"Oral CBD","urun_turu":"saf_cbd","doz":"400–1200 mg","titrasyon":"Fixed-dose arms","sure":"Single-dose sessions","sonuc":"Before methadone, descending pain inhibition increased with dose; after methadone, 1200 mg lowered the pain threshold (worsening); opioid craving did not change. A single-dose study using laboratory pain tests. In the registry (NCT04587791), the primary outcomes are safety, abuse potential and cognition, with pain measures secondary; the article presents pain modulation measures as the primary outcome. The manufacturer supplied the CBD and placebo; 1 of the 6 authors reported drug support and consulting fees from pharmaceutical companies","yan_etki":"Cognition preserved; safety reported as 'favorable'","pmid":"42162267","doi":"10.1038/s41386-026-02443-w","diger_kaynak":"ClinicalTrials.gov NCT04587791 (no results in the registry); the same group's open-label preliminary study: Costa 2026b (PMID 41496743; 7 people with chronic pain on methadone or buprenorphine, 400–1200 mg CBD; no significant main effect on pain sensitivity, an interaction with medication type; CBD well tolerated)"},{"ad":"Anelli 2026 (DREAMLAND)","tasarim":"Single-center, triple-blind, placebo-controlled parallel RCT; stopped at an interim analysis","n":"102 (51/51)","populasyon":"Women with endometriosis who had had surgery, were on hormone therapy and whose symptoms had returned (chronic pelvic pain)","urun":"CBD-rich extract oil (THC content not in the abstract)","urun_turu":"cbd_zengin_thc_belirsiz","doz":"From 10 mg/day to 150 mg/day by week 9, then tapered; twice a day","titrasyon":"Weekly increases: 10 mg/day (week 1) → 150 mg/day (week 9), then tapered off","sure":"10 weeks","sonuc":"A ≥50% reduction in pain in about 40% of both groups; pain at the end of treatment 41.6 mm with CBD, 36.8 mm with placebo (difference not significant); stopped at the interim analysis because of lack of effect and more side effects","yan_etki":"Mild side effects more common with CBD (gastrointestinal complaints, a sense of weight change); no serious adverse events","pmid":"42261989","doi":"10.1177/25785125251413989","diger_kaynak":null},{"ad":"Reeve 2026","tasarim":"Single-center, placebo-controlled RCT (2:1 randomization); in the registry only participants were blinded, according to the publication assessors were also blinded","n":"62 registered and randomized; 54 analyzed (35 CBD / 19 placebo)","populasyon":"Myofascial pain in the jaw joint area (US)","urun":"Sublingual CBD oil (20 mg/mL); placebo hemp seed oil","urun_turu":"cbd_zengin_thc_belirsiz","doz":"20 mg/day (1 mL sublingual)","titrasyon":null,"sure":"3 months","sonuc":"Jaw pain did not differ between groups at months 1, 2 and 3 (p>0.56); jaw function improved in both groups. 8 of 62 people were not included in the analysis (5 did not return for follow-up, 3 were excluded because of a diagnostic error). The dose was low (the authors also note this); the product and funding were provided by a CBD oil manufacturer","yan_etki":"Mild side effects in 4/38 with CBD (10.5%; most common headache), 4/19 with placebo (21%)","pmid":"42016900","doi":"10.1159/000551040","diger_kaynak":"ClinicalTrials.gov NCT04298554 (59 people and participant-only blinding in the registry; the registered primary outcome was change in pain from baseline at weeks 3, 7 and 11, the published primary outcome was pain at month 1; no difference under either definition; no results in the registry); PMC13095194; the same study is also in the site's jaw joint and teeth clenching table"},{"ad":"Manini 2015","tasarim":"Crossover, double-blind, placebo-controlled","n":"17 (CBD 400 mg: 6, 800 mg: 6, placebo: 5)","populasyon":"Opioid-experienced healthy volunteers","urun":"Oral CBD + IV fentanyl","urun_turu":"saf_cbd","doz":"400–800 mg","titrasyon":null,"sure":"Single dose","sonuc":"CBD did not increase the side effects of fentanyl","yan_etki":"No respiratory depression or cardiovascular complications","pmid":"25748562","doi":"10.1097/ADM.0000000000000118","diger_kaynak":null},{"ad":"Karst 2025 (VER-01, placebo-controlled)","tasarim":"Phase 3, double-blind, placebo-controlled RCT","n":"820","populasyon":"Chronic low back pain","urun":"Full-spectrum C. sativa extract, oral; 2.5 mg THC, 0.1 mg CBG, 0.02 mg CBD per dose unit","urun_turu":"thc_iceren","doz":"Individualized; at most 13 dose units/day (2.5 mg THC per unit)","titrasyon":"Increased by one unit morning and evening every 3 days","sure":"12 weeks (+ extension)","sonuc":"In the 12-week double-blind period, pain fell by 1.9 points with VER-01; difference versus placebo −0.6 NRS (95% CI −0.9 to −0.3; p < 0.001). The difference was larger in those with a neuropathic component (−1.5). In the open-label extension, pain fell further (−2.9; no control group); in the randomized withdrawal period, the primary outcome (time to treatment failure) was not significant (HR 0.75; 95% CI 0.44–1.27). The study was funded by the product's manufacturer (Vertanical), which took part in its design; 2 of the 6 authors received consulting fees from the company or research support to their institution, and 1 worked at the firm the company hired for statistics","yan_etki":"Adverse events 83.3% versus 67.3%; discontinuation due to side effects 17.3% versus 3.5% (most common dizziness, drowsiness, nausea); no signs of dependence or withdrawal","pmid":"41023483","doi":"10.1038/s41591-025-03977-0","diger_kaynak":"ClinicalTrials.gov NCT04940741 (no results in the registry); the RCT comparing the same product with opioids is a separate row in the table (Meissner 2025)"},{"ad":"Moore 2024 (J Pain)","tasarim":"Systematic review (pure CBD pain RCTs after IASP)","n":"16 studies","populasyon":"Various types of pain","urun":"Pharmaceutical-grade CBD","urun_turu":"saf_cbd","doz":"6–1600 mg","titrasyon":null,"sure":null,"sonuc":"No superiority over placebo in 15 of 16 studies; product content and purity problematic; signal of liver toxicity","yan_etki":null,"pmid":"37863344","doi":"10.1016/j.jpain.2023.10.009","diger_kaynak":null},{"ad":"Fisher 2021 (IASP systematic review)","tasarim":"Systematic review (RCTs; IASP task force; GRADE)","n":"36 RCTs, 7217 people","populasyon":"All types of pain","urun":"Cannabinoids, cannabis, cannabis-based medicines","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"Benefit signal only with short-term cannabis and with nabiximols for >7 days (very low quality); 81% of subgroups negative; no pure CBD RCT; the evidence neither supports nor refutes efficacy","yan_etki":null,"pmid":"32804836","doi":"10.1097/j.pain.0000000000001929","diger_kaynak":null},{"ad":"Wang 2021","tasarim":"Systematic review and meta-analysis (32 RCTs)","n":"5174","populasyon":"Chronic non-cancer and cancer pain","urun":"Oral/topical cannabinoids","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"Pain −0.50 cm VAS (moderate certainty): small effect","yan_etki":"Increased risk of dizziness, drowsiness and nausea","pmid":"34497047","doi":"10.1136/bmj.n1034","diger_kaynak":null},{"ad":"Busse 2021 (BMJ Rapid Recommendation)","tasarim":"Clinical practice guideline","n":null,"populasyon":"Chronic pain","urun":"Oral cannabinoids","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"Weak recommendation for a trial of oral cannabinoids if standard treatment is inadequate; shared decision-making required","yan_etki":null,"pmid":"34497062","doi":"10.1136/bmj.n2040","diger_kaynak":null},{"ad":"Nielsen 2022","tasarim":"Systematic review and meta-analysis (preclinical + clinical)","n":null,"populasyon":"Opioid reduction","urun":"Cannabinoids","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"No opioid-reducing effect was shown in RCTs (opioid dose difference in 4 RCTs in cancer pain −3.8 mg; 95% CI −10.97 to 3.37); opioid reduction was reported only in observational studies (prone to bias; pooled proportion reporting a lower dose 85%, stopping 39%). In 5 laboratory studies in healthy volunteers, adding a cannabinoid increased pain in two, reduced it in two, and in one reduced only the unpleasantness of pain; in three, it could increase the abuse potential of the opioid. In animals, the morphine dose needed for the same painkilling effect was 3.5 times lower with THC","yan_etki":null,"pmid":"35459926","doi":"10.1038/s41386-022-01322-4","diger_kaynak":null},{"ad":"Moore 2024 (Pain)","tasarim":"Publication bias analysis","n":null,"populasyon":"Cannabinoid–pain publications","urun":null,"urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"Moderate–severe narrative bias ('spin') in 24% of RCTs and 17% of reviews; the bias always favored the product","yan_etki":null,"pmid":"38227560","doi":"10.1097/j.pain.0000000000003140","diger_kaynak":null},{"ad":"IASP 2021 position statement","tasarim":"Task force position statement","n":null,"populasyon":"Pain","urun":"Cannabinoids","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"Does not support the general use of cannabinoids for pain; calls for more research, product standards and regulation","yan_etki":null,"pmid":"33729207","doi":"10.1097/j.pain.0000000000002265","diger_kaynak":"https://www.iasp-pain.org/advocacy/iasp-statements/iasp-position-statement-on-the-use-of-cannabinoids-to-treat-pain/"},{"ad":"Notcutt 2004","tasarim":"Open-label run-in period followed by randomized, double-blind, placebo-controlled crossover 'N-of-1' (single-patient) trials","n":"34 patients (each patient their own control)","populasyon":"Patients with chronic pain, mostly neuropathic","urun":"Three cannabis extracts sprayed under the tongue: THC, CBD and 1:1 THC:CBD","urun_turu":"thc_iceren","doz":"Adjusted for each patient; dose requirements varied widely (figures not in the abstract)","titrasyon":"During the open-label period, each patient found their own dose","sure":"12 weeks","sonuc":"Extracts containing THC reduced symptoms the most; the CBD-only extract lagged behind them (no numerical comparison in the abstract). Because these were single-patient trials, results were assessed patient by patient rather than between groups; a small, old, early-experience study","yan_etki":"Side effects were common; according to the authors, similar to those of other psychoactive medicines used for pain and generally acceptable","pmid":"15096238","doi":"10.1111/j.1365-2044.2004.03674.x","diger_kaynak":null},{"ad":"Pinsger 2006","tasarim":"Double-blind, placebo-controlled crossover pilot RCT (2 × 4-week drug periods) followed by a 16-week period in which patients chose their own medicine","n":"30 (all analyzed)","populasyon":"Treatment-resistant chronic pain related to the musculoskeletal system (mostly spinal pain)","urun":"Nabilone capsules (a synthetic THC-like cannabinoid), added to standard treatment","urun_turu":"cbn_diger","doz":"0.25–1 mg/day (1–4 capsules a day)","titrasyon":"Patients adjusted the dose themselves between 1 and 4 capsules a day","sure":"14-week crossover period + 16-week choice period","sonuc":"During nabilone periods, current spinal pain fell by 0.6 points on the VAS, with no change on placebo (0.0; medians; p = 0.006); there is also a difference in favor of nabilone in mean spinal pain over the last 4 weeks (0.9 versus 0.5) and in headache (1.0 versus 0.2), but the abstract gives no p value for these two. In the choice period, patients used nabilone on 89% of days and placebo on 11% (p = 0.003). Small pilot study; only the English abstract of the German-language article was read","yan_etki":"Not reported (in the abstract)","pmid":"16855921","doi":"10.1007/s00508-006-0611-4","diger_kaynak":null},{"ad":"Narang 2008","tasarim":"Two phases: phase 1 randomized, double-blind, placebo-controlled, single-dose crossover RCT (3 visits × 8 hours); phase 2 open-label extension with dose adjustment","n":"30","populasyon":"Patients with chronic non-cancer pain whose pain persisted despite a stable dose of opioids (US)","urun":"Dronabinol capsules (synthetic THC), added to opioids","urun_turu":"thc_iceren","doz":"Phase 1: 10 mg or 20 mg single dose; phase 2: adjusted dose","titrasyon":"Open-label dose adjustment in phase 2","sure":"Single-dose sessions + open-label extension (duration not in the abstract)","sonuc":"As a single dose, dronabinol reduced pain intensity and increased satisfaction compared with placebo; no difference between 10 and 20 mg. In the open-label extension, pain fell from baseline (no control group). The opioid dose was not changed in this study: the study examined the added painkilling effect on top of opioids, not opioid reduction. In the second publication from the same trial, a single dose of dronabinol produced mind-altering effects at a level similar to smoked marijuana. According to the registry, the drug's manufacturer at the time (Solvay) supported the study","yan_etki":"Side effects increased with dose","pmid":"18088560","doi":"10.1016/j.jpain.2007.10.018","diger_kaynak":"ClinicalTrials.gov NCT00153192 (no results in the registry); second publication from the same trial Issa 2014 (PMID 24281276; 10 and 20 mg dronabinol increased mind-altering effects more than placebo on 4 of 5 subscales, with peak effects similar to smoked marijuana)"},{"ad":"de Vries 2016","tasarim":"Randomized, double-blind, double-dummy, active placebo-controlled, single-dose crossover RCT","n":"24","populasyon":"Chronic abdominal pain due to chronic pancreatitis (Netherlands; later divided into subgroups of opioid users and non-users)","urun":"Oral purified THC tablet; comparison diazepam (active placebo)","urun_turu":"thc_iceren","doz":"8 mg THC single dose (diazepam 5 or 10 mg)","titrasyon":null,"sure":"Single dose (2 sessions)","sonuc":"A single dose of THC did not reduce pain differently from diazepam (no difference in VAS change). With THC, feelings of anxiety and heart rate increased compared with diazepam; no difference in alertness, mood and balance","yan_etki":"Most common were drowsiness, dry mouth, dizziness and euphoric mood; all mild or moderate","pmid":"26505163","doi":"10.1111/bcp.12811","diger_kaynak":"ClinicalTrials.gov NCT01318369 (no results in the registry)"},{"ad":"de Vries 2017","tasarim":"Phase 2, randomized, double-blind, placebo-controlled parallel RCT","n":"65 randomized","populasyon":"Chronic abdominal pain lasting at least 3 months, after surgery or due to chronic pancreatitis (Netherlands)","urun":"Oral purified THC tablets, added to current pain medicines","urun_turu":"thc_iceren","doz":"3 × 3 mg for 5 days, 3 × 5 mg for 5 days, then 3 × 8 mg (24 mg/day)","titrasyon":"From 3 × 3 mg to 3 × 8 mg over 10 days","sure":"50–52 days","sonuc":"No difference between groups in the primary outcome (mean diary VAS pain, days 50–52) (p = 0.901): pain fell by 1.6 points (40%) with THC and 1.9 points (37%) with placebo; no difference in secondary outcomes (pain, quality of life) either","yan_etki":"Discontinuation due to side effects in 7 patients on THC and 2 on placebo; all possibly drug-related side effects were mild or moderate","pmid":"27720917","doi":"10.1016/j.cgh.2016.09.147","diger_kaynak":"ClinicalTrials.gov NCT01562483 and NCT01551511"},{"ad":"Abrams 2020","tasarim":"Pilot, randomized, double-blind, placebo-controlled crossover RCT (inpatient, 2 × 5 days)","n":"27 randomized; 23 completed and were analyzed","populasyon":"Adults with sickle cell disease and chronic pain taking stable pain medicines (mostly opioids) (US)","urun":"Vaporized inhaled cannabis (4.4% THC, 4.9% CBD); placebo cannabis","urun_turu":"thc_iceren","doz":"3 times a day (the contents of one cannabis cigarette, vaporized)","titrasyon":null,"sure":"2 × 5 days","sonuc":"The difference in pain (VAS, 0–100) ranged from −5.3 to −16.5 points across days in favor of cannabis, but was not significant on any day; no difference in pain interference with daily activities, walking, sleep and enjoyment of life; improvement only in pain interference with mood (p = 0.02). Opioid use was similar in the two periods. Publicly funded (NIH); one of the 9 authors (the first author) reported receiving fees from cannabis companies outside the study","yan_etki":"No difference between groups in treatment-related side effects","pmid":"32678452","doi":"10.1001/jamanetworkopen.2020.10874","diger_kaynak":"ClinicalTrials.gov NCT01771731 (results in the registry)"},{"ad":"Kliuk-Ben Bassat 2023","tasarim":"Randomized, double-blind, three-arm crossover feasibility RCT (primary outcome safety)","n":"15 randomized; periods analyzed: whole-plant extract 7, purified product 5, placebo 9","populasyon":"Patients on hemodialysis with chronic pain (Israel; 87% men, mean age 64)","urun":"Sublingual oil, THC:CBD 1:6 (24.5 mg THC, 147 mg CBD per mL); two forms, whole-plant extract or purified; product and funding from a pharmaceutical company (BOL Pharma)","urun_turu":"thc_iceren","doz":"3 drops = 2.5 mg THC + 15 mg CBD; started at 3 drops once a day and raised to at most 3 × 6 drops a day (15 mg THC + 90 mg CBD/day)","titrasyon":"To 3 × 3 drops a day in the first week, and if there were no side effects, to at most 3 × 6 drops; because of tolerability problems the protocol was changed to a slower start","sure":"8 weeks per period (2 weeks apart)","sonuc":"Safety study; the authors write that they did not compare efficacy statistically between groups (few people and a feasibility design). Worst pain (BPI, 1–10) fell by 3.3 points with the whole-plant extract and 1.3 points with placebo, and rose by 0.3 with the purified product; average pain −1.9, −0.9 and +0.6. Liver enzymes did not change. The study was funded by the product's manufacturer; 4 of the 10 authors are current or former employees of the company","yan_etki":"Side effects in 8 of 9 people with the whole-plant extract, all 6 people with the purified product, and 8 of 10 people with placebo; most common were drowsiness and dizziness. Serious adverse event considered drug-related by the investigator: hallucinations and rapid heart rate after an accidental overdose with the whole-plant extract. With the purified product, the drug was stopped in one patient because of a marked drop in blood pressure considered drug-related, and the dose-increase schedule was slowed; one patient died of sepsis during dose adjustment (unrelated to the drug according to the investigator)","pmid":"37007688","doi":"10.1093/ckj/sfac275","diger_kaynak":null},{"ad":"Gilman 2022","tasarim":"Pragmatic RCT (getting a medical cannabis card immediately or after 12 weeks; 2:1 randomization; participants not blinded, only assessors blinded)","n":"269 randomized (173 immediate, 96 delayed); 186 analyzed (105 immediate, 81 delayed): 53 who did not get the card, 15 found to have cannabis use disorder at baseline and 15 who did not attend follow-up were not included in the analysis; pain analysis in 61 people who sought care for pain (37/24)","populasyon":"Adults aged 18–65 seeking medical cannabis for pain, insomnia, or symptoms of anxiety or depression; daily cannabis users and people with cannabis use disorder were not enrolled (US, Boston)","urun":"Cannabis products chosen by participants themselves from a dispensary (THC and/or CBD)","urun_turu":"karma","doz":"Participant's choice (product, dose and frequency unrestricted)","titrasyon":"Participant's choice","sure":"12 weeks","sonuc":"Among those seeking care for pain, no difference between groups in pain severity (BPI, 0–10) (mean difference 0; 95% CI −0.8 to 0.9; p = 0.93); baseline pain was low (2.8 and 3.9). No difference in anxiety and depression either; only the insomnia score improved. Symptoms of cannabis use disorder increased in those who got the card (0.28; 95% CI 0.15–0.40)","yan_etki":"At 12 weeks, cannabis use disorder in 17.1% of those who got the card immediately and 8.6% of those who waited (adjusted OR 2.88; 95% CI 1.17–7.07)","pmid":"35302633","doi":"10.1001/jamanetworkopen.2022.2106","diger_kaynak":"ClinicalTrials.gov NCT03224468 (results in the registry); daily survey analysis of the same trial: Tervo-Clemmens 2023 (PMID 36638745; 181 people, 12 weeks; cannabis use frequency rose in those who got the card, reported sleep quality was better on days of use; no improvement in pain or depressive symptoms)"},{"ad":"Meissner 2025 (VER-01, comparison with opioids)","tasarim":"Phase 3, multicenter, randomized, open-label (not blinded) parallel RCT; comparison: opioid","n":"384 randomized (192/192); 140 and 126 completed treatment","populasyon":"Chronic nonspecific low back pain without adequate benefit from non-opioid painkillers (mean age 55)","urun":"VER-01: oral full-spectrum Cannabis sativa extract (THC-dominant; dose unit 2.5 mg THC); comparison: a marketed opioid chosen by the physician (mostly tramadol, tapentadol, tilidine)","urun_turu":"thc_iceren","doz":"VER-01 an average of ~7.5 dose units a day (about 19 mg THC); opioid group an average of 27–32 mg morphine equivalent/day","titrasyon":"3-week dose adjustment","sure":"3 weeks of dose adjustment + 24 weeks of treatment","sonuc":"Primary outcome constipation: with VER-01, the risk of constipation was a quarter of that with opioids (RR 0.25; 95% CI 0.09–0.69); laxative use 5.8% versus 17.2%. Superiority for pain was not shown: the first pain outcome tested in the pre-specified order (proportion with at least a 30% reduction in pain at week 27) was not significant; so the subsequent pain analyses are exploratory only. In these analyses, averaged over 6 months, pain fell by 2.50 points with VER-01 and 2.16 points with opioids (difference 0.34; 95% CI 0.00–0.67; p = 0.048): a borderline and small difference (the authors present this as 'superiority' in the abstract). There was no blinding, most people in the opioid group took a weak opioid at a low dose, and discontinuation was higher in the opioid group. The study was run and funded by the product's manufacturer (Vertanical); 3 of the 5 authors received consulting fees from the company or research support to their institution, and 1 worked at the firm the company hired for statistics","yan_etki":"Side effects 73.0% versus 73.7%; most common with VER-01 were dizziness (22%), vertigo (15%) and dry mouth (11%), and with opioids constipation (23%) and nausea (13%); discontinuation due to side effects 12.7% versus 13.4%; no withdrawal symptoms were seen when VER-01 was stopped abruptly","pmid":"41028525","doi":"10.1007/s40122-025-00773-z","diger_kaynak":"ClinicalTrials.gov NCT05610813; EudraCT 2022-001358-41"},{"ad":"NCT04527003 (endometriosis, registry results)","tasarim":"Randomized, double-blind, placebo-controlled three-arm pilot RCT; ended early because patients could not be recruited; no peer-reviewed publication","n":"12 enrolled; 10 randomized (4 placebo, 3 low dose, 3 high dose); primary analysis 7 people (4/2/1)","populasyon":"Women with pain due to endometriosis; everyone also took norethindrone acetate (a progestin medicine) (US, Penn State Hershey)","urun":"Sublingual CBD extract (product source and THC content not stated in the registry); placebo","urun_turu":"cbd_zengin_thc_belirsiz","doz":"10 mg/day or 20 mg/day","titrasyon":null,"sure":"8 weeks","sonuc":"Primary outcome (area under the curve of daily pain over 8 weeks): placebo 2254, low-dose CBD 2211, high-dose CBD 1042 (only 1 person); no statistical comparison in the registry. Because the groups are very small, no conclusion can be drawn","yan_etki":"No serious adverse events; other side effects in 3 of 4 people on placebo, 2 of 3 on the low dose, and no one on the high dose","pmid":null,"doi":null,"diger_kaynak":"ClinicalTrials.gov NCT04527003 (results posted to the registry on April 4, 2025; no publication found in the October 2026 search)"},{"ad":"Chesterman 2025","tasarim":"Three-arm, randomized, placebo-controlled feasibility RCT","n":"12 randomized (target 63); 4 completed, 7 withdrew, 1 lost to follow-up","populasyon":"People with endometriosis (Australia)","urun":"1) Vaporized inhaled dried flower with 16% THC + oral CBD oil (100 mg CBD per mL); 2) oral CBD oil alone; 3) placebo oil matched for taste and color","urun_turu":"thc_iceren","doz":"Not reported (in the abstract)","titrasyon":null,"sure":"Not reported (in the abstract)","sonuc":"Feasibility was not achieved: only 12 of the targeted 63 people could be enrolled, and 4 finished the study; efficacy could not be assessed. According to the authors, the main reasons for failure were the requirement not to drive and the high withdrawal rate. Funded by a state government; an employee of the company that donated the study products (ANTG) and the manager of the pharmacy that dispensed the product are among the authors (2 of 17 authors), and one author received consulting fees from the same company in 2019–2022","yan_etki":"10 side effects (8 possibly related to cannabis) and 2 serious adverse events (both unrelated to treatment)","pmid":"41005282","doi":"10.1016/j.ctcp.2025.102023","diger_kaynak":null},{"ad":"NCT04760613 (CBD in opioid users, registry results)","tasarim":"Phase 1/2, randomized, double-blind, placebo-controlled pilot RCT; no peer-reviewed publication","n":"14 enrolled; 6 started and finished (5 CBD, 1 placebo)","populasyon":"Patients with chronic spine-related radicular pain (radiculopathy) taking a stable dose of opioids for at least 1 month, without opioid use disorder (US, New York University)","urun":"Oral CBD capsules (50 mg CBD per capsule; product source not stated in the registry); placebo","urun_turu":"saf_cbd","doz":"600 mg/day","titrasyon":null,"sure":"2 weeks","sonuc":"Primary outcome (change in blood opioid level): mean +10.9 ng/mL (SD 14.4) in the CBD group, −11.4 in the single placebo patient; pain (BPI) fell by 1.5 points in the CBD group, and the placebo patient did not complete the questionnaire. Because the groups had 5 and 1 people, no comparison can be made; these data cannot tell whether CBD changed opioid levels or pain. Supported by NIDA","yan_etki":"Drowsiness, nausea, diarrhea and headache in 2 each of the 5 people taking CBD; the only serious adverse event was in the placebo patient (kidney stone)","pmid":null,"doi":null,"diger_kaynak":"ClinicalTrials.gov NCT04760613 (results posted to the registry on September 19, 2024; no publication found in the October 2026 search)"},{"ad":"NCT04827992 (cannabis in opioid users, registry results)","tasarim":"Pragmatic, randomized, waitlist-controlled parallel study (only outcome assessors blinded); both groups attended a weekly opioid tapering support group for 24 weeks; no peer-reviewed publication","n":"87 randomized (42 cannabis, 45 waitlist); pain analysis 78 people (41/37)","populasyon":"Adults with non-cancer chronic pain taking prescription opioids at a stable dose of at least 25 mg morphine equivalent a day who wanted to reduce their pain or opioid dose with cannabis (US, three academic centers)","urun":"Cannabis products chosen by participants themselves from commercial dispensaries (product type, dose and frequency unrestricted); comparison: waitlist group that agreed not to use cannabis for 24 weeks","urun_turu":"karma","doz":"Participant's choice (no dose information in the registry)","titrasyon":"Participant's choice","sure":"24 weeks","sonuc":"No difference in either primary outcome: at week 24, opioid dose verified through the prescription monitoring system was 113.3 mg morphine equivalent/day in the cannabis group and 97.9 in the waitlist group (difference 15.4; 95% CI −24.4 to 55.3; p = 0.45); pain and its interference with daily life (PEG, 0–10) 5.35 versus 5.30 (difference 0.05; 95% CI −0.46 to 0.57; p = 0.85). No difference in self-reported opioid dose either (−5.6; 95% CI −29.0 to 17.9). The anxiety score was somewhat higher in the cannabis group (difference 3.2; p = 0.047). Participants were not blinded and products were unrestricted; results only in the ClinicalTrials.gov registry (no peer-reviewed publication found in the October 2026 search). Supported by NIDA","yan_etki":"More cannabis use disorder symptoms in the cannabis group (0.54 versus 0.03; difference 0.51; 95% CI 0.30–0.72; p < 0.001); serious adverse events in 7 of 42 and 5 of 45 people (one in the cannabis group was opioid withdrawal); anxiety symptoms as a side effect in 12 versus 4 people","pmid":null,"doi":null,"diger_kaynak":"ClinicalTrials.gov NCT04827992 (results posted to the registry on June 24, 2026); protocol: Jashinski 2022 (PMID 35680252)"},{"ad":"Abrams 2011","tasarim":"Open-label clinical study without a control group (inpatient, 5 days; drug interaction)","n":"21","populasyon":"Patients with chronic pain taking long-acting morphine or oxycodone twice a day (US)","urun":"Vaporized inhaled cannabis (THC content not in the abstract)","urun_turu":"thc_iceren","doz":"Evening of day 1, 3 times a day on days 2–4, morning of day 5","titrasyon":null,"sure":"5 days","sonuc":"Total blood levels of morphine and oxycodone did not change significantly with cannabis (registry: geometric mean ratio morphine 0.95, oxycodone 0.94); the peak morphine level fell slightly (0.90). Pain fell by an average of 27% (95% CI 9–46); because there was no control group and no blinding, it is not known how much of this reduction came from cannabis. The opioid dose was not reduced in the study","yan_etki":"No side effects reported in the registry (24 participants)","pmid":"22048225","doi":"10.1038/clpt.2011.188","diger_kaynak":"ClinicalTrials.gov NCT00308555 (results in the registry)"},{"ad":"Chou 2026 (AHRQ living review update)","tasarim":"Systematic review and meta-analysis (placebo-controlled RCTs only; products grouped by THC:CBD ratio; search up to July 28, 2025; PROSPERO CRD42021229579)","n":"25 short-term (1–6 months) RCTs, 2303 people (64% neuropathic pain)","populasyon":"Adults with chronic pain (mostly neuropathic pain)","urun":"Cannabis-based products (THC-dominant, balanced THC:CBD, CBD-dominant; synthetic, purified or extract)","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"Oral synthetic or purified THC may reduce pain slightly (−0.78/10), and a balanced THC:CBD oral spray probably reduces it slightly (−0.54/10). Among THC products, nabilone reduced pain moderately (−1.59), while dronabinol did not (−0.23). CBD-dominant (low THC:CBD ratio) products may not improve outcomes; CBD alone may not increase side effects. No long-term outcomes. Funded by the US Agency for Healthcare Research and Quality (AHRQ). The 2025 report of the same living review found the evidence insufficient for the effect of cannabis on opioid use","yan_etki":"Moderate or large increase in dizziness, drowsiness and nausea with THC products","pmid":"41429020","doi":"10.7326/ANNALS-25-03152","diger_kaynak":"AHRQ 2025 report (PMID 40956916; search April 28, 2025; 29 RCTs and 15 observational studies; oral pure CBD did not reduce pain: 4 RCTs, 334 people, difference 0.40, 95% CI −0.14 to 1.00, moderate certainty; evidence insufficient for its effect on opioid use); first publication McDonagh 2022 (PMID 35667066)"},{"ad":"Stockings 2018","tasarim":"Systematic review and meta-analysis (controlled and observational studies; search July 2017)","n":"104 studies (47 RCTs, 57 observational), 9958 people","populasyon":"Non-cancer chronic pain (48 neuropathic, 7 fibromyalgia, 13 MS, 6 visceral pain, 29 mixed or undefined)","urun":"Cannabis and cannabinoids (various product types)","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"In RCTs, at least a 30% reduction in pain occurred in 29.0% with cannabinoids and 25.9% with placebo; 24 people need to be treated for one person to benefit at this level (95% CI 15–61). No difference for a 50% reduction. The difference in pain intensity was about 3 mm on a 100 mm scale (SMD −0.14). No difference in physical and emotional functioning. The authors write that cannabinoids seem unlikely to be highly effective medicines for non-cancer chronic pain","yan_etki":"Any side effect 81.2% versus 66.2%: 1 in every 6 people treated has an additional side effect","pmid":"29847469","doi":"10.1097/j.pain.0000000000001293","diger_kaynak":null},{"ad":"Jeddi 2024","tasarim":"Systematic review and network meta-analysis (RCTs only, at least 4 weeks of follow-up; GRADE; search up to March 2021; PROSPERO CRD42020185184)","n":"90 RCTs, 22,028 people (66 opioid–placebo, 23 cannabis product–placebo, 1 nabilone–dihydrocodeine comparison)","populasyon":"Adults with non-cancer chronic pain","urun":"Non-inhaled cannabis products (THC:CBD 11, THC 7, CBD 2, CBDV 1 and palmitoylethanolamide 2 studies) and opioids","urun_turu":"karma","doz":null,"titrasyon":null,"sure":"28–180 days","sonuc":"No difference or a very small difference in pain between cannabis products and opioids (0.23 cm on a 10 cm scale; 95% credible interval −0.06 to 0.53; low certainty); probably no difference in physical function (moderate certainty). Both reduced pain slightly compared with placebo (moderate certainty for opioids, low or moderate certainty for cannabis products). The comparisons were almost entirely indirect: there was only one study directly comparing a cannabis product with an opioid; the large comparative RCT in chronic low back pain (Meissner 2025) was published after this review. Publicly funded (Canada); the authors reported no conflicts of interest","yan_etki":"Discontinuation due to side effects less common with cannabis products than with opioids (OR 0.55; 95% credible interval 0.36–0.83; moderate certainty)","pmid":"38171632","doi":"10.1136/bmjopen-2022-068182","diger_kaynak":null},{"ad":"Noori 2021","tasarim":"Systematic review and meta-analysis (RCTs and observational studies; GRADE; part of the BMJ Rapid Recommendations series; PROSPERO CRD42018091098)","n":"5 RCTs (all in cancer pain) and 12 observational studies","populasyon":"Patients with chronic pain taking prescription opioids","urun":"Medical cannabis or cannabinoids added to opioids","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"In RCTs (all of which kept the opioid dose fixed), adding cannabis did not change opioid use (−3.4 mg morphine equivalent; 95% CI −12.7 to 5.8; very low certainty) and did not reduce pain (−0.18 cm/10 cm; high certainty). In 8 observational studies, opioid use fell (−22.5 mg; 95% CI −43.06 to −1.97), but the evidence is very low certainty. The authors write that the opioid-sparing effect is uncertain. Because all the RCTs were done in cancer pain, there was no RCT examining opioid reduction in non-cancer pain","yan_etki":"Adding cannabis probably increased nausea (RR 1.43; 95% CI 1.04–1.96) and vomiting (RR 1.5; 1.01–2.24); no difference in constipation","pmid":"34321302","doi":"10.1136/bmjopen-2020-047717","diger_kaynak":null},{"ad":"Zeraatkar 2022","tasarim":"Systematic review and meta-analysis of observational studies (GRADE; part of the BMJ Rapid Recommendations series)","n":"39 studies, 12,143 adults","populasyon":"Patients with chronic pain using medical cannabis or cannabinoids, followed for at least 4 weeks","urun":"Medical cannabis and cannabinoids (including palmitoylethanolamide studies)","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"Side effects are common with long-term use: in 26% of users (95% CI 13.2–41.2), with psychiatric side effects in 13.5%. Serious adverse events, side effects leading to discontinuation, cognitive side effects, accidents and injuries, and dependence and withdrawal each occurred in fewer than 1 in 20 people. Side effects were reported more often with longer follow-up. The evidence is very low certainty; comparative harm data against other treatments such as opioids are insufficient","yan_etki":"Any side effect 26%; psychiatric 13.5%; serious side effects each below 5%","pmid":"35926992","doi":"10.1136/bmjopen-2021-054282","diger_kaynak":null},{"ad":"Bialas 2022","tasarim":"Systematic review and meta-analysis of prospective observational studies (at least 26 weeks); search up to December 2021","n":"6 studies, 2686 people","populasyon":"Non-cancer chronic pain (nociceptive, nociplastic, neuropathic and mixed)","urun":"Cannabis-based medicines","urun_turu":"karma","doz":null,"titrasyon":null,"sure":"26–52 weeks","sonuc":"With long-term use, pain fell from baseline by an average of 1.75 points (0–10; 95% CI 0.72–2.78); 20.8% of patients reported at least 50% relief. The evidence was very low certainty for all outcomes (no control group). Only 53% of patients completed the study. The authors write that observational data should be interpreted with caution and that their pre-specified 'large effect' criterion was not met","yan_etki":"Discontinuation due to side effects 6.8%; serious adverse events 3.0%; deaths 0.3%","pmid":"35467781","doi":"10.1002/ejp.1957","diger_kaynak":null},{"ad":"Fink 2026","tasarim":"Systematic review (state-level policy studies; PROSPERO CRD42023416119; search up to October 21, 2025)","n":"43 studies","populasyon":"US states: medical and recreational cannabis laws and opioid outcomes","urun":"Cannabis legalization (a policy, not a product)","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"The effect of cannabis laws on opioid prescriptions varies from study to study; no study found a decrease in non-prescribed opioid use or opioid use disorder after medical cannabis laws. An association between medical cannabis laws and lower opioid death rates was seen only in older studies, not in newer ones. The authors write that legalization should not be considered an effective policy for reducing the opioid epidemic. Population-level data; does not show an opioid-reducing effect in individuals","yan_etki":null,"pmid":"42061001","doi":"10.1016/j.drugalcdep.2026.113167","diger_kaynak":null},{"ad":"NICE 2019 (NG144 guideline)","tasarim":"National clinical guideline (United Kingdom; systematic evidence review and cost-effectiveness model)","n":null,"populasyon":"Adults with chronic pain (the guideline also covers nausea, spasticity and epilepsy)","urun":"Cannabis-based medicinal products (nabilone, dronabinol, THC, THC + CBD, CBD)","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"Does not recommend nabilone, dronabinol, THC or the THC + CBD combination for chronic pain; recommends CBD only as part of a clinical trial. Rationale: the average benefit was small (about 0.4 points on a 0–10 scale), the evidence did not show that opioid use fell in people receiving medical cannabis, there was no evidence for CBD alone, and the small benefit did not justify the high cost. Recommends research on CBD in fibromyalgia and treatment-resistant neuropathic pain","yan_etki":null,"pmid":"31909928","doi":null,"diger_kaynak":"https://www.nice.org.uk/guidance/ng144 (published November 11, 2019, last updated March 22, 2021); chronic pain evidence review B (PMID 35107907)"},{"ad":"ACP 2025 (American College of Physicians recommendation)","tasarim":"Best practice advice (American College of Physicians Population Health and Medical Science Committee; based on a living systematic review of cannabis and cannabinoids in non-cancer chronic pain and on other reviews)","n":null,"populasyon":"Adults with non-cancer chronic pain","urun":"Cannabis and cannabinoids","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"Physicians should discuss benefits and harms with patients with non-cancer chronic pain who are considering or using cannabis or cannabinoids; explain to young adults and adolescents, to patients with a current or past substance use disorder, with serious mental illness, or who are frail or at risk of falls, that the harms most likely outweigh the benefits; advise not starting or stopping in pregnancy, breastfeeding or when planning a pregnancy; and advise against inhaled cannabis. There is no general 'use' or 'don't use' recommendation for everyone","yan_etki":null,"pmid":"40183677","doi":"10.7326/ANNALS-24-03319","diger_kaynak":null},{"ad":"Bell 2024 (Canadian guideline)","tasarim":"Clinical practice guideline (Canada; based on a systematic review, GRADE; PROSPERO 135886; search up to May 2019; uncontrolled and observational studies also included, studies of synthetic drugs such as nabilone and dronabinol excluded)","n":"70 publications (19 systematic reviews, 51 original studies); the chronic pain section rests on 47 studies (22 RCTs, 11 before-and-after or uncontrolled studies, 11 cross-sectional or observational cohorts, 3 case series)","populasyon":"People with chronic pain and related conditions (sleep, anxiety, depression, opioid use; pain in diseases such as MS, HIV, arthritis and fibromyalgia)","urun":"Cannabinoid-based medicines derived from the cannabis plant (THC, CBD and combinations of the two; including cannabis flower and a THC:CBD mouth spray)","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"The guideline summarizes the evidence as ‘most studies in chronic pain (38 of 47) report at least a moderate benefit’ and recommends cannabinoid-based medicines in chronic pain (including central and peripheral nerve pain) on their own, in place of another medicine or as an add-on treatment at the level of ‘strong recommendation, moderate-quality evidence’; it also gives a strong recommendation for adding them to opioids in people whose pain is not adequately controlled with opioids. The guideline itself also writes that the strongest evidence in chronic pain is for THC-containing products, not for CBD, and that most side effects are due to THC. This judgment rests on a review that also counts uncontrolled studies and whose search ended in 2019; it is clearly more favorable than meta-analyses pooling only placebo-controlled studies (Wang 2021, Chou 2026: small or very small benefit, low or moderate certainty) and other guidelines (BMJ 2021 weak recommendation, NICE 2019 does not recommend). The guideline was supported by the Canadian Institutes of Health Research, the Arthritis Society of Canada and a cannabis company (Canopy Growth); 7 of the 20 authors reported ties to cannabis companies (consulting, speaking, shares, research support, company partnership or product from a company for a study), and the employer of 2 received a grant for the guideline from the same company","yan_etki":"Main side effects listed by the guideline: dizziness, impaired attention, sleepiness, dry mouth, nausea, diarrhea (mostly not serious)","pmid":"36971587","doi":"10.1089/can.2021.0156","diger_kaynak":"Protocol: Wright 2020, PMID 32448797"},{"ad":"Ware 2015 (COMPASS)","tasarim":"Prospective, multicenter controlled cohort (control group: people with chronic pain who did not use cannabis)","n":"431 (215 cannabis, 216 control)","populasyon":"Non-cancer chronic pain (Canada, 7 clinics); most people in the cannabis group were already using or had previously used cannabis","urun":"Standardized herbal cannabis (12.5% THC)","urun_turu":"thc_iceren","doz":"Median 2.5 g/day","titrasyon":null,"sure":"1 year","sonuc":"The primary outcome was safety: the risk of serious adverse events did not differ between groups (adjusted rate ratio 1.08; 95% CI 0.57–2.04); non-serious adverse events were more common in the cannabis group (1.73; 1.41–2.13), most mild or moderate. No difference in lung function, cognitive function or blood tests. Not randomized; cannabis-experienced patients were enrolled","yan_etki":"Non-serious adverse events 73% more common; most mild or moderate","pmid":"26385201","doi":"10.1016/j.jpain.2015.07.014","diger_kaynak":"ISRCTN19449752"},{"ad":"Campbell 2018 (POINT)","tasarim":"Prospective national cohort (4 years, annual interviews)","n":"1514","populasyon":"People with non-cancer chronic pain prescribed opioids (Australia; recruited through pharmacies)","urun":"People's own cannabis use; not a medical cannabis program, but cannabis obtained through illegal channels (no product information)","urun_turu":"karma","doz":"Number of days used in the past month","titrasyon":null,"sure":"4 years","sonuc":"Over 4 years, 24% of participants used cannabis for pain. Cannabis users had greater pain severity (RR 1.14–1.17) and pain interference, lower confidence in coping with pain, and more anxiety. No temporal relationship was found between cannabis use and pain; there is no evidence that cannabis reduced opioid dose or increased opioid discontinuation. Observational; cannabis use was self-reported. Publicly funded","yan_etki":null,"pmid":"29976328","doi":"10.1016/S2468-2667(18)30110-5","diger_kaynak":null},{"ad":"Goedel 2022","tasarim":"Population-based, retrospective individual cohort (medical cannabis registry + prescription monitoring program; comparison with each person's own earlier period)","n":"5296 people with a medical cannabis license","populasyon":"Adults who obtained a medical cannabis license in Rhode Island (US)","urun":"Licensed medical cannabis (no product information)","urun_turu":"karma","doz":null,"titrasyon":null,"sure":"April 2016–March 2019","sonuc":"Obtaining a license did not change the likelihood of receiving any opioid prescription (OR 0.99; 95% CI 0.94–1.05), a prescription of 50 mg morphine equivalent and above (0.93; 0.84–1.04) or 90 mg and above (0.99; 0.86–1.15). The authors write that a medical cannabis license was not associated with stopping or reducing opioids. Publicly funded (NIH)","yan_etki":null,"pmid":"34695720","doi":"10.1016/j.drugpo.2021.103502","diger_kaynak":null},{"ad":"Nguyen 2023","tasarim":"Retrospective cohort (New York State prescription monitoring data; comparison of people receiving medical cannabis for more than 30 days versus 30 days or less)","n":"8165 (4041 longer, 4124 shorter duration)","populasyon":"Patients who started medical cannabis for chronic pain while on long-term opioid therapy (US, 2017–2019)","urun":"Medical cannabis products in the state program (product details not in the abstract)","urun_turu":"karma","doz":null,"titrasyon":null,"sure":"8 months after starting cannabis","sonuc":"Opioid dose fell more in those who received cannabis for longer; the difference in monthly reduction grew with baseline dose: below 50 mg morphine equivalent −1.52 (95% CI −1.67 to −1.37), at 50–90 mg −3.24 (−3.61 to −2.87), at 90 mg and above −9.33 (−9.89 to −8.77) mg/month. The comparison group also consisted of people who received cannabis for a short time; observational, pain was not measured. The authors reported no conflicts of interest","yan_etki":null,"pmid":"36716026","doi":"10.1001/jamanetworkopen.2022.54573","diger_kaynak":null},{"ad":"Slawek 2026","tasarim":"Prospective cohort (pharmacist-reported medical cannabis dispensing and state prescription monitoring data; marginal structural models)","n":"204","populasyon":"Adults prescribed opioids for chronic pain who received a new medical cannabis certification in New York (Bronx; mean age 57)","urun":"Medical cannabis products in the state program (varying THC and CBD ratios)","urun_turu":"karma","doz":null,"titrasyon":null,"sure":"18 months","sonuc":"Daily opioid dose fell on average from 73.3 to 57.4 mg morphine equivalent over 18 months; in months with 30 days of cannabis dispensed, 3.53 mg less opioid a day compared with months with none (95% CI −6.68 to −0.04; p = 0.03): a small difference. Non-prescribed cannabis use was taken into account; not randomized. Funded by NIDA; 1 of the 13 authors is a shareholder and former employee of a cannabis company (Vireo) outside the study","yan_etki":null,"pmid":"41359313","doi":"10.1001/jamainternmed.2025.6496","diger_kaynak":"ClinicalTrials.gov NCT04308148; the same team's discounted cannabis coupon RCT NCT04495725 (270 people, finished March 2024; result not published as of the October 2026 search)"},{"ad":"Fontaine 2026","tasarim":"Population-based cohort (Ontario health data; inverse probability weighted comparison)","n":"3427 with a cannabis prescription, 12,006 controls","populasyon":"Patients aged 66 and over with chronic pain who had not taken opioids in the past year (Canada, 2014–2019)","urun":"Authorized cannabis prescription (product information not in the abstract)","urun_turu":"karma","doz":null,"titrasyon":null,"sure":"1 year after the prescription","sonuc":"Starting opioid treatment of at least 90 days in the following year was more common among those who received a cannabis prescription (1.84 versus 1.19 per 100 person-years; adjusted RR 1.54; 95% CI 1.07–2.23); significant in men (1.82), not significant in women (1.35). Observational; people who start cannabis may be sicker","yan_etki":null,"pmid":"41267332","doi":"10.1080/10826084.2025.2586250","diger_kaynak":null},{"ad":"Vozoris 2024","tasarim":"Population-based retrospective cohort (Ontario health data; propensity score matching; comparison: new opioid starters)","n":"18,863 new nabilone starters and 18,863 matched new opioid starters","populasyon":"People aged 12 and over diagnosed with a musculoskeletal condition in the past 3 years (Ontario, Canada)","urun":"Nabilone capsules (a synthetic THC-like cannabinoid); comparison: opioids","urun_turu":"cbn_diger","doz":"Not reported (in the abstract)","titrasyon":null,"sure":"First 3 months after starting","sonuc":"Compared with opioid starters, nabilone starters had less pneumonia (HR 0.78; 95% CI 0.63–0.96), fewer falls or fractures (0.56; 0.50–0.64) and fewer deaths (0.79; 0.65–0.95), but more mental and behavioral disorders due to substance use (2.23; 1.45–3.43); no difference in traffic accidents. Observational; unmeasured confounders may have affected the results; pain and opioid dose were not measured. The authors warn against widely recommending nabilone in place of opioids because the results are mixed. Funded by the Ontario Ministry of Health; the authors reported no conflicts of interest","yan_etki":"Risk of mental and behavioral disorders due to substance use about 2-fold","pmid":"39141203","doi":"10.1007/s11606-024-08978-2","diger_kaynak":null},{"ad":"Erridge 2026 (UK Medical Cannabis Registry)","tasarim":"Prospective patient registry cohort (no comparison group; missing data filled in with multiple imputation)","n":"3744","populasyon":"Patients whose primary indication was chronic pain and who were prescribed cannabis-based products at a private clinic (United Kingdom)","urun":"Dried flower and/or oil (products containing THC and CBD)","urun_turu":"thc_iceren","doz":"Median daily THC 19 mg at baseline, 126.5 mg at month 24; CBD from 15 mg to 20.5 mg","titrasyon":null,"sure":"Up to 24 months","sonuc":"All measures improved from baseline (effect size for pain intensity d = 0.57); at month 24, more than half of patients reported a clinically meaningful reduction in pain. Among opioid users, 22.7% had a clinically meaningful reduction in opioid dose (at least 28%) (baseline average 33 mg morphine equivalent/day). However, at month 24 only 35% of patients had pain data, and results were calculated by statistically filling in the missing data; there is no comparison group. 11 of the 12 authors are linked to the company that runs the registry and prescribes the products (Curaleaf)","yan_etki":"14.4% of patients reported side effects; most mild or moderate","pmid":"42885647","doi":"10.1002/jcph.70313","diger_kaynak":"Earlier chronic pain analyses from the same registry: Harris 2022 (PMID 34937477; 190 patients), Tait 2023 (PMID 37021592; 761 patients), Datta 2025 (PMID 39545361; 1139 patients)"},{"ad":"Überall 2026 (CARE, German Pain e-Registry)","tasarim":"Retrospective, propensity score–matched two-cohort registry study (no placebo, not randomized)","n":"968 (484 CBD-dominant extract, 484 THC or dronabinol)","populasyon":"Patients aged 65 and over with chronic or treatment-resistant pain (Germany)","urun":"CBD-dominant full-spectrum extracts (CBD > THC) or pure THC/dronabinol; the CBD-dominant group also took 16–17 mg of THC a day on average (CBD:THC 2.1:1)","urun_turu":"thc_iceren","doz":"At week 24, an average of 33.5 mg CBD + 16.2 mg THC/day in the CBD-dominant group; 18.6 mg THC/day in the THC group","titrasyon":null,"sure":"24 weeks","sonuc":"Composite outcome (no discontinuation due to side effects and meaningful improvement in pain, function or sleep) 85.7% in the CBD-dominant group, 21.9% in the THC group (p < 0.001). This is not a CBD–placebo comparison: the CBD-dominant group also took around 16 mg of THC a day, and patients were not randomized to treatment. The analysis was funded by an unrestricted grant from a company that sells cannabis products (Stadapharm); 2 of the 4 authors reported receiving fees from this company, and the first author is a manager of the data company that runs the registry","yan_etki":"Patients with drug-related side effects 15.5% versus 35.7%; discontinuation due to side effects 5.6% versus 19.2%","pmid":"41821925","doi":"10.2147/JPR.S551457","diger_kaynak":"EU PAS EUPAS1000000490"},{"ad":"Capano 2020","tasarim":"Prospective, single-arm cohort (no control group)","n":"131 enrolled; 97 completed","populasyon":"Patients aged 30–65 with chronic pain who had been taking opioids for at least 1 year (a private pain clinic)","urun":"CBD-rich hemp extract (THC content not in the abstract)","urun_turu":"cbd_zengin_thc_belirsiz","doz":"Not reported (in the abstract)","titrasyon":null,"sure":"8 weeks","sonuc":"At 8 weeks, 53% of patients reported reducing or stopping their opioid dose; sleep (PSQI; p = 0.003) and pain interference (PEG; p = 0.006) improved, with no significant change in pain-related disability or mood. No control group and no blinding; the full text could not be read, and the product dose, funding and conflict-of-interest statement could not be verified","yan_etki":"Not reported (in the abstract)","pmid":"31711352","doi":"10.1080/00325481.2019.1685298","diger_kaynak":null},{"ad":"Khatib 2026","tasarim":"Single-center longitudinal observational study based on a registry database (no control group)","n":"1000 consecutive patients; 638 (63.8%) completed 10 years of follow-up","populasyon":"Patients with chronic low back pain who had not used cannabis before (Israel; orthopedic department of Rabin Medical Center)","urun":"Medical cannabis (product type and THC and CBD content not in the abstract)","urun_turu":"karma","doz":"Not reported (in the abstract)","titrasyon":null,"sure":"10 years (registry period in the abstract 2015–2024)","sonuc":"In those who completed follow-up, the daily opioid dose fell from 62.8 to 6.4 mg morphine equivalent (−89.8%), pain from 8.71 to 1.37 (0–10 scale; −84.2%) and the disability score (Oswestry) from 52.9% to 36.8% (all p < 0.001); 91.2% of patients for opioids and 96.6% for pain passed a predefined threshold of clinical importance; the use of tramadol/tapentadol, benzodiazepines and SSRIs also decreased. There was no comparison group and no blinding, more than a third of patients did not finish follow-up, and the numbers come from those who completed it; the authors themselves write that the effects are far larger than in placebo-controlled studies (e.g., a difference of 0.6 points), that observational biases play a part in this, and that the findings need to be confirmed by randomized studies. Because it is uncontrolled, it does not show cause and effect; very low certainty evidence. The authors reported no conflicts of interest; the full text could not be read","yan_etki":"Drug-related (tolerability-related) side effects at 11.4% of visits; serious psychiatric events at 0.02% of visits (abstract)","pmid":"42734834","doi":"10.1007/s00586-026-10290-y","diger_kaynak":"A smaller analysis from the same center: Robinson 2026 (PMID 42351683; 241 patients, inhaled cannabis, 5 years, retrospective)"}],"ilgili_ilaclar":["opioid","metadon","gabapentin","pregabalin","nsaii","parasetamol","tizanidin"],"son_inceleme":"2026-11-01","arastirma_gecmisi":[{"tarih":"2026-10-19","not":"Page published. This first review examined 12 studies."},{"tarih":"2026-10-21","not":"The full texts of the studies were reread and the information on the page was checked against its sources. Corrected: participant numbers, doses, products and dose-increase details in the study table. Points that could not be verified from the full text went down from 2 items to 1 item. The year of 2 publications named on the page was corrected to the journal's print year instead of the online publication year. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-21","not":"PubMed and ClinicalTrials.gov were searched for newly published and previously missed clinical studies. 2 studies added: Anelli 2026 (DREAMLAND) and Reeve 2026. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-22","not":"The names of the finding labels were simplified: on this page the \"No benefit seen\" label became \"No effect found.\" The assessment did not change."},{"tarih":"2026-10-28","not":"In October 2026, PubMed, Cochrane, ClinicalTrials.gov and Europe PMC were searched systematically; 33 studies were added: 13 randomized studies in non-cancer chronic pain (nabilone, dronabinol, purified THC, vaporized inhaled cannabis, THC:CBD oil, two pragmatic studies in which cannabis use was assigned by lottery, and an open-label study comparing a THC-dominant extract with opioids in chronic low back pain; including three studies with results only in the registry: CBD in endometriosis and in opioid users, and cannabis in opioid users), 7 systematic reviews (including the 2026 update from the US Agency for Healthcare Research and Quality and reviews on opioid reduction, long-term safety and comparisons of cannabis with opioids), the UK's national guideline (NICE), the American College of Physicians' (ACP) 2025 recommendation, and 11 observational or uncontrolled studies, including studies that measured opioid use through prescription records. In the topic text, the effect on chronic pain and lowering the opioid dose were described separately, a transparency sentence was added, and a reader-visible reference to an internal file was removed. In existing rows: the chronic low back pain study's withdrawal phase with a negative result and its company ties, the product type of two reviews ('mixed,' because they pooled more than one product), the number of people in one review, and the laboratory and observational findings of the opioid reduction review were added; the fibromyalgia study was aligned with its row on that topic. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-28","not":"October 2026 additional review: sources found for this page in the searches of other topics were read and worked into the page. The number of people in the medical cannabis card study (Gilman 2022) was corrected (269 people randomized, 186 analyzed), and the daily survey analysis of the same trial was added; for the CBD study in patients with chronic pain on methadone treatment (Costa 2026), it was noted that the primary outcomes in the registry differed from those in the article, that the manufacturer supplied the product, and the registry number was added. Two suggestions were reviewed and not added to the table: a study measuring the effect of THC on experimental pain in people on methadone treatment (participants were not selected for chronic pain), and a 2020 meta-analysis that overlaps with the more recent reviews in the table. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-30","not":"Two rows were added to the table. A clinical guideline prepared in Canada that gives cannabinoid-based medicines a strong recommendation in chronic pain (Bell 2024): the guideline itself writes that the strongest evidence is for THC-containing products, not for CBD; its search ends in 2019, it also counts studies without a control group, and a cannabis company supported its preparation; these points are written in the row. A series without a comparison group in which 1000 patients with chronic low back pain who started cannabis in Israel were followed for 10 years (Khatib 2026): in those who completed follow-up, pain and opioid dose fell sharply, but the authors themselves write that this effect is far larger than in placebo-controlled studies and that biases play a part in it. Both were added to show differing views and real-world data transparently; they do not change the finding of the placebo-controlled studies. A 2024 review on nabilone in chronic non-cancer pain by Canada's drug assessment agency (CADTH) was added to \"Trusted sources from around the world\". The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-30","not":"The last sentence of the page's short summary was rewritten in a calmer, more guiding tone: instead of \"Talk to your doctor before you start.\", it now says whom you can talk with, and about what, if you are considering CBD. The conclusion and the strength of evidence did not change."},{"tarih":"2026-11-01","not":"The Reeve 2026 row was corrected: the publication date is now the day of online publication (February 19, 2026); added were the study's ClinicalTrials.gov record (NCT04298554: participant blinding only, a differently defined primary outcome), the fact that 54 of 62 people were analyzed, and that the manufacturer provided the product and the funding (PMID 42016900, full text). The conclusion and the evidence level did not change."}]},{"id":"topical-cbd-cream","baslik":"Topical CBD (applied to the skin) and pain","grup":"Pain and surgery","grup_kodu":"agri","tr_id":"agri-topikal-cbd","kanit_duzeyi":"zayif","kanit_yonu":"celiskili","kanit_ozet":"A small crossover RCT in arthritis of the thumb base joint (n=18), an RCT in jaw joint muscle pain (n=60) and an RCT with an intraoral CBD gel in jaw muscle pain due to bruxism (n=60; 10% and 5% gels better than placebo for pain, no between-group difference in teeth-grinding severity) reported positive results. No benefit was seen after total knee replacement (n=80), in chemotherapy-induced neuropathy (n=40) or in muscle soreness after exercise (three small studies). In vestibulodynia, a CBD + myrcene gel (n=40) did not differ from placebo for pain; only pain during intercourse fell more, but the baseline score was higher in this group. Samples are small and product contents vary; the carrier oil's own effect, blinding and measurement of systemic absorption are inadequate. The two positive RCTs in jaw pain come from the same university department and their participants were mostly in their 20s; the first was registered retrospectively, and the number of participants and date in the second one's registration do not match the paper; in both studies, groups were assigned by choosing numbers. In recurrent canker sores, in a 69-person, three-arm (CBD, steroid, placebo) RCT with a 0.1% CBD paste applied to the ulcers, ulcers shrank faster than with placebo, but pain was lower than with placebo only on day 5. In a study with no control group (4% CBD gel in hand osteoarthritis, n=18), pain decreased from baseline. With THC-containing products: in diabetic neuropathy, a single-center RCT with a THC-dominant oil (n=100, 12 weeks) reported a large benefit (NPSI-T difference −17.3), but it has not been confirmed and the numbers in the paper are inconsistent; in an open-label study without placebo (n=21) comparing CBD and THC ointments in hand pain caused by aromatase inhibitors, both ointments were well tolerated, and the groups were not compared statistically. The evidence for THC-containing products is very weak. Systematic reviews: high risk of bias in topical CBD studies (2023); the AHRQ 2025 living review found the evidence for topical CBD and for the THC:CBD:CBN oil insufficient; a 2025 review of medicines applied through the skin or inside the mouth in jaw disorders saw a short-term benefit in two CBD studies but did not perform a pooled analysis. In healthy volunteers (n=46), CBD passed into the blood with three of five commercial products; there was no THC in the blood, but in 9 people the oral fluid test exceeded the THC threshold. October 2026 search (PubMed, Cochrane, ClinicalTrials.gov, Europe PMC): 13 randomized studies measuring pain with cannabinoid products applied to the skin or inside the mouth (12 placebo- or vehicle-controlled; 2 with a THC-containing product) and 3 systematic reviews were found; all of them are in the table below, along with 1 study with no control group and 1 study of absorption in healthy volunteers. Cochrane has no review specific to this topic. Not included in the table: hemp seed oil products (seed oil is not a CBD or THC product), a wound pain study in which CBD was also given by mouth, two small studies with no control group using products that contained camphor, methyl salicylate or other undisclosed substances alongside CBD (it cannot be separated whether the improvement came from CBD or the other substances), publications in which pain was not measured or that are at the level of case reports, and a knee gel study published only as a conference abstract; studies whose results are unpublished are listed under the unverifiable items.","kanit_duzeyi_metin":"Weak; conflicting (many small RCTs, results in both directions)","kanit_duzeyi_thc_icerenler":"cok_zayif","kanit_duzeyi_thc_icerenler_metin":"Very weak (a single placebo-controlled study with a THC-containing product rubbed on the skin: single-center, not confirmed by another study, some numbers in the paper inconsistent; plus a small feasibility study without placebo)","kaynak_dosya":"agri-ameliyat.md","saf_cbd_sonuc":"With topical CBD, the results conflict; the positive studies are small and single-center (the two positive RCTs in jaw pain come from the same research group), and the negative studies include knee replacement (80 people) and chemotherapy neuropathy (40 people). In mouth ulcers (canker sores, 69 people), a CBD paste sped up ulcer shrinkage, but pain was lower than with placebo on only one measurement day. A small study with no control group (hand osteoarthritis, 18 people) reported improvement from baseline; because there was no comparison group, it does not count as evidence of effectiveness. Systematic reviews find the evidence insufficient or the risk of bias high (AHRQ 2025, a 2023 review of topical CBD); a 2025 review evaluating the two jaw pain studies sees a short-term benefit but makes no strong recommendation.","thc_icerenler_sonuc":"There are two studies with THC-containing products rubbed on the skin. In nerve pain caused by diabetes, a THC-dominant cannabis oil (THC:CBD:CBN) reduced pain symptoms much more than placebo in a 100-person, 12-week, single-center placebo-controlled study (NPSI-T difference −17.3 points); some numbers in the paper do not match each other and there is no second study confirming the result. In a 21-person open-label study without placebo comparing THC-dominant and CBD-dominant ointments in hand joint pain caused by a breast cancer medicine (aromatase inhibitor), both ointments were well tolerated; the share of people reporting clear improvement was given as 50% with the THC ointment and 18% with the CBD ointment, but the two groups were not compared statistically and participants knew which ointment they were using, so these rates do not show that one ointment is better. The AHRQ 2025 review found the evidence for the THC:CBD:CBN oil insufficient.","ruhsat":null,"doz_araligi_ozet":"In topical studies, 6.2 mg/mL (1 mL twice a day), 4% gel 3 times a day, ~100 mg per application, intraoral 5–10% gel (20–40 mg/day), 5% CBD + myrcene gel once a day; in canker sores, 0.1% CBD paste 3 times a day; THC-dominant oil on the skin, 1–6 drops depending on pain severity (3.2 mg of THC per drop); hand ointments 3 times a day (2210 mg of CBD or 375 mg of THC per jar); most did not report the concentration","titrasyon_ozet":null,"yan_etkiler":["Most studies reported no adverse events, or they are not in the abstract. No side effects were reported in the bruxism and vestibulodynia RCTs (in the bruxism study, 6 of 66 people did not complete the study); in the chemotherapy neuropathy RCT, side effect scores were similar in both periods and there were no serious side effects; no side effects were seen in the canker sore RCT. Skin reactions: 24% mild irritation in the hand ointment study; in the THC oil RCT, mild skin reactions at 10% in both groups (including placebo)"],"izlem":[],"dikkat":["With topical products, urine tests were not positive, but THC ≥2 ng/mL was found in oral fluid in 9 participants (Zamarripa 2024)","Product contents vary; cosmetic products may contain CBD together with other active ingredients","Products rubbed on the skin can cause mild skin reactions (irritation, redness, hives); in a study testing hand ointments, mild irritation was reported in a quarter of users"],"ilac_etkilesim_notlari":[],"dogrulanamayan":["Haffar 2022 (concentration, amount, side effects), Pastina 2025 (side effects) and Xu 2020 (amount applied) were read only from the abstract","The full text of D'Andre 2024 could not be read; the amount of CBD in the cream is not in the abstract or the registration (according to the registration, it was applied twice a day). In Alpy 2023, the amount applied is not clear in the paper","Murina 2025: the abstract says CBD was better for pain and in the cotton swab test; in the full text these differences are not significant (p=0.39; p=0.06). The result from the full text was entered in the table","The full text of Zylla 2026 could not be read (publisher embargo): pain scale (BPI) results and a statistical comparison between the two ointments are not in the abstract that was read. Scholfield 2023 and Zamarripa 2024 (amounts of CBD and THC in the products, conflict of interest statement) were read only from the abstract; which topical studies the AHRQ 2025 report included could not be read because the report page required bot verification","In Seevathee 2025, some numbers do not match each other: the between-group difference at week 4 is −5.50 points in the table and −8.14 in the text; at week 8, −12.56 and −14.54; the placebo group's week 4 score is 22.22 in the table and 24.86 in the text. The daily application frequency is not stated in the paper","A study with a synthetic CBD gel in knee osteoarthritis (Hunter 2018) was published only as a conference abstract; the abstract page could not be read because it required bot verification, and it was not included in the table","Studies completed but with results unpublished or not posted to the registry (October 2026): NCT07162454 (CBD and urea cream in diabetic foot, 23 people, ended June 2025), NCT06771076 (CBD cream in tendon pain in athletes, 35 people, May 2025), NCT07445568 (exercise and CBD on the skin in knee osteoarthritis, 50 people, November 2025), ISRCTN29199098 (cannabis cream on the fingers in rheumatoid arthritis, pilot, 2014). NCT04103814 (CBD acid cream in big toe osteoarthritis and hallux valgus) was stopped with 11 people, and the data were not analyzed. Status unknown: NCT04585230 (CBD roll-on after knee replacement, 92 people in the registration; same center and same four-arm layout as Haffar 2022: CBD, oil, CBD + oil, placebo; very likely the same trial, but the paper's abstract has no registration number and the registration lists the oil as 'mineral oil', so the match could not be verified), NCT05908552, NCT06099171, NCT05411913. Recruiting or not yet started: NCT06108349 (carpal tunnel), NCT07638189 (knee osteoarthritis), NCT07776405 (heel pain), NCT07093138 (migraine), NCT07027566 (tooth sensitivity)"],"calismalar":[{"ad":"Heineman 2022","tasarim":"Crossover, double-blind RCT","n":"18","populasyon":"Arthritis of the thumb base joint","urun":"Topical CBD 6.2 mg/mL in shea butter (control: shea butter alone)","urun_turu":"saf_cbd","doz":"1 mL twice a day","titrasyon":null,"sure":"2 weeks + 1-week washout + 2 weeks crossover","sonuc":"During the CBD period, greater improvement in VAS pain, DASH and SANE scores than during the control period; grip and pinch strength and range of motion similar. Numbers not in the abstract (full text could not be read); each period 2 weeks, 18 people","yan_etki":"No adverse events","pmid":"35637038","doi":"10.1016/j.jhsa.2022.03.002","diger_kaynak":"ClinicalTrials.gov NCT04611347 (results posted to the registry on July 3, 2025; the primary measures in the registration are grip strength, PROMIS upper extremity, Kapandji and range of motion, not the pain scales highlighted in the paper)"},{"ad":"Nitecka-Buchta 2019","tasarim":"Double-blind RCT","n":"60","populasyon":"Jaw joint (TMJ) myofascial pain","urun":"20% cannabis extract oil in a cholesterol ointment (about 1.46% CBD; THC 0 according to the manufacturer's certificate; the extract also contains small amounts of CBG and CBC), applied over the masseter muscle","urun_turu":"cbd_zengin_thc_belirsiz","doz":"Twice a day","titrasyon":null,"sure":"14 days","sonuc":"The primary measure in the registration was resting sEMG activity of the masseter muscle: over 14 days, it fell by 11% on the right and 12.6% on the left with CBD, and by 0.2% and 3.3% with placebo. Pain (VAS 0–10) fell from 5.6 to 1.7 (70.2%) with CBD and from 5.1 to 4.6 (9.8%) with placebo; between-group difference on day 14 significant (p < 0.001). Participants were young (average age 23); groups were assigned by drawing an even or odd number from a container; the study was registered after it ended, and the registration lists 20 participants. From the same university department as Walczyńska-Dragon 2024; the authors reported no conflicts of interest","yan_etki":"No adverse events recorded","pmid":"31698733","doi":"10.3390/jcm8111886","diger_kaynak":"ClinicalTrials.gov NCT03994640 (retrospective registration; 20 participants in the registration)"},{"ad":"Walczyńska-Dragon 2024","tasarim":"Described as double-blind, placebo-controlled RCT, 3 arms (10% CBD / 5% CBD / placebo); according to the main publication, the CBD gels were slightly bitter and the placebo gel almost tasteless; according to the sleep publication of the same trial, the placebo gel was clear and the CBD gels slightly opaque (blinding may have been compromised)","n":"66 randomized; 60 completed and were analyzed (20 in each arm)","populasyon":"Sleep bruxism (teeth clenching/grinding) and jaw joint disorder originating in the chewing muscles (Poland)","urun":"CBD gel applied to the chewing muscle from inside the mouth (prepared with 100% CBD isolate)","urun_turu":"saf_cbd","doz":"40 mg/day with the 10% gel, 20 mg/day with the 5% gel (on both sides, at bedtime)","titrasyon":null,"sure":"30 days","sonuc":"Pain fell by 57.4% with the 10% gel and 40.8% with the 5% gel; no significant change with placebo; on day 30, both gels differed significantly from placebo in pain (VAS) and masseter muscle activity; the difference in pain between the 10% and 5% gels was not significant; no between-group difference in teeth-clenching severity (Bruxoff) (p = 0.23). Groups were assigned by choosing numbers from opaque containers, and only the 60 people who completed the study were analyzed (66 people were randomized). Participants were young (average age 24); from the same university department as Nitecka-Buchta 2019; the authors reported no conflicts of interest","yan_etki":"No side effects reported","pmid":"38592260","doi":"10.3390/jcm13051417","diger_kaynak":"ClinicalTrials.gov NCT05562635 (the plan in the registration does not match the paper: the registration lists 30 people, a July 2023 start and an 'orally dissolving film' title; the paper gives January–May 2023 and 66 people; sleep and migraine results of the same trial: PMID 40732351; PMID 41517391, which cites the same registration number, is a separate study: a pilot comparing two CBD gels in 20 students, without placebo and without measuring pain)"},{"ad":"Haffar 2022","tasarim":"Double-blind, placebo-controlled RCT, 4 arms","n":"80 (19 CBD, 21 essential oil, 21 CBD + essential oil, 19 placebo)","populasyon":"Primary total knee replacement","urun":"Topical CBD (± essential oil); concentration not reported","urun_turu":"saf_cbd","doz":"3 times a day; amount not reported","titrasyon":null,"sure":"2 weeks","sonuc":"No difference between CBD and placebo in pain, sleep or 42-day opioid use; the only significant difference was against CBD: on day 2 after surgery, pain was higher in the CBD group than in the essential oil group (VAS 69.9 vs. 51.0; p = 0.013)","yan_etki":"Not reported (in the abstract)","pmid":"35390457","doi":"10.1016/j.arth.2022.03.081","diger_kaynak":null},{"ad":"Murina 2025","tasarim":"Multicenter, double-blind, placebo-controlled RCT","n":"40 (20/20)","populasyon":"Vestibulodynia (persistent pain at the vulvar entrance)","urun":"5% CBD + myrcene (a cannabis terpene) gel, applied to the vulvar entrance","urun_turu":"cbd_zengin_thc_belirsiz","doz":"Once a day, at bedtime (2 pumps)","titrasyon":null,"sure":"60 days","sonuc":"Pain (p=0.39) and the cotton swab test (p=0.06) decreased in both groups, difference not significant; pain during intercourse fell more with CBD (p<0.01), but the baseline score was higher in this group; no difference in percentage changes (full text; the abstract is written more positively)","yan_etki":"No one dropped out; no side effects reported","pmid":"41153723","doi":"10.3390/biomedicines13102440","diger_kaynak":null},{"ad":"D'Andre 2024","tasarim":"Double-blind, placebo-controlled crossover pilot RCT","n":"40 randomized (20 + 20); 36 people completed both periods","populasyon":"Established chemotherapy-induced peripheral neuropathy with pain or tingling of at least 4/10 severity (US, Mayo Clinic)","urun":"Pure CBD (isolate) cream","urun_turu":"saf_cbd","doz":"Twice a day on the affected areas (amount of CBD in the cream not in the abstract or the registration)","titrasyon":null,"sure":"2 weeks + 2 weeks crossover","sonuc":"Neuropathy symptoms (EORTC QLQ-CIPN20) were similar in the CBD and placebo periods; according to the investigators, the results do not support that CBD isolate cream reduces this pain. A small, short (2 + 2 weeks) pilot study","yan_etki":"Well tolerated; side effect scores similar in both periods; no serious side effects (registry)","pmid":"39016024","doi":"10.1089/can.2023.0253","diger_kaynak":"ClinicalTrials.gov NCT05388058 (results in the registry)"},{"ad":"Pastina 2025","tasarim":"Double-blind, placebo-controlled pilot RCT","n":"28 (9 CBD, 10 placebo cream, 9 no-cream controls)","populasyon":"Muscle soreness after exercise","urun":"Topical cream, about 100 mg of CBD per application","urun_turu":"saf_cbd","doz":"~100 mg per application","titrasyon":null,"sure":"3 application days","sonuc":"No difference in pain, pressure pain threshold or performance; on the muscle soreness questions, the group difference favored the placebo cream (the placebo cream group perceived recovery as better)","yan_etki":"Not reported (in the abstract)","pmid":"38980809","doi":"10.1089/can.2024.0012","diger_kaynak":"ClinicalTrials.gov NCT06320327 (no results in the registry; the primary measure in the registration is the vertical jump test)"},{"ad":"Mendes 2026","tasarim":"Crossover, double-blind pilot RCT","n":"15","populasyon":"Exercise-induced muscle damage","urun":"Topical gel 1% CBD (10 mg/g), 2 g per application (20 mg CBD)","urun_turu":"saf_cbd","doz":"2 g of gel (20 mg CBD)","titrasyon":null,"sure":"72 hours","sonuc":"No difference in delayed-onset muscle soreness; only a moderate difference in isometric torque. The gels were provided by a company (Becann); the authors reported no conflicts of interest","yan_etki":"Not reported (not in the full text either)","pmid":"41877261","doi":"10.1186/s42238-026-00420-0","diger_kaynak":null},{"ad":"Alpy 2023","tasarim":"Double-blind RCT (CBD on one arm, placebo on the other arm)","n":"21","populasyon":"Exercise-induced delayed-onset muscle soreness (biceps muscle), healthy university students","urun":"Commercial CBD balm (1000 mg per container); placebo coconut oil moisturizer","urun_turu":"cbd_zengin_thc_belirsiz","doz":"Applied 30 minutes and 24, 48 and 72 hours after exercise","titrasyon":null,"sure":"72 hours","sonuc":"No difference between CBD and placebo on any day in arm circumference, muscle strength or pain","yan_etki":"Not reported (in the abstract)","pmid":"38287971","doi":"10.70252/KAGH6991","diger_kaynak":null},{"ad":"Xu 2020","tasarim":"Placebo-controlled RCT (followed by crossover)","n":"29 (15 CBD, 14 placebo)","populasyon":"Lower limb peripheral neuropathy","urun":"Topical CBD oil (250 mg CBD / 3 fl oz); THC not reported","urun_turu":"cbd_zengin_thc_belirsiz","doz":"Not reported (in the abstract)","titrasyon":null,"sure":"4 weeks","sonuc":"Over four weeks, a significant reduction compared with placebo in intense pain, sharp pain, cold sensations and itch was reported; the abstract does not state blinding or the source of the product (methodologically weak; full text could not be read)","yan_etki":"No adverse events reported","pmid":"31793418","doi":"10.2174/1389201020666191202111534","diger_kaynak":null},{"ad":"Seevathee 2025","tasarim":"Double-blind, placebo-controlled, parallel phase 3 RCT (single center)","n":"100 randomized (50 + 50); all in the intention-to-treat analysis; 7 people did not complete follow-up","populasyon":"Adults with type 2 diabetes and painful diabetic peripheral neuropathy in the lower limbs who were not taking neuropathic pain medicines (Thailand, Kalasin)","urun":"THC-dominant cannabis oil applied to the skin (per drop THC 3.2 mg, CBD 0.32 mg, CBN 0.65 mg); placebo MCT and coconut oil. The product was provided by the Department of Thai Traditional and Alternative Medicine of Thailand's Ministry of Public Health","urun_turu":"thc_iceren","doz":"1–2, 3–4 or 5–6 drops depending on pain severity (the daily application frequency is not stated in the full text that was read)","titrasyon":null,"sure":"12 weeks","sonuc":"The neuropathic pain symptom score (NPSI-T total) fell from 25.6 to 5.6 with the cannabis oil and from 25.2 to 22.9 with placebo; between-group difference at week 12 −17.3 points (p < 0.001). An effect of this size has not been seen with other products applied to the skin or in other cannabinoid studies in diabetic neuropathy; the single-center result has not been confirmed by another study, and some numbers in the paper do not match each other (the difference at week 4 is −5.50 in the table and −8.14 in the text). Because the product is THC-dominant, the result cannot be attributed to CBD. 3 of the 9 authors work at the ministry department that provided the product; the authors reported no conflicts of interest","yan_etki":"Side effects 10% in both groups, all mild (hives, redness, skin pain); resolved by the end of follow-up","pmid":"39720705","doi":"10.1159/000542511","diger_kaynak":"Thai Clinical Trials Registry TCTR20211220008"},{"ad":"Zylla 2026","tasarim":"Randomized, open-label feasibility study; no placebo (CBD-dominant vs. THC-dominant ointment)","n":"24 registered (ClinicalTrials.gov); 21 women completed the study","populasyon":"Women with stage 1–3 breast cancer taking an aromatase inhibitor, with drug-related joint, muscle and bone pain (AIMSS) (US, Minnesota)","urun":"Ointments provided free of charge by a medical cannabis company (Vireo Health): CBD-dominant (2210 mg of CBD per jar, THC under 0.3%) or THC-dominant (375 mg of THC per jar, CBD under 20 mg); on the hands","urun_turu":"thc_iceren","doz":"3 times a day, one scoop (1.25 mL spoon) applied to the back of each hand and spread over the hand, wrist and fingers","titrasyon":null,"sure":"2 weeks randomized + 2-week open extension with the chosen ointment","sonuc":"The primary aim was feasibility: 71% of participants continued into the 2-week extension, and 86% of weekly questionnaires were completed. At week 2, 86% of participants reported improvement in hand symptoms (M-SACRAH); the share reporting more than 50% improvement was given as 50% in the THC ointment group and 18% in the CBD ointment group. The two groups were not compared statistically (no test in the abstract that was read); there was no placebo and participants knew which ointment they were using, so the improvements cannot be interpreted as an effect of the ointment and the rates do not show that one ointment is better. The CBD-dominant ointment also contained a small amount of THC (under 0.3%). Pain scale (BPI) results are not in the abstract that was read (full text could not be read). Supported by the US National Cancer Institute and NIH; a medical cannabis company provided the ointments free of charge; the authors reported no conflicts of interest","yan_etki":"Mild skin irritation in 24% of participants; 1 person stopped because of the ointment's greasy texture","pmid":"41467893","doi":"10.1177/25785125251398286","diger_kaynak":"ClinicalTrials.gov NCT05935891 (no results in the registry)"},{"ad":"Umpreecha 2023","tasarim":"Randomized, double-blind, placebo- and active-drug-controlled RCT, 3 arms (CBD / steroid / placebo)","n":"72 randomized (24 each); 69 analyzed (23 CBD, 22 steroid, 24 placebo); plus 100 and 50 healthy volunteers for safety","populasyon":"Adults with recurrent canker sores (mouth ulcers) (Thailand, Bangkok)","urun":"0.1% CBD oral paste applied to the ulcer (CBD from a 5% cannabis extract donated by a company; purity and THC content not reported); comparisons: 0.1% triamcinolone (steroid) paste and an inactive paste","urun_turu":"cbd_zengin_thc_belirsiz","doz":"3 times a day, after meals, applied to the ulcer with a measuring spoon","titrasyon":null,"sure":"7 days","sonuc":"The main measure was ulcer size (the sample size was calculated for it): with CBD and with the steroid, ulcers shrank more than with placebo on all measurement days. Pain (daily VAS) was lower than placebo in the CBD group only on day 5 (p = 0.039); with the steroid on days 4, 5 and 7; no difference in pain between CBD and the steroid. Oral health–related quality of life improved similarly in all three groups. The same person could be re-enrolled for different canker sore episodes; registration was retrospective. Supported by Thailand Science Research and Innovation Fund; the authors reported no conflicts of interest","yan_etki":"No allergies or side effects were seen; vital signs and blood values did not change in the volunteers in the safety phase","pmid":"36803360","doi":"10.1186/s12906-023-03886-0","diger_kaynak":"Thai Clinical Trials Registry TCTR20220802004 (retrospective registration, August 2, 2022)"},{"ad":"Bawa 2024","tasarim":"Open-label, single arm, feasibility","n":"18 (15 completed)","populasyon":"Hand osteoarthritis","urun":"Transdermal CBD gel 4%","urun_turu":"saf_cbd","doz":"0.25 mL 3 times a day (~30 mg CBD/day)","titrasyon":null,"sure":"4 weeks","sonuc":"About −1.9 NRS in pain (no control group); returned to baseline during the washout period. The company that developed the gel co-funded the study and donated the product; 4 of the 11 authors are employees of this company","yan_etki":"31 mild adverse event reports and 1 moderate; no THC detected in urine, CBD and breakdown products detected","pmid":"38783008","doi":"10.1038/s41598-024-62428-x","diger_kaynak":"ANZCTR ACTRN12621001512819"},{"ad":"Chou 2025 (AHRQ living review)","tasarim":"Living systematic review and meta-analysis (US Agency for Healthcare Research and Quality; search up to April 28, 2025)","n":"Since the start, 29 RCTs (2,579 people) and 15 observational studies (49,453 people)","populasyon":"Chronic pain in adults and adolescents (48% of studies in neuropathic pain)","urun":"Cannabinoids (grouped by THC:CBD ratio and product type) and plant-based products; CBD applied to the skin as a separate group","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"The evidence for CBD applied to the skin was found insufficient: no firm conclusion can be drawn. The RCT comparing a CBD gel applied inside the mouth with placebo in jaw disorder was added in the 2024 update, and the RCT testing a THC:CBD:CBN oil applied to the skin in diabetic neuropathy was added in the 2025 update; the evidence for the THC:CBD:CBN product is also insufficient. For comparison: pure CBD by mouth did not reduce pain more than placebo (4 RCTs, 334 people; moderate certainty); an oral spray containing THC and CBD in similar proportions slightly reduced pain (mean difference −0.54/10; moderate certainty). A public agency review","yan_etki":"Dizziness, drowsiness and nausea increased with THC-containing products; no separate side effect result for products applied to the skin in the abstract","pmid":"40956916","doi":"10.23970/AHRQEPCCER250UPDATE2025","diger_kaynak":"NCBI Bookshelf NBK618045 (AHRQ report no. 25-EHC036); PROSPERO CRD42021229579; 2024 update PMID 40238954; journal publication Chou 2026, Ann Intern Med (PMID 41429020)"},{"ad":"Galant 2025 (systematic review)","tasarim":"Systematic review of RCTs (RoB 2; no meta-analysis because the criteria for pooled analysis were not met)","n":"9 placebo-controlled RCTs, 390 people; 2 with CBD","populasyon":"Jaw joint disorders, chewing muscle pain and sleep bruxism","urun":"Medicines applied through the skin or the lining of the mouth; CBD studies: cannabis extract ointment (about 1.46% CBD) and CBD isolate gel (5% and 10%)","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"In both CBD studies, pain fell more than with placebo over 14–30 days, and both studies were judged to have a low risk of bias; the largest percentage reduction was with the 1.46% CBD ointment. But because each medicine was tested in only one or two studies and with different methods, no pooled analysis was done; the authors write that no strong clinical recommendation can be made; no improvement in mouth opening compared with placebo. The two CBD studies come from the same university department; the review authors are independent of it, but the review does not discuss that the first study was registered retrospectively or that groups were assigned by choosing numbers in both studies. No external funding; the authors reported no conflicts of interest","yan_etki":"No side effects were reported in the CBD studies","pmid":"41463118","doi":"10.3390/biomedicines13123110","diger_kaynak":"PROSPERO CRD42025632021"},{"ad":"Scholfield 2023 (systematic review)","tasarim":"Systematic review (no meta-analysis)","n":"8 studies (3 placebo-controlled RCTs, 5 single-arm); 11 more studies found in registries but not accessible","populasyon":"Human studies with CBD applied to the skin (skin conditions or safety 2, pain 2, behavior 1; the others not detailed in the abstract)","urun":"CBD products applied to the skin (50–250 mg or 0.075–1% CBD; most combined with other substances)","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"The studies have a high risk of bias and incomplete reporting; because of differences in formulation and methods, no pooled conclusion could be drawn about CBD's dose, effectiveness and safety. The authors warn of the risk that users generalize poorly designed studies to all CBD products, and call for new placebo-controlled studies that measure blood CBD levels and show that the effect comes from CBD. Most of the knee replacement, chemotherapy neuropathy and exercise studies were published after this review (full text could not be read)","yan_etki":"Side effects rare and mild; according to the authors, of limited meaning without efficacy data","pmid":"35605018","doi":"10.1089/can.2021.0154","diger_kaynak":null},{"ad":"Zamarripa 2024","tasarim":"Randomized, double-blind, placebo-controlled pharmacokinetic and drug testing study (pain not measured)","n":"46 (6–8 people in each of 5 product groups, 9 on placebo)","populasyon":"Healthy adults (US, Johns Hopkins University)","urun":"5 commercial hemp-derived products high in CBD and low in THC: cream, lotion, patch, balm, gel; placebo","urun_turu":"thc_iceren","doz":"Twice a day (amounts of CBD in the products not in the abstract)","titrasyon":null,"sure":"17 days (application in the lab on the first day, 9 days of use at home twice a day, 1-week washout)","sonuc":"With three of the five products, CBD passed through the skin into the blood; levels rose most after 7–10 days of use, and most with the lotion containing CBD plus vitamin E, which increases absorption. No THC was detected in the blood; no urine sample was positive by US workplace testing criteria; but in 9 people (7 lotion, 1 patch, 1 gel), THC in oral fluid exceeded the 2 ng/mL \"positive\" threshold used in workplace tests. The products had no subjective, mental or physical effects. Funded by the US Department of Defense and SAMHSA (the substance use and mental health agency); 1 of the 15 authors works at a CBD company (full text could not be read, conflict of interest statement not seen)","yan_etki":"Well tolerated (no details in the abstract)","pmid":"38217086","doi":"10.1093/jat/bkae001","diger_kaynak":"ClinicalTrials.gov NCT04741477 (47 people enrolled; no results in the registry)"}],"son_inceleme":"2026-11-01","arastirma_gecmisi":[{"tarih":"2026-10-19","not":"Page published. This first review examined 7 studies."},{"tarih":"2026-10-21","not":"The full texts of the studies were reread and the information on the page was checked against its sources. Corrected: side effect, product and dose information in the study table. Points that could not be verified from the full text went down from 2 items to 1. The year of one publication named on the page was corrected to the journal's print year instead of the online publication year. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-21","not":"Newly published and previously missed clinical studies were searched in PubMed and ClinicalTrials.gov. 4 studies added: Walczyńska-Dragon 2024, Murina 2025, D'Andre 2024 and Alpy 2023. In one of the four new randomized studies, pain fell clearly (Walczyńska-Dragon 2024); in the others, no difference from placebo was seen on the main measures. With the new studies, the strength of evidence changed from \"Very weak\" to \"Weak\"."},{"tarih":"2026-10-28","not":"Display fix: internal working file names left in the text were removed; content and evidence did not change."},{"tarih":"2026-10-28","not":"In October 2026, PubMed, Cochrane, ClinicalTrials.gov and Europe PMC were systematically searched; 7 studies were added: 2 randomized studies with THC-containing products rubbed on the skin (a placebo-controlled study with a THC-dominant oil in diabetic neuropathy and a study without placebo comparing CBD and THC ointments in hand pain caused by a breast cancer medicine), a placebo-controlled study with a CBD paste applied to mouth ulcers (canker sores), 3 systematic reviews (one of them the US Agency for Healthcare Research and Quality's living review) and an absorption study in healthy volunteers that is the source of the drug test information on the page. Two small uncontrolled studies with products that also contained other pain relievers or undisclosed substances alongside CBD were not included in the table because the improvement could not be attributed to CBD. In existing rows: the product type of the cannabis extract ointment in jaw pain, of a CBD oil rubbed on the skin and of the CBD + myrcene gel used in vulvar pain became 'CBD-rich extract, THC content unclear'; it was written that the two positive jaw pain studies come from the same research group, that the first was registered retrospectively, that the second one's registration does not match the paper, and that an article thought to be an additional publication is a separate pilot study; it was added that the only significant difference in the knee replacement study was against CBD, along with the company ties and registration numbers of the hand osteoarthritis gel study and details of the chemotherapy neuropathy study; the incorrect 'no one dropped out' statement in the side effect summary was corrected. The conclusion and strength of evidence for THC-containing products were written for the first time (very weak). The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-28","not":"October 2026 additional review: the single source found for this page in the searches for other topics was read; no change to the page was needed. A study comparing a cannabis oil containing THC and CBD with placebo for pain in epidermolysis bullosa (Schräder 2026) was not added to the table: the product is not rubbed onto an area of the skin or inside the mouth, but is given under the tongue and spreads through the body. The study, with its pain result, is in the table of the Skin Conditions page."},{"tarih":"2026-10-30","not":"The last sentence of the page's short summary was rewritten in a calmer, more guiding tone: instead of \"Talk to your doctor before you start.\", it now says whom you can talk with, and about what, if you are considering CBD. The conclusion and the strength of evidence did not change."},{"tarih":"2026-11-01","not":"A blinding note was added to the Walczyńska-Dragon 2024 row: the CBD gels differed from the placebo gel in taste and appearance, so participants may have noticed which group they were in (PMID 38592260 and the sleep publication from the same trial, PMID 40732351, full texts). The conclusion and the evidence level did not change."}]},{"id":"anxiety","baslik":"Generalized anxiety disorder and general anxiety","grup":"Anxiety and mental health","grup_kodu":"kaygi","tr_id":"kaygi-yaygin-anksiyete","kanit_duzeyi":"zayif","kanit_yonu":"celiskili","kanit_ozet":"A 15-week, 178-person RCT in India reported a very large effect (6 of the 7 authors are executives or employees of pharmaceutical companies; the reported spread is unusually small for a psychiatry study); its dose is unknown, the result has not been independently repeated, and in November 2024 the drug regulator's expert committee questioned the absence of a placebo response in the placebo group of a phase 3 application whose features match this study (178 people, 150 mg/mL CBD solution, mild to moderate anxiety disorder; no trial identifier in the minutes). In May 2026, the same committee recommended approving the product on condition that a phase 4 study comparing it with an active medicine be done and that it be sold only with a psychiatrist's prescription; this recommendation is not the result of an independent repeat, and the approval document itself could not be found. In people with high levels of worry, 300 mg/day for 2 weeks did not reduce worry, and anxiety symptoms decreased somewhat. Other placebo-controlled studies measuring anxiety found no difference: a single 400 mg dose for pre-scan anxiety in advanced breast cancer (n=50; Nayak 2024), a CBD-rich extract before root canal treatment (de Andrade Silva 2024) and a low-dose full-spectrum oil for 30 days in stressed students (n=180; Winkler 2025); anxiety also did not improve with early access to medical cannabis by lottery for anxiety or depression (n=83; Gilman 2022). In a small double-blind part comparing full-spectrum and pure CBD with placebo (31 people; NCT02548559, no peer-reviewed publication), self-reported anxiety fell clearly in all groups, including placebo, and interviewer-rated anxiety fell more in the CBD arms; in the registry, the groups were not compared statistically. Positive results in open-label studies therefore cannot be separated from the expectation effect. The small nabilone (a synthetic THC-like cannabinoid) studies from 1978–1981 are inconsistent (Fabre 1981 positive; Glass 1980 and Nakano 1978 weak or ineffective). In artificially created anxiety in the lab, single-dose results are inconsistent: no effect was seen on exam anxiety, in emotional face tasks or in a virtual reality paranoia setting; results in lab anxiety do not substitute for treatment of anxiety disorders. THC can increase anxiety in the lab (Hutten 2022; at a high dose in Childs 2017); a low dose of THC slightly reduced distress after a stress test (n=42; Childs 2017); in regular users, the stress-reducing effect of vaporized THC was similar to placebo (n=120; Cuttler 2026). Meta-analyses find the evidence of low or very low certainty: in RCTs in people whose primary diagnosis is a mental disorder, no significant difference from placebo for anxiety (Wilson 2026); in the analysis that also included anxiety measured as a secondary outcome in other diseases, a small to moderate reduction, but very low certainty (Bharat 2026); in the analysis split by drug type, no cannabinoid alone is significant (Bilbao 2022). Real-world data go both ways: in a UK patient registry, patients mostly prescribed THC-rich flower reported reduced anxiety (no control; most of the authors are linked to the clinic chain that runs the registry; Rifkin-Zybutz 2023), while in a 5,075-person registry in Canada the average change was clinically meaningless (Lee 2022). The pooled association between cannabis use and later development of generalized anxiety disorder is not significant (OR 1.44; 95% CI 0.94–2.22; observational; Xue 2021). The anxiety disorder guidelines that could be read (Germany 2022, Brazil 2024) do not mention cannabinoids. Studies in social anxiety, panic disorder and PTSD are on their own pages. October 2026 search (PubMed, Cochrane, ClinicalTrials.gov): 21 controlled studies with cannabinoids on this topic were found; 11 in patients or people experiencing anxiety or stress (8 placebo-controlled; only 1 placebo-controlled study with more than 100 people was done in patients diagnosed with an anxiety disorder; the follow-up publication of one is also in the table), 10 in volunteers in a lab or experimental setting (THC was also tested in 3). Alongside these, the table has 4 studies with no control group, 7 systematic reviews (5 of them meta-analyses) and 5 observational studies (one a meta-analysis of observational studies). Older lab experiments and meta-analyses whose question is answered by a newer or larger study or review in the table were not added separately. No Cochrane review and no treatment study from Turkey were found.","kanit_duzeyi_metin":"Weak: the only positive large RCT has not been independently repeated; the other controlled studies are small and most found no difference from placebo","kanit_duzeyi_thc_icerenler":"cok_zayif","kanit_duzeyi_thc_icerenler_metin":"Very weak: there are no controlled studies showing a benefit of THC-containing products in anxiety disorders; there is a small double-blind part whose groups were not compared statistically (registry only), a negative RCT that assigned access to medical cannabis by lottery, and data without placebo and observational data. Lab findings go both ways: increased anxiety at high doses, a slight reduction in distress after stress at low doses","kaynak_dosya":"kaygi-panik.md","saf_cbd_sonuc":"The results of controlled anxiety studies with pure CBD are mixed; the only large positive RCT has not been repeated and its dose was not reported in the abstract. In anxious cancer patients, a single 400 mg dose was no different from placebo on the primary outcome; of the two meta-analyses that looked at CBD separately, one found an effect in the pure CBD subgroup (wide confidence interval) and the other did not; in both, the certainty of the evidence is low.","thc_icerenler_sonuc":"There are no controlled studies showing a benefit of THC-containing products in anxiety disorders. In a small double-blind part with a low-THC full-spectrum product, self-reported anxiety decreased in all groups, including placebo, and interviewer-rated anxiety decreased more in those taking the full-spectrum product; but nearly half of this arm came from the open-label first phase and the groups were not compared statistically (registry only). In an RCT giving access to medical cannabis by lottery, anxiety did not improve; in a study without placebo comparing cannabis flowers, THC-dominant flower was linked to a smaller drop in anxiety than CBD-dominant flower. In the lab, THC and THC+CBD increased state anxiety (THC+CBD less than THC alone); a low dose of THC slightly reduced distress after stress, and a higher dose increased anxiety.","ruhsat":null,"doz_araligi_ozet":"In controlled studies, 30–300 mg/day (2–4 weeks) and, in one study, a low dose increased step by step according to body weight (at most 1 mg/kg/day); single doses 32–600 mg; in open-label studies about 30–800 mg/day; in an uncontrolled case series 25–175 mg/day","titrasyon_ozet":"The only anxiety study that reported the dose-increase schedule in detail is Berger 2022: it started at 200 mg/day and, if the response was inadequate, increased in 200 mg steps (at most 400 at week 1, 600 at week 4 and 800 mg/day at week 8). Most other controlled studies used a fixed dose; in stressed students, a low-dose full-spectrum oil was increased step by step according to body weight over 30 days (Winkler 2025); the schedule of Gundugurti 2024 is unknown","yan_etkiler":["Sedation/'mental sedation' (Crippa 2004); mild impairment in alertness, longer duration of attention lapses (Rudisill 2023)","Berger 2022 (12 weeks, 200–800 mg/day): side effects in 80.6% (drug-related or possibly drug-related in 61.3%), all mild to moderate — tiredness, low mood, hot flashes/chills","Crippa 2021 (300 mg/day, 28 days): 5 serious side effects, all in the CBD group (4 liver enzyme elevations, 1 of them critical; 1 severe drug rash)","Bogenschutz 2026 (PMID 41312717; in people with PTSD and alcohol use disorder, 600–1200 mg/day): 22.6% of those taking CBD reduced the dose or stopped because of side effects; nausea (20% vs. 0%) and diarrhea (27% vs. 12%) more common","Kwee 2022 RCT (add-on to therapy in social anxiety and panic disorder; 300 mg, 8 doses): no serious side effects; side effect frequency similar to placebo (10.3% vs. 15.4%)","Gilman 2022 (medical cannabis card, 12 weeks): cannabis use disorder 17.1% in those who got the card immediately, 8.6% in those who waited; 28.3% vs. 10.8% in those who applied for anxiety or depression","Rifkin-Zybutz 2023 (UK patient registry, mostly THC-rich flower, 6 months): 39 of 302 patients (12.9%) reported side effects, 11 severe; most common were dry mouth, tiredness, insomnia and sleepiness","Wilson 2026 (54 RCTs in mental disorders): any side effect more common with cannabinoids (OR 1.75; number needed to harm 7); no difference in serious side effects","Nabilone: at a high single dose (4–5 mg), a drop in blood pressure on standing and a mild increase in pulse (Glass 1980); with 4 weeks of use, dry mouth and eyes, sleepiness (Fabre 1981)"],"izlem":["With long-term use, monitoring of liver tests is the physician's decision"],"dikkat":["Bipolar disorder: in mania, 600–1200 mg/day CBD was ineffective in 2 patients (Zuardi 2010, PMID 18801823); in bipolar depression, 150–300 mg/day was not superior to placebo, and no increase in mania was seen (Pinto 2024, PMID 37920963); there is no evidence that CBD works in treating mania","History of psychosis: no controlled data were found showing that CBD alone triggers psychosis, but in people with high paranoia proneness, 600 mg showed a trend toward increased anxiety (Hundal 2018); the main risk is THC-containing products. A person with a history of psychosis should not use CBD without consulting a physician (this is a precautionary recommendation, not a direct study result)","Pregnancy and breastfeeding: no human studies show it is safe; in animals, signals of harm to prenatal development (Sarrafpour 2020, PMID 32524214; Argueta 2020, PMID 32425793)","Driving: 13.75 mg of vaporized CBD-dominant marijuana did not impair driving, but clinically important impairment could not be fully ruled out; CBD did not prevent THC's driving-impairing effect; after 300 mg of oral CBD, the duration of attention lapses increased (Arkell 2020, PMID 33258890; Rudisill 2023, PMID 36625844)","Liver: in healthy adults, ALT/AST >3×ULN in 5.6% with 5 mg/kg/day (Florian 2025, PMID 40622698); with 300 mg/day, 4 liver enzyme elevations, 1 of them critical (Crippa 2021)","Young people (aged 12–25): the only data are open-label, with side effects in 80.6% of participants (Berger 2022); an interaction was shown with citalopram/escitalopram, which are commonly used at this age","Allergic skin reaction: 1 severe drug rash with 300 mg/day (Crippa 2021)","Athletes: in healthy volunteers who used 150 mg a day of a broad-spectrum CBD oil for 10 weeks, CBG and CBDV, which are prohibited under WADA's 2026 list, were detected in urine (42% and 68% of pre-exercise samples, 74% and 84% of post-exercise samples); THC was not detected. CBDV was not listed on the product's certificate of analysis (Gillham 2026, PMID 40920736)","No study has shown that CBD is a first-line treatment for anxiety disorders; cannabinoids are not included in the anxiety disorder treatment guidelines that could be read (Germany 2022, Brazil 2024)","It cannot be said that 300 mg is the best dose: a moderate dose was found more effective only in two small studies in healthy volunteers (single dose, public speaking; Zuardi 2017, PMID 28553229; Linares 2019, PMID 30328956; on the Social Anxiety page); this could not be repeated in other conditions","Urine test: in 7 of 14 people who used a full-spectrum product containing about 30 mg of CBD and less than 1 mg of THC a day for 4 weeks, the urine THC test was positive (Dahlgren 2021); in a similar 6-week study, a rapid urine test was positive in 25–33% of patients and a more sensitive laboratory measurement in half (Smith 2025)","Cannabis use disorder: in people given early access to medical cannabis for anxiety or depression, cannabis use disorder at 12 weeks was 28.3% vs. 10.8% (Gilman 2022)"],"ilac_etkilesim_notlari":["Citalopram/escitalopram: when CBD (200–800 mg/day) was added, citalopram blood levels rose significantly in 6 patients; in the lab, breakdown through CYP3A4 and CYP2C19 was inhibited (Anderson 2021, PMID 34121064)","Sertraline, fluoxetine, mirtazapine: in the lab, CBD affected their breakdown very little; not measured in patients (Anderson 2021, PMID 34121064)","In people taking serotonergic antidepressants, CBD affected the re-extinction of subjective fear worse than placebo (Kwee 2024, PMID 38044339, exploratory subgroup)","Clobazam: in 13 children with epilepsy, the active metabolite N-desmethylclobazam rose by an average of 500%; the rise in clobazam itself (average 60%) was uncertain (confidence interval −2 to 91). In healthy volunteers, clobazam did not change and the metabolite rose ~3-fold (FDA/EMA). Side effects in 10 of 13 patients, which resolved when the clobazam dose was reduced (Geffrey 2015, PMID 26114620)","Other benzodiazepines (alprazolam, clonazepam, etc.): no direct interaction study was found in an anxiety population","THC-containing products: CBD does not consistently reduce THC's effects; full-spectrum products may contain THC (e.g., 0.23 mg/mL)","Antipsychotic + 1000 mg/day CBD (schizophrenia) was well tolerated (McGuire 2017, PMID 29241357)","No direct interaction study was found with venlafaxine, duloxetine, pregabalin, buspirone or hydroxyzine"],"dogrulanamayan":["The following studies were read only from the PubMed abstract (the full text could not be accessed): Gundugurti 2024, Gournay 2023, Gournay 2026, Stanley 2023, Hundal 2018, Crippa 2004, Das 2013, Han 2024, Raminelli 2025. Berger 2022 was read from the author manuscript. Of those added in the October 2026 search, Fabre 1981, Glass 1980, Nakano 1978, de Andrade Silva 2024, Feingold 2018, Bharat 2026, Wilson 2026 and Cuttler 2026 were read only from the abstract (full text not open); the nabilone dose in Fabre 1981 and the number of participants in Nakano 1978 and de Andrade Silva 2024 (and the dose as well in de Andrade Silva) are not in the abstract. Gournay 2023's anxiety result 'compared with placebo' and its conflict of interest statement could not be verified because the full text could not be read","In Gundugurti 2024, the dose and titration are unknown: the full text could not be accessed, and the registration (CTRI/2023/01/049110) does not give a mg dose; the '300–600 mg/day, 12 weeks' in secondary sources could not be verified. In the minutes of the expert committee of India's drug regulator (March 12, 2024, 26–November 27, 2024 and May 6, 2026), the applicant company is Zenara Pharma; the trial identifier and publication title are not stated. That the minutes belong to this trial was inferred from the match of 178 people, a 150 mg/mL product, the indication of mild to moderate anxiety disorder and the multicenter design. The information on a 'placebo run-in period' and 'primary outcome at week 11' in the study duration is not in the abstract; it could not be re-verified because the Clinical Trials Registry of India could not be reached in October 2026. The abstract of the same team's research letter dated October 2026 (PMID 42901095) is not available, its full text is not open, and its content could not be read","Ongoing study: NCT07123467 (GAD; 5-week brief CBT + Epidiolex 5 or 10 mg/kg/day, placebo-controlled, target 90 people; recruiting, estimated completion August 2027; primary outcome is brain imaging, not symptoms). Other registrations with results not posted or not published (ClinicalTrials.gov, October 28, 2026): NCT03549819 (McMaster University, in partnership with a cannabis company; pure CBD 200–800 mg/day, 8 weeks, placebo-controlled, target 50 people; registration not updated since February 2023), NCT06672666 (University of Florida; hemp-derived CBD extract 50–150 mg/day, 4 weeks, placebo-controlled, 30 people; estimated completion December 2026), NCT05283382 (University of Connecticut; single dose of 600 mg, 160 people; recruiting), NCT05324449 (anxiety in children with epilepsy; open-label with an approved (licensed) CBD medicine, 20 people; ended May 2025, no results). The anxiety study in glioblastoma, NCT05753007, was terminated early with only 2 people","The correction to Wilson 2026 published in the journal (Lancet Psychiatry 2026;13(8):e11; PMID 42302809) was read on October 29, 2026: only the axis of one figure and the study counts in a table were corrected; the numbers in the row (54 RCTs, 2,477 participants, side effect OR 1.75, high risk of bias in 44% of the studies) did not change. According to the corrected table, 5 of the anxiety disorder studies were done with CBD alone and 1 with THC alone","Clinical guidelines: Germany's anxiety disorders guideline (2022 revision) and the Brazilian Psychiatric Association's generalized anxiety disorder guideline (2024) do not mention cannabinoids in their full texts; the full text of the World Federation of Societies of Biological Psychiatry guideline (2023) could not be read (the publisher's site blocked access). The ClinicalTrials.gov registration of Stanley 2023 (NCT04269252) was matched to the paper by design, number of participants and dose steps; the paper's abstract has no registration number. Because the registration describes the product as a 'CBD-rich extract' (CHI-907), the row's product type was corrected to 'CBD-rich, THC content unclear' (October 28, 2026); the full text of the paper could not be read (the publisher's site blocks automated access)"],"calismalar":[{"ad":"Gundugurti 2024","tasarim":"Phase 3, double-blind, placebo-controlled, multicenter RCT (India; 6 of the 7 authors are affiliated with pharmaceutical companies: 5 are executives or employees of Leiutis Pharmaceuticals, which funded the pharmacokinetic part of the trial, and 1 is the medical director of Biophore Pharma)","n":"178 randomized (89 CBD, 89 placebo); number analyzed not in the abstract","populasyon":"Mild to moderate generalized anxiety disorder; people not taking psychotropic medicines","urun":"Nanodispersion oral solution of synthetic CBD (150 mg/mL; product description from the pharmacokinetic publication of the same trial)","urun_turu":"saf_cbd","doz":"Unknown (full text could not be accessed; no mg dose in the registration)","titrasyon":"Unknown (full text could not be accessed)","sure":"About 15 weeks (including a placebo run-in period); primary outcome at week 11","sonuc":"GAD-7 difference −7.02; HAM-A difference −11.9 (p<0.0001); PHQ-9 and sleep also improved. The reported standard error (0.25 for GAD-7) in an 89-vs-89 study means a between-person spread of only about 1.7 points on a 0–21 point scale; this is unusually small for a psychiatry study. The effect size is much larger than in other studies and has not been independently repeated. The expert committee of India's drug regulator (November 26–27, 2024), for a phase 3 trial whose features match this study (in the minutes: 178 people, 150 mg/mL oral CBD solution, mild to moderate anxiety disorder, six centers), asked for an explanation of the absence of any placebo response in the placebo group, raw data from all centers, data on dependence potential and a new, larger, comparative phase 3 protocol. On May 6, 2026, the committee recommended granting manufacturing and marketing permission on condition of a phase 4 study comparing it with an active medicine and sale only on a psychiatrist's prescription. The minutes have no trial identifier or publication title, and the applicant company is Zenara Pharma; it is not certain that the minutes belong to the trial in this publication, although the product, number of participants, indication and multicenter design match","yan_etki":"No serious side effects (abstract); side effect counts not in the abstract. In May 2026, the expert committee asked for all side effects and a section on dependence potential to be added to the product information","pmid":"38797087","doi":"10.1016/j.ajp.2024.104073","diger_kaynak":"Clinical Trials Registry of India CTRI/2023/01/049110. Pharmacokinetic study that is part of the same trial: Gundugurti 2026, PMID 41613360 (18 healthy men, 300 mg single dose; funded by Leiutis Pharmaceuticals). Research letter from the same team: Gundugurti 2026, PMID 42901095 (no abstract, full text not open; content could not be verified)"},{"ad":"Gournay 2023","tasarim":"Double-blind, placebo-controlled RCT","n":"63","populasyon":"People with high levels of worry","urun":"Oral CBD","urun_turu":"saf_cbd","doz":"50 or 300 mg/day","titrasyon":"None","sure":"Single dose + 2 weeks","sonuc":"No effect with a single dose; worry did not decrease under any condition; 300 mg for 2 weeks reduced anxiety symptoms compared with placebo (from the abstract only; analysis details and effect size could not be verified); the authors write that the effect may be limited to the physical symptoms of anxiety. Conflict of interest statement and funding not in the abstract","yan_etki":"Not reported (in the abstract); no sedation or cognitive impairment was seen in the sleep publication of the same trial (Gournay 2026)","pmid":"37552290","doi":"10.1007/s00213-023-06437-0","diger_kaynak":"Sleep results of the same trial: Gournay 2026, PMID 41678223 (300 mg better than 50 mg for sleep, difference from placebo not significant; p = 0.10, d = 0.07; no sedation or cognitive impairment)"},{"ad":"NCT02548559 (McLean Hospital, double-blind phase; registry results)","tasarim":"Phase 2, two-phase trial: phase 1 open-label (Dahlgren 2022, in this table), phase 2 randomized, triple-blind, placebo-controlled, parallel-group. Results only on ClinicalTrials.gov; no peer-reviewed publication","n":"46 enrolled: 15 in phase 1 (14 completed), 31 in phase 2 (full-spectrum 19, pure CBD 6, placebo 6); in the analysis, the full-spectrum arm includes the 32 completers of both phases together","populasyon":"Adults reporting moderate or severe anxiety (those using cannabinoids more than once a month were excluded; US, McLean Hospital)","urun":"Sublingual solution: full-spectrum CBD (10 mg/mL CBD; THC measured in phase 1 0.23 mg/mL) or single-compound (pure) CBD (10 mg/mL); placebo solution","urun_turu":"thc_iceren","doz":"1 mL 3 times a day (30 mg of CBD a day; in the full-spectrum arm, also under 1 mg of THC a day)","titrasyon":"None (fixed dose)","sure":"4 weeks","sonuc":"For all four primary anxiety scales (BAI, OASIS, STAI, HAM-A), the registry has only one-sided t-tests within each group; the CBD arms were not compared statistically with placebo. Self-reported anxiety also fell clearly in those taking placebo (6 people) (BAI from 21.0 to 8.2; OASIS from 11.2 to 5.5); BAI fell from 21.0 to 6.9 in the full-spectrum arm and from 22.5 to 10.0 in the pure CBD arm. On the interviewer-rated HAM-A, the drop in the placebo group was small and not significant (from 20.2 to 17.5; p = 0.13), and large in the full-spectrum (from 21.5 to 5.1) and pure CBD (from 23.7 to 9.7) arms. The groups are very small and the full-spectrum arm also includes patients from the open-label phase 1; with these numbers it cannot be said whether there is a difference between CBD and placebo","yan_etki":"No serious side effects. Mild side effects in 8 of 34 people in the full-spectrum arm (such as dry mouth or throat, abdominal pain, palpitations, panic attack symptoms, a feeling of unreality; each in 1–2 people), in 2 of 6 in the pure CBD arm, and in 1 of 6 on placebo","pmid":null,"doi":null,"diger_kaynak":"ClinicalTrials.gov NCT02548559 (principal investigator Staci Gruber; results posted to the registry on March 27, 2026). Publication of phase 1: Dahlgren 2022 (PMID 36352103), in this table"},{"ad":"Fabre 1981","tasarim":"Double-blind, placebo-controlled clinical study (randomization method not in the abstract)","n":"25 outpatients (allocation to groups not in the abstract)","populasyon":"Outpatients followed for anxiety complaints (US; diagnostic criteria not in the abstract)","urun":"Nabilone (a synthetic THC-like cannabinoid; not THC)","urun_turu":"cbn_diger","doz":"Not in the abstract (full text could not be read)","titrasyon":"Not in the abstract","sure":"28 days","sonuc":"Clear improvement compared with placebo was reported in the nabilone group on the Hamilton Anxiety Scale and in the patients' global assessment (p < 0.001). A small, single-center study published in 1981; method details and effect size are not in the abstract. No other anxiety treatment study with nabilone was found in this search; in two small nabilone studies with anxious volunteers from the same period, the results were weak or inconsistent (Glass 1980, Nakano 1978)","yan_etki":"Dry mouth and eyes, sleepiness; patients did not report a marijuana-like altered state of consciousness (abstract)","pmid":"6117575","doi":"10.1002/j.1552-4604.1981.tb02617.x","diger_kaynak":null},{"ad":"Glass 1980","tasarim":"Single-blind, placebo-controlled, single-dose study in the same people in a balanced Latin square design (one session a week)","n":"8 anxious volunteers (two series of 4 people)","populasyon":"Anxious volunteers (diagnostic criteria not in the abstract)","urun":"Nabilone (a synthetic THC-like cannabinoid; not THC)","urun_turu":"cbn_diger","doz":"Three single doses set according to each person's response to a test dose; 1–5 mg in the first series, lower doses in the second series","titrasyon":"The dose range was first set in each person with a test dose","sure":"5 sessions, 1 week apart (2 placebo, 3 doses)","sonuc":"No significant change in anxiety score (POMS anxiety) at the group level. 2 of the 4 people in the first series had reduced anxiety at a low dose (1–2 mg); no reduction in anxiety was seen in the second series, which received lower doses. There was marked sleepiness at high doses","yan_etki":"At 4–5 mg, a drop in blood pressure on standing (orthostatic hypotension), a mild dose-related rise in heart rate, marked sleepiness","pmid":"6108592","doi":"10.1007/BF00434401","diger_kaynak":"Other publications of the same study: Glass 1981, J Clin Pharmacol 21(S1):383S–396S (PMID 6117576; behavioral tasks added); conference abstract Glass 1979 (PMID 373011)"},{"ad":"Gilman 2022","tasarim":"Pragmatic RCT (getting a medical cannabis card immediately or after 12 weeks; 2:1 randomization; participants not blinded, only assessors blinded)","n":"269 randomized; 186 analyzed (105 immediate, 81 delayed; those with a baseline and at least one follow-up measurement); anxiety analysis in 83 people who applied for anxiety or depression (46/37)","populasyon":"Adults aged 18–65 seeking medical cannabis for pain, insomnia, or symptoms of anxiety or depression; daily cannabis users and people with cannabis use disorder were excluded (US, Boston)","urun":"Cannabis products chosen by participants themselves at a dispensary (THC and/or CBD; ratios in a supplementary table, not read)","urun_turu":"karma","doz":"Participant's choice (product, dose and frequency unrestricted)","titrasyon":"None (participants adjusted it themselves)","sure":"12 weeks","sonuc":"For the primary outcome of anxiety symptoms (HADS anxiety; only in those who applied for anxiety or depression; baseline mean 9.4 in both groups), no difference between groups (mean difference −0.1; 95% CI −1.1 to 1.0; p = 0.90); no difference in depression or pain either, only the insomnia score improved (−2.90; 95% CI −4.31 to −1.51). Cannabis use disorder symptoms increased (0.28; 95% CI 0.15–0.40). Because product and dose were unrestricted, it gives no information about the effect of a specific cannabinoid","yan_etki":"At 12 weeks, cannabis use disorder 17.1% in those who got the card immediately, 8.6% in those who waited (adjusted OR 2.88; 95% CI 1.17–7.07); 28.3% vs. 10.8% in those who applied for anxiety or depression","pmid":"35302633","doi":"10.1001/jamanetworkopen.2022.2106","diger_kaynak":"ClinicalTrials.gov NCT03224468 (results in the registry)"},{"ad":"Nayak 2024","tasarim":"Phase 2, double-blind, placebo-controlled RCT","n":"50 randomized (25 CBD, 25 placebo)","populasyon":"Women with advanced breast cancer, clinical-level anxiety at baseline, awaiting a tumor assessment scan (US, Dana-Farber); an anxiety disorder diagnosis was not required","urun":"FDA-approved oral CBD solution (pure); placebo syrup","urun_turu":"saf_cbd","doz":"400 mg single dose","titrasyon":"None","sure":"Single dose (within 48 hours before the scan)","sonuc":"The primary outcome (change on the fear subscale of the Visual Analog Mood Scale from before to 2–4 hours after the drug) did not differ between groups (−19.1 vs. −15.0; p = 0.37). In a secondary comparison, the fear score 2–4 hours after the drug was lower in the CBD group (T score 51.5 vs. 58.0; p = 0.02); this was not the prespecified main outcome. Funded by two foundation grants","yan_etki":"No grade 3–4 side effects; in the CBD group, grade 1 nausea in 1 person, grade 2 nausea and pain in 1 person","pmid":"39680411","doi":"10.1001/jamanetworkopen.2024.50391","diger_kaynak":"ClinicalTrials.gov NCT04482244 (results in the registry)"},{"ad":"de Andrade Silva 2024","tasarim":"Double-blind, placebo-controlled RCT","n":"Not in the abstract (full text could not be read)","populasyon":"Dental patients scheduled for root canal treatment (Brazil, Recife); an anxiety disorder diagnosis was not required","urun":"CBD-rich cannabis extract, by mouth (THC content not in the abstract)","urun_turu":"cbd_zengin_thc_belirsiz","doz":"Not in the abstract","titrasyon":"None","sure":"Single dose (before the procedure); pain followed for 7 days","sonuc":"No significant difference between CBD and placebo in dental anxiety (Modified Dental Anxiety Scale and visual analog scale) at the start of and during the procedure; mean anxiety scores were slightly higher in the CBD group at every measurement (5.06 vs. 3.07 before the procedure). No difference in pain after the procedure either","yan_etki":"Not reported (in the abstract)","pmid":"39505200","doi":"10.1016/j.joen.2024.10.010","diger_kaynak":null},{"ad":"Winkler 2025","tasarim":"RCT, 3 arms (CBD oil / placebo oil / no treatment)","n":"180 randomized (CBD oil 59, placebo oil 61, no treatment 60); 166 analyzed (52/58/56)","populasyon":"Stressed university students at risk of depression (Germany); an anxiety disorder diagnosis was not required","urun":"10% full-spectrum CBD oil (over-the-counter product; 1000 mg of CBD in 10 mL, a small amount of THC, amount not reported); placebo hemp seed oil","urun_turu":"cbd_zengin_thc_belirsiz","doz":"By body weight: 0.02 mg/kg on day 1, 1 mg/kg on day 30 (about 1.7–85 mg a day for 85 kg)","titrasyon":"Increase every three days (0.02 → 1 mg/kg)","sure":"30 days","sonuc":"No difference among the three groups on the secondary outcome of anxiety symptoms (DASS-21 anxiety subscale); no difference between CBD oil and placebo oil on any outcome. On the primary outcomes of stress and depression symptoms, both oil groups improved more than the group that received nothing; the authors attribute the improvement largely to the placebo effect","yan_etki":"Not reported (side effects were asked about on day 30, but the paper does not give the results)","pmid":"41316488","doi":"10.1186/s42238-025-00366-9","diger_kaynak":"German Clinical Trials Register DRKS00030971 (preregistered on December 22, 2022)"},{"ad":"Crippa 2021","tasarim":"Open-label RCT (CBD + standard care vs. standard care alone; no placebo; only assessors blinded)","n":"120 randomized (61 CBD, 59 control); 118 analyzed","populasyon":"Frontline healthcare workers during COVID-19","urun":"Pure CBD (99.6%), 150 mg/mL in MCT oil","urun_turu":"saf_cbd","doz":"300 mg/day (2 × 150 mg)","titrasyon":"None","sure":"28 days","sonuc":"The emotional exhaustion score decreased on days 14, 21 and 28; GAD-7 fell by an average of 2.79 points from baseline on day 28 (95% CI 1.03–4.56; secondary outcome; group × time interaction p = 0.001). There was no placebo and participants knew what they were taking. 7 of the 24 authors hold or have applied for patents related to CBD compounds (the patents are outside the subject of this study); the CBD was donated by a company","yan_etki":"5 serious side effects, all in the CBD group: 4 liver enzyme elevations (1 critical, 3 mild), 1 severe drug rash; CBD was stopped in 2 people, both recovered fully. The most common side effects (sleepiness, tiredness) were similar in both groups","pmid":"34387679","doi":"10.1001/jamanetworkopen.2021.20603","diger_kaynak":"ClinicalTrials.gov NCT04504877 (no results in the registry); 3-month follow-up publication: Souza 2022, in this table"},{"ad":"Souza 2022","tasarim":"Non-randomized comparison: CBD group from Crippa 2021, control group from a separate observational study in the same period; 3 months of follow-up","n":"300 at baseline (100 CBD, 200 control); 150 completed 3 months (71/79)","populasyon":"Healthcare workers","urun":"Oral CBD","urun_turu":"saf_cbd","doz":"300 mg/day","titrasyon":"None","sure":"28 days of treatment + follow-up","sonuc":"The reduction in GAD-7 compared with the control group lasted until 1 month after treatment ended (time × group interaction at weeks 2, 4 and 8, p = 0.006–0.04). The control group came from a separate observational study in the same period; no randomization or blinding. 7 of the 23 authors hold or have applied for patents related to CBD compounds (outside the subject of the study); the CBD was donated by a company","yan_etki":"No new side effect data in this publication (refers to Crippa 2021)","pmid":"36263136","doi":"10.3389/fphar.2022.856846","diger_kaynak":"Main trial: Crippa 2021 (NCT04504877), in this table"},{"ad":"Bidwell 2024","tasarim":"Quasi-experimental study: participants who would use cannabis were randomly assigned to one of three product types; the non-using comparison group was self-selected; no placebo, participants bought their products themselves from a dispensary (only researchers blinded)","n":"300 analyzed (258 cannabis users: THC-dominant 86, CBD-dominant 92, THC+CBD 80; 42 non-users)","populasyon":"Adults with at least mild anxiety (GAD-7 ≥ 5) who wanted to use cannabis to cope with anxiety (US, Colorado)","urun":"Cannabis flower from the legal market: THC-dominant (24% THC, <1% CBD), THC+CBD (12%/12%) or CBD-dominant (<1% THC, 24% CBD)","urun_turu":"thc_iceren","doz":"Free use (ad libitum); average use 3–4 days a week","titrasyon":"None (participants adjusted it themselves)","sure":"4 weeks (a single at-home use session at the end)","sonuc":"Over 4 weeks, anxiety decreased in all groups (including non-users) (DASS anxiety). The three cannabis-using groups reported feeling more improvement than non-users (a single-item global impression scale), but there was no difference among the four groups on the DASS subscales. Only among users, and after accounting for frequency of use, CBD-dominant flower was linked to a slightly larger drop in DASS anxiety than THC-dominant flower (difference −1.03; SE 0.45; p = 0.02). Right after use, the CBD-dominant product reduced tension; THC-dominant and THC+CBD products slightly increased suspiciousness (paranoia). No placebo, and participants knew their products; the authors write that expectation may have affected the results. Public funding (US National Institute on Drug Abuse); the authors reported no conflicts of interest","yan_etki":"With THC-dominant and THC+CBD flower, a slight increase in suspiciousness right after use; 4 weeks of use did not increase anxiety","pmid":"38252547","doi":"10.1089/can.2023.0187","diger_kaynak":"ClinicalTrials.gov NCT03491384 (registered as an observational cohort; results in the registry). Other publications of the same study: Rosa 2026 (PMID 41752306; 30-day daily diary with flower and edible products, 345 people), Skrzynski 2025 (PMID 40522823), Lisano 2025 and 2026 (PMID 40667474, 41864773), Martin-Willett 2024 (PMID 39458976), Chen 2025 (PMID 38608236)"},{"ad":"Berger 2022","tasarim":"Open-label, no control group","n":"31","populasyon":"Young people aged 12–25 with treatment-resistant anxiety disorder (no response to CBT and/or an antidepressant)","urun":"Pure CBD capsule (200 mg, purity >99.9%), add-on treatment","urun_turu":"saf_cbd","doz":"200–800 mg/day (at week 12, 19 people on 800, 9 on 600, 1 on 400 mg/day)","titrasyon":"Started at 200 mg/day; if improvement was inadequate, increased in 200 mg steps; upper limit 400 at week 1, 600 at week 4, 800 mg/day at week 8; after 12 weeks, tapered off over 1 week","sure":"12 weeks","sonuc":"OASIS 10.8 → 6.3 (−42.6%); depression, CGI and functioning improved; at least a 50% reduction in 12 of 30 people. After treatment ended, the improvements did not last at week 26. Because there was no control group and usual treatment (therapy, antidepressants) continued, the effect cannot be attributed to CBD alone","yan_etki":"Side effects in 80.6% (drug-related or possibly drug-related in 61.3%): tiredness, low mood, appetite change, sleepiness, nausea, diarrhea, dry mouth, insomnia, hot flashes/chills; all mild to moderate, no serious side effects","pmid":"35921510","doi":"10.4088/JCP.21m14130","diger_kaynak":"ANZCTR ACTRN12617000825358"},{"ad":"Dahlgren 2022","tasarim":"Open-label (first phase of a phase 2 study)","n":"15 enrolled, 14 analyzed","populasyon":"Outpatients with moderate to severe anxiety","urun":"Full-spectrum sublingual solution (9.97 mg/mL CBD, 0.23 mg/mL THC)","urun_turu":"thc_iceren","doz":"1 mL 3 times a day (target 30 mg CBD + <1 mg THC/day); actual use average 34.7 mg CBD + 0.8 mg THC/day","titrasyon":"None","sure":"4 weeks","sonuc":"Reduction in BAI and OASIS (no control)","yan_etki":"Sleepiness/tiredness, increased energy, dry mouth (each in 3 of 14 people); no severe side effects, intoxication or serious side effects; urine THC test positive in 7 of 14 patients at week 4 (Dahlgren 2021)","pmid":"36352103","doi":"10.1038/s43856-022-00202-8","diger_kaynak":"ClinicalTrials.gov NCT02548559 (this study is the open-label phase 1 of the trial; results of the double-blind phase 2 are in the registry, a separate row in this table). Urine THC test in the same 14 patients: Dahlgren 2021, PMID 33146684"},{"ad":"Smith 2025","tasarim":"Open-label pilot (funded by the product manufacturer Charlotte's Web)","n":"15 enrolled, 12 completed","populasyon":"Patients diagnosed with GAD (DSM-5) with at least moderate anxiety","urun":"Hemp-derived full-spectrum sublingual solution (31.52 mg/mL CBD, 0.77 mg/mL THC)","urun_turu":"thc_iceren","doz":"0.5 mL twice a day (target 30 mg CBD/day; actual average 31.3 mg CBD + 0.6 mg THC/day)","titrasyon":"None (fixed dose)","sure":"6 weeks","sonuc":"Anxiety decreased; mood, sleep and quality of life improved (no control)","yan_etki":"3 moderate side effects (decreased libido, nausea, weight gain; 1 person each); no serious side effects. Urine THC metabolite positive in half of the patients","pmid":"40868129","doi":"10.3390/biomedicines13081874","diger_kaynak":"ClinicalTrials.gov NCT04286594 (terminated early by the sponsor, McLean Hospital; results in the registry)"},{"ad":"Stanley 2023","tasarim":"Double-blind, placebo-controlled RCT","n":"32","populasyon":"University students with high test anxiety","urun":"Oral CBD-rich extract (CHI-907, Canopy Growth; product description from the registration, no THC content in the registration; the full text of the paper could not be read); placebo oil (CHI-804)","urun_turu":"cbd_zengin_thc_belirsiz","doz":"150 / 300 / 600 mg single dose","titrasyon":"None","sure":"Single session (statistics exam)","sonuc":"No effect compared with placebo on test anxiety or general anxiety at any dose; the experimental setup successfully induced test anxiety. One of the 4 authors is an employee of a cannabis company (Canopy Growth)","yan_etki":"Not reported (in the abstract)","pmid":"35861792","doi":"10.1089/can.2022.0062","diger_kaynak":"Registration: ClinicalTrials.gov NCT04269252 (no registration number in the paper's abstract or in the readable metadata; matched by sponsor, partner university, title, number of participants and dose groups; sponsor Canopy Growth, partner institution James Madison University; 32 people, three single doses and placebo; the registration describes the product as a 'CBD-rich extract' CHI-907; terminated when recruitment became difficult because of COVID; no results in the registry)"},{"ad":"Bloomfield 2022","tasarim":"Double-blind, placebo-controlled, crossover; fMRI","n":"24","populasyon":"Healthy","urun":"Synthetic pure CBD capsule","urun_turu":"saf_cbd","doz":"600 mg single dose","titrasyon":"None","sure":"Single dose, 2.5 hours before testing; two sessions an average of 9.5 days apart","sonuc":"No effect on brain responses, emotion processing or experimental anxiety","yan_etki":"Side effects not systematically reported; no difference in heart rate or blood pressure","pmid":"35445839","doi":"10.1007/s00213-022-06070-3","diger_kaynak":null},{"ad":"Hundal 2018","tasarim":"Double-blind RCT, virtual reality","n":"32","populasyon":"Non-clinical volunteers with high paranoia proneness","urun":"Oral CBD","urun_turu":"saf_cbd","doz":"600 mg single dose","titrasyon":"None","sure":"Single session","sonuc":"No effect on anxiety or paranoia; trend toward increased anxiety (p=0.09)","yan_etki":"Not reported (in the abstract)","pmid":"29086614","doi":"10.1177/0269881117737400","diger_kaynak":null},{"ad":"Crippa 2004","tasarim":"Double-blind, crossover RCT, SPECT","n":"10","populasyon":"Healthy men","urun":"Oral CBD","urun_turu":"saf_cbd","doz":"400 mg single dose","titrasyon":"None","sure":"2 sessions, 1 week apart","sonuc":"Subjective anxiety decreased; blood flow changed in limbic regions","yan_etki":"Increased 'mental sedation'","pmid":"14583744","doi":"10.1038/sj.npp.1300340","diger_kaynak":null},{"ad":"Rudisill 2023","tasarim":"Double-blind RCT (feasibility)","n":"40 (21 CBD, 19 placebo)","populasyon":"Healthy university students","urun":"Commercial CBD oil (THC 0.006% in independent analysis)","urun_turu":"saf_cbd","doz":"300 mg single dose","titrasyon":"None","sure":"Testing after 120 min","sonuc":"Subjective anxiety did not change; attention lapse duration longer with CBD (76 vs. 66 ms)","yan_etki":"Participants reported no side effects; on testing, attention lapse duration increased (a sign of mild impairment in alertness)","pmid":"36625844","doi":"10.1111/fcp.12868","diger_kaynak":null},{"ad":"Das 2013","tasarim":"Double-blind, placebo-controlled, fear conditioning","n":"48","populasyon":"Healthy","urun":"Vaporized CBD (as reported by Kwee 2022; the full text of Das was not read)","urun_turu":"saf_cbd","doz":"32 mg","titrasyon":"None","sure":"Before or after extinction","sonuc":"CBD given after extinction enhanced the consolidation of extinction learning (shock expectancy measure)","yan_etki":"Not reported (in the abstract)","pmid":"23307069","doi":"10.1007/s00213-012-2955-y","diger_kaynak":null},{"ad":"Nakano 1978","tasarim":"Double-blind, placebo-controlled lab study (nabilone, diazepam and placebo; single dose)","n":"Not in the abstract (full text could not be read)","populasyon":"Volunteers selected for high trait (personality) anxiety; experimental stress: mirror drawing and the Stroop color-word test","urun":"Nabilone (a synthetic THC-like cannabinoid; not THC); comparison drug diazepam","urun_turu":"cbn_diger","doz":"Nabilone 2 mg or diazepam 5 mg, single dose","titrasyon":"None","sure":"Single-dose sessions","sonuc":"Diazepam reduced the anxiety caused by experimental stress; nabilone also reduced it, but less. The authors write that the doses and durations of action of the two drugs may not be equivalent and that the comparison should be interpreted with caution; the number of participants and statistics are not in the abstract","yan_etki":"Not reported (in the abstract)","pmid":"22419","doi":"10.1002/cpt197823154","diger_kaynak":null},{"ad":"Hutten 2022","tasarim":"Double-blind, placebo-controlled, randomized, 4 conditions in the same people (at least 7 days apart)","n":"26","populasyon":"Healthy occasional marijuana users","urun":"Vaporized marijuana (THC / CBD / THC+CBD / placebo; THC <1% in the CBD-rich variety as well)","urun_turu":"thc_iceren","doz":"13.75 mg CBD; 13.75 mg THC","titrasyon":"None","sure":"Single sessions","sonuc":"THC+CBD caused less anxiety than THC alone; if baseline anxiety was high, CBD did not prevent the anxiety caused by THC","yan_etki":"THC and THC+CBD increased state anxiety","pmid":"36227352","doi":"10.1007/s00213-022-06248-9","diger_kaynak":null},{"ad":"Childs 2017","tasarim":"Double-blind, placebo-controlled RCT (3 parallel dose groups; each participant had 2 sessions, with a stressful and a non-stressful task)","n":"42 (placebo 13, 7.5 mg 14, 12.5 mg 15)","populasyon":"Healthy young adults (aged 18–40; no mental disorder, using cannabis at most once a week; those who had experienced anxiety with cannabis were excluded); Trier Social Stress Test (speech in front of a panel and mental arithmetic)","urun":"Oral dronabinol (synthetic THC; Marinol) capsule; placebo dextrose","urun_turu":"thc_iceren","doz":"7.5 or 12.5 mg single dose (2.5 hours before the tasks)","titrasyon":"None","sure":"2 sessions (5 days apart)","sonuc":"7.5 mg THC made subjective distress after the stress test pass more quickly (total distress over time lower than placebo, p < 0.05; no difference at the peak value, p = 0.18) and led participants to rate the test afterward as less \"stressful\" and \"challenging\". 12.5 mg THC, on the other hand, increased negative mood and anxiety even before the tasks began, raised distress in both the stressful and the non-stressful task, and borderline increased pausing during the speech (p = 0.052). Not tested in people with anxiety disorders; single session","yan_etki":"12.5 mg: increased negative mood, anxiety and mental clouding; the rise in blood pressure during the stress test was blunted. 7.5 mg: slight increase in heart rate","pmid":"28599212","doi":"10.1016/j.drugalcdep.2017.03.030","diger_kaynak":null},{"ad":"Cuttler 2026","tasarim":"Randomized, double-blind, placebo-controlled, parallel-group lab study (3 groups)","n":"120 (56 men, 52 women, 12 nonbinary or trans); group sizes not in the abstract","populasyon":"Adults who use cannabis regularly (US); an anxiety disorder diagnosis was not required","urun":"Vaporized inhaled cannabis: placebo, moderate dose (20 mg THC) or high dose (40 mg THC)","urun_turu":"thc_iceren","doz":"20 or 40 mg THC, single dose (vaporized)","titrasyon":"None","sure":"Single session (60 minutes of follow-up after vaporizing)","sonuc":"The subjective stress score decreased to a similar extent in all three groups (including placebo); the authors interpret this as an effect of expectation, not of cannabis. Cannabis lowered salivary cortisol and the skin conductance response, but the high dose raised heart rate more than placebo; no effect on heart rate variability. Read only from the abstract; the abstract does not mention a separate stress task. Two of the 7 authors received study materials from a vaporizer manufacturer; the first author has received research funding from cannabis and cannabinoid companies outside this study","yan_etki":"At the high dose (40 mg THC), heart rate significantly higher than placebo during and right after vaporizing","pmid":"42632818","doi":"10.1038/s41386-026-02533-9","diger_kaynak":null},{"ad":"Wilson 2026","tasarim":"Systematic review and meta-analysis of RCTs (1980 to May 13, 2025; PROSPERO CRD42023392718; GRADE)","n":"54 RCTs; 2,477 participants (all mental disorders and substance use disorders)","populasyon":"People whose primary diagnosis is a mental disorder or substance use disorder; anxiety was examined under a separate heading; no separate result for generalized anxiety disorder in the abstract","urun":"CBD, THC, mixtures of THC and CBD, and other cannabinoids","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"For anxiety-related outcomes, no significant difference was found between cannabinoids and placebo (of the anxiety disorder studies, 5 used CBD alone and 1 used THC alone); no result specific to generalized anxiety disorder in the abstract. A significant benefit was seen only in cannabis use disorder, insomnia, tics and Tourette syndrome, and autism; the certainty of the evidence is low for most outcomes, with a high risk of bias in 44% of studies; the authors conclude that routine use of cannabinoids in mental disorders can rarely be justified for now. The correction published in the journal (June 16, 2026) corrected the axis of a figure and the study counts in the table; the results did not change","yan_etki":"Any side effect more common with cannabinoids (OR 1.75; 95% CI 1.25–2.46; number needed to harm 7); no difference in serious side effects or dropping out of the study","pmid":"41856154","doi":"10.1016/S2215-0366(26)00015-5","diger_kaynak":"Correction: Lancet Psychiatry 2026;13(8):e11, PMID 42302809 (June 16, 2026; the axis of a figure and the study counts in the table were corrected, results unchanged)"},{"ad":"Bharat 2026","tasarim":"Systematic review and meta-analysis of experimental and observational studies (up to May 2025; PROSPERO CRD42023467536; GRADE)","n":"82 experimental and 118 observational studies","populasyon":"Adults with ADHD, anxiety, depression, PTSD, psychosis, Tourette syndrome or substance use disorder, or in whom these symptoms were measured","urun":"THC, CBD, a mix of the two and other cannabinoids; medical cannabis","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"In RCTs, cannabinoids reduced anxiety symptoms by a small to moderate amount (SMD −0.40; 95% CI −0.57 to −0.23), but there is very large inconsistency between studies (I² 90%) and most of the anxiety evidence was measured as a secondary outcome in other diseases. The certainty of the evidence is mostly very low; the authors write that the signal for anxiety is limited because of indirect evidence and low certainty, and they do not support cannabinoids as a first-choice treatment. Observational studies suggest improvement but have a high risk of bias","yan_etki":"The only significant safety finding: stopping because of side effects was more common with THC (OR 2.78; 95% CI 1.66–4.65)","pmid":"42617303","doi":"10.1016/j.psychres.2026.117380","diger_kaynak":null},{"ad":"Bilbao 2022","tasarim":"Systematic review and meta-analysis of RCTs split by drug type (8 databases, up to October 2021; PROSPERO CRD42021229932; GRADE)","n":"152 RCTs, 12,123 participants (all indications); 27 placebo-controlled RCTs measuring anxiety (dronabinol 4, nabilone 6, CBD 11, nabiximols 6) and 3 RCTs compared with an active drug","populasyon":"All medical indications; anxiety studies in different diseases and anxiety models","urun":"Dronabinol, nabilone, pure CBD and nabiximols (natural products such as smoked cannabis excluded)","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"With all cannabinoids together, a borderline small reduction in anxiety (SMD −0.19; 95% CI −0.37 to −0.00; p = 0.05); none of the subanalyses by drug type (including CBD) showed significant improvement; for dronabinol SMD −0.03 (−0.47 to 0.41). The quality of the evidence is low or very low. Later RCTs (2022–2026) were not included in this analysis","yan_etki":"Across all indications, the likelihood of any side effect with CBD was higher than with placebo (OR 1.82; 95% CI 1.08–3.07)","pmid":"35982439","doi":"10.1186/s12916-022-02459-1","diger_kaynak":"PROSPERO CRD42021229932"},{"ad":"Raminelli 2025","tasarim":"Systematic review and meta-analysis (21 placebo-controlled RCTs; SAD 5, GAD 1, PTSD 7, OCD 1, Tourette 7)","n":null,"populasyon":"Anxiety-related disorders and Tourette syndrome","urun":"Pure or CBD-rich products","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"Overall effect not significant (SMD −0.40; −0.84/0.03); only in the pure CBD subgroup SMD −0.61 (−1.15/−0.07). The authors: 'low-quality evidence, limited efficacy' for SAD and GAD","yan_etki":null,"pmid":"40956670","doi":"10.1177/25785125251378242","diger_kaynak":null},{"ad":"Han 2024","tasarim":"Systematic review and meta-analysis (8 studies)","n":"316","populasyon":"Anxiety disorders","urun":"CBD","urun_turu":"saf_cbd","doz":null,"titrasyon":null,"sure":null,"sonuc":"Hedges g = −0.92 (95% CI −1.80 to −0.04); very wide confidence interval, small sample","yan_etki":null,"pmid":"38924898","doi":"10.1016/j.psychres.2024.116049","diger_kaynak":null},{"ad":"Kwee 2022 (systematic review)","tasarim":"Systematic review (87 studies, human and animal)","n":null,"populasyon":"Clinical and preclinical anxiety research","urun":"CBD","urun_turu":"saf_cbd","doz":null,"titrasyon":null,"sure":null,"sonuc":"In 70.3% of observations, CBD had no effect on anxiety; no consistent relationship between blood CBD level and effect","yan_etki":null,"pmid":"36239014","doi":"10.1177/02698811221124792","diger_kaynak":null},{"ad":"Rutledge 2026","tasarim":"Systematic review (brain imaging, 12 studies)","n":"146 (7 cohorts)","populasyon":"Stress and anxiety","urun":"CBD","urun_turu":"saf_cbd","doz":null,"titrasyon":null,"sure":null,"sonuc":"Effects on the brain inconsistent; GRADE certainty low to very low","yan_etki":null,"pmid":"42494831","doi":"10.3389/fnimg.2026.1860919","diger_kaynak":null},{"ad":"Rifkin-Zybutz 2023 (UK Medical Cannabis Registry)","tasarim":"Prospective patient registry (no control group); United Kingdom","n":"302 patients with generalized anxiety disorder; data available for 94 of the 150 people who could be assessed at month 6","populasyon":"Adults with a primary diagnosis of generalized anxiety disorder who started a cannabis-based medicine on a specialist's prescription (69% men; 86% had previous or current experience with cannabis; half were taking antidepressants)","urun":"Prescribed cannabis-based medicines: dried flower (vaporized) and/or oil; the most commonly prescribed product was a 20% THC flower with no CBD","urun_turu":"thc_iceren","doz":"At baseline, median daily THC 21 mg, CBD 2 mg; in the 12-month analysis, in flower-only users, median THC 200 mg/day, CBD 10 mg/day","titrasyon":"Prescription adjusted by the physician; no standard schedule","sure":"6 months (12-month analysis of the same patients: Murphy 2024)","sonuc":"GAD-7 fell from baseline by 5.3 points at month 1, 5.5 at month 3 and 4.5 at month 6 (all p < 0.001); clinically meaningful (at least 4 points) improvement in 43.6% of those with data at month 6. In the 12-month analysis of the same 302 patients, when missing data were replaced with the baseline score, mean GAD-7 went from 13.3 to 10.2 at month 12 (Murphy 2024). No control group, most patients were already using cannabis and data loss was high; expectation and selection effects cannot be ruled out. 11 of the 14 authors work for or are former executives of the clinic chain that runs the registry (Sapphire Medical Clinics); one is the medical director of the producer of the most commonly prescribed products (Curaleaf International)","yan_etki":"Over 6 months, 39 patients (12.9%) reported 269 side effects, 11 (3.6%) at least one severe side effect; most common were dry mouth (8.3%), tiredness (7.3%), insomnia (6.3%), sleepiness, lack of energy and nausea (5.3%); no life-threatening side effects. In the 12-month analysis, 55 patients (18.2%) reported a total of 707 side effects","pmid":"37314478","doi":"10.1007/s00213-023-06399-3","diger_kaynak":"Other generalized anxiety analyses of the same registry: Ergisi 2022 (PMID 34937473; first 67 patients), Murphy 2024 (PMID 38155535; same 302 patients, 12 months), Warner-Levy 2024 (PMID 39526700; 302 patients, comparison of product forms), Li 2024 (PMID 38299624; a single producer's products, 120 patients)"},{"ad":"Lee 2022","tasarim":"Observational cohort (records of medical cannabis clinics in Canada, 2014–2019); no control group","n":"84,809 authorized patients; baseline GAD-7 in 37,303, a follow-up measurement in 5,075 (13.6%); analysis in these 5,075 people","populasyon":"Adults authorized to use medical cannabis (Ontario and Alberta; average age 54); 45.6% reported anxiety complaints at baseline","urun":"Medical cannabis (product type and THC/CBD ratios not in the analysis)","urun_turu":"karma","doz":"Not reported","titrasyon":null,"sure":"Average follow-up of about 9 months (up to 3.2 years)","sonuc":"Mean GAD-7 went from 9.11 to 9.04 (mean change −0.23; 95% CI −0.28 to −0.17); statistically significant but clinically unimportant. No change in 90.8% of patients, clinically meaningful improvement in 3.7%, meaningful worsening in 1.3%; the authors write that they found no clinical benefit or harm for anxiety. Follow-up measurements exist only for a small portion and there is no control group. One of the 6 authors is a former board member of a cannabis producer (Aurora Cannabis) and has a financial interest in the company; another previously consulted for a cannabis clinic chain","yan_etki":null,"pmid":"34520280","doi":"10.1177/07067437211043393","diger_kaynak":null},{"ad":"Martin 2021","tasarim":"Observational, prospective online survey study (comparison group of cannabis users and non-users; follow-up every 3 months)","n":"538 (368 users, 170 non-users); at follow-up, 36 new starters, 121 continuing users, 23 who did not start","populasyon":"Adults reporting a diagnosis of anxiety or depression (US; mostly women and white); from the Realm of Caring patient registry","urun":"Medical cannabis products: of those who knew the content, 82% used a CBD-dominant and 23% a THC-dominant product; 26% did not know the content","urun_turu":"karma","doz":"In CBD-dominant products for which a certificate of analysis was obtained, an average of 61 mg of CBD (median 30 mg) and 2.1 mg of THC (median 1 mg) a day by mouth","titrasyon":null,"sure":"Follow-up at 3-month intervals (duration varies by person)","sonuc":"At baseline, there was no difference in anxiety score (HADS) between cannabis users and non-users (the depression score was lower in users). At follow-up, the anxiety score fell by 2.52 points in those who started cannabis (36 people) (p < 0.001) and by 1.40 points in those who continued using it (121 people), and did not change in those who did not start (23 people). No randomization, all measurements self-reported; the authors write that an expectation effect cannot be ruled out. The study was supported by a nonprofit cannabinoid patient foundation (Realm of Caring) and fellowship programs of the US National Institute on Drug Abuse; two of the seven authors have ties to cannabis companies (one is a Canopy Growth employee)","yan_etki":"Side effects were reported more often by people using THC-dominant products (38% vs. 26%); no difference between those using CBD-dominant products and non-users","pmid":"34566726","doi":"10.3389/fpsyt.2021.729800","diger_kaynak":null},{"ad":"Shannon 2019","tasarim":"Retrospective case series (psychiatry clinic, add-on treatment)","n":"72 (47 anxiety, 25 sleep)","populasyon":"Adults","urun":"CBD capsule (provided by CV Sciences; content and THC content not reported)","urun_turu":"cbd_zengin_thc_belirsiz","doz":"25 mg/day in most; 50–75 mg/day in a few patients; 175 mg/day in 1 patient","titrasyon":"No standard schedule; at the physician's discretion","sure":"Monthly follow-up, up to 3 months","sonuc":"In the first month, the anxiety score fell in 57 patients (79.2%) (no control)","yan_etki":"3 patients could not tolerate it: 2 stopped in the first week because of tiredness; in 1 patient with a developmental disorder, CBD was stopped because of increased inappropriate sexual behavior. Mild sedation at first in 3 patients","pmid":"30624194","doi":"10.7812/TPP/18-041","diger_kaynak":null},{"ad":"Feingold 2018","tasarim":"Prospective nationally representative follow-up (US NESARC waves 1 and 2)","n":"3,723 people with any anxiety disorder diagnosis in wave 1","populasyon":"US adults with a diagnosis of social anxiety, panic disorder, generalized anxiety disorder or specific phobia at baseline","urun":"Recreational cannabis use and cannabis use disorder (not given in the study)","urun_turu":"thc_iceren","doz":"Not administered (observational)","titrasyon":null,"sure":"About 3 years between the two interviews","sonuc":"As the level of cannabis use increased, the rate of recovery from anxiety disorder fell, but this association disappeared when baseline factors were taken into account. In people with cannabis use disorder, only a few functioning outcomes were worse (end of a romantic relationship: adjusted OR 3.85; 95% CI 1.66–8.97; repeatedly dropping out of school: adjusted OR 6.02; 95% CI 2.65–13.66); no adjusted differences in suicidal thoughts, general functioning or quality of life. Observational data: does not show cause and effect","yan_etki":null,"pmid":"29486095","doi":"10.1002/da.22735","diger_kaynak":null},{"ad":"Xue 2021","tasarim":"Systematic review and meta-analysis of longitudinal (prospective) studies (MEDLINE, Embase, PsycINFO; up to May 31, 2020)","n":"24 cohort studies; 10 in the quantitative analysis; 4 studies for generalized anxiety disorder","populasyon":"General population and adolescent cohorts (8 countries)","urun":"Recreational cannabis use (contains THC; not given in the studies)","urun_turu":"thc_iceren","doz":"Not administered (observational; frequency of use self-reported)","titrasyon":null,"sure":null,"sonuc":"Cannabis use was weakly but significantly associated with later developing any anxiety condition (OR 1.25; 95% CI 1.01–1.54; 7 studies); when only high-quality studies were included, the association lost significance (OR 1.10; 0.82–1.47). The pooled association for generalized anxiety disorder was not significant (OR 1.44; 95% CI 0.94–2.22; I² 35%; 4 studies). Observational data: does not show cause and effect","yan_etki":null,"pmid":"32909828","doi":"10.1177/0706743720952251","diger_kaynak":null}],"ilgili_ilaclar":["sitalopram","essitalopram","sertralin","fluoksetin","mirtazapin","snri","alprazolam","klonazepam","benzodiazepin","pregabalin","hidroksizin","buspiron"],"son_inceleme":"2026-10-30","arastirma_gecmisi":[{"tarih":"2026-10-19","not":"Page published. This first review examined 20 studies."},{"tarih":"2026-10-21","not":"The full texts of the studies were reread and the information on the page was checked against its sources. Corrected: side effect, product, study design and dose information in the study table; drug interaction notes; the dose range in the studies; the starting and increase summary; the \"Who should be careful\" list; the reported side effects; the evidence summary. Points that could not be verified from the full text went down from 4 items to 3. The years of 7 publications named on the page were corrected to the journal's print year instead of the online publication year. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-27","not":"The official minutes of the decisions of the expert committee of India's drug regulator were found and added as a source; the information that in May 2026 the committee recommended approving the product on condition of a comparative phase 4 study was added. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-28","not":"Display fix: internal working notes left from the previous cleanup were removed; content and evidence did not change."},{"tarih":"2026-10-28","not":"PubMed, Cochrane and ClinicalTrials.gov were systematically searched again in October 2026 (2,159 records in PubMed and 144 in ClinicalTrials.gov; together with an independent second check). Added: 8 controlled studies in patients or people experiencing anxiety or stress (one with results only in the trial registry; most found no difference from placebo), 3 lab studies in volunteers (including those showing THC's two-way effect on stress and anxiety and that its stress-reducing effect is similar to placebo), 3 meta-analyses and 5 observational studies. Older lab experiments and meta-analyses whose question is answered by a newer or larger study or review in the table were not added separately; the second publication reporting the sleep results of the same trial was removed as a separate row and moved to the main study's sources. Corrected: the company ties and unusually small standard error of the large India study, the fact that the match with the drug regulator's minutes is not certain, the patent ties of the Brazilian research group, the trial registrations and urine THC test results of the open-label studies, the statement 'only uncontrolled data exist' for THC-containing products, and the order of the table. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-28","not":"October 2026 additional review: sources found for this page in the searches for other topics were read and incorporated into the page. The product of the exam anxiety study (Stanley 2023) is, according to the trial registration, a CBD-rich extract; the row's product type was corrected accordingly to 'CBD-rich, THC content unclear', and the basis for the registration match was written down. In the row of the 178-person study in India (Gundugurti 2024), the role of the company the authors are affiliated with was corrected according to the conflict of interest statement and the pharmacokinetic publication of the same trial: it is not the company that developed the product, but the company that funded the pharmacokinetic part of the trial. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-30","not":"The correction to the Wilson 2026 meta-analysis published in the journal was read: the results did not change. According to the corrected table, 5 of the anxiety disorder studies were done with CBD alone and 1 with THC alone; this information was added to the page."},{"tarih":"2026-10-31","not":"The last sentence of the page's short summary was rewritten in a calmer, more guiding tone: instead of \"Talk to your doctor before you start.\", it now says whom you can talk with, and about what, if you are considering CBD. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-31","not":"The evidence level text now uses the same level name as the top of the page; the level and the result did not change."}]},{"id":"panic-attacks","baslik":"Panic disorder","grup":"Anxiety and mental health","grup_kodu":"kaygi","tr_id":"kaygi-panik-bozuklugu","kanit_duzeyi":"yetersiz","kanit_yonu":"veri_yok","kanit_ozet":"No RCT testing CBD on its own in panic disorder was found. In treatment-resistant panic disorder and social anxiety, adding 300 mg of CBD to exposure therapy gave no benefit. In a study in healthy volunteers using inhalation of 10% CO₂ (a panic model), no effect was seen at any dose. The review reporting a positive result (Soares 2017) relies on animal, healthy volunteer and social anxiety patient data; it includes no panic disorder patients. The two most recent reviews gathering cannabinoid RCTs in mental health conditions add no new data for panic disorder: in a meta-analysis of 54 RCTs, there was no significant difference between cannabinoids and placebo in anxiety-related outcomes, and no separate result is given for panic disorder (Wilson 2026; certainty of evidence low for most outcomes); a scoping review of RCTs found no RCT targeting panic disorder (Cooling 2026). There is no treatment study of THC-containing products in panic disorder. Prospective observational studies looking at whether panic disorder develops later with recreational cannabis use are conflicting: in a cohort followed from adolescence to young adulthood, cannabis use and dependence were associated with panic disorder, but the association disappeared once daily smoking and other substance dependencies were taken into account (Zvolensky 2008); in adults in the Netherlands, the association was not significant after adjustment (van Laar 2007); one analysis from the US national follow-up (NESARC) found that weekly use predicted panic disorder with agoraphobia (Cougle 2015; the size of the risk is not in the abstract), while another from the same data found no significant association between cannabis dependence and panic disorder and, conversely, showed that people with panic disorder at baseline started cannabis more often (Feingold 2016); in a meta-analysis pooling van Laar 2007, Zvolensky 2008 and Feingold 2016 from these three cohorts, the association was not significant (OR 1.52; 95% CI 0.96–2.40; Xue 2021). In patients being treated for panic disorder, using cannabis at least once a month did not change the effect of treatment on panic symptoms (Bricker 2007; observational secondary analysis of a trial). October 2026 search (PubMed, Cochrane, ClinicalTrials.gov): 2 controlled studies with cannabinoids on this topic were found (one with CBD added to therapy in patients, one a lab study in healthy volunteers; the fear-conditioning substudy of the first was published separately and is mentioned in the main study’s row in the table); there are no controlled studies with THC-containing products, no Cochrane review, and no study with registered but unpublished results. Besides these, the table has 2 recent reviews gathering cannabinoid trials in mental health conditions, 1 meta-analysis on cannabis use and panic disorder risk, 5 observational studies and 1 narrative review.","kanit_duzeyi_metin":"Insufficient","kanit_duzeyi_thc_icerenler":"yetersiz","kanit_duzeyi_thc_icerenler_metin":"Insufficient: no treatment studies; findings on cannabis use come only from observational studies","kaynak_dosya":"kaygi-panik.md","saf_cbd_sonuc":"There is no controlled human study showing an effect of pure CBD in panic disorder; the existing controlled data are negative.","thc_icerenler_sonuc":"No treatment study of THC-containing products (cannabis, THC, nabilone, dronabinol, a mouth spray containing THC and CBD) in panic disorder was found. The results of observational studies following recreational cannabis use over years do not agree with each other: in some, panic disorder was later seen more often in cannabis users, in others it was not; in the analysis pooling three follow-up studies, the link was not statistically clear. In one study the link disappeared once smoking was taken into account; in another, people with panic disorder were more likely to start cannabis later, meaning the link may go both ways. There is no evidence for treatment; because the findings on risk are only observational and conflicting, they are weak and do not show cause and effect.","ruhsat":null,"doz_araligi_ozet":"In controlled studies, 300 mg (before a therapy session) and 150–600 mg single doses","titrasyon_ozet":null,"yan_etkiler":["Kwee 2022 (300 mg, 8 doses): no serious side effects; side effect rate similar to placebo (10.3% vs 15.4%)"],"izlem":["With long-term use, monitoring of liver tests is the physician’s decision"],"dikkat":["Bipolar disorder: in mania, 600–1200 mg/day of CBD was ineffective in 2 patients (Zuardi 2010, PMID 18801823); in bipolar depression, 150–300 mg/day was not superior to placebo and no increase in mania was seen (Pinto 2024, PMID 37920963); there is no evidence that CBD works in treating mania","History of psychosis: no controlled data were found showing that CBD alone triggers psychosis, but in people with a strong tendency toward paranoia, 600 mg showed a trend toward increased anxiety (Hundal 2018, PMID 29086614); the main risk is THC-containing products. A person with a history of psychosis should not use CBD without consulting a physician (this is a precautionary recommendation, not a direct study result)","Pregnancy and breastfeeding: no human studies show it is safe; signals of harm to prenatal development in animals (Sarrafpour 2020, PMID 32524214; Argueta 2020, PMID 32425793)","Driving: 13.75 mg of vaporized CBD-dominant marijuana did not impair driving, but clinically important impairment could not be fully ruled out; CBD did not prevent THC’s driving-impairing effect; lapses in attention lasted longer after 300 mg of oral CBD (Arkell 2020, PMID 33258890; Rudisill 2023, PMID 36625844)","Liver: in healthy adults, ALT/AST >3×ULN in 5.6% with 5 mg/kg/day (Florian 2025, PMID 40622698); with 300 mg/day, 4 liver enzyme elevations, 1 of them critical (Crippa 2021, PMID 34387679)","Young people (ages 12–25): the only data are open-label, with side effects in 80.6% of participants (Berger 2022, PMID 35921510); an interaction has been shown with citalopram/escitalopram, which are commonly used at this age","Allergic skin reaction: 1 severe drug rash with 300 mg/day (Crippa 2021, PMID 34387679)","Athletes: in the urine of healthy volunteers who used 150 mg a day of broad-spectrum CBD oil for 10 weeks, CBG and CBDV, which are prohibited under WADA’s 2026 list, were detected (42% and 68% of pre-exercise samples, 74% and 84% of post-exercise samples); THC was not detected. CBDV was not listed on the product’s certificate of analysis (Gillham 2026, PMID 40920736)","No study has shown that CBD is a first-line treatment for anxiety disorder"],"ilac_etkilesim_notlari":["Citalopram/escitalopram: when CBD (200–800 mg/day) was added, citalopram blood levels rose significantly in 6 patients; in the lab, breakdown via CYP3A4 and CYP2C19 was inhibited (Anderson 2021, PMID 34121064)","Sertraline, fluoxetine, mirtazapine: in the lab, CBD affected breakdown very little; not measured in patients (Anderson 2021, PMID 34121064)","In people taking serotonergic antidepressants, CBD affected the re-extinction of subjective fear worse than placebo (Kwee 2024, substudy of the Kwee 2022 trial; exploratory subgroup)","Clobazam: in 13 children with epilepsy, the active metabolite N-desmethylclobazam rose by an average of 500%; the rise in clobazam itself (average 60%) was uncertain (confidence interval −2 to 91). In healthy volunteers, clobazam did not change and the metabolite rose ~3-fold (FDA/EMA). In 10 of 13 patients, side effects resolved when the clobazam dose was reduced (Geffrey 2015, PMID 26114620)","Other benzodiazepines (alprazolam, clonazepam, etc.): no direct interaction study in an anxiety population was found","THC-containing products: CBD does not consistently reduce THC’s effects; full-spectrum products may contain THC (e.g., 0.23 mg/mL)","Antipsychotic + 1000 mg/day CBD (schizophrenia) was well tolerated (McGuire 2017, PMID 29241357)","No direct interaction study was found with venlafaxine, duloxetine, pregabalin, buspirone or hydroxyzine"],"dogrulanamayan":["Kwee 2024 and Leen-Feldner 2025 from the PubMed abstract only (full text not accessible; tried again on October 27, 2026, paywalled at the publisher); the other studies were checked against the full text (October 19, 2026). Wilson 2026, Cougle 2015, Feingold 2016, van Laar 2007 and Bricker 2007, added in October 2026, were also read from the abstract only (the panic disorder results of Feingold 2016 and van Laar 2007 from the table in Xue 2021); the correction to Wilson 2026 published in the journal was read on October 29, 2026: only the axis of one figure and the study counts in a table were corrected, and the results did not change; according to the corrected table, 5 of the anxiety disorder studies were done with CBD alone and 1 with THC alone. Leen-Feldner 2025 has 84 participants in its registration and 61 in its publication; the difference is not explained in the abstract. The product of Leen-Feldner 2025 (CHI-554) is not described in the open parts of the publication; the registration says 'hemp-derived CBD in MCT oil', and the full text of another study with the same product code states that the product is a CBD isolate (October 28, 2026)","The only registered study that also covers panic disorder is NCT03549819 (GAD/SAD/panic, CBD 200–800 mg/day): its status has not been updated since 2023, and there are no results; NCT04569760 was canceled before it started. The status of NCT04726475, which was to test a CBD-rich cannabis oil with a 35% CO₂ test in volunteers who fear bodily sensations, has not been updated since January 2022; its protocol was published in 2022, but there is no results record or results publication (checked on October 27, 2026)"],"calismalar":[{"ad":"Kwee 2022 (RCT)","tasarim":"Double-blind, placebo-controlled parallel RCT, 3 centers","n":"80 (39 CBD, 41 placebo)","populasyon":"Treatment-resistant panic disorder + agoraphobia or social anxiety disorder","urun":"Synthetic CBD (purity >99.9%; STI/THC Pharm), capsule; placebo lactose","urun_turu":"saf_cbd","doz":"300 mg, about 2 hours before each exposure session (8 doses in total)","titrasyon":"None","sure":"8 weekly sessions (1 a week); 3- and 6-month follow-up","sonuc":"On the primary outcome (Fear Questionnaire, FQ), no difference over time between CBD and placebo in the outcome of exposure therapy (all patients β = 0.32; 95% CI −0.60 to 1.25; looking at diagnostic groups separately β = −0.11; −1.62 to 1.40); no difference on panic scales (PDSS, ACQ, MI) either. The placebo group improved numerically more","yan_etki":"No serious side effects; side effect rate similar (CBD 4/39, 10.3%; placebo 6/39, 15.4%): with CBD, dizziness, sleepiness, tiredness","pmid":"35561538","doi":"10.1016/j.euroneuro.2022.04.003","diger_kaynak":"Protocol: van der Flier 2019, PMID 30760241 (Netherlands Trial Register NTR5100); fear-conditioning substudy: Kwee 2024, PMID 38044339 (69 patients, after the first single 300 mg dose: CBD reduced threat expectancy and did not increase re-extinction of fear; in an exploratory subgroup analysis, re-extinction of subjective fear was worse with CBD than with placebo in people taking serotonergic antidepressants, and safety learning was impaired in women taking antidepressants)"},{"ad":"Leen-Feldner 2025","tasarim":"Double-blind, placebo-controlled RCT, 4 groups (healthy volunteer lab study)","n":"61 analyzed (actual enrollment in the ClinicalTrials.gov registration 84 people; the difference is not explained in the abstract, and the full text could not be read)","populasyon":"Healthy young adults; 10% CO₂ inhalation (panic model)","urun":"Oral hemp-derived CBD in MCT oil (CHI-554; the product was donated by the sponsor Canopy Growth), 90 min before the CO₂ test; placebo MCT oil. The publication’s methods section could not be read; in the publication of another study whose registration lists the same product code (CHI-554) and which was funded by the same company, the product is described as CBD isolate in MCT oil (Wolinsky 2026, NCT05317507)","urun_turu":"saf_cbd","doz":"150 / 300 / 600 mg single dose","titrasyon":"None","sure":"Single session","sonuc":"No difference from placebo at any dose in fear, panic symptoms or heart rate. The study was supported by a CBD manufacturer (Canopy Growth); three of the authors are company employees","yan_etki":"Not reported (in the abstract; the full text could not be read)","pmid":"36241853","doi":"10.1007/s00213-022-06258-7","diger_kaynak":"ClinicalTrials.gov NCT04577612 (84 people enrolled in the registration; no results entered)"},{"ad":"Soares 2017","tasarim":"Narrative review (PubMed, 1990–July 2015)","n":null,"populasyon":"Animal studies, healthy volunteers and social anxiety patients; no panic disorder patients","urun":"CBD","urun_turu":"saf_cbd","doz":null,"titrasyon":null,"sure":null,"sonuc":"The authors suggest that CBD has an anti-panic effect; but they state that there are no studies in panic disorder patients and that the dose range is unknown","yan_etki":null,"pmid":"27157263","doi":"10.2174/1570159x14666160509123955","diger_kaynak":null},{"ad":"Wilson 2026","tasarim":"Systematic review and meta-analysis of RCTs (1980–May 13, 2025; PROSPERO CRD42023392718)","n":"54 RCTs; 2477 participants (all mental disorders and substance use disorders)","populasyon":"People whose primary diagnosis is a mental disorder or a substance use disorder; anxiety was examined under a separate heading; no separate result for panic disorder in the abstract","urun":"CBD, THC, THC and CBD combinations and other cannabinoids","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"No significant difference was found between cannabinoids and placebo in anxiety-related outcomes (of the anxiety disorder studies, 5 used CBD alone and 1 used THC alone); no result specific to panic disorder in the abstract. Significant benefit was seen only in cannabis use disorder, insomnia, tics and Tourette syndrome, and autism; certainty of evidence low for most outcomes, high risk of bias in 44% of studies. The correction published in the journal (June 16, 2026) corrected the axis of a figure and the study counts in the table; the results did not change","yan_etki":"Any side effect more common with cannabinoids (OR 1.75; 95% CI 1.25–2.46; number needed to harm 7); no difference in serious side effects or dropping out of the study","pmid":"41856154","doi":"10.1016/S2215-0366(26)00015-5","diger_kaynak":"Correction: Lancet Psychiatry 2026;13(8):e11, PMID 42302809 (June 16, 2026; the axis of a figure and the study counts in the table were corrected, results unchanged)"},{"ad":"Cooling 2026","tasarim":"Scoping review of RCTs (PubMed, Web of Science, PsycINFO; 1980–2024; patients with DSM-5 diagnoses)","n":"28 RCTs (12 mental health conditions); 3 RCTs in anxiety disorders","populasyon":"Patients with a DSM-5 mental disorder diagnosis; in anxiety disorders, 2 social anxiety studies and Kwee 2022, which also included patients with panic disorder with agoraphobia","urun":"Pure CBD, mouth sprays containing THC and CBD, cannabis flower containing THC/CBD","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"The authors write that they found no RCT targeting panic disorder and see this as an example of the gap between cannabis prescribing in clinics and the evidence. They assessed Kwee 2022 under anxiety disorders: CBD did not change the outcome of exposure therapy. None of the studies reviewed showed long-term efficacy","yan_etki":"For Kwee 2022: side effect rate CBD 10.3%, placebo 15.4%","pmid":"41343139","doi":"10.1007/s40261-025-01501-3","diger_kaynak":null},{"ad":"Xue 2021","tasarim":"Systematic review and meta-analysis of longitudinal (prospective) studies (MEDLINE, Embase, PsycINFO; up to May 31, 2020)","n":"24 cohort studies; 10 in the quantitative analysis; 3 studies for panic disorder","populasyon":"General community and adolescent cohorts (8 countries)","urun":"Recreational cannabis use (contains THC; not given in the studies)","urun_turu":"thc_iceren","doz":"Not applied (observational; frequency of use self-reported)","titrasyon":null,"sure":"Follow-up of up to 20 years in the studies","sonuc":"Cannabis use was weakly but significantly associated with later development of any anxiety condition (OR 1.25; 95% CI 1.01–1.54; 7 studies); when only high-quality studies were included, the association lost significance (OR 1.10; 0.82–1.47). For panic disorder, the pooled association was not significant (OR 1.52; 95% CI 0.96–2.40; I² 0%; 3 studies: van Laar 2007, Zvolensky 2008 and Feingold 2016; all three are separate rows in the table). Observational data: does not show cause and effect","yan_etki":null,"pmid":"32909828","doi":"10.1177/0706743720952251","diger_kaynak":null},{"ad":"Zvolensky 2008","tasarim":"Prospective community cohort (Oregon Adolescent Depression Project), 3 assessments","n":"1709 adolescents at the start; 1507 (about 1 year later); 941 (at age 24); 52 people with a prior history of panic excluded from the analysis","populasyon":"High school students in the USA (western Oregon), followed into young adulthood","urun":"Recreational cannabis use, abuse and dependence (not given in the study)","urun_turu":"thc_iceren","doz":"Not applied (observational; diagnostic interview)","titrasyon":null,"sure":"From a mean age of 16.6 to 24.2 (about 8 years)","sonuc":"Without taking other factors into account, cannabis use (OR 2.6; 95% CI 1.04–6.5) and cannabis dependence (OR 4.9; 1.7–14.0) were associated with later development of panic disorder; similar for panic attacks (use OR 2.5; dependence OR 3.7). Once daily smoking and other substance dependence were taken into account, cannabis had no additional association; daily smoking, on the other hand, was clearly associated with panic disorder (OR 4.8; 1.9–12.2). Few new cases of panic disorder (21)","yan_etki":null,"pmid":"18076905","doi":"10.1016/j.jpsychires.2007.10.012","diger_kaynak":null},{"ad":"Cougle 2015","tasarim":"Prospective nationally representative follow-up (US NESARC waves 1 and 2, 3 years apart)","n":"43,093 (wave 1); 34,653 (wave 2)","populasyon":"US general adult population","urun":"Regular recreational cannabis use (weekly in the past year) (not given in the study)","urun_turu":"thc_iceren","doz":"Not applied (observational)","titrasyon":null,"sure":"About 3 years","sonuc":"Weekly cannabis use in the past year predicted the new onset of panic disorder with agoraphobia over about 3 years of follow-up (also for social phobia and bipolar disorder); the size of the risk and the factors taken into account in the analysis are not in the abstract, and the full text could not be read. Feingold 2016, done with the same national data, did not find a significant association of starting cannabis with anxiety disorders or of cannabis dependence with panic disorder; cannabis use was defined differently in the two analyses. Observational data: does not show cause and effect","yan_etki":null,"pmid":"26022838","doi":"10.1016/j.jpsychires.2015.05.004","diger_kaynak":null},{"ad":"Feingold 2016","tasarim":"Prospective nationally representative follow-up (US NESARC waves 1 and 2)","n":"34,653 people who took part in both waves (according to the Xue 2021 table); analysis subsamples not in the abstract","populasyon":"US general adult population; anxiety disorders at the start (generalized anxiety, social anxiety, panic disorder, specific phobia) were taken into account","urun":"Recreational cannabis use and cannabis use disorder (not given in the study)","urun_turu":"thc_iceren","doz":"Not applied (observational)","titrasyon":null,"sure":"3 years","sonuc":"Starting cannabis (starting between the two interviews after never having used it before) was not associated with the new onset of any anxiety disorder over 3 years (adjusted OR 1.12; the confidence interval in the abstract is written inconsistently); similar for cannabis use disorder. The result specific to panic disorder is in the Xue 2021 table: cannabis dependence was not significantly associated with a new panic disorder diagnosis (OR 1.69; 95% CI 0.88–3.25). Conversely, people with panic disorder at the start were more likely to start cannabis during follow-up (adjusted OR 2.2; 95% CI 1.15–4.18); the authors think this may be a kind of attempt at self-medication. Observational data: does not show cause and effect","yan_etki":null,"pmid":"26775742","doi":"10.1016/j.euroneuro.2015.12.037","diger_kaynak":null},{"ad":"van Laar 2007","tasarim":"Prospective community cohort (Netherlands NEMESIS), 3-year follow-up","n":"3854 (adults without a lifetime anxiety disorder at the start)","populasyon":"General adult population ages 18–64 in the Netherlands","urun":"Recreational cannabis use, lifetime (more than 5 times, according to the Xue 2021 table); not given in the study","urun_turu":"thc_iceren","doz":"Not applied (observational; diagnostic interview, CIDI, DSM-III-R)","titrasyon":null,"sure":"3 years","sonuc":"Once other strong factors that could affect the outcome were taken into account, none of the associations between cannabis use and the later first onset of anxiety disorders remained significant. Adjusted OR for panic disorder 1.29 (95% CI 0.61–2.71; according to Xue 2021 Table 1). Observational data: does not show cause and effect","yan_etki":null,"pmid":"17624975","doi":"10.1111/j.1360-0443.2007.01875.x","diger_kaynak":null},{"ad":"Bricker 2007","tasarim":"Secondary analysis of a randomized effectiveness trial (CCAP); cannabis use observational","n":"232 (the number using at least once a month is not in the abstract)","populasyon":"Adults with panic disorder at 6 primary care clinics in the USA","urun":"Recreational cannabis (not given in the study); those using at least once a month were compared with those using less often or not at all","urun_turu":"thc_iceren","doz":"Not applied (observational)","titrasyon":null,"sure":"12-month trial (assessments at months 3, 6, 9 and 12)","sonuc":"Using cannabis at least once a month did not change the effect of collaborative care delivered with cognitive behavioral therapy and medication on panic disorder and social phobia symptoms (interaction p > 0.05). There was an interaction for depression symptoms: monthly users receiving usual care had more depression symptoms, while there was no difference in those receiving collaborative care. Cannabis use was not determined by randomization; the number of monthly-using patients is not in the abstract, and the full text could not be read","yan_etki":null,"pmid":"17096386","doi":"10.1002/da.20248","diger_kaynak":"Main trial: Roy-Byrne 2005, PMID 15753242; follow-up times PMID 15993254"}],"ilgili_ilaclar":["sitalopram","essitalopram","sertralin","fluoksetin","mirtazapin","snri","alprazolam","klonazepam","benzodiazepin","pregabalin","hidroksizin","buspiron"],"son_inceleme":"2026-10-30","arastirma_gecmisi":[{"tarih":"2026-10-19","not":"Page published. In this first assessment, 4 studies were reviewed."},{"tarih":"2026-10-21","not":"The full texts of the studies were reread and the information on the page was checked against its sources. Corrected: outcome, participant, duration and side effect details in the study table; drug interaction notes; the \"Who should be careful\" list; reported side effects; the evidence summary. Points that could not be verified from the full text went down from 3 items to 2. The year of 6 publications named on the page was corrected to the journal’s print year instead of the online publication year. The conclusion and strength of evidence did not change."},{"tarih":"2026-10-22","not":"The names of the finding labels were simplified: the \"Not enough research\" label on this page became \"Not studied enough\". The assessment did not change."},{"tarih":"2026-10-27","not":"PubMed, Cochrane and ClinicalTrials.gov were searched again systematically in October 2026 (665 records in PubMed, 113 in ClinicalTrials.gov). No new controlled study with cannabinoids in panic disorder was found. Added: the two most recent reviews gathering cannabinoid trials in mental health conditions, a meta-analysis on recreational cannabis use and panic disorder risk, and five observational studies; a separate conclusion text and evidence level for THC-containing products ('Insufficient': no treatment studies) were written for the first time. Corrected: the primary outcome numbers and protocol registration of the therapy study, the exploratory findings in the substudy, the registration number of the CO₂ study in healthy volunteers, the participant numbers in the registration and the publication, the fact that it was a lab study and its manufacturer support, and the description of the data the review relies on. The conclusion and the strength of evidence for CBD did not change."},{"tarih":"2026-10-28","not":"Display fix: internal working notes left over from the previous cleanup were removed; content and evidence did not change."},{"tarih":"2026-10-28","not":"October 2026 supplementary review: sources found for this page during the searches for other topics were read and added to the page. The fear-conditioning substudy of the therapy study (Kwee 2022) was removed as a separate row because it is a secondary publication of the same trial; its finding, including the exploratory subgroup result in people taking antidepressants, was moved to the main study’s row. The product of the CO₂ study in healthy volunteers was re-examined: according to the study registration and the publication of another study registered with the same product code, it is a CBD isolate; the article’s own methods section could not be read, and the product type (pure CBD) did not change. The conclusion and strength of evidence did not change."},{"tarih":"2026-10-30","not":"The correction to the Wilson 2026 meta-analysis published in the journal was read: the results did not change. According to the corrected table, 5 of the anxiety disorder studies were done with CBD alone and 1 with THC alone; this information was added to the page."},{"tarih":"2026-10-30","not":"The last sentence of the page's short summary was rewritten in a calmer, more guiding tone: instead of \"Talk to your doctor before you start.\", it now says whom you can talk with, and about what, if you are considering CBD. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-31","not":"The evidence level text now uses the same level name as the top of the page; the level and the result did not change."}]},{"id":"social-anxiety","baslik":"Social anxiety disorder","grup":"Anxiety and mental health","grup_kodu":"kaygi","tr_id":"kaygi-sosyal-kaygi","kanit_duzeyi":"zayif","kanit_yonu":"celiskili","kanit_ozet":"In untreated patients with social anxiety, a single 600 mg dose reduced public speaking anxiety (n=24); a single 400 mg dose reduced subjective anxiety (n=10). In 37 young people aged 18–19, 300 mg/day for 4 weeks was found positive; but the randomization method was not described, 3 people who dropped out were left out of the analysis, side effects were not systematically monitored, and another CBD study by the author (2025, in cats) was retracted for lack of ethics approval (the journal's retraction notice dated June 2026). In treatment-resistant patients, adding 300 mg to exposure therapy gave no benefit (n=80). In healthy volunteers, only the medium dose (300 mg) appeared effective in the speaking test ('inverted U'); this finding could not be repeated in other anxiety models. Other controlled laboratory studies are not consistent either: in patients with Parkinson's disease, a single 300 mg dose reduced anxiety in the speaking test (n=24, crossover; de Faria 2020); in people at high risk of psychosis, 600 mg/day for one week made no significant difference from placebo in anxiety and cortisol response during a social stress test (n=33; Appiah-Kusi 2020); in healthy volunteers, 300–900 mg did not change responses to social exclusion and negative stimuli (n=38; Arndt 2017). All six single-dose laboratory studies with positive results were carried out with the involvement of the same Brazilian research group (Ribeirão Preto); in Zuardi 2017 and Linares 2019, 4 of the 7 authors are inventors on a patent for a CBD derivative. Two studies from other centers (London, Chicago) found no difference between CBD and placebo. These experiments lasted a single session or one week; they do not show the effect on social anxiety in daily life. In a 12-week study in young people without a control group, anxiety scores fell, but no separate result was given for social anxiety (n=31; Berger 2022). Two systematic reviews specific to social anxiety found CBD promising (Fliegel 2022, 7 studies up to June 2021; Andreoli 2026); a meta-analysis pooling 54 RCTs in mental disorders, however, found no significant difference from placebo in anxiety outcomes (Wilson 2026; certainty of evidence low for most outcomes). There is no treatment study of THC-containing products in social anxiety disorder; in healthy volunteers, 12.5 mg of THC increased distress and anxiety in a social stress test, and 7.5 mg slightly reduced distress after the test (n=42; Childs 2017). The link between cannabis use and later development of social anxiety disorder is inconsistent in follow-up studies: in a US national follow-up, regular use predicted new social phobia (Cougle 2015), while in an analysis pooling three follow-up studies the link was not significant (OR 1.12; 95% CI 0.61–2.05; Xue 2021; observational). As of October 2026, the results of three completed social anxiety studies have not been published (the largest with 239 people; NCT05600114). October 2026 search (PubMed, Cochrane, ClinicalTrials.gov): 11 controlled studies with cannabinoids were found on this topic; 4 were in patients with social anxiety disorder (one in a group mixed with panic disorder), 2 in other patient groups (people with Parkinson's disease and people at high risk of psychosis), and 5 in healthy volunteers; the only controlled study with a THC-containing product was also in healthy volunteers. No Cochrane review and no clinical guideline assessing cannabinoids were found. Alongside these, the table includes 1 study without a control group, 1 case report, 4 systematic reviews (2 of them meta-analyses), 1 meta-analysis looking at cannabis use and social anxiety risk, and 1 follow-up study; all are in the table below.","kanit_duzeyi_metin":"Weak: a short-term positive signal, but laboratory results are inconsistent and the only large study (Kwee) was negative","kanit_duzeyi_thc_icerenler":"yetersiz","kanit_duzeyi_thc_icerenler_metin":"Insufficient (for treatment): there is no controlled treatment study of THC-containing products in social anxiety disorder. Findings pointing to increased anxiety are separate: in the only controlled social stress study in healthy volunteers, 12.5 mg of THC increased distress and anxiety, and 7.5 mg slightly reduced distress after the test (42 people, single session); follow-up studies looking at cannabis use and later development of social anxiety disorder are inconsistent, and in an analysis pooling three studies the link was not significant (observational; does not show cause and effect)","kaynak_dosya":"kaygi-panik.md","saf_cbd_sonuc":"Single-dose pure CBD reduced speaking anxiety in some small studies, but was no different from placebo in similar experiments at other centers; in the largest and longest study, it gave no extra benefit on top of therapy.","thc_icerenler_sonuc":"There is no treatment study in social anxiety disorder with THC-containing products (cannabis, THC or dronabinol, a mouth spray containing THC and CBD) or with the THC-like synthetic drug nabilone. In a single-session study of 42 healthy volunteers, 12.5 mg of THC taken before a social stress test increased distress and anxiety; 7.5 mg helped distress after the test pass more quickly (Childs 2017). The link between cannabis use and later development of social anxiety disorder is inconsistent in follow-up studies (Cougle 2015; Xue 2021). That the cannabis oil in Masataka 2019 contained no THC rests only on the product's own claim; there is no independent analysis. There is no controlled treatment study showing that THC-containing products ease social anxiety.","ruhsat":null,"doz_araligi_ozet":"Single dose 100–900 mg (those found effective 300–600 mg); 300 mg/day for 4 weeks; 300 mg before therapy sessions; 600 mg/day for 1 week (people at high risk of psychosis); 200–800 mg/day for 12 weeks (no control group, young people)","titrasyon_ozet":"Single dose in laboratory studies, no titration; in the 12-week study in young people, treatment started at 200 mg/day and was increased in 200 mg steps according to response, up to 800 mg/day (study dose; not a personal recommendation)","yan_etkiler":["Sedation/'mental sedation' (Crippa 2004, PMID 14583744); slight impairment of alertness, longer attention lapses (Rudisill 2023, PMID 36625844)","Berger 2022 (12 weeks, 200–800 mg/day): side effects in 80.6% (drug-related or possibly related in 61.3%), all mild–moderate — tiredness, low mood, hot flashes/chills","Crippa 2021 (PMID 34387679; 300 mg/day, 28 days): 5 serious side effects, all in the CBD group (4 liver enzyme elevations, 1 of them critical; 1 severe drug rash)","Bogenschutz 2026 (PMID 41312717; 600–1200 mg/day): 22.6% of those taking CBD reduced the dose or stopped because of side effects; nausea (20% vs 0%) and diarrhea (27% vs 12%) more frequent","Kwee 2022 (300 mg, 8 doses): no serious side effects; side-effect frequency similar to placebo (10.3% vs 15.4%)","Single-dose CBD laboratory studies (100–900 mg): in the speaking test, blood pressure, and in the studies where they were measured, pulse and skin conductance did not change differently from placebo (Bergamaschi 2011, Zuardi 1993, Zuardi 2017, Linares 2019); slight rise in pulse at the end of the session with 900 mg (Arndt 2017)","THC (dronabinol) 12.5 mg single dose: in healthy volunteers, negative mood, anxiety and mental fogginess increased, and the blood pressure rise during the stress test was blunted; slight rise in pulse at 7.5 mg (Childs 2017)"],"izlem":["Monitoring liver tests with long-term use is a doctor's decision"],"dikkat":["Bipolar disorder: 600–1200 mg/day CBD was ineffective in 2 patients with mania (Zuardi 2010, PMID 18801823); in bipolar depression, 150–300 mg/day was no better than placebo, and no increase in mania was seen (Pinto 2024, PMID 37920963); there is no evidence that CBD works for treating mania","History of psychosis: no controlled data were found showing that CBD alone triggers psychosis, but in people with a high tendency to paranoia, 600 mg showed a trend toward increased anxiety (Hundal 2018, PMID 29086614); the main risk is THC-containing products. A person with a history of psychosis should not use CBD without consulting a doctor (this is a precautionary recommendation, not a direct study result)","Pregnancy and breastfeeding: no human studies show it is safe; signals of harm to prenatal development in animals (Sarrafpour 2020, PMID 32524214; Argueta 2020, PMID 32425793)","Driving: 13.75 mg of vaporized CBD-dominant marijuana did not impair driving, but clinically important impairment could not be fully ruled out; CBD did not prevent THC's driving-impairing effect; after 300 mg oral CBD, attention lapse duration increased (Arkell 2020, PMID 33258890; Rudisill 2023, PMID 36625844)","Liver: in healthy adults, 5 mg/kg/day led to ALT/AST >3× ULN in 5.6% (Florian 2025, PMID 40622698); 300 mg/day led to 4 liver enzyme elevations, 1 of them critical (Crippa 2021, PMID 34387679)","Young people (ages 12–25): the only data are open-label, with side effects in 80.6% of participants (Berger 2022); an interaction has been shown with citalopram/escitalopram, which are often used at this age","Allergic skin reaction: 1 severe drug rash with 300 mg/day (Crippa 2021, PMID 34387679)","Athletes: in healthy volunteers who used 150 mg a day of broad-spectrum CBD oil for 10 weeks, CBG and CBDV, which are prohibited under WADA's 2026 list, were detected in urine (42% and 68% of pre-exercise samples, 74% and 84% of post-exercise samples); THC was not detected. CBDV was not listed on the product's certificate of analysis (Gillham 2026, PMID 40920736)","No study has shown that CBD is a first-line treatment for anxiety disorder","It cannot be said that 300 mg is the best dose: the medium dose was found more effective only in two small studies in healthy volunteers (single dose, public speaking); this could not be repeated in other conditions","THC-containing products: in healthy volunteers, 12.5 mg THC (dronabinol) increased distress and anxiety starting before a social stress test and tended to increase pauses in speech; 7.5 mg helped distress after the test pass more quickly (Childs 2017, 42 people). THC has not been tested in people with social anxiety disorder; 'full-spectrum' products may contain THC"],"ilac_etkilesim_notlari":["Citalopram/escitalopram: when CBD (200–800 mg/day) was added, citalopram blood levels rose significantly in 6 patients; in the laboratory, breakdown via CYP3A4 and CYP2C19 was inhibited (Anderson 2021, PMID 34121064)","Sertraline, fluoxetine, mirtazapine: in the laboratory, CBD had very little effect on their breakdown; not measured in patients (Anderson 2021, PMID 34121064)","In people taking serotonergic antidepressants, CBD affected the re-extinction of subjective fear worse than placebo (Kwee 2024, exploratory subgroup)","Clobazam: in 13 children with epilepsy, the active metabolite N-desmethylclobazam rose by an average of 500%; the rise in clobazam itself (average 60%) was uncertain (confidence interval −2 to 91). In healthy volunteers, clobazam did not change and the metabolite rose ~3-fold (FDA/EMA). Side effects in 10 of the 13 patients resolved when the clobazam dose was reduced (Geffrey 2015, PMID 26114620)","Other benzodiazepines (alprazolam, clonazepam, etc.): no direct interaction study in an anxiety population was found","THC-containing products: CBD does not consistently reduce THC's effects; full-spectrum products may contain THC (e.g., 0.23 mg/mL)","Antipsychotic + 1000 mg/day CBD (schizophrenia) was well tolerated (McGuire 2017, PMID 29241357)","No direct interaction studies were found with venlafaxine, duloxetine, pregabalin, buspirone or hydroxyzine"],"dogrulanamayan":["Crippa 2011, Zuardi 1993 and Raminelli 2025 only from the PubMed abstract (full text not accessible); the other studies were checked against the full text (October 19, 2026). Of those added in the October 2026 search, de Faria 2020, Andreoli 2026, Wilson 2026 and Cougle 2015 were read only from the abstract (full text not open access); de Faria 2020's product purity, numbers of women and men and side-effect information were taken from the tables of a systematic review (Thanabalasingam 2021), and its conflict-of-interest statement could not be read. The correction to Wilson 2026 published in the journal (Lancet Psychiatry 2026;13(8):e11) was read on October 29, 2026: only the axis of one figure and the study counts in a table were corrected; the numbers in the row (54 RCTs, 2,477 participants, side-effect OR 1.75, high risk of bias in 44% of studies) did not change. According to the corrected table, 5 of the anxiety disorder studies were done with CBD alone and 1 with THC alone. Berger 2022 was read from the authors' accepted manuscript, and the manuscript does not say how many participants had social anxiety disorder","Masataka 2019: the randomization sequence method and the absence of THC in the product could not be independently verified (product claim only). There is no retraction, correction or expression of concern for the 2019 paper (PubMed, Crossref/Retraction Watch, October 19, 2026; rechecked on PubMed on October 28, 2026); the same author's 2025 cat study was retracted on June 12, 2026 (no valid ethics approval). The paper gives exactly the same statistic for the time effect of two scales (F1,35 = 10.35; p = 0.003), and the effect sizes reported for this effect do not match the F value; while the paper says participants could not tell the groups apart, it also states that 3 people from the CBD group dropped out because of the oil's smell and taste. The reason for these inconsistencies (a typo or something else) cannot be determined from the paper","Completed SAD studies with unpublished results: NCT05600114 (by the drug company EmpowerPharm; phase 2, 239 people, 300/600 mg/day, 10 weeks; the company's press release only mentions 'efficacy in a subgroup with moderate-to-severe SAD' and gives no numbers), NCT05823753 (Epidiolex 300/900 mg/day, 4 days, 63 people), NCT05571592 (400/800 mg/day, 3 weeks, 60 people, completed in December 2025). As of October 28, 2026, none of the three has results on ClinicalTrials.gov or a publication on PubMed. Ongoing or of unclear status: NCT05649059 (single dose 300 mg, 50 people, expected to finish in May 2027), NCT06123702 (fear extinction with 600 mg, 20 people; not updated since April 2024), ACTRN12623000872639 (speaking task in virtual reality in healthy volunteers, 150 mg; protocol published, no results found)","Clinical guidelines: the full texts of the Brazilian Psychiatric Association's social anxiety guideline (2025), Japan's social anxiety guideline (2021) and Germany's anxiety disorders guideline (2021) do not mention cannabinoids; the full text of the World Federation of Societies of Biological Psychiatry guideline (2023) could not be read. The social anxiety subgroup result of the Han 2024 meta-analysis could not be read because the full text was not accessible"],"calismalar":[{"ad":"Bergamaschi 2011","tasarim":"Double-blind RCT (allocation in matched pairs) + healthy control group without the drug","n":"24 untreated SAD (12 CBD, 12 placebo) + 12 healthy","populasyon":"Untreated social anxiety disorder; SPST","urun":"Oral CBD, powder (~99.9% pure; STI-Pharm/THC-Pharm), in corn oil in gelatin capsules; corn oil placebo","urun_turu":"saf_cbd","doz":"600 mg single dose (1.5 hours before the test)","titrasyon":"None","sure":"Single session","sonuc":"During the speech, anxiety, cognitive impairment and discomfort were lower than with placebo; cognitive impairment, discomfort and negative self-evaluation were similar to healthy people, but the anxiety score during the speech was still different from healthy people (p=0.007); no group difference in blood pressure or skin conductance. The conflict-of-interest statement lists no CBD-related patent or company tie (one of the 14 authors reported ties to non-CBD drug companies); funding from a Brazilian public fund (FAPESP). The international application for the CBD derivative patent reported by its authors in later publications was published in 2014, that is, after this study","yan_etki":"No side-effect report in the full text","pmid":"21307846","doi":"10.1038/npp.2011.6","diger_kaynak":null},{"ad":"Crippa 2011","tasarim":"Double-blind, crossover, SPECT","n":"10","populasyon":"Untreated social anxiety disorder","urun":"Oral CBD","urun_turu":"saf_cbd","doz":"400 mg single dose","titrasyon":"None","sure":"2 sessions","sonuc":"Subjective anxiety decreased compared with placebo (p<0.001); the anxiety was caused not by a speaking test but by the brain imaging (SPECT) procedure itself. Blood flow changed in anxiety-related brain regions (left parahippocampal gyrus, hippocampus) (uncorrected p<0.001). The conflict-of-interest statement could not be read (the publisher's page blocks automated access); the study was published before the CBD derivative patent its authors reported in later publications (international application published in 2014)","yan_etki":"Not reported (in the abstract)","pmid":"20829306","doi":"10.1177/0269881110379283","diger_kaynak":null},{"ad":"Masataka 2019","tasarim":"Randomized, double-blind, placebo-controlled pilot; allocation done by an independent statistician, sequence method not described; single author","n":"40 randomized (20/20); 3 people from the CBD group dropped out because of smell/taste, 37 analyzed (17 CBD, 20 placebo)","populasyon":"Japanese young people aged 18–19 with SAD + avoidant personality disorder","urun":"RSHO-X cannabis oil (HempMeds, US; from stalks), 21.4 mg/mL CBD; according to the paper, no THC or other cannabinoids (no independent analysis done); olive oil placebo","urun_turu":"cbd_zengin_thc_belirsiz","doz":"300 mg/day, single dose in the afternoon","titrasyon":"None (300 mg from the first day)","sure":"4 weeks; weekly home visits for up to 6 months","sonuc":"Fear of negative evaluation (FNE) 24.4 → 19.1 (placebo 23.5 → 23.3); Liebowitz (LSAS) 74.2 → 62.1 (placebo 69.9 → 66.8); analysis of completers only; the paper gives exactly the same statistic for the time effect of two scales (F1,35 = 10.35; p = 0.003), and the effect sizes reported for this effect (ηp² 0.0228 and 0.023) do not match the F value (should be about 0.23); the values given for the group × time interaction are internally consistent","yan_etki":"Side effects were not systematically assessed; no 'significant health complaint' was reported during follow-up","pmid":"31787910","doi":"10.3389/fpsyg.2019.02466","diger_kaynak":null},{"ad":"Kwee 2022 (RCT)","tasarim":"Double-blind, placebo-controlled parallel RCT, 3 centers","n":"80 (39 CBD, 41 placebo); SAD subgroup 37 (18 CBD, 19 placebo); 78 analyzed","populasyon":"Treatment-resistant panic disorder + agoraphobia or social anxiety disorder","urun":"Synthetic CBD (purity >99.9%; STI/THC Pharm), capsule; lactose placebo","urun_turu":"saf_cbd","doz":"300 mg, about 2 hours before each exposure session (8 doses in total)","titrasyon":"None","sure":"8 weekly sessions (once a week); follow-up at 3 and 6 months","sonuc":"On the primary outcome (Fear Questionnaire, FQ), there was no difference over time between CBD and placebo in the outcome of exposure therapy (all patients β = 0.32; 95% CI −0.60 to 1.25; looking separately by diagnosis group β = −0.11; −1.62 to 1.40); CBD also did not increase early response or within-session fear extinction; the placebo group improved numerically more","yan_etki":"No serious side effects; similar side-effect frequency (CBD 4/39, 10.3%; placebo 6/39, 15.4%); treatment discontinuation CBD 17.9%, placebo 29.3%","pmid":"35561538","doi":"10.1016/j.euroneuro.2022.04.003","diger_kaynak":"Protocol: van der Flier 2019, PMID 30760241 (Netherlands Trial Register NTR5100); fear conditioning substudy: Kwee 2024, PMID 38044339 (69 patients; CBD reduced threat expectancy, did not enhance fear re-extinction)"},{"ad":"Zuardi 1993","tasarim":"Double-blind, 4 parallel groups (placebo, CBD, diazepam, ipsapirone)","n":"40 (10/group)","populasyon":"Healthy volunteers; simulated public speaking test (SPST)","urun":"Oral CBD","urun_turu":"saf_cbd","doz":"300 mg single dose","titrasyon":"None","sure":"Single session","sonuc":"CBD reduced anxiety after the speech; diazepam caused sedation, CBD did not","yan_etki":"No separate side-effect report; marked drowsiness was seen only with diazepam; only ipsapirone reduced the systolic blood pressure raised by the test, CBD did not change it (abstract)","pmid":"22290374","doi":"10.1177/026988119300700112","diger_kaynak":null},{"ad":"Zuardi 2017","tasarim":"Randomized, 5 groups (placebo, clonazepam 1 mg, CBD 100/300/900 mg)","n":"60 (12/group); 1 person from the CBD 300 mg group did not attend the session, 59 analyzed","populasyon":"Healthy, ages 18–35, both sexes; real public speaking","urun":"Oral CBD, powder (99.6% pure, no other cannabinoids; BSPG-Pharm), in corn oil in gelatin capsules","urun_turu":"saf_cbd","doz":"100 / 300 / 900 mg single dose","titrasyon":"None","sure":"Single session","sonuc":"Only 300 mg reduced anxiety after the speech; 100 and 900 mg were ineffective (inverted U). 4 of the 7 authors are inventors on a patent for a CBD derivative (fluorinated CBD); the university has an agreement with a drug company (Prati-Donaduzzi) to develop a synthetic CBD product, including for anxiety disorders; the supplier company (BSPG-Pharm) provided the CBD free of charge, and 2 authors received travel support from this company","yan_etki":"Clonazepam was more sedating than all other groups (including the CBD doses); no separate side-effect report; no main effect of group on blood pressure and pulse; during the speech, clonazepam lowered blood pressure while 300 mg CBD did not (the 300 mg group's systolic and diastolic blood pressure differed from the clonazepam group's, and its diastolic blood pressure from the 100 mg group's)","pmid":"28553229","doi":"10.3389/fphar.2017.00259","diger_kaynak":null},{"ad":"Linares 2019 (SPST)","tasarim":"Double-blind, 4 parallel groups","n":"57 (150 mg: 15, 300 mg: 15, 600 mg: 12, placebo: 15)","populasyon":"Healthy men; SPST","urun":"Oral CBD, powder (99.9% pure; STI-Pharm), in corn oil in gelatin capsules","urun_turu":"saf_cbd","doz":"150 / 300 / 600 mg single dose (1.5 hours before the test)","titrasyon":"None","sure":"Single session","sonuc":"Only 300 mg kept anxiety during the speech lower than placebo (post hoc p=0.042; group×phase interaction not significant, p=0.1); 150 and 600 mg were similar to placebo (inverted U). 4 of the 7 authors are inventors on a patent for a CBD derivative (fluorinated CBD); the university has an agreement with a drug company to develop a synthetic CBD product, including for anxiety disorders; the manufacturer (STI-Pharm) supplied the CBD free of charge; the disclosure states that one author is a consultant to another CBD supplier (BSPG-Pharm)","yan_etki":"No separate side-effect report; no group difference on sedation and cognitive impairment scales; no difference between groups in systolic and diastolic blood pressure (pulse was measured, result not reported)","pmid":"30328956","doi":"10.1590/1516-4446-2017-0015","diger_kaynak":null},{"ad":"Arndt 2017","tasarim":"Double-blind, placebo-controlled laboratory study with 4 sessions in the same people (crossover)","n":"39 started (1 person was excluded after a positive cannabis test); 38 completed (19 women, 19 men)","populasyon":"Healthy volunteers (people with anxiety disorders were not included; no social anxiety diagnosis); exclusion in a virtual ball game (Cyberball) and emotional stimulus tasks, no speaking test","urun":"Oral CBD solution (300 mg/mL; Insys Therapeutics), with sugar-free syrup; purity not stated in the paper","urun_turu":"saf_cbd","doz":"300 / 600 / 900 mg single dose (2.5 hours before the tasks)","titrasyon":"None","sure":"4 single-dose sessions (at least 1 week apart)","sonuc":"At no dose did CBD change responses to negative emotional stimuli or the drop in mood and self-esteem during exclusion in the game (all p > 0.05); no difference from placebo in subjective anxiety and mood. 900 mg only borderline-reduced attentional bias toward emotional facial expressions. The study was supported by the drug company that supplied the CBD (Insys Therapeutics) and the US National Institute on Drug Abuse; a review specific to social anxiety (Fliegel 2022) judged the risk of bias high because of the short time between sessions","yan_etki":"Well tolerated; slight rise in pulse at the end of the session with 900 mg (p = 0.036); no difference in blood pressure","pmid":"28861510","doi":"10.1089/can.2017.0014","diger_kaynak":null},{"ad":"Childs 2017","tasarim":"Double-blind, placebo-controlled RCT (3 parallel dose groups; each participant had 2 sessions, with a stressful and a non-stressful task)","n":"42 (placebo 13, 7.5 mg 14, 12.5 mg 15)","populasyon":"Healthy young adults (ages 18–40; no mental disorder, using cannabis at most once a week; people who had experienced anxiety with cannabis were not included); Trier Social Stress Test (speech in front of a panel and mental arithmetic)","urun":"Oral dronabinol (synthetic THC; Marinol) capsule; dextrose placebo","urun_turu":"thc_iceren","doz":"7.5 or 12.5 mg single dose (2.5 hours before the tasks)","titrasyon":"None","sure":"2 sessions (5 days apart)","sonuc":"7.5 mg of THC helped subjective distress pass more quickly after the stress test (total distress over time lower than placebo, p < 0.05; no difference at peak, p = 0.18), and led participants to rate the test afterward as less \"stressful\" and \"challenging\". 12.5 mg of THC, by contrast, increased negative mood and anxiety even before the tasks began, raised distress in both the stressful and non-stressful tasks, and borderline-increased pauses in speech (p = 0.052). Not tested in people with social anxiety disorder; single session","yan_etki":"12.5 mg: negative mood, anxiety and mental fogginess increased; the blood pressure rise during the stress test was blunted. 7.5 mg: slight rise in pulse","pmid":"28599212","doi":"10.1016/j.drugalcdep.2017.03.030","diger_kaynak":null},{"ad":"Appiah-Kusi 2020","tasarim":"Social stress substudy of a double-blind, placebo-controlled parallel RCT (+ a healthy comparison group not taking the drug)","n":"32 patients in the abstract, 33 in the table (16 CBD, 17 placebo) + 25 healthy people; 7 patients and 4 healthy participants were left out of the anxiety analysis because of missing data","populasyon":"People at clinical high risk of psychosis who had not used antipsychotics (a diagnosis of social anxiety disorder was not required; London) + healthy volunteers not taking the drug; Trier Social Stress Test (speech in front of a two-person panel)","urun":"Oral CBD capsule (STI Pharmaceuticals, UK); identical placebo capsule","urun_turu":"saf_cbd","doz":"600 mg/day, 7 days","titrasyon":"None","sure":"7 days of treatment; stress test on day 8","sonuc":"In direct comparison, there was no significant difference between CBD and placebo in anxiety during the stress test (STAI, area under the curve; p = 0.36), negative self-statements (p = 0.088) or cortisol response (p = 0.70). When the three groups were ranked together, the CBD group fell between placebo and healthy people (linear trend, p = 0.012 for anxiety); the authors state that this trend mainly reflects the difference between the placebo group and the healthy group","yan_etki":"Not reported in this publication","pmid":"31915861","doi":"10.1007/s00213-019-05442-6","diger_kaynak":"Main trial: Bhattacharyya 2018, PMID 30167644 (ISRCTN46322781); relationship between cortisol and brain function from the same trial: Davies 2022, PMID 34480630"},{"ad":"de Faria 2020","tasarim":"Double-blind, placebo-controlled, crossover RCT (2 sessions, 15 days apart)","n":"24 (22 men, 2 women; sex breakdown per a review's table)","populasyon":"Patients with Parkinson's disease (a diagnosis of social anxiety disorder was not required; Brazil); simulated public speaking test","urun":"Oral CBD capsule (powder, 99.9% pure, in corn oil; product information per a review's table, the full text could not be read); identical placebo capsule","urun_turu":"saf_cbd","doz":"300 mg single dose","titrasyon":"None","sure":"Single dose, 2 sessions","sonuc":"A drug effect favoring CBD on the anxiety dimension of the Visual Analogue Mood Scale: the anxiety caused by the speaking test was reduced; tremor amplitude measured with an accelerometer also decreased. Effect sizes and p values are not in the abstract. The conflict-of-interest statement could not be read (the publisher's page blocks automated access; per a review's table, funding came from the Brazilian public funds FAPESP and CNPq); of the 9 authors, Zuardi, Hallak and Crippa state in their other publications (e.g., Zuardi 2017, Bolsoni 2022b) that they are inventors on a patent for a CBD derivative, and that their university has an agreement with a drug company to develop a synthetic CBD product, including for anxiety disorders","yan_etki":"No side effects reported during or after the sessions (per the review's table; the full text could not be read); pulse and blood pressure were measured, results not in the abstract","pmid":"31909680","doi":"10.1177/0269881119895536","diger_kaynak":null},{"ad":"Berger 2022","tasarim":"Open-label, single-arm phase 2 study (no control group)","n":"31 (efficacy analysis 30)","populasyon":"Young people aged 12–25 with an anxiety disorder who had not responded to cognitive behavioral therapy and/or an antidepressant (Australia); diagnoses included social anxiety disorder, generalized anxiety disorder, panic disorder and specific phobia; the number with social anxiety disorder and a separate result for them are not in the authors' manuscript","urun":"Pure CBD capsule (200 mg, purity >99.9%), in addition to usual treatment (CBT every two weeks, antidepressants)","urun_turu":"saf_cbd","doz":"200–800 mg/day (at week 12: 19 people on 800, 9 on 600, 1 on 400 mg/day)","titrasyon":"Started at 200 mg/day; if improvement was not enough, increased in 200 mg steps (at most 400 mg/day at week 1, 600 at week 4, 800 at week 8)","sure":"12 weeks (+1 week of tapering off; follow-up at week 26)","sonuc":"Anxiety severity (OASIS) fell from 10.8 to 6.3 (−42.6%; p < 0.0001); at least a 50% reduction in 12 of 30 people. Depression, clinical global impression and functioning also improved; at week 26, after treatment ended, the improvements did not last. Because there was no control group and usual treatment continued, the effect cannot be attributed to CBD alone. Funding: Lambert Initiative for Cannabinoid Therapeutics (University of Sydney); the authors reported no conflicts of interest","yan_etki":"Side effects in 25 of 31 people (80.6%), drug-related or possibly related in 19 (61.3%): tiredness, low mood, appetite change, drowsiness, nausea, diarrhea, dry mouth, insomnia, hot flashes/chills; all mild–moderate, no serious side effects; 1 person stopped because of a rash possibly related to CBD. In 5 of the 6 people taking citalopram or escitalopram, blood levels of these drugs rose","pmid":"35921510","doi":"10.4088/JCP.21m14130","diger_kaynak":"ANZCTR ACTRN12617000825358"},{"ad":"Berger 2020","tasarim":"Single case","n":"1","populasyon":"20-year-old man; severe SAD + depression + insomnia + attenuated psychotic symptoms (in addition to mirtazapine + CBT)","urun":"CBD (product name and purity not stated in the full text; prescribed in Australia through the Clinical Trial Notification Scheme and the Special Access Scheme; the dose-escalation schedule is exactly the same as in the same team's open-label trial with >99.9% pure CBD capsules, Berger 2022)","urun_turu":"saf_cbd","doz":"200–800 mg/day","titrasyon":"Started at 200 mg/day; 400 at week 1, 600 at week 4, 800 mg/day at week 8; increases based on absence of side effects and on response; tapered off over 1 week at the end of 6 months","sure":"6 months","sonuc":"Marked improvement was reported after week 8 (800 mg/day); because mirtazapine and CBT continued, the authors cannot attribute the effect to CBD alone","yan_etki":"No side effects observed (liver and routine blood tests taken at baseline and at months 1, 2 and 3)","pmid":"33028567","doi":"10.1136/bcr-2020-235307","diger_kaynak":null},{"ad":"Raminelli 2025","tasarim":"Systematic review and meta-analysis (21 placebo-controlled RCTs; SAD 5, GAD 1, PTSD 7, OCD 1, Tourette 7)","n":null,"populasyon":"Anxiety-related disorders and Tourette","urun":"Pure or CBD-rich products","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"Pooled effect not significant (SMD −0.40; −0.84/0.03); only in the pure CBD subgroup SMD −0.61 (−1.15/−0.07). Authors: for SAD and GAD, 'low-quality evidence, limited efficacy'","yan_etki":null,"pmid":"40956670","doi":"10.1177/25785125251378242","diger_kaynak":null},{"ad":"Fliegel 2022","tasarim":"Systematic review (Medline, Embase, PsycInfo; up to June 25, 2021; risk of bias with RoB 2)","n":"7 studies; 278 participants (71 patients with social anxiety disorder, 207 healthy volunteers)","populasyon":"Patients with social anxiety disorder and healthy volunteers taking part in an experimental social anxiety task","urun":"Pure CBD and CBD-rich cannabis oil","urun_turu":"karma","doz":"100–900 mg single dose; 300 mg/day for 4 weeks","titrasyon":null,"sure":null,"sonuc":"CBD reduced anxiety in 3 of 4 studies in healthy volunteers and in all 3 studies in patients; no effect in the study measuring social exclusion. The authors find CBD promising, but note that the studies were small and mostly single-dose, women were underrepresented, and side effects were not systematically measured; risk of bias was \"some concerns\" in 5 studies and high in 2 (Masataka 2019, Arndt 2017). The search was done before the publication of the 80-person study that added CBD to therapy (Kwee 2022)","yan_etki":null,"pmid":"36875967","doi":"10.1016/j.psycom.2022.100074","diger_kaynak":null},{"ad":"Andreoli 2026","tasarim":"Systematic review of RCTs (PubMed, Scopus, Web of Science, PsycINFO; publications after 2015; Cochrane risk-of-bias tool)","n":"18 RCTs (all drug treatments)","populasyon":"Adults with social anxiety disorder","urun":"Drug treatments; CBD among them","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"When cognitive behavioral therapy is not available, the first-line drug treatment is selective serotonin reuptake inhibitors (SSRIs); the authors list CBD and d-cycloserine among \"promising\" new options. Which CBD studies were included, the effect size for CBD and the bias assessment are not in the abstract (the full text could not be read); of the two RCTs of CBD in social anxiety published after 2015, one (Kwee 2022) was negative","yan_etki":null,"pmid":"41388755","doi":"10.1080/14737175.2025.2604303","diger_kaynak":null},{"ad":"Wilson 2026","tasarim":"Systematic review and meta-analysis of RCTs (1980 to May 13, 2025; PROSPERO CRD42023392718; GRADE)","n":"54 RCTs; 2477 participants (all mental disorders and substance use disorders)","populasyon":"People whose primary diagnosis is a mental disorder or a substance use disorder; anxiety was examined under a separate heading; no separate result for social anxiety disorder in the abstract","urun":"CBD, THC, THC and CBD combinations and other cannabinoids","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"No significant difference was found between cannabinoids and placebo in anxiety-related outcomes (of the anxiety disorder studies, 5 used CBD alone and 1 used THC alone); no result specific to social anxiety disorder in the abstract. Significant benefit was seen only in cannabis use disorder, insomnia, tics and Tourette syndrome, and autism; certainty of evidence was low for most outcomes, and risk of bias was high in 44% of studies. The correction published in the journal (June 16, 2026) corrected the axis of a figure and the study counts in the table; the results did not change","yan_etki":"Any side effect more frequent with cannabinoids (OR 1.75; 95% CI 1.25–2.46; number needed to harm 7); no difference in serious side effects or study discontinuation","pmid":"41856154","doi":"10.1016/S2215-0366(26)00015-5","diger_kaynak":"Correction: Lancet Psychiatry 2026;13(8):e11, PMID 42302809 (June 16, 2026; the axis of a figure and the study counts in the table were corrected, results unchanged)"},{"ad":"Xue 2021","tasarim":"Systematic review and meta-analysis of longitudinal (prospective) studies (MEDLINE, Embase, PsycINFO; up to May 31, 2020)","n":"24 cohort studies; 10 in the quantitative analysis; 3 studies for social anxiety disorder","populasyon":"General population and adolescent cohorts (8 countries)","urun":"Recreational cannabis use (contains THC; not given in the studies)","urun_turu":"thc_iceren","doz":"Not administered (observational; frequency of use self-reported)","titrasyon":null,"sure":"Follow-up of up to 20 years in the studies","sonuc":"Cannabis use was weakly but significantly linked with later development of any anxiety condition (OR 1.25; 95% CI 1.01–1.54; 7 studies); when only high-quality studies were included, the link lost significance (OR 1.10; 0.82–1.47). For social anxiety disorder, the pooled link was not significant (OR 1.12; 95% CI 0.61–2.05; I² 38%; 3 studies: van Laar 2007, Fröjd 2011 and Feingold 2016). Observational data: does not show cause and effect","yan_etki":null,"pmid":"32909828","doi":"10.1177/0706743720952251","diger_kaynak":null},{"ad":"Cougle 2015","tasarim":"Prospective nationally representative follow-up (US NESARC waves 1 and 2, 3 years apart)","n":"43,093 (wave 1); 34,653 (wave 2)","populasyon":"US general adult population","urun":"Regular recreational cannabis use (weekly in the past year) (not given in the study)","urun_turu":"thc_iceren","doz":"Not administered (observational)","titrasyon":null,"sure":"About 3 years","sonuc":"Weekly cannabis use in the past year predicted new onset of social phobia (social anxiety disorder) over about 3 years of follow-up (also for panic disorder with agoraphobia and bipolar disorder); the size of the risk and the factors accounted for in the analysis are not in the abstract, and the full text could not be read. In another analysis of the same national data (Feingold 2016, PMID 26775742; one of the three studies pooled by Xue 2021), the link with heavy use did not remain significant in the final adjusted model; the two analyses defined cannabis use differently. Observational data: does not show cause and effect","yan_etki":null,"pmid":"26022838","doi":"10.1016/j.jpsychires.2015.05.004","diger_kaynak":null}],"ilgili_ilaclar":["sitalopram","essitalopram","sertralin","fluoksetin","mirtazapin","snri","alprazolam","klonazepam","benzodiazepin","pregabalin","hidroksizin","buspiron"],"son_inceleme":"2026-10-30","arastirma_gecmisi":[{"tarih":"2026-10-19","not":"Page published. This first review examined 9 studies."},{"tarih":"2026-10-21","not":"The full texts of the studies were reread, and the information on the page was checked against its sources. Corrected: side effect, product, result and study design information in the study table; drug interaction notes; the \"Who should be careful\" list; reported side effects; evidence summary; the conclusion for THC-containing products. Points that could not be verified from the full text went down from 4 items to 3. The year of 8 publications named on the page was corrected to the journal's print year instead of the online publication year. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-27","not":"The reason for the retraction of another CBD study by the author, done in cats, was verified from the journal's retraction notice, and its source was given. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-28","not":"PubMed, Cochrane and ClinicalTrials.gov were systematically searched again in October 2026 (1,185 records on PubMed, 85 on ClinicalTrials.gov; together with an independent second check). Added: 3 controlled studies comparing CBD with placebo in social stress, speaking or social exclusion tasks (in people with Parkinson's disease, people at high risk of psychosis and healthy volunteers; two found no difference), a social stress study with THC in healthy volunteers, a CBD study in young people without a control group, 2 systematic reviews specific to social anxiety, the most recent meta-analysis of cannabinoid trials in mental disorders, 1 meta-analysis looking at cannabis use and social anxiety risk, and 1 follow-up study. A review repeating the same question, a second analysis of the same national data and a virtual reality experiment that did not measure social anxiety were not added separately. Corrected: the primary outcome of the therapy study was written out with numbers and with its sub-study; the source of anxiety in the imaging study, the authors' patent and company ties in two laboratory studies, blood pressure and pulse measurements, the statistical inconsistency in the Japanese study and the basis for the product in a case report were added; the conclusion and strength of evidence for THC-containing products were written for the first time; the search numbers were added to the evidence summary. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-28","not":"Display fix: internal working notes left over from the previous cleanup were removed; content and evidence did not change."},{"tarih":"2026-10-28","not":"October 2026 supplementary review: sources found for this page during the searches for other topics were read and worked into the page. In three studies by the same Brazilian research group (Bergamaschi 2011, Crippa 2011, de Faria 2020), the authors' patent and company ties were written consistently with the other rows: the conflict-of-interest statement where it could be read, an explicit note where it could not, and the date of the group's patent on a CBD derivative. No studies were added to the table. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-30","not":"The correction to the Wilson 2026 meta-analysis published in the journal was read: the results did not change. According to the corrected table, 5 of the anxiety disorder studies were done with CBD alone and 1 with THC alone; this information was added to the page."},{"tarih":"2026-10-31","not":"The last sentence of the page's short summary was rewritten in a calmer, more guiding tone: instead of \"Talk to your doctor before you start.\", it now says whom you can talk with, and about what, if you are considering CBD. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-31","not":"The evidence level text now uses the same level name as the top of the page; the level and the result did not change."}]},{"id":"ptsd","baslik":"Post-traumatic stress disorder (PTSD)","grup":"Anxiety and mental health","grup_kodu":"kaygi","tr_id":"kaygi-tssb","kanit_duzeyi":"zayif","kanit_yonu":"yarar_gosterilmedi","kanit_ozet":"A single 300 mg dose did not reduce anxiety during trauma recall; it reduced only the 'cognitive impairment' subscale, and in a secondary analysis the effect was seen only in non-sexual trauma. In trauma-exposed people, 300 mg/day for 1 week was ineffective; in alcohol use disorder + PTSD, 600 mg/day for 6 weeks was ineffective. In a 21-person pilot study in which 500 mg/day was added to prolonged exposure therapy for 18 days (registry results only), two scales differed in opposite directions, and no statistics were published. In a 96-person RCT in veterans in which CBD (600 mg/day according to the protocol) was added to the same therapy for 16 weeks (NCT03518801; registry results only, October 28, 2026), scores on the clinician-rated CAPS-5 scale fell in both groups (36.9 and 35.1 at baseline; 22.6 and 23.1 at the end of treatment; 21.2 and 21.9 at month 3); the registry gives no between-group statistics, and 23 of 50 people in the CBD group and 15 of 46 in the placebo group did not complete the study. The only clearly positive data for CBD are an open-label case series of 11 patients. In an RCT with smoked cannabis in veterans (80 people), no type of cannabis, including one containing 11% CBD, reduced PTSD symptoms more than placebo. For PTSD-related nightmares, in a 10-person crossover RCT with nabilone, a THC-like synthetic medicine, nightmares decreased more than with placebo. In a 171-patient multicenter RCT, dronabinol (synthetic THC, 2.5–15 mg at night, 10 weeks) lowered the nightmare score by 1.50 points more than placebo (0–8 scale; 95% CI 0.71–2.28); on the main secondary outcome measuring overall PTSD severity (clinician assessment), the difference was not significant (p = 0.08). Of the people taking dronabinol who answered the question, 81% correctly guessed which group they were in, reports of improvement were strongly linked to this guess, and the drug's manufacturer supported the study with an unrestricted grant; the nightmare finding rests on a single large study. In two uncontrolled case series with nabilone (47 and 104 people), nightmares decreased clearly. In two laboratory RCTs with a single dose of THC in people with PTSD, brain activity changed but the fear response did not. Real-world data point both ways: in a follow-up of 2,276 veterans, symptoms were more severe in those who started cannabis after treatment, and in a cohort of 361 veterans, cannabis use was linked to more intense intrusive memories in the following months; on the other hand, a 150-person cohort comparing cannabis users with non-users (5 of 7 authors with company ties) and two patient registries in the UK (no comparison group) reported improvement. In none of these studies were the groups formed by random assignment. In data from 410 people with PTSD who also had alcohol or substance problems, cannabis users benefited from trauma-focused therapy as much as non-users. The most recent meta-analysis, which finished its search before the nightmare study (2026, 54 RCTs), found no significant effect in PTSD; the 2023 guideline of the US Departments of Veterans Affairs and Defense makes a strong recommendation against cannabis, and the American Academy of Sleep Medicine (2018), relying only on the 10-person study, states that nabilone \"may be used\" for nightmares. October 2026 search (PubMed, Cochrane, ClinicalTrials.gov): 11 controlled studies with cannabinoids on this topic (6 treatment studies lasting weeks; 5 single-dose or short laboratory studies, one in healthy volunteers) and 4 systematic reviews were found; together with 2 guidelines and 9 observational studies, all are in the table below. Cochrane has no review dedicated to this question; 2 controlled studies that were completed but whose results have not been released, and studies left unfinished, are under \"unverifiable\".","kanit_duzeyi_metin":"Weak; controlled studies are mostly negative","kanit_duzeyi_thc_icerenler":"zayif","kanit_duzeyi_thc_icerenler_metin":"Weak for overall PTSD symptoms (no clear difference from placebo in two RCTs); moderate for nightmares (a 171-person multicenter dronabinol RCT and a 10-person nabilone RCT were positive; the large study is the only one and is manufacturer-supported, and most people taking dronabinol noticed which group they were in)","kaynak_dosya":"kaygi-panik.md","saf_cbd_sonuc":"In controlled studies in PTSD, pure CBD did not reduce anxiety or symptoms more than placebo. These studies are small (21–42 people) and short (from a single dose to 6 weeks). Results from a 96-person study of veterans in which CBD or placebo was added for 16 weeks to prolonged exposure therapy (NCT03518801) were released in October 2026, only in the trial registry: on a clinician-rated scale (0–80), scores fell in both groups, and at the end of treatment they were 22.6 in the CBD group and 23.1 in the placebo group; the groups were not compared statistically and there is no peer-reviewed publication.","thc_icerenler_sonuc":"For overall PTSD symptoms: smoked cannabis containing THC or THC+CBD did not reduce symptoms more than placebo over 3 weeks (Bonn-Miller 2021); in the nightmare study, dronabinol was also not clearly different from placebo on the main secondary outcome measuring overall PTSD severity (clinician assessment); on the scale patients filled in themselves the difference favored dronabinol, but this was an additional analysis without correction for multiple comparisons (Roepke 2026). For nightmares: dronabinol, a synthetic THC, reduced the frequency and intensity of nightmares more than placebo in a multicenter, 10-week RCT with 171 patients (Roepke 2026); nabilone, a THC-like synthetic medicine, gave a similar result in a small crossover RCT with 10 soldiers (Jetly 2015). There is only one large study, most people taking dronabinol noticed which group they were in, and the drug's manufacturer supported the study; the finding needs to be repeated. Real-world data point both ways: some studies following cannabis users reported improvement, others a more severe course; the 2023 guideline of the US Departments of Veterans Affairs and Defense makes a strong recommendation against cannabis in the treatment of PTSD.","ruhsat":null,"doz_araligi_ozet":"300 mg single dose, 300 mg/day (1 week), 500 mg/day (18 days, added to therapy; NCT05132699), 600 mg/day (16 weeks, added to therapy; according to the protocol; NCT03518801), 600–1200 mg/day (6–8 weeks); 25–100 mg/day in the open-label case series; THC-containing: dronabinol 2.5–15 mg/day at night (10 weeks; single doses of 5–10 mg in laboratory studies), nabilone 0.5–3 mg/day (RCT) and 0.2–6 mg/day in case series, smoked cannabis up to 1.8 g a day","titrasyon_ozet":null,"yan_etkiler":["Sedation/'mental sedation' (Crippa 2004, PMID 14583744); slight impairment of alertness, longer attention lapse time (Rudisill 2023, PMID 36625844)","Berger 2022 (PMID 35921510; 12 weeks, 200–800 mg/day): side effects in 80.6% (drug-related or possibly related in 61.3%), all mild to moderate — tiredness, low mood, hot flushes/chills","Crippa 2021 (PMID 34387679; 300 mg/day, 28 days): 5 serious side effects, all in the CBD group (4 liver enzyme elevations, 1 of them critical; 1 severe drug rash)","Bogenschutz 2026 (600–1200 mg/day): 22.6% of people taking CBD reduced or stopped the dose because of side effects; nausea (20% vs 0%) and diarrhea (27% vs 12%) were more common","Kwee 2022 (300 mg, 8 doses): no serious side effects; side effect frequency similar to placebo (10.3% vs 15.4%)","Roepke 2026 (dronabinol 2.5–15 mg at night, 10 weeks): any side effect 89.7% vs 77.1%; serious side effects 7 vs 0 people (none considered drug-related); dizziness 23% vs 14.5%, dry mouth 9.2% vs 1.2%, diarrhea 11.5% vs 3.6%, increased appetite 16.1% vs 8.4%; stopping because of side effects 5.7% vs 7.2%","Nabilone patient records: in Fraser 2009, 13 of 47 patients (28%) stopped because of lightheadedness, forgetfulness, dizziness and headache; in Cameron 2014, side effects in 29.8% of 104 patients, psychosis in 2 people with a prior psychotic illness"],"izlem":["Monitoring liver tests during long-term use is the doctor's decision"],"dikkat":["Bipolar disorder: in mania, 600–1200 mg/day CBD was ineffective in 2 patients (Zuardi 2010, PMID 18801823); in bipolar depression, 150–300 mg/day was no better than placebo and no increase in mania was seen (Pinto 2024, PMID 37920963); there is no evidence that CBD works in treating mania","History of psychosis: no controlled data were found showing that CBD alone triggers psychosis, but in people with high paranoid tendencies, 600 mg showed a trend toward increased anxiety (Hundal 2018, PMID 29086614); the main risk is THC-containing products. A person with a history of psychosis should not use CBD without consulting a doctor (this is a precautionary recommendation, not a direct study finding)","Pregnancy and breastfeeding: no human studies show it is safe; in animals, signals of harm to prenatal development (Sarrafpour 2020, PMID 32524214; Argueta 2020, PMID 32425793)","Driving: 13.75 mg of vaporized CBD-dominant marijuana did not impair driving, but clinically important impairment could not be fully ruled out; CBD did not prevent THC's driving-impairing effect; after 300 mg oral CBD, attention lapse time lengthened (Arkell 2020, PMID 33258890; Rudisill 2023, PMID 36625844)","Liver: in healthy adults, ALT/AST >3×ULN in 5.6% with 5 mg/kg/day (Florian 2025, PMID 40622698); with 300 mg/day, 4 liver enzyme elevations, 1 of them critical (Crippa 2021, PMID 34387679)","Young people (ages 12–25): the only data are open-label, with side effects in 80.6% of participants (Berger 2022, PMID 35921510); an interaction has been shown with citalopram/escitalopram, which are commonly used at this age","Allergic skin reaction: 1 severe drug rash with 300 mg/day (Crippa 2021, PMID 34387679)","Athletes: in healthy volunteers who used 150 mg a day of broad-spectrum CBD oil for 10 weeks, CBG and CBDV, which are prohibited under WADA's 2026 list, were detected in urine (42% and 68% of pre-exercise samples, 74% and 84% of post-exercise samples); THC was not detected. CBDV was not listed on the product's certificate of analysis (Gillham 2026, PMID 40920736)","No study has shown that CBD is a first-line treatment for anxiety disorders","Cannabis (THC) use: in veterans with PTSD, those who started using cannabis after treatment had more severe symptoms and violent behavior (Wilkinson 2015, observational); the 2023 guideline of the US Departments of Veterans Affairs and Defense makes a strong recommendation against cannabis and its derivatives in the treatment of PTSD (Schnurr 2024). In records of people treated with nabilone, psychosis occurred in 2 people with a prior psychotic illness (Cameron 2014)"],"ilac_etkilesim_notlari":["Citalopram/escitalopram: when CBD (200–800 mg/day) was added, citalopram blood levels rose significantly in 6 patients; in the laboratory, breakdown via CYP3A4 and CYP2C19 was inhibited (Anderson 2021, PMID 34121064)","Sertraline, fluoxetine, mirtazapine: in the laboratory, CBD affected their breakdown very little; not measured in patients (Anderson 2021, PMID 34121064)","In people taking serotonergic antidepressants, CBD affected the re-extinction of subjective fear worse than placebo (Kwee 2024, PMID 38044339, exploratory subgroup)","Clobazam: in 13 children with epilepsy, the active metabolite N-desmethylclobazam rose by an average of 500%; the rise in clobazam itself (average 60%) was uncertain (confidence interval −2 to 91). In healthy volunteers, clobazam did not change and the metabolite rose ~3-fold (FDA/EMA). Side effects in 10 of the 13 patients, which resolved when the clobazam dose was reduced (Geffrey 2015, PMID 26114620)","Other benzodiazepines (alprazolam, clonazepam, etc.): no direct interaction study was found in the anxiety population","THC-containing products: CBD does not consistently reduce the effects of THC; full-spectrum products may contain THC (e.g., 0.23 mg/mL)","Antipsychotic + 1000 mg/day CBD (schizophrenia) was well tolerated (McGuire 2017, PMID 29241357)","No direct interaction study was found with venlafaxine, duloxetine, pregabalin, buspirone or hydroxyzine"],"dogrulanamayan":["Bolsoni 2022a, Gournay 2024, Das 2013 and Raminelli 2025 from the PubMed abstract only (full text not accessible; Gournay is open access, but the publisher's page blocks automated access); the other studies were checked against the full text (October 19, 2026)","Results of NCT05132699 and NCT03518801 are only on ClinicalTrials.gov (no peer-reviewed publication, no between-group statistics given). Results of NCT03518801 were entered in the registry on October 28, 2026; the registry states that 136 people were enrolled, while in the results tables 96 people start the study (the difference is not explained in the registry); the registry gives no dose, and the dose and product come from the protocol attached to the registry (synthetic CBD capsule, 300 mg twice daily). The protocol is not internally consistent: the same section has a sentence saying 'target daily dose of 300 mg', and other sections have sentences saying the drug would be given under the tongue and the dose would be reduced in 0.10 mL steps; the dose patients actually took was not reported. Ongoing or not yet started (October 28, 2026): NCT04550377 (CBD, 120 people; estimated completion of June 2026 has passed, still 'recruiting'), NCT05269459 (CBD; estimated 2028; CBD dose in the registry unclear), NCT06381180 (THC and CBD, 500 people, estimated 2030), NCT07224698 (THC-rich inhaled cannabis, 320 people, estimated 2028), NCT06222268 (CBD, THC and both together, added to prolonged exposure therapy; 280 people, estimated 2031)","Controlled studies completed but with results not released as of October 2026: NCT04080427 (dronabinol 7.5 mg or placebo before exposure sessions, 102 people; May 2025), NCT05226351 (fear extinction with a single dose of dronabinol 2.5 mg in people with PTSD and healthy people, 192 people; August 2024). A dronabinol study using a trauma film in healthy female volunteers (NCT04871269, 291 people) is \"active, not recruiting\". A 150-person study comparing CBD isolate with broad-spectrum CBD (NCT04197102) was suspended because it required approval from the US drug agency. The nabilone study NCT03251326 was stopped early with 4 people; its data are not in the registry. A manufacturer-supported crossover RCT planned with vaporized inhaled cannabis (NCT02517424) ended with 6 people instead of the targeted 42; because no comparison with placebo could be made, only change from baseline was published (Walsh 2023), and it was not included in the table. The status of Hadassah's randomized THC study (NCT00965809) is \"unknown\".","Full text could not be read (October 28, 2026): Roepke 2026 (paywalled; primary and secondary outcomes, side effects and group guessing were read from the publisher's publicly available table pages), Haggarty 2026 (closed on PMC until October 2027; abstract only), Wilson 2026 and Rodas 2024 (abstract only; the numbers of the PTSD subanalysis could not be read; the correction published for Wilson 2026 was read on October 29, 2026 and does not change the results), Datta 2025 (abstract only; product breakdown and conflict-of-interest statement could not be read). The 2019 PTSD recommendations of the International Society for Traumatic Stress Studies (ISTSS) could not be accessed (the site required human verification); in the drug meta-analysis commissioned by the society (Hoskins 2021), the only cannabinoid study included is Jetly 2015.","The status of dronabinol and nabilone in Turkey was read from two lists of TİTCK (Turkish Medicines and Medical Devices Agency) (List of Licensed Medicinal Products for Human Use, 16.10.2026; List of Active Substances from Abroad, 28.09.2026; downloaded on 29.10.2026). Whether a medicine that is not on the list can be brought in some other way was not researched in this review; the Turkish Pharmacists' Association's list of medicines from abroad was not searched because its current version could not be found."],"calismalar":[{"ad":"Bolsoni 2022a","tasarim":"Double-blind RCT","n":"33 (17 CBD, 16 placebo)","populasyon":"PTSD patients","urun":"Oral CBD (99.6% pure, BSPG-Pharm), capsule in corn oil (according to the 2022b full text on the same sample)","urun_turu":"saf_cbd","doz":"300 mg single dose","titrasyon":"None","sure":"Single dose; repeated without drug 1 week later","sonuc":"No difference in anxiety; only the cognitive impairment subscale decreased (lasted 1 week); no difference in physiological measures. There is no conflict-of-interest statement in this publication's PubMed record; according to the 2022b publication by the same authors with the same patients, 3 of 5 authors are inventors on CBD patents, and 1 is a consultant to pharmaceutical companies, including the company that supplied the CBD in the study (BSPG Pharm)","yan_etki":"Not reported (in the abstract)","pmid":"35029706","doi":"10.1007/s00213-021-06043-y","diger_kaynak":null},{"ad":"Bolsoni 2022b","tasarim":"Exploratory secondary analysis of the same sample (1:1 randomization by minimization; no correction for multiple comparisons)","n":"33 (sexual trauma 14: 7 CBD/7 placebo; non-sexual 19: 10 CBD/9 placebo)","populasyon":"PTSD patients","urun":"Oral CBD (99.6% pure, no other cannabinoids; BSPG-Pharm), capsule in corn oil","urun_turu":"saf_cbd","doz":"300 mg single dose (90 min before recall)","titrasyon":"None","sure":"Single dose","sonuc":"In non-sexual trauma, the rise in anxiety (difference −9.82; p=0.033) and cognitive impairment (−8.21; p=0.008) were lower than with placebo; no difference in sexual trauma; no difference in physiological measures. Funding: Brazilian public funds (FAPESP, CNPq); 3 of 5 authors are inventors on CBD patents, and 1 is a consultant to pharmaceutical companies, including the company that supplied the CBD in the study (BSPG Pharm)","yan_etki":"No side effect reporting in the full text","pmid":"35293520","doi":"10.1590/1516-4446-2021-2317","diger_kaynak":null},{"ad":"Gournay 2024","tasarim":"Double-blind, placebo-controlled RCT","n":"42","populasyon":"Trauma-exposed people with high stress levels","urun":"Oral CBD","urun_turu":"saf_cbd","doz":"300 mg/day","titrasyon":"None","sure":"Single dose + 1 week","sonuc":"No effect on the anxiety, distress or heart rate response to a trauma script. Funding: according to the PubMed record, the cannabis company Canopy Growth (the conflict-of-interest statement and the company's role could not be read)","yan_etki":"Not reported (in the abstract)","pmid":"38959155","doi":"10.1002/jts.23072","diger_kaynak":null},{"ad":"Bogenschutz 2026","tasarim":"Two double-blind, placebo-controlled RCTs","n":"S1: 27 (14 CBD, 13 placebo); S2: 30 (17 CBD, 13 placebo)","populasyon":"Alcohol use disorder (S1); alcohol use disorder + full or subthreshold PTSD (S2; 66.7% full PTSD)","urun":"Oral CBD capsule (Tilray, 200 mg, oil-based; hemp-derived, THC <0.1%), twice daily","urun_turu":"saf_cbd","doz":"S1: 600 mg/day for 4 weeks (400 in the morning + 200 in the evening), then 1200 mg/day for 4 weeks (600 × 2); S2: 600 mg/day (same split)","titrasyon":"In S1, dose increase after 4 weeks; the dose could be reduced if not tolerated","sure":"8 / 6 weeks","sonuc":"No advantage over placebo for alcohol, craving, mood, anxiety or PTSD symptoms (in S2, the model-estimated PTSD symptom score, PCL-5, over treatment was 27.5 with CBD and 25.9 with placebo; difference 1.56, 95% CI −7.66 to 10.78; p = 0.74). Tilray provided the study drug and funding for part of the pharmacokinetic analysis (according to the publication, the funders had no role in design, conduct or analysis); 2 of 7 authors reported research support from Tilray","yan_etki":"7/31 (22.6%) of people taking CBD reduced or stopped the dose because of side effects; nausea 20% vs 0% (p=0.025), diarrhea 27% vs 12%; liver enzymes/bilirubin 1.5–6.5×ULN: 2 CBD, 1 placebo; 1 serious event (diabetic ketoacidosis, 'possibly related')","pmid":"41312717","doi":"10.1111/acer.70212","diger_kaynak":"ClinicalTrials.gov NCT03252756 (S1: alcohol use disorder) and NCT03248167 (S2: alcohol use disorder + PTSD; results in the registry)"},{"ad":"Elms 2019","tasarim":"Retrospective case series, flexible dose","n":"21 started; 11 analyzed (those who attended the week 4 and week 8 follow-ups)","populasyon":"PTSD (in addition to medication and psychotherapy)","urun":"Hemp-derived CBD capsule (22–28 mg/capsule) and/or liquid spray (CV Sciences); according to the authors, may contain trace THC","urun_turu":"cbd_zengin_thc_belirsiz","doz":"Starting mean 33 mg/day (capsule median 25 mg, 25–100); mean 48.6 mg/day at week 8 (2–100)","titrasyon":"Flexible dose; adjusted every 4 weeks, increased in most","sure":"8 weeks","sonuc":"Mean PCL-5 51.82 → 37.14 (−28%) (no control)","yan_etki":"No one stopped because of side effects; among 21 people, 2 tiredness, 1 next-day grogginess/difficulty focusing, 2 digestive complaints, 1 increased reflux","pmid":"30543451","doi":"10.1089/acm.2018.0437","diger_kaynak":null},{"ad":"Straud (NCT05132699, registry results)","tasarim":"Double-blind, placebo-controlled pilot RCT (phase 1/2); added to 10 sessions of intensive prolonged exposure therapy over 2 weeks; no peer-reviewed results publication","n":"21 (11 CBD, 10 placebo); 3 people withdrew from the CBD group","populasyon":"PTSD","urun":"Epidiolex oral solution (according to the registry); matching strawberry-flavored placebo","urun_turu":"saf_cbd","doz":"250 mg twice daily (500 mg/day)","titrasyon":"Not defined in the registry","sure":"18 days of drug + 2 weeks of therapy; 1-month follow-up","sonuc":"Clear decrease in both groups at month 1; clinician-rated CAPS-5 favored placebo (15.2 vs 10.1), self-report PCL-5 favored CBD (19.97 vs 27.3); no statistical comparison published","yan_etki":"No serious side effects; other side effects CBD 10/11, placebo 7/10 (sleep disturbance 4 vs 0, digestive 4 vs 2)","pmid":null,"doi":null,"diger_kaynak":"NCT05132699 (clinicaltrials.gov/study/NCT05132699, results October 10, 2024); protocol: Straud 2024, PMID 38404650"},{"ad":"Das 2013 (fear extinction)","tasarim":"Double-blind, placebo-controlled","n":"48","populasyon":"Healthy","urun":"Vaporized (inhaled) CBD (according to the full texts of Kwee 2022 and Elms 2019; the Das full text was not read)","urun_turu":"saf_cbd","doz":"32 mg","titrasyon":"None","sure":"Before or after extinction","sonuc":"CBD given after extinction enhanced the consolidation of extinction learning (laboratory model)","yan_etki":"Not reported (in the abstract)","pmid":"23307069","doi":"10.1007/s00213-012-2955-y","diger_kaynak":null},{"ad":"Bonn-Miller 2021","tasarim":"Double-blind, placebo-controlled, 2-stage crossover RCT","n":"80 (stage 1), 74 (stage 2)","populasyon":"US military veterans with PTSD","urun":"Smoked cannabis: high THC (12% THC), high CBD (11% CBD, 0.5% THC), THC+CBD (7.9% + 8.1%), placebo","urun_turu":"thc_iceren","doz":"Self-directed use, up to 1.8 g a day","titrasyon":null,"sure":"3 weeks (each stage)","sonuc":"In stage 1, no type of cannabis reduced PTSD symptoms more than placebo; clear improvement in all groups, including placebo. Everyone in the THC-containing groups correctly guessed that they were receiving an active product. Funding: a Colorado state health department grant and MAPS, a nonprofit that designed the protocol and analyzed the data; 2 of 11 authors reported fees or shares from cannabis or pharmaceutical companies, 7 receive a salary from MAPS, and 1 from a private research company (Scottsdale Research Institute)","yan_etki":"Generally well tolerated; most common cough 12.3%, throat irritation 11.7%, anxiety 10.4%; 8.4% stopped because of side effects","pmid":"33730032","doi":"10.1371/journal.pone.0246990","diger_kaynak":"ClinicalTrials.gov NCT02759185"},{"ad":"Raminelli 2025","tasarim":"Systematic review and meta-analysis (21 placebo-controlled RCTs; SAD 5, GAD 1, PTSD 7, OCD 1, Tourette 7)","n":null,"populasyon":"Anxiety-related disorders and Tourette syndrome","urun":"Pure or CBD-rich products","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"Pooled effect not significant (SMD −0.40; −0.84/0.03); only in the pure CBD subgroup, SMD −0.61 (−1.15/−0.07). Authors: for SAD and GAD, 'low-quality evidence, limited efficacy'","yan_etki":null,"pmid":"40956670","doi":"10.1177/25785125251378242","diger_kaynak":null},{"ad":"Jetly 2015","tasarim":"Double-blind, placebo-controlled, randomized crossover pilot study","n":"10 (mITT)","populasyon":"Canadian male soldiers diagnosed with PTSD whose trauma-related nightmares continued despite standard treatment","urun":"Nabilone (THC-like synthetic cannabinoid, oral capsule)","urun_turu":"cbn_diger","doz":"Started at 0.5 mg and raised until nightmares were suppressed, up to a maximum of 3.0 mg","titrasyon":"Increased up to the effective dose or the 3.0 mg ceiling","sure":"2 × 7 weeks, with a 2-week washout in between","sonuc":"Reduction on the CAPS nightmare item −3.6 with nabilone, −1.0 with placebo (p = 0.03); CGI-C 1.9 vs 3.2 (p = 0.05); 5 of 10 people improved greatly with nabilone, 1 of 9 with placebo","yan_etki":"Treatment-related side effects 50% with nabilone, 60% with placebo; no severe side effects or stopping because of side effects","pmid":"25467221","doi":"10.1016/j.psyneuen.2014.11.002","diger_kaynak":"Health Canada registration"},{"ad":"Roepke 2026","tasarim":"Multicenter (Germany), double-blind, placebo-controlled, parallel-group RCT (phase 2)","n":"171 randomized (87 dronabinol, 84 placebo); efficacy analysis 169 (87/82); safety analysis 170 (87/83)","populasyon":"Adults diagnosed with PTSD who have recurrent nightmares (mean age 37.9; 79.3% women; 46% were in psychotherapy at the same time, 62% were taking antidepressants)","urun":"Dronabinol (synthetic THC; BX-1, oral), before bed; matching placebo","urun_turu":"thc_iceren","doz":"Started at 2.5 mg once daily, up to a maximum of 15 mg/day","titrasyon":"According to the protocol, 2.5 mg for 4 days, then 2.5 mg increases on days 5, 8, 12, 15 and 19; the goal was the dose at which nightmares disappeared (maximum 15 mg)","sure":"10 weeks (4 weeks of dose adjustment + 6 weeks at a fixed dose); follow-up at week 12","sonuc":"On the primary outcome (nightmare frequency and intensity, CAPS-IV B2, 0–8 points), the change at week 10 was −3.66 points with dronabinol and −2.17 with placebo; difference −1.50 (95% CI −2.28 to −0.71; p < 0.001; effect size d = 0.65); similar in sensitivity analyses. At least a 50% reduction in nightmares 57.9% vs 29%, complete disappearance 36.8% vs 14.5% (no correction for multiple comparisons). On overall PTSD severity (clinician-rated CAPS-5, main secondary outcome), the difference was not significant (−3.43; 95% CI −7.33 to 0.47; p = 0.08); after correction for multiple comparisons, only the patient's global impression of improvement remained significant among the main secondary outcomes. On the PTSD scale patients filled in themselves (PCL-5), the week 10 difference was −6.03 points (95% CI −10.30 to −1.75; uncorrected additional analysis). At the end of the study, among those who answered the question, 80.8% of people taking dronabinol and 52.5% of those taking placebo correctly guessed which group they were in (most based on the drug's effects); reports of improvement were strongly linked to which group people believed they were in (of those on placebo, 80% of those who thought they were taking dronabinol and 33% of those who thought they were taking placebo said they had improved). Investigator-initiated; the manufacturer Bionorica provided an unrestricted grant and the study drug (according to the publication, it had no role in design or analysis; the 2023 protocol publication also names the cannabis company Canopy Growth as a funder); 1 of 20 authors (the lead author) had received personal fees from Bionorica before the contract","yan_etki":"Any side effect 89.7% vs 77.1%; serious side effects 7 (8.0%) people vs 0 (the researchers did not attribute any to the drug); stopping because of side effects 5.7% vs 7.2%; dizziness 23% vs 14.5%, increased appetite 16.1% vs 8.4%, diarrhea 11.5% vs 3.6%, dry mouth 9.2% vs 1.2%","pmid":"42557458","doi":"10.1038/s41591-026-04546-9","diger_kaynak":"ClinicalTrials.gov NCT04448808 and EU registry EudraCT 2019-002211-25 (no results in either; October 28, 2026); protocol: Roepke 2023 (PMID 37147642)"},{"ad":"Ayers (NCT03518801, registry results)","tasarim":"Double-blind (quadruple-masked), placebo-controlled, parallel-group RCT (phase 2); added to 12 sessions of prolonged exposure therapy; no peer-reviewed results publication","n":"96 started the study (50 CBD, 46 placebo; the registry's 'actual enrollment' figure is 136, the difference is not explained); 27 and 31 completed; 93 people in the baseline analysis of the primary outcome (3 people were excluded because the validity of their symptom reports was found doubtful), 31 and 30 at the end of treatment, 24 and 28 at month 3","populasyon":"Military veterans diagnosed with PTSD (US, VA San Diego Healthcare System; mean age 42.8; 31% women); after March 2020, visits and therapy were remote","urun":"Synthetic, pharmaceutical-grade crystalline CBD, capsule (according to the protocol; the registry says only 'active drug'); placebo cellulose capsule","urun_turu":"saf_cbd","doz":"According to the drug section of the protocol, 300 mg capsule twice daily (600 mg/day); another sentence in the same section says 'target daily dose of 300 mg'. No dose in the registry; the dose patients actually took was not reported","titrasyon":"None; the dose could be reduced in case of side effects (in steps of 50 mg in the protocol's drug section, 0.10 mL in its risk section)","sure":"16 weeks of drug (12 weeks of therapy); 1- and 3-month follow-up","sonuc":"Primary outcome was total severity on the clinician-rated CAPS-5 scale (0–80; higher score is more severe): at baseline 36.9 in the CBD group and 35.1 with placebo; at the end of treatment (week 16) 22.6 vs 23.1; at the 1-month follow-up 22.9 vs 21.5; at month 3 21.2 vs 21.9. Scores fell from baseline in both groups; the registry gives no statistical comparison between groups. On the secondary outcome (number of therapy sessions until a 10-point drop on the patient-rated PCL-5 scale, in responders), median 5 vs 5 sessions (27 and 26 people). Non-completers: 23 of 50 people in the CBD group, 15 of 46 in the placebo group. Sponsor: US Department of Veterans Affairs Office of Research and Development (public); results were entered on ClinicalTrials.gov on October 28, 2026","yan_etki":"No deaths and no serious side effects (CBD 0/46, placebo 0/45); other side effects above the 5% threshold in 11/46 people with CBD and 15/45 with placebo: tiredness 6 vs 8, headache 3 vs 6, dry mouth 3 vs 3, nausea 0 vs 3, drowsiness 3 vs 2. The side effect scale (UKU) was dropped when follow-up switched to remote","pmid":null,"doi":null,"diger_kaynak":"NCT03518801 (clinicaltrials.gov/study/NCT03518801, results October 28, 2026); protocol and statistical analysis plan in the registry (version 1.44, November 6, 2023); collaborating institution University of California San Diego"},{"ad":"Zabik 2023","tasarim":"Double-blind, placebo-controlled, parallel-group RCT (single dose; laboratory fear extinction study with brain imaging)","n":"71 analyzed (THC 34, placebo 37): 19 with PTSD, 26 trauma-exposed without PTSD, 26 healthy; according to the registry, 86 people were enrolled","populasyon":"Adults with PTSD and trauma-exposed adults, plus a healthy comparison group (US, Detroit)","urun":"Dronabinol (synthetic THC, oral capsule) and placebo","urun_turu":"thc_iceren","doz":"7.5 mg single dose, about 2 hours before extinction learning","titrasyon":"None","sure":"Single dose; 3-day fear learning, extinction and recall experiment","sonuc":"On behavioral fear measures (skin conductance, expectancy ratings), no difference between THC and placebo in the extinction, recall and fear return phases; in people with PTSD who took THC, brain imaging showed higher activity in the frontal brain (vmPFC) and amygdala. Clinical symptoms were not measured. Funding: US National Institute of Mental Health (NIMH)","yan_etki":"Not reported","pmid":"37088409","doi":"10.1016/j.nlm.2023.107758","diger_kaynak":"ClinicalTrials.gov NCT02069366 (results in the registry; primary outcomes were brain imaging and expectancy ratings). Other publications of the same trial: Rabinak 2020 (PMID 32162103; in response to threat images, THC reduced amygdala reactivity in people with PTSD) and Pacitto 2022, done under the same grant and with the same dose (PMID 35981598; 51 people; THC reduced negative emotion during emotional reappraisal)"},{"ad":"Zabik 2026","tasarim":"Double-blind, placebo-controlled, 3-arm RCT (single dose; laboratory fear extinction study with brain imaging)","n":"44 randomized; 36 analyzed (placebo 11, 5 mg 11, 10 mg 14)","populasyon":"Adults with PTSD (US, Detroit)","urun":"Dronabinol (synthetic THC, oral capsule) and placebo","urun_turu":"thc_iceren","doz":"5 mg or 10 mg single dose, before extinction learning","titrasyon":"None","sure":"Single dose; testing 24 hours and 1 week later","sonuc":"No difference between dose groups in fear expectancy ratings; on brain imaging, activity in some frontal brain and hippocampal regions was higher 24 hours later with 5 mg and 1 week later with 10 mg. Clinical symptoms were not measured; the sample was small. Funding: US National Institute of Mental Health (NIMH)","yan_etki":"Not reported","pmid":"39412674","doi":"10.1007/s00213-024-06702-w","diger_kaynak":"ClinicalTrials.gov NCT03008005 (results in the registry; 46 people enrolled). Haggarty 2026 (PMID 42463794; 37 people with PTSD), done under the same grant (R61MH111935) and with the same dose groups: THC reduced frontal brain activity during emotional reappraisal, negative emotion ratings did not change (abstract only)"},{"ad":"Wilson 2026","tasarim":"Systematic review and meta-analysis of RCTs (1980–May 13, 2025; GRADE; PROSPERO CRD42023392718)","n":"54 RCTs; 2,477 participants (all mental disorders and substance use disorders; the number of PTSD studies is not in the abstract)","populasyon":"People whose primary diagnosis is a mental disorder or substance use disorder; PTSD was examined under a separate heading","urun":"CBD, THC, THC and CBD combinations, and other cannabinoids","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"No significant difference was found between cannabinoids and placebo for PTSD-related outcomes (the number of studies and effect size of the subanalysis are not in the abstract; full text could not be read). Significant benefit was seen only in cannabis use disorder, insomnia, tics and Tourette syndrome, and autism; the certainty of evidence is low for most outcomes, 44% of studies had a high risk of bias; the authors conclude that routine use of cannabinoids in mental disorders can rarely be justified for now. Because the search ended in May 2025, the 2026 dronabinol nightmare study (Roepke 2026) is not included. The correction published in the journal (June 16, 2026) corrected the axis of a figure and the study counts in the table; the results did not change","yan_etki":"Across all studies, any side effect was more common with cannabinoids (OR 1.75; 95% CI 1.25–2.46; number needed to harm 7); no difference in serious side effects or dropping out of the study","pmid":"41856154","doi":"10.1016/S2215-0366(26)00015-5","diger_kaynak":"Correction: Lancet Psychiatry 2026;13(8):e11, PMID 42302809 (June 16, 2026; the axis of a figure and the study counts in the table were corrected, results unchanged)"},{"ad":"Aviram 2026","tasarim":"Scoping review (PRISMA-ScR; 5 databases and ClinicalTrials.gov, up to December 22, 2024; with quality assessment; not preregistered)","n":"26 studies: 7 RCT publications (6 trials, because two publications of the same trial were counted separately), 18 observational studies, 1 RCT with unpublished results; 3,598 patients in total","populasyon":"People diagnosed with PTSD","urun":"Medical cannabis, THC, CBD, dronabinol, nabilone","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"Of the 7 RCT publications, only one (nabilone, nightmares; Jetly 2015) showed a clear clinical advantage over placebo. The RCT with smoked cannabis was not better than placebo; a second study planned with vaporized cannabis stopped at 6 people and so could not be compared with placebo (the review also counts it as 'not better'). Two laboratory RCTs with THC found changes in brain activity but showed no improvement in symptoms; the two RCTs counted for single-dose CBD are actually two publications of the same 33-person trial (Bolsoni 2022a and 2022b), and the effect was small and temporary. Most observational studies reported improvement in nightmares, sleep and hyperarousal, but the risk of bias was high and most had no comparison group. Authors: high-quality RCT evidence is insufficient to support clinical use. Because the search ended in December 2024, Roepke 2026 is not included. 1 of 4 authors is tied to Syqe Medical, which develops a medical cannabis delivery device, and 1 is a former employee of the company; the same company paid the open-access fee","yan_etki":"Side effects generally mild (dry mouth, dizziness)","pmid":"42210342","doi":"10.1186/s42238-026-00451-7","diger_kaynak":null},{"ad":"Rodas 2024","tasarim":"Systematic review (PubMed, PsycINFO, Embase; January 1990–February 2023; no meta-analysis)","n":"14 studies (3 in people with PTSD together with cannabis use disorder)","populasyon":"PTSD patients who use cannabis","urun":"Cannabis and cannabinoids","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"Of 10 studies examining overall PTSD symptoms in people without cannabis use disorder, 5 reported benefit and 5 reported no effect or worsening; some benefits were seen in re-experiencing and hyperarousal symptoms. All 3 studies in patients who also had cannabis use disorder reported a risk of worsening symptoms; a risk of worsening suicidal thoughts and violent behavior was also reported. The authors found no clear benefit for overall PTSD symptoms","yan_etki":null,"pmid":"38353645","doi":"10.4088/JCP.23r14862","diger_kaynak":"Commentary in the same issue: PMID 38353646"},{"ad":"Schnurr 2024 (VA/DoD 2023 guideline)","tasarim":"Clinical practice guideline synopsis (US Department of Veterans Affairs and Department of Defense; systematic evidence review and GRADE)","n":null,"populasyon":"Adults with PTSD and acute stress disorder","urun":"Cannabis and cannabis derivatives; for the nightmare question, cannabis and nabilone were also assessed","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"Recommendation 20: strong recommendation against cannabis or cannabis derivatives in the treatment of PTSD (very low confidence in the quality of evidence). Rationale: the lack of large, well-designed RCTs and potentially serious side effects; because no new evidence was found in the 2023 review, the recommendation rests on the evidence assessment of the 2017 guideline. The 2021 RCT with smoked cannabis (Bonn-Miller 2021) was not included in the assessment because its follow-up was short; it had also found no difference. For nightmares, cannabis and nabilone were among the drugs assessed, but no recommendation was written about them; for nightmares there is only a weak recommendation for prazosin. The guideline predates the 2026 dronabinol nightmare study (Roepke 2026)","yan_etki":"Based on the 2017 evidence assessment, the guideline mentions possible harms such as impaired attention, memory and driving ability, psychosis, suicide attempts, paranoia and agitation","pmid":"38408360","doi":"10.7326/M23-2757","diger_kaynak":"Full guideline: VA/DoD Clinical Practice Guideline for the Management of Posttraumatic Stress Disorder and Acute Stress Disorder, June 2023 (healthquality.va.gov), Recommendations 20 and 32–33"},{"ad":"Morgenthaler 2018 (AASM)","tasarim":"Position paper (American Academy of Sleep Medicine; literature search March 2009–August 2017 and expert opinion; a position paper instead of a guideline because the evidence is limited)","n":null,"populasyon":"Adults with nightmare disorder and PTSD-related nightmares","urun":"Nabilone (THC-like synthetic cannabinoid); for cannabis, it says only 'no evidence to make a recommendation'","urun_turu":"cbn_diger","doz":null,"titrasyon":null,"sure":null,"sonuc":"For PTSD-related nightmares, nabilone is among the options described as \"may be used\"; in the paper this is a weaker level than \"recommended,\" where the evidence or expert opinion is uncertain. The basis is a single 10-person RCT (Jetly 2015). It states there is no evidence to make a recommendation for cannabis. The only \"recommended\" treatment for nightmares is imagery rehearsal therapy (a psychotherapy method)","yan_etki":"For Jetly 2015, dry mouth and headache are reported as most common","pmid":"29852917","doi":"10.5664/jcsm.7178","diger_kaynak":null},{"ad":"Fraser 2009","tasarim":"Retrospective chart review (the author calls it an \"open-label study\"; no control group)","n":"47","populasyon":"Patients with PTSD whose nightmares had continued for at least 2 years despite antidepressants and sleep medicines (Canada, private psychiatric clinic; 27 women, 20 men)","urun":"Nabilone (THC-like synthetic cannabinoid, oral capsule), added to existing medicines","urun_turu":"cbn_diger","doz":"Started at 0.5 mg 1 hour before bed; mean effective dose 0.5 mg (0.2–4 mg)","titrasyon":"Weekly increase or decrease according to effect and side effects","sure":"Not reported (some patients used it for 4–12 months and longer)","sonuc":"In 34 of 47 patients (72%), nightmares stopped completely (28) or eased clearly (6); in most of those who tried stopping the drug, nightmares returned within a few nights. The assessment relies on patients' own nightly records; there is no comparison group, and the patients were those referred to a single specialist clinic","yan_etki":"13 patients (28%) stopped because of mild to moderate side effects: lightheadedness, forgetfulness, dizziness, headache","pmid":"19228182","doi":"10.1111/j.1755-5949.2008.00071.x","diger_kaynak":null},{"ad":"Cameron 2014","tasarim":"Retrospective chart review (no control group)","n":"104","populasyon":"Male inmates with serious mental illness (Canada, prison treatment center); nabilone was most often given for insomnia (97%), nightmares (87%) and chronic pain (65%)","urun":"Nabilone (THC-like synthetic cannabinoid); in powder form with water to prevent misuse","urun_turu":"cbn_diger","doz":"Starting mean 1.4 mg/day (0.5–2), final dose mean 4.0 mg/day (0.5–6)","titrasyon":"Increased according to effect","sure":"Mean 11.2 weeks (1 day–36 weeks)","sonuc":"Nights with nightmares fell from 5.2 to 0.9 per week (90 people), sleep duration rose from 5.0 to 7.2 hours per night (101 people), and the PTSD symptom score (PCL-C) fell from 54.7 to 38.8 (58 people; all p ≤ 0.001). Before-and-after comparison; no control group, and measurements rely on patient reports and clinical records","yan_etki":"Side effects in 31 people (29.8%), 10 (9.6%) stopped; the most serious was psychosis in 2 people with a prior psychotic illness; also drowsiness 12.5%, dry mouth 6.7%, feeling \"high\" 3.8%","pmid":"24987795","doi":"10.1097/JCP.0000000000000180","diger_kaynak":null},{"ad":"Wilkinson 2015","tasarim":"Observational, prospective follow-up (national evaluation data from US Veterans Health Administration intensive PTSD treatment programs, 1992–2011)","n":"2,276 veterans","populasyon":"Veterans admitted to intensive PTSD treatment programs (those with problematic alcohol and other substance use were excluded)","urun":"Cannabis (marijuana) use; not prescribed","urun_turu":"thc_iceren","doz":"Use in the last 30 days (yes/no)","titrasyon":null,"sure":"Up to 4 months after discharge","sonuc":"PTSD symptoms were most severe in those who started cannabis after the program (effect size +0.34 vs never-users); symptoms were mildest in those who stopped and in never-users (effect size of stopping −0.18). Cannabis use was also linked to more violent behavior and alcohol and drug use. Because it is observational, it does not show cause and effect","yan_etki":"Violent behavior was highest in those who started cannabis","pmid":"26455669","doi":"10.4088/JCP.14m09475","diger_kaynak":"Another analysis of the same database: De Aquino 2020 (PMID 33035104; in 1,413 veterans using nonprescribed opioids, cannabis use neither improved nor worsened PTSD symptoms over 4 months)"},{"ad":"Metrik 2022","tasarim":"Observational, prospective cohort (baseline, month 6 and month 12; cross-lagged panel analysis)","n":"361 veterans","populasyon":"US veterans who served after September 11, 2001","urun":"Cannabis use (not prescribed)","urun_turu":"thc_iceren","doz":"Frequency of use","titrasyon":null,"sure":"12 months","sonuc":"Cannabis use at baseline was linked to more severe symptoms of involuntary re-experiencing of traumatic memories 6 months later (β = 0.46; 95% CI 0.16–0.77; p = 0.002); the link in the opposite direction was also significant but weaker (from intrusive memories at baseline to cannabis use 6 months later, β = 0.22; p = 0.04). PTSD at baseline predicted cannabis use disorder 12 months later. Observational; does not show cause and effect","yan_etki":null,"pmid":"32546286","doi":"10.1017/S003329172000197X","diger_kaynak":null},{"ad":"Bonn-Miller 2022","tasarim":"Observational, prospective controlled cohort (cannabis users and non-users; not randomized)","n":"150 (75 cannabis users, 75 non-users)","populasyon":"Adults diagnosed with PTSD living in Colorado (73% men; veterans and civilians)","urun":"Cannabis bought from licensed medical or recreational outlets; 91% of users mainly used THC-rich products (mostly smoked flower)","urun_turu":"thc_iceren","doz":"Self-directed use (at least once a week)","titrasyon":null,"sure":"1 year (assessment every 3 months)","sonuc":"On the primary outcome (CAPS-5), PTSD severity decreased in both groups, faster in cannabis users (group × time interaction −0.32; 95% CI −0.59 to −0.05; p = 0.02); at the end of the year, users were 2.57 times as likely to no longer meet diagnostic criteria (95% CI 1.12–6.07). The difference came mainly from hyperarousal symptoms; no group difference in sleep, functioning or physical activity. The groups differed at baseline in age, proportion of veterans and type of trauma. Funding: Colorado state health department; 5 of 7 authors have ties to cannabis or pharmaceutical companies (two Canopy Growth employees, one Jazz Pharmaceuticals employee, two company consultants)","yan_etki":"Not reported","pmid":"33998874","doi":"10.1089/can.2020.0056","diger_kaynak":null},{"ad":"Hill 2024","tasarim":"Individual patient data meta-analysis (4 RCTs from Project Harmony, a set of 36 RCTs on treating PTSD and substance use disorder; cannabis use was not randomized and was weighted using propensity scores)","n":"410 people (33.2% reported using cannabis at baseline; 70% men)","populasyon":"Adults with PTSD together with alcohol or substance use disorder","urun":"Cannabis use (in the month before treatment; not prescribed)","urun_turu":"thc_iceren","doz":"Use in the last 30 days (15 days or more in the sensitivity analysis)","titrasyon":null,"sure":"Treatment duration (varies by study)","sonuc":"Trauma-focused therapy (COPE, which includes prolonged exposure) produced more improvement in PTSD than non-trauma-focused therapy, whether or not people used cannabis (d = 0.70 in users); session attendance and PTSD improvement did not differ between cannabis users and non-users, and the outcome was the same in frequent users too. It does not test whether cannabis treats PTSD; it shows that cannabis users can benefit from a proven therapy. 1 of 10 authors consulted for Canopy Growth in the last 2 years","yan_etki":null,"pmid":"38266511","doi":"10.1016/j.janxdis.2024.102827","diger_kaynak":null},{"ad":"Lynskey 2024","tasarim":"Observational, prospective patient registry (Project Twenty21, UK; no control group)","n":"238 (month 3 data for 116; 114 for PCL-C)","populasyon":"Patients with PTSD starting prescribed cannabis treatment at a private clinic (77% screened positive for depression)","urun":"Prescribed cannabis-based products (oil and flower); 74.8% of patients were prescribed at least one THC-rich flower","urun_turu":"thc_iceren","doz":"Not reported (products were classified by form and THC/CBD ratio)","titrasyon":null,"sure":"3 months","sonuc":"PTSD symptom score (PCL-C) fell from 58.0 to 47.0 over 3 months (p < 0.001); the drop was larger in those with depression (15.3 vs 7 points). Fewer than half of the patients at baseline have month 3 data; no comparison group. The organization running the registry (Drug Science) receives an unrestricted grant from a consortium of medical cannabis companies; 1 of 5 authors is a scientific advisor to two companies","yan_etki":"Not reported","pmid":"38468390","doi":"10.1192/bjo.2024.13","diger_kaynak":"Another analysis of the same registry: Sultan 2024 (PMID 39474239; 58 patients prescribed THC-rich flower, improvement in symptoms reported at months 3 and 6; all 3 authors work at the cannabis company Khiron or a clinic linked to it)"},{"ad":"Datta 2025","tasarim":"Observational, prospective patient registry (UK Medical Cannabis Registry; no control group)","n":"269","populasyon":"PTSD patients using prescribed cannabis products who had been followed in the registry for at least 18 months","urun":"Prescribed cannabis-based products (the product breakdown for this analysis is not in the abstract; full text could not be read)","urun_turu":"karma","doz":"Not reported (in the abstract); in the same registry's 2022 PTSD analysis (162 people), median daily dose 145 mg THC and 5 mg CBD","titrasyon":null,"sure":"18 months (measurements at months 1, 3, 6, 12 and 18)","sonuc":"PTSD-specific symptoms (IES-R), anxiety, sleep quality and overall quality of life improved significantly from baseline at all follow-up points (p < 0.001); men were less likely to report improvement (OR 0.51). No comparison group; the authors state that cause and effect cannot be inferred. 14 of 18 authors work at the private cannabis clinic that runs the registry (Curaleaf Clinic); the conflict-of-interest statement is in the full text, which could not be read","yan_etki":"Side effects in 70 patients (26%); most common insomnia (15.6%) and tiredness (14.9%)","pmid":"40235073","doi":"10.1080/14737175.2025.2490539","diger_kaynak":"Earlier analysis of the same registry: Pillai 2022 (PMID 36503404; 162 patients, 6 months; 88.9% had used cannabis before; a total of 220 side effects in 33 people (20.4%), most common insomnia and tiredness)"}],"ilgili_ilaclar":["sitalopram","essitalopram","sertralin","fluoksetin","mirtazapin","snri","alprazolam","klonazepam","benzodiazepin","pregabalin","hidroksizin","buspiron"],"son_inceleme":"2026-10-31","arastirma_gecmisi":[{"tarih":"2026-10-19","not":"Page published. This first review looked at 7 studies."},{"tarih":"2026-10-21","not":"The full texts of the studies were reread and the information on the page was checked against its sources. Corrected: product, number of participants, side effect and dose information in the study table; drug interaction notes; the dose range in the studies; the \"Who should be careful\" list; reported side effects; the evidence summary. Study added: Straud (NCT05132699, registry results). Points that could not be verified from the full text went from 3 items to 2. The year of 7 publications named on the page was corrected to the journal's print year instead of the online publication year. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-21","not":"PubMed and ClinicalTrials.gov were searched for newly published and previously missed clinical studies. Study added: Bonn-Miller 2021. For pure CBD, the conclusion and the strength of evidence did not change; for THC-containing products, the strength of evidence was stated for the first time, as \"Weak\"."},{"tarih":"2026-10-22","not":"The names of the finding labels were simplified: this page's \"No benefit seen\" label became \"No effect found\". The assessment did not change."},{"tarih":"2026-10-27","not":"A small controlled study of nabilone, a THC-like synthetic medicine, in PTSD-related nightmares (Jetly 2015) was added; the conclusion for THC-containing products was split in two: overall symptoms and nightmares. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-28","not":"In the October 2026 search (PubMed, Cochrane, ClinicalTrials.gov), 16 studies were added to this topic: 3 controlled studies (a 171-patient multicenter dronabinol study in PTSD-related nightmares, two laboratory studies with THC in people with PTSD), 3 systematic reviews, 2 guidelines (the 2023 guideline of the US Departments of Veterans Affairs and Defense, American Academy of Sleep Medicine 2018) and 8 observational studies (nabilone patient records, cannabis use and the course of PTSD in veterans, therapy outcomes in cannabis users, two patient registries in the UK). The conclusion and evidence text for THC-containing products were updated in light of the new nightmare study: two RCTs positive for nightmares ('moderate' in the evidence text), no clear difference in overall PTSD symptoms ('weak'). The two-way nature of the real-world data, the guideline recommendations, and registrations with unreleased results or left unfinished were added to the text. Registration numbers, PTSD outcome, funding, company ties and blinding information were added to five existing rows; the product type of the smoked cannabis study was corrected to 'THC-containing'. The conclusion and evidence labels ('Weak' for CBD, 'Weak' for THC-containing products) did not change."},{"tarih":"2026-10-28","not":"Display fix: internal working notes left over from the previous cleanup were removed; content and evidence did not change."},{"tarih":"2026-10-28","not":"October 2026 additional review: sources found for this page during the searches for other topics were read and incorporated into the page. Results of the study in which CBD or placebo was added to prolonged exposure therapy in veterans (NCT03518801) were entered on ClinicalTrials.gov on October 28, 2026; the study was added to the table with its registry results (96 people started; symptoms decreased in both groups, the groups were not compared statistically, no peer-reviewed publication), and the 'results not released' sentences were corrected. Because the nightmare studies also appear on the insomnia page, a reference to that page was added. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-30","not":"The correction to the Wilson 2026 meta-analysis published in the journal was read: only the axis of one figure and the study counts in a table were corrected; the results on this page did not change."},{"tarih":"2026-10-31","not":"The Turkey question now adds that dronabinol and nabilone, which were tested in PTSD studies, are not licensed in Turkey: the list of licensed medicines of the Turkish Medicines and Medical Devices Agency (October 16, 2026) contains no medicine containing cannabinoids, and neither drug is on the agency's list of active substances from abroad (September 28, 2026) either. The result and the strength of evidence did not change."},{"tarih":"2026-10-31","not":"The last sentence of the page's short summary was rewritten in calmer, more guiding language: instead of \"Talk to your doctor before you start.\", it now says who you can talk with, and about what, if you are considering CBD. The result and the strength of evidence did not change."},{"tarih":"2026-11-01","not":"The evidence level text now uses the same level name as the top of the page; the level and the result did not change."}]},{"id":"insomnia","baslik":"Insomnia and sleep problems","grup":"Sleep","grup_kodu":"uyku","tr_id":"uyku-uykusuzluk","kanit_duzeyi":"zayif","kanit_yonu":"yarar_gosterilmedi","kanit_ozet":"Pure CBD has not clearly shown an effect on insomnia in controlled studies: in the most recent meta-analysis, CBD alone did not significantly improve sleep quality compared with placebo (SMD 0.13). In primary insomnia, 150 mg of CBD at night for 2 weeks did not change insomnia severity, time to fall asleep or night awakenings; in healthy people, a single 300 mg dose did not change sleep structure. With THC-containing products, subjective improvement is more consistent; objective measures, however, diverge by type of measurement: in a single-dose pilot lab study, THC/CBD reduced total sleep and REM sleep, in a two-week study polysomnography did not change, and in one meta-analysis sleep time measured with an electronic device got longer. According to a review pooling polysomnography studies, the drop in REM comes mostly from older, small studies with high THC doses. In the 2026 Cochrane review (9 RCTs, 537 people), medical cannabis adds little or nothing meaningful to sleep quality, total sleep and daytime functioning (very low certainty); side effects may increase (low certainty). In healthy young people, 50 mg/day of CBD for 8 weeks raised the questionnaire sleep score, but superiority over placebo on the overall score was not shown (there was a difference on only one subscale); sleep time measured at the wrist did not change (28 people); in systemic sclerosis, a low-dose THC+CBD oil made no significant difference in sleep quality. Studies added in October 2026 did not change the picture for pure CBD: in people with high levels of worry, 300 mg of CBD for 2 weeks did not differ from placebo for sleep problems; two positive findings come from small or weakly designed studies (in 1981, longer sleep reported with 160 mg in 15 people with insomnia; in 60 young people who clench their teeth in their sleep, PSQI improved with a CBD gel applied inside the mouth to the chewing muscle: a secondary publication of a pain trial, the sleep measure is not in the study’s registration, and the CBD groups had worse starting scores). With THC-containing products, insomnia patients who got a cannabis card right away had insomnia scores on average 2.9 points lower than those who waited over the 12-week period (participants knew their group; cannabis use disorder rose across the whole sample); in Thailand, with a traditional blend containing cannabis leaf and with a cannabis oil, sleep quality improved over 4 weeks about as much as in those taking lorazepam (one a double-blind study testing whether it was not worse than lorazepam, the other a small open-label study that did not test equivalence; neither had a placebo); a supplement containing very little THC and plant ingredients reduced sleep disturbance slightly more than placebo in an online 620-person RCT (company study); in healthy volunteers, 15 mg of THC taken at bedtime caused sleepiness and weaker memory the next morning. Nabilone was better than amitriptyline in fibromyalgia patients with insomnia (no placebo); CBG did not differ from placebo in veterans with sleep problems. A 2026 meta-analysis (10 RCTs, 2,134 people) reported a positive pooled result, while Cochrane rated the evidence as very low certainty; the Brazilian Sleep Association’s 2023 guideline does not recommend cannabis, CBD or THC for insomnia. In sleep apnea, dronabinol reduced breathing pauses in a 73-person, 6-week RCT and in a 9-person crossover study combined with acetazolamide (in the large study, 11–13 events per hour fewer than placebo; part of the difference comes from a rise in the placebo group), but sleep structure and oxygen levels did not change; in the open-label study combining it with atomoxetine, the main measure was negative; the studies are short and side effects common; the American Academy of Sleep Medicine’s 2018 position statement recommends against its use; there are no CBD data. In REM sleep behavior disorder (acting out dreams) in Parkinson’s patients, CBD did not differ from placebo on the primary measures in a 33-person RCT; the Brazilian Academy of Neurology’s 2025 Parkinson’s guideline, based on this study, also states that CBD does not clearly affect how often these behaviors occur and does not list CBD among the treatments it recommends. In restless legs, the only controlled data are a negative analysis done afterward (18 people); an 18-person open-label THC+CBD study is positive; the German guideline does not recommend it. In PTSD-related nightmares, a 171-person multicenter dronabinol RCT and a 10-person nabilone RCT are positive (the large study is the only one and was manufacturer-supported; most people taking dronabinol figured out which group they were in); the American Academy of Sleep Medicine lists nabilone among the options that 'may be used' for these nightmares. The studies are small and short (1 night–14 weeks in controlled studies). October 2026 search (PubMed, Cochrane, ClinicalTrials.gov): the table includes 29 controlled studies with cannabinoids on this topic, 6 studies without a control group or whose control could not be verified and 1 patient registry, 8 systematic or scoping reviews, and 4 guidelines or position statements. Additional publications of the same trials are in the 'other source' section of the relevant row; pain, Parkinson’s, MS and epilepsy trials in which sleep was only a secondary measure, 1970s sleep EEG studies of a few people each, and older reviews answering the same question were not included in the table (the reviews pooling them are in the table). Completed studies whose results have not been published in a peer-reviewed journal (e.g., a 121-person dronabinol combination study in sleep apnea, a 208-person CBD study in insomnia) and ongoing studies (e.g., a 519-person CBD insomnia study) are not in the table.","kanit_duzeyi_metin":"Weak / inconsistent (pure CBD — insomnia); no pure CBD data in sleep apnea; in restless legs, the only controlled data (a small analysis done afterward) are negative","kanit_duzeyi_thc_icerenler":"zayif","kanit_duzeyi_thc_icerenler_metin":"Weak (small RCTs, blinding problems, mostly subjective measures); CBN: very low/low; dronabinol in sleep apnea: low (two small and short RCTs, one combined with acetazolamide; the American Academy of Sleep Medicine does not recommend it); THC+CBD in restless legs: very low (a single uncontrolled study); dronabinol and nabilone in PTSD-related nightmares: moderate (same assessment as the PTSD page: a single large 171-person RCT and a 10-person RCT are positive; the large study was manufacturer-supported, and most people taking dronabinol figured out which group they were in)","kaynak_dosya":"uyku-depresyon.md","saf_cbd_sonuc":"Pure CBD did not significantly improve sleep quality compared with placebo (meta-analysis SMD 0.13; 95% CI −0.38 to 0.65); in newer studies too, 300 mg of CBD for 2 weeks in worried people did not differ from placebo. Positive findings come from small or weakly designed studies: in a 1981 study of 15 people, longer sleep was reported with 160 mg; in 60 young people who clench their teeth in their sleep, sleep scores improved with a CBD gel applied inside the mouth to the chewing muscle (a secondary publication of a pain trial; the sleep measure was not in the study’s registration and the CBD groups had worse starting scores). There is no CBD study in sleep apnea; in restless legs and REM sleep behavior disorder, the only controlled data are negative.","thc_icerenler_sonuc":"With THC-containing formulas, subjective sleep is better (meta-analysis SMD 0.82), but measured sleep differs by type of measurement: in a single-dose lab study total sleep and REM decreased, in a two-week study the lab measurement did not change, and in one meta-analysis sleep time measured with an electronic device got longer; according to Cochrane 2026, medical cannabis adds little or nothing meaningful to sleep quality and total sleep (very low certainty); in people who got a medical cannabis card for insomnia, insomnia scores fell over 12 weeks, but participants knew their group, and in the same study cannabis use disorder developed about twice as often in those who got a card (most in those who applied for anxiety or depression); in sleep apnea, dronabinol reduced breathing pauses in short RCTs (11–13 events per hour fewer than placebo in 73 people; part of the difference comes from a rise in the placebo group), but the American Academy of Sleep Medicine recommends against its use; in PTSD-related nightmares, a 171-person dronabinol RCT found nightmares decreased more than with placebo (most people taking dronabinol figured out which group they were in); THC’s addiction and driving risks are separate.","ruhsat":null,"doz_araligi_ozet":"In pure CBD studies, 15–300 mg (at night or as a single dose), 50 mg/day for 8 weeks; with THC-containing products, ~2–20 mg THC + ~0.5–22.5 mg CBD/day (plus 1–2 mg CBN in ZTL-101) or a single dose of 10 mg THC + 200 mg CBD; CBN 15–300 mg; nabilone 0.25–1.75 mg/day (0.5–1 mg in insomnia; at most 3 mg for PTSD nightmares); CBG 25–50 mg/day; dronabinol in sleep apnea 2.5–10 mg (alone or with acetazolamide or atomoxetine); dronabinol for PTSD nightmares 2.5–15 mg/day; in other THC-containing products, from very-low-dose supplements (0.35–0.85 mg THC) up to 30 mg THC in an old study; in one patient registry the THC dose rose clearly over time (observational; the authors write it may be a sign of tolerance)","titrasyon_ozet":"Fixed dose in most studies; in Ried 2023, increase from 0.2 → 1.5 mL/day; in de Almeida 2021, 75 → 300 mg/day; in sleep apnea, weekly 2.5 → 5 → 10 mg dronabinol in Prasad 2013, in Carley 2018 the 10 mg group started with 2.5 and 5 mg in the first two weeks, in Messineo 2023 weekly 2.5 → 5 → 10 mg together with atomoxetine; in Emerson 2026, CBG 25 → 50 mg after 2 weeks","yan_etkiler":["Dry mouth (150 mg/night; Narayan 2024)","With THC/CBD, a small increase in subjective sleepiness the next day and a feeling of sedation at hour 10 (Suraev 2026; next-day publication of the same trial Suraev 2024)","CBD increased drowsiness in epilepsy studies (moderate certainty; Solmi 2023, PMID 37648266)","In chronic pain, with cannabinoids (most containing THC): dizziness (RD 29%), drowsiness, dry mouth, tiredness, nausea (AminiLari 2022)","Dronabinol in sleep apnea: sleepiness (at 10 mg, 17 of 27 people in the Carley 2018 registry record, 0 with placebo; 50% in Prasad 2013); in combination with acetazolamide, tingling in the fingers, constipation, nausea (Walsh 2025); in combination with atomoxetine, excessive suspiciousness (paranoia), a state of detachment and suicidal thoughts in one person; in this open-label study, side effects were also common in the first week on atomoxetine alone (9 of 15 people), and a third of patients did not finish the study (Messineo 2023, registry NCT05101122)"],"izlem":["With pure CBD, 150 mg at night did not impair daytime cognitive performance (Narayan 2024); with THC-containing products, next-day sedation should be monitored","With THC-containing products, signs of cannabis use disorder should be monitored (Gilman 2022); in people with sleep apnea, cannabis products should not replace treatment, and follow-up with a sleep physician should continue (Ramar 2018)"],"dikkat":["Together with sleep medicines, benzodiazepines or sedatives: extra sedation and higher drug levels are possible; physician monitoring is required","Driving: 13.75 mg of vaporized CBD-dominant cannabis did not impair driving, but clinically important impairment could not be fully ruled out; THC-containing products impaired it (Arkell 2020, PMID 33258890)","Older adults: sleep studies were mostly in young/middle-aged people; pharmacokinetics, multiple medicines and interactions may differ (Draghmeh 2026, PMID 42855715)","Some of the CBN and formula studies were run by companies that make the products","Sleep apnea: dronabinol and cannabis products do not replace CPAP or the treatment recommended by a sleep physician; the AASM recommends against their use (Ramar 2018); dronabinol can cause sleepiness (at 10 mg, in half of patients in Prasad 2013 and in 17 of 27 people in the Carley 2018 registry record)","Cannabis use disorder: in people who got a cannabis card for pain, insomnia, anxiety or depression, 17.1% vs 8.6% at 12 weeks; most in those who applied for anxiety or depression (Gilman 2022)"],"ilac_etkilesim_notlari":["Clobazam: in 13 children with epilepsy, the active metabolite N-desmethylclobazam rose by an average of 500%; the rise in clobazam itself (average 60%) was uncertain (confidence interval −2 to 91). In healthy volunteers, clobazam did not change and the metabolite rose ~3-fold (FDA/EMA). In 10 of 13 patients, side effects resolved when the clobazam dose was reduced (Geffrey 2015, PMID 26114620)","No short-term increase in side effects was seen in people taking benzodiazepines/antipsychotics (advanced cancer, Downs 2026, PMID 39539239)","Alcohol: 200 mg CBD + alcohol was not clearly different from the impairment caused by alcohol alone (Consroe 1979, PMID 120541; 10 people, old and small)","Pure oral CBD (15–1500 mg) did not cause THC-positive results on roadside saliva tests (McCartney 2022, PMID 34412166)"],"dogrulanamayan":["The correction to Wilson 2026 published in the journal was read on October 29, 2026: only the axis of one figure and the study counts in a table were corrected, and the insomnia results did not change. Which 10 studies Asim 2026 pooled could not be seen because the full text is not open access, so its overlap with the studies in the table is not known."],"calismalar":[{"ad":"Linares 2018 (sleep)","tasarim":"Double-blind, crossover RCT","n":"27 (1 left)","populasyon":"Healthy volunteers","urun":"Pure CBD (oral)","urun_turu":"saf_cbd","doz":"300 mg single dose, 30 min before polysomnography","titrasyon":"None","sure":"1 night/arm","sonuc":"No significant effect on the sleep-wake cycle. 4 of 8 authors are inventors on a patent for a CBD derivative (fluorinated CBD); the university has an agreement with a drug company (Prati-Donaduzzi) to develop a synthetic CBD product for epilepsy, schizophrenia, Parkinson’s and anxiety disorders; 3 authors are medical advisers to a CBD supplier company (BSPG-Pharm); the manufacturer (STI-Pharm) supplied the CBD free of charge","yan_etki":"Not reported (no difference on cognitive/subjective measures)","pmid":"29674967","doi":"10.3389/fphar.2018.00315","diger_kaynak":null},{"ad":"Narayan 2024 (JCSM)","tasarim":"Parallel RCT, 1-week single-blind placebo run-in (8 people who responded to placebo during the run-in were removed before randomization)","n":"34 randomized (18 CBD / 16 placebo); 32 completed; per the registered plan, 30 people were analyzed (15 CBD / 15 placebo)","populasyon":"Moderate-severe primary insomnia","urun":"CBD, sublingual","urun_turu":"saf_cbd","doz":"150 mg, 60 min before bed","titrasyon":"None (fixed)","sure":"2 weeks","sonuc":"No difference in insomnia severity (ISI), falling asleep or nighttime wakefulness (WASO); well-being improved, actigraphic sleep efficiency rose at week 2. In the second publication of the same trial (Narayan 2025), daytime cognitive performance (attention, executive function, memory) was not affected; those taking CBD reported feeling calmer and more clear-headed in the mornings. Supported by the company Cannvalate and a foundation; the product was supplied by Brains Bioceuticals (according to the second publication, funding also came from Brains Bioceuticals)","yan_etki":"No details in this publication; according to the authors, all side effects were mild and temporary. According to the second publication of the same trial (Narayan 2025), dry mouth was reported 25 times in 4 people in the CBD group and 6 times in 3 people with placebo (p = 0.003); 1 person in the CBD group stopped because of persistent restlessness","pmid":"38174873","doi":"10.5664/jcsm.10998","diger_kaynak":"Daytime cognitive function and mood publication of the same trial: Narayan 2025, Psychopharmacology 242(2):297–308 (PMID 39153080; its findings are in this row’s outcome and side effect fields); ANZCTR ACTRN12620000070932 (prospectively registered)"},{"ad":"Wang 2025","tasarim":"Double-blind, crossover RCT, phase 2","n":"125 randomized; 62 completed; 56 analyzed","populasyon":"Insomnia","urun":"CBD + 8 terpenes (1 mg each), THC-free","urun_turu":"saf_cbd","doz":"300 mg CBD","titrasyon":"None (fixed dose; at least 4 nights a week)","sure":"≥4 days a week, 4 weeks","sonuc":"Percentage of deep+REM sleep measured at the wrist +1.3% (marginal); total sleep time, resting heart rate and heart rate variability did not change; 63 of 125 people left before starting the drug, 6 more were removed after unblinding on grounds of protocol deviation, and the analysis was done in 56 people. Funded by the company Defined Research; 6 of 8 authors hold shares in the company, and 2 are unpaid advisers with stock options","yan_etki":"No side effects reported","pmid":"39167421","doi":"10.5664/jcsm.11324","diger_kaynak":"ClinicalTrials.gov NCT05233761 (prospectively registered; results in the registry)"},{"ad":"Kisiolek 2023","tasarim":"Randomized, placebo-controlled study","n":"28 (14/14)","populasyon":"Healthy young adults (mean age 26)","urun":"Hemp-derived purified CBD gel capsule (50 mg); placebo MCT oil","urun_turu":"saf_cbd","doz":"50 mg/day, 1–1.5 hours before bed","titrasyon":null,"sure":"8 weeks","sonuc":"On the overall sleep questionnaire (LSEQ) score, only an effect of time (it rose in both groups; 14.3% with placebo), no group × time interaction; a before–after increase in the CBD group (27.8%, a post hoc comparison). On the 'sleep quality' subscale, a group × time interaction in favor of CBD (p=0.002). Sleep time measured at the wrist, mental health measures and weight did not change","yan_etki":"Not reported (no side effect data in the full text either)","pmid":"37836465","doi":"10.3390/nu15194173","diger_kaynak":null},{"ad":"Saleska 2024","tasarim":"Double-blind RCT, 6 arms, remote; no placebo arm","n":"1793","populasyon":"Adults with symptoms of sleep disturbance","urun":"CBD isolate; CBD+CBN(±CBC); melatonin(±CBD+CBN) capsules","urun_turu":"cbn_diger","doz":"15 mg CBD; 15 mg CBN; 5 mg CBC; 5 mg melatonin","titrasyon":"None","sure":"4 weeks","sonuc":"Within-group improvement in all arms; no difference between CBD isolate and the CBN/CBC formulas and melatonin (no placebo arm). 4 of 8 authors are from the company Radicle Science (PubMed affiliation data); funding source not in the abstract","yan_etki":"12% side effects, none serious","pmid":"37162192","doi":"10.1080/27697061.2023.2203221","diger_kaynak":null},{"ad":"Shannon 2019","tasarim":"Retrospective case series","n":"72 (25 with a primary sleep complaint)","populasyon":"Psychiatric clinic patients","urun":"CBD capsule (supplied by CV Sciences; content and THC ratio not reported)","urun_turu":"cbd_zengin_thc_belirsiz","doz":"25 mg/day in most; 50–75 mg/day in a few patients; 175 mg/day in 1 patient","titrasyon":"No standard schedule; according to physician preference","sure":"Monthly follow-up, up to 3 months","sonuc":"Sleep score improved in 66.7% at month 1, fluctuated over time (no control)","yan_etki":"3 patients could not tolerate it: 2 stopped in the first week because of tiredness; in 1 patient with a developmental disorder, CBD was stopped because of an increase in inappropriate sexual behavior. Mild sedation at first in 3 patients","pmid":"30624194","doi":"10.7812/TPP/18-041","diger_kaynak":null},{"ad":"Walsh 2021","tasarim":"Double-blind, crossover RCT","n":"24 randomized / 23 completed","populasyon":"Chronic insomnia","urun":"ZTL-101 sublingual cannabis extract: 20 mg/mL THC + 2 mg/mL CBN + 1 mg/mL CBD + terpenes (THC-dominant)","urun_turu":"thc_iceren","doz":"0.5 mL 1 hour before bed (10 mg THC + 1 mg CBN + 0.5 mg CBD); could be raised to 1.0 mL (20 + 2 + 1 mg) from night 4","titrasyon":"The dose could be doubled from night 4; on night 14, 12 of 23 people were on the double dose","sure":"2 weeks/arm, 1-week washout","sonuc":"ISI −5.07; subjective total sleep +64.6 min; actigraphic WASO −10.2 min; no difference in sleep time or stages on polysomnography; all participants guessed they were receiving the active drug (blinding broken). Funded by the product company Zelira Therapeutics (according to the publication, design and analysis were in the hands of the investigators)","yan_etki":"36 mild side effects in the active period (17 people), 4 with placebo; dry mouth 33%, dizziness 25%; 1 auditory and 1 visual hallucination; no serious side effects","pmid":"34115851","doi":"10.1093/sleep/zsab149","diger_kaynak":null},{"ad":"Ried 2023","tasarim":"Double-blind, crossover RCT","n":"29","populasyon":"Self-reported clinical insomnia","urun":"Entoura-10:15 oil (10 mg/mL THC + 15 mg/mL CBD)","urun_turu":"thc_iceren","doz":"0.2–1.5 mL/day (calculated from the concentration in the publication: ~2–15 mg THC, ~3–22.5 mg CBD)","titrasyon":"0.2 → 1.5 mL/day","sure":"2 weeks/arm, 1-week washout","sonuc":"ISI and sleep quality improved; broken blinding was reported in phase 2","yan_etki":"'Generally well tolerated'","pmid":"36539991","doi":"10.1111/jsr.13793","diger_kaynak":null},{"ad":"So-Ngern 2025","tasarim":"Placebo-controlled RCT","n":"27 (26 analyzed)","populasyon":"Patients with systemic sclerosis (scleroderma) with sleep problems (Thailand)","urun":"THC + CBD oil (2.7 mg THC + 2.5 mg CBD per mL), sublingual","urun_turu":"thc_iceren","doz":"Week 1, 1 drop × 2 (0.73 mg THC + 0.81 mg CBD), then 2 drops × 2 (2.92 mg THC + 3.24 mg CBD a day)","titrasyon":"Dose doubled after 1 week","sure":"4 weeks","sonuc":"Improvement in sleep quality score (PSQI) greater than placebo but not significant (p=0.09)","yan_etki":"1 patient hospitalized for low sodium and sleepiness (withdrawn from the study); non-serious side effects 10 vs 7","pmid":"40430155","doi":"10.3390/life15050727","diger_kaynak":null},{"ad":"Suraev 2026","tasarim":"Crossover pilot RCT, HD-EEG","n":"20","populasyon":"DSM-5 insomnia","urun":"THC/CBD oral","urun_turu":"thc_iceren","doz":"10 mg THC + 200 mg CBD single dose","titrasyon":"None","sure":"Single night","sonuc":"On the primary measures, total sleep −24.5 min (p = 0.05), time awake at night (WASO) no different from placebo (+10.7 min); REM −33.9 min; REM latency +65.6 min; subjective sleep quality did not change","yan_etki":"Small increase in subjective sleepiness the next day (+0.42 points; p = 0.02), no difference in measured alertness; in the next-day publication of the same trial, a small drop on the Stroop task and an increase in feeling of sedation at hour 10 (Suraev 2024)","pmid":"40631525","doi":"10.1111/jsr.70124","diger_kaynak":"ANZCTR ACTRN12619000714189 (prospectively registered). Next-day functioning publication of the same trial (secondary outcomes): Suraev 2024, Psychopharmacology 241:1815–25 (PMID 38758300): at least 9 hours after the dose, no impairment compared with placebo on 27 of 28 cognitive and psychomotor tests or in a driving simulation; a small drop in accuracy on the easy Stroop task (−1.4%); a small increase in feeling of 'sedation' at hour 10, no difference in alertness and sleepiness scores"},{"ad":"Hausenblas 2025","tasarim":"Double-blind, crossover pilot RCT","n":"20","populasyon":"Subthreshold insomnia","urun":"Softgel: 3 mg THC + 6 mg CBN + 10 mg CBD + 90 mg terpenes","urun_turu":"thc_iceren","doz":"1 softgel at night (3 mg THC + 6 mg CBN + 10 mg CBD + 90 mg terpenes), 1 hour before bed","titrasyon":"None","sure":"10 days/arm, 2-week washout","sonuc":"Compared with placebo, no difference in insomnia severity (ISI; p = 0.70) or overall PSQI score (p = 0.32). There is a borderline difference on the PSQI sleep quality subscore (p = 0.05); the borderline difference on the sleep efficiency subscore (p = 0.05) comes not from improvement during the product period but from worsening during the placebo period; the difference on the sleep medication use subscore favors placebo (p = 0.03). The abstract reports superiority over placebo on the ISI, but the comparison table in the full text does not show this. The product’s company, Sanna Science, partly funded the study","yan_etki":"No side effects reported","pmid":"39980821","doi":"10.1002/hsr2.70481","diger_kaynak":"ISRCTN 15022302"},{"ad":"Bonn-Miller 2024","tasarim":"Double-blind RCT, 5 arms","n":"301 enrolled (registration); 293 analyzed (mITT)","populasyon":"'Poor' sleep quality, ages 18–55","urun":"CBN ± CBD","urun_turu":"cbn_diger","doz":"20 mg CBN; +10/20/100 mg CBD","titrasyon":"None","sure":"7 nights","sonuc":"On the primary measure (sleep quality), 20 mg of CBN was not significantly different from placebo (OR 2.26; 95% CI 0.93–5.52; p = 0.082); among the secondary measures, the number of night awakenings (p = 0.025) and overall sleep disturbance (p = 0.023) decreased; adding CBD added no benefit; falling asleep, WASO and daytime tiredness did not differ. Funded by Canopy Growth; 8 of 9 authors are employees of Canopy Growth and 1 of Wana Brands","yan_etki":"No difference in daytime tiredness","pmid":"37796540","doi":"10.1037/pha0000682","diger_kaynak":"ClinicalTrials.gov NCT05839964 (registered in April 2023, after the study ended in December 2022; the primary measure in the registration is the same as in the publication: sleep quality; no results in the registry)"},{"ad":"Kolobaric 2024","tasarim":"Double-blind RCT, 5 arms","n":"1,020 randomized (CBN 25 mg 206, 50 mg 205, 100 mg 203; melatonin 4 mg 202; placebo 204)","populasyon":"Adults wanting better sleep (remote, USA; no sleep disorder diagnosis required)","urun":"TruCBN (hemp-derived CBN); comparison with melatonin","urun_turu":"cbn_diger","doz":"25, 50, 100 mg CBN; 4 mg melatonin","titrasyon":"None","sure":"4 weeks (+1 week of product-free follow-up)","sonuc":"On the primary measure (PROMIS sleep disturbance), all CBN doses and melatonin gave slightly more improvement over the weeks than placebo (interaction coefficients −0.54 to −0.60; p = 0.018–0.030; the authors describe the difference for 25 and 100 mg as 'borderline'); no difference between CBN and melatonin; among the exploratory measures, stress decreased slightly more than with placebo only at 100 mg, and there was no difference from placebo in anxiety, pain and well-being. A company study run remotely with online surveys: funded by the product manufacturer FloraWorks, 6 of 8 authors are employees of Radicle Science, which ran the study","yan_etki":"Side effect rate no different from placebo","pmid":"39204082","doi":"10.3390/ph17080977","diger_kaynak":"ClinicalTrials.gov NCT05511818 (Radicle Rest template registration: a 2,679-person registration covering several products and a placebo arm, August 2022; the registration date is written in two different ways in the publication)"},{"ad":"Lavender 2026","tasarim":"Double-blind, 3-arm crossover RCT, polysomnography","n":"20","populasyon":"DSM-5/ICSD-3 insomnia","urun":"CBN oral","urun_turu":"cbn_diger","doz":"30 mg or 300 mg single dose","titrasyon":"None","sure":"Single night/arm, 2-week washout","sonuc":"The primary outcome (WASO) did not change; at 300 mg, time to fall asleep got shorter and subjective quality rose (secondary)","yan_etki":"247 mild-moderate side effects (total across all arms)","pmid":"41698831","doi":"10.1111/jsr.70284","diger_kaynak":null},{"ad":"Chagas 2014 (RBD)","tasarim":"Case series","n":"4","populasyon":"Parkinson’s + REM sleep behavior disorder","urun":"CBD","urun_turu":"saf_cbd","doz":"75 mg/day (3 patients), 300 mg/day (1 patient) (according to review tables)","titrasyon":"not reported","sure":"6 weeks (according to a review table)","sonuc":"Rapid and marked reduction in RBD events (no control). The conflict-of-interest statement could not be read (the publisher’s page blocks automated access); of the 12 authors, Zuardi, Hallak and Crippa state in other publications that they are inventors on a patent for a CBD derivative (the international application was published in 2014)","yan_etki":"No side effects","pmid":"24845114","doi":"10.1111/jcpt.12179","diger_kaynak":null},{"ad":"de Almeida 2021 (RBD)","tasarim":"Double-blind RCT, phase 2/3","n":"33","populasyon":"Parkinson’s + REM sleep behavior disorder","urun":"CBD capsule (add-on treatment)","urun_turu":"saf_cbd","doz":"75–300 mg/day","titrasyon":"75 → 300 mg (schedule not reported)","sure":"14 weeks","sonuc":"Primary outcomes (frequency of RBD nights, CGI) not different from placebo; with 300 mg, a temporary increase in sleep satisfaction at weeks 4–8 (secondary). In a post hoc analysis of 18 patients who also had restless legs, restless legs severity also did not differ from placebo (de Almeida 2023). The conflict-of-interest statement could not be read (full text closed); of the 9 authors, Zuardi, Crippa and Hallak state in other publications that they are inventors on a patent for a CBD derivative and that their university has an agreement with a drug company for synthetic CBD","yan_etki":"Not reported (in this abstract)","pmid":"33754375","doi":"10.1002/mds.28577","diger_kaynak":"Exploratory restless legs syndrome analysis of the same trial: de Almeida 2023, Cannabis Cannabinoid Res 8(2):374–8 (PMID 35749710): in 18 patients who also had restless legs (6 CBD / 12 placebo), no difference from placebo in symptom severity (IRLS) on primary and secondary outcomes; a post hoc analysis. Also a row in the Parkinson’s topic"},{"ad":"AminiLari 2022","tasarim":"Systematic review and meta-analysis (39 RCTs)","n":"5100","populasyon":"33 in chronic pain/cancer","urun":"Oral cannabinoids (38 studies; most containing THC: THC+CBD mouth spray, dronabinol, THC and cannabis extracts; according to the trial list in the references, nabilone and CBDV studies are also included) and inhaled cannabis in 1 study","urun_turu":"karma","doz":"Various","titrasyon":"Various","sure":"Median 35 days","sonuc":"Small improvement in sleep quality in chronic pain (moderate certainty)","yan_etki":"Dizziness (RD 29%, ≥3 months), drowsiness, dry mouth, tiredness, nausea","pmid":"34546363","doi":"10.1093/sleep/zsab234","diger_kaynak":null},{"ad":"da Silva 2025","tasarim":"Systematic review and meta-analysis","n":"6 RCTs, 1077 people (total; the number of people in the CBD-only subanalysis is not in the abstract)","populasyon":"People with and without insomnia","urun":"Cannabinoids","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"CBD-only treatments did not significantly improve sleep quality (SMD 0.13; 95% CI −0.38 to 0.65); the significant effect came from non-CBD/THC-containing formulas (SMD 0.82)","yan_etki":null,"pmid":"40929927","doi":"10.1016/j.smrv.2025.102156","diger_kaynak":null},{"ad":"Varela 2026 (Cochrane)","tasarim":"Cochrane systematic review and meta-analysis (9 RCTs; 8 compared with placebo, 1 with amitriptyline)","n":"537","populasyon":"Adults with insomnia (ages 18–76; 73% women)","urun":"Medical cannabis (magistral preparations in 7 studies, approved (licensed) medicines in 2 studies: one plant-derived, one synthetic)","urun_turu":"karma","doz":"Variable","titrasyon":null,"sure":null,"sonuc":"Compared with placebo, little or no meaningful contribution to sleep quality/satisfaction (SMD −0.49; 95% CI −1.06 to 0.08), total sleep (MD 7.68 min; −23.04 to 38.39) and daytime functioning (SMD −0.34; −0.83 to 0.16); evidence of very low certainty","yan_etki":"Side effects may increase (OR 11.25; 4.46–28.35; 3 studies, 98 people; low certainty)","pmid":"42863850","doi":"10.1002/14651858.CD016216.pub2","diger_kaynak":null},{"ad":"Velzeboer 2025","tasarim":"Systematic review and meta-analysis (18 studies, 9 in the meta-analysis)","n":null,"populasyon":"Studies in which sleep was measured by polysomnography","urun":"Cannabis and cannabinoids","urun_turu":"karma","doz":"Variable","titrasyon":null,"sure":null,"sonuc":"Cannabis did not consistently change sleep time, falling asleep, wakefulness, efficiency or sleep stages; the drop in REM comes mostly from older, small studies with high THC doses; in newer studies it is mixed or absent. Stopping use consistently disrupted sleep","yan_etki":null,"pmid":"40967124","doi":"10.1016/j.smrv.2025.102164","diger_kaynak":null},{"ad":"Wilson 2026","tasarim":"Systematic review and meta-analysis (54 RCTs in mental health and substance use disorders)","n":"2,477 (total; the number of people in the insomnia analysis is not in the abstract)","populasyon":"People with insomnia (the meta-analysis’s insomnia analysis)","urun":"Cannabinoids (all types)","urun_turu":"karma","doz":"Variable","titrasyon":null,"sure":null,"sonuc":"In insomnia, sleep time measured with an electronic device (SMD 0.54; 95% CI 0.14–0.95) and sleep time in sleep diaries (SMD 0.55; 0.01–1.09) increased with cannabinoids of all types compared with placebo; certainty of evidence low for most outcomes, high risk of bias in 44% of studies","yan_etki":null,"pmid":"41856154","doi":"10.1016/S2215-0366(26)00015-5","diger_kaynak":"A correction was published in the journal: Lancet Psychiatry 2026;13(8):e11 (PMID 42302809; online June 16, 2026); it corrects the axis of a figure and the study counts in the table, and the results did not change"},{"ad":"Carlini 1981","tasarim":"Placebo- and active drug (nitrazepam)-controlled crossover study (double blinding and randomization not stated in the abstract; one review reports it as a 'crossover trial'); the same publication also summarizes studies in healthy volunteers and in epilepsy","n":"15","populasyon":"Volunteers with insomnia (Brazil)","urun":"Pure CBD, oral; comparison with placebo and 5 mg nitrazepam (a sleep medicine)","urun_turu":"saf_cbd","doz":"40, 80 or 160 mg single dose","titrasyon":"None","sure":"Single dose (at night); how many nights it lasted is not in the abstract","sonuc":"Those taking 160 mg of CBD reported sleeping significantly longer than with placebo; at all three doses, dream recall was lower than with placebo. According to a review, there was no difference between CBD, nitrazepam and placebo in falling asleep. Measurements are based on people’s own reports; detailed numbers and statistics are not in the abstract. The publication is a report summarizing the same lab’s studies since 1972; an old 1981 study of 15 people whose methods cannot be assessed from the abstract","yan_etki":"No separate information for the insomnia arm in the abstract; in the healthy volunteer studies in the same publication (10–600 mg), no signs of toxicity or intoxication were seen, and some volunteers complained of sleepiness","pmid":"7028792","doi":"10.1002/j.1552-4604.1981.tb02622.x","diger_kaynak":null},{"ad":"Nicholson 2004","tasarim":"Double-blind, placebo-controlled, 4-period crossover study (sleep lab)","n":"8 (4 women, 4 men)","populasyon":"Healthy young adults (ages 21–34; United Kingdom)","urun":"Cannabis extracts sprayed into the mouth: THC alone or THC with an equal amount of CBD","urun_turu":"thc_iceren","doz":"At 22.00 at night over 30 minutes: placebo, 15 mg THC, 5 mg THC + 5 mg CBD or 15 mg THC + 15 mg CBD","titrasyon":"None","sure":"4 nights (a single dose each)","sonuc":"15 mg of THC did not change night sleep (EEG). When THC and CBD were given together, deep sleep (stage 3) decreased; with the high-dose combination, wakefulness during the night increased. The next morning (about 10 hours after the dose), those who took 15 mg of THC had weaker memory, fell asleep faster on a morning sleep-onset test and reported feeling sleepier; according to the authors, 15 mg of CBD showed a wakefulness-promoting effect and partly offset THC’s lingering next-day sleepiness. A very small study; funding and conflict-of-interest statements not in the abstract","yan_etki":"Next-morning sleepiness, weaker memory and mood changes with THC","pmid":"15118485","doi":"10.1097/01.jcp.0000125688.05091.8f","diger_kaynak":null},{"ad":"Ware 2010","tasarim":"Double-blind, active drug (amitriptyline)-controlled, randomized crossover equivalence study","n":"31 enrolled; 29 completed (26 women)","populasyon":"Fibromyalgia patients with chronic insomnia (Canada; mean age 49.5)","urun":"Nabilone (synthetic cannabinoid similar to THC) and amitriptyline, oral, at bedtime","urun_turu":"cbn_diger","doz":"Nabilone 0.5–1.0 mg, amitriptyline 10–20 mg; before bed","titrasyon":"Started at 0.5 mg and raised to 1 mg if needed","sure":"2 weeks for each drug, with a 2-week drug-free period in between","sonuc":"On the primary measure, sleep improved with both drugs; nabilone was 3.2 points better than amitriptyline on the Insomnia Severity Index (ISI) (95% CI 1.2–5.3); borderline superior for feeling rested on waking (0.5; 0.0–1.0), no different for wakefulness (0.3; −0.2 to 0.8). There was no difference in pain, mood and quality of life. No placebo group, short duration; the only active-comparator study in the 2026 Cochrane review","yan_etki":"More common with nabilone; most often dizziness, nausea and dry mouth; mostly mild–moderate","pmid":"20007734","doi":"10.1213/ANE.0b013e3181c76f70","diger_kaynak":"ClinicalTrials.gov NCT00381199 (no results in the registry); also a row in the fibromyalgia topic"},{"ad":"Gilman 2022","tasarim":"Pragmatic RCT (getting a medical cannabis card right away or after 12 weeks; 2:1 randomization; participants were not blinded, only assessors were blinded)","n":"269 randomized; 186 analyzed (105 immediate, 81 waiting; in the immediate group only those who got the card and came to at least one follow-up: 53 of the 173 people assigned to this group did not get a card); the insomnia analysis is in the 42 people who applied for insomnia (22 immediate, 20 waiting)","populasyon":"Adults ages 18–65 seeking medical cannabis for pain, insomnia, or anxiety or depression symptoms; daily cannabis users and people with cannabis use disorder were not included (USA, Boston)","urun":"Cannabis products chosen by the participant at a dispensary (THC and/or CBD; product, dose and frequency free)","urun_turu":"karma","doz":"Participant’s choice (product, dose and frequency free)","titrasyon":"Participant’s choice","sure":"12 weeks","sonuc":"In those who applied for insomnia, the Athens Insomnia Scale (0–24, higher score worse) was 12.4 and 12.2 at the start; at week 12, 7.6 in those who got the card right away and 11.2 in those who waited; mean difference over the 12-week period −2.90 points (95% CI −4.31 to −1.51; p < 0.001). Participants knew their group and the measure was only self-rated; those who did not get a card were not included in the analysis; because product and dose are unknown, it cannot be said which cannabinoid was effective. In the same study there was no difference in pain, anxiety and depression; symptoms of cannabis use disorder rose in those who got a card, most in those who applied for anxiety or depression. According to the authors, development of use disorder was rare in those who applied for insomnia (number not in the text). Supported by the US National Institute on Drug Abuse (NIDA)","yan_etki":"Across the whole sample, cannabis use disorder at 12 weeks 17.1% in those who got the card right away, 8.6% in those who waited (adjusted OR 2.88; 95% CI 1.17–7.07)","pmid":"35302633","doi":"10.1001/jamanetworkopen.2022.2106","diger_kaynak":"ClinicalTrials.gov NCT03224468 (results in the registry); daily survey analysis of the same trial: Tervo-Clemmens 2023 (PMID 36638745; in card holders, reported sleep quality was better on days cannabis was used, and frequency of use rose). Also a row in the pain, depression and substance use topics"},{"ad":"Kolobaric 2023","tasarim":"Double-blind, placebo-controlled, parallel 3-group, remote (online) RCT","n":"620 randomized (206 / 207 / 207); analysis with available data (about 26% of participants never filled in a follow-up survey)","populasyon":"Self-reported healthy adults seeking better sleep (76% of participants complained most of sleep disturbance; no diagnostic screening was done; USA, October–December 2022)","urun":"Softgel supplements: 'Sleep A' (0.35 mg THC; 150 mg GABA, 75 mg each of hops and valerian oil), 'Sleep B' (0.85 mg THC; 125 mg GABA, 20 mg each of hops and valerian oil); both with the same amounts of CBD, CBN and L-theanine (amounts not in the publication)","urun_turu":"thc_iceren","doz":"1 capsule 30 min before bed; could be increased to at most 4 capsules a day if needed","titrasyon":"At least 5 days of waiting before increasing; at most 4 capsules a day; the number of capsules used did not differ between groups","sure":"4 weeks (+1 week of product-free follow-up)","sonuc":"On the primary measure (PROMIS sleep disturbance), sleep disturbance decreased more over the weeks with Sleep A than with placebo (week × group interaction β −0.639; p = 0.0027); with Sleep B, which contained more THC, there was no difference from placebo on any measure. The planned second primary measure (proportion achieving meaningful improvement) was not reported in the results. Because it is a multi-ingredient product, it cannot be known whether the effect came from THC or from the plant ingredients; data were collected with online surveys. Funded by the product brand MDbio; 5 of 8 authors are employees of Radicle Science, the company that ran the study","yan_etki":"Side effects slightly more common in the active groups (p = 0.059); mostly lightheadedness and sleepiness, mild; no serious side effects or events requiring health care","pmid":"37686820","doi":"10.3390/nu15173788","diger_kaynak":"ClinicalTrials.gov NCT05511818 (Radicle Rest template protocol; according to the publication, not this study’s own registration; Kolobaric 2024 in the table also cites the same template)"},{"ad":"Peball 2022","tasarim":"Post hoc sleep analysis of a double-blind, placebo-controlled, enriched randomized withdrawal trial (NMS-Nab)","n":"Of the 38 randomized patients in the trial, the 31 with marked sleep problems at the start (17 nabilone / 14 placebo)","populasyon":"Parkinson’s patients with troublesome non-motor symptoms and marked sleep problems at the start (Austria); sleep problems were not an inclusion criterion for the trial","urun":"Nabilone (synthetic cannabinoid similar to THC, oral capsule)","urun_turu":"cbn_diger","doz":"Mean 0.9 mg/day at randomization (median 1 mg; 0.25–1.75 mg)","titrasyon":"In the open-label period, started at 0.25 mg/day and increased according to response; only responders were randomized","sure":"Open-label dose finding + 4-week double-blind period","sonuc":"With open-label nabilone, 77% of patients no longer had marked sleep problems (uncontrolled). In the double-blind period, sleep problems got worse in those switched to placebo and did not get worse in those who stayed on nabilone: difference on the nighttime sleep problems item 1.88 points (95% CI 1.04–2.73; p < 0.001), on the sleep/fatigue domain 8.57 (2.24–14.91; p = 0.011), on the insomnia question 5.00 (1.92–8.09; p = 0.004); no difference in daytime sleepiness. A post hoc subgroup analysis, and only drug responders were randomized; so the effect may look larger than it would be for all patients. The manufacturer AOP Orphan supplied the drug and placebo and covered visit and monitoring costs; 1 of 10 authors received fees outside the study from this company","yan_etki":"No separate side effect data in this publication (in the main trial, side effects in the double-blind period 32% with nabilone, 42% with placebo; Peball 2020 row in the Parkinson’s topic)","pmid":"35937495","doi":"10.1002/mdc3.13471","diger_kaynak":"Main publication: Peball 2020 (PMID 32757413; row in the Parkinson’s topic); ClinicalTrials.gov NCT03769896 (results in the registry); EudraCT 2017-000192-86; open-label extension: Peball 2024 (PMID 38491070; uncontrolled, 22 patients)"},{"ad":"Walczyńska-Dragon 2025","tasarim":"Sleep and migraine results of a double-blind, placebo-controlled, 3-group RCT (secondary publication of the same trial; the main publication examined pain, muscle tension and teeth clenching); according to this publication, the placebo gel was clear and the CBD gels slightly opaque, and according to the main publication, the CBD gels were slightly bitter (blinding may have been compromised; according to the authors, participants were not told about these differences and no one reported noticing their group)","n":"60 analyzed (20 / 20 / 20); according to the main publication, 66 randomized, completers only analyzed","populasyon":"Young adults with sleep bruxism (clenching/grinding teeth during sleep) and chewing muscle pain (mean age 24; Poland)","urun":"CBD gel applied inside the mouth to the chewing muscle (prepared with 100% CBD isolate, 5% and 10%); comparison with placebo gel","urun_turu":"saf_cbd","doz":"Every night before bed, inside the mouth onto the chewing muscles on both sides; according to this publication, 25 mg of CBD in the 5% gel and 50 mg in the 10% gel per 0.5 mL single-dose container; the main publication, however, states 20 mg/day for the 5% gel and 40 mg/day for the 10% gel (the two publications do not match)","titrasyon":"None","sure":"30 days","sonuc":"Sleep quality (PSQI; 0–21, higher score worse) improved more over 30 days with both CBD gels than with placebo (5%: p = 0.002; 10%: p < 0.001; no correction for multiple comparisons); the median score fell from 12 to 7 with the 10% gel and from 12 to 8 with the 5% gel, and stayed at 9 in the placebo group; no difference between the two doses; the impact of migraine on daily life also decreased. At the start, the CBD groups had worse sleep scores than the placebo group (12 vs 9). The sleep measure is not in the study’s ClinicalTrials.gov registration or in the methods of the main publication; the two publications describe the randomization method and the dose differently. Single-center, small and young sample; teeth clenching during sleep is a sleep movement disorder, but participants were not selected for insomnia; in the main publication there was no difference between groups in teeth-clenching severity. This publication has no funding section (the main publication was university-funded); the authors reported no conflicts of interest","yan_etki":"No gel-related side effects were reported in any group; no stopping due to side effects","pmid":"40732351","doi":"10.3390/ph18071064","diger_kaynak":"Main publication: Walczyńska-Dragon 2024 (PMID 38592260; row in the topical CBD topic); ClinicalTrials.gov NCT05562635 (the primary measures in the registration are muscle EMG and pain; no sleep measure)"},{"ad":"Emerson 2026","tasarim":"Triple-blind, placebo-controlled, remote (online) RCT","n":"63 randomized (33 CBG / 30 placebo); 55 people completed the study; 35 people in the per-protocol analysis (18 / 17). The planned 50 people per arm were not reached","populasyon":"Veterans reporting sleep problems (USA, California; mean age 44, 78% men; 86% regularly used cannabis and were allowed to continue during the study; probable PTSD in more than 40%)","urun":"CBG (cannabigerol)-dominant tablet; matching placebo","urun_turu":"cbn_diger","doz":"25 mg/day for 2 weeks, then 50 mg/day for 2 weeks (at least 3 hours before bed)","titrasyon":"Dose doubled after 2 weeks","sure":"2-week placebo run-in + 4 weeks of treatment","sonuc":"On the primary measure (MOS sleep problems index), both groups improved; the difference favored placebo and was not significant (4.4 points; 95% CI −4.1 to 13.0; p = 0.3; per-protocol 3.8; −4.8 to 12.0). Scores had also improved during the 2-week placebo run-in before the drug started. No difference in quality of life or PTSD symptoms either; sleep measured at the wrist did not change. Most participants were using other cannabis products at the same time, and the trial did not reach its planned size. Funded by the product manufacturer Metta Medical (LEVEL); all 5 of 5 authors have ties to the company: 1 is a company employee and shareholder, 1 is an employee of the firm the company hired to run the study, and 3 are consultants paid by this firm or the company","yan_etki":"5 mild side effects possibly related to CBG (headache, fatigue, stomach upset, nausea, oversleeping; each in 1 person); 2 people left the study; no serious side effects","pmid":"41574318","doi":"10.1159/000549902","diger_kaynak":"ClinicalTrials.gov NCT05088018 (no results in the registry)"},{"ad":"Gournay 2026","tasarim":"Sleep results of a double-blind, placebo-controlled, 3-group RCT (the anxiety results of the same trial are in a separate publication)","n":"63","populasyon":"Adults with high levels of worry (mean age 29; USA, Arkansas)","urun":"Pure CBD, oral; matching placebo","urun_turu":"saf_cbd","doz":"50 or 300 mg/day","titrasyon":"None","sure":"2 weeks, daily","sonuc":"300 mg of CBD reduced sleep problems significantly more than 50 mg (B = −0.39; p < 0.05), but the difference from placebo was not significant (B = −0.32; p = 0.10); effect sizes very small (d = 0.07–0.08). No sleepiness or cognitive impairment was seen. The authors state that no strong conclusion can be drawn. Participants were not selected for sleep problems","yan_etki":"No sleepiness or cognitive impairment; no other side effect information in the abstract","pmid":"41678223","doi":"10.1037/pha0000832","diger_kaynak":"Anxiety results of the same trial: Gournay 2023 (PMID 37552290; row in the anxiety topic); this publication is also in the anxiety table under the name 'Gournay 2026 (sleep results)'"},{"ad":"Kamoltham 2026","tasarim":"Phase 2, double-blind, double-dummy, active drug (lorazepam)-controlled, randomized equivalence (non-inferiority) study","n":"100 randomized (50 / 50); 82 completed and were analyzed (41 / 41; completers only)","populasyon":"Adults ages 25–70 with insomnia symptoms for at least 1 month and PSQI > 5 (Thailand, Chanthaburi)","urun":"Traditional Thai 'Anti-Pom-Leung Fever' (Prasa Kuncha) blend: 8 plants, half by weight roasted cannabis leaf; measured at 6.6 mg THC, 5.8 mg CBN and 4.1 mg THCV per gram, CBD not detected. Comparison with lorazepam 0.5 mg","urun_turu":"thc_iceren","doz":"4 of the 500 mg capsules before breakfast and 4 at bedtime (4 g of the blend a day). The daily amount of cannabinoids is not stated in the publication; multiplying the per-gram content in the table (6.6 mg THC, 5.8 mg CBN, 4.1 mg THCV) by the daily 4 g gives about 27 mg THC, 23 mg CBN and 16 mg THCV (a calculation made on this page, not in the publication; not a personal recommendation)","titrasyon":"None","sure":"4 weeks","sonuc":"At week 4, PSQI was 3.44 with the blend and 4.78 with lorazepam; difference −1.34 (95% CI −2.99 to 0.31); based on a prespecified 2.1-point margin, it was concluded not to be worse than lorazepam. In both groups, PSQI fell clearly from 12–13; because there was no placebo group, how much of the improvement came from the drug cannot be known. Only completers were analyzed, measurement by questionnaire only; registered after the study ended (study August 2023–February 2024, registration July 2024). Supported by the Thai Traditional Medicine Knowledge Fund; the authors reported no conflicts of interest","yan_etki":"Mild side effects that went away on their own, no difference between groups: dizziness 4 people (9.8%) vs 1, sleepiness 1 vs 0, palpitations 1 vs 0, stomach complaints 1 vs 1, fever 0 vs 1; small ECG changes at the end of treatment 6 vs 8 (5 vs 8 in the text; also 5 vs 8 at the start; not significant); no difference in liver, kidney and blood values","pmid":"41736083","doi":"10.1186/s42238-026-00415-x","diger_kaynak":"Thai Clinical Trials Registry TCTR20240718004 (after the study ended)"},{"ad":"Pakdee 2026","tasarim":"Open-label, randomized, 3-group parallel study (only assessors blinded; no placebo)","n":"60 (20 / 20 / 20)","populasyon":"Adults ages 40–70 with chronic insomnia by DSM-5, PSQI ≥ 5; people taking sleep medicines or antidepressants were not included (Thailand, Kamphaeng Phet)","urun":"'Deja formula' cannabis oil (from the hospital’s traditional medicine unit; THC and CBD content not in the publication); comparison with the Suk-Sai-Yat herbal blend (which also contains cannabis) and lorazepam 1 mg","urun_turu":"diger","doz":"1 drop (0.05 mL) before bed; in the publication the route is written as 'subcutaneous', without explanation","titrasyon":"None","sure":"4 weeks","sonuc":"PSQI fell in all three groups (cannabis oil 13.6 → 5.1; herbal blend 12.3 → 6.6; lorazepam 14.4 → 5.8; within-group p < 0.01); no difference between groups at the end of treatment (p = 0.27). The comparison was not designed to show equivalence or superiority; the authors also write in their reply letter that they do not interpret the finding as equivalence. Quality of life rose more in the cannabis and herbal blend groups than with lorazepam, but the groups also differed at the start. No placebo, participants knew their group, the study was not registered, and the product content is unknown; the final cannabis oil value in the abstract (3.68) does not match the table in the text (5.10) (3.68 is the same number as the baseline standard deviation in the table). No funding; the authors reported no conflicts of interest","yan_etki":"In the cannabis oil group, headache, dizziness and nausea in 1 person (5%); with the herbal blend, palpitations and muscle pain in 2 people; in the lorazepam group, no side effects in the table, mild daytime sleepiness in some people in the text; no serious side effects","pmid":"41623556","doi":"10.1016/j.sleepx.2026.100173","diger_kaynak":"The authors’ reply to a critique (PMID 41756111, PMC12933466): they acknowledge as limitations that no sleep apnea screening was done and that the analysis relied on within-group before–after change"},{"ad":"Carley 2018 (PACE)","tasarim":"Phase 2, multicenter, fully blinded, placebo-controlled, parallel 3-group RCT","n":"73 randomized and analyzed (25 placebo, 21 dronabinol 2.5 mg, 27 dronabinol 10 mg); 56 people completed the protocol","populasyon":"Adults ages 21–65 with moderate or severe obstructive sleep apnea (15–50 breathing pauses or reductions per hour) and daytime sleepiness (USA, Chicago; mean body mass index 33)","urun":"Dronabinol (synthetic THC), oral capsule, 1 hour before bed","urun_turu":"thc_iceren","doz":"2.5 mg or 10 mg/day","titrasyon":"In the 10 mg group, to follow the drug label, it was started at 2.5 mg/day in the first week and 5 mg/day in the second week, then raised to 10 mg/day; fixed dose in the placebo and 2.5 mg groups","sure":"6 weeks (preceded by a 5–10-day placebo run-in)","sonuc":"On the primary measure (breathing pauses/reductions per hour, AHI), compared with placebo it was 10.7 ± 4.4 (p = 0.02) events/hour lower with dronabinol 2.5 mg and 12.9 ± 4.3 (p = 0.003) lower with 10 mg; the two doses did not differ from each other. Part of the difference comes from AHI rising in the placebo group (after adjustment for age, race, ethnicity and baseline value, this rise was not significant); according to the results on ClinicalTrials.gov, among those who completed the study AHI fell by 1.7 and 5.2 per hour with dronabinol and rose by 8.0 with placebo. With 10 mg, daytime sleepiness (Epworth) fell 2.3 points more than with placebo (p = 0.05). The maintenance of wakefulness test, sleep structure and night oxygen levels did not change. A short study, only initial findings were published, and the precalculated 37 people per group were not reached (21–27 people). NIH-supported; 1 of 10 authors (the lead author) is the inventor on patents for treating sleep-disordered breathing with cannabinoids and a shareholder in RespireRx, the company that licenses these patents","yan_etki":"According to the publication, 88% of participants reported at least one side effect and the rate did not differ between groups; most often sleepiness, headache, nausea/vomiting, dizziness. The results on ClinicalTrials.gov differ, however: sleepiness was reported in 17 of 27 people in the 10 mg group and in no one in the placebo and 2.5 mg groups; headache 13 vs 4, nausea 9 vs 1 (10 mg vs placebo). 7 people left because of side effects (some during the placebo run-in); those thought possibly related to the drug included dizziness and changes in vision, a spinning sensation (vertigo), a heart rhythm disturbance on ECG, headache and vomiting. 1 person stayed one night in the hospital because of vomiting and diarrhea","pmid":"29121334","doi":"10.1093/sleep/zsx184","diger_kaynak":"ClinicalTrials.gov NCT01755091 (results in the registry); journal commentary PMID 29361189"},{"ad":"Walsh 2025","tasarim":"Double-blind, placebo-controlled, randomized crossover dose-finding study (single-blind placebo run-in)","n":"11 randomized; 9 analyzed (8 completed all doses)","populasyon":"Patients with obstructive sleep apnea with at least 15 breathing pauses/reductions per hour (Australia; mean age 54)","urun":"Dronabinol + acetazolamide combination (IHL-42X), oral, 1 hour before bed","urun_turu":"thc_iceren","doz":"Low: 2.5 mg dronabinol + 125 mg acetazolamide; medium: 5 mg + 250 mg; high: 10 mg + 500 mg","titrasyon":"None (each dose in a separate period, in random order)","sure":"7–8 nights for each dose and placebo, with at least 7 drug-free nights in between","sonuc":"According to the table in the full text, AHI fell from baseline by 19.4 ± 27.3 events/hour at the low dose, 17.8 ± 23.6 at the medium dose and 18.2 ± 24.8 at the high dose, and by 4.6 ± 21.5 with placebo (all p < 0.001 vs placebo; about a 35–40% reduction; the numbers in the abstract differ slightly). On the oxygen desaturation index, only the medium dose was better than placebo; the arousal index decreased; daytime sleepiness, mood and sleep structure did not change. 9 people and 1 week per dose; acetazolamide is itself a drug that reduces sleep apnea, and dronabinol’s contribution was not measured separately. Funded by the manufacturer Incannex; 2 of 12 authors are company employees and shareholders","yan_etki":"35 mild–moderate side effects possibly related to the drug (in 6 people): 16 at the medium dose, 10 at the high dose, 4 at the low dose, 5 with placebo; most often tingling in the fingers (4 of 9 people), constipation, nausea, diarrhea; no serious side effects or stopping due to side effects","pmid":"39589391","doi":"10.1093/sleep/zsae276","diger_kaynak":"ANZCTR ACTRN12620000916943; respiratory physiology analysis of the same trial: Thomson 2025 (PMID 40328187)"},{"ad":"Cousens 1973","tasarim":"Experimental dose study (three dose levels); randomization, placebo control and number of participants not in the abstract (one review refers to it as an RCT)","n":"Not reported (in the abstract)","populasyon":"Physically healthy people with insomnia (men, according to PubMed indexing; country and number of participants not in the abstract)","urun":"(−)Δ9-THC, oral","urun_turu":"thc_iceren","doz":"Three dose levels; only 30 mg is mentioned in the abstract, the other doses are not","titrasyon":"Not reported (in the abstract)","sure":"Not reported (in the abstract)","sonuc":"THC significantly shortened the time to fall asleep; awakenings during the night did not change significantly (a trend toward fewer in the first half of the night). The authors wrote that because of a 'hangover' lasting into the next day at 30 mg, this dose should not be considered as a sleep medicine. An old study from 1973 whose methods cannot be assessed from the abstract","yan_etki":"Distorted time perception and mood changes before falling asleep (at all doses; more frequent and severe as the dose increased); a 'hangover' or a feeling of lingering intoxication the next day, lasting longer depending on the dose","pmid":"4776660","doi":"10.1007/BF00437513","diger_kaynak":null},{"ad":"Prasad 2013","tasarim":"Open-label, single-center dose-escalation study (no control group)","n":"17 enrolled; 15 people completed 21 days","populasyon":"Patients with obstructive sleep apnea with at least 15 breathing pauses/reductions per hour; after stopping CPAP for 7 days (USA, Chicago)","urun":"Dronabinol (synthetic THC), oral, 30 min before bed","urun_turu":"thc_iceren","doz":"Increased once a week, 2.5 → 5 → 10 mg/day (if tolerated)","titrasyon":"Each dose for 7 days; if side effects occurred, the dose was kept the same","sure":"3 weeks","sonuc":"On night 21, AHI fell by 14.1 ± 17.5 events/hour from baseline (p = 0.007 in the abstract, 0.003 in the text); sleep structure was not disrupted, oxygen measures did not improve; the sleepiness score decreased slightly (p = 0.05). No control group, duration 3 weeks. Done with a donation from the company Pier Pharmaceuticals; 1 of 3 authors had previously been on this company’s board of directors","yan_etki":"Side effects in 76% of patients at 2.5 mg, 57% at 5 mg, 75% at 10 mg; most often sleepiness (50% at 10 mg), increased appetite at 2.5 mg (23%); 1 person was withdrawn for palpitations and 1 for a drop in oxygen; no serious side effects","pmid":"23346060","doi":"10.3389/fpsyt.2013.00001","diger_kaynak":"Sleep EEG analysis of the same study: Farabi 2014 (PMID 24426820)"},{"ad":"Messineo 2023","tasarim":"Open-label, two-center, 4-period dose-escalation study (no placebo; comparison with baseline and with atomoxetine alone)","n":"15","populasyon":"Patients with obstructive sleep apnea with 10–50 breathing pauses/reductions per hour, ages 25–65 (USA)","urun":"Atomoxetine (a drug that blocks noradrenaline reuptake) + dronabinol","urun_turu":"thc_iceren","doz":"Week 1 atomoxetine alone (40 → 80 mg); then weekly atomoxetine + dronabinol 40 + 2.5 mg, 80 + 5 mg, 80 + 10 mg","titrasyon":"Weekly dose increases","sure":"About 4 weeks (weekly dose increases)","sonuc":"No significant improvement from baseline on the primary measure (AHI with 80 mg atomoxetine + 10 mg dronabinol). On a secondary measure, at the 80 + 5 mg dose, AHI fell by 8.3 events/hour from baseline (95% CI 0.3–16.3) and oxygen burden decreased; at no dose was there a difference compared with the atomoxetine-only period; dronabinol was not tested alone. Because of side effects and a narrow treatment window, the authors advise against using this combination in sleep apnea for now. Open-label, no placebo. Funded by the company Apnimed, which took part in the design; all 3 of 3 authors have ties to the company (consulting or research funding)","yan_etki":"According to the registry, side effects were also common in the first week on atomoxetine alone (9 of 15 people; most often insomnia); in the weeks when dronabinol was added, 7 of 14, 6 of 12 and 5 of 11 people reported side effects. Those seen with the combination include excessive suspiciousness (paranoia; 2 people), a state of detachment (1 person), suicidal thoughts (1 person, during the 80 mg atomoxetine + 5 mg dronabinol period), raised blood pressure, a racing heartbeat (tachycardia) and nausea; no serious side effects were reported. 5 of 15 people did not finish the study (1 in the atomoxetine-only week, 4 during the combination periods; one by the physician's decision)","pmid":"36805833","doi":"10.5664/jcsm.10528","diger_kaynak":"ClinicalTrials.gov NCT05101122 (results in the registry)"},{"ad":"Lillo Triguero 2026","tasarim":"Prospective, open-label exploratory study (no control group)","n":"18 (16 of them with multiple sclerosis)","populasyon":"Patients with restless legs syndrome; 16 with multiple sclerosis, normal iron levels (Spain, Getafe)","urun":"THC + CBD (2.7 mg THC / 2.5 mg CBD; product name and form not in the abstract)","urun_turu":"thc_iceren","doz":"2.7 mg THC / 2.5 mg CBD (how many times a day it was taken is not in the abstract); dose adjustment at week 4 if needed","titrasyon":"Increase at week 4 if needed (schedule not in the abstract)","sure":"3 months (1-year follow-up)","sonuc":"Restless legs severity (IRLS) improved significantly at months 1 and 3 (p < 0.001); time awake at night measured by actigraphy decreased (p = 0.015), while time to fall asleep and sleep efficiency did not change; at 1 year, 67% of patients were continuing treatment and the improvement was holding. No control group, most patients had MS; a placebo effect cannot be ruled out. Supported by the IdiPAZ research institute; all 5 of 5 authors reported fees, travel support or research funding from drug or health companies (two from Almirall)","yan_etki":"Not reported (in the abstract)","pmid":"42387200","doi":"10.1007/s00415-026-13975-y","diger_kaynak":null},{"ad":"Asim 2026","tasarim":"Systematic review and meta-analysis of RCTs (up to January 2025)","n":"10 RCTs, 2,134 people","populasyon":"Adults with insomnia or poor sleep quality","urun":"Cannabinoids (types not specified separately in the abstract); comparison with placebo or melatonin","urun_turu":"karma","doz":"Variable","titrasyon":null,"sure":null,"sonuc":"Compared with placebo or melatonin, insomnia severity (ISI; mean difference −3.73; 95% CI −5.04 to −2.42) and sleep quality (PSQI; −3.94; −5.47 to −2.40) improved with cannabinoids; total sleep got longer by 34 min (20–48), sleep efficiency rose by 4.3% (3.0–5.6), and time to fall asleep got shorter by 12 min (95% CI −22.6 to −1.4; p = 0.03). The authors see cannabinoids as a possible option. The Cochrane review published the same year (Varela 2026), however, found the certainty of evidence very low; the abstract of this review does not grade the certainty of the evidence, and very different products, doses and comparisons (including melatonin) were assessed together; the list of included studies could not be read","yan_etki":"Side effects more common with cannabinoids (RR 3.96; 95% CI 1.75–9.00), mostly mild dizziness and dry mouth; no serious harm observed","pmid":"42574897","doi":"10.1016/j.sleep.2026.109193","diger_kaynak":"Letter to the journal: Wang 2026 (PMID 42753382; contents could not be read)"},{"ad":"Drager 2023 (Brazilian Sleep Association)","tasarim":"National clinical guideline (Brazilian Sleep Association; systematic literature searches, Oxford levels of evidence, expert voting)","n":null,"populasyon":"Adults with chronic insomnia","urun":"Cannabis (Cannabis sativa), CBD and Δ9-THC","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"Cannabis, CBD and THC are not recommended for difficulty falling asleep and staying asleep (level of evidence 3 for all three; consensus 94–100%); they are also not recommended in pregnancy and breastfeeding. Rationale: studies lasted at most 8 weeks, there are no quality studies to guide dosing and safety; it is not known whether the improvement in sleep comes through anxiety or pain","yan_etki":"The guideline’s summary: with CBD, sleepiness, stomach pain, diarrhea, raised liver enzymes; interactions with valproate and clobazam; with THC, sleepiness, euphoria, psychosis at high doses, misuse and withdrawal","pmid":"38370879","doi":"10.1055/s-0043-1776281","diger_kaynak":null},{"ad":"Ramar 2018 (AASM)","tasarim":"Position statement (American Academy of Sleep Medicine)","n":null,"populasyon":"Adults with obstructive sleep apnea","urun":"Medical cannabis and its synthetic extracts (including dronabinol)","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"The AASM stated that medical cannabis or its synthetic extracts should not be used to treat sleep apnea because of unreliable delivery methods and insufficient evidence of efficacy, tolerability and safety; it asked that sleep apnea be removed from the lists of conditions in state medical cannabis programs. The 73-person placebo-controlled dronabinol study (Carley 2018) was also included in the assessment; according to the statement, the dronabinol studies are small 3–6-week studies, long-term effects are unknown, and the most effective treatment is positive airway pressure (CPAP); it recommends that patients discuss treatment options with a physician at a sleep center","yan_etki":"It notes that side effects occurred in most patients in the dronabinol studies and that sleepiness was reported in 29–50% in the first study; it states that daytime sleepiness can lead to unwanted outcomes such as traffic accidents","pmid":"29609727","doi":"10.5664/jcsm.7070","diger_kaynak":"Letters commenting on the statement: PMID 30353820, 30353823, 30353829 (contents not read)"},{"ad":"Boylan 2024","tasarim":"Systematic review (no meta-analysis)","n":"9 studies (5 full texts, 4 conference abstracts)","populasyon":"Adults with obstructive sleep apnea","urun":"Dronabinol in 7 experimental studies, cannabis in 2 observational studies","urun_turu":"thc_iceren","doz":"Variable","titrasyon":null,"sure":null,"sonuc":"8 of 9 studies reported a significant positive result, such as a reduction in the number of breathing pauses or an improvement in daytime sleepiness; treatment durations 1–6 weeks (median 3 weeks). 4 of the 9 studies are conference abstracts only; of the 5 full-text studies, 2 had low, 1 moderate and 2 high risk of bias. The authors stress that there are no long-term efficacy and safety data and that longer, adequately sized studies are needed; they note that the AASM does not recommend cannabinoids","yan_etki":"Nervous system or digestive side effects in 70–80% of participants","pmid":"39498540","doi":"10.1002/phar.4622","diger_kaynak":null},{"ad":"Saha 2026","tasarim":"Scoping review (PRISMA-ScR; up to April 2025; no meta-analysis)","n":"7 studies","populasyon":"Adults with restless legs syndrome","urun":"Cannabis and CBD (smoked cannabis, sublingual CBD, CBD capsules, cannabidiolic acid cream applied to the skin)","urun_turu":"karma","doz":"Variable","titrasyon":null,"sure":null,"sonuc":"Of the 7 included studies, 2 are case series (6 and 12 patients; complete or near-complete resolution of symptoms was reported, mostly with smoked cannabis), 3 are surveys, 1 is an uncontrolled 10-person cream study, and 1 is an analysis done afterward of a controlled trial (de Almeida 2023; no difference between CBD and placebo). According to the authors, no clinical recommendation can be made without high-quality RCTs","yan_etki":null,"pmid":"42617004","doi":"10.4103/aian.aian_1168_25","diger_kaynak":"Case series in the review: Megelin 2017 (PMID 28655453; 6 patients), Ghorayeb 2020 (PMID 31820197; 12 patients); cream study ClinicalTrials.gov NCT06570941 (no publication found in PubMed)"},{"ad":"Trenkwalder 2024 (German guideline)","tasarim":"National guideline (German Sleep Society and German Neurological Society; abbreviated guideline)","n":null,"populasyon":"Patients with restless legs syndrome","urun":"Cannabinoids (THC and CBD)","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"Because THC and CBD have not yet been studied in randomized controlled trials in restless legs syndrome, treatment with cannabinoids cannot be recommended and should not be used (as of November 2024, when the guideline was published)","yan_etki":null,"pmid":"39501372","doi":"10.1186/s42466-024-00353-0","diger_kaynak":"Cannabinoids are not addressed in the American Academy of Sleep Medicine’s 2025 restless legs guideline (Winkelman 2025, PMID 39324694)"},{"ad":"Koye 2026 (UK Medical Cannabis Registry)","tasarim":"Prospective observational cohort (patient registry; no control group)","n":"211","populasyon":"Patients whose primary reason for prescription was insomnia, who had not responded adequately to licensed medicines, and who were prescribed self-paid cannabis-based medicines at a private clinic (United Kingdom; mean age 42, 73% men); 60% were already using cannabis at the start, and only 40 people (19%) had never used it before","urun":"Prescription cannabis-based medicines: dried flower inhaled by vaporizing (41%), oil (30%) or both (29%)","urun_turu":"thc_iceren","doz":"At month 24, median THC 143 mg/day (interquartile range 110–248), CBD 13.75 mg/day (6–48); at the start, THC 20 mg/day","titrasyon":"By physician decision; the THC dose rose over time (median 20 → 143 mg/day); the authors consider the rising dose and the narrowing improvement over time a possible sign of tolerance","sure":"24 months","sonuc":"Single-item sleep quality score (0–10) 2.46 at the start, 5.14 at month 24 (difference 2.68; 95% CI 2.23–3.14); better than baseline at all time points; anxiety and quality of life also improved. No control group; missing data were filled in statistically; participants were paying patients, most of whom had used cannabis before (expectation effect); no objective sleep measurement; the authors note that the improvement in the worst sleepers may partly be regression to the mean. The registry belongs to Curaleaf Clinic; 7 of 8 authors work at Curaleaf or are executives there","yan_etki":"17 of 211 people (8%) reported at least one side effect: most often insomnia (13; 5 of them severe), tiredness (12), dry mouth (10), sleepiness (9); none life-threatening; more common over age 60 (adjusted OR 19.1; 95% CI 1.5–536)","pmid":"42935025","doi":"10.1002/npr2.70180","diger_kaynak":"Earlier insomnia analyses of the same registry: Vivek 2024 (PMID 38337193; 61 patients, 6 months) and Aggarwal 2025 (PMID 41662070; 124 patients, 18 months)"},{"ad":"Roepke 2026","tasarim":"Multicenter (Germany), double-blind, placebo-controlled, parallel-group RCT (phase 2)","n":"171 randomized (87 dronabinol, 84 placebo); efficacy analysis 169 (87/82); safety analysis 170 (87/83)","populasyon":"Adults diagnosed with PTSD with recurring nightmares (mean age 37.9; 79.3% women; 46% were in psychotherapy and 62% were taking antidepressants during the same period); participants were selected for nightmares, not for insomnia","urun":"Dronabinol (synthetic THC; BX-1, oral), before bed; matching placebo","urun_turu":"thc_iceren","doz":"Started at 2.5 mg as 1 dose a day, up to 15 mg/day","titrasyon":"Per protocol, 2.5 mg for 4 days, then 2.5 mg increases on days 5, 8, 12, 15 and 19; the target was the dose at which nightmares disappeared (up to 15 mg)","sure":"10 weeks (4 weeks of dose adjustment + 6 weeks at a fixed dose); follow-up at week 12","sonuc":"On the primary measure (nightmare frequency and severity, CAPS-IV B2, 0–8 points), the drop at week 10 was −3.66 points with dronabinol and −2.17 with placebo; difference −1.50 (95% CI −2.28 to −0.71; p < 0.001; effect size d = 0.65); similar in sensitivity analyses. At least a halving of nightmares 57.9% vs 29%, complete disappearance 36.8% vs 14.5% (no correction for multiple comparisons). Week-10 difference in sleep quality (PSQI) −1.28 points, in PTSD-specific nighttime symptoms (PSQI-A) −2.22 points (both uncorrected additional analyses; p = 0.046 and p < 0.001). The difference in overall PTSD severity (CAPS-5) was not significant (p = 0.08). 80.8% of those taking dronabinol and 52.5% of those taking placebo correctly guessed their group (mostly based on the drug’s effects), and reports of improvement were strongly linked to this guess; this can make the result look better than it is. A single large study. Investigator-initiated; the manufacturer Bionorica provided an unrestricted grant and the study drug (according to the publication, it had no role in design or analysis; the 2023 protocol publication also names Canopy Growth as a funder); 1 of 20 authors (the lead author) had received personal fees from Bionorica before the contract","yan_etki":"Any side effect 89.7% vs 77.1%; serious side effects in 7 (8.0%) people vs 0 (the investigators attributed none to the drug); stopping due to side effects 5.7% vs 7.2%; dizziness 23% vs 14.5%, increased appetite 16.1% vs 8.4%, diarrhea 11.5% vs 3.6%, dry mouth 9.2% vs 1.2%","pmid":"42557458","doi":"10.1038/s41591-026-04546-9","diger_kaynak":"ClinicalTrials.gov NCT04448808 and EU registration EudraCT 2019-002211-25 (no results in either; October 28, 2026); protocol: Roepke 2023 (PMID 37147642); also a row in the PTSD topic"},{"ad":"Jetly 2015","tasarim":"Double-blind, placebo-controlled, randomized crossover pilot study","n":"10 (mITT)","populasyon":"Canadian male soldiers diagnosed with PTSD whose trauma-related nightmares continued despite standard treatment","urun":"Nabilone (synthetic cannabinoid similar to THC, oral capsule)","urun_turu":"cbn_diger","doz":"Started at 0.5 mg and increased until nightmares were suppressed, up to 3.0 mg","titrasyon":"Increase to the effective dose or to the 3.0 mg ceiling","sure":"2 × 7 weeks, with a 2-week washout in between","sonuc":"Reduction on the CAPS nightmare item −3.6 with nabilone, −1.0 with placebo (p = 0.03); clinical global impression of change (CGI-C) 1.9 vs 3.2 (p = 0.05); 5 of 10 people improved greatly with nabilone, 1 of 9 with placebo. A very small pilot study (10 people, male soldiers only)","yan_etki":"Treatment-related side effects 50% with nabilone, 60% with placebo; no severe side effects or stopping due to side effects","pmid":"25467221","doi":"10.1016/j.psyneuen.2014.11.002","diger_kaynak":"Health Canada registration; also a row in the PTSD topic"},{"ad":"Morgenthaler 2018 (AASM)","tasarim":"Position statement (American Academy of Sleep Medicine; literature search March 2009–August 2017 and expert opinion; a position statement instead of a guideline because the evidence is limited)","n":null,"populasyon":"Adults with nightmare disorder and PTSD-related nightmares","urun":"Nabilone (synthetic cannabinoid similar to THC); for cannabis it says only 'there is not enough evidence to make a recommendation'","urun_turu":"cbn_diger","doz":null,"titrasyon":null,"sure":null,"sonuc":"For PTSD-related nightmares, nabilone is among the options that 'may be used'; in the statement this is a weaker level than 'recommended', where the evidence or expert opinion is uncertain. The basis is only a 10-person RCT (Jetly 2015). It states that there is not enough evidence to make a recommendation for cannabis. The only 'recommended' treatment for nightmares is imagery rehearsal therapy (a psychotherapy method)","yan_etki":"For Jetly 2015, the most common were reported to be dry mouth and headache","pmid":"29852917","doi":"10.5664/jcsm.7178","diger_kaynak":"Also a row in the PTSD topic; journal commentary PMID 32088375"}],"ilgili_ilaclar":["benzodiazepin"],"son_inceleme":"2026-11-01","arastirma_gecmisi":[{"tarih":"2026-10-19","not":"Page published. In this first assessment, 20 studies were reviewed."},{"tarih":"2026-10-21","not":"The full texts of the studies were reread and the information on the page was checked against its sources. Corrected: duration, dose, side effect and product details in the study table; drug interaction notes; the dose range in the studies. No point remains that could not be verified from the full text (previously 2 items). The year of 7 publications named on the page was corrected to the journal’s print year instead of the online publication year. The conclusion and strength of evidence did not change."},{"tarih":"2026-10-21","not":"Newly published and previously missed clinical studies were searched in PubMed and ClinicalTrials.gov. 2 studies added: Kisiolek 2023 and So-Ngern 2025. The conclusion and strength of evidence did not change."},{"tarih":"2026-10-22","not":"The names of the finding labels were simplified: the \"No benefit seen\" label on this page became \"No effect found\". The assessment did not change."},{"tarih":"2026-10-27","not":"A new Cochrane review (October 2026) and a review pooling sleep lab studies were added; the insomnia finding of a meta-analysis pooling cannabinoid studies in mental health conditions (sleep time measured with an electronic device got longer) was added to the table. The effect of THC-containing products on measured sleep was separated by type of measurement: the drop in total sleep and REM is the finding of a single-dose pilot study. It was corrected that a CBD study in healthy young people did not show superiority over placebo on the overall sleep score. The conclusion and strength of evidence did not change."},{"tarih":"2026-10-28","not":"October 2026 evidence search: PubMed, Cochrane and ClinicalTrials.gov were searched systematically, and the findings were reread from primary sources in an independent check; by the founder’s scope decision, sections on sleep apnea and restless legs syndrome were opened on this topic. 27 studies were added to the table. In insomnia: a 2-week study with pure CBD in worried people (no different from placebo), a small 1981 study and a CBD gel applied inside the mouth; with THC-containing products, a sleep lab study in healthy volunteers, the cannabis card trial, two studies from Thailand and a multi-ingredient supplement study; nabilone and CBG studies; a meta-analysis, the Brazilian Sleep Association guideline and a patient registry from the UK. In sleep apnea, four studies with dronabinol, the American Academy of Sleep Medicine position statement and a systematic review; in restless legs, an open-label study, a review and the German guideline. In nightmares linked to post-traumatic stress disorder, two placebo-controlled studies with dronabinol and nabilone and the American Academy of Sleep Medicine nightmare position statement (also on the PTSD page) were added. Three rows that were secondary publications of the same trials, and a Parkinson’s trial in which sleep was only a secondary measure, were removed from this topic’s table; the findings of the secondary publications were moved to the main rows. Corrected in existing rows: that the primary measure was negative in a CBN study (Bonn-Miller 2024), that superiority over placebo stated in the abstract of a formula study was not seen in the full-text analysis (Hausenblas 2025), participant numbers, durations, registration numbers and company ties. The conclusion and strength of evidence did not change."},{"tarih":"2026-10-28","not":"October 2026 supplementary review: sources found for this page during the searches for other topics were read and added to the page. The product type of the review pooling cannabinoid trials in disturbed sleep (AminiLari 2022) was changed to 'mixed', because besides THC-containing products it also covers nabilone and CBDV studies; an internal note in a dose field was rewritten in reader language; the Brazilian Academy of Neurology’s 2025 Parkinson’s guideline assessment of CBD in REM sleep behavior disorder was added to the text; in three rows from the same Brazilian research group, the authors’ patent and company ties were written consistently with the other rows. No studies were added to the table. The conclusion and strength of evidence did not change."},{"tarih":"2026-10-30","not":"The correction to the Wilson 2026 meta-analysis published in the journal was read: only the axis of one figure and the study counts in a table were corrected; the results on this page did not change."},{"tarih":"2026-10-30","not":"The last sentence of the page's short summary was rewritten in a calmer, more guiding tone: instead of \"Talk to your doctor before you start.\", it now says whom you can talk with, and about what, if you are considering CBD. The conclusion and the strength of evidence did not change."},{"tarih":"2026-11-01","not":"The evidence level text now uses the same level name as the top of the page; the level and the result did not change."},{"tarih":"2026-11-01","not":"A blinding note was added to the Walczyńska-Dragon 2025 row: the CBD gels differed from the placebo gel in appearance and taste, so participants may have noticed which group they were in (PMID 40732351 and the main publication, PMID 38592260, full texts). The conclusion and the evidence level did not change."},{"tarih":"2026-11-01","not":"The side effects of the sleep apnea study in which atomoxetine and dronabinol were tested together (Messineo 2023) were corrected according to the study's registry record: side effects were also common in the first week, when only atomoxetine was taken (9 of 15 people), suicidal thoughts were reported during the 80 mg atomoxetine + 5 mg dronabinol period, and one of the 5 people who did not finish the study dropped out in the first week (ClinicalTrials.gov NCT05101122, results section). The conclusion and the evidence level did not change."}]},{"id":"depression","baslik":"Depression","grup":"Anxiety and mental health","grup_kodu":"kaygi","tr_id":"depresyon","kanit_duzeyi":"cok_zayif","kanit_yonu":"veri_yok","kanit_ozet":"There is no published RCT with a positive result that targeted depression as its primary outcome. A 2026 Lancet Psychiatry meta-analysis reported that there is no RCT evidence for treating depression. Low-dose full-spectrum CBD oil was no different from placebo in stressed students; in an open-label study, 300 mg/day reduced burnout in health care workers and, as a secondary outcome, depression scores (PHQ-9), but there was no placebo and 5 serious side effects were seen only in the CBD arm. Other placebo-controlled CBD studies measuring depression symptoms found no difference: 600 mg a day in 20 patients with brain tumors and anxiety (stopped early; Belgers 2026), 144 patients with advanced cancer (Hardy 2023), 136 patients with hand osteoarthritis and psoriatic arthritis (Vela 2022, exploratory outcome). A 178-person study in anxiety disorder in India also reported improvement in depression scores; but the reported effect is much larger than in other anxiety studies, its statistics are unusual for a study of this size, the result has not been independently replicated, six of the seven authors are tied to pharmaceutical companies, and the full text could not be read (Gundugurti 2024). The consistent effect in animal studies has not carried over to humans (Jantsch 2026). For THC-containing products: in two small 1970s studies with hospitalized patients with depression, THC gave no benefit and frequently caused distressing reactions (Kotin 1973, Ablon 1974; details from Stanciu 2021); in a 269-person study in which a medical cannabis card was randomly given either right away or after 12 weeks (186 analyzed), depression symptoms did not change and cannabis use disorder increased (Gilman 2022). Meta-analyses pooling depression symptoms measured in other conditions found no difference (Black 2019: SMD −0.05; Bharat 2026: SMD −0.20, 95% CI −0.43 to 0.04; very low certainty of evidence). In studies without a comparison group that followed patients with depression using medical cannabis, depression scores went down (Lillywhite 2026, Specka 2024); a follow-up study comparing users with non-users, most of whose participants used CBD-dominant products, gave a similar result (Martin 2021). Most of these were carried out by teams tied to cannabis companies or cannabis clinics, and the expectation effect cannot be separated out; in Canada, meanwhile, among people authorized to use medical cannabis, the risk of emergency visits and hospitalization for depression was about twice as high (Yana 2023). For recreational use, a meta-analysis of longitudinal studies shows that depression develops slightly more often later in cannabis users (OR 1.29, Churchill 2025; HR 1.34 in a cohort of 463,396 adolescents, Young-Wolff 2026), but in a meta-analysis that included only general population studies and dealt with tobacco separately, the link was not significant (RR 1.31; 95% CI 0.92–1.86; Burke 2024). In people with depression, cannabis use goes along with more severe symptoms and a worse course in most studies (Sorkhou 2024); the systematic review by the Canadian CANMAT guideline group found these findings less consistent in major depression than in bipolar disorder and made avoiding cannabis a conditional recommendation for people with major depression (low to moderate certainty of evidence; Tourjman 2023). In young people with mood disorders, cannabis use disorder was linked to a threefold increase in the risk of self-harm (Fontanella 2021). In a study in which teenagers who used cannabis at least once a week were randomly assigned to 4 weeks of abstinence or to monitoring only, stopping did not change depression symptoms (Cooke 2021). Observational studies do not show cause and effect. CBD cannot be recommended as a treatment for depression; it does not replace prescription antidepressants. October 2026 search (PubMed, Cochrane, ClinicalTrials.gov): 10 controlled studies with cannabinoids on this topic were found that focused on depression or mood or measured depression symptoms with CBD (only 2 in patients diagnosed with depression, with THC in the 1970s; 1 tests stopping cannabis), along with 8 systematic reviews or meta-analyses (one by a mental health guideline group); Cochrane has no review on this topic. All are in the table below, together with 6 observational studies, 1 case report and 1 meta-analysis pooling animal studies. THC-containing product studies that measured depression only as a secondary outcome in other conditions, and studies asking the same question that are covered by the reviews in the table, were not included one by one.","kanit_duzeyi_metin":"Very weak (animal data consistent; no CBD RCT in people diagnosed with depression, and most small RCTs measuring depression symptoms show no difference from placebo)","kanit_duzeyi_thc_icerenler":"cok_zayif","kanit_duzeyi_thc_icerenler_metin":"Very weak: in patients with depression there are only two small 1970s studies and one randomized medical cannabis study, none showing benefit; no difference in meta-analyses; the data pointing to harm are observational (Black 2019, Bharat 2026, Gilman 2022)","kaynak_dosya":"uyku-depresyon.md","saf_cbd_sonuc":"There is no published RCT showing that pure CBD is effective in depression; no CBD RCT in patients diagnosed with depression has been published either. Most placebo-controlled CBD studies that measured depression symptoms found no difference: stressed students (Winkler 2025), brain tumors (Belgers 2026), advanced cancer (Hardy 2023), hand osteoarthritis (Vela 2022). The positive results come from a study without placebo (Crippa 2021) and from an anxiety study whose authors were mostly tied to pharmaceutical companies, whose details could not be read, and whose reported effect is much larger than in the other studies (Gundugurti 2024). The strength of evidence is very weak.","thc_icerenler_sonuc":"There are only two small, old controlled studies with THC in patients with depression: THC did not improve depression, and 10 of 21 patients could not continue because of side effects such as intense anxiety or panic (Kotin 1973, Ablon 1974; information from a review). Meta-analyses that pooled studies measuring depression symptoms in other conditions found no significant difference from placebo, either with THC-containing medicines (Black 2019) or with cannabinoids in general (Bharat 2026); across studies of mental disorders, THC increased side effects (OR 1.99) and stopping because of side effects (OR 2.78) (Black 2019). In people randomly assigned to start medical cannabis early for anxiety or depression, depression symptoms did not improve and cannabis use disorder developed more often (Gilman 2022). In observational studies, cannabis use goes along with a small increase in the later risk of depression (about 1.3 times) (Churchill 2025, Young-Wolff 2026); but in a meta-analysis that included only general population studies, the link was not significant (Burke 2024), and cause and effect has not been shown. The Canadian CANMAT guideline group recommends that people with major depression avoid cannabis; the certainty of evidence is low to moderate, and the recommendation is conditional (Tourjman 2023).","ruhsat":null,"doz_araligi_ozet":"In controlled studies, pure CBD 20–600 mg a day (in hand osteoarthritis, starting at 10 mg and going up to 20–30 mg; 300 mg in health care workers; 600 mg in brain tumors; in advanced cancer, a median dose of 400 mg chosen by patients); in the student study, full-spectrum oil from 0.02 mg to 1 mg per kilogram per day","titrasyon_ozet":"In the student study, the dose was raised every three days; in the cancer study, patients adjusted the dose over the first 14 days based on effect and side effects; in the hand osteoarthritis study, the dose was stepped up from 10 mg to 20 and 30 mg","yan_etkiler":["Crippa 2021 (300 mg/day): 4 liver enzyme elevations (1 critical), 1 severe drug rash","Side effects with any cannabinoid OR 1.75 (NNTH 7) (Wilson 2026)","A single case of mania after high-dose vaporized CBD (Auf 2025)","THC (1970s, hospitalized patients with depression): 10 of 21 patients could not continue because of intense anxiety, a feeling of detachment from oneself, panic or psychosis-like reactions (Kotin 1973, Ablon 1974; details from a secondary source, Stanciu 2021)","Medical cannabis card (12 weeks): cannabis use disorder 17.1% vs 8.6% (adjusted OR 2.88); among those applying for anxiety or depression, 28.3% vs 10.8% (Gilman 2022)"],"izlem":["Doctor monitoring for changes in medicine levels in people taking antidepressants"],"dikkat":["Depression is a serious illness; there is no evidence that CBD can replace prescription treatment","If someone taking an antidepressant adds CBD, medicine levels may change","Risk of label/content mismatch in nonprescription products (Auf 2025)","Depression symptoms did not improve with medical cannabis products; cannabis use disorder developed more often in those randomly assigned to start early (Gilman 2022)","In young people with mood disorders, cannabis use disorder went along with an increased risk of self-harm (observational; Fontanella 2021)","A Canadian mental health guideline group (CANMAT) recommends that people with major depression avoid cannabis; the certainty of evidence is low to moderate, and the recommendation is conditional (Tourjman 2023)"],"ilac_etkilesim_notlari":["Citalopram: in healthy adults, CBD (2.5 mg/kg twice daily, 12 days) increased citalopram exposure (AUC) by 43% (Salcedo 2026, PMID 41622700)","Amitriptyline: a single 30 mg dose of CBD increased amitriptyline AUC by 13% and Cmax by 17%; the effect may be larger with continuous use (Gorbenko 2026, PMID 41398552)","In an emergency department survey, 69.7% of people using CBD at home were taking a medicine with interaction potential; the most common group was antidepressants (64.4%) (Geneau 2025, PMID 41227172)","Reports of interactions with antidepressants, antiepileptics, opioids and alcohol were reviewed (Balachandran 2021, PMID 33515191)"],"dogrulanamayan":["No published RCT in treatment-resistant depression (PubMed and ClinicalTrials.gov, October 19, 2026; checked again on October 27, 2026, no change). NCT04732169 was withdrawn due to lack of funding (0 people); NCT07696871 (THC-containing full-spectrum oil, 12 weeks, target 120) has been recruiting since June 2026","NCT07651930 (anxiety/depression in Parkinson’s; 30/60/300 mg/day full-spectrum oil, no placebo, 60 days, 27 people) was completed in November 2024; no results on ClinicalTrials.gov and no publication on PubMed (October 19, 2026; checked again on October 27, 2026)","NCT05041647 (insomnia in major depression; CBD:THC 25:1 and 5:1 oil vs placebo, pilot, 14 people) was completed in January 2025, and NCT05066308 (measurement of brain inflammation with pure CBD in people with low back pain and depression symptoms, 69 people) in May 2026; neither has results on ClinicalTrials.gov or a publication on PubMed (October 27, 2026)","Kotin 1973 and Ablon 1974 (THC, hospitalized patients with depression): the original articles and their abstracts could not be read; details come from the Stanciu 2021 review, and the review's text and table give the two studies' doses the other way around","In the 1940s, a synthetic substance similar to THC (synhexyl) was tried in depression (Stockings 1947, Pond 1948); these articles have no abstract on PubMed and their full texts could not be accessed, so their results could not be verified","The full text of the Wilson 2026 meta-analysis could not be read; its correction published in the journal (Lancet Psychiatry 2026;13(8):e11) was read on October 29, 2026: only the axis of one figure and the study counts in a table were corrected, and the results did not change"],"calismalar":[{"ad":"Winkler 2025","tasarim":"RCT, 3 arms (CBD oil / placebo oil / no treatment)","n":"180 randomized (CBD oil 59, placebo oil 61, no treatment 60); 166 analyzed (52/58/56)","populasyon":"Stressed university students at risk of depression","urun":"10% full-spectrum CBD oil (nonprescription product; 1000 mg CBD per 10 mL, a small amount of THC, amount not reported); placebo hemp seed oil","urun_turu":"cbd_zengin_thc_belirsiz","doz":"By body weight: 0.02 mg/kg on day 1, 1 mg/kg on day 30 (about 1.7–85 mg a day for 85 kg)","titrasyon":"Increased every three days (0.02 → 1 mg/kg)","sure":"30 days","sonuc":"Primary outcomes were stress (PSS-10) and depression symptoms (DASS-21). No difference between CBD oil and placebo oil on any outcome (difference in change in depression symptoms 0.23 points; p = 0.774; d = 0.05). Both oil groups improved more than the group that received nothing in stress, depression symptoms and physical complaints (for depression, CBD d = 0.65, placebo d = 0.61); the groups did not differ in anxiety, sleep or well-being. The authors attribute the improvement largely to the placebo effect","yan_etki":"not reported (side effects were asked about on day 30, but the article does not report the results)","pmid":"41316488","doi":"10.1186/s42238-025-00366-9","diger_kaynak":"German Clinical Trials Register DRKS00030971 (preregistered on December 22, 2022)"},{"ad":"Crippa 2021","tasarim":"Open-label RCT (no placebo)","n":"214 people assessed; 120 randomized (61 CBD, 59 control); 118 analyzed","populasyon":"Frontline health care workers during the COVID-19 period","urun":"Pure CBD (99.6%), 150 mg/mL in MCT oil + standard care","urun_turu":"saf_cbd","doz":"300 mg/day (150 mg × 2)","titrasyon":"None","sure":"28 days","sonuc":"Primary outcome was emotional exhaustion: it decreased in the CBD + standard care group compared with control on days 14, 21 and 28 (difference at day 28 4.01 points; 95% CI 0.43–7.59). Secondary outcome was depression symptoms (PHQ-9): group × time interaction significant (p < 0.001), a 2.72-point drop from baseline at day 28 in the CBD group (95% CI 0.95–4.48); the number of people with PHQ-9 above 10 decreased only in the CBD group. There was no placebo and participants knew what they were taking. 7 of 24 authors are patent holders or applicants related to CBD compounds (the patents are outside the subject of this study); the CBD was donated by a company","yan_etki":"5 serious side effects, all in the CBD group: 4 liver enzyme elevations (1 critical, 3 mild), 1 severe drug rash; CBD was stopped in 2 people, both recovered fully. The most common side effects (drowsiness, tiredness) were similar in both groups","pmid":"34387679","doi":"10.1001/jamanetworkopen.2021.20603","diger_kaynak":"ClinicalTrials.gov NCT04504877 (BONSAI; no results in the registry); 3-month follow-up publication by the same team (anxiety outcomes): Souza 2022, PMID 36263136"},{"ad":"Kotin 1973","tasarim":"Double-blind, placebo-controlled small study (inpatient; 7 days placebo, 7 days THC, 7 days placebo)","n":"8 (4 unipolar, 4 bipolar depression); 4 people completed the THC period","populasyon":"Hospitalized, unmedicated adults with moderate to severe depression (US National Institute of Mental Health research unit)","urun":"THC (oral)","urun_turu":"thc_iceren","doz":"Oral THC; dose contradictory in the secondary source (Stanciu 2021 text: 0.3 mg/kg twice daily; the same review's table: from 5 mg a day to 2 × 20 mg a day)","titrasyon":"not reported (original article could not be read)","sure":"3 weeks (7 days of THC)","sonuc":"THC did not improve depression on subjective or observer-rated mood measures; scale scores not reported, no separate result for the unipolar depression subgroup. The original article and its abstract could not be read; information from the Stanciu 2021 review","yan_etki":"4 of 8 patients stopped THC because of side effects (in two, severe anxiety with a feeling of detachment from oneself after the first dose); drowsiness in those who completed","pmid":"4569675","doi":"10.1001/archpsyc.1973.01750330041007","diger_kaynak":null},{"ad":"Ablon 1974","tasarim":"Double-blind, placebo-controlled small study (inpatient; THC or placebo after 3 weeks of observation)","n":"13 (8 unipolar, 5 bipolar depression)","populasyon":"Hospitalized adults with depression (US National Institute of Mental Health research unit)","urun":"THC (oral)","urun_turu":"thc_iceren","doz":"Oral THC; dose contradictory in the secondary source (Stanciu 2021 text: from 5 mg a day to 2 × 20 mg a day; the same review's table: 0.3 mg/kg twice daily, 7 days)","titrasyon":"Contradictory in the secondary source: according to the Stanciu 2021 text, raised from 5 mg a day to 2 × 20 mg a day; according to its table, 0.3 mg/kg twice daily (original article could not be read)","sure":"not reported (unclear in the secondary source)","sonuc":"Depression symptoms did not improve; standard scale scores not reported. A distressing (dysphoric) reaction was seen in 7 of 13 patients: 6 had unipolar and 1 had bipolar depression. The original article and its abstract could not be read; information from the Stanciu 2021 review","yan_etki":"6 patients could not continue the study after the first dose because of panic or psychosis-like reactions","pmid":"4592555","doi":"10.1176/ajp.1974.131.4.448","diger_kaynak":null},{"ad":"Gilman 2022","tasarim":"Pragmatic RCT (getting a medical cannabis card right away or after 12 weeks; 2:1 randomization; participants were not blinded, only assessors were blinded)","n":"269 randomized; 186 analyzed (105 immediate, 81 delayed; those with baseline and at least one follow-up measurement; in the immediate group, only those who got the card: 53 of the 173 people assigned to this group did not get a card); depression analysis in 83 people who applied for anxiety or depression (46/37)","populasyon":"Adults aged 18–65 seeking medical cannabis for pain, insomnia, or anxiety or depression symptoms; daily cannabis users and people with cannabis use disorder were excluded (US, Boston)","urun":"Cannabis products chosen by participants themselves at a dispensary (THC and/or CBD; ratios in a supplementary table, not read)","urun_turu":"karma","doz":"Participant's choice (product, dose and frequency unrestricted)","titrasyon":"Participant's choice","sure":"12 weeks","sonuc":"On depression symptoms, one of the primary outcomes (HADS-depression; only in those who applied for anxiety or depression), no difference between groups (mean difference −0.5; 95% CI −1.4 to 0.4; p = 0.30); no difference in anxiety or pain either, only the insomnia score improved (−2.90; 95% CI −4.31 to −1.51). Cannabis use disorder symptoms increased (0.28; 95% CI 0.15–0.40). At baseline, the mean HADS-depression score was below the clinical threshold (6.1 and 5.2)","yan_etki":"At 12 weeks, cannabis use disorder in 17.1% of those who got the card right away and 8.6% of those who waited (adjusted OR 2.88; 95% CI 1.17–7.07); among those who applied for anxiety or depression, 28.3% vs 10.8%","pmid":"35302633","doi":"10.1001/jamanetworkopen.2022.2106","diger_kaynak":"ClinicalTrials.gov NCT03224468 (results in the registry); daily survey analysis of the same trial: Tervo-Clemmens 2023 (PMID 36638745; 181 people; frequency of cannabis use increased in those who got the card; no improvement in depression symptoms at 12 weeks; the depression score was found to be very slightly lower on days when cannabis was used, but when limited to those whose use was confirmed by urine testing, this difference was not significant)"},{"ad":"Belgers 2026","tasarim":"Double-blind, placebo-controlled crossover RCT (Bayesian analysis); stopped early because of slow recruitment","n":"20 randomized (55 planned); 15 completed both periods","populasyon":"Adults with brain tumors, stable disease and clinically significant anxiety (S-STAI ≥ 44) (Netherlands); not selected because of depression","urun":"Pure CBD tablet (more than 99% CBD, less than 0.1% THC)","urun_turu":"saf_cbd","doz":"600 mg/day","titrasyon":"not reported (not in the research letter)","sure":"2 × 3 weeks (with at least a 2-week washout in between)","sonuc":"Primary outcome was anxiety; depression symptoms (CES-D) secondary. Anxiety and depression symptoms decreased more in the placebo period than in the CBD period; the probability that CBD improved depression symptoms was 11% (median difference +1.61 points, against CBD; 95% credible interval −0.97 to 4.21). The authors do not recommend further research on CBD for anxiety and depression in this patient group; the study is small and statistically underpowered","yan_etki":"Side effects similar (3 events in the CBD period, one grade 3; 6 events in the placebo period, all grade 1 or 2); a rash in one patient during the CBD period (may have been due to the carrier substance)","pmid":"42750778","doi":"10.1093/nop/npag025","diger_kaynak":"Netherlands Trial Register NL9623 (GRASS study)"},{"ad":"Gundugurti 2024","tasarim":"Multicenter, double-blind, placebo-controlled RCT (phase 3)","n":"178 randomized (89 CBD, 89 placebo); number analyzed not in the abstract","populasyon":"Adults with mild to moderate anxiety disorder (India); not selected because of depression","urun":"Nanodispersed CBD oral solution (150 mg per mL); purity and manufacturer not stated in the abstract","urun_turu":"saf_cbd","doz":"not reported (not in the abstract)","titrasyon":"not reported (not in the abstract)","sure":"15 weeks (study duration in the abstract; treatment duration not given separately in the abstract)","sonuc":"Primary outcomes were anxiety (GAD-7, HAM-A): CBD was reported to be superior to placebo (GAD-7 difference in change −7.02; standard error 0.25; 95% CI −7.52 to −6.52; p < 0.0001). In a study of 89 vs 89 people, this standard error means the spread between people was only about 1.7 points on a 0–21 scale; this is unusually small for a psychiatry study, and the effect is much larger than in other anxiety studies; the result has not been independently replicated. The study was also reported to have met its target for depression symptoms measured with PHQ-9, a secondary outcome; there are no depression numbers in the abstract, the full text could not be read, and the analysis method could not be verified. Six of the seven authors are tied to pharmaceutical companies (five are executives or employees of Leiutis Pharmaceuticals, which funded the pharmacokinetic part of the trial, and one is medical director of Biophore Pharma)","yan_etki":"No serious side effects (abstract); side effect numbers not in the abstract","pmid":"38797087","doi":"10.1016/j.ajp.2024.104073","diger_kaynak":"Clinical Trials Registry – India CTRI/2023/01/049110. Pharmacokinetic study that is part of the same trial: Gundugurti 2026, PMID 41613360 (18 healthy men, single dose of 300 mg; funded by Leiutis Pharmaceuticals). Research letter from the same team: Gundugurti 2026, PMID 42901095 (no abstract; new patient data could not be verified)"},{"ad":"Vela 2022","tasarim":"Double-blind, placebo-controlled RCT","n":"136 randomized; 129 analyzed","populasyon":"Patients with hand osteoarthritis or psoriatic arthritis with moderate pain despite treatment (Denmark); not selected because of depression","urun":"Synthetic CBD, oral; no THC","urun_turu":"saf_cbd","doz":"Started at 10 mg/day; 20 mg/day at week 2; 30 mg/day at week 4 if no response","titrasyon":"Stepwise: 10 → 20 → 30 mg/day","sure":"12 weeks","sonuc":"No significant difference between CBD and placebo in depression (HADS; exploratory outcome) or anxiety (depression numbers not in the abstract). No difference in the primary outcome, pain, either (0.23 mm; 95% CI −9.41 to 9.90; p = 0.96)","yan_etki":"Side effects in 33 patients in the CBD group and 26 with placebo; serious events 2 vs 2, none attributed to the drug","pmid":"34510141","doi":"10.1097/j.pain.0000000000002466","diger_kaynak":"ClinicalTrials.gov NCT03693833 (no results in the registry)"},{"ad":"Hardy 2023 (MedCan1-CBD)","tasarim":"Double-blind, placebo-controlled, dose-escalation RCT (phase 2b)","n":"144 randomized; 121 at day 14 (58 CBD, 63 placebo)","populasyon":"Patients with advanced cancer and a high symptom burden receiving palliative care (Australia); not selected because of depression","urun":"Synthetic pure CBD oil (100 mg per mL)","urun_turu":"saf_cbd","doz":"Started at 0.5 mL (50 mg) once daily, up to a maximum of 2 mL three times daily (600 mg/day); median dose chosen by patients 400 mg/day","titrasyon":"Increased over the first 14 days according to response and side effects","sure":"28 days","sonuc":"On depression, a secondary outcome (and on anxiety and quality of life), CBD had no detectable effect (scale and numbers not in the abstract). The primary outcome, total symptom burden, fell by 3.0 points with CBD and 6.2 points with placebo at day 14; no difference (p = 0.24)","yan_etki":"Side effects similar between groups; shortness of breath more common with CBD","pmid":"36409969","doi":"10.1200/JCO.22.01632","diger_kaynak":"ANZCTR ACTRN12618001220257; protocol: Good 2019, PMID 31810437"},{"ad":"Cooke 2021","tasarim":"RCT (4 weeks of cannabis abstinence with financially incentivized support, or monitoring only)","n":"179 randomized (112 abstinence, 67 monitoring); in the abstinence group, 90 people did not use for 4 weeks","populasyon":"Healthy adolescents and young adults who used cannabis at least once a week and were not seeking treatment (US; including participants under 18)","urun":"Recreational cannabis (THC)","urun_turu":"thc_iceren","doz":"Not applicable (abstinence study)","titrasyon":"None","sure":"4 weeks","sonuc":"Depression and anxiety symptoms (MASQ) decreased slightly over time in all participants; no difference between the abstinence and monitoring groups (p > 0.46). In exploratory analyses, there was a trend suggesting that abstinence may bring more improvement in those who used cannabis to cope with negative emotions and in those using at risky levels. According to the authors, 4 weeks of abstinence did not worsen symptoms","yan_etki":"not reported","pmid":"34276449","doi":"10.3389/fpsyt.2021.689957","diger_kaynak":null},{"ad":"Black 2019","tasarim":"Systematic review and meta-analysis","n":"83 studies (40 RCTs, n=3067); 42 studies for depression, 23 of them RCTs (n=2551)","populasyon":"Mental disorders","urun":"All cannabinoids","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"No RCT examining depression as the primary diagnosis was found. In 12 placebo-controlled THC (± CBD) studies measuring depression symptoms, mostly in patients with MS and chronic pain, no significant difference (SMD −0.05; 95% CI −0.20 to 0.11; very low certainty of evidence); there was no CBD RCT measuring a depression outcome (search up to April 30, 2018). Across all mental disorders, THC increased side effects and stopping because of side effects","yan_etki":"THC: side effects OR 1.99; stopping because of side effects OR 2.78","pmid":"31672337","doi":"10.1016/S2215-0366(19)30401-8","diger_kaynak":"Correction: Lancet Psychiatry 2020;7(1):e3, PMID 31860461 (content could not be read)"},{"ad":"Wilson 2026","tasarim":"Systematic review and meta-analysis","n":"54 RCTs, 2477 people","populasyon":"Mental and substance use disorders","urun":"All cannabinoids","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"No RCT evidence for treating depression; insufficient data for meta-analysis in bipolar disorder","yan_etki":"Any side effect OR 1.75 (NNTH 7); no difference in serious side effects","pmid":"41856154","doi":"10.1016/S2215-0366(26)00015-5","diger_kaynak":"Correction: Lancet Psychiatry 2026;13(8):e11, PMID 42302809 (June 16, 2026; the axis of a figure and the study counts in the table were corrected, results unchanged)"},{"ad":"Bharat 2026","tasarim":"Systematic review and meta-analysis of experimental and observational studies (up to May 2025; PROSPERO CRD42023467536)","n":"82 experimental and 118 observational studies","populasyon":"Adults with ADHD, anxiety, depression, PTSD, psychosis, Tourette syndrome or substance use disorder, or in whom these symptoms were measured","urun":"THC, CBD, combinations of the two and other cannabinoids; medical cannabis","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"In RCTs, the effect of cannabinoids on depression symptoms was negligibly small and not significant (SMD −0.20; 95% CI −0.43 to 0.04; I² 91.6%); most of the depression evidence was measured as a secondary outcome in other conditions. The certainty of evidence is mostly very low; observational studies suggest improvement but have a high risk of bias. The authors see no benefit in depression and do not support cannabinoids as a first-choice treatment","yan_etki":"The only significant safety finding: stopping because of side effects was more common with THC (OR 2.78; 95% CI 1.66–4.65)","pmid":"42617303","doi":"10.1016/j.psychres.2026.117380","diger_kaynak":null},{"ad":"Stanciu 2021","tasarim":"Systematic review of controlled studies (1970–February 5, 2020; 8 databases; no meta-analysis)","n":"8 controlled studies; two in patients with depression (21 people, 12 with unipolar depression)","populasyon":"People with mood disorders, anxiety disorders and post-traumatic stress disorder","urun":"CBD, THC or nabilone (THC-like synthetic cannabinoid) at defined doses","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"In two small 1970s studies with THC in depression, depression did not improve, and anxiety, panic or psychosis-like reactions were seen in more than half of the patients. No prospective placebo-controlled studies were found in mood disorders with CBD, a defined ratio of THC and CBD, or the cannabis plant (the search ended in February 2020). The authors conclude that cannabinoids should not be recommended in these disorders","yan_etki":"In the depression studies, intense anxiety, a feeling of detachment from oneself, panic and psychosis-like reactions","pmid":"33530732","doi":"10.1176/appi.ps.202000189","diger_kaynak":null},{"ad":"Churchill 2025","tasarim":"Systematic review and meta-analysis of longitudinal studies (up to March 31, 2023; update of the Lev-Ran 2014 meta-analysis)","n":"22 longitudinal studies (14 from the previous meta-analysis)","populasyon":"General population samples that accounted for baseline depression (in 12, participants were under 18 at the first measurement); studies examining only specific patient groups were not included","urun":"Cannabis use (from occasional use to use disorder)","urun_turu":"thc_iceren","doz":null,"titrasyon":null,"sure":null,"sonuc":"People who use cannabis are more likely to develop depression later (OR 1.29; 95% CI 1.13–1.46); large variation between studies (prediction interval 0.75–2.20). The odds are higher with heavy use; no significant difference between early and late onset. The previous meta-analysis had found OR 1.17 (1.05–1.30), and 1.62 (1.21–2.16) for heavy use (Lev-Ran 2014). Observational; the measurement of cannabis use is the main source of bias, confounders cannot be fully ruled out, and cause and effect cannot be shown","yan_etki":null,"pmid":"39936870","doi":"10.1017/S0033291724003143","diger_kaynak":null},{"ad":"Burke 2024","tasarim":"Systematic review and meta-analysis of longitudinal studies in the general population (up to November 2022; PROSPERO CRD42021243903)","n":"75 studies (7 for cannabis and new mood disorders)","populasyon":"General population samples","urun":"Cannabis use (compared with tobacco)","urun_turu":"thc_iceren","doz":null,"titrasyon":null,"sure":null,"sonuc":"The link between cannabis use and new-onset mood disorders was not significant (RR 1.31; 95% CI 0.92–1.86; 7 studies); cannabis was linked to psychotic disorders (RR 3.19). Tobacco use was linked to mood disorders (RR 1.39; 43 studies). Confounder analyses suggest that the effects may have been overestimated; only 27% of the studies were high quality","yan_etki":null,"pmid":"39620474","doi":"10.1017/S0033291724002587","diger_kaynak":null},{"ad":"Tourjman 2023 (CANMAT)","tasarim":"Systematic review and clinical recommendation (Canadian CANMAT task force; from inception to October 2020; PubMed, Embase, PsycINFO, CINAHL, Cochrane; GRADE; no meta-analysis)","n":"56 studies (1 RCT, 3 prospective, 26 longitudinal or cohort, 26 cross-sectional); 21 in major depression, 11 in both major depression and bipolar disorder; 408,223 people in the major depression studies (5,044 with cannabis use or use disorder)","populasyon":"People with major depression or bipolar disorder (meeting diagnostic criteria)","urun":"Cannabis use and cannabis use disorder (THC/CBD content not specified in the studies)","urun_turu":"thc_iceren","doz":null,"titrasyon":null,"sure":null,"sonuc":"In major depression, cannabis use was linked to more severe depression symptoms (especially inability to feel pleasure) and, in some studies, lower functioning; no link was seen with the number of episodes or age at onset, and the link with suicide was sparse and inconsistent (suicide attempts more common in one adolescent study, no difference in the others); no study looked at remission or relapse. In the only RCT testing combined treatment of major depression and cannabis use disorder (fluoxetine added to cognitive behavioral therapy, 70 people), there was no difference from placebo. Findings are more consistent in bipolar disorder than in major depression. The certainty of evidence is low for most outcomes (studies mostly observational, amount of cannabis measured in different ways, THC/CBD content not specified, common causes cannot be ruled out). Recommendation: people with major depression should avoid cannabis (in the recommendation table, certainty of evidence low to moderate, strength of recommendation conditional); in bipolar disorder the same recommendation is strong","yan_etki":null,"pmid":"35711159","doi":"10.1177/07067437221099769","diger_kaynak":null},{"ad":"Sorkhou 2024","tasarim":"Systematic review (from inception to November 2023; EMBASE, PsycINFO, PubMed, MEDLINE; no meta-analysis)","n":"78 studies (1 RCT, 52 longitudinal, 25 cross-sectional); 31 examined cannabis and later depression, 11 the course of major depression","populasyon":"The general population and people with major depression and bipolar disorder","urun":"Cannabis use and cannabis use disorder; one CBD RCT","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"Of 31 prospective studies examining cannabis and later depression, 22 found a temporal association, and 9 did not once confounders were taken into account. In 10 of 11 studies looking at the course of major depression, cannabis use was linked to a worse course or treatment outcome (more inability to feel pleasure, suicidal thoughts, lower medication adherence); no evidence was found that cannabis improves clinical outcomes in depression. In an uncontrolled 11-person study, stopping cannabis for 28 days reduced depression symptoms. Most studies are observational; cause and effect cannot be shown","yan_etki":null,"pmid":"38655516","doi":"10.3389/fpubh.2024.1346207","diger_kaynak":null},{"ad":"Lillywhite 2026 (UK Medical Cannabis Registry)","tasarim":"Case series without a comparison group (patient registry; patient-reported measures)","n":"698 (those treated for depression out of 34,563 patients in the registry)","populasyon":"Adults started on prescribed cannabis products for depression (UK); half had severe anxiety at baseline","urun":"Prescribed cannabis products (product type and THC/CBD breakdown not in the abstract)","urun_turu":"karma","doz":"not reported (in the abstract)","titrasyon":"not reported (in the abstract)","sure":"24 months","sonuc":"PHQ-9 depression score, anxiety, sleep and quality of life improved from baseline at all measurement times (p < 0.001), most in the first 3 months; numbers not in the abstract. In the same registry's earlier analysis of 129 patients, median PHQ-9 fell from 16 to 7 at month 6 (Mangoo 2022). No comparison group; cause and effect cannot be shown. 16 of 17 authors are employees or contractors of the clinic that prescribed these products to the patients (Curaleaf Clinic)","yan_etki":"At least one side effect in 63 patients (9%); 87% of events mild or moderate (Mangoo 2022: 153 side effects in 18 of 129 patients)","pmid":"41506388","doi":"10.1016/j.jad.2025.121130","diger_kaynak":"Earlier analysis of the same registry: Mangoo 2022, PMID 36573268 (129 patients, 6 months)"},{"ad":"Specka 2024","tasarim":"Retrospective longitudinal study (telemedicine platform records; no comparison group)","n":"59 (22% had stopped by week 18)","populasyon":"Outpatients aged 20–54 with major depression who had previously received antidepressant treatment (Germany); 73% men, one third had used cannabis regularly at times in the last 5 years","urun":"Medical cannabis prescribed through a telemedicine platform (product and THC/CBD content not in the abstract)","urun_turu":"karma","doz":"not reported (in the abstract)","titrasyon":"not reported (in the abstract)","sure":"18 weeks","sonuc":"Depression severity (0–10 rating; the abstract does not name a standard depression scale) fell from 6.9 to 3.8 (95% CI for the difference 2.4–3.8; p < 0.001); at week 18, a drop of more than half in 50.8% of patients. Antidepressant use (31%) did not affect the outcome. No comparison group, measurements at monthly visits. Four of the seven authors are employees, executives or former employees of the company that runs the platform (Algea Care). The authors write that the risk of cannabis use disorder should be kept in mind","yan_etki":"One third of patients reported side effects; none severe","pmid":"38211630","doi":"10.1055/a-2215-6114","diger_kaynak":null},{"ad":"Martin 2021","tasarim":"Observational, prospective online survey study (comparison group of cannabis users and non-users; follow-up every 3 months)","n":"538 (368 users, 170 non-users); at follow-up, 36 new starters, 121 continuing users, 23 who did not start","populasyon":"Adults reporting a diagnosis of anxiety or depression (US; mostly women and white); from the Realm of Caring patient registry","urun":"Medical cannabis products: of those who knew the content, 82% used CBD-dominant and 23% THC-dominant products; 26% did not know the content","urun_turu":"karma","doz":"In CBD-dominant products with a certificate of analysis obtained, an oral mean of 61 mg CBD a day (median 30 mg) and 2.1 mg THC (median 1 mg)","titrasyon":"Participant's choice","sure":"Follow-up at 3-month intervals (duration varies by person)","sonuc":"At baseline, users' depression score (HADS) was lower than non-users', with no difference in anxiety. At follow-up, depression (−2.57 points) and anxiety scores fell in those who started cannabis and did not change in those who did not start. CBD-dominant product use was linked to a lower depression score, but this was not significant after correction for multiple comparisons. No randomization, all measures self-reported; the authors write that an expectation effect cannot be ruled out. The study was supported by a nonprofit cannabinoid patient foundation (Realm of Caring) and US National Institute on Drug Abuse fellowship programs; two of the seven authors have ties to cannabis companies (one a Canopy Growth employee)","yan_etki":"Side effect reports were more common among THC-dominant product users (38% vs 26%); no difference between CBD-dominant product users and non-users","pmid":"34566726","doi":"10.3389/fpsyt.2021.729800","diger_kaynak":null},{"ad":"Yana 2023","tasarim":"Retrospective, propensity score–matched cohort (Ontario health databases)","n":"54,006 patients authorized for medical cannabis and 161,265 matched people","populasyon":"Adults authorized to use medical cannabis (Canada, Ontario); 16% had a prior anxiety or mood disorder","urun":"Medical cannabis authorization (no information on products used)","urun_turu":"karma","doz":null,"titrasyon":null,"sure":"Authorizations 2014–2019; follow-up duration not in the abstract","sonuc":"In people authorized for cannabis, the risk of an emergency department visit or hospitalization for a depressive disorder was about twice as high (adjusted HR 2.02; 95% CI 1.83–2.22); HR 2.23 (1.95–2.55) in those with no prior mental disorder. Observational; how much the authorized people actually used is unknown, and cause and effect cannot be shown. Three of the six authors have ties to a medical cannabis company (Aurora Cannabis)","yan_etki":null,"pmid":"36638694","doi":"10.1016/j.psychres.2022.115047","diger_kaynak":null},{"ad":"Fontanella 2021","tasarim":"Retrospective, population-based cohort (Ohio Medicaid records and death certificates; weighted models)","n":"204,780 (10.3% with cannabis use disorder)","populasyon":"Young people aged 10–24 diagnosed with a mood disorder in 2010–2017 (US, Ohio); breakdown of diagnoses not in the abstract","urun":"Doctor-diagnosed cannabis use disorder","urun_turu":"thc_iceren","doz":null,"titrasyon":null,"sure":"1 year after diagnosis","sonuc":"Cannabis use disorder was linked to nonfatal self-harm (adjusted HR 3.28; 95% CI 2.55–4.22) and death from any cause (HR 1.59; 1.13–2.24); deaths from accidental overdose and homicide were also more common. The link with suicide was not significant in adjusted models. Observational; cannabis use disorder may be a risk marker, and cause and effect cannot be shown","yan_etki":null,"pmid":"33464286","doi":"10.1001/jamapediatrics.2020.5494","diger_kaynak":null},{"ad":"Young-Wolff 2026","tasarim":"Retrospective cohort (Kaiser Permanente Northern California electronic health records; 2016–2023)","n":"463,396 adolescents (26,345 reported using cannabis in the past year)","populasyon":"Adolescents aged 13–17 who were asked about cannabis use at a routine well-child visit (US)","urun":"Cannabis use in the past year (self-reported on a confidential screening form)","urun_turu":"thc_iceren","doz":null,"titrasyon":null,"sure":"Mean follow-up of 3.3 years for depression (up to age 25 at most)","sonuc":"Cannabis use was linked to a higher risk of a new depressive disorder diagnosis later (HR 1.34 adjusted for sex, ethnicity, deprivation, insurance, alcohol and other substance use; 95% CI 1.30–1.39); HR 1.33 (1.29–1.38) when prior mental disorders were also taken into account. The link with depression and anxiety weakened as the adolescents got older. Observational; cannabis use is self-reported, diagnoses come from records","yan_etki":null,"pmid":"41719031","doi":"10.1001/jamahealthforum.2025.6839","diger_kaynak":null},{"ad":"Auf 2025","tasarim":"Case report","n":"1","populasyon":"31-year-old man with no psychiatric history","urun":"Vaporized CBD (product purity not verified)","urun_turu":"cbd_zengin_thc_belirsiz","doz":"Increasing, 'high dose' (mg not reported)","titrasyon":"Self-directed increase","sure":"3 months","sonuc":"Manic episode; resolved when CBD was stopped and treatment was given","yan_etki":"Mania","pmid":"40630971","doi":"10.64719/pb.4542","diger_kaynak":null},{"ad":"Jantsch 2026","tasarim":"Systematic review and meta-analysis of animal studies (not human data)","n":"123 animal studies","populasyon":"Animal models","urun":"CBD","urun_turu":"saf_cbd","doz":"Various","titrasyon":null,"sure":null,"sonuc":"In animals, CBD consistently reduced anxiety- and depression-like behaviors (moderate-sized effect in some tests); according to the authors, clinical evidence in humans is still limited and inconclusive","yan_etki":null,"pmid":"42380607","doi":"10.1038/s41380-026-03733-x","diger_kaynak":null}],"ilgili_ilaclar":["sitalopram","amitriptilin"],"son_inceleme":"2026-10-30","arastirma_gecmisi":[{"tarih":"2026-10-19","not":"Page published. This first review looked at 6 studies."},{"tarih":"2026-10-21","not":"The full texts of the studies were reread and the information on the page was checked against its sources. Corrected: side effect and product information in the study table. The year of one publication named on the page was corrected to the journal's print year instead of the online publication year. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-22","not":"The names of the finding labels were simplified: this page's \"Not enough research\" label became \"Not studied enough\". The assessment did not change."},{"tarih":"2026-10-27","not":"PubMed, Cochrane and ClinicalTrials.gov were systematically searched again in October 2026 (3,707 records on PubMed, 730 on ClinicalTrials.gov; together with an independent second check). There is still no published controlled CBD study in patients diagnosed with depression. Added: placebo-controlled CBD studies measuring depression symptoms (brain tumors, advanced cancer, hand osteoarthritis and anxiety disorder), two small studies in which THC was tried in patients with depression in the 1970s, two studies testing randomized access to medical cannabis and stopping cannabis, three meta-analyses and three systematic reviews including the review by a Canadian mental health guideline group, medical cannabis registries, and large observational studies on cannabis use and depression risk. Studies asking the same question and covered by the reviews in the table were not added separately. Corrected: the dose of the student study (it was reported in the full text) and its outcome numbers, the depression outcome and company ties of the health care worker study, the number for the depression finding in the review, the table description of the animal studies review, and the table order. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-28","not":"On October 28, 2026, two sources found for this page during the searches for other topics were incorporated. In the medical cannabis card study (Gilman 2022), the number of people was corrected: 269 people were randomly assigned to groups, and 186 were analyzed; the daily survey analysis of the same trial (Tervo-Clemmens 2023) was added, which also found no improvement in depression symptoms at 12 weeks. In the anxiety study in India (Gundugurti 2024), the description of the company tie was corrected in the table and the text: the authors' conflict-of-interest statement does not say that the company developed the product; according to the pharmacokinetic publication of the same trial, that part was funded by the pharmaceutical company where most of the authors worked. The trial registration and the pharmacokinetic publication were added to the table as sources. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-30","not":"The correction to the Wilson 2026 meta-analysis published in the journal was read: only the axis of one figure and the study counts in a table were corrected; the results on this page did not change."},{"tarih":"2026-10-31","not":"The last sentence of the page's short summary was rewritten in a calmer, more guiding tone: instead of \"Talk to your doctor before you start.\", it now says whom you can talk with, and about what, if you are considering CBD. The conclusion and the strength of evidence did not change."},{"tarih":"2026-11-01","not":"The evidence level text now uses the same level name as the top of the page; the level and the result did not change."}]},{"id":"bipolar-depression","baslik":"Depression in bipolar disorder","grup":"Anxiety and mental health","grup_kodu":"kaygi","tr_id":"bipolar-depresyon","kanit_duzeyi":"cok_zayif","kanit_yonu":"yarar_gosterilmedi","kanit_ozet":"As add-on treatment in bipolar depression, 150–300 mg/day of pure CBD did not lower the depression score (MADRS) differently from placebo at 8 weeks; both groups had a drop of about 15 points (strong placebo effect). An exploratory subanalysis shows a signal in favor of 300 mg; no difference was seen in the development of mania. In mania, 600–1200 mg/day of CBD was ineffective in 2 patients. A phase 3 study of 360 people is underway (according to its registry entry, the estimated completion for primary outcomes is December 2029). Treatment data for THC-containing products in bipolar depression consist only of two small double-blind studies from the 1970s in hospitalized patients with depression (21 people, 9 of them bipolar): THC did not improve depression, and about half of the patients could not continue treatment because of side effects such as intense anxiety or psychosis-like reactions (Kotin 1973, Ablon 1974; original articles could not be read, details from Stanciu 2021). The 2026 single-dose THC laboratory study (Miranda 2026) looked only at cognitive tests. The most recent meta-analysis of RCTs did not find enough data in bipolar disorder to pool (Wilson 2026). Most studies following cannabis use in people with bipolar disorder are negative: in a 2-year follow-up of 1922 people in Europe, those who kept using had less recovery and more frequent new episodes, while outcomes in those who stopped during the episode were similar to those who never used (Zorrilla 2015); among those followed after a first hospitalization for mania, cannabis was associated with more time spent in episodes and with rapid cycling (Strakowski 2007); over 24 months, remission of depressive symptoms was less frequent in regular users (Kim 2015, unadjusted); in a long follow-up of 788 people, periods of increased cannabis use were followed by a small increase in suicidal thoughts (Smith 2025); in diaries kept by 24 people for 6 days, cannabis use was followed by increases in manic and depressive symptoms, while depressive symptoms did not predict use (Tyler 2015). On the other hand, in two follow-up studies cannabis did not independently predict new episodes or rehospitalization (Lagerberg 2021, Olivier 2025). Systematic reviews point in the same direction (Sorkhou 2024; Tourjman 2023, with low certainty of evidence for most outcomes); in cross-sectional data, cannabis use disorder is weakly associated with suicide attempts (OR 1.35; Bartoli 2019). Cannabis users also smoke and drink alcohol more often, and a reverse relationship, such as symptoms increasing use, cannot be ruled out; cause and effect has not been shown. October 2026 search (PubMed, Cochrane, ClinicalTrials.gov): 4 controlled studies with cannabinoids on this topic were found (1 CBD RCT in bipolar depression; 2 old THC studies in which some patients were bipolar; 1 single-dose THC laboratory study), along with 6 systematic reviews or meta-analyses and 1 umbrella review; there is no Cochrane review and no unpublished study with registered results, and 1 phase 3 study is underway. All of them, together with 8 observational studies, 2 case reports and 1 clinical review, are in the table below.","kanit_duzeyi_metin":"Very weak: a single small RCT that was ended early and gave results no different from placebo (Pinto 2024)","kanit_duzeyi_thc_icerenler":"cok_zayif","kanit_duzeyi_thc_icerenler_metin":"Very weak; with THC products there are only two small controlled studies from the 1970s in patients with depression (some of them bipolar) (no benefit, frequent distressing reactions; Kotin 1973, Ablon 1974, details from a secondary source); the harm signal rests on observational studies: with continued use in bipolar disorder, less recovery and more frequent episodes (Zorrilla 2015; Sorkhou 2024 and Tourjman 2023 reviews, with low certainty of evidence for most outcomes in Tourjman), and a later diagnosis of bipolar disorder and mania more common in cannabis users (Sanjuan-Ortiz 2027, unadjusted; 1.7–2-fold in a large adjusted cohort: Young-Wolff 2026); a recommendation to avoid it in a guideline and a clinical review (Tourjman 2023, Kansagara 2026)","kaynak_dosya":"uyku-depresyon.md","saf_cbd_sonuc":"Pure CBD was not superior to placebo in bipolar depression; safety data rest on a single small RCT.","thc_icerenler_sonuc":"THC-dominant cannabis can worsen manic symptoms and functioning in bipolar disorder; people with bipolar or psychotic disorders are advised to avoid cannabis (Kansagara 2026; the systematic review by Canada's CANMAT guideline group makes the same recommendation: Tourjman 2023). In two small, old controlled studies in which THC was tested in patients with depression (some of them bipolar), depression did not improve and about half of the patients could not continue treatment because of side effects (Kotin 1973, Ablon 1974; information from a review). In most studies following people with bipolar disorder, cannabis users recovered less and had episodes more often (Zorrilla 2015, Strakowski 2007); these findings are observational and do not show cause and effect.","ruhsat":null,"doz_araligi_ozet":"150–300 mg/day in the RCT; 600–1200 mg/day in a case report in mania","titrasyon_ozet":"In Pinto 2024, 150 → 300 mg/day (the dose was increased at week 2 in non-responders)","yan_etkiler":["Pinto 2024: no more side effects than placebo, no difference in the development of mania","A single case of mania after high-dose vaped CBD (Auf 2025)","THC (1970s, hospitalized patients with depression): 10 of 21 patients could not continue because of side effects such as intense anxiety, a sense of detachment from oneself, panic or psychosis-like reactions (Kotin 1973, Ablon 1974; details from a secondary source, Stanciu 2021)"],"izlem":["Monitoring by a doctor for symptoms of mania (monitored in the studies)"],"dikkat":["THC-containing products are in the group to be avoided in bipolar disorder (Kansagara 2026)","In the general population, cannabis use is associated with psychosis, mania, depression and suicide attempts (observational; Solmi 2023)","Safety data for pure CBD are limited and rest on a single small RCT","Mood stabilizers/antipsychotics should not be stopped on one's own","In bipolar disorder, continued cannabis use is associated in most follow-up studies with less recovery and more frequent episodes (observational; Zorrilla 2015, Strakowski 2007); the CANMAT guideline group recommends avoiding it (Tourjman 2023)"],"ilac_etkilesim_notlari":["Citalopram: in healthy adults, CBD (2.5 mg/kg twice a day, 12 days) increased citalopram exposure (AUC) by 43% (Salcedo 2026, PMID 41622700)","Amitriptyline: a single 30 mg dose of CBD increased amitriptyline AUC by 13% and Cmax by 17%; the effect may be larger with continuous use (Gorbenko 2026, PMID 41398552)","In an emergency department survey, 69.7% of people using CBD at home were taking a medicine with interaction potential; the most common group was antidepressants (64.4%) (Geneau 2025, PMID 41227172)","Reports of interactions with antidepressants, antiepileptics, opioids and alcohol were reviewed (Balachandran 2021, PMID 33515191)","Lithium: a single case of lithium toxicity developing weeks after CBD was added (Singh 2020, PMID 32851114)"],"dogrulanamayan":["NCT05457465 (anxiety in bipolar disorder; single-arm, open-label pilot, 4 weeks, target 25) is recruiting (registry updated March 30, 2026; estimated completion December 2026); the product tested is a CBD-rich solution derived from hemp that, according to the registry, contains no THC; people in an acute depressive or manic episode are not enrolled; there is no control group","Kotin 1973 and Ablon 1974 (THC, hospitalized patients with depression): the original articles could not be read; details were taken from the Stanciu 2021 review, and the review's text and table give the dose information for the two studies the other way round","Miranda 2026 (single-dose THC in bipolar disorder): the full text could not be read (it will become open on PMC in October 2027); the number of participants, dose and route of administration are not in the abstract; it could not be verified whether it is the same study as the same center's ClinicalTrials.gov entry (NCT04231643: single oral dose of 5 mg dronabinol, CBD or placebo; 19 people; ended early for budget reasons)"],"calismalar":[{"ad":"Pinto 2024","tasarim":"Double-blind, placebo-controlled pilot RCT (ended early because of the COVID-19 pandemic)","n":"35 randomized (CBD 19, placebo 16); 36 participants in the ClinicalTrials.gov registry","populasyon":"Acute bipolar depression (add-on treatment)","urun":"Pure CBD (99.6% purity, THC-free; capsules in corn oil, oral)","urun_turu":"saf_cbd","doz":"150–300 mg/day","titrasyon":"Started at 150 mg/day; raised to 300 mg/day at week 2 in non-responders (if there was no drop of at least 50% on the MADRS)","sure":"8 weeks efficacy + safety up to week 12","sonuc":"MADRS drop similar to placebo (−15.38 versus −14.56; difference −0.82, 95% CI −7.81 to 6.17; p = 0.82); no difference in anxiety; in an exploratory analysis, a signal in favor of 300 mg (among 11 patients per group who had not responded at week 2 and had their dose raised to 300 mg, MADRS drop over weeks 2–8 −13.72 versus −6.64; p = 0.01; the authors interpret this only as a signal to be tested in the future). Six of the authors are co-inventors on CBD-related patents (the article's conflict-of-interest statement)","yan_etki":"No more side effects than placebo (1 person in the CBD group stopped because of a skin rash); no difference in the development of mania","pmid":"37920963","doi":"10.1177/07067437231209650","diger_kaynak":"NCT03310593"},{"ad":"Zuardi 2010","tasarim":"Case report (2 patients; inpatient; 5 days of placebo each at the start and end)","n":"2","populasyon":"Manic episode in bipolar I disorder (two women aged 34 and 36; inpatient)","urun":"CBD","urun_turu":"saf_cbd","doz":"600–1200 mg/day","titrasyon":"Started orally at 600 mg/day and raised to 1200 mg/day; the first patient also took olanzapine on days 6–20","sure":"25 days of CBD (days 6–30)","sonuc":"CBD was found to be ineffective in the manic episode: the first patient improved while on olanzapine, but CBD alone gave no additional improvement; the second patient did not improve at any CBD dose","yan_etki":"No side effects reported; both patients tolerated CBD well","pmid":"18801823","doi":"10.1177/0269881108096521","diger_kaynak":null},{"ad":"Auf 2025","tasarim":"Case report","n":"1","populasyon":"A 31-year-old man with no psychiatric history","urun":"Vaped CBD (product purity not verified)","urun_turu":"cbd_zengin_thc_belirsiz","doz":"Increasing, 'high dose' (mg not reported)","titrasyon":"Self-escalation","sure":"3 months","sonuc":"Manic episode; resolved after CBD was stopped and treatment was given","yan_etki":"Mania","pmid":"40630971","doi":"10.64719/pb.4542","diger_kaynak":null},{"ad":"NCT05867849","tasarim":"Phase 3, double-blind, placebo-controlled RCT (ongoing)","n":"Target 360","populasyon":"Acute bipolar depression that has not responded to at least one first-line treatment (bipolar I or II, aged 19–70; add-on treatment; 6 centers in Canada, 3 of them recruiting)","urun":"CBD","urun_turu":"saf_cbd","doz":"200–600 mg/day, added to current treatment (according to the registry)","titrasyon":"not reported","sure":"6 weeks (according to the registry)","sonuc":"Recruiting (University of British Columbia; started October 2023; registry last updated April 23, 2025; estimated completion for the primary outcome December 2029, study completion December 2030); no results","yan_etki":null,"pmid":null,"doi":null,"diger_kaynak":"ClinicalTrials.gov NCT05867849"},{"ad":"Sanjuan-Ortiz 2027","tasarim":"Systematic review and meta-analysis (19 longitudinal observational studies; PubMed and Web of Science, up to October 2025)","n":"6,960,517 (total); bipolar disorder analysis 206,572 (8 studies), manic symptoms 57,243 (6 studies)","populasyon":"People without bipolar disorder at baseline (mean age 23.8)","urun":"Cannabis use","urun_turu":"thc_iceren","doz":null,"titrasyon":null,"sure":null,"sonuc":"Cannabis use is associated with later bipolar disorder (RR 2.46; 95% CI 1.57–3.84) and manic/hypomanic symptoms (RR 2.11; 1.07–4.18); unadjusted ratios, observational data, does not show cause and effect","yan_etki":null,"pmid":"42838231","doi":"10.1016/j.jad.2026.122588","diger_kaynak":null},{"ad":"Kotin 1973","tasarim":"Double-blind, placebo-controlled small study (inpatient; 7 days placebo, 7 days THC, 7 days placebo)","n":"8 (4 bipolar, 4 unipolar depression); 4 people completed the THC period","populasyon":"Hospitalized, medication-free adults with moderate to severe depression (US National Institute of Mental Health research unit)","urun":"THC (oral)","urun_turu":"thc_iceren","doz":"Oral THC; dose conflicting in the secondary source (Stanciu 2021's text: 0.3 mg/kg twice a day; the same review's table: from 5 mg a day to 2 × 20 mg a day)","titrasyon":"not reported (original article could not be read)","sure":"3 weeks (7 days of THC)","sonuc":"THC did not improve depression on subjective and observer-rated mood measures; scale scores not reported. No separate result for the bipolar subgroup. The original article and its abstract could not be read; information from the Stanciu 2021 review","yan_etki":"4 of 8 patients stopped THC because of side effects (two had severe anxiety with a sense of detachment from oneself after the first dose); drowsiness in those who completed","pmid":"4569675","doi":"10.1001/archpsyc.1973.01750330041007","diger_kaynak":null},{"ad":"Ablon 1974","tasarim":"Double-blind, placebo-controlled small study (inpatient; THC or placebo after 3 weeks of observation)","n":"13 (5 bipolar, 8 unipolar depression)","populasyon":"Hospitalized adults with depression (US National Institute of Mental Health research unit)","urun":"THC (oral)","urun_turu":"thc_iceren","doz":"Oral THC; dose conflicting in the secondary source (Stanciu 2021's text: from 5 mg a day to 2 × 20 mg a day; the same review's table: 0.3 mg/kg twice a day, 7 days)","titrasyon":"Conflicting in the secondary source: according to Stanciu 2021's text, raised from 5 mg a day to 2 × 20 mg a day; according to its table, 0.3 mg/kg twice a day (original article could not be read)","sure":"not reported (unclear in the secondary source)","sonuc":"Depressive symptoms did not improve; standard scale scores not reported. A distressing (dysphoric) reaction was seen in 7 of 13 patients: 6 had unipolar and 1 bipolar depression. The original article and its abstract could not be read; information from the Stanciu 2021 review","yan_etki":"6 patients could not continue the study after the first dose because of panic or psychosis-like reactions","pmid":"4592555","doi":"10.1176/ajp.1974.131.4.448","diger_kaynak":null},{"ad":"Miranda 2026","tasarim":"Randomized, placebo-controlled single-dose THC laboratory study; also a cross-sectional comparison of cannabis users and non-users","n":"not reported (not in the abstract; the full text will become open on PMC in October 2027)","populasyon":"Randomized part: adults with bipolar disorder who do not use cannabis, and healthy volunteers; cross-sectional part: bipolar patients who do and do not use cannabis, and healthy volunteers (US)","urun":"THC (Δ9-THC; route of administration not in the abstract)","urun_turu":"thc_iceren","doz":"not reported (not in the abstract)","titrasyon":"None (single dose)","sure":"Single dose","sonuc":"Bipolar participants who received a single dose of THC had faster time perception than healthy volunteers who received placebo; the abstract does not compare bipolar participants given THC with those given placebo. In the cross-sectional part, the time perception and attention tests of bipolar patients who used cannabis were similar to those of healthy volunteers, while bipolar patients who did not use cannabis had less precise time perception; the authors interpret this as consistent with an attempt at 'self-medication.' Only laboratory cognitive tests were measured; mood, depression or clinical outcomes are not in the abstract","yan_etki":"not reported (in the abstract)","pmid":"42481733","doi":"10.1038/s41386-026-02489-w","diger_kaynak":"Possibly ClinicalTrials.gov NCT04231643 (UC San Diego; bipolar patients and healthy volunteers; in the registry, a single oral dose of 5 mg dronabinol, 600 mg CBD or placebo; ended at 19 people for budget reasons, no results in the registry); the abstract gives no registry number, so the match could not be verified"},{"ad":"Wilson 2026","tasarim":"Systematic review and meta-analysis of RCTs (1980 to May 13, 2025; PROSPERO CRD42023392718)","n":"54 RCTs; 2,477 participants (all mental disorders and substance use disorders)","populasyon":"People whose primary diagnosis is a mental disorder or substance use disorder; bipolar disorder under a separate heading","urun":"CBD, THC, THC and CBD mixtures and other cannabinoids","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"Not enough data were found for a meta-analysis in bipolar disorder; no RCTs at all were found for the treatment of depression (the search starts in 1980, so the two 1970s THC studies fall outside its scope). Across all disorders, there was no significant difference from placebo for anxiety, psychosis and post-traumatic stress disorder outcomes; significant benefit was seen only in cannabis use disorder, insomnia, tics and Tourette syndrome, and autism; the certainty of evidence is low for most outcomes, and 44% of studies are at high risk of bias. The correction published in the journal (June 16, 2026) corrected the axis of a figure and the study counts in the table; the results did not change","yan_etki":"Any side effect more common with cannabinoids (OR 1.75; 95% CI 1.25–2.46; number needed to harm 7); no difference in serious adverse events or study discontinuation","pmid":"41856154","doi":"10.1016/S2215-0366(26)00015-5","diger_kaynak":"Correction: Lancet Psychiatry 2026;13(8):e11, PMID 42302809 (June 16, 2026; the axis of a figure and the study counts in the table were corrected, results unchanged)"},{"ad":"Stanciu 2021","tasarim":"Systematic review of controlled studies (1970 to February 5, 2020; 8 databases; no meta-analysis)","n":"8 controlled studies; two in patients with depression (21 people, 9 of them bipolar)","populasyon":"People with mood disorders, anxiety disorders and post-traumatic stress disorder","urun":"Defined doses of CBD, THC or nabilone (a synthetic THC-like cannabinoid)","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"In two small 1970s studies with THC in bipolar and unipolar depression, depression did not improve, and anxiety and psychosis-like symptoms emerged in more than half of the patients. No placebo-controlled studies were found with THC or cannabis in bipolar mania or long-term treatment, or with CBD in mood disorders (the search ended in February 2020; Pinto 2024 was published later). The authors conclude that cannabinoids should not be recommended for these disorders","yan_etki":"In the depression studies, intense anxiety, a sense of detachment from oneself, panic and psychosis-like reactions","pmid":"33530732","doi":"10.1176/appi.ps.202000189","diger_kaynak":null},{"ad":"Sorkhou 2024","tasarim":"Systematic review (inception to November 2023; EMBASE, PsycINFO, PubMed, MEDLINE; no meta-analysis)","n":"78 studies (1 RCT, 52 longitudinal, 25 cross-sectional); 30 related to bipolar disorder or mania","populasyon":"The general population and people with major depression and bipolar disorder","urun":"Cannabis use and cannabis use disorder; one CBD RCT","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"4 of 5 prospective studies following cannabis use in bipolar disorder reported negative outcomes (less recovery and remission, more episodes, rapid cycling, mania severity); in 11 of 13 cross-sectional studies, cannabis went together with more severe depressive and manic symptoms, more hospitalizations, poorer medication adherence and more suicide attempts. In a small study, bipolar patients reported that their mood improved right after smoking cannabis. In the only RCT (Pinto 2024), there was no difference between CBD and placebo. Most studies are observational, and cannabis use was mostly self-reported; cause and effect cannot be shown","yan_etki":null,"pmid":"38655516","doi":"10.3389/fpubh.2024.1346207","diger_kaynak":null},{"ad":"Tourjman 2023 (CANMAT)","tasarim":"Systematic review and clinical recommendation (Canadian CANMAT task force; inception to October 2020; PubMed, Embase, PsycINFO, CINAHL, Cochrane; GRADE; no meta-analysis)","n":"56 studies (1 RCT, 3 prospective, 26 longitudinal or cohort, 26 cross-sectional); 23 in bipolar disorder, 11 in both bipolar disorder and major depression; 73,891 people in the bipolar studies (2761 with cannabis use or cannabis use disorder)","populasyon":"People with bipolar disorder or major depression","urun":"Cannabis use and cannabis use disorder","urun_turu":"thc_iceren","doz":null,"titrasyon":null,"sure":null,"sonuc":"In bipolar disorder, cannabis use was associated with more manic and mixed episodes, rapid cycling and psychotic symptoms, more severe depressive and manic symptoms, earlier onset, more suicide attempts and suicide deaths, and lower functioning; in one study, less remission and more frequent recurrence. The associations were more consistent in bipolar disorder than in major depression. The certainty of evidence is low for most outcomes (studies mostly of low quality, cannabis amount measured in different ways, THC/CBD content not determined, confounders not controlled for some outcomes). Recommendation, also informed by expert clinical opinion: people with bipolar disorder should avoid cannabis (in the recommendation table, moderate certainty of evidence, strong recommendation). No studies were found on treating bipolar disorder and cannabis use disorder together","yan_etki":null,"pmid":"35711159","doi":"10.1177/07067437221099769","diger_kaynak":null},{"ad":"Bartoli 2019","tasarim":"Systematic review and meta-analysis of observational studies (up to July 2018)","n":"11 studies; 6375 people","populasyon":"People with bipolar disorder","urun":"Cannabis use disorder","urun_turu":"thc_iceren","doz":null,"titrasyon":null,"sure":null,"sonuc":"Cannabis use disorder was weakly but significantly associated with a history of suicide attempts (OR 1.35; p=0.01; cross-sectional data); no publication bias was detected. Prospective data were insufficient for meta-analysis; cause and effect could not be assessed","yan_etki":null,"pmid":"31121199","doi":"10.1016/j.neubiorev.2019.05.017","diger_kaynak":null},{"ad":"Solmi 2023","tasarim":"Umbrella review (meta-analyses of RCTs and observational studies; up to February 9, 2022)","n":"101 meta-analyses (50 observational, 51 RCT)","populasyon":"General population and various patient groups","urun":"Cannabis, cannabinoids and cannabis-based medicines","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"In the general population, the evidence for an association between cannabis use and manic symptoms was weak in the main analysis and 'suggestive' in the sensitivity analysis (based on the Gibbs 2015 meta-analysis); the strongest harm association was with psychosis in adolescents. In RCTs, cannabis-based medicines increased psychiatric side effects (moderate certainty). It includes no meta-analysis on the treatment of bipolar disorder","yan_etki":null,"pmid":"37648266","doi":"10.1136/bmj-2022-072348","diger_kaynak":null},{"ad":"Kansagara 2026","tasarim":"Clinical (narrative) review; not a systematic review","n":null,"populasyon":"People with mental illness (aimed at physicians)","urun":"THC-dominant cannabis and CBD","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"The benefit of cannabis in mental illness has not been studied enough; THC-dominant cannabis can worsen manic symptoms and functioning in bipolar disorder and is associated with a risk of self-harm in young people with mood disorders. The authors recommend that people with bipolar or psychotic disorders avoid cannabis. Not a systematic review; the primary studies it relies on are not specified in the abstract","yan_etki":null,"pmid":"41801216","doi":"10.1001/jamainternmed.2025.8215","diger_kaynak":null},{"ad":"Zorrilla 2015 (EMBLEM)","tasarim":"Prospective observational cohort (EMBLEM; Europe, multicenter)","n":"1922 analyzed (3459 people in the 12-month analysis of the same cohort)","populasyon":"Adults with bipolar disorder starting treatment for a manic or mixed episode","urun":"Cannabis use","urun_turu":"thc_iceren","doz":null,"titrasyon":null,"sure":"2 years","sonuc":"Those who continued using (6.9%) had less recovery (p=0.004) and remission (p=0.014), more frequent new episodes (p=0.014) and more impairment in work life than never-users. Outcomes of those who stopped during the episode (4.6%) were similar to never-users (remission 68.1%, recovery 38.7%). In the 12-month analysis of the same cohort, cannabis users had lower treatment adherence and higher illness severity, mania and psychosis (van Rossum 2009). Observational; stopping was not assigned by lottery","yan_etki":null,"pmid":"25430820","doi":"10.1111/acps.12366","diger_kaynak":"12-month analysis of the same EMBLEM cohort: van Rossum 2009, PMID 19155808 (3459 people); its second publication in Dutch PMID 20458676"},{"ad":"Strakowski 2007","tasarim":"Inception cohort (prospective follow-up after a first hospitalization for mania)","n":"144 (in 33, cannabis use disorder began before bipolar disorder, in 36 after; 75 with bipolar disorder only)","populasyon":"Bipolar I patients aged 12–45 hospitalized for the first time with a manic or mixed episode, with no previous hospitalization and very little prior treatment (US)","urun":"Cannabis use disorder","urun_turu":"thc_iceren","doz":null,"titrasyon":null,"sure":"Up to 5 years","sonuc":"Cannabis use was associated with more time spent in mood episodes during follow-up and with rapid cycling. Recovery at first appeared better in those whose cannabis use disorder began before bipolar disorder, but the difference disappeared after adjustment for mediating variables. Most cannabis use disorders improved right after hospitalization, then quickly returned","yan_etki":null,"pmid":"17199055","doi":"10.1001/archpsyc.64.1.57","diger_kaynak":null},{"ad":"Kim 2015 (BCOS)","tasarim":"Prospective observational cohort (Australia, Bipolar Comprehensive Outcomes Study; 9 assessments over 24 months)","n":"239 enrolled; 234 analyzed (25 regular cannabis users)","populasyon":"Adults with bipolar I disorder or bipolar-type schizoaffective disorder taking mood stabilizers and/or olanzapine","urun":"Regular cannabis use (3 or more days a week; self-reported at baseline)","urun_turu":"thc_iceren","doz":null,"titrasyon":null,"sure":"24 months","sonuc":"Among regular cannabis users, overall remission and remission of depressive symptoms (HAMD-21) were significantly less frequent over 24 months; remission of manic symptoms was also less frequent, but the difference was borderline (p=0.051). Less remission of depressive symptoms in women and of manic symptoms in men. Only 3 of the cannabis users did not smoke cigarettes daily; remission was lowest in those who used both tobacco and cannabis. Cannabis use was asked about only at baseline; comparisons were not adjusted for confounders","yan_etki":null,"pmid":"26207128","doi":"10.4306/pi.2015.12.3.349","diger_kaynak":null},{"ad":"Lagerberg 2021 (TOP)","tasarim":"Prospective cohort (Oslo, TOP study; bipolar disorder in the first treatment period)","n":"220 enrolled; 112 completed follow-up","populasyon":"Adults with bipolar I, II or not otherwise specified bipolar disorder receiving their first treatment (Norway)","urun":"Harmful cannabis use (above the DUDIT threshold)","urun_turu":"thc_iceren","doz":null,"titrasyon":null,"sure":"1 year","sonuc":"Harmful cannabis use fell from 29% to 15%. The course of cannabis use (none, stopping, continuing) did not independently predict the risk of a new episode; a borderline trend in the crude analysis (p=0.058) disappeared after adjustment for age at onset, alcohol and smoking. Continued harmful alcohol use, however, increased the risk of a new episode. In an earlier, smaller analysis of the same cohort, continued cannabis use was associated with a higher mania score and lower functioning at 1 year (Kvitland 2015)","yan_etki":null,"pmid":"34017275","doi":"10.3389/fpsyt.2021.656912","diger_kaynak":"Earlier analysis of the same Oslo TOP cohort: Kvitland 2015, PMID 25651990 (62 bipolar I patients; continued use associated with the mania score measured with the YMRS and functioning measured with the GAF)"},{"ad":"Olivier 2025","tasarim":"Prospective cohort (Barcelona, Hospital Clínic acute psychiatric unit; admissions 2015–2019)","n":"279","populasyon":"Patients with bipolar disorder hospitalized for a manic or mixed episode (Spain)","urun":"Cannabis use","urun_turu":"thc_iceren","doz":null,"titrasyon":null,"sure":"3 years","sonuc":"Cannabis use was not associated with emergency visits or rehospitalization over 3 years (this association was seen only for tobacco); but it went together with earlier onset of illness, a current episode with manic polarity, psychotic symptoms and a higher likelihood of stopping treatment. The pattern of use was not recorded in detail; follow-up was incomplete for those who moved out of the area or to the private sector","yan_etki":null,"pmid":"40221053","doi":"10.1016/j.jad.2025.04.026","diger_kaynak":null},{"ad":"Smith 2025 (Prechter cohort)","tasarim":"Long-term prospective cohort (Prechter Longitudinal Study of Bipolar Disorder, US); within-person temporal model","n":"788 (bipolar I 565, bipolar II 162, not otherwise specified 61)","populasyon":"Adults with bipolar spectrum disorder (67% women, mean age 39.8)","urun":"Cannabis use frequency and intensity (modified AUDIT; self-report)","urun_turu":"thc_iceren","doz":null,"titrasyon":null,"sure":"Median 72 months of participation; substance use measured every 6 months, suicidal ideation every 2 months","sonuc":"When a person's cannabis use rose above their own average, suicidal ideation was slightly higher at the next measurement (time-lagged coefficient 0.042; 95% credible interval 0.020–0.063; small effect); suicidal ideation did not predict later cannabis use. In the concurrent analysis, there was no association between cannabis and suicidal ideation. When alcohol and substance use disorder diagnoses were added, the cannabis model could not be estimated (did not converge); with these diagnoses removed, age, sex and bipolar subtype did not change the association. Suicidal ideation was measured with a single PHQ-9 item (thoughts that you would be better off dead or of hurting yourself)","yan_etki":null,"pmid":"39793525","doi":"10.1016/j.psychres.2025.116357","diger_kaynak":null},{"ad":"Tyler 2015","tasarim":"Experience sampling study (diary entries at 10 random times a day for 6 days)","n":"29 enrolled; 24 analyzed","populasyon":"Adults with bipolar I or II disorder, outside an episode, who used cannabis at least 2 times a week (England)","urun":"Cannabis (their own use in daily life)","urun_turu":"thc_iceren","doz":null,"titrasyon":null,"sure":"6 days","sonuc":"The likelihood of using cannabis increased at moments of high positive affect (OR 1.25; 95% CI 1.06–1.47); negative affect, manic or depressive symptoms did not predict cannabis use. Cannabis use was followed by increases in positive affect (β = 0.35), manic symptoms (β = 0.20) and depressive symptoms (β = 0.17). According to the authors, there is no evidence of use to 'self-medicate' depression in daily life. Very small sample, short duration","yan_etki":null,"pmid":"25738578","doi":"10.1371/journal.pone.0118916","diger_kaynak":"Correction: PLoS One 2015;10(3):e0123953, PMID 25822166 (only the funding section was corrected)"},{"ad":"Young-Wolff 2026","tasarim":"Retrospective cohort (Kaiser Permanente Northern California electronic health records; 2016–2023)","n":"463,396 adolescents (26,345 reported cannabis use in the past year)","populasyon":"Adolescents aged 13–17 asked about cannabis use at a routine well-child visit (US)","urun":"Cannabis use in the past year (self-reported on a confidential screening form)","urun_turu":"thc_iceren","doz":null,"titrasyon":null,"sure":"Mean follow-up 3.7 years (up to age 25 at most)","sonuc":"Cannabis use was associated with an increased risk of a later new diagnosis of bipolar disorder (HR adjusted for sex, ethnicity, deprivation, insurance, alcohol and other substance use 2.01; 95% CI 1.82–2.22); when other mental disorders at baseline were also taken into account, HR 1.73 (1.57–1.90). Observational; cannabis use self-reported, diagnoses from records","yan_etki":null,"pmid":"41719031","doi":"10.1001/jamahealthforum.2025.6839","diger_kaynak":null}],"ilgili_ilaclar":["sitalopram","amitriptilin","lityum"],"son_inceleme":"2026-10-30","arastirma_gecmisi":[{"tarih":"2026-10-19","not":"Page published. This first review examined 4 studies."},{"tarih":"2026-10-21","not":"The full texts of the studies were reread and the information on the page was checked against its sources. Corrected: duration and dose details in the study table. Points that could not be verified from the full text went down from 2 items to 1 item. The year of 3 publications named on the page was corrected to the journal's print year instead of the online publication year. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-22","not":"The names of the finding labels were simplified: on this page the \"No benefit seen\" label became \"No effect found.\" The assessment did not change."},{"tarih":"2026-10-27","not":"A new observational meta-analysis (Sanjuan-Ortiz 2027) examining the link between cannabis use and later bipolar disorder and mania was added. For CBD, the conclusion and the strength of evidence did not change."},{"tarih":"2026-10-27","not":"PubMed, Cochrane and ClinicalTrials.gov were systematically searched again in October 2026 (1235 unique records in PubMed, 47 in ClinicalTrials.gov). No new controlled study of CBD in bipolar depression was found. Added: two small controlled studies from the 1970s in which THC was tested in patients with depression (some of them bipolar) (original articles could not be read, information from a review), a single-dose THC laboratory study in bipolar disorder, five systematic reviews or meta-analyses, one of them by Canada's CANMAT guideline group, an umbrella review, the clinical review cited as a source in the text, seven studies following the link between cannabis use and the course of bipolar disorder, and a large adolescent cohort; the conclusion text for THC-containing products was expanded accordingly. Corrected: the duration, dose increase and side effect details of the mania case report; the pilot study's reason for early termination (COVID-19 pandemic), number of participants, dose-increase schedule, product purity and the authors' conflict-of-interest statement (from the full text); the registry status, centers and dates of the ongoing phase 3 study; that the product tested in the anxiety pilot contains no THC according to the registry; the meta-analysis's online publication date and how many studies were pooled. For CBD, the conclusion and the strength of evidence did not change; for THC-containing products, the strength of evidence rose from 'Insufficient' to 'Very weak' (separate note)."},{"tarih":"2026-10-27","not":"For THC-containing products, the strength of evidence became 'Very weak' instead of 'Insufficient.' The October 2026 search found two small double-blind studies in which THC was tested in hospitalized patients with depression (21 people, 9 of them bipolar): no benefit, frequent and severe distressing reactions (original articles could not be read, information from a review). The main basis for harm is observational: 5 of 7 studies following the course of illness in bipolar disorder found a worse course in cannabis users, and 2 found no independent association; two systematic reviews, a meta-analysis and Canada's CANMAT guideline group point in the same direction and recommend avoiding cannabis. Because these findings do not show cause and effect, the evidence was not rated 'Weak.' For pure CBD, the conclusion and the strength of evidence did not change."},{"tarih":"2026-10-28","not":"Display fix: internal working file names left in the text were removed; content and evidence did not change."},{"tarih":"2026-10-30","not":"The correction to the Wilson 2026 meta-analysis published in the journal was read: only the axis of one figure and the study counts in a table were corrected; the results on this page did not change."},{"tarih":"2026-10-31","not":"The last sentence of the page's short summary was rewritten in a calmer, more guiding tone: instead of \"Talk to your doctor before you start.\", it now says whom you can talk with, and about what, if you are considering CBD. The conclusion and the strength of evidence did not change."}]},{"id":"migraine","baslik":"Migraine and headache","grup":"Pain and surgery","grup_kodu":"agri","tr_id":"migren","kanit_duzeyi":"yetersiz","kanit_yonu":"veri_yok","kanit_ozet":"No controlled human study in migraine with pure CBD oil published as a full article was found. A small preliminary study in Argentina comparing CBD with placebo for 3 months in 30 people with chronic migraine reported a reduction in monthly migraine days compared with placebo at the European Headache Congress in December 2025; however, it was presented only as a short abstract: the number of people in each group, confidence intervals, how the product was taken, whether it contained THC and the daily amount were not stated, no full article or study registration was found, and 4 of the 10 authors are from the research department of the pharmaceutical company that supplied the product. A 79-person study (2017) comparing oral drops containing THC and CBD with a migraine medicine (amitriptyline) for migraine prevention also exists only as a conference abstract. Because neither abstract could be verified, they were not counted as evidence and were not included in the table. In the only placebo-controlled study in acute migraine (92 people enrolled, 73 treated a total of 247 attacks), CBD-dominant vaporized and inhaled marijuana was not clearly different from placebo at 2 hours; the mixture containing both THC and CBD reduced pain at 2 hours. The positive result came from an inhaled product containing THC; it does not count as evidence for CBD oil taken by mouth. The other controlled study is small and indirect: in a 30-person study in medication overuse headache (headache caused by overusing pain relievers) comparing the synthetic THC-like medicine nabilone with ibuprofen, nabilone reduced pain and pain reliever use more, while there was no difference in the number of headache days; no placebo group was used. Observational studies without a comparison group (charts of 121 patients in the US and 32 in Italy, and a 203-person patient registry in the United Kingdom) reported fewer complaints, but cannot separate out the placebo effect and spontaneous improvement; in the charts of 368 patients with chronic migraine, medication overuse headache was more common among cannabis users (an association; cause and effect not shown). There are no controlled studies in cluster headache or tension-type headache. On ClinicalTrials.gov, the results of two studies have not been published: one completed in 2007 (inhaled dronabinol, acute migraine) and one that stopped enrolling after an interim analysis and ended in 2025 (CBD, CBG and low THC, chronic migraine). Two small studies done in other conditions that tracked headache as a secondary outcome (nabilone in chronic musculoskeletal pain, an intraoral CBD gel in teeth clenching) were not counted because they were not done in migraine patients. October 2026 search (PubMed, Cochrane, ClinicalTrials.gov): 2 controlled studies and 3 systematic reviews of cannabinoid treatment on this topic were found (no Cochrane review); the two controlled studies and the two most comprehensive reviews are in the table below, and the third review, which includes only observational studies and overlaps with these two reviews, was not included in the table. A second search on October 28, 2026 (including child and adolescent migraine, oral, inhaled and sublingual products, nabilone and dronabinol, patient registries, ClinicalTrials.gov results, guidelines and conference abstracts) found no new study to add to the table; a 2024 network meta-analysis comparing treatments for medication overuse headache included the nabilone study but did not give a separate result for nabilone. None of the guidelines and position statements reviewed recommend cannabinoids: the 2022 medication overuse headache guideline of the German Society of Neurology and the German Migraine and Headache Society states that the small study with cannabinoids gives no firm conclusion because of weaknesses in its methods and that this treatment cannot be recommended; the Brazilian Academy of Neurology's 2021 position statement (written before the acute migraine study) states that there are no clinical studies supporting cannabinoid use in primary headaches; the Canadian Headache Society's 2024 migraine prevention guideline did not assess cannabinoids.","kanit_duzeyi_metin":"Pure CBD: Insufficient","kanit_duzeyi_thc_icerenler":"orta","kanit_duzeyi_thc_icerenler_metin":"THC+CBD: Moderate (acute migraine, inhaled; single controlled study); nabilone: Very weak (medication overuse headache; single 30-person study, no placebo)","kaynak_dosya":"diger-hastaliklar.md","saf_cbd_sonuc":"There is no controlled study in migraine with pure CBD oil published as a full article; the positive results of a small 30-person preliminary study in chronic migraine appeared only in a conference abstract and could not be verified, so they were not counted as evidence. The CBD-dominant product tested in the only controlled study in acute migraine was also not an oil but inhaled marijuana (it also contained 0.35% THC), and it was not clearly different from placebo at 2 hours; in an additional measurement at 1 hour, relief was more common in this group (59% vs. 37%), but this was not the study's main outcome.","thc_icerenler_sonuc":"Vaporized and inhaled marijuana containing THC and CBD eased pain more than placebo at 2 hours in acute migraine (67.2% vs. 46.6%); inhaled marijuana containing THC alone also eased pain (68.9%), but was no different from placebo for the pain going away completely. Inhaled products containing THC can cause a high and mental fogginess; these effects can let participants figure out which group they are in and make the result look better than it is (in the study's measurement, guesses in the THC and CBD group were mostly at the level of chance). In medication overuse headache, the synthetic THC-like medicine nabilone reduced pain and pain reliever use more than ibuprofen in a 30-person preliminary study (no placebo group). Registry studies without a comparison group following migraine patients prescribed cannabis reported fewer complaints; in the charts of patients with chronic migraine, medication overuse headache was more common among cannabis users (81% vs. 41%); this is an association, and it was not shown that cannabis caused it.","ruhsat":null,"doz_araligi_ozet":"In the acute migraine study, vaporized and inhaled marijuana (11% CBD and/or 6% THC); amount not reported in mg; in medication overuse headache, oral nabilone 0.5 mg/day","titrasyon_ozet":null,"yan_etkiler":["In healthy volunteers, CBD increased the risk of diarrhea (RR 5.85); non-significant trend toward more abdominal pain and headache (Sawaira 2026, PMID 41789242)","Psychiatric and nervous system side effects more common with products containing THC (Filippini 2022, PMID 35510826); the likelihood of side effects increased with any cannabinoid (OR 1.75; Wilson 2026, PMID 41856154)","In healthy volunteers, headache was among the side effects tracked; the increase was not significant (RR 1.56; 95% CI 0.40–6.14; Sawaira 2026, PMID 41789242). In a UK registry of migraine patients, the most commonly reported side effect was headache (22 of 249 reports; no control group; Hooper 2026); in chronic migraine, medication overuse headache was more common among cannabis users (adjusted OR 6.3; association, cause and effect not shown; Zhang 2021); recreational cannabis use has been linked to reversible narrowing of brain blood vessels (RCVS), which comes with a sudden, very severe headache, and is the most commonly reported trigger among illegal substances (case-level evidence; Short 2021, PMID 33868555)"],"izlem":[],"dikkat":["High doses and market doses cannot be compared: in low-dose (≤175 mg/day) studies, plasma levels were 5–100 times lower than with a 20 mg/kg Epidiolex dose (Warren 2026, PMID 42473010)","Anyone taking long-term medication should consult a doctor before starting; the studies on this page did not systematically assess drug interactions","The positive result came from an inhaled product containing THC; it cannot be cited as evidence for CBD oil sales in Turkey"],"ilac_etkilesim_notlari":["The migraine studies on this page did not systematically assess drug interactions. CBD can slow the breakdown of some medicines in the body; if you take medicines regularly, talk to your doctor or pharmacist."],"dogrulanamayan":["Laino 2025 (19th European Headache Congress, Lisbon, December 2025; abstract OP008, The Journal of Headache and Pain 2026 supplement): a preliminary study in Argentina, reported as randomized and double-blind, comparing CBD at two strengths with placebo for 3 months in 30 people with chronic migraine. According to the abstract, monthly migraine days fell by 68% and 79% in the CBD groups compared with the placebo group; the most common side effect was sleepiness. Conference abstract only: no full article or study registration was found; the number of people in each group, how these rates were calculated, confidence intervals, how the product was taken, THC content and the daily CBD amount are not stated; 4 of the 10 authors are from the research department of the pharmaceutical company that supplied the product and the placebo. Because it could not be verified, it was not counted as evidence and was not included in the table (October 28, 2026).","Nicolodi 2017 (European Academy of Neurology Congress abstract, European Journal of Neurology 2017 supplement): as reported by a 2022 systematic review (Okusanya 2022), a randomized study in Italy in 79 people with migraine comparing oral drops containing THC and CBD with a medicine used for migraine prevention (amitriptyline); the reduction in the number of attacks was reported as similar in both groups (40.4% vs. 40.1%). No placebo group; the THC and CBD ratio was not reported. Conference abstract only; the abstract itself could not be accessed and no full article was found. Because it could not be verified, it was not counted as evidence and was not included in the table (October 28, 2026)."],"calismalar":[{"ad":"Schuster 2026","tasarim":"Double-blind, placebo-controlled, crossover randomized study","n":"92 randomized; 73 people treated a total of 247 attacks; 234 attacks (71 people) with 2-hour data were analyzed","populasyon":"Adults aged 21–65 with 2–23 migraine days per month (episodic and chronic migraine; US, single center); moderate or severe attack, within 4 hours of onset","urun":"Vaporized and inhaled marijuana: 6% THC / 11% CBD / 6% THC + 11% CBD / placebo (marijuana with THC and CBD removed); the CBD-dominant product also contained 0.35% THC","urun_turu":"thc_iceren","doz":"Not reported in mg; a single session per attack: with a handheld vaporizer at 180 °C, 4 puffs guided by an app (each a 5 s draw, 10 s hold)","titrasyon":null,"sure":"A single use per attack, at least 1 week apart","sonuc":"THC+CBD brought pain relief at 2 hours (67.2%; placebo 46.6%). The share of attacks in which the pain was completely gone (34.5% vs. 15.5%) and in which the most bothersome symptom was gone (60.3% vs. 34.5%) at 2 hours was also higher with THC+CBD; 24-hour pain freedom was also more common (28% vs. 11%). THC alone brought relief at 2 hours (68.9%) but was no different from placebo in pain freedom and the most bothersome symptom. The CBD-dominant group was not clearly different from placebo at 2 hours (relief 59% vs. 37% in an additional measurement at 1 hour). Each product was tested in only one attack; single center; done with foundation and public support, without pharmaceutical industry involvement (according to the disclosure, the lead author has consulted for several companies)","yan_etki":"No serious side effects. Reporting any side effect: placebo 5%, CBD 20%, THC+CBD 20%, THC 31%; euphoria at 1 hour 36% with THC, 29% with THC+CBD, 9% with CBD, 7% with placebo","pmid":"41469488","doi":"10.1111/head.70025","diger_kaynak":"ClinicalTrials.gov NCT04360044; preprint medRxiv February 2024 (PMID 38405890)"},{"ad":"Costa-Oliveira 2026","tasarim":"Systematic review (5 RCTs, 1,072 people; low back pain + headache)","n":"1,072","populasyon":"Adults with low back pain, migraine and medication overuse headache (double-blind RCTs only)","urun":"Various cannabinoid products","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"THC+CBD in acute migraine 'moderate certainty'; the CBD-dominant formulation showed no clear benefit; in medication overuse headache and chronic musculoskeletal pain, the signal for nabilone is positive but the evidence is 'very uncertain'; according to the authors, an effect of cannabinoids as a class in headache has not been shown; with inhaled products containing THC, intoxicating side effects and a risk of participants figuring out their group","yan_etki":null,"pmid":"42773786","doi":"10.1177/25785125261490003","diger_kaynak":null},{"ad":"Pini 2012","tasarim":"Double-blind, randomized crossover study compared with an active medicine (ibuprofen); no placebo","n":"30 randomized; 26 completed","populasyon":"Adults aged 35–65 with medication overuse headache (headache caused by overusing pain relievers) for at least 5 years and at least 3 failed attempts to stop medicines (Italy, Modena)","urun":"Nabilone (synthetic THC-like cannabinoid, oral capsule)","urun_turu":"cbn_diger","doz":"Nabilone 0.5 mg/day; comparison ibuprofen 400 mg/day","titrasyon":null,"sure":"8 weeks on each medicine with a 1-week break in between; 20 weeks in total (follow-up 2 weeks after the medicines were stopped)","sonuc":"On the primary outcomes, there was no difference between the two medicines in headache day frequency and pain duration; pain intensity (7.9 at baseline; 5.7 points with nabilone, 6.6 with ibuprofen) and daily pain reliever use (0.89 vs. 1.34) decreased more with nabilone (p < 0.05). The medication dependence score, a secondary outcome, was also lower with nabilone (9.2 vs. 13.8; p < 0.05); a small improvement from baseline on quality-of-life scales was seen only with nabilone. Both medicines brought improvement from baseline. No placebo (the ethics committee did not allow placebo); small preliminary study; the benefit of ibuprofen was seen only when it was taken in the first period, and the effect of nabilone carried over from the second period into follow-up","yan_etki":"Mild and temporary: 11 side effects with nabilone and 8 with ibuprofen (dizziness, vomiting, weakness, dry mouth, nausea, etc.); 1 person stopped each medicine because of side effects (with nabilone, attention and memory problems, which resolved within a month)","pmid":"23070400","doi":"10.1007/s10194-012-0490-1","diger_kaynak":null},{"ad":"Okusanya 2022","tasarim":"Systematic review, narrative synthesis (12 publications: 7 peer-reviewed articles, 5 conference abstracts; the only randomized study only as a conference abstract)","n":"1,980 (12 publications)","populasyon":"Adults with migraine (studies in Italy and the US)","urun":"Medical cannabis (inhaled, oral, topical; most containing THC)","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"All the peer-reviewed articles included were retrospective chart reviews, app data or surveys; the authors found no well-conducted prospective experimental study. Reductions in attack frequency and severity were reported, but the evidence is not enough to make recommendations with confidence; tolerance and an association with medication overuse headache stood out as concerns. The search ended in January 2022; the 2026 acute migraine RCT is not included","yan_etki":"Mostly mild side effects in 43.75% of those using oral cannabis preparations (from Baraldi 2022); an association between cannabis use and medication overuse headache in chronic migraine (from Zhang 2021)","pmid":"35711271","doi":"10.3389/fneur.2022.871187","diger_kaynak":null},{"ad":"Hooper 2026 (UK Medical Cannabis Registry)","tasarim":"Case series from a prospective patient registry; no control group and no blinding","n":"203 (80 people with a measurement at month 24; measurements missing for 123 people, 60.6%)","populasyon":"Adults with a primary diagnosis of migraine who had not benefited enough from approved migraine medicines (United Kingdom; 56% male; 59% were already using cannabis before the prescription)","urun":"Prescription cannabis products: oil (35%), vaporized and inhaled flower (24%) or both (41%); later pastilles and vape cartridges","urun_turu":"thc_iceren","doz":"Median CBD 20 mg/day and THC 19 mg/day (baseline); at month 24, CBD 25.5 mg/day and THC 134 mg/day","titrasyon":"Doses were increased over time (especially THC)","sure":"24 months","sonuc":"The impact of headache on daily life (HIT-6) fell from 67.5 to 61.3 at month 24 (still in the 'severe impact' range, above 60, at month 24); it was lower than baseline at every measurement (p < 0.001). Migraine-related disability (MIDAS) decreased up to month 12 and was no different from baseline at months 18 and 24. Even though doses were increased, the share of people with meaningful improvement tended to decrease over time (according to the authors, this may be tolerance or the natural course of the disease). Those in the highest THC dose quartile were more likely to improve on MIDAS than those in the lowest quartile (OR 4.03; 95% CI 1.07–17.31). No control group; at month 24, measurements were missing for 61% of patients, and the results rely on an analysis that statistically fills in the missing values (multiple imputation); the registry was set up and is run by a cannabis clinic, and most of the authors work there","yan_etki":"31 patients (15.3%) reported a total of 249 side effects; the most commonly reported was headache (22 reports), followed by dry mouth, difficulty concentrating, tiredness and nausea. 57 reports were classified as severe and 3 as life-threatening or disabling (sleepiness, delirium, confusion); their relationship to the medicine was not assessed","pmid":"41943196","doi":"10.1002/brb3.71323","diger_kaynak":"Earlier analysis of the same registry: Nicholas 2023 (PMID 36722292; headache disorders, 97 patients, 6 months; improvement in HIT-6 and MIDAS, side effects in 17.5% of patients); the patients very likely overlap"},{"ad":"Rhyne 2016","tasarim":"Retrospective chart review; no control group","n":"121","populasyon":"Adults with a primary diagnosis of migraine for whom a doctor recommended medical marijuana for migraine (US, two medical marijuana clinics in Colorado)","urun":"Medical marijuana: inhaled, edible and other forms (most patients used more than one form)","urun_turu":"thc_iceren","doz":"not reported (in the abstract); most patients used it every day to prevent attacks","titrasyon":null,"sure":"Records from January 2010–September 2014 (with at least one follow-up visit)","sonuc":"Monthly migraines fell from 10.4 to 4.6 (p < 0.0001). 39.7% of patients reported a positive effect (most often fewer attacks, 19.8%; stopping an attack, 11.6%); inhaled forms were used more during attacks. No comparison group; a cause-and-effect relationship cannot be shown (the authors recommend prospective studies)","yan_etki":"11.6% of patients reported negative effects; most often sleepiness (2 patients) and difficulty controlling the timing and intensity of the effect (2 patients), both only with the edible product; edible products were associated with more negative effects","pmid":"26749285","doi":"10.1002/phar.1673","diger_kaynak":null},{"ad":"Baraldi 2022","tasarim":"Retrospective cohort (patient charts); no control group","n":"32 (number not in the abstract; from the tables of Okusanya 2022 and Lo Castro 2022)","populasyon":"Chronic migraine patients given cannabis preparations as off-label use (Italy)","urun":"Oral medical cannabis preparations: FM2, Bedrocan or Bediol (standard cannabis varieties dispensed by prescription in Italy; THC and CBD ratios not given in the abstract)","urun_turu":"thc_iceren","doz":"At most 1 mL (25 drops) per day (from the Okusanya 2022 table; not in the abstract)","titrasyon":null,"sure":"Up to 6 months (assessment at months 3 and 6)","sonuc":"Monthly migraine days at months 3 and 6 did not differ from baseline (p = 0.1182). Pain intensity (p = 0.0004), the monthly number of pain relievers (p = 0.0006) and the number of days pain relievers were taken (p = 0.0004) decreased. There was no difference between the three preparations. According to the authors, the effect was modest; no comparison group","yan_etki":"In 43.75% of patients, mostly mild","pmid":"34347088","doi":"10.1093/pm/pnab245","diger_kaynak":null},{"ad":"Zhang 2021","tasarim":"Case-control (case-referent) study; retrospective electronic health record review","n":"368 chronic migraine patients (212 with medication overuse headache, 156 without)","populasyon":"Adults with chronic migraine for at least 1 year (US, headache clinics)","urun":"Cannabis products (inhaled and oral; types not detailed in the abstract)","urun_turu":"karma","doz":"not reported (in the abstract)","titrasyon":null,"sure":"Clinical records from 2015–2019","sonuc":"Medication overuse headache in 81% (122/150) of current cannabis users and 41% (90/218) of non-users; adjusted OR 6.3 (95% CI 3.56–11.1; p < 0.0001). In the preprint, the same analysis was adjusted for age, sex, migraine frequency, duration of chronic migraine and use of opioids, butalbital and benzodiazepines (OR 5.99); the list of variables in the published version could not be verified. Cannabis use was also associated with opioid use. As reported by Okusanya 2022, in an analysis limited to those who developed medication overuse headache after starting cannabis, OR 2.6 (1.52–4.42). Retrospective chart study in a single institution's headache clinics; charts were searched with terms related to 'medication overuse' and cannabis. Shows an association, not cause and effect: sicker patients turning to cannabis more often could also explain this difference; the benefit of cannabis was not measured","yan_etki":null,"pmid":"34370866","doi":"10.1111/head.14195","diger_kaynak":"Preprint: Research Square, February 8, 2021, doi 10.21203/rs.3.rs-185874/v1 (Europe PMC PPR279684; OR 5.99 in the preprint)"}],"ilgili_ilaclar":["propranolol","amitriptilin","topiramat"],"son_inceleme":"2026-10-28","arastirma_gecmisi":[{"tarih":"2026-10-19","not":"Page published. This first review examined 2 studies."},{"tarih":"2026-10-21","not":"Technical terms in the For clinicians section were simplified; it was noted that the \"CBD-dominant\" group in one study used an inhaled product, not pure CBD oil. The year of one publication named on the page was corrected to the journal's print year instead of the online publication year. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-22","not":"The names of the result labels were simplified: the \"No benefit found\" label on this page became \"No effect found.\" The assessment did not change."},{"tarih":"2026-10-27","not":"In October 2026, PubMed, Cochrane and ClinicalTrials.gov were systematically searched; 6 studies were added: a small study in medication overuse headache comparing the synthetic THC-like medicine nabilone with ibuprofen (Pini 2012), a systematic review (Okusanya 2022) and four observational studies (Hooper 2026, Rhyne 2016, Baraldi 2022, Zhang 2021). The result of the group that inhaled THC alone, secondary outcomes, side effect rates and the number of people who treated attacks (73 of 92) were added to the acute migraine study's row, and the medication overuse headache finding was added to the review's row; 'single study' wording in the texts was corrected. Two small studies done in other conditions that tracked headache as a secondary outcome were not included in the table because they were not done in migraine patients. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-28","not":"On October 28, 2026, a second, broader search was done (child and adolescent migraine, oral, inhaled and sublingual products, nabilone and dronabinol, patient registries, ClinicalTrials.gov results, guidelines and conference abstracts); no new study to add to the table was found. Added to the text: that a 30-person preliminary study comparing CBD with placebo in chronic migraine and a 79-person study comparing oral THC and CBD with a migraine medicine exist only as conference abstracts and could not be verified, an ongoing safety study in teenagers, and that the guidelines reviewed do not recommend cannabinoids; the wording 'oral CBD has not been tested in a controlled study' was clarified to 'there is no controlled study published as a full article.' The wording of the drug interaction notes was corrected. The strength of evidence did not change."},{"tarih":"2026-10-28","not":"This page's result label was changed from 'No effect found' to 'Not studied enough.' The second search on October 28, 2026 confirmed that neither CBD oil nor any other oral CBD product has been tested in migraine patients in any controlled study published as a full article. Apart from inhaled marijuana, the only data comparing CBD with placebo in migraine is a conference abstract of a small preliminary study in 30 people with chronic migraine; because it could not be verified, it was not counted as evidence. In the only placebo-controlled acute migraine study (Schuster 2026), the CBD-dominant product tested was not an oil but vaporized and inhaled marijuana that also contained a small amount of THC; it was tested in only one attack, was no different from placebo on the main outcome (2 hours), and relief was more common in an additional measurement at 1 hour. This picture means 'not yet tested enough,' not 'tested and found ineffective.' The strength of evidence remained 'Insufficient' for CBD (the only fully published study testing a CBD-dominant product used an inhaled product in a single attack) and 'Moderate' for products containing THC."},{"tarih":"2026-10-31","not":"The last sentence of the page's short summary was rewritten in a calmer, more guiding tone: instead of \"Talk to your doctor before you start.\", it now says whom you can talk with, and about what, if you are considering CBD. The conclusion and the strength of evidence did not change."}]},{"id":"fibromyalgia","baslik":"Fibromyalgia","grup":"Pain and surgery","grup_kodu":"agri","tr_id":"fibromiyalji","kanit_duzeyi":"orta","kanit_yonu":"yarar_gosterilmedi","kanit_ozet":"For pure CBD, the best evidence is negative: in a 200-person, 24-week RCT, CBD 50 mg a day reduced pain less than placebo. This result says nothing about higher doses; those doses were not tested. For THC-containing products there are only small pilot signals; adding vaporized THC+CBD to oxycodone gave no added benefit in an 81-patient open-label RCT, and one-third of those taking cannabis stopped because of side effects; in a single-dose experimental study, no product was clearly different from placebo. There are two small RCTs with nabilone, a synthetic THC-like medicine (40 people, 4 weeks vs. placebo; 31 people, 2 weeks vs. amitriptyline): pain and quality of life improved in one and sleep in the other; the Cochrane review (2016) rated this evidence as very low certainty. A THC-rich cannabis oil lowered the fibromyalgia impact score more than placebo in an 8-week RCT of 17 women (the product was not standardized; the two oils differed in color and taste); in a crossover lab study (20 people) with a single dose of THC oil under the tongue, the change in pain from baseline was not significantly different from the placebo session (the analysis in the full text does not support the 'superior to placebo' wording in the abstract); of the two central pain inhibition tests the study mainly measured, one did not change, and in the other only one indicator strengthened. In a randomized study without placebo comparing three different cannabinoid capsules (164 people, 64 with fibromyalgia), improvement was reported in all groups; it cannot be interpreted because there was no placebo. In analyses combining RCTs in fibromyalgia, there is no significant difference from placebo in pain (3 RCTs, 83 people; low certainty); the before–after improvement in a meta-analysis that also included uncontrolled studies (12 studies, 1,248 people) is not a comparison with placebo. In large real-world studies (Israel 367, United Kingdom 497, Canada 323, Italy 102 patients), those who stayed on treatment reported improvement; however, there was no control group, rates of stopping treatment or dropping out of follow-up were high (75% dropped out of follow-up within 12 months in Canada), and in the UK registry nearly half of patients reported side effects. In a German comparison of 120 inpatients, pain went down slightly more in those taking dronabinol (synthetic THC), but the groups were not randomly assigned. The result of a dronabinol RCT (NCT00176163) listed as completed on ClinicalTrials.gov (completion May 2009; fibromyalgia and low back pain) has been neither published nor posted to the registry. October 2026 search (PubMed, Cochrane, ClinicalTrials.gov, Europe PMC): 9 randomized studies with cannabinoids on this topic (6 placebo-controlled) and 1 non-randomized comparative study were found; all are in the table below. More than 10 systematic reviews specific to fibromyalgia or examining fibromyalgia separately were found; the 4 most recent and comprehensive (including Cochrane) and 4 large observational studies are also in the table.","kanit_duzeyi_metin":"Pure CBD: moderate (negative result)","kanit_duzeyi_thc_icerenler":"zayif","kanit_duzeyi_thc_icerenler_metin":"THC-containing: weak (small, short RCTs; inconsistent results)","kaynak_dosya":"diger-hastaliklar.md","saf_cbd_sonuc":"Pure CBD 50 mg a day gave a worse result than placebo for fibromyalgia pain (difference −0.7; p=0.0028, in favor of placebo). No other controlled study comparing pure CBD with placebo in fibromyalgia was found (October 2026).","thc_icerenler_sonuc":"In fibromyalgia, all RCTs comparing THC-containing products and nabilone with placebo or another drug are small (17–81 people) and short (from a single dose to 16 weeks). There are positive signs in a pilot study with a 1:1 THC:CBD oil, in a 17-person study with a THC-rich oil, and in two small studies with nabilone; in contrast, vaporized cannabis did not differ from placebo at a single dose, gave no added benefit when added to oxycodone, and with a single dose of THC oil under the tongue the change in pain was not clearly different from placebo. In analyses combining placebo-controlled studies, there was no significant difference from placebo in pain (low or very low certainty). The results cannot be applied to pure CBD.","ruhsat":null,"doz_araligi_ozet":"Pure CBD 50 mg/day (24 weeks); 18.4 mg CBD in a single inhalation; with the 1:1 THC:CBD oil, final dose 5–35 mg THC + 5–35 mg CBD a day (median 10 + 10 mg; calculated from mL and product concentration); nabilone 0.5–2 mg/day; THC-rich oil about 4.4 mg THC/day on average; dronabinol 14.8 mg/day on average; single dose of THC under the tongue 0.2 mg/kg (average 13.1 mg)","titrasyon_ozet":"In Kurlyandchik 2026, over 4 weeks: started at 0.25 mL and increased by 0.25 mL every 2 days (up to 3.5 mL/day); in Skrabek 2008, nabilone from 0.5 mg to 2 × 1 mg over 4 weeks; in Chaves 2020, from 1 drop a day, increased by at most 1 drop every 10 days; in Bettstetter 2024, dronabinol over 13.4 days on average","yan_etkiler":["In healthy volunteers, CBD increased the risk of diarrhea (RR 5.85); a non-significant trend toward more abdominal pain and headache (Sawaira 2026, PMID 41789242)","Psychiatric and nervous system side effects are more common with THC-containing products (Filippini 2022, PMID 35510826); the likelihood of side effects increased with any cannabinoid (OR 1.75; Wilson 2026, PMID 41856154). In fibromyalgia, dropouts due to side effects were 4/52 with nabilone and 1/52 in control groups (Walitt 2016); with vaporized THC + CBD cannabis, 31% dropped out in the first 2–3 weeks (van Dam 2024); after a single dose of THC oil, nausea 57% and reduced attention 52% (Agbaria 2025); in the UK patient registry, 45.7% of patients reported side effects (Varadpande 2026)"],"izlem":[],"dikkat":["High doses and market doses cannot be compared: in low-dose (≤175 mg/day) studies, plasma levels were 5–100 times lower than with the 20 mg/kg Epidiolex dose (Warren 2026, PMID 42473010)","Anyone taking a medicine long-term should talk to a doctor before starting; the studies on this page did not systematically assess interactions","Using pure CBD at 50 mg/day as a painkiller is not supported"],"ilac_etkilesim_notlari":["The studies on this page did not systematically assess drug interactions; details are in the site's drug interactions section"],"dogrulanamayan":[],"calismalar":[{"ad":"Rasmussen 2026","tasarim":"Double-blind, placebo-controlled, parallel, single-center RCT","n":"200 (100/100)","populasyon":"Fibromyalgia","urun":"Plant-derived CBD tablet (CBD as the only active ingredient; THC content not reported in the abstract or registry)","urun_turu":"saf_cbd","doz":"50 mg/day","titrasyon":"According to the plan in the registry, it was to start at 10 mg/day and increase every 3 days to reach 50 mg/day in 2 weeks (the full text of the article could not be read; the schedule actually used could not be verified)","sure":"24 weeks","sonuc":"Pain decreased by −0.4 points with CBD and −1.1 points with placebo; difference in favor of placebo (−0.7; p=0.0028)","yan_etki":"Mild, evenly distributed between the two groups","pmid":"40846590","doi":"10.1016/j.ard.2025.07.008","diger_kaynak":"ClinicalTrials.gov NCT04729179 (CANNFIB; no results in registry)"},{"ad":"van de Donk 2019","tasarim":"Experimental, 4-arm crossover RCT","n":"25 enrolled; 20 completed (the 5 people who dropped out after the first visit were replaced)","populasyon":"Fibromyalgia","urun":"Vaporized Bedrocan (THC), Bediol (THC+CBD), Bedrolite (CBD, <1 mg THC), placebo","urun_turu":"thc_iceren","doz":"Single inhalation (e.g., Bedrolite 18.4 mg CBD)","titrasyon":null,"sure":"Single dose, 3 hours of observation","sonuc":"None was clearly different from placebo for spontaneous pain; CBD reduced the pain-relieving effect of THC. The reduction in pain was associated with the intensity of the feeling of intoxication. The products were provided in collaboration with the manufacturer; one of the authors is an employee of the manufacturer","yan_etki":"Only with active products: coughing during inhalation 65–70%, sore throat and bad taste 25–35%, nausea in one-third of patients (all mild); most patients did not like the feeling of intoxication. 3 people stopped after the first visit because of dizziness and nausea; no serious side effects","pmid":"30585986","doi":"10.1097/j.pain.0000000000001464","diger_kaynak":"Netherlands Trial Register NTR6091; EudraCT 2015-003811-39 (Spirocan)"},{"ad":"Kurlyandchik 2026","tasarim":"Pilot, double-blind, placebo-controlled RCT","n":"24 randomized (12/12); 22 completed; efficacy analysis 10/10","populasyon":"Fibromyalgia (Australia; all participants women)","urun":"1:1 THC:CBD oil (10 mg/mL each)","urun_turu":"thc_iceren","doz":"Single evening dose; final dose 0.5–3.5 mL (median 1 mL), i.e., 5–35 mg THC + 5–35 mg CBD a day (median 10 + 10 mg) (calculated from mL and product concentration)","titrasyon":"4 weeks: started at 0.25 mL and increased by 0.25 mL every 2 days, up to 3.5 mL/day; then fixed for 12 weeks","sure":"4 weeks of titration + 12 weeks at a fixed dose","sonuc":"Feasibility study. Primary outcomes: 24 people could be enrolled instead of the target 36; completion 92%, medication adherence reached the target, no serious side effects. Secondary (preliminary) efficacy: at week 12, the pain score was 1.02 points lower than placebo, but the difference was not significant (95% CI −2.73 to 0.69); at least 30% pain reduction 70% with cannabis vs. 40% with placebo; clinically meaningful improvement on FIQR 40% vs. 10%; sleep (PSQI) difference −3.09 (−6.42 to 0.25). Effect sizes were moderate to large, but the confidence intervals include zero and the analysis was 10 vs. 10 people. In both groups, 75% of participants correctly guessed which group they were in. The company supplying the product co-funded the lead author's PhD scholarship together with the university","yan_etki":"Mostly mild, none serious","pmid":"42142029","doi":"10.1155/prm/7311235","diger_kaynak":"ANZCTR ACTRN12623000345684; plasma endocannabinoid-like substance analysis of the same trial: Kurlyandchik 2026b, PMID 42464432 (no change found)"},{"ad":"van Dam 2024","tasarim":"Open-label RCT, 3 arms (oxycodone / cannabis / both together)","n":"81 (23 / 29 / 29)","populasyon":"Fibromyalgia (Netherlands)","urun":"Vaporized cannabis (6.3% THC + 8% CBD) and/or oxycodone 5 mg tablet","urun_turu":"thc_iceren","doz":"For cannabis, 150 mg of plant material per session (about 9.5 mg THC + 12 mg CBD), up to 3 sessions a day in the first week, then up to 5; oxycodone up to 4 × 5 mg a day; dose self-titrated","titrasyon":"Adjusted by the patient","sure":"6 weeks","sonuc":"No advantage of the combination over single treatments; it reduced oxycodone tablet use by 35%, but the total medication burden was highest; ≥1-point reduction in pain in half of patients","yan_etki":"31% of those taking cannabis and 13% of those taking oxycodone alone stopped within 2–3 weeks because of side effects","pmid":"39654798","doi":"10.3389/fpain.2024.1497111","diger_kaynak":"WHO ICTRP NL7902; EU-CTR 2019-001861-33; protocol: PMID 36707893 (Trials 2023, SPIRAL)"},{"ad":"Skrabek 2008","tasarim":"Double-blind, placebo-controlled, parallel RCT","n":"40 randomized (20/20); 15 people completed in the nabilone group; analysis of completers","populasyon":"Fibromyalgia (Canada)","urun":"Nabilone (synthetic THC-like cannabinoid, oral capsule)","urun_turu":"cbn_diger","doz":"Started at 0.5 mg at bedtime and increased to 2 × 1 mg a day over 4 weeks","titrasyon":"Weekly increase: 0.5 mg → 2 × 0.5 mg → 0.5 + 1 mg → 2 × 1 mg","sure":"4 weeks of treatment + 4 weeks of drug-free follow-up","sonuc":"At week 4, pain (VAS −2.04; p < 0.02), fibromyalgia impact score (FIQ −12.07; p < 0.02) and anxiety decreased from baseline in the nabilone group; there was no significant improvement in the placebo group (no direct between-group comparison in the abstract; Cochrane reports this as greater improvement than placebo). After 4 drug-free weeks, the gains were lost. Analysis of completers only (nabilone 15, placebo 18). Cochrane (Walitt 2016) rated the certainty of this evidence as very low","yan_etki":"Side effects per person were higher in the nabilone group (1.58 at week 2, 1.54 at week 4; p < 0.05); most often drowsiness and dry mouth; 2 people in the nabilone group stopped because of side effects","pmid":"17974490","doi":"10.1016/j.jpain.2007.09.002","diger_kaynak":"ClinicalTrials.gov NCT00272207 (no results in registry); commentary: Staud and Koo 2008, PMID 18521112"},{"ad":"Ware 2010","tasarim":"Double-blind, active drug (amitriptyline)-controlled, randomized crossover equivalence study","n":"31 enrolled; 29 completed (26 women)","populasyon":"Fibromyalgia patients with chronic insomnia (Canada)","urun":"Nabilone (synthetic THC-like cannabinoid) and amitriptyline, by mouth, at bedtime","urun_turu":"cbn_diger","doz":"Nabilone 0.5–1.0 mg, amitriptyline 10–20 mg; before bedtime","titrasyon":"Started at 0.5 mg and increased to 1 mg if needed","sure":"2 weeks on each drug, with a 2-week drug-free period in between","sonuc":"Sleep improved with both drugs; nabilone was better than amitriptyline on the insomnia severity scale (difference 3.2 points; 95% CI 1.2–5.3), borderline superior for feeling rested on waking, and no different for wakefulness. There was no difference in pain, mood or quality of life. No placebo group, short duration","yan_etki":"More common with nabilone; most often dizziness, nausea and dry mouth; mostly mild–moderate","pmid":"20007734","doi":"10.1213/ANE.0b013e3181c76f70","diger_kaynak":"ClinicalTrials.gov NCT00381199 (no results in registry)"},{"ad":"Chaves 2020","tasarim":"Double-blind, placebo-controlled, parallel RCT","n":"18 randomized; 17 analyzed (8 cannabis, 9 placebo)","populasyon":"Women with fibromyalgia, a low-income neighborhood (Florianópolis, Brazil)","urun":"THC-rich whole-plant cannabis oil (24.44 mg THC, 0.51 mg CBD per mL; not standardized, supplied by a patient association); placebo olive oil","urun_turu":"thc_iceren","doz":"Under the tongue, started at 1 drop a day (about 1.2 mg THC); at the end of the study an average of 3.6 drops (about 4.4 mg THC + 0.08 mg CBD/day)","titrasyon":"Increase of at most 1 drop every 10 days","sure":"8 weeks","sonuc":"At week 8, the fibromyalgia impact score (FIQ, 0–100) fell from 75.5 to 30.5 in the cannabis group and from 70.2 to 61.2 with placebo; the between-group difference was significant (p = 0.005). A very small study (analysis with 17 people); the product was not standardized and its terpene content was not measured; according to the authors, the color and taste of the two oils did not fully match, which may have made it easier for participants to notice which group they were in. Registered after the study ended. No funding","yan_etki":"In the cannabis group, drowsiness 87.5%, dizziness 25%, dry mouth 25%; no intolerable side effects reported. Drowsiness in 1 person with placebo","pmid":"33118602","doi":"10.1093/pm/pnaa303","diger_kaynak":"ReBEC RBR-2f8mtn (registered after data collection, in March 2020)"},{"ad":"Agbaria 2025","tasarim":"Double-blind, placebo-controlled, randomized crossover, single-dose lab study (subgroup without brain imaging from a registered 40-person trial)","n":"25 women enrolled; 23 took THC, 20 completed both sessions","populasyon":"Women with fibromyalgia, aged 20–55, moderate–severe pain, not regular cannabis users (Israel)","urun":"THC-rich oil under the tongue (10% THC, 2% CBD) and placebo oil","urun_turu":"thc_iceren","doz":"Single dose 0.2 mg/kg THC (average 13.1 mg)","titrasyon":null,"sure":"Single dose, measured 2 hours later; 2–6 weeks between sessions","sonuc":"The main measures were central pain inhibition tests: conditioned pain modulation (CPM) did not change with THC; the change from baseline in offset analgesia (OA) magnitude did not differ between the two sessions (treatment × time p = 0.32), while the OA index increased more after THC (p = 0.004). The Short-Form McGill pain score fell from 20.5 to 9.5 in the THC session and from 22.7 to 17.1 in the placebo session; the difference between sessions in change from baseline was not significant (treatment × time p = 0.50). This analysis in the full text does not support the abstract's statement that 'THC was significantly superior to placebo for pain (p = 0.02).' Participants were not asked what they had received; frequent side effects may have made it easier for them to notice which oil they took","yan_etki":"After THC, nausea 57%, reduced attention 52%, headache 35%, mental fogginess 26%, drowsiness 22%; 3 people stopped after the THC session because of side effects that were not severe but were intolerable; no notable side effects with placebo","pmid":"41199355","doi":"10.1186/s42238-025-00348-x","diger_kaynak":"ClinicalTrials.gov NCT05644054 (product: Panaxia AXIBAN T10/C2; no results in registry)"},{"ad":"Kruger 2026","tasarim":"Randomized study comparing three cannabinoid formulations without placebo (a real-world data study according to the authors); blinding not stated in the abstract","n":"276 enrolled; 164 people who completed the questionnaires and continued the product were analyzed (64 fibromyalgia, 25 rheumatoid arthritis, 75 knee/hip osteoarthritis)","populasyon":"Adults living in California diagnosed with fibromyalgia, rheumatoid arthritis or knee/hip osteoarthritis (USA)","urun":"Oral capsule, three formulations: 1) 12.5 mg CBD + 12.5 mg THC; 2) 10 mg THCA + 10 mg CBDA (unheated acid forms of THC and CBD) + 5 mg CBG + 3 mg CBC; 3) 10 mg CBD + 10 mg CBDA","urun_turu":"karma","doz":"Amounts above per capsule; daily number of capsules not reported (in the abstract)","titrasyon":"Not reported (in the abstract)","sure":"12 weeks","sonuc":"In the per-protocol analysis, improvement from baseline in all symptoms except cognitive function (small to large effect); most effects did not differ between products or pain types, while there was a difference between products for sleep. Because there was no placebo group, how much of the improvement came from the products is unknown; 39% of those enrolled did not complete the questionnaires; fibromyalgia-specific numbers are not in the abstract; four of six authors are tied to a company (MoreBetter), and the authors reported no conflict of interest","yan_etki":"Not reported (in the abstract)","pmid":"42140793","doi":"10.1016/j.clinthera.2026.04.018","diger_kaynak":null},{"ad":"Walitt 2016 (Cochrane)","tasarim":"Cochrane systematic review (RCTs lasting at least 4 weeks; search through April 2016)","n":"72 (2 RCTs)","populasyon":"Adults with fibromyalgia","urun":"Nabilone (in both studies); no suitable RCTs with herbal cannabis or other cannabinoids were found","urun_turu":"cbn_diger","doz":"Nabilone 0.5–2 mg/day (in Ware 2010, 0.5–1 mg at bedtime; in Skrabek 2008, from 0.5 mg at bedtime to 2 × 1 mg a day)","titrasyon":null,"sure":null,"sonuc":"There is no convincing, unbiased, high-quality evidence that nabilone works in fibromyalgia; all outcomes are very low certainty. In one study, pain and quality of life improved more than with placebo; in the comparison with amitriptyline, sleep was better with nabilone, with no difference in pain. As of October 2026, there is no update on PubMed","yan_etki":"Dropouts due to side effects 4/52 with nabilone, 1/20 with placebo, 0/32 with amitriptyline; most often dizziness, nausea, dry mouth and drowsiness; no serious side effects reported. According to the authors, nabilone was not well tolerated in fibromyalgia","pmid":"27428009","doi":"10.1002/14651858.CD011694.pub2","diger_kaynak":null},{"ad":"Giossi 2022","tasarim":"Systematic review and meta-analysis (8 RCTs in chronic primary pain; search through October 2021); fibromyalgia subgroup analysis","n":"240 (all); fibromyalgia pain analysis 83 people, 3 RCTs","populasyon":"Chronic primary pain (fibromyalgia, irritable bowel syndrome, complex regional pain syndrome, etc.)","urun":"Cannabinoids (nabilone, dronabinol, THC-rich oil, vaporized cannabis, CBD chewing gum)","urun_turu":"karma","doz":"Variable","titrasyon":null,"sure":null,"sonuc":"In fibromyalgia, pain was not significantly different from placebo (−0.70 on a 0–10 scale; 95% CI −1.54 to 0.12; 3 RCTs, 83 people; low certainty); difference in fibromyalgia impact score −21.7 (−46.2 to 2.8; 2 RCTs). In parallel studies lasting at least 4 weeks, a small reduction in pain (−0.82; −1.41 to −0.24; 2 RCTs, 58 people). Across all chronic primary pain, the difference was also not significant (−0.64; −1.30 to 0.02)","yan_etki":"No significant difference from placebo in dropouts due to side effects (OR 2.15; 0.44–10.65; all chronic primary pain)","pmid":"36129666","doi":"10.1007/s40122-022-00434-5","diger_kaynak":null},{"ad":"Duarte 2026","tasarim":"Systematic review (RCTs only; search through March 2024), meta-analysis of 2 studies; PROSPERO CRD42024525247","n":"4 RCTs (Skrabek 2008, Ware 2010, Chaves 2020, van Dam; the last via its protocol publication, PMID 36707893)","populasyon":"Fibromyalgia (ACR 1990, 2010 or 2016 criteria)","urun":"Nabilone, THC-rich oil, vaporized THC + CBD cannabis (Bediol)","urun_turu":"karma","doz":"Variable","titrasyon":null,"sure":null,"sonuc":"The true effect of cannabis products on pain, disease impact or insomnia could not be determined from four small RCTs. In the pooled analysis of two placebo-controlled studies, the difference from placebo in pain and fibromyalgia impact score was not significant; evidence very low certainty (risk of bias, inconsistency, imprecision). The pooled analysis is methodologically weak: because the spread of change scores was not reported, baseline spread and p values were used; single-dose studies were excluded","yan_etki":"Side effects of the included studies were reported one by one (most often drowsiness, dry mouth, dizziness, nausea); no pooled analysis","pmid":"42370077","doi":"10.1016/j.ero.2026.01.016","diger_kaynak":null},{"ad":"Lam 2026","tasarim":"Systematic review and meta-analysis (2 RCTs + 10 observational studies, 14 comparisons); PROSPERO CRD42024495525","n":"1,248","populasyon":"Fibromyalgia","urun":"Cannabinoids (various)","urun_turu":"karma","doz":"Variable","titrasyon":null,"sure":null,"sonuc":"Reduction in pain intensity compared with before treatment (SMD −1.41; 95% CI −1.98 to −0.84); improvement also in sleep, anxiety, depression and quality of life. The analysis was mostly based on observational studies without a control group and on before–after differences; it is not a comparison with placebo. Evidence is low certainty, with very large heterogeneity between studies","yan_etki":"Common: dizziness, dry mouth, drowsiness; serious side effects rare","pmid":"42013320","doi":null,"diger_kaynak":null},{"ad":"Bettstetter 2024","tasarim":"Retrospective, non-randomized comparative study (patients who did and did not receive dronabinol)","n":"120 (62 dronabinol, 58 comparison)","populasyon":"Fibromyalgia patients receiving inpatient multimodal pain treatment in the hospital (Germany, 2017–2018)","urun":"Dronabinol (synthetic THC; more than 90% as capsules, the rest as oily drops)","urun_turu":"thc_iceren","doz":"Average 14.8 mg/day (2.6–31.3 mg)","titrasyon":"Increased gradually over an average of 13.4 days","sure":"During inpatient multimodal pain treatment (average about 2 weeks)","sonuc":"Pain (0–10) fell from 6.0 to 4.2 in the dronabinol group and from 5.6 to 4.6 in the comparison group; the reduction was significantly greater with dronabinol, as were improvements in depression and quality of life; no difference in anxiety or sleep. In 5 of 7 pain medicine groups, dose reduction or stopping was more common in the dronabinol group. The groups were not randomly assigned and differed at baseline (in the dronabinol group, the illness was more chronic and more previous drug treatments had been tried); everyone was in an intensive treatment program at the same time","yan_etki":"Not systematically recorded; 2 patients who stopped dronabinol because of side effects were excluded from the analysis","pmid":"37289246","doi":"10.1007/s00482-023-00727-4","diger_kaynak":null},{"ad":"Sagy 2019","tasarim":"Prospective observational cohort (medical cannabis clinic)","n":"367 started; response rate to the month-6 questionnaire 70.8%","populasyon":"Fibromyalgia (Israel, 2015–2017; 82% women)","urun":"Medical cannabis: 67% dried flower (smoked or vaporized), 20% oil, 12% both; most prescriptions THC-rich","urun_turu":"thc_iceren","doz":"At month 6, median 1,000 mg cannabis/day; median 140 mg THC and 39 mg CBD/day","titrasyon":"Started at a low dose (e.g., 1 drop 3 times a day) and increased gradually","sure":"6 months","sonuc":"Pain (0–10) fell from a median of 9 to 5; 81.1% of those assessed reported at least moderate improvement. 22.2% of opioid users stopped or reduced opioids. No control group; one of the authors is an employee of the company supplying the product, and one is an advisory board member","yan_etki":"Most common were dizziness 7.9%, dry mouth 6.7% and nausea/vomiting 5.4%; stopping treatment before 6 months 7.6%","pmid":"31195754","doi":"10.3390/jcm8060807","diger_kaynak":null},{"ad":"Giorgi 2020","tasarim":"Prospective observational study (consecutive patients)","n":"102","populasyon":"Fibromyalgia patients with ongoing pain despite standard pain treatment (Italy, Milan)","urun":"Oil-diluted cannabis extracts: Bedrocan (22% THC, <1% CBD) and Bediol (6.3% THC, 8% CBD)","urun_turu":"thc_iceren","doz":"Not reported (in the abstract)","titrasyon":"Not reported (in the abstract)","sure":"6 months","sonuc":"At month 6, 64% were still on treatment; significant improvement on the sleep scale (PSQI) in 44% of patients and on the fibromyalgia impact scale (FIQR) in 33%; moderate improvement in anxiety and depression in 50%; 47% of patients reduced or stopped their other pain medicines. No control group","yan_etki":"Mild side effects in one-third; no change in treatment needed","pmid":"32116208","doi":null,"diger_kaynak":null},{"ad":"Sotoodeh 2023","tasarim":"Prospective cohort","n":"323; 75% had dropped out of follow-up by month 12","populasyon":"Fibromyalgia patients starting medical cannabis under a doctor's supervision (Canada, Montreal)","urun":"Medical cannabis (composition not in the abstract)","urun_turu":"karma","doz":"Not reported (in the abstract)","titrasyon":"Not reported (in the abstract)","sure":"12 months","sonuc":"The reduction in pain was partly explained by a reduction in sleep problems and negative affect (anxiety, depression) over the same period (both p < 0.001). The size of the change in pain is not in the abstract. By month 12, 75% of patients had dropped out of follow-up; according to the authors, the results therefore cannot be generalized to all patients. No control group; two authors are tied to a cannabis company (Canopy Growth)","yan_etki":"Not reported (in the abstract)","pmid":"35876631","doi":"10.1002/acr.24985","diger_kaynak":null},{"ad":"Varadpande 2026","tasarim":"Prospective patient registry case series (UK Medical Cannabis Registry)","n":"497","populasyon":"Fibromyalgia patients who had not benefited enough from licensed treatments (United Kingdom; 69% women, 54% not working)","urun":"Prescription cannabis products: oil, dried flower or both (most often CBD-rich and THC-rich oils, THC-rich flower)","urun_turu":"thc_iceren","doz":"Median CBD 20 mg/day (at baseline) → 25 mg/day (month 18); median THC 2 mg/day → 112.5 mg/day","titrasyon":"Not reported; THC dose increased markedly over 18 months","sure":"18 months","sonuc":"Improvement from baseline on all scales (p < 0.01); at month 18, fibromyalgia symptom severity fell from 9.1 to 8.4 and the widespread pain index from 14.0 to 13.0; improvement was greatest at month 1 and then lessened. Those taking more than 25 mg of CBD a day were more likely to improve on fibromyalgia scales. No control group; missing responses were counted as 'no change'; the registry belongs to a private clinic in the same corporate group as the manufacturer of the most frequently prescribed products, and most of the authors work there","yan_etki":"45.7% of patients reported at least one side effect (2,100 in total; 85% mild–moderate, 14.6% severe, 2 life-threatening: anxiety and lung infection); most common were fatigue 30.8%, dry mouth 27.6% and impaired concentration 26.2%","pmid":"41343025","doi":"10.1007/s10067-025-07846-6","diger_kaynak":"Earlier fibromyalgia analyses of the same registry: Wang 2023, PMID 37199833 (306 patients); Sridharan 2025, PMID 39417761 (148 patients, products from a single manufacturer; correction PMID 39432707)"}],"ilgili_ilaclar":["amitriptilin","pregabalin","snri"],"son_inceleme":"2026-10-27","arastirma_gecmisi":[{"tarih":"2026-10-19","not":"Page published. In this first review, 3 studies were examined."},{"tarih":"2026-10-21","not":"A technical phrase (\"failed to beat placebo\") was replaced with a clearer one (\"was not clearly different from placebo\"). The year of a publication named on the page was corrected to the journal's print year instead of the online publication year. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-21","not":"PubMed and ClinicalTrials.gov were searched for newly published and previously missed clinical studies. Study added: van Dam 2024. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-22","not":"The names of the result labels were simplified: the \"No benefit found\" label on this page became \"No effect found\". The assessment did not change."},{"tarih":"2026-10-27","not":"In October 2026, PubMed, Cochrane, ClinicalTrials.gov and Europe PMC were systematically searched; 14 studies were added: 2 randomized studies with the THC-like medicine nabilone, 2 with THC-containing cannabis oils and 1 comparing three cannabinoid capsules, 1 non-randomized comparison with dronabinol, 4 systematic reviews including Cochrane, and 4 large real-world studies. Among existing rows, the daily dose and result numbers of the THC and CBD oil study were added from the full text, the number of people and side effects of the vaporized cannabis study were corrected, and registry numbers were added to four rows. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-28","not":"Display fix: internal working file names left in the text were removed; content and evidence did not change."},{"tarih":"2026-10-28","not":"Display fix: internal working notes left over from the previous cleanup were removed; content and evidence did not change."},{"tarih":"2026-10-30","not":"The last sentence of the page's short summary was rewritten in a calmer, more guiding tone: instead of \"Talk to your doctor before you start.\", it now says whom you can talk with, and about what, if you are considering CBD. The conclusion and the strength of evidence did not change."}]},{"id":"crohns-ulcerative-colitis","baslik":"Inflammatory bowel disease (Crohn’s disease, ulcerative colitis)","grup":"Other","grup_kodu":"diger","tr_id":"inflamatuvar-bagirsak","kanit_duzeyi":"zayif","kanit_yonu":"yarar_gosterilmedi","kanit_ozet":"Low-dose pure CBD was ineffective in Crohn’s disease. A CBD oil containing THC eased symptoms (in the analysis adjusted for differences in age, sex and disease duration, the difference was not confirmed), but endoscopy, CRP and calprotectin, which show inflammation in the bowel, did not change. In ulcerative colitis, the primary outcome was negative with a CBD-rich extract that also contained THC. In two small RCTs with THC-rich marijuana cigarettes (21 people in Crohn’s disease, 32 in ulcerative colitis), symptoms and quality of life improved compared with placebo; but in Crohn’s disease the difference in complete remission was not significant, and in ulcerative colitis there was no difference from placebo in endoscopy, CRP or calprotectin, and blinding was weak. Reviews assessing the RCTs (Cochrane 2018, Doeve 2021, Kang 2025, Jugl 2026) found no significant difference from placebo in remission, endoscopy or inflammation markers; some report improvement in symptom scores and quality of life, but the certainty of evidence ranges from very low to moderate, and all rest on the same small studies. In a 14-patient uncontrolled pilot study with a CBD + sodium propionate enema in ulcerative proctitis, the Mayo score improved; there was no control group, and the product contains another active ingredient besides CBD. A patient may 'feel well' while the disease progresses; CBD should not replace standard treatment (biologic medicines, steroids, etc.). The 2019 position statement of the Canadian Association of Gastroenterology also states that, based on the evidence at the time, cannabis did not appear to change the course of these conditions for better or worse, that the evidence is insufficient to recommend it as a treatment that reduces inflammation, and that it should not be used in place of approved treatment (expert opinion without a formal grading of evidence; 3 of the 7 authors have ties to cannabis or cannabinoid companies). The results of observational studies comparing patients who use cannabis with those who do not are conflicting: in Canada, use for more than 6 months was linked to surgery in Crohn’s disease; in a large US study based on health records, emergency visits, hospital admissions, and steroid and opioid use were more common in cannabis users, but there was no difference in surgery or death; in coded data of hospitalized patients, some complications were less common and others more common. People with more severe disease using cannabis more often may explain these links; these studies do not show cause and effect. October 2026 search (PubMed, Cochrane, ClinicalTrials.gov, Europe PMC): 5 randomized controlled trials with cannabinoids on this topic (all small: 20–60 people, 8–10 weeks) and 9 systematic reviews or meta-analyses, including two Cochrane reviews, were found; all of the controlled trials, the most comprehensive and up-to-date reviews, the 2019 position statement of the Canadian Association of Gastroenterology (added in the October 28, 2026 completion round) and the main observational studies are in the table below. There are no controlled studies in children and adolescents; a 15-person RCT with pure CBD in steroid-dependent Crohn’s disease was completed in 2022, but its results have not been published.","kanit_duzeyi_metin":"Weak (a single small RCT with pure CBD, low dose)","kanit_duzeyi_thc_icerenler":"zayif","kanit_duzeyi_thc_icerenler_metin":"Weak (4 small RCTs; signs of improvement in symptoms, no difference shown in inflammation)","kaynak_dosya":"diger-hastaliklar.md","saf_cbd_sonuc":"The only RCT with pure, low-dose CBD (10 mg twice a day) was negative in Crohn’s disease. There is no published study comparing pure CBD with placebo in ulcerative colitis; in a 14-person uncontrolled study in mild to moderate ulcerative colitis limited to the rectum (proctitis) with an enema containing both synthetic CBD and sodium propionate, which is not a cannabinoid, the disease score improved, but because there was no placebo group and the product contained a second active ingredient, the effect of CBD cannot be shown on its own. A 15-person RCT with synthetic pure CBD in steroid-dependent Crohn’s patients was completed in 2022, but its results have been neither published nor posted to the registry (October 2026).","thc_icerenler_sonuc":"There are 4 small RCTs with THC-containing products (21–60 people, 8–10 weeks). In Crohn’s disease, with a CBD/THC oil the disease activity score and quality of life improved more than with placebo, but once differences in age, sex and disease duration between the two groups were taken into account, this difference was not statistically confirmed; objective measures of inflammation (endoscopy, CRP, calprotectin) did not change either. In Crohn’s disease, clinical response was more common with THC-rich marijuana cigarettes, but the difference in the primary outcome, complete remission, was not significant. In ulcerative colitis, the primary outcome (remission) was negative with a CBD-rich extract that also contained THC; THC-rich marijuana cigarettes improved the symptom score, but there was no difference from placebo on endoscopy. Because the effect of THC can be felt, blinding was weak. Reviews find no difference in remission or inflammation; the certainty of evidence ranges from very low to moderate.","ruhsat":null,"doz_araligi_ozet":"Pure CBD 10 mg twice a day (Crohn’s disease); 100–500 mg/day CBD in a THC-containing extract (ulcerative colitis); in the CBD/THC oil in Crohn’s disease, from 2 × 1 drop a day up to at most 2 × 20 drops (according to secondary sources, about 8 mg CBD + 2 mg THC per drop); THC-rich marijuana cigarettes, 2 a day (Crohn’s disease and ulcerative colitis); in ulcerative proctitis, 60 mg synthetic CBD in 1 enema a day","titrasyon_ozet":"Drop-by-drop increase with the CBD/THC oil (at most 40 drops a day); with the CBD-rich capsules, from 2 × 50 mg to 2 × 250 mg if tolerated; in the cigarette study in ulcerative colitis, from half a cigarette to 2 × 0.5 g a day","yan_etkiler":["In healthy volunteers, CBD increased the risk of diarrhea (RR 5.85); a non-significant trend toward more belly pain and headache (Sawaira 2026, PMID 41789242)","Psychiatric and nervous system side effects more common with THC-containing products (Filippini 2022, PMID 35510826); the odds of side effects increased with any cannabinoid (OR 1.75; Wilson 2026, PMID 41856154)","With THC-rich marijuana cigarettes, cough 41%, dizziness 35%, confusion 29% (20%, 6%, 6% with placebo; in the 32-person study, the differences were not statistically significant; Naftali 2021, ulcerative colitis); in Crohn’s disease, side effects more common with THC cigarettes than with placebo (RR 4.09; 95% CI 1.15–14.57; very low certainty; Cochrane, Kafil 2018)","In a real-world series in Israel, 63% of patients assessed at month 3 reported a side effect and 31% stopped treatment or reduced the dose (Fliss Isakov 2023); in a UK registry, 17% of patients reported a side effect over 18 months (Gupta 2024)"],"izlem":["Even when symptoms improve, inflammation checks (calprotectin, CRP, endoscopy) continue according to the doctor’s plan; in the studies, these measurements did not change differently from placebo while symptoms improved (Naftali 2021, Crohn’s disease and ulcerative colitis)"],"dikkat":["High doses and over-the-counter doses cannot be compared: in low-dose studies (≤175 mg/day), plasma levels were 5–100 times lower than with a 20 mg/kg Epidiolex dose (Warren 2026, PMID 42473010)","Anyone who takes medicines long-term should consult a doctor before starting; the studies on this page did not systematically assess interactions","CBD should not replace the standard treatment of inflammatory bowel disease","Even when symptoms improve, there is no objective evidence that inflammation goes down","In observational studies, cannabis use was linked to surgery in Crohn’s disease (Storr 2014) and to emergency visits, hospital admissions and steroid use (Glickman 2024); in other registry studies, some complications were less common. People with severe disease using cannabis more often may explain these links; cause and effect has not been shown"],"ilac_etkilesim_notlari":["The studies on this page did not systematically assess drug interactions; details are in the site's drug interactions section"],"dogrulanamayan":["The full text of Irving 2018 was not read (paywalled); n, dose and side effects are from the ClinicalTrials.gov record, the THC proportion (at most 4.7%) from the Cochrane summary; the daily THC amount in mg is unknown","The full texts of Naftali 2013, Naftali 2021 (Crohn’s disease), Doeve 2021, Kang 2025, Storr 2014, Glickman 2024, Gupta 2024 and Desai 2019 could not be read; the rows are based on the abstracts. For Naftali 2021 (Crohn’s disease), the oil’s dosing schedule, the median amount used, the side effect table and the analyses adjusted for age, sex and disease duration were taken not from the main publication but from the data supplement of a systematic review (Jugl 2026) and from a secondary publication on the same patients (Tartakover Matalon 2021); in this secondary publication the oil’s concentration is given as '8 mg/mL CBD and 2 mg/mL THC', which matches the per-drop value","Naftali 2019 (a 127-patient Israeli series, PMID 31567639) was not included in the table: the disease scores in its abstract (Harvey-Bradshaw from 14 ± 6.7 to 7 ± 4.7) are identical to those of the 2011 study of 30 patients, and the same authors cite these values in 2021 as the result of the 30-patient study; because the full text could not be read, whether these are new data could not be verified. In the Naftali group’s publications, product concentrations differ from source to source (e.g., for the ulcerative colitis cigarette, 16% THC and 80 mg per cigarette in the full text; 23 mg THC a day in Cochrane; 23% THC and 11.5 mg per cigarette in a secondary publication); the table uses the values from the primary publications. The Kang 2025 abstract counts 8 studies, whereas the known separate RCTs number 5; which studies it combined could not be read"],"calismalar":[{"ad":"Naftali 2017","tasarim":"Placebo-controlled RCT","n":"20 randomized; 19 completed","populasyon":"Crohn’s disease","urun":"Pure CBD (by mouth)","urun_turu":"saf_cbd","doz":"10 mg × 2/day","titrasyon":null,"sure":"8 weeks","sonuc":"No difference from placebo in disease activity (CDAI): 220 ± 122 vs 216 ± 121 at week 8 (337 and 308 at baseline). According to Cochrane, remission 4/10 vs 3/9 (RR 1.20; 95% CI 0.36–3.97; very low certainty)","yan_etki":"No side effects observed according to the abstract; according to the Cochrane review, worsening of the disease was recorded as a serious event in 1 person in each group (1/10 vs 1/9)","pmid":"28349233","doi":"10.1007/s10620-017-4540-z","diger_kaynak":"ClinicalTrials.gov NCT01037322 (no results in the registry; in the registry the arm description gives the dose as 2 × 5 mg sublingual drops a day and the inclusion criteria give 10 mg; the publication gives 2 × 10 mg a day)"},{"ad":"Naftali 2021 (Crohn’s)","tasarim":"Double-blind, placebo-controlled RCT","n":"56 randomized (30 cannabis oil, 26 placebo)","populasyon":"Crohn’s disease","urun":"CBD/THC oil 160/40 mg/mL (contains THC)","urun_turu":"thc_iceren","doz":"Started at 2 × 1 drop a day and increased based on benefit or side effects; upper limit 2 × 20 drops a day. According to secondary sources, one drop contained 8 mg CBD + 2 mg THC (at most 320 mg CBD + 80 mg THC a day); the median amount used in the cannabis group was 10 drops (0.5 mL; about 80 mg CBD + 20 mg THC, IQR 52–108 mg CBD), not stated whether per day or per dose","titrasyon":"Drop-by-drop increase based on benefit or side effects; upper limit 40 drops a day","sure":"8 weeks","sonuc":"CDAI fell from 282 to 166 with cannabis oil and from 264 to 237 with placebo (median; between-group p = 0.038); quality of life 91 vs 75 (p = 0.004). However, the groups differed in age, sex and disease duration (median age 28 vs 33); in the analysis adjusted for these, neither difference was significant (CDAI p = 0.072; quality of life p = 0.143), and the target of a 30-point improvement in quality of life was not met. Endoscopy score (SES-CD 10 to 7 and 11 to 8; p = 0.75), CRP and calprotectin did not change. The product was supplied by the manufacturing company; one of the authors is a company employee. The adjusted analysis and detailed numbers come from the data supplement of Jugl 2026, not from the full text of the main publication","yan_etki":"Not in the abstract. According to the main publication's side effect table (from the Jugl 2026 data supplement): blurred vision, confusion, forgetfulness and dizziness were more common with cannabis oil (e.g., confusion 4/16 vs 0/20, forgetfulness 6/14 vs 1/19, dizziness 5/15 vs 2/18); none of the differences was significant; the denominators vary by question","pmid":"33858011","doi":"10.1093/ecco-jcc/jjab069","diger_kaynak":"Secondary analysis (endocannabinoid levels): Tartakover Matalon 2021, PMID 34531823. Dosing schedule, amount used, adjusted analyses and side effect table from Table 1 and the data supplement of Jugl 2026 (PMID 42231518). No registration number in the abstract; the same center's registration NCT01826188 (THC + CBD drops in Crohn’s disease, 50 people, 2013–2018, registered concentration 50 mg/mL CBD + 5 mg/mL THC, no results in the registry) may be this study's registration; the link could not be verified"},{"ad":"Irving 2018","tasarim":"Multicenter pilot RCT","n":"60 randomized (29 CBD-rich extract / 31 placebo); 16 and 23 completed","populasyon":"Ulcerative colitis","urun":"CBD-rich botanical extract, capsule (THC up to 4.7%)","urun_turu":"thc_iceren","doz":"Started at 50 mg × 2/day, increased to 250 mg × 2/day if tolerated (100–500 mg/day)","titrasyon":"Dose increased over the first 2 weeks, then continued at the highest tolerated dose","sure":"10 weeks","sonuc":"Primary outcome (remission) negative: 28% vs 26%; in per-protocol patients, some subjective measures favored CBD. Sponsored by the company that makes the product","yan_etki":"Side effects in 100% of the CBD group (29/29) and 77% of the placebo group (24/31), mostly mild to moderate. Withdrawal due to side effects 10/29 vs 5/31. Serious side effects 0 with CBD, 4 with placebo. Some of the side effects were attributed to THC","pmid":"29538683","doi":"10.1093/ibd/izy002","diger_kaynak":"ClinicalTrials.gov NCT01562314 (n, dose and side effects from the registry); THC content from the Cochrane summary (Kafil 2018, PMID 30406638)"},{"ad":"Naftali 2026","tasarim":"Open-label, single-arm pilot study","n":"14 (9 completed)","populasyon":"Mild-to-moderate ulcerative proctitis not responding to at least 3 months of mesalamine","urun":"Synthetic CBD + sodium propionate enema (rectal); sodium propionate is not a cannabinoid but a separate active ingredient","urun_turu":"saf_cbd","doz":"1 enema a day (50 mL; 60 mg synthetic CBD + 70 mg sodium propionate)","titrasyon":null,"sure":"12 weeks","sonuc":"Reduction of ≥3 in Mayo score: 50% by intention to treat, 77% among those who completed the protocol; tissue (histologic) healing not significant; no control group. Funded by the manufacturing company; one of the authors is a company employee","yan_etki":"Mild side effects; 1 serious event unrelated to treatment","pmid":"42578019","doi":"10.1159/000552842","diger_kaynak":"The registration cited in the publication, NCT06353828, was opened after the study ended (March 2024) and describes a 45-person randomized, placebo-controlled phase 2a trial; it does not match this open-label pilot (no results in the registry)"},{"ad":"Kafil 2020 (Cochrane summary)","tasarim":"Journal summary of two Cochrane systematic reviews (5 RCTs, 185 people)","n":"185","populasyon":"Crohn’s disease and ulcerative colitis","urun":"Marijuana cigarettes, cannabis oil, CBD extract","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"No firm conclusions can be drawn; certainty of evidence ranges from 'very low' to 'moderate'. The search was run in 2018: the marijuana cigarette study in ulcerative colitis (Naftali 2021, ulcerative colitis) existed only as a conference abstract at the time; a 50-person study of CBD/THC oil in Crohn’s disease was also included using unpublished data (most likely the one later published as Naftali 2021, Crohn’s)","yan_etki":"Side effects more common in the cannabis groups","pmid":"31613959","doi":"10.1093/ibd/izz233","diger_kaynak":"Cochrane reviews: Kafil 2018, Crohn’s (CD012853; PMID 30407616) and ulcerative colitis (CD012954; PMID 30406638)"},{"ad":"Naftali 2013","tasarim":"Placebo-controlled RCT (triple-blind per the registry; Cochrane rated the blinding as high risk of bias)","n":"21 randomized (11 cannabis, 10 placebo)","populasyon":"Active Crohn’s disease (CDAI > 200) not responding to steroids, immunomodulators or anti-TNF therapy, Israel","urun":"THC-rich marijuana cigarette (115 mg THC per cigarette); placebo: cannabis flower with the THC removed","urun_turu":"thc_iceren","doz":"2 cigarettes a day","titrasyon":null,"sure":"8 weeks + 2 weeks of follow-up","sonuc":"The primary outcome (complete remission, CDAI < 150) was not significant: 5/11 vs 1/10 (p = 0.43; Cochrane: RR 4.55; 95% CI 0.63–32.56; very low certainty). Clinical response (a drop of more than 100 points in CDAI) 10/11 vs 4/10 (p = 0.028); in the cannabis group, 3 patients stopped steroids, and appetite and sleep improved. The abstract gives no endoscopy or inflammatory marker results. Cochrane: the cannabis group was older; blinding at high risk of bias","yan_etki":"The abstract states there were no significant side effects; according to Cochrane, side effects were more common in the cannabis group (RR 4.09; 95% CI 1.15–14.57; very low certainty): sleepiness, nausea, difficulty concentrating, forgetfulness, confusion, dizziness; all mild","pmid":"23648372","doi":"10.1016/j.cgh.2013.04.034","diger_kaynak":"ClinicalTrials.gov NCT01040910 (single registration for Crohn’s disease and ulcerative colitis; no results in the registry); letters PMID 24262941, 24269921 and authors' reply PMID 24418092"},{"ad":"Naftali 2021 (ulcerative colitis)","tasarim":"Double-blind, placebo-controlled RCT (single center)","n":"32 randomized (17 cannabis, 15 placebo); all completed","populasyon":"Adults with mild-to-moderate active ulcerative colitis (excluding disease limited to the rectum) who had not used cannabis before, Israel","urun":"THC-rich marijuana cigarette (0.5 g; 16% THC on analysis, about 80 mg THC, 0.1% CBD); placebo: marijuana with the THC removed","urun_turu":"thc_iceren","doz":"2 × 0.5 g cigarettes a day","titrasyon":"Half a cigarette (0.25 g) on the first day, increased in 0.25 g steps to 2 × 0.5 g a day","sure":"8 weeks + 2 weeks of follow-up","sonuc":"The primary outcome, the Lichtiger symptom score, fell from 10.9 to 5 with cannabis and from 11 to 8 with placebo (between-group p = 0.006; 0.001 in the abstract). Quality of life rose from 77 to 98 with cannabis and did not change with placebo (p = 0.026). No between-group difference in the endoscopic Mayo score (p = 0.374); CRP and calprotectin did not change. The cannabis was supplied by the producing company, and one of the authors is a company employee; according to the authors, at least 3 placebo patients thought they had received cannabis","yan_etki":"Cough 41% vs 20%, dizziness 35% vs 6%, confusion 29% vs 6%, difficulty stopping 29% vs 12%, behavior change 23% vs 0%; in these small groups none of these differences was statistically significant (p ≥ 0.27); none led to stopping treatment","pmid":"33571293","doi":"10.1371/journal.pone.0246871","diger_kaynak":"ClinicalTrials.gov NCT01040910 (registration shared with Naftali 2013: opened in December 2009 for Crohn’s disease and ulcerative colitis with an estimated 20 people, last updated December 2011; the design and results of this 32-person study are not in the registry); secondary analysis: Tartakover Matalon 2021, PMID 34531823 (endocannabinoid levels)"},{"ad":"Doeve 2021","tasarim":"Systematic review and meta-analysis (5 RCTs + 15 non-randomized studies)","n":"146 randomized patients in the remission meta-analysis","populasyon":"Crohn’s disease and ulcerative colitis (all ages searched; all RCTs in adults)","urun":"Cannabis and cannabinoids (cigarettes, oil, capsules)","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"No significant difference from placebo in remission (RR 1.56; 95% CI 0.99–2.46); no effect on inflammatory markers. Patient-reported symptoms such as abdominal pain, general well-being, nausea, diarrhea and appetite, and quality of life, improved. In observational studies, hospital stays were shorter and the need for parenteral (IV) nutrition was lower, with no difference in other complications. Search through August 2019; moderate risk of bias","yan_etki":"Not reported (in the abstract)","pmid":"32675631","doi":"10.1097/MCG.0000000000001393","diger_kaynak":null},{"ad":"Kang 2025","tasarim":"Meta-analysis of RCTs (8 studies: 4 Crohn’s disease, 3 ulcerative colitis, 1 both)","n":"Not reported (in the abstract)","populasyon":"Crohn’s disease and ulcerative colitis","urun":"Cannabinoids (CBD, THC-containing products)","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"Clinical disease activity decreased in Crohn’s disease (pooled effect −0.91; 95% CI −1.54 to −0.28; high heterogeneity, I² 72%); not significant in ulcerative colitis (−2.13; −4.80 to 0.55; I² 90%). Quality of life improved in both diseases; no difference in endoscopic activity or inflammatory markers. The abstract counts 8 studies, whereas the known number of separate RCTs on this topic is 5 (3 in Crohn’s disease, 2 in ulcerative colitis): secondary analyses of the same patients or conference abstracts may have been counted separately. The effect measures in the abstract are labeled 'risk ratio' but have negative values. Full text could not be read; the list of included studies could not be verified","yan_etki":"Not reported (in the abstract)","pmid":"39197096","doi":"10.1093/ibd/izae158","diger_kaynak":null},{"ad":"Jugl 2026","tasarim":"Systematic review (GRADE; 4 RCTs + 4 observational studies; no meta-analysis)","n":"4 RCTs (21–60 people; the pure CBD study without THC was out of scope) + 4 observational studies (Desai 2019, the two Mbachi 2019 analyses, Coates 2022)","populasyon":"Crohn’s disease and ulcerative colitis (adults)","urun":"THC-containing cannabis products (marijuana cigarette, CBD/THC oil, CBD-rich capsule that also contains THC)","urun_turu":"thc_iceren","doz":null,"titrasyon":null,"sure":null,"sonuc":"No difference from placebo in remission (3 RCTs, 150 people), endoscopic score, IBDQ, nausea or weight; mixed results for disease activity score, quality of life and pain; bloating and appetite improved in one study only (low quality of evidence). For the Crohn’s oil study, the authors' analysis adjusted for age, sex and disease duration was used. All RCTs had a high risk of bias; the observational studies were not included in the evidence assessment because of serious or critical risk of bias. Conclusion: the benefit of THC-containing products is uncertain. Search February 2023; repeated for RCTs through February 2026, with no new RCTs found. Funded by the US Food and Drug Administration (FDA)","yan_etki":"Limited safety information in the RCTs","pmid":"42231518","doi":"10.1186/s42238-026-00456-2","diger_kaynak":"PROSPERO CRD42023411910"},{"ad":"CAG 2019 (Andrews)","tasarim":"Professional society position statement (Canadian Association of Gastroenterology; non-comprehensive literature review and expert opinion; no formal evidence grading of the statements)","n":null,"populasyon":"Digestive and liver diseases; this row reports the inflammatory bowel disease (Crohn’s, ulcerative colitis) section and the general statements","urun":"Cannabis and cannabinoids","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"Inflammatory bowel disease statement: based on the evidence at the time, cannabis does not appear to change the course of the disease for better or worse. Commentary: evidence that cannabis reduces objective measures of inflammation is largely lacking and limited to studies too small to show a clinically meaningful difference; the evidence is insufficient to recommend cannabis as a treatment that reduces inflammation; large RCTs with standardized products, objective outcomes and long follow-up are needed. General statement: cannabis should not be used in place of approved treatment for any digestive or liver disease when approved treatment is available and has not yet been tried; use alongside approved treatment for symptoms only may be reasonable if the risk of harm appears low. The document notes that three Israeli studies were supported by a cannabis-producing company, and it reports the marijuana cigarette study in ulcerative colitis from what was then only a 28-patient conference abstract (the abstract had reported endoscopic improvement; in the same team's full 32-patient paper published in 2021, Naftali 2021, endoscopy showed no difference from placebo). The statement was written in 2018; it does not cover later RCTs and reviews","yan_etki":null,"pmid":"31294362","doi":"10.1093/jcag/gwy064","diger_kaynak":"PMC6507278 (full text read). According to the conflict-of-interest statement, 3 of the 7 authors have ties to companies that make cannabis or cannabinoid products (advisory board and executive role; research support and donated product; speaker fees and advisory board). The same document also appears in the irritable bowel and stomach table"},{"ad":"Gupta 2024","tasarim":"Patient registry analysis (no control group)","n":"116","populasyon":"Patients with Crohn’s disease and ulcerative colitis prescribed cannabis-based medicines (UK Medical Cannabis Registry; 81% male)","urun":"Cannabis-based medicinal products (containing THC and CBD; product details not given in the abstract)","urun_turu":"thc_iceren","doz":"Not reported (in the abstract)","titrasyon":null,"sure":"18 months","sonuc":"IBD-specific quality of life (SIBDQ), anxiety (GAD-7), sleep and general quality of life improved at month 18 compared with baseline (p < 0.001); 26% (30 patients) reached a clinically meaningful improvement on the SIBDQ, more often in those with severe anxiety at baseline and those taking above-median THC. No control group; the authors state that cause and effect cannot be inferred","yan_etki":"155 side effects in total in 20 patients (17%)","pmid":"39689344","doi":"10.1080/17474124.2024.2443574","diger_kaynak":"Earlier analysis of the same registry: Dalavaye 2023, PMID 36562418 (76 patients, 3 months; overlapping sample)"},{"ad":"Fliss Isakov 2023","tasarim":"Prospective case series (no control group)","n":"149 started; 88 assessed at month 3, 74 at month 6","populasyon":"Patients with Crohn’s disease (72%), ulcerative colitis and pouchitis starting medical cannabis (Israel, single center)","urun":"Medical cannabis flower, oil or both (contains THC and CBD)","urun_turu":"thc_iceren","doz":"Mean prescribed THC 1.7 ± 1.3 g/month, CBD 2.4 ± 0.9 g/month","titrasyon":null,"sure":"6 months","sonuc":"At month 3, a non-significant increase in appetite score (p = 0.08); energy and nutrient intake and body mass index did not change. Among the 50 patients started on cannabis to increase appetite, appetite rose clearly in one third (17), but calorie intake and weight did not change; in this group, those whose appetite did not increase had a lower body mass index at month 6. Half of the patients dropped out of follow-up by month 6; no control group. Disease activity was not the subject of this publication","yan_etki":"At month 3, 63% of patients (55/88) reported a side effect; 31% stopped treatment or reduced the dose","pmid":"38201908","doi":"10.3390/nu16010078","diger_kaynak":null},{"ad":"Storr 2014","tasarim":"Cross-sectional survey (comparison of patients who use and do not use cannabis)","n":"313","populasyon":"Consecutive patients with Crohn’s disease and ulcerative colitis (Calgary, Canada)","urun":"Self-directed cannabis use (96% by inhalation)","urun_turu":"thc_iceren","doz":null,"titrasyon":null,"sure":null,"sonuc":"17.6% of patients had used cannabis for bowel symptoms; they reported improvement in abdominal pain, cramping, joint pain and diarrhea. In Crohn’s disease, use for more than 6 months was associated with needing surgery (OR 5.03; 95% CI 1.45–17.46; adjusted for demographic factors, smoking, disease duration and biologic drugs); there was no association with hospitalization in the past year. Survey-based and retrospective; no adjustment for disease severity (according to the abstract), and patients with more severe disease may use cannabis longer (reverse causation); does not show cause and effect. The number of Crohn’s patients using cannabis is not given in the abstract","yan_etki":"Side effects were commonly reported (no numbers in the abstract)","pmid":"24407485","doi":"10.1097/01.MIB.0000440982.79036.d6","diger_kaynak":null},{"ad":"Glickman 2024","tasarim":"Retrospective cohort, propensity score–matched (TriNetX health records network, US)","n":"Not reported (in the abstract)","populasyon":"Crohn’s disease and ulcerative colitis; cannabis users versus non-users","urun":"Cannabis use in health records (definition and product not given in the abstract)","urun_turu":"thc_iceren","doz":null,"titrasyon":null,"sure":null,"sonuc":"Cannabis users had more steroid use (RR 1.10; 95% CI 1.02–1.17), emergency department visits (RR 2.14; 2.03–2.26), hospitalizations (RR 1.93; 1.78–2.08) and opioid use (RR 1.35; 1.14–1.60); there was no difference in disease-related surgery or death. Results were similar when Crohn’s disease and ulcerative colitis were looked at separately; the increase in steroid and opioid use was seen only in Crohn’s disease. How cannabis use was identified is not stated in the abstract. Observational; the authors write that it is unclear whether these risks stem from disease severity or from other factors; does not show cause and effect","yan_etki":null,"pmid":"37580878","doi":"10.1093/ibd/izad151","diger_kaynak":"Commentary and letters: PMID 37580879, 37738592, 37738640, 39241176, 39361966"},{"ad":"Desai 2019","tasarim":"Retrospective, propensity score–matched analysis (US National Inpatient Sample, 2010–2014); two Mbachi 2019 analyses using overlapping years of the same database are also covered in this row","n":"6,002 Crohn’s admissions (2,999 cannabis users) and 1,481 ulcerative colitis admissions (742 cannabis users); Mbachi 2019: 615 Crohn’s and 298 ulcerative colitis users, with matched non-users","populasyon":"Hospitalized patients with Crohn’s disease and ulcerative colitis; those with versus without a diagnosis code for cannabis use or dependence","urun":"Recreational cannabis use (by diagnosis codes)","urun_turu":"thc_iceren","doz":null,"titrasyon":null,"sure":null,"sonuc":"In Crohn’s disease, cannabis users had less colorectal cancer (0.3% vs 1.2%), parenteral (IV) nutrition and anemia; fistula or intra-abdominal abscess (8.6% vs 5.9%), lower gastrointestinal bleeding and fluid loss were more common. In ulcerative colitis, fluid and electrolyte disorders were more common. In both diseases, hospital stays were shorter. The Mbachi 2019 analyses of the same database, which excluded people using other substances, found the opposite for fistula or abscess in Crohn’s disease: less common (11.5% vs 15.9%); colon surgery was less common in Crohn’s disease (3.7% vs 7.5%) and in ulcerative colitis (4.4% vs 9.7%). That the same data give opposite results with different selections shows how fragile these analyses are. Cannabis use was identified by diagnosis codes (abuse or dependence); cross-sectional; disease severity and medications could not be taken into account; Jugl 2026 rated the risk of bias of the three analyses as critical; does not show cause and effect","yan_etki":null,"pmid":"31355219","doi":"10.21037/atm.2019.04.63","diger_kaynak":"Separate analyses of the same database with overlapping years: Mbachi 2019, Crohn’s (Dig Dis Sci, PMID 30825109; 2012–2014; commentary PMID 31388856) and ulcerative colitis (Medicine (Baltimore), PMID 31393356, PMC6708902; 2010–2014; correction notice concerns an author name only: PMID 31464963)"}],"son_inceleme":"2026-10-28","arastirma_gecmisi":[{"tarih":"2026-10-19","not":"Page published. This first review examined 4 studies."},{"tarih":"2026-10-21","not":"The full texts of the studies were reread and the information on the page was checked against the sources. Corrected: the registry number, number of participants, side effect and dose information in the study table; the dose range in the studies. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-21","not":"PubMed and ClinicalTrials.gov were searched for newly published and previously missed clinical studies. Study added: Naftali 2026. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-22","not":"The names of the result labels were simplified: the \"No benefit seen\" label on this page became \"No effect found\". The assessment did not change."},{"tarih":"2026-10-27","not":"In October 2026, PubMed, Cochrane, ClinicalTrials.gov and Europe PMC were searched systematically; 10 studies were added: one randomized trial each with THC-rich marijuana cigarettes in Crohn’s disease and ulcerative colitis, 3 systematic reviews and meta-analyses, 2 studies following patients in real life, and 3 observational studies linking cannabis use to surgery, hospital admission and disease complications. In existing rows, the following were corrected: the dosing schedule, outcome numbers and adjusted analysis of the CBD/THC oil in Crohn’s disease; the serious event information and registry number of the pure CBD study; and the CBD amount, funding, registry information and product type of the ulcerative proctitis enema; citations for the Cochrane reviews were added. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-28","not":"Display fix: leftover internal working file names were removed from the text; content and evidence did not change."},{"tarih":"2026-10-28","not":"Display fix: internal working notes left over from the previous cleanup were removed; content and evidence did not change."},{"tarih":"2026-10-28","not":"October 2026 additional review: sources found for this page during the searches for other topics were read and added to the page. The 2019 position statement of the Canadian Association of Gastroenterology was added to the table. Based on the evidence at the time it was written, the statement says that cannabis did not appear to change the course of Crohn’s disease and ulcerative colitis and that the evidence is insufficient to recommend it as a treatment that reduces inflammation; it also recommends that cannabis not be used in place of approved treatments. The statement is expert opinion without a formal grading of evidence. The evidence summary and the reviews paragraph were updated accordingly. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-31","not":"The last sentence of the page's short summary was rewritten in a calmer, more guiding tone: instead of \"Talk to your doctor before you start.\", it now says whom you can talk with, and about what, if you are considering CBD. The conclusion and the strength of evidence did not change."}]},{"id":"ms-spasticity","baslik":"Multiple sclerosis (MS) spasticity","grup":"Other","grup_kodu":"diger","tr_id":"ms-spastisite","kanit_duzeyi":"zayif","kanit_yonu":"yarar_gosterilmedi","kanit_ozet":"Most of the evidence in MS spasticity concerns the prescription THC:CBD medicine nabiximols (Sativex): it increases the number of people reporting a significant reduction in spasticity in the short term (moderate certainty), with little or no effect on quality of life; the difference in doctor-measured muscle tone, however, is very small or absent (Cochrane: −0.23 points on the Ashworth scale, low certainty); in a 2024 RCT (68 people) with muscle tone as the primary endpoint there was no difference from placebo, and a small difference was found only in its 31-person companion study of the same design, whose results were published only on ClinicalTrials.gov; in the same program's 137-person parallel study, there was no difference in the number of muscle spasms that patients recorded in a diary (these two studies were stopped early by a business decision of the sponsor). The largest differences come from studies that first gave the drug to everyone and then randomized those who responded (enriched designs); a 2026 review of 27 studies through the end of 2025 rated the certainty of the patient-reported benefit as low. In the largest study with oral cannabis extract or synthetic THC (CAMS, 630 people), there was no difference in doctor-measured spasticity, but patient-reported spasticity improved; in the 279-person MUSEC trial, the number of people reporting relief of muscle stiffness was about twice that with placebo (29.4% vs. 15.7%). For pure CBD, there are only two small, short RCTs (55 people in total received pure CBD): in the study that raised the dose to 80 mg/day over 4 weeks (49 people), spasticity was no different from placebo, and only the walking test and peak pain improved more; in the CBD arm that took up to 45 mg/day for 6 weeks (31 people), there was no difference in spasticity or pain. Higher doses have not been tested in controlled parallel studies. Oral synthetic THC (dronabinol) did not slow disease progression over 3 years in progressive MS (498-person RCT). Nabiximols results cannot be applied to pure CBD oil. Two RCTs looked specifically at bladder problems caused by MS, both with THC-containing products: in the CAMS bladder substudy, incontinence frequency adjusted for baseline imbalance decreased by 38% with cannabis extract, by 33% with THC, and by 18% with placebo (both active groups significantly better than placebo; absolute difference vs. placebo 0.21 and 0.16 episodes a day, as calculated by Torres-Moreno 2018); in the 135-person nabiximols RCT done specifically for the bladder (8 weeks, sponsored by the manufacturer), there was no difference in the primary outcome, the daily number of incontinence episodes (−0.11; 95% CI −0.47 to 0.26), while secondary measures such as nighttime urination, the daily number of urinations, and the patient's overall bladder assessment favored nabiximols. Two large RCTs that assessed the bladder as a secondary measure found no difference: in Wade 2004 (160 people, spray), on the bladder problem VAS (difference −6.3; 95% CI −14.9 to 2.4; p = 0.15) and on the bladder control test (p = 0.89; ClinicalTrials.gov result), and in CUPID (498 people, 3 years, oral THC), on secondary measures including the bladder (full report; Torres-Moreno 2018). In the 2018 meta-analysis pooling placebo-controlled RCTs, the effect on bladder function was very small (standardized mean difference −0.11; 95% CI −0.22 to −0.0008) and was not significant once the studies supported by the manufacturer were removed. The MS-specific 2017 meta-analysis (2 RCTs and 1 study without a comparison group, 426 patients) reported a reduction in urinary incontinence but considered the evidence base weak; from the abstract it is not clear what its pooled figure (−0.35 episodes a day) compares with what, and this figure is larger than the differences vs. placebo in the included RCTs (0.11–0.21 a day). A 2026 scoping review (12 studies, 3 of them RCTs) also found the evidence limited and largely observational. In three small studies without a comparison group (15–31 people; Brady 2004, PMID 15327041; Maniscalco 2018, PMID 29052091; Torri Clerici 2023, PMID 37062198), urinary symptoms and some urodynamic measures improved. There are no bladder studies of pure CBD in MS. In a controlled study of 40 people with MS who had smoked cannabis almost daily for a long time and had cognitive impairment (groups were assigned by registration number, not randomly), those who stopped for 28 days showed clear improvement on tests of memory, processing speed, and executive function, while those who continued did not (Feinstein 2019). The UK national guideline (NICE, 2019) recommends a 4-week trial of the THC:CBD spray for moderate to severe MS spasticity that has not improved with other medicines, and continuing it if patient-reported symptoms decrease by at least 20%; the committee judged most of the evidence to be of low quality and noted that the evidence for other cannabis products was much more limited. The American Academy of Neurology's guideline on complementary therapies in MS (2014; reaffirmed on February 21, 2026) lists oral cannabis extract (level A), THC, and the THC:CBD spray (level B) as options for patient-reported spasticity symptoms and pain (excluding central neuropathic pain); it states that these products are probably ineffective for doctor-measured spasticity, and that the spray is probably helpful for urinary frequency and probably ineffective for urinary incontinence (level B); the guideline is based on studies up to September 2013. October 2026 search (PubMed, Cochrane, ClinicalTrials.gov): 25 randomized controlled trials examining spasticity or the course of the disease with cannabinoids in people with MS (three with results only in the ClinicalTrials.gov registry) and more than 20 systematic reviews asking the same question were found; all of the randomized trials, the 3 most comprehensive reviews, and 3 large real-world and safety registries from different countries are in the table below. Only two of the randomized trials tested pure CBD. In an additional October 2026 search (bladder problems in MS only; PubMed and ClinicalTrials.gov), the only separate RCT on bladder problems, two reviews on this topic, and the American Academy of Neurology's MS guideline were added to the table; the CAMS bladder substudy is in the CAMS row, the bladder results of the other RCTs in the table and of the 2018 meta-analysis are in their own rows, and the three small bladder studies without a comparison group are mentioned only in this text. The NICE guideline and the controlled study of the effect of stopping on thinking skills in long-term cannabis users were also added to the table. Trials in MS done only for pain were not included in this table; no studies from Turkey were found. In an additional October 2026 search (MS-related tremor and ataxia only; PubMed, Cochrane, ClinicalTrials.gov, Europe PMC), the only randomized study that looked specifically at tremor (Fox 2004: 14 people, crossover, oral cannabis extract; no difference from placebo on objective tremor measures, finger tapping faster with placebo), an 8-person THC study without a comparison group (open-label) (Clifford 1983; improvement in coordination on examination in 2 patients) and a systematic review on this topic (Pourmohammadi 2022; did not recommend cannabis-based medicines) were added to the table; the tremor result of Wade 2004 (no difference in the patient-reported tremor score: −6.85; 95% CI −20.31 to 6.60) was written into its own row. There are no studies of pure CBD in MS-related tremor; the evidence for tremor is weak.","kanit_duzeyi_metin":"Pure CBD: weak (two small, short RCTs, both negative for spasticity; low doses: 45–80 mg/day)","kanit_duzeyi_thc_icerenler":"orta","kanit_duzeyi_thc_icerenler_metin":"Nabiximols: moderate (benefit in patient-reported spasticity; certainty moderate in Cochrane 2022, low in a 2026 review; difference in doctor-measured muscle tone very small or absent); MS-related tremor: weak (a single 14-person RCT looking specifically at tremor and a secondary tremor measurement in one RCT; no difference in either)","kaynak_dosya":"diger-hastaliklar.md","saf_cbd_sonuc":"In two small RCTs, pure CBD did not reduce spasticity more than placebo (45–80 mg/day, 4–6 weeks); one study found improvement in a walking test and in peak pain. Pure CBD has never been tested for MS-related bladder problems or tremor.","thc_icerenler_sonuc":"Nabiximols (THC:CBD about 1:1, prescription) reduces perceived spasticity in the short term (OR 2.51; pooled from four spray studies and one oral cannabis extract study; moderate certainty, a 2026 review rated certainty as low); the difference in doctor-measured muscle tone is very small or absent (low certainty; the 2024 RCT was negative, its unpublished 31-person companion study was positive); in the same program's unpublished 137-person study, there was no difference in the number of muscle spasms patients recorded in a diary; results with oral cannabis extract and THC are mixed (in the largest study, benefit only in patient reports); nervous system and psychiatric side effects may be increased. In MS-related tremor, oral cannabis extract (14-person crossover RCT) and THC:CBD spray (tremor measurement in a 160-person RCT) were no different from placebo.","ruhsat":"Pure CBD is not approved for MS spasticity. Nabiximols (a mouth spray containing THC and CBD; 2.7 mg THC + 2.5 mg CBD per spray) is approved in many countries, including the United Kingdom (in 29 countries, according to a 2024 publication by authors from the manufacturer), as an add-on to existing treatment for moderate to severe MS spasticity in adults who have not responded adequately to other spasticity medicines and who show clear improvement during an initial trial period. Treatment is started and supervised by a specialist doctor experienced in treating these patients. Dosing schedule in the product information: 1 spray in the evening on day 1; a morning dose is added on day 5; the daily number is increased gradually up to a maximum of 12 by day 14 (at least 15 minutes between sprays); in clinical studies, the median was 8 sprays/day; more than 12 a day is not recommended. If there is no clinically meaningful improvement in spasticity symptoms after 4 weeks (at least 20% on a 0–10 scale in studies), treatment is stopped. Not recommended under 18 years of age or in moderate or severe liver impairment. Source: UK product information (text revision April 2, 2026) §4.1, §4.2. Turkey: the active substance (tetrahydrocannabinol and cannabidiol, oromucosal spray) is on the Foreign Active Substance List of TİTCK (Turkish Medicines and Medical Devices Agency) (September 28, 2026), among medicines that require a red prescription and can be imported with the agency's written approval.","doz_araligi_ozet":"Pure CBD 45–80 mg/day (4–6 weeks); nabiximols up to 12 sprays a day (32.4 mg THC + 30 mg CBD); mean 8.3 sprays/day in Novotna 2011; mean 6.4–12.4 sprays/day in the other spray studies; oral cannabis extract and THC capsules up to 10–30 mg THC/day (CAMS and MUSEC 25 mg, CUPID 28 mg)","titrasyon_ozet":"Mousavi 2025: from 5 mg/day to 70 mg/day over 2 weeks, then 80 mg/day; Hansen 2023: standard 3-week titration; Bethoux 2024: 14 days of dose adjustment in each period; nabiximols product information: start with 1 spray in the evening on day 1, increase the number gradually up to a maximum of 12 by day 14 (at least 15 minutes between sprays), stop if there is no clear improvement at 4 weeks (at least 20% on a 0–10 scale in studies); MUSEC: from 5 to 25 mg THC/day over 2 weeks","yan_etkiler":["In healthy volunteers, CBD increased the risk of diarrhea (RR 5.85); a non-significant trend toward more abdominal pain and headache (Sawaira 2026, PMID 41789242)","Psychiatric and nervous system side effects are more common with THC-containing products (Filippini 2022); the likelihood of side effects increased with any cannabinoid (OR 1.75; Wilson 2026, PMID 41856154)","Long-term use of the THC:CBD spray (open-label follow-up and registries): in a 137-patient extension study (mean 434 days), 4 patients had a first-ever seizure (Wade 2006); in the 1,615-patient Italian registry, the main reasons for stopping because of side effects within 6 months were cognitive and psychiatric complaints such as confusion, fatigue, drowsiness, and dizziness (Patti 2016); in the manufacturer's 941-patient safety registry, 6% clinically significant psychiatric side effects and 6% falls requiring medical care were reported, with no signal of dependence or abuse (Etges 2016; all authors were employees of the manufacturer)","In people with MS and cognitive impairment who had smoked cannabis almost daily for a long time (mainly THC according to urine tests) (40 people, controlled but not randomized), those who stopped for 28 days showed clear improvement on tests of memory, processing speed, and executive function, while those who continued did not; those who stopped did not notice this improvement in their own assessments, and all of them went back to cannabis after the study ended (Feinstein 2019; Feinstein 2021, PMID 34087949)"],"izlem":["CANSEP in Canada (NCT05092191): pure CBD (up to 200 mg a day), THC, and the two together vs. placebo; 250 people planned, participant-blinded only; primary outcome patient-reported spasticity. The registry was last updated in December 2024; no results as of October 2026","DroSpas-1 (NCT03756974): a 397-person phase 3 placebo-controlled study of oral dronabinol was completed in March 2021; as of October 2026, there are no results in the registry and no publication was found in PubMed","A double-blind study in Canada (University of Calgary) comparing oral THC with CBD for 15 weeks in 30 people with MS, with thinking skills and bladder symptoms as the main outcomes (NCT06261489; no placebo group): started in December 2025, estimated completion September 2027; as of October 2026, the registry shows 'recruiting'"],"dikkat":["High doses and market doses cannot be compared: in low-dose (≤175 mg/day) studies, plasma levels were 5–100 times lower than with the 20 mg/kg Epidiolex dose (Warren 2026, PMID 42473010)","Anyone taking long-term medicines should consult a doctor before starting; the studies on this page did not systematically assess interactions","Nabiximols is a prescription THC:CBD medicine; THC carries driving, cognitive, and psychiatric risks","Product information for the THC:CBD spray: not to be used if the person or their family has a history of schizophrenia or other psychosis, or during breastfeeding; not recommended in serious cardiovascular disease; use with caution in people with a history of epilepsy or recurrent seizures; an additional contraceptive method is needed because it may reduce the effectiveness of hormonal contraceptives; the risk of falls may increase in people whose muscle strength is insufficient once spasticity decreases; do not drive while dizzy or drowsy (UK product information, April 2, 2026, §4.3–4.7)"],"ilac_etkilesim_notlari":["The studies on this page did not systematically assess drug interactions; details are in the site's drug interactions section","Product information for the THC:CBD spray (§4.5): strong CYP3A4 inhibitors such as ketoconazole raise THC and CBD levels (the dose may need to be readjusted if itraconazole, ritonavir, or clarithromycin is started or stopped); fluconazole increases THC exposure; strong inducers such as rifampin, carbamazepine, phenytoin, phenobarbital, and St. John's wort should be avoided if possible; sedative effects and fall risk may increase with sleep medicines, muscle relaxants, and alcohol; hormonal contraceptives may become less effective"],"dogrulanamayan":["The full text of Novotna 2011 was not read (paywalled); dose from the ClinicalTrials.gov registry and product information, mean number of sprays from review tables","The full text of Mousavi 2025 could not be read (no publisher access); blinding, side effects, and the product's THC content are not in the abstract","The full text of Bethoux 2024 could not be read; the mean number of sprays taken is not in the abstract or the registry (the registry gives only a maximum of 12 sprays a day and 14 days of dose adjustment); side effect counts from the ClinicalTrials.gov registry (NCT04657666)","RELEASE MSS3 (NCT04203498) and RELEASE MSS5 (NCT04984278) were stopped early by a business decision of the sponsor; their results are only in the ClinicalTrials.gov registry, with no peer-reviewed publication as of October 2026; for MSS5, the registry gives only the dosing schedule (up to 12 sprays within 14 days), not the mean dose taken. The data from the UC Davis study (NCT00682929) were never statistically analyzed","The full texts of Wade 2003, Wade 2004, Collin 2007, Collin 2010, Notcutt 2012, Markovà 2019, CAMS, MUSEC, Vaney 2004, Killestein 2002, Leocani 2015, and Flachenecker 2014 could not be read (paywalled); figures from abstracts, ClinicalTrials.gov results, product information, and the tables of Cochrane 2022 and Torres-Moreno 2018. In Wade 2004, the difference on the spasticity scale was significant in the publication's abstract (p = 0.001) and borderline in the registry analysis (p = 0.062)","Vachová 2013 was published in a journal not indexed in PubMed and could not be read; the row is based on ClinicalTrials.gov results (NCT01964547). The first THC study in 1981 (Petro 1981, 9 patients, single dose) was not included in the table: it could not be confirmed from the abstract whether it was randomized or whether the patients had MS (Cochrane 2022 counted it as a non-randomized study)","The full texts of the bladder studies added in the additional October 2026 search (Kavia 2010, the CAMS bladder substudy Freeman 2006, Abo Youssef 2017, Cheng 2026) and of Feinstein 2019 could not be read (paywalled); figures from abstracts, ClinicalTrials.gov results (NCT00678795; NCT01610700 for Wade 2004), and the open-access full text of the 2018 meta-analysis (Torres-Moreno 2018). In Kavia 2010, the p values for the daily number of urinations and the patient's global impression of change differ between the publication's abstract (0.001 and 0.005) and the registry (0.007 and 0.002); the number of people in the CAMS bladder substudy is not in the abstract. From the abstract, it is not clear what the pooled figure in Abo Youssef 2017 (−0.35 a day) compares with what; which studies entered the bladder analysis of the 2018 meta-analysis is shown only in a figure, and the figure could not be opened. NICE's spasticity evidence review could not be opened because it required human verification; the guideline's recommendation, rationale, and research recommendation pages were read. Only the abstract of the American Academy of Neurology guideline was read.","The full texts of Fox 2004, Clifford 1983 and Pourmohammadi 2022, added for MS-related tremor, could not be read (paywalled; Clifford 1983's publisher page blocked access); the numbers are from the abstracts. Fox 2004's dose, period lengths and side effects are not in the abstract; the information on side effects and blinding in the row is as reported by two reviews (Koch 2007, Kluger 2015). That Clifford 1983 was open-label (no comparison group), the amount of THC and the number of subjective improvements also come from the same two reviews; the length of the study is not known. Which cannabinoid studies Pourmohammadi 2022 included is not clear from the abstract. The tremor results of the CAMS study are reported only in a secondary review and were not included because they could not be verified from the primary source; whether the 2007 Cochrane review on ataxia included any cannabinoid studies is not clear from the abstract."],"calismalar":[{"ad":"Mousavi 2025","tasarim":"Randomized, placebo-controlled study (blinding not stated in the abstract)","n":"49 (24 CBD / 25 placebo)","populasyon":"People with MS who have walking difficulty due to spasticity (Iran)","urun":"Purified CBD, oral drops","urun_turu":"saf_cbd","doz":"From 5 mg/day to 70 mg/day over 2 weeks, 80 mg/day in weeks 3–4","titrasyon":"Gradual increase over 2 weeks (details not in the abstract)","sure":"1 month (spasticity measured at weeks 4 and 8)","sonuc":"Spasticity severity did not differ between groups; the time on the 7.6-meter (25-foot) timed walk test (p=0.031) and peak pain (p=0.033) decreased more with CBD","yan_etki":"Not reported (in the abstract)","pmid":"40498097","doi":"10.1007/s00210-025-04347-w","diger_kaynak":null},{"ad":"Hansen 2023","tasarim":"Multicenter, double-blind, placebo-controlled, 4-arm parallel RCT (THC / CBD / THC+CBD / placebo)","n":"134 (MS 119, spinal cord injury 15; CBD 31, THC 32, THC+CBD 31, placebo 40)","populasyon":"Neuropathic pain and/or spasticity due to MS or spinal cord injury (Denmark)","urun":"Oral capsules: synthetic pure CBD; THC; the two together","urun_turu":"saf_cbd","doz":"CBD up to 45 mg/day, THC up to 22.5 mg/day (divided into 3 doses a day, up to 9 capsules)","titrasyon":"Standard titration over 3 weeks; patients stayed at a lower dose if they had sufficient effect or side effects","sure":"6 weeks + 1 week of tapering","sonuc":"In the pure CBD group, improvement in spasticity did not differ from placebo (difference 0.46 points; 95% CI −0.74 to 1.65); there was also no difference in the THC (0.24; −0.67 to 1.45) and THC+CBD (0.10; −1.18 to 1.39) groups; no group differed from placebo in neuropathic pain either. Spasticity was assessed in the 100 patients who met the criterion; only 134 of the targeted 448 people could be enrolled","yan_etki":"Side effects most common in the THC-containing arms; dry mouth 29% with CBD, 27.5% with placebo; 1 hospitalization in the CBD arm (gallstone attack)","pmid":"37630995","doi":"10.3390/ph16081079","diger_kaynak":"EudraCT 2018-002315-98"},{"ad":"Wade 2003","tasarim":"Double-blind, placebo-controlled, randomized series of single-patient crossover trials","n":"24 (18 MS, 4 spinal cord injury, 2 other)","populasyon":"Patients with neurological symptoms (pain, spasticity, muscle spasms, bladder problems) not responding to standard treatment; most with MS (United Kingdom)","urun":"Sublingual spray: THC-rich, CBD-rich, and 1:1 THC:CBD plant extracts, and placebo","urun_turu":"karma","doz":"2.5–120 mg per 24 hours (based on symptoms and unwanted effects)","titrasyon":"Self-titrated by the patient","sure":"2-week periods for each product (four periods)","sonuc":"Pain decreased significantly more than with placebo with both the THC-rich and the CBD-rich extract. Bladder control, muscle spasms, and spasticity improved with the extracts in some patients; a separate spasticity result by product and the THC content of the CBD extract are not in the abstract. Cochrane 2022 did not include it in the review because no separate data were given for patients with MS; in the 2026 network meta-analysis, the CBD-rich extract was not significantly different from placebo. Very small","yan_etki":"With the THC-containing extract, transient drops in blood pressure and intoxication in 3 patients during rapid initiation; unwanted effects were generally well tolerated (abstract)","pmid":"12617376","doi":"10.1191/0269215503cr581oa","diger_kaynak":null},{"ad":"Novotna 2011","tasarim":"Phase 3, enriched design, double-blind RCT","n":"572 enrolled; 241 randomized (124 nabiximols / 117 placebo)","populasyon":"Resistant MS spasticity","urun":"Nabiximols mouth spray, add-on treatment","urun_turu":"thc_iceren","doz":"2.7 mg THC + 2.5 mg CBD per spray; up to 12 sprays a day (32.4 mg THC + 30 mg CBD). Mean: 6.9 sprays/day in the single-blind phase, 8.3 sprays/day in the randomized phase (~22.4 mg THC + 20.8 mg CBD)","titrasyon":null,"sure":"4-week single-blind trial + 12 weeks randomized","sonuc":"Significant difference in favor of nabiximols in spasticity NRS (0.84 points on a 0–10 scale; 95% CI 0.40–1.29; p=0.0002). Only those who responded in the first 4 weeks were randomized; this design makes the effect look larger than it would be across all people with MS. No significant difference on objective measures (Ashworth, 10 m walk) (ClinicalTrials.gov)","yan_etki":"In the randomized phase, serious side effects 6/124 vs. 1/117; vertigo 7 vs. 1, fatigue 6 vs. 1 (ClinicalTrials.gov)","pmid":"21362108","doi":"10.1111/j.1468-1331.2010.03328.x","diger_kaynak":"ClinicalTrials.gov NCT00681538; Sativex product information; mean number of sprays from review tables (PMC6324456, PMC8214588)"},{"ad":"Bethoux 2024 (RELEASE MSS1)","tasarim":"Phase 3, multicenter, double-blind, placebo-controlled crossover RCT","n":"68","populasyon":"People with MS whose lower limb spasticity persisted despite an oral antispastic medicine","urun":"Nabiximols (THC:CBD mouth spray, prescription)","urun_turu":"thc_iceren","doz":"Up to 12 sprays a day; 14 days of dose adjustment in each period, then 7 days at a stable dose (ClinicalTrials.gov); mean dose taken not reported","titrasyon":"14 days of dose adjustment + 7 days at a stable dose in each period","sure":"2 × 3 weeks","sonuc":"No difference from placebo in doctor-measured muscle tone (MAS LLMT-6) (difference 0.04; p=0.72); a different result from earlier studies using patient-reported measures; in the 31-person companion study using the same measure (RELEASE MSS5; stopped early, results only in the registry), there was a small but significant difference (−0.29; 95% CI −0.48 to −0.10)","yan_etki":"Any side effect 27/66 vs. 15/65; dizziness 10 vs. 1, fatigue 5 vs. 1; serious side effects 1 vs. 1 (ClinicalTrials.gov); according to the authors, consistent with the known safety profile","pmid":"39106541","doi":"10.1016/j.msard.2024.105740","diger_kaynak":"ClinicalTrials.gov NCT04657666"},{"ad":"Zajicek 2013 (CUPID)","tasarim":"Multicenter, parallel, double-blind, placebo-controlled RCT (2:1)","n":"498 randomized (dronabinol 329, placebo 164 received at least one dose)","populasyon":"Primary or secondary progressive MS, aged 18–65 years (United Kingdom)","urun":"Oral synthetic THC (dronabinol)","urun_turu":"thc_iceren","doz":"Up to 28 mg/day; adjusted based on body weight and side effects","titrasyon":"Based on weight and side effects","sure":"36 months","sonuc":"No difference from placebo in EDSS progression (HR 0.92; 95% CI 0.68–1.23; p = 0.57); no difference on the MSIS-29 physical subscale (−0.9; −2.0 to 0.2). No significant effect on secondary clinical measures or MRI measures either (full report: Ball 2015); according to a meta-analysis, patient-reported spasticity, pain, and bladder dysfunction results numerically favored placebo (Torres-Moreno 2018). Because progression was slower than expected, the power to detect change may have been limited","yan_etki":"At least one serious side effect 35% (dronabinol) and 28% (placebo); according to the authors, no serious safety concerns","pmid":"23856559","doi":"10.1016/S1474-4422(13)70159-5","diger_kaynak":"ISRCTN 62942668; full report: Ball 2015, Health Technol Assess (PMID 25676540)"},{"ad":"Markovà 2019 (SAVANT)","tasarim":"Two-phase, enriched design: 4-week open-label trial, washout, then double-blind, placebo-controlled parallel RCT (15 centers)","n":"191 entered the open-label trial; 106 randomized (53 nabiximols / 53 placebo)","populasyon":"People with MS whose moderate to severe spasticity persisted despite an optimized oral spasticity medicine (baclofen, tizanidine) (Czechia, Austria)","urun":"Nabiximols (THC:CBD mouth spray; 2.7 mg THC + 2.5 mg CBD per spray) and placebo; in both groups, the doses of current spasticity medicines could be adjusted","urun_turu":"thc_iceren","doz":"Up to 12 sprays a day; mean 7.3 sprays/day (~20 mg THC + 18 mg CBD)","titrasyon":"Dose readjustment after washout","sure":"4-week open-label trial + 12 weeks randomized","sonuc":"Only those whose spasticity improved by at least 20% in the first 4 weeks were randomized. At week 12, at least 30% improvement 77.4% vs. 32.1% (p < 0.0001); spasticity NRS (p < 0.0001), pain (p = 0.0013), and modified Ashworth (p = 0.0007) also favored the spray. This design makes the effect look larger than it would be across all patients: in Cochrane 2022, this study had the largest effect (OR 7.24) and was the main source of heterogeneity. Funded by the manufacturer","yan_etki":"Side effects mild to moderate, no new safety concerns (abstract)","pmid":"29792372","doi":"10.1080/00207454.2018.1481066","diger_kaynak":"EudraCT 2015-004451-40; subgroup analysis Meuth 2020 (PMID 32065006); pooled analysis with GWSP0604 Nicholas 2023 (PMID 37209500)"},{"ad":"Notcutt 2012","tasarim":"Multicenter (5), placebo-controlled, randomized withdrawal study (parallel)","n":"36 randomized (18 nabiximols / 18 placebo)","populasyon":"People with MS spasticity who had been using the spray with benefit for at least 12 weeks (mean 3.6 years) (United Kingdom)","urun":"Nabiximols (THC:CBD mouth spray) or placebo (abrupt discontinuation of the spray)","urun_turu":"thc_iceren","doz":"The patient's current effective dose; mean 8.25 sprays/day","titrasyon":null,"sure":"4 weeks","sonuc":"Treatment failure (at least 20% worsening of spasticity or leaving the study) was 44% (8/18) among those continuing the spray and 94% (17/18) among those switched to placebo (p = 0.013). The between-group difference in change in spasticity NRS and modified Ashworth score was not significant (registry); patient and caregiver global impressions favored the spray. Very small; most of the placebo group left the study early. Funded by the manufacturer","yan_etki":"Serious side effects 1 vs. 0 (registry); the effect of abrupt discontinuation is not detailed in the abstract","pmid":"21878454","doi":"10.1177/1352458511419700","diger_kaynak":"ClinicalTrials.gov NCT00702468 (results in the registry)"},{"ad":"Collin 2007","tasarim":"Multicenter (8 in the United Kingdom, 4 in Romania), double-blind, placebo-controlled parallel RCT (2:1)","n":"189 randomized (124 nabiximols / 65 placebo); 184 ITT","populasyon":"People with MS with marked spasticity (Ashworth ≥2) in at least two muscle groups who were not getting adequate benefit from current treatment","urun":"Nabiximols (THC:CBD mouth spray; 2.7 mg THC + 2.5 mg CBD per spray) and placebo","urun_turu":"thc_iceren","doz":"Up to 48 sprays a day; mean 9.4 sprays/day (~25 mg THC + 23.5 mg CBD)","titrasyon":"Self-titrated by the patient","sure":"6 weeks","sonuc":"Primary outcome, spasticity NRS (0–10): difference −0.52 points (95% CI −1.03 to −0.004; p = 0.048); at least 30% improvement 40% vs. 22% (p = 0.014). The product information considers the clinical importance of this difference debatable. No difference in Ashworth score (difference −0.11; −0.29 to 0.07) or spasm frequency. Funded by the manufacturer","yan_etki":"Discontinuation due to side effects 6 vs. 2; dizziness 40/124 vs. 7/65 (registry). In the open-label extension (146 patients, mean 334 days, mean 7.3 sprays a day), 36% stopped in the first year (14% due to side effects, 9% due to lack of effect); most common dizziness (24.7%) and fatigue (12.3%); no tolerance developed","pmid":"17355549","doi":"10.1111/j.1468-1331.2006.01639.x","diger_kaynak":"ClinicalTrials.gov NCT00711646 (results in the registry); open-label extension: Serpell 2013 (PMID 22878432; NCT01606137)"},{"ad":"Collin 2010","tasarim":"Multicenter (15 in the United Kingdom, 8 in Czechia), double-blind, placebo-controlled parallel RCT","n":"337 randomized (167 nabiximols / 170 placebo)","populasyon":"People with advanced MS and moderate to severe spasticity (NRS ≥4) not adequately improved by current treatment","urun":"Nabiximols (THC:CBD mouth spray) and placebo, added to current treatment","urun_turu":"thc_iceren","doz":"Up to 24 sprays a day; mean 8.5 sprays/day (1–22)","titrasyon":"Self-titrated by the patient","sure":"15 weeks (14 weeks of treatment)","sonuc":"In the primary analysis (ITT), the difference in spasticity NRS was not significant (−0.23; 95% CI −0.59 to 0.14; p = 0.22); at least 30% improvement in 51 vs. 42 people (OR 1.34; 0.83–2.17). Only in the 79% per-protocol group was the difference significant (−1.3 vs. −0.8; p = 0.035). No difference in modified Ashworth score. The product information summarizes this study as 'failed to show a significant treatment effect'. Funded by the manufacturer","yan_etki":"Serious side effects 15/167 vs. 7/170; dizziness 53 vs. 17 (registry); mostly mild to moderate","pmid":"20307378","doi":"10.1179/016164109X12590518685660","diger_kaynak":"ClinicalTrials.gov NCT01599234 (results in the registry)"},{"ad":"Wade 2004","tasarim":"Multicenter (3), double-blind, placebo-controlled parallel RCT","n":"160 randomized (80 nabiximols / 80 placebo)","populasyon":"People with MS with at least one prominent symptom among spasticity, spasms, bladder problems, tremor, or pain (United Kingdom)","urun":"Nabiximols (THC:CBD mouth spray; 27 mg THC + 25 mg CBD per mL) and placebo","urun_turu":"thc_iceren","doz":"2.5–120 mg THC and CBD a day (up to 48 sprays); mean 12.4 sprays/day (~33 mg THC + 31 mg CBD)","titrasyon":"Self-titrated by the patient (up to 8 sprays in 3 hours)","sure":"6 weeks","sonuc":"The primary outcome (patient's most troublesome symptom, 0–100 VAS) did not differ from placebo (difference −5.9; 95% CI −13.5 to 1.7). The spasticity VAS improved significantly vs. placebo in the publication's abstract (p = 0.001); in the ClinicalTrials.gov result, the difference for the same measure was −7.1 points (95% CI −14.6 to 0.4; p = 0.062): the two sources may have used different analyses. No difference from placebo on the bladder problem VAS (−28.1 vs. −21.6; median difference in final values −6.3, 95% CI −14.9 to 2.4; p = 0.15) or on the bladder control test (difference −0.12; 95% CI −1.77 to 1.54; p = 0.89) (ClinicalTrials.gov result, secondary measures). No difference from placebo on the tremor VAS (25 vs. 25 people whose tremor was assessed) (−21.4 vs. −15.7 points; difference −6.85; 95% CI −20.31 to 6.60; p = 0.31; ClinicalTrials.gov result, secondary measure). No clear negative effect on cognitive function or mood. Funded by the manufacturer","yan_etki":"Dizziness 25/80 vs. 10/80, fatigue 12 vs. 3 (registry); intoxication generally mild. In the open-label extension (137 patients, mean 434 days), 42% stopped (24 for lack of effect, 17 for side effects); a first-ever seizure in 4 patients; no consistent withdrawal syndrome during a planned 2-week interruption","pmid":"15327042","doi":"10.1191/1352458504ms1082oa","diger_kaynak":"ClinicalTrials.gov NCT01610700 (results in the registry); open-label extension: Wade 2006 (PMID 17086911; NCT01610687)"},{"ad":"NCT04203498 (RELEASE MSS3, registry results)","tasarim":"Multicenter (37), double-blind, placebo-controlled parallel phase 3 RCT; terminated early by a business decision of the sponsor","n":"139 randomized (69 / 70); 137 received the drug; 121 completed","populasyon":"People with MS whose spasticity persisted despite at least one optimized oral spasticity medicine (baclofen or tizanidine) (US, United Kingdom, Czechia, Poland, Romania)","urun":"Nabiximols (THC:CBD mouth spray) and placebo, added to current treatment","urun_turu":"thc_iceren","doz":"Morning and evening; up to 12 sprays a day","titrasyon":null,"sure":"12 weeks","sonuc":"The primary outcome (change in daily number of muscle spasms, weeks 9–12) did not differ from placebo: −3.84 vs. −3.11; difference −0.73 (95% CI −2.54 to 1.08; p = 0.43). No clear difference on the MS spasticity scale (MSSS-88) either (no statistics given). Stopped before reaching the planned number of participants; results only on ClinicalTrials.gov, no peer-reviewed publication. Sponsor: the manufacturer","yan_etki":"Any side effect 47/67 vs. 32/70; discontinuation due to side effects 4 vs. 1; dizziness 14 vs. 5, drowsiness 7 vs. 2; serious side effects 3 vs. 5","pmid":null,"doi":null,"diger_kaynak":"ClinicalTrials.gov NCT04203498 (GWSP18023; EudraCT 2019-002623-14; results in the registry, May 8, 2024; no publication found in PubMed as of October 2026)"},{"ad":"NCT04984278 (RELEASE MSS5, registry results)","tasarim":"Multicenter (7), triple-blind, placebo-controlled, randomized crossover phase 3 study; terminated early by a business decision of the sponsor","n":"31 randomized (16 / 15); 30 people analyzed on both treatments","populasyon":"People with MS and lower limb spasticity (MAS ≥2 in at least 2 muscle groups) (Poland, Czechia, Spain, United Kingdom)","urun":"Nabiximols (THC:CBD mouth spray) and placebo","urun_turu":"thc_iceren","doz":"Up to 12 sprays a day (split between morning and evening); mean dose taken not in the registry","titrasyon":"In each period, starting at 1 spray/day and reaching the optimal dose or a maximum of 12 within the first 14 days","sure":"2 × 21 days (about 14 days of dose adjustment + 7 days at a stable dose in each period; at least 7 days of washout in between)","sonuc":"Primary outcome, doctor-measured lower limb muscle tone (MAS LLMT-6): −0.32 vs. −0.04; difference −0.29 (95% CI −0.48 to −0.10; p = 0.005), in favor of the spray. Positive, unlike the 68-person companion study using the same measure (Bethoux 2024, RELEASE MSS1); very small and stopped early; results only on ClinicalTrials.gov, no peer-reviewed publication. Sponsor: the manufacturer","yan_etki":"Any side effect 19/30 vs. 6/30; fatigue 4 vs. 0, vertigo 2 vs. 0; no serious side effects; 1 person withdrew because of side effects","pmid":null,"doi":null,"diger_kaynak":"ClinicalTrials.gov NCT04984278 (GWSP20105; EudraCT 2020-003271-18; results in the registry, February 5, 2024; no publication found in PubMed as of October 2026)"},{"ad":"Vachová 2013","tasarim":"Multicenter, double-blind, placebo-controlled parallel RCT (phase 4)","n":"121 randomized (62 nabiximols / 59 placebo); 98 completed","populasyon":"People with MS and moderate spasticity not adequately improved by current treatment (Czechia)","urun":"Nabiximols (THC:CBD mouth spray) and placebo","urun_turu":"thc_iceren","doz":"Up to 12 sprays a day; mean 7.6 sprays/day in the first month and 6.4 in the last period","titrasyon":null,"sure":"48 weeks","sonuc":"Primary outcome, cognitive function (PASAT): no decline with the spray over 48 weeks, not worse than placebo (difference −1.47). No difference in depression score. Patient global impression of spasticity favored the spray (OR 4.02; 95% CI 1.96–8.22); caregiver and doctor impressions also favored the spray. No difference in modified Ashworth score (difference −2.36; −6.09 to 1.37; p = 0.21) or in the 10-meter walk. Results from the ClinicalTrials.gov registry; the article is in a journal not indexed in PubMed. Funded by the manufacturer; according to the registry, all publications had to be submitted to the company for review before publication","yan_etki":"Any side effect 39/62 vs. 19/59; discontinuation due to side effects 8 vs. 2; serious side effects 5 vs. 0; vertigo 6 vs. 0, fatigue 5 vs. 1","pmid":null,"doi":"10.4172/jmso.1000122","diger_kaynak":"ClinicalTrials.gov NCT01964547 (GWMS1137; results in the registry, May 2, 2014); article: J Mult Scler (Foster City) 2013;1(2)"},{"ad":"Leocani 2015","tasarim":"Double-blind, placebo-controlled, randomized crossover study (single center)","n":"44 randomized; 34 analyzed","populasyon":"People with progressive MS and lower limb spasticity (Italy)","urun":"Nabiximols (THC:CBD mouth spray) and placebo","urun_turu":"thc_iceren","doz":"Up to 12 sprays a day; mean 7 sprays/day (~19 mg THC + 17.5 mg CBD)","titrasyon":"2 weeks, according to the product information","sure":"2 × 4 weeks (including 2 weeks of dose adjustment; 2-week break in between)","sonuc":"The primary outcome (reflex ratio measured by nerve conduction, H/M) did not differ from placebo. At least 20% improvement in modified Ashworth score: 50% with the spray, 23.5% with placebo (p = 0.041). 6 people withdrew and 4 were excluded from the analysis; the study's power was reduced. Sponsored by a drug company (Almirall)","yan_etki":"Side effects did not differ between groups (abstract)","pmid":"26289497","doi":"10.1007/s00415-015-7878-1","diger_kaynak":"ClinicalTrials.gov NCT01538225"},{"ad":"Aragona 2009","tasarim":"Double-blind, placebo-controlled, randomized crossover study (single center)","n":"17","populasyon":"People with secondary progressive MS and spasticity who had never used cannabis (Italy)","urun":"Nabiximols (THC:CBD mouth spray) and placebo","urun_turu":"thc_iceren","doz":"Flexible dose; mean 8.2 sprays/day (~22 mg THC + 20.5 mg CBD)","titrasyon":"Self-titrated by the patient","sure":"2 × 3 weeks (2-week break in between)","sonuc":"The primary aim was safety: no difference from placebo in psychiatric symptoms, cognitive function (PASAT), quality of life, fatigue, or motor function; spasticity was not measured in this publication. Blood THC levels were associated with some psychiatric symptom scores (interpersonal sensitivity, hostility, paranoid ideation). Very small; public funding","yan_etki":"No serious side effects, abuse, or withdrawal; 1 person had increasing craving for the drug followed by depression","pmid":"18978501","doi":"10.1097/WNF.0B013E3181633497","diger_kaynak":"Other publications on the same patient group: Conte 2009 (PMID 18603457; pain reflex) and Tomassini 2014 (J Neurosci Rehabil; neurophysiology, not in PubMed)"},{"ad":"De Blasiis 2021","tasarim":"Randomized controlled study without placebo (the control group received no treatment, no blinding); randomization method unclear","n":"32 (22 nabiximols / 10 control)","populasyon":"People with MS and spasticity (Italy)","urun":"Nabiximols (THC:CBD mouth spray); the control group received no spray","urun_turu":"thc_iceren","doz":"Not reported (in the abstract)","titrasyon":null,"sure":"4 weeks","sonuc":"45 minutes after the first dose, improvement vs. control in several clinical measures and in 3D gait analysis in the spray group; the improvement was still present at week 4. Because there was no placebo or blinding, the effect cannot be separated from the medicine; Cochrane 2022 placed the study's classification on hold because the randomization and the definition of the control were unclear","yan_etki":"Not reported (in the abstract)","pmid":"33862313","doi":"10.1016/j.msard.2021.102805","diger_kaynak":null},{"ad":"Zajicek 2003 (CAMS)","tasarim":"Multicenter (33), double-blind, placebo-controlled, three-arm parallel RCT","n":"667 enrolled; 630 treated (211 cannabis extract, 206 THC, 213 placebo); 611 in the primary outcome","populasyon":"Patients with stable MS and muscle spasticity (Ashworth ≥2 in at least two muscle groups) (United Kingdom)","urun":"Oral capsules: cannabis extract (2.5 mg THC + 1.25 mg CBD per capsule), synthetic THC (dronabinol), and placebo","urun_turu":"thc_iceren","doz":"Based on body weight, up to 25 mg THC a day; mean ~13.6 mg THC (+ 6.8 mg CBD in the extract group)","titrasyon":"Gradual increase based on body weight and side effects","sure":"15 weeks; those who wished continued double-blind for up to 12 months","sonuc":"No difference in the primary outcome, the Ashworth spasticity score (p = 0.40; difference vs. placebo 0.32 for extract, 95% CI −1.04 to 1.67; 0.94 for THC, −0.44 to 2.31). Improvement in patient-reported spasticity 61%, 60%, and 46% (p = 0.003); some participants in the active groups figured out their group; the authors also reported an objective improvement in mobility. At 12-month follow-up, the Ashworth score decreased by 1.82 points in the THC group and by 0.10 with the extract, and increased by 0.23 with placebo (unadjusted p = 0.04). In the bladder substudy (CAMS-LUTS; among those keeping an incontinence diary, number of participants not in the abstract), incontinence frequency adjusted for baseline imbalance decreased by 38% with cannabis extract, 33% with THC, and 18% with placebo; both active groups were significantly better than placebo (p = 0.005 and p = 0.039); absolute difference vs. placebo 0.21 (extract) and 0.16 (THC) incontinence episodes a day (as calculated by Torres-Moreno 2018). Public funding","yan_etki":"No details in the abstract; no important safety concerns reported at 12-month follow-up","pmid":"14615106","doi":"10.1016/S0140-6736(03)14738-1","diger_kaynak":"12-month follow-up: Zajicek 2005 (PMID 16291891); bladder substudy: Freeman 2006 (PMID 16552618)"},{"ad":"Zajicek 2012 (MUSEC)","tasarim":"Multicenter (22), double-blind, placebo-controlled parallel phase 3 RCT","n":"279 randomized (144 cannabis extract / 135 placebo); 277 analyzed","populasyon":"People with stable MS and muscle stiffness lasting at least 3 months (United Kingdom)","urun":"Oral standardized cannabis extract capsule (2.5 mg THC + 0.8–1.8 mg CBD per capsule) and placebo","urun_turu":"thc_iceren","doz":"From 5 mg up to a maximum of 25 mg THC a day; at the end of the study, mean ~17 mg THC + 8.5 mg CBD; 47% of the extract group reached the highest dose","titrasyon":"From 5 to 25 mg THC/day over 2 weeks","sure":"12 weeks (2 weeks of dose adjustment + 10 weeks at a stable dose)","sonuc":"Primary outcome: patient-reported relief from muscle stiffness at week 12, 29.4% vs. 15.7% (OR 2.26; 95% CI 1.24–4.13; one-sided p = 0.004); also in favor of the extract at weeks 4 and 8 and on the pain, spasm, and sleep scales. Doctor-measured spasticity was not the primary outcome. In the ClinicalTrials.gov registry, the study is listed as 'terminated due to recruitment problems and on the recommendation of an independent committee'. Joint public and manufacturer funding","yan_etki":"Consistent with the known side effects of cannabinoids; no new safety concerns (abstract)","pmid":"22791906","doi":"10.1136/jnnp-2012-302468","diger_kaynak":"ClinicalTrials.gov NCT00552604 (sponsor: Institut für Klinische Forschung, Germany)"},{"ad":"Vaney 2004","tasarim":"Double-blind, placebo-controlled, randomized crossover study (single center, during inpatient rehabilitation)","n":"57 enrolled; 50 ITT; 37 per protocol","populasyon":"People with MS and spasticity not controlled by other medicines (Switzerland)","urun":"Oral cannabis extract capsule (2.5 mg THC + 0.9 mg CBD per capsule) and placebo","urun_turu":"thc_iceren","doz":"Starting at 15 mg THC a day and, if tolerated, increasing by 5 mg a day up to a maximum of 30 mg THC (mean ~18 mg THC + 6.5 mg CBD)","titrasyon":"Increase of 5 mg a day","sure":"14 days of extract + 7 days of placebo (3-day breaks in between)","sonuc":"In the ITT analysis, no significant difference from placebo on any measure; trends in favor of the extract in spasm frequency, mobility, and falling asleep. In the 37 patients who took at least 90% of the dose, spasm frequency (p = 0.013) and mobility (p = 0.01) improved (subgroup analysis). Public funding","yan_etki":"Mild side effects and signs of intoxication were somewhat more frequent and pronounced in the active period; generally mild","pmid":"15327040","doi":"10.1191/1352458504ms1048oa","diger_kaynak":null},{"ad":"Killestein 2002","tasarim":"Double-blind, placebo-controlled, randomized three-period crossover study (single center)","n":"16","populasyon":"People with progressive MS and severe spasticity (Netherlands)","urun":"Oral capsules: dronabinol (synthetic THC), cannabis plant extract containing the same amount of THC (20–30% CBD), and placebo","urun_turu":"thc_iceren","doz":"2.5 mg THC twice a day; if well tolerated, 5 mg twice a day (5–10 mg THC a day)","titrasyon":"Dose increase after 2 weeks","sure":"3 × 4 weeks (4-week breaks in between)","sonuc":"Neither THC nor the plant extract reduced spasticity more than placebo; the patients' global assessment worsened with both treatments. Very small; public funding","yan_etki":"Side effects were more common with the plant extract; both treatments were found to be safe (abstract)","pmid":"12011290","doi":"10.1212/wnl.58.9.1404","diger_kaynak":"Immune system publication from the same study: Killestein 2003, J Neuroimmunol"},{"ad":"van Amerongen 2018","tasarim":"Two phases: double-blind crossover dose finding + 4-week double-blind, placebo-controlled parallel RCT (single center)","n":"24 (12 THC / 12 placebo)","populasyon":"People with progressive MS and moderate spasticity (Netherlands)","urun":"Oral THC tablet (ECP002A) and placebo","urun_turu":"thc_iceren","doz":"Based on the dose-finding phase; about 24 mg a day according to the Cochrane 2022 table, with a 4.5 mg increase after week 2","titrasyon":"Increase after week 2; reduced in 2 patients because of side effects","sure":"4 weeks (parallel phase)","sonuc":"Pain and patient-perceived spasticity decreased when measured in the clinic right after the medicine, but not when measured in the daily diary; no difference from placebo in other clinical outcomes; no cognitive decline at weeks 2 and 4. Very small; funded by the manufacturer","yan_etki":"Well tolerated (abstract); the dose was lowered in 2 patients because of side effects (Cochrane table)","pmid":"28189366","doi":"10.1016/j.clinthera.2017.01.016","diger_kaynak":"EudraCT 2010-022033-28"},{"ad":"Ungerleider 1987","tasarim":"Double-blind, placebo-controlled, randomized crossover study (repeated paired periods with increasing doses)","n":"13 randomized; 12 completed at least two paired periods","populasyon":"People with MS and spasticity not responding to treatment (US)","urun":"Oral THC (Δ9-THC) and placebo","urun_turu":"thc_iceren","doz":"2.5–15 mg (increasing doses)","titrasyon":"The dose was increased with each new paired period","sure":"5 days of THC and 5 days of placebo, with a 2-day break in between (paired periods)","sonuc":"At doses above 7.5 mg, patients' self-rated spasticity improved significantly compared with placebo; the result of the neurological examination is not in the abstract. Very small and short","yan_etki":"No details in the abstract","pmid":"2831701","doi":"10.1300/j251v07n01_04","diger_kaynak":null},{"ad":"Corey-Bloom 2012","tasarim":"Placebo-controlled, randomized crossover study (single center)","n":"37 randomized; 30 completed","populasyon":"People with MS and treatment-resistant spasticity (modified Ashworth ≥3) (US); 80% had used cannabis before","urun":"Smoked marijuana cigarette (about 4% THC) and THC-extracted placebo cigarette","urun_turu":"thc_iceren","doz":"1 cigarette a day (on average 4 puffs)","titrasyon":null,"sure":"2 × 3 days (11-day break in between)","sonuc":"The modified Ashworth score decreased 2.74 points more with marijuana than with placebo (p < 0.0001); pain (0–100 VAS) decreased 5.28 points more (p = 0.008); no difference in walking time. The thinking speed test (PASAT) score was 8.67 points worse (p = 0.003). Very short; 80% of participants were used to cannabis and most guessed correctly which cigarette they had smoked (17 of 30 people at all six visits), so blinding was largely broken. Public funding","yan_etki":"No serious side effects; 5 people withdrew because of side effects (2 for uncomfortable intoxication, 2 for dizziness, 1 for fatigue); feeling high markedly more common than with placebo","pmid":"22586334","doi":"10.1503/cmaj.110837","diger_kaynak":null},{"ad":"NCT00682929 (UC Davis, registry results)","tasarim":"Double-blind, placebo-controlled, three-arm parallel randomized study (double-dummy); terminated early because enrollment could not be completed","n":"41 randomized (13 inhaled cannabis, 14 oral THC, 14 placebo); 28 completed","populasyon":"People with MS and moderate to severe spasticity (US)","urun":"Smoked cannabis cigarette (THC content not in the registry), oral dronabinol (synthetic THC), and placebo","urun_turu":"thc_iceren","doz":"1 cigarette a day or 10 mg dronabinol a day","titrasyon":null,"sure":"7 weeks","sonuc":"The data were not statistically analyzed (registry: insufficient patients and funding, departure of the investigator). Primary outcome, the resistance to movement applied to the knee joint by a motorized device (weeks 3 and 7): no clear pattern between groups in the descriptive values in the registry (25 people at week 3). Secondary outcome, change in modified Ashworth score (a positive value means worsening): at week 3, −0.33 with cannabis (6 people), 0 with THC (11), −0.45 with placebo (11); at week 7, +1.14 with cannabis (7), −0.38 with THC (8), −0.25 with placebo (12). Very small; results only on ClinicalTrials.gov, no peer-reviewed publication. Public funding","yan_etki":"Discontinuation due to side effects 4/13 with cannabis, 1/14 with THC, 1/14 with placebo; serious side effects 3/13, 1/14, 0/14; euphoria 10/13, 6/14, 2/14","pmid":null,"doi":null,"diger_kaynak":"ClinicalTrials.gov NCT00682929 (results in the registry, May 18, 2018; no publication found in PubMed as of October 2026)"},{"ad":"Kavia 2010","tasarim":"Multicenter (United Kingdom, Belgium, Romania; countries per the table of a meta-analysis), double-blind, placebo-controlled, parallel-group phase 3 RCT","n":"135 randomized (67 nabiximols / 68 placebo); 118 completed (56 / 62); 60 / 64 in the primary analysis","populasyon":"People with MS and overactive bladder (detrusor overactivity) not fully controlled by current treatment; at least 3 incontinence episodes in 5 days at baseline, anticholinergic dose stable for at least 14 days; people using intermittent self-catheterization were excluded (registry)","urun":"Nabiximols (THC:CBD mouth spray; 2.7 mg THC + 2.5 mg CBD per spray) and placebo spray","urun_turu":"thc_iceren","doz":"Up to 48 sprays a day (about 130 mg THC + 120 mg CBD) were allowed (registry); mean use 8.9 sprays a day (median 7.2; about 24 mg THC + 22 mg CBD; per the table of a meta-analysis)","titrasyon":"Self-titrated by the patient (details not in the abstract)","sure":"8 weeks of treatment (preceded by a 2-week baseline period; 10 weeks in total)","sonuc":"The primary outcome (reduction in the daily number of incontinence episodes) did not differ from placebo: −1.08 vs. −0.99; difference −0.11 (95% CI −0.47 to 0.26; p = 0.57). Among secondary measures, nighttime urination (difference −0.28; −0.50 to −0.07; p = 0.010), daily number of urinations (−0.85; −1.47 to −0.23), the patient's overall bladder condition on a 0–10 scale (−1.16; −1.82 to −0.51; p = 0.001), and the global impression of change (improvement 51/63 vs. 39/67) favored nabiximols; there was no difference in urgency (p = 0.071), pad use (p = 0.74), or incontinence-related quality of life (p = 0.17). Figures from the ClinicalTrials.gov results; the p values for daily urinations and the global impression of change differ between the publication's abstract (0.001 and 0.005) and the registry (0.007 and 0.002). Sponsored by the manufacturer; according to the registry, all publications from the study had to be submitted to the company for review before publication","yan_etki":"Serious side effects in 2 people in each group; dizziness 12/67 vs. 5/68, disorientation 4/67 vs. 0, feeling detached from oneself or one's surroundings (dissociation) 4/67 vs. 0; discontinuation due to side effects 7/67 vs. 3/68; urinary tract infection 4/67 vs. 7/68 (registry)","pmid":"20829244","doi":"10.1177/1352458510378020","diger_kaynak":"ClinicalTrials.gov NCT00678795 (results in the registry; the sponsor today is Jazz Pharmaceuticals)"},{"ad":"Feinstein 2019","tasarim":"Controlled, non-randomized study (groups assigned by whether the registration number was odd or even; single center, Toronto): continuing cannabis or stopping for 28 days; abstinence monitored with urine tests","n":"40 (1 person in the abstinence group was excluded for being unable to stay off cannabis; 19 people in the abstinence group)","populasyon":"People with MS (Canada) who had started using cannabis after MS onset, had used it at least 4 days a week for years, and had impairment in at least two cognitive domains at baseline","urun":"Their own cannabis (mostly smoked; mainly THC according to urine tests)","urun_turu":"thc_iceren","doz":"Not reported (in the abstract); in the abstinence group, the THC breakdown product in urine fell to zero by day 28 (Feinstein 2021)","titrasyon":null,"sure":"28 days","sonuc":"On day 28, the abstinence group was markedly better than the continuation group on all cognitive measures (verbal and visual memory, processing speed, executive function) (p < 0.0001 for all); improvement over time occurred only in those who stopped, so it cannot be explained by practice effects. On functional MRI, those who stopped gave more correct answers on the symbol-digit test and were faster, with increased activity in the relevant brain regions; no difference on structural MRI. Self-reported cognitive complaints did not differ between the groups, and all 19 people who stopped went back to cannabis after the study ended (Feinstein 2021, PMID 34087949). Among those who used cannabis for mood, the depression score fell after stopping (p = 0.006; subgroup size not in the abstract; Feinstein 2021, PMID 32589554). Spasticity and pain results are not in the abstracts; groups were not randomized. Funding source not in the abstract; the lead author's disclosure lists speaker fees from MS drug manufacturers, and no cannabis company is mentioned (Feinstein 2021, PMID 34087949)","yan_etki":"Not reported (in the abstract); those who stopped reported more difficulty carrying on their activities away from home (Feinstein 2021, PMID 34087949)","pmid":"31363742","doi":"10.1093/brain/awz213","diger_kaynak":"Other publications from the same study: Feinstein 2021 (depression, PMID 32589554), Feinstein 2021 (cognitive awareness, PMID 34087949, PMC8413765), Meza 2024 (resting-state brain network, 33 people, PMID 38815510), and Meza 2024 (sex differences, 19 who stopped, PMID 39024968)"},{"ad":"Fox 2004","tasarim":"Randomized, double-blind, placebo-controlled crossover RCT (for tremor)","n":"14 (8 women, 6 men)","populasyon":"People with MS with tremor in the arms (mean age 45, mean EDSS 6.25; Plymouth, UK)","urun":"Oral cannabis extract (Cannador; contains THC and CBD; amounts not in the abstract)","urun_turu":"thc_iceren","doz":"Not in the abstract (gradually increased over 2 weeks in each period)","titrasyon":"Gradual increase over 2 weeks before each assessment","sure":"2 weeks of dose increase before each assessment; period length and washout interval not in the abstract","sonuc":"On the primary outcome, the tremor index of a validated tremor scale, and on secondary objective measures (accelerometer, ataxia scale, spiral drawing, finger tapping, nine-hole peg test), there was no significant difference between the cannabis extract and placebo; finger tapping was faster with placebo (p < 0.02). There was a non-significant trend in favor of the extract in patients’ subjective tremor relief. The study was planned to be powered to detect a 50% improvement in the tremor index; it may have missed smaller effects. Very small; the full text could not be read","yan_etki":"Not in the abstract. According to two reviews, 10 patients reported side effects during the extract period and 2 during the placebo period (mild cognitive changes, sleepiness, light-headedness, dry mouth); 9 of 13 patients correctly guessed the period in which they received the drug, suggesting that blinding was partly broken (Koch 2007, Kluger 2015; the full text could not be read)","pmid":"15079008","doi":"10.1212/01.wnl.0000118203.67138.3e","diger_kaynak":null},{"ad":"Filippini 2022 (Cochrane)","tasarim":"Cochrane systematic review and meta-analysis (25 RCTs; search up to December 2021)","n":"3,763","populasyon":"Multiple sclerosis","urun":"Nabiximols (13 studies); oral synthetic THC or related compounds (dronabinol 3, nabilone 1, oral THC tablet 1); oral THC-rich cannabis extract (3); inhaled cannabis (1); dronabinol together with extract or inhaled cannabis in 3 studies","urun_turu":"karma","doz":"Variable","titrasyon":null,"sure":"3–48 weeks","sonuc":"Nabiximols and oral cannabis extract increase the number of people reporting an important (at least 30%) reduction in spasticity (OR 2.51; 95% CI 1.56–4.04; 4 spray studies and 1 oral extract study, 1,143 people; moderate certainty); mean difference on a 0–10 scale −0.55 points (7 studies, two of them with oral THC or cannabis extract; moderate certainty). The difference on the doctor-measured Ashworth scale is very small or absent (−0.23; −0.44 to −0.03; 11 studies; low certainty). Little or no effect on quality of life. Of the 25 studies in the review, 15 were funded by the manufacturer and 2 by joint public and company sources","yan_etki":"Discontinuation due to side effects (OR 2.41), nervous system (OR 2.61), and psychiatric (OR 1.94) side effects may be increased","pmid":"35510826","doi":"10.1002/14651858.CD013444.pub2","diger_kaynak":null},{"ad":"Hamm-Buiar 2026","tasarim":"Systematic review, meta-analysis, and network meta-analysis (RCTs only; RoB 2, GRADE)","n":"27 RCT publications, more than 3,000 people","populasyon":"Spasticity due to MS (a small number with other neurological diseases in 2 studies)","urun":"THC:CBD mouth spray, oral cannabis extracts, synthetic THC and related compounds (dronabinol, nabilone), pure CBD, smoked marijuana","urun_turu":"karma","doz":"Variable","titrasyon":null,"sure":"2 weeks – 36 months","sonuc":"The THC:CBD spray reduced patient-reported spasticity by an average of 0.82 points on a 0–10 scale (95% CI 0.40–1.24; 7 studies; low certainty). In the network analysis, the THC:CBD spray was the only product significantly better than placebo; no significant difference for pure CBD, dronabinol, or other extracts. Limited benefit in doctor-measured muscle tone; side effects common but mostly mild to moderate, serious events rare. No funding","yan_etki":"Most common: dizziness, fatigue, drowsiness, dry mouth, nausea; a feeling of intoxication especially with THC alone","pmid":"42543771","doi":"10.1002/bcp.70719","diger_kaynak":"PROSPERO CRD42024557313; search December 2, 2025"},{"ad":"Torres-Moreno 2018","tasarim":"Systematic review and meta-analysis (double-blind, placebo-controlled RCTs)","n":"17 RCTs, 3,161 people","populasyon":"MS (spasticity, pain, or bladder problems)","urun":"Nabiximols, oral cannabis extract, dronabinol, nabilone","urun_turu":"karma","doz":"Variable","titrasyon":null,"sure":"A few weeks – 3 years","sonuc":"Small benefit in patient-reported spasticity (standardized mean difference −0.25; 95% CI −0.38 to −0.13); no effect on the Ashworth scale; small benefit in pain (−0.17) and bladder function (−0.11; 95% CI −0.22 to −0.0008); when company-supported studies were removed, the bladder result was no longer significant (according to the authors, company-supported studies appear to have favored the active treatment), and in the largest and longest study independent of the company (CUPID), the spasticity, pain, and bladder results leaned toward placebo. According to the authors, efficacy is limited. Public funding; no conflicts of interest reported","yan_etki":"Any side effect RR 1.72 (1.46–2.02); discontinuation due to side effects RR 2.95 (2.14–4.07); no significant difference in serious side effects","pmid":"30646241","doi":"10.1001/jamanetworkopen.2018.3485","diger_kaynak":"PROSPERO CRD42014015391; search up to July 2016"},{"ad":"Abo Youssef 2017","tasarim":"Systematic review and meta-analysis (PRISMA; Cochrane register, Embase, Medline, Scopus; last search November 11, 2016)","n":"3 studies (2 RCTs, 1 open-label), 426 patients","populasyon":"Neurogenic lower urinary tract dysfunction due to MS (bladder problems)","urun":"THC-containing cannabis products: nabiximols, oral cannabis extract and synthetic THC (CAMS-LUTS), plant extracts containing THC and CBD (open-label study)","urun_turu":"thc_iceren","doz":"Variable","titrasyon":null,"sure":null,"sonuc":"According to the authors, the number of incontinence episodes decreased markedly in all three studies; when the data from the three studies were pooled, the mean difference in incontinence episodes per 24 hours was −0.35 (95% CI −0.46 to −0.24). A study without a comparison group was also included in the pooling, and it is not clear from the abstract what was compared with what; in the two included RCTs, the difference vs. placebo was only 0.11–0.21 incontinence episodes a day (as calculated by Torres-Moreno 2018), so the pooled figure should not be read as a difference vs. placebo; the main measure of the only separate bladder RCT was no different from placebo (Kavia 2010). According to the authors, the evidence base is weak; better-designed, adequately powered studies are needed (from the abstract; full text could not be read)","yan_etki":"Mild side effects common (38–100%); serious side effects in 2 patients (0.7%)","pmid":"28058780","doi":"10.1111/bju.13759","diger_kaynak":null},{"ad":"Cheng 2026","tasarim":"Scoping review (following Cochrane and PRISMA methods; MEDLINE, EMBASE, CENTRAL; English-language publications only)","n":"12 studies (9 in MS; 3 RCTs)","populasyon":"Adults with overactive bladder and lower urinary tract symptoms due to neurological disease, benign prostate enlargement, or cystitis","urun":"Cannabis products containing THC, CBD, or both","urun_turu":"karma","doz":"Variable","titrasyon":null,"sure":null,"sonuc":"Some improvements in urinary incontinence, urinary frequency, and quality of life were reported with cannabis products, especially in patients with MS; however, only 3 studies were randomized controlled trials, and according to the authors the evidence is limited and largely observational; randomized studies focusing on outcomes that matter to patients are needed. No pooled effect size (scoping review; from the abstract, full text could not be read)","yan_etki":"Mild side effects such as dizziness and dry mouth were common (2–18%); they sometimes led to stopping treatment","pmid":"42678682","doi":"10.5489/cuaj.9478","diger_kaynak":null},{"ad":"NICE 2019 (guideline NG144)","tasarim":"National clinical guideline (United Kingdom; systematic evidence review and cost-effectiveness model)","n":null,"populasyon":"Adults with moderate to severe MS spasticity (the guideline also covers nausea, chronic pain, and epilepsy)","urun":"Cannabis-based medicinal products; the spasticity recommendation is for the THC:CBD mouth spray","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"Recommends a 4-week trial of the THC:CBD spray in adults with moderate to severe MS spasticity that has not improved with other medicines (on the condition of a 'pay for responders' scheme in which the manufacturer covers the first 3 bottles); treatment continues if, at the end of 4 weeks, patient-reported spasticity symptoms on a 0–10 scale have decreased by at least 20%; treatment is started and supervised by a doctor who specializes in MS spasticity. The committee's rationale: there was a reduction in some measures of patient-reported spasticity, and in the committee's assessment side effects did not differ from placebo, but most of the evidence was of low quality and the effect on quality of life was unclear; the cost-effectiveness model built for the guideline predicted a gain equivalent to about 30 days in full health for the average patient and supported the recommendation only if the reduction in spasticity halved care costs and the price of the medicine came down. It states that the evidence for other cannabis products is much more limited and recommends research on them (including in children)","yan_etki":null,"pmid":"31909928","doi":null,"diger_kaynak":"https://www.nice.org.uk/guidance/ng144 (published November 11, 2019, last updated March 22, 2021, last reviewed May 20, 2025; recommendations 1.3.1–1.3.2, rationale section, research recommendation 5); evidence review C: spasticity (NCBI Bookshelf PMID 35107908, NBK577084; could not be opened in this search)"},{"ad":"Yadav 2014 (American Academy of Neurology)","tasarim":"Evidence-based clinical guideline (American Academy of Neurology guideline subcommittee; complementary and alternative therapies in MS; literature 1970–September 2013; recommendations at levels A–C)","n":null,"populasyon":"Adults with MS (spasticity, pain, bladder complaints, and tremor; the guideline also covers other complementary approaches)","urun":"Oral cannabis extract, THC, and THC:CBD mouth spray (nabiximols)","urun_turu":"thc_iceren","doz":null,"titrasyon":null,"sure":null,"sonuc":"Doctors may offer oral cannabis extract (level A) and THC (level B) for patient-reported spasticity symptoms and pain (excluding central neuropathic pain); patients should be told that these products are probably ineffective for doctor-measured spasticity (in the short term) and for tremor (level B), and possibly helpful for spasticity and pain in the long term (level C). The THC:CBD mouth spray may be offered for patient-reported spasticity, pain, and urinary frequency (level B); it is probably ineffective for doctor-measured spasticity and urinary incontinence (level B); it may not be offered for tremor (level C). Cannabinoids can cause side effects; caution is needed with non-standardized cannabis extracts. The abstract contains no recommendation for pure CBD. The guideline is based on studies up to September 2013; later RCTs (e.g., the pure CBD studies, RELEASE MSS) were not assessed. The Academy reaffirmed the guideline on February 21, 2026","yan_etki":null,"pmid":"24663230","doi":"10.1212/WNL.0000000000000250","diger_kaynak":"Status: 'Reaffirmed on February 21, 2026' in the American Academy of Neurology guideline list (aan.com, October 28, 2026); the same academy's 2014 systematic review of medical marijuana (Koppel 2014, PMID 24778283) was retired on February 25, 2023 and is not in the table. PMC3962995 (abstract and author disclosures)"},{"ad":"Pourmohammadi 2022","tasarim":"Systematic review (PRISMA; no meta-analysis; risk of bias with the CASP checklist)","n":"26 clinical studies (13 judged at low risk of bias and examined in detail); the names and number of the cannabinoid studies are not in the abstract","populasyon":"Adults with MS-related tremor (drug treatments only)","urun":"Medicines tried for MS tremor, including cannabis-based medicines","urun_turu":"karma","doz":"Varied by study","titrasyon":null,"sure":null,"sonuc":"The effect of cannabis-based medicines on MS-related tremor was not found to be conclusive, and they were not recommended because of their many side effects. The only medicine with a clear effect in the review was botulinum toxin (side effects and difficult injections limit its use); results for the other medicines were inconsistent or small. The full text could not be read","yan_etki":"Many side effects were reported with cannabis-based medicines (no details in the abstract)","pmid":"35339007","doi":"10.1016/j.msard.2022.103722","diger_kaynak":null},{"ad":"Patti 2016 (Italian AIFA registry)","tasarim":"Prospective observational study based on a mandatory national drug registry (30 centers; no comparison group)","n":"1,615 patients","populasyon":"Patients starting the spray for moderate to severe MS spasticity (NRS ≥4) that had not responded to other spasticity medicines (Italy, January 2014 – February 2015)","urun":"Nabiximols (THC:CBD mouth spray), according to the approved conditions of use","urun_turu":"thc_iceren","doz":"Mean 6.3–6.8 sprays/day","titrasyon":"According to the product information; 1-month trial","sure":"6 months","sonuc":"At month 1, at least 20% improvement in spasticity NRS in 70.5% of patients and at least 30% in 28.2%; mean NRS from 7.5 to 5.8. 39.5% stopped within 6 months (main reasons insufficient effect and side effects). In an 18-month analysis of the same registry (1,845 patients), 48% of those who responded in the first month had stopped by month 18. No comparison group; 27 of the 33 authors declared fees or support from drug companies, 21 of them from Almirall","yan_etki":"Among discontinuations due to side effects, mainly cognitive and psychiatric complaints (55 people, 3.9%; mostly confusion), fatigue (2.5%), drowsiness (2.2%), and dizziness (2%)","pmid":"27160523","doi":"10.1136/jnnp-2015-312591","diger_kaynak":"Other analyses of the same registry: Messina 2017 (PMID 28763462; discontinuation), Patti 2020 (PMID 32335779), Chisari 2020 (PMID 32661083; 18 months, 1,845 patients), Patti 2022 (PMID 35590453)"},{"ad":"Flachenecker 2014 (MOVE 2)","tasarim":"Prospective, multicenter, non-interventional observational study (no comparison group)","n":"335 patients; 276 in the efficacy analysis","populasyon":"Patients starting the spray for moderate to severe MS spasticity resistant to other medicines (Germany)","urun":"Nabiximols (THC:CBD mouth spray), in routine care","urun_turu":"thc_iceren","doz":"Not reported (in the abstract)","titrasyon":null,"sure":"3–4 months (12-month extension in 52 patients)","sonuc":"At month 1, relief in 74.6% of patients according to specialist assessment; mean NRS from 6.1 to 5.2. At month 3, 55.3% of patients were continuing treatment, and NRS was 25% lower than baseline. In the 12-month extension (52 patients), NRS from 6.0 to 4.5. No comparison group; funding and conflict of interest statements could not be read","yan_etki":"17% of patients reported side effects; in the 12-month extension, 84% reported no side effects","pmid":"24525548","doi":"10.1159/000357427","diger_kaynak":"12-month extension: Flachenecker 2014, Eur Neurol 72:95–102 (PMID 24943098)"},{"ad":"Etges 2016 (manufacturer safety registry)","tasarim":"Postmarketing observational safety registry (voluntary reporting by doctors; no comparison group)","n":"941 patients (2,214 patient-years); 78% for MS, 59% with a confirmed diagnosis of MS spasticity","populasyon":"Patients using the spray on prescription in the United Kingdom, Germany, and Switzerland","urun":"Nabiximols (THC:CBD mouth spray)","urun_turu":"thc_iceren","doz":"Not reported (in the abstract)","titrasyon":null,"sure":"About 5 years of registry data","sonuc":"60% of patients were continuing treatment, and according to their doctors 83% benefited; 32% stopped (about one third because of lack of effect, one quarter because of side effects). No signal of abuse, diversion, or dependence. Based on voluntary reporting by doctors; all authors were employees and shareholders of the manufacturer (GW Pharmaceuticals), and the registry was funded by the company","yan_etki":"Clinically significant psychiatric side effects 6%, falls requiring medical care 6%, suicidal thoughts or attempts 2%; driving ability worsened in 2% and improved in 7%; the most common treatment-related side effects were dizziness (2.3%) and fatigue (1.7%); side effects were more common in the first month","pmid":"27956834","doi":"10.2147/TCRM.S115014","diger_kaynak":null},{"ad":"Clifford 1983","tasarim":"Small open-label study (case series); no comparison group and no blinding (as reported by two reviews; tagged in PubMed as ‘clinical trial’ and ‘case report’; the full text could not be read)","n":"8","populasyon":"People with MS severely disabled by tremor and ataxia (a disorder of balance and coordination) (USA)","urun":"Oral THC (tetrahydrocannabinol)","urun_turu":"thc_iceren","doz":"Oral THC, 5–15 mg per dose (4 times a day according to one review; as reported by Koch 2007 and Kluger 2015)","titrasyon":null,"sure":"Not reported (in the abstract)","sonuc":"In this study, started after one patient spontaneously described benefiting from THC, motor coordination improved on examination in 2 of 8 patients; according to two reviews, 5 patients reported feeling better. There is no comparison group, and no numerical measurements were given in the abstract; this design cannot separate the effect of expectation and spontaneous change, and no cause and effect can be inferred","yan_etki":"Not reported (in the abstract); according to one review, no side effects were reported (Koch 2007)","pmid":"6309074","doi":"10.1002/ana.410130616","diger_kaynak":"Ann Neurol 1983;13(6):669–671; funding: US National Institutes of Health (NINDS, NCRR) grants (PubMed record)"}],"ilgili_ilaclar":["tizanidin","gabapentin","pregabalin"],"son_inceleme":"2026-10-31","arastirma_gecmisi":[{"tarih":"2026-10-19","not":"Page published. This first assessment reviewed 2 studies."},{"tarih":"2026-10-21","not":"The full texts of the studies were reread and the information on the page was checked against its sources. Corrected: the registration number, number of participants, side effect, and dose information in the study table; the dose range in the studies. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-21","not":"Newly published and previously missed clinical studies were searched for in PubMed and ClinicalTrials.gov. 3 studies added: Mousavi 2025, Hansen 2023, and Bethoux 2024 (RELEASE MSS1). In the first two randomized studies with pure CBD, spasticity was no different from placebo (Mousavi 2025, Hansen 2023). With the new studies, the strength of evidence changed from \"Insufficient\" to \"Weak\", and the conclusion from \"Not studied enough\" to \"No effect found\"."},{"tarih":"2026-10-22","not":"The names of the conclusion labels were simplified: the \"No benefit seen\" label on this page became \"No effect found\". The assessment did not change."},{"tarih":"2026-10-27","not":"A 3-year controlled study (CUPID) showing that synthetic THC did not slow disease progression in progressive MS was added; the statement 'higher doses have not been tested' was limited to controlled parallel studies. The conclusion and the strength of evidence did not change. The Turkey question now notes that the active substance of the mouth spray containing THC and CBD is on the Foreign Active Substance List of TİTCK (Turkish Medicines and Medical Devices Agency)."},{"tarih":"2026-10-27","not":"In October 2026, PubMed, Cochrane, and ClinicalTrials.gov were systematically searched; 25 studies were added: 19 randomized studies with THC-containing products (mouth spray containing THC and CBD, oral cannabis extract, synthetic THC, smoked marijuana) (three with results only in the ClinicalTrials.gov registry), 1 small crossover study in which a CBD-rich extract was also tested, 2 systematic reviews, and 3 real-world or safety registries. The product type of the Cochrane 2022 review was corrected to 'Multiple product types' (it also includes a nabilone study), and its conclusion was completed with the very small difference in doctor-measured muscle stiffness; in the row for the Danish study, the result for the pure CBD group is now given first. The dosing schedule, warnings, and drug interactions of the approved THC:CBD spray were added from the product information. There are still only two small randomized studies with pure CBD. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-28","not":"Display fix: internal working file names left in the text were removed; content and evidence did not change."},{"tarih":"2026-10-28","not":"Display fix: internal working notes left over from the previous cleanup were removed; content and evidence did not change."},{"tarih":"2026-10-28","not":"October 2026 additional review: sources found for this page during the searches for other topics were read and incorporated into the page. A separate section on bladder problems caused by MS was added: the only randomized study done specifically for the bladder (Kavia 2010; the mouth spray containing THC and CBD was no different from placebo in the main measure, urinary incontinence, and helpful on some secondary measures), the figures from the bladder part of the 630-person CAMS study (urinary incontinence decreased slightly more with cannabis extract and with THC than with placebo), the absence of a difference in bladder complaints in two large studies in the table, the loss of significance of the 2018 meta-analysis's very small bladder effect once manufacturer-supported studies were removed, two reviews on this topic (Abo Youssef 2017, Cheng 2026; both found the evidence weak), and the American Academy of Neurology's MS guideline reaffirmed in 2026 (the spray is probably ineffective for urinary incontinence); pure CBD has never been tested for this. Also added to the table: the UK NICE guideline's (2019) recommendation of a 4-week trial of the THC:CBD spray, and a controlled study showing that stopping improved thinking skills in people with MS who had smoked cannabis for a long time (Feinstein 2019). Assessed but not added: the Brazilian Academy of Neurology's 2021 position paper (adds no new information; its statement that the spray is approved in the US is incorrect) and a 19-person uncontrolled sleep study. For spasticity, the conclusion and the strength of evidence did not change."},{"tarih":"2026-10-30","not":"The last sentence of the page's short summary was rewritten in a calmer, more guiding tone: instead of \"Talk to your doctor before you start.\", it now says whom you can talk with, and about what, if you are considering CBD. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-31","not":"A separate section on MS-related tremor was added to the page. In the only randomized study that looked specifically at tremor (Fox 2004; 14 people, oral cannabis extract), there was no difference from placebo on objective tests measuring tremor; in the 160-person study with the mouth spray containing THC and CBD (Wade 2004), there was also no difference in the tremor measurement. An old 8-person THC study without a comparison group (Clifford 1983) and a 2022 systematic review that did not recommend cannabis-based medicines for MS tremor (Pourmohammadi 2022) were also added to the table. Pure CBD has never been tested in MS-related tremor; the evidence for tremor is weak. For spasticity, the conclusion and the strength of evidence did not change."}]},{"id":"parkinsons-disease","baslik":"Parkinson’s disease (motor symptoms, psychosis, tremor, anxiety)","grup":"Other","grup_kodu":"diger","tr_id":"parkinson","kanit_duzeyi":"zayif","kanit_yonu":"yarar_gosterilmedi","kanit_ozet":"All RCTs with CBD-containing products for motor symptoms, levodopa-related involuntary movements, pain and REM sleep behavior disorder were negative; on some measures (sleep, cognition, quality of life), placebo did better. In most of these RCTs, the CBD came with a small amount of THC. For psychosis there is only one 6-patient open-label study; no RCT was found. The tremor and anxiety data come from a single-dose laboratory test; they do not count as evidence for daily use. Two small RCTs with a THC-like synthetic drug (nabilone), however, reported positive results: a 7-person crossover study on levodopa-related involuntary movements and a 38-person study on non-movement symptoms in which drug responders were selected first (enriched design); both are small and their designs may inflate the effect. In the 6-month open extension study with responders, the improvement in sleep and pain continued; the improvement in the total non-movement symptom score, however, was borderline, and there was no control group. Studies without a comparison group (high-dose pure CBD, smoked marijuana, medical marijuana at doses patients adjusted themselves, a chart review of patients given medical marijuana in routine practice) reported improvement; these designs cannot separate out the effect of expectation, and liver enzymes rose with high-dose CBD. In a 1–3-year matched comparison of medical marijuana users, no worsening was seen in disease progression or mental health symptoms (observational). The most recent meta-analysis pooling the RCTs (Messak 2026) found no significant benefit for movement and non-movement symptoms; a meta-analysis that separated the drugs by type (Bilbao 2022) found a difference in favor of CBD when it pooled three small studies with pure CBD, but these studies had measured different outcomes, and studies published after October 2021 were not included in this analysis. The Brazilian Academy of Neurology wrote that there are no scientific data supporting the use of cannabinoids in Parkinson’s; the academy’s 2025 Parkinson’s guideline also found the evidence for cannabis in pain insufficient. Cannabinoids are not included in the UK’s NICE Parkinson’s guideline or in the International Parkinson and Movement Disorder Society’s evidence-based treatment reviews for non-motor symptoms (2019) and motor fluctuations (2025). October 2026 search (PubMed, Cochrane, ClinicalTrials.gov): on this topic we found 10 randomized, placebo-controlled studies with cannabinoids (the largest 101 people), 6 studies without a comparison group, 1 observational comparison, 3 systematic reviews and a position paper from a national academy of neurology; there is no Cochrane review. All are in the table below. An 8-person dose-finding study that did not measure efficacy and a guideline that was later withdrawn were not included in the table.","kanit_duzeyi_metin":"Weak","kanit_duzeyi_thc_icerenler":"zayif","kanit_duzeyi_thc_icerenler_metin":"Weak (RCTs with products containing THC and CBD negative; two small RCTs with nabilone positive)","kaynak_dosya":"diger-hastaliklar.md","saf_cbd_sonuc":"In three small controlled studies with pure CBD, there was no clear difference from placebo in movement symptoms (21 people, 6 weeks) or REM sleep behavior disorder (33 people, 14 weeks); a single 300 mg dose reduced anxiety and tremor triggered in the laboratory. A 2022 meta-analysis pooling these three studies found a difference in favor of CBD; however, the studies had measured different things, and in two of them the movement or sleep measures were no different from placebo. In a 13-person uncontrolled study with a very high dose (20–25 mg per kilogram of body weight a day), improvement in movement scores was reported; the tremor score, however, did not change clearly (this result is only on the study’s registry page and was not tested statistically), and liver enzymes rose in 5 people. For psychosis there is only one 6-patient open-label study. The strength of evidence is weak.","thc_icerenler_sonuc":"RCTs with products containing CBD + low THC showed no benefit for motor symptoms, pain or cognition; some results favored placebo. Cannabis extract capsules containing THC and CBD did not reduce levodopa-related involuntary movements (19-person crossover RCT); with short-term CBD + low THC, a slight worsening was seen on a verbal fluency test. Two small RCTs with the THC-like synthetic drug nabilone reported positive results (levodopa-related involuntary movements, 7 people; non-movement symptoms, 38 people in a study in which only drug responders were randomized); in the 6-month open extension study of responders, the improvement in sleep and pain continued (no control group). Three uncontrolled studies with smoked marijuana (22 people) and medical marijuana (a 50-person prospective and a 69-person retrospective study) reported improvement in movement or non-movement symptoms; because there was no comparison group, the effect of expectation cannot be separated out. In a 1–3-year matched comparison of 76 patients using medical marijuana, no relative worsening was seen in disease progression or in psychosis, depression and cognition (observational). The strength of evidence is weak.","ruhsat":null,"doz_araligi_ozet":"Pure CBD 75–300 mg/day and a single 300 mg dose; in an uncontrolled safety study, pure CBD up to 20–25 mg/kg/day; CBD + low THC products ~15.6–191.8 mg CBD + 0.6–6.4 mg THC/day; nabilone 0.25–2 mg/day","titrasyon_ozet":"In the studies, treatment started at a low dose and was raised to the target dose over 1–2 weeks (Liu 2024: 2.5 mg/kg/day over 2 weeks; Kanjanarangsichai 2022: 2 weeks of individual titration); these are research protocols","yan_etkiler":["In healthy volunteers, CBD increased the risk of diarrhea (RR 5.85); non-significant trend toward more abdominal pain and headache (Sawaira 2026, PMID 41789242)","Psychiatric and nervous system side effects more common with THC-containing products (Filippini 2022, PMID 35510826); the likelihood of side effects increased with any cannabinoid (OR 1.75; Wilson 2026, PMID 41856154)","Raised alkaline phosphatase (Mitarnun 2025)","Mild side effects more common in the CBD/THC group (Liu 2024)","With high-dose pure CBD (20–25 mg/kg/day), raised liver enzymes in 5 of 13 patients; diarrhea 85%, sleepiness 69%, stopping because of side effects 23% (Leehey 2020)","With a cannabis extract containing THC and CBD, mental side effects (sleepiness, confusion, suspiciousness, nightmares) more common than with placebo (Carroll 2004); with nabilone, dizziness, a drop in blood pressure on standing and visual hallucinations were reported (Sieradzan 2001). The full text of both studies could not be read; the information comes from the tables of a systematic review"],"izlem":["People with Parkinson’s take many medicines: drug interactions, liver enzymes and falls/sedation should be monitored with the doctor"],"dikkat":["High doses cannot be compared with market doses: in low-dose (≤175 mg/day) studies, plasma levels were 5–100 times lower than with the 20 mg/kg Epidiolex dose (Warren 2026, PMID 42473010)","Anyone taking long-term medicines should talk to a doctor before starting; the studies on this page did not systematically assess interactions"],"ilac_etkilesim_notlari":["The studies on this page did not systematically assess drug interactions; details are in the site’s Drug interactions section"],"dogrulanamayan":["Full text of Chagas 2014 not read (paywalled); duration (6 weeks), product and side effect information (no notable side effects on the side effect scale) taken from review tables","The full texts of Carroll 2004 and Sieradzan 2001 could not be accessed (the publisher page required bot verification); product content, dose and side effect information were taken from the tables of a systematic review. The amount of THC per capsule in Carroll 2004 could not be verified from the primary source.","In the Bilbao 2022 meta-analysis, which measures were pooled from the three CBD studies is shown only in a figure and could not be verified from the text. For Messak 2026, Urbi 2022, Kubota 2026, Mitarnun 2025, de Almeida 2021, Leehey 2020, Lotan 2014, Anis 2026, Goldberg 2023 and Aladeen 2023, only the abstracts were read; the tremor result of Leehey 2020 is from the study’s ClinicalTrials.gov registry entry.","A study with unpublished results: a 27-person double-blind study in Warsaw comparing the effect of three doses of full-spectrum CBD oil (30, 60 and 300 mg a day) on anxiety and depression in Parkinson’s patients finished in November 2024 (NCT07651930); as of October 2026, there are no results or publications in the registry. Because there is no placebo group, even if results come out they will answer the question of efficacy only in a limited way."],"calismalar":[{"ad":"Liu 2024","tasarim":"Double-blind, placebo-controlled RCT","n":"61 (31/30)","populasyon":"Parkinson’s","urun":"Cannabis extract, oral solution in sesame oil (100 mg/mL CBD + 3.3 mg/mL THC; contains THC)","urun_turu":"thc_iceren","doz":"Avg. 191.8 mg CBD + 6.4 mg THC/day (2.5 mg/kg/day)","titrasyon":"2 weeks of titration","sure":"~2 weeks (at the final dose)","sonuc":"No difference from placebo on motor MDS-UPDRS (difference −1.80 points; 95% CI −5.88 to 2.27; p = 0.379; marked improvement in the placebo group too); sleep and cognition results favored placebo","yan_etki":"Mild side effects more common in the CBD/THC group","pmid":"38487964","doi":"10.1002/mds.29768","diger_kaynak":"ClinicalTrials.gov NCT03582137 (results in the registry, July 23, 2024); cognitive safety publication from the same trial: Domen 2023 (PMID 37212386; 29 vs. 29 people; after adjusting for age and education, the CBD/THC group did worse than placebo on the animal naming test, and cognitive side effects were at least twice as common); seborrheic dermatitis secondary analysis: Weber 2024 (PMID 38466972; on the Skin Conditions topic)"},{"ad":"Kubota 2026","tasarim":"Phase 2, placebo-controlled RCT","n":"101 (87 completed)","populasyon":"Painful Parkinson’s disease","urun":"CBD 96 mg/mL + THC 2.1 mg/mL","urun_turu":"thc_iceren","doz":"Final dose 43.88 mg CBD + 0.96 mg THC/day","titrasyon":"not reported","sure":"9 weeks","sonuc":"No difference from placebo on the primary outcome (Parkinson’s pain classification system score) (p = 0.757); no difference on other non-motor symptom scales either","yan_etki":"No serious side effects","pmid":"42563548","doi":"10.1002/mds.70449","diger_kaynak":null},{"ad":"Mitarnun 2025","tasarim":"Double-blind RCT","n":"60 (51 analyzed)","populasyon":"Parkinson’s","urun":"Sublingual CBD-rich product (101.9 mg/mL CBD + 4.8 mg/mL THC; contains THC)","urun_turu":"thc_iceren","doz":"Avg. 26 mg CBD + 1.2 mg THC/day","titrasyon":"not reported","sure":"12 weeks","sonuc":"No difference on the primary outcome (delayed recall); small increase in naming score","yan_etki":"Alkaline phosphatase rose in the CBD group; no serious side effects","pmid":"40267585","doi":"10.1016/j.parkreldis.2025.107841","diger_kaynak":null},{"ad":"Kanjanarangsichai 2022","tasarim":"Double-blind RCT","n":"40 (36 analyzed)","populasyon":"Parkinson’s","urun":"Sublingual CBD-rich cannabis flower extract in olive oil (100 mg/mL CBD + 3.9 mg/mL THC; contains THC)","urun_turu":"thc_iceren","doz":"Avg. 15.59 mg CBD + 0.61 mg THC/day","titrasyon":"2 weeks of individual titration","sure":"8 weeks","sonuc":"No difference in UPDRS, gait, anxiety or depression; quality of life better with placebo","yan_etki":"Side effect frequency similar in the two groups (47.3% vs. 47.1%), all mild (most common: dry throat); no serious side effects","pmid":"36743777","doi":"10.25259/JNRP-2022-6-19","diger_kaynak":null},{"ad":"Chagas 2014","tasarim":"Exploratory double-blind study","n":"21 (3 × 7)","populasyon":"Parkinson’s","urun":"Pure CBD (99.9% pure powder in corn oil, capsule; according to reviews); added to Parkinson’s medicines","urun_turu":"saf_cbd","doz":"75 or 300 mg/day","titrasyon":"not reported","sure":"6 weeks (according to review tables)","sonuc":"No difference on the UPDRS; in the 300 mg group, quality of life (PDQ-39) differed from placebo (p=0.05)","yan_etki":"No notable side effects in any group on the side effect scale (UKU) or in verbal reports (according to a review table; full text could not be read)","pmid":"25237116","doi":"10.1177/0269881114550355","diger_kaynak":"Duration and product from review tables (PMC6710502, PMC8161868); full text not read"},{"ad":"de Faria 2020","tasarim":"Double-blind, placebo-controlled, crossover RCT (2 sessions, 15 days apart; simulated public speaking test)","n":"24 (22 men, 2 women; sex distribution according to a review table)","populasyon":"Parkinson’s patients (Brazil; mean age 64, mean disease duration 6.5 years, Hoehn-Yahr stage 1–2.5; 19 of 24 were taking levodopa; according to a review table)","urun":"Oral CBD capsule (powder, 99.9% pure, in corn oil; product information according to a review table, full text could not be read); placebo identical capsule","urun_turu":"saf_cbd","doz":"300 mg single dose","titrasyon":"None","sure":"Single session","sonuc":"Drug effect favoring CBD on the anxiety dimension of the Visual Analog Mood Scale: the anxiety caused by the speaking test decreased. Tremor amplitude measured with an accelerometer decreased with CBD (p = 0.022); no difference in tremor frequency or in the other tremor measure (p = 0.899 and 0.216), and no difference on the finger-tapping test (slowness of movement) either (p = 0.701; tremor and finger-tapping results according to a review table). Limited to a single dose and two laboratory sessions. Public funding (São Paulo Research Foundation FAPESP and Brazil’s National Council for Scientific and Technological Development CNPq; according to a review table); conflict of interest statement could not be read; of the 9 authors, Zuardi, Hallak and Crippa report in their other publications (e.g., Linares 2019, Bolsoni 2022b) that they are inventors on a CBD derivative patent and that their university has an agreement with a pharmaceutical company to develop a synthetic CBD product, including for Parkinson’s disease","yan_etki":"No side effects reported during or after the sessions (according to a review table; full text could not be read). Pulse and blood pressure were measured during the speaking test; the results are not in the abstract or the review table","pmid":"31909680","doi":"10.1177/0269881119895536","diger_kaynak":"Secondary source for product, participant characteristics, funding, tremor measures and side effects: Thanabalasingam 2021 systematic review (PMID 34104218, PMC8161868; Tables 1, 2, 5 and 6)"},{"ad":"Sieradzan 2001","tasarim":"Double-blind, placebo-controlled, randomized crossover pilot study","n":"7","populasyon":"Parkinson’s patients with levodopa-related involuntary movements (dyskinesia)","urun":"Nabilone (THC-like synthetic cannabinoid, by mouth)","urun_turu":"cbn_diger","doz":"0.03 mg/kg nabilone, divided into two doses 12 hours and 1 hour before the levodopa test (according to a review table)","titrasyon":"None (single day, divided into two doses)","sure":"A single treatment day (divided into two doses); two levodopa tests 2 weeks apart (according to a review table)","sonuc":"Nabilone significantly reduced levodopa-related dyskinesia compared with placebo (very small study)","yan_etki":"With nabilone, 2 patients were withdrawn from the study (one for dizziness, one for a symptomatic drop in blood pressure on standing); in 5 patients, mild sleepiness, a floating sensation, dizziness, oversensitivity to sounds, partial disorientation or visual hallucinations (according to a review table; full text could not be read)","pmid":"11739835","doi":"10.1212/wnl.57.11.2108","diger_kaynak":null},{"ad":"Peball 2020","tasarim":"Phase 2, double-blind, placebo-controlled, enriched randomized withdrawal design (open-label dose finding first, then responders randomized)","n":"47 in the open-label period; 38 randomized (19/19)","populasyon":"Parkinson’s patients with stable motor symptoms and troublesome non-motor symptoms (Austria)","urun":"Nabilone (THC-like synthetic cannabinoid, oral capsule)","urun_turu":"cbn_diger","doz":"Started at 0.25 mg a day, up to at most 1 mg twice a day; median 0.75 mg/day in the randomized period","titrasyon":"In the open-label period, 0.25 mg/day → at most 2 × 1 mg","sure":"Open-label dose finding + 4-week randomized period","sonuc":"MDS-UPDRS-I (non-motor symptoms) worsened by 2.63 points with placebo and 1.00 point with nabilone over 4 weeks (difference 1.63; p = 0.030). Because only drug responders were randomized, the effect may look larger than it would be across all patients. The manufacturer supplied the drug and placebo and covered the costs of visits and independent monitoring; 5 of the 18 authors have ties to the manufacturer (one is a company employee)","yan_etki":"Side effects in 77% in the open-label period (mostly temporary); in the double-blind period 32% (nabilone) and 42% (placebo); no serious side effects","pmid":"32757413","doi":"10.1002/ana.25864","diger_kaynak":"ClinicalTrials.gov NCT03769896 (results in the registry, March 2, 2021); EudraCT 2017-000192-86; protocol: Peball 2019 (PMID 31129719); sleep secondary analysis of the same trial: Peball 2022 (PMID 35937495; sleep problems worsened only in those who switched to placebo); cognition analysis using eye movement tests: Ellmerer 2022 (PMID 35625047; no difference from placebo). The open-label extension study is in a separate row (Peball 2024)"},{"ad":"Carroll 2004","tasarim":"Double-blind, placebo-controlled, randomized crossover RCT (preceded by a 6-patient open dose-escalation study)","n":"19 randomized; 17 completed (plus a 6-person dose-finding pilot study)","populasyon":"Parkinson’s patients with levodopa-related involuntary movements (dyskinesia) (England)","urun":"Cannador: ethanol extract of the cannabis plant, oral capsule (contains THC and CBD; according to a review table, more THC than CBD)","urun_turu":"thc_iceren","doz":"By body weight; mean 0.146 mg/kg/day (according to a review table; full text could not be read)","titrasyon":"Dose escalation was tried in the pilot study; the adjustment schedule in the RCT is not in the abstract","sure":"2 × 4 weeks (2-week washout in between)","sonuc":"No difference from placebo on the primary outcome (UPDRS items 32–34: dyskinesia); no difference on secondary measures either (Rush and Bain dyskinesia scales, total UPDRS after a levodopa test, quality of life PDQ-39, on-off diaries). The cannabis extract neither improved nor worsened Parkinson’s symptoms. By the review’s calculation, the difference in UPDRS dyskinesia score was 0.52 (95% CI −0.1 to 1.1; p = 0.09), in the direction against cannabis but not significant","yan_etki":"Physical side effects 18 with cannabis, 9 with placebo; mental side effects (sleepiness, feeling detached, suspiciousness, nightmares, confusion, forgetfulness) 20 with cannabis, 6 with placebo (given as “n” in the review table; not stated whether people or events); all mild and resolved when the dose was reduced; no serious side effects","pmid":"15477546","doi":"10.1212/01.wnl.0000140288.48796.8e","diger_kaynak":"Commentary and author reply: Neurology 2005;64(6):1100 (PMID 15781848; content not read)"},{"ad":"de Almeida 2021 (RBD)","tasarim":"Phase 2/3, double-blind, placebo-controlled RCT (parallel, 1:1)","n":"33 randomized","populasyon":"Parkinson’s patients with REM sleep behavior disorder (a sleep disorder in which dreams are acted out with movements) (Brazil)","urun":"Pure CBD capsule (added to Parkinson’s medicines)","urun_turu":"saf_cbd","doz":"75–300 mg/day","titrasyon":"From 75 mg to 300 mg (schedule not in the abstract)","sure":"14 weeks","sonuc":"No difference from placebo on the primary outcomes (frequency of nights with REM sleep behavior disorder, the physician’s global impression scales CGI-I and CGI-S). On secondary outcomes, a temporary improvement in sleep satisfaction with 300 mg between weeks 4 and 8 (p = 0.049 and p = 0.038). According to the authors, CBD as an add-on treatment did not reduce the symptoms of this disorder","yan_etki":"Not reported (in the abstract; full text could not be read)","pmid":"33754375","doi":"10.1002/mds.28577","diger_kaynak":"Exploratory analysis of restless legs syndrome from the same trial: de Almeida 2023 (PMID 35749710; 18 patients, 6 CBD / 12 placebo; no difference on primary and secondary outcomes). Both are also in the table for the Insomnia topic"},{"ad":"Messak 2026","tasarim":"Systematic review and meta-analysis of RCTs (PubMed, Scopus, Web of Science; risk of bias RoB-2)","n":"11 RCTs; 6 in the meta-analysis","populasyon":"Parkinson’s patients","urun":"Cannabinoids (CBD, CBD with THC, nabilone, etc.)","urun_turu":"karma","doz":"Variable","titrasyon":null,"sure":null,"sonuc":"Cannabinoids did not change disease severity (SMD 0.16; 95% CI −0.13 to 0.44), motor examination (SMD −0.08; −0.35 to 0.20), motor difficulties in daily life (SMD −0.08; −0.49 to 0.33) or non-motor symptoms (SMD −0.03; −0.72 to 0.67; high heterogeneity between studies) significantly differently from placebo. When the nabilone study was removed, the estimate for non-motor symptoms changed (SMD 0.34; −0.19 to 0.88); according to the authors, the signal of benefit seen with nabilone is a separate question and needs its own trial. The authors note as a limitation that earlier reviews also pooled drugs that block the cannabinoid receptor","yan_etki":"Not reported in the abstract","pmid":"42138778","doi":"10.1007/s13760-026-03082-0","diger_kaynak":null},{"ad":"Bilbao 2022","tasarim":"Systematic review and meta-analysis of RCTs separated by drug type (up to October 2021; GRADE)","n":"152 RCTs (all indications, 12,123 participants); in Parkinson’s, 3 RCTs with pure CBD (101 participants) and 2 RCTs with nabilone (51 participants)","populasyon":"All medical indications (including a Parkinson’s subgroup)","urun":"Dronabinol, nabilone, pure CBD and nabiximols (natural products such as smoked cannabis excluded)","urun_turu":"karma","doz":"Variable (75–300 mg/day or a single dose in the Parkinson’s CBD studies)","titrasyon":null,"sure":null,"sonuc":"In Parkinson’s, all cannabinoids together were found better than placebo (SMD −0.41; 95% CI −0.69 to −0.13). In the subgroup, the three small pure CBD studies (Chagas 2014, de Faria 2020, de Almeida 2021) were significant (SMD −0.41; −0.75 to −0.08; GRADE: moderate), while the two nabilone studies were not (SMD −0.38; −1.05 to 0.29; very low). However, these three CBD studies had measured different things (movement and quality-of-life scores, anxiety triggered in the laboratory, REM sleep behavior disorder), and in two of them the movement or sleep measures were no different from placebo; which measures were pooled is shown only in a figure. Later RCTs (2022–2026) were not included in this analysis","yan_etki":"Across all indications, the likelihood of any side effect with CBD higher than with placebo (OR 1.82; 95% CI 1.08–3.07); no Parkinson’s-specific side effect analysis","pmid":"35982439","doi":"10.1186/s12916-022-02459-1","diger_kaynak":"PROSPERO CRD42021229932"},{"ad":"Urbi 2022","tasarim":"Systematic review and meta-analysis (up to June 2021)","n":"5 RCTs and 18 non-randomized studies","populasyon":"Parkinson’s patients","urun":"Cannabis and cannabinoids (CBD, THC-containing products, nabilone)","urun_turu":"karma","doz":"Variable","titrasyon":null,"sure":null,"sonuc":"No strong evidence was found that would be enough to recommend cannabis use in Parkinson’s. A possible signal of benefit was reported for tremor, anxiety, pain, sleep quality and quality of life; the authors stressed the scarcity of well-designed randomized studies. Meta-analysis numbers not in the abstract","yan_etki":"Not reported in the abstract","pmid":"34958046","doi":"10.3233/JPD-212923","diger_kaynak":null},{"ad":"Brucki 2021","tasarim":"Position paper of a national academy of neurology (scientific departments of the Brazilian Academy of Neurology; literature assessment)","n":"Not applicable","populasyon":"Neurological diseases (including the movement disorders and sleep disorders sections)","urun":"Cannabinoids (CBD, THC, nabiximols, etc.)","urun_turu":"karma","doz":"Not applicable","titrasyon":null,"sure":null,"sonuc":"According to the movement disorders section, there are no scientific data supporting the use of cannabinoids in Parkinson’s: the positive response in movement symptoms seen in uncontrolled studies was not repeated in controlled studies; reports of improvement in psychosis, sleep and pain mostly come from small, short and uncontrolled studies. The same academy’s 2025 Parkinson’s guideline (a separate document, other source) found the evidence for cannabis in pain insufficient (level U; at that time the only study in pain was an 8-person dose-finding study that did not measure efficacy) and wrote that CBD does not reduce REM sleep behavior disorder","yan_etki":"Not applicable","pmid":"34133518","doi":"10.1590/0004-282X-ANP-2020-0432","diger_kaynak":"Movement Disorders Department of the Brazilian Academy of Neurology, Parkinson’s treatment guideline part II (non-motor symptoms): Maia 2025 (PMID 39993447; its correction PMID 41173036 corrects only a recommendation about dementia medicines and has nothing to do with cannabinoids). Cannabinoids are not mentioned in part I of the guideline (Saba 2022, PMID 35319667)"},{"ad":"Leehey 2020","tasarim":"Open-label dose-escalation study; no control group","n":"15 enrolled, 13 started, 10 completed","populasyon":"Parkinson’s patients with marked resting tremor who did not use cannabis (US)","urun":"Pure CBD oral solution (Epidiolex, 100 mg/mL)","urun_turu":"saf_cbd","doz":"From 5 mg/kg/day to 20–25 mg/kg/day","titrasyon":"Increased by 2.5–5 mg/kg every 3–5 days (per the registry)","sure":"Dose escalation + 10–15 days at a fixed dose (5 weeks in total per the registry)","sonuc":"In the 10 completers, total MDS-UPDRS fell by 7.7 points (17.8%; p = 0.012) and the motor section by 6.1 points (24.7%; p = 0.004); night-time sleep and emotional-behavioral control scores improved. No placebo. The patients selected for the study had marked tremor, but the change in tremor score was −0.4 points (SD 1.26; only in the registry results, no statistical test). The authors stressed that the high dose caused problems with liver values and that a randomized study is needed","yan_etki":"Side effects in everyone: diarrhea 85%, sleepiness 69%, fatigue 62%, weight gain 31%, dizziness and abdominal pain 23%; at 20–25 mg/kg/day, liver enzymes rose in 5 people (38.5%) (mostly cholestatic (bile duct) type, 1 with symptoms); 3 people (23%) could not tolerate it and stopped; no serious side effects","pmid":"33381646","doi":"10.1089/can.2019.0068","diger_kaynak":"ClinicalTrials.gov NCT02818777 (results in the registry, February 19, 2019; the registry title says crossover RCT, but only the open-label first phase was done). The manufacturer (GW Research Ltd) is listed as a collaborator in the registry; the publication’s abstract states there was no conflict of interest"},{"ad":"Zuardi 2009","tasarim":"Open-label pilot, no control group","n":"6","populasyon":"Parkinson’s psychosis","urun":"Pure CBD","urun_turu":"saf_cbd","doz":"Started at 150 mg/day, flexible dose","titrasyon":"Flexible","sure":"4 weeks","sonuc":"Psychotic symptoms decreased (no control). The conflict of interest statement and funding could not be read from the primary source (full text not open access); according to the table of a systematic review, the study was supported by Brazil’s national and state science funds, and the companies THC-Pharm (Germany) and STI-Pharm are also listed as supporters in the table (Thanabalasingam 2021). 3 of the 8 authors later became inventors on CBD patents (fluorinated CBD compounds; international application WO/2014/108899)","yan_etki":"No side effects observed","pmid":"18801821","doi":"10.1177/0269881108096519","diger_kaynak":"Secondary source for the funding information: Thanabalasingam 2021 systematic review (PMID 34104218, PMC8161868; Table 2)"},{"ad":"Peball 2024 (NMS-Nab2)","tasarim":"Open-label extension study (those who responded to nabilone in the NMS-Nab trial and completed the double-blind period without problems); no control group","n":"22 started; 21 analyzed; 19 completed","populasyon":"Parkinson’s patients with non-motor symptoms who had previously responded to nabilone (Austria)","urun":"Nabilone (THC-like synthetic cannabinoid, oral capsule)","urun_turu":"cbn_diger","doz":"Mean 0.87 mg/day (range 0.25–1.5 mg)","titrasyon":"Re-titrated until non-motor symptoms improved","sure":"6 months","sonuc":"According to the physician’s global impression, improvement was maintained in 79% of patients at the last visit. Compared with the state before restarting nabilone, overall sleep (NMSS domain 2 −8.26 points; 95% CI −13.82 to −2.71; p = 0.004), night-time sleep problems (MDS-UPDRS 1.7 −1.42; p = 0.002) and pain (KPPS −8.00; 95% CI −15.05 to −0.95; p = 0.046) were better; the drop in the total non-motor symptom score, however, was borderline (MDS-UPDRS-I −2.58; p = 0.052), and the scales (except the depression subscale) did not change significantly over the 6-month follow-up. No control group and only prior responders were enrolled; the results cannot be generalized to all patients. The drug was supplied by the manufacturer; 2 of the 12 authors reported fees from the manufacturer outside the study","yan_etki":"Most common: difficulty concentrating; 1 person stopped because of a side effect (night-time sleep problem); in the registry, 4 serious events in 22 people (rectal cancer, lumbar disc herniation, worsening of Parkinson’s symptoms, vomiting; relationship to the drug not stated in the registry)","pmid":"38491070","doi":"10.1038/s41531-024-00665-7","diger_kaynak":"ClinicalTrials.gov NCT03773796 (results in the registry, March 2, 2021); the main trial is Peball 2020 in the table"},{"ad":"Lotan 2014","tasarim":"Open-label observational study (before-after); no placebo or control group","n":"22","populasyon":"Parkinson’s patients using medical marijuana (Israel, 2011–2012)","urun":"Smoked marijuana (contains THC; patients’ own product)","urun_turu":"thc_iceren","doz":"0.5 g (according to a review table)","titrasyon":"None","sure":"Single session (before smoking and 30 minutes after)","sonuc":"UPDRS motor score fell from 33.1 to 23.2 (p < 0.001); improvement in tremor, muscle stiffness and slowness of movement, as well as in sleep and pain scores, was reported. No placebo, open assessment, and patients were already using marijuana; the effect of expectation cannot be separated out. Controlled studies with products taken by mouth did not show improvement in movement symptoms; there is no controlled study with smoked marijuana","yan_etki":"No notable side effects observed (abstract); according to a review table, low blood sugar in 1 person and dizziness in 1 person","pmid":"24614667","doi":"10.1097/WNF.0000000000000016","diger_kaynak":null},{"ad":"Anis 2026","tasarim":"Single-center, open-label prospective cohort; no control group","n":"68 started; 50 completed follow-up (26.5% dropout, mostly lost to follow-up)","populasyon":"Parkinson’s patients newly starting medical marijuana (Israel)","urun":"Cannabis oil extract or dried flower; variable THC/CBD ratio (product content measured in the laboratory)","urun_turu":"karma","doz":"Dose adjusted by the patient (details not in the abstract)","titrasyon":"Self-titration","sure":"3 months","sonuc":"At 3 months vs. baseline, total non-motor symptoms (NMSS) improved by 14.5 points (p = 0.001), sleep (PDSS-2) by 5.9 points (p < 0.001), pain (KPPS) by 8.1 points (p = 0.004) and quality of life (PDQ-8) by 1.5 points (p = 0.040); night-time urination frequency decreased (median 0.5; p = 0.016), while daytime urination measures did not change. No link was found between the product’s THC/CBD composition and response. No control group and no blinding","yan_etki":"Generally well tolerated (abstract); side effect details not in the abstract","pmid":"42304702","doi":"10.1177/25785125261458680","diger_kaynak":"ClinicalTrials.gov NCT05106504 is most likely this study’s registry entry (same principal investigator and center, same scales and product analysis; status “unknown” in the registry, no results entered); the publication’s abstract gives no registration number"},{"ad":"Goldberg 2023","tasarim":"Retrospective case-control study (matched comparison)","n":"152 (76 medical marijuana users, 76 matched controls)","populasyon":"Patients with idiopathic Parkinson’s disease (Israel, single center, 2008–2022)","urun":"Whole-plant medical marijuana (median 10% THC, 4% CBD)","urun_turu":"thc_iceren","doz":"Median 20 g/month","titrasyon":null,"sure":"At least 1 year of use; 1–3 years of follow-up","sonuc":"Levodopa equivalent dose and disease stage (Hoehn and Yahr) progressed similarly in the two groups (p = 0.90 and p = 0.77); no relative worsening in the marijuana group in psychosis, depression and cognitive problems reported by patients to their physician (p = 0.16–0.50). Retrospective and not randomized; patients chose to use marijuana. Observational data","yan_etki":"No safety concerns with long-term use in terms of disease progression and mental health symptoms (abstract); other side effects not in the abstract","pmid":"37211456","doi":"10.1016/j.parkreldis.2023.105406","diger_kaynak":null},{"ad":"Aladeen 2023","tasarim":"Retrospective chart review (single center); no control group","n":"69","populasyon":"Parkinson’s patients given medical marijuana in routine practice (US, New York State, single neurology center)","urun":"Medical marijuana products; most patients started on a tincture with equal amounts of THC and CBD (1:1), followed by changes in ratio and form","urun_turu":"thc_iceren","doz":"not reported (in the abstract)","titrasyon":"Ratio and form adjusted in routine practice (details not in the abstract)","sure":"not reported (in the abstract)","sonuc":"According to the records, improvement in at least one symptom was noted in 60 of 69 patients (87%); most often in muscle cramps and dystonia, pain, muscle stiffness, loss of appetite, involuntary movements and tremor. 56% of opioid users (14 people) reduced or stopped their opioid (mean daily morphine equivalent from 31 to 22 mg). Retrospective with no comparison group; improvement was determined from physician notes rather than standard scales, and the effects of expectation and patient selection cannot be separated out. 1 of the 8 authors has a financial interest in a cannabis company (according to the authors, patients did not use this company’s products); funding from a nonprofit foundation","yan_etki":"No serious side effects reported; 4 patients stopped because of side effects","pmid":"37191563","doi":"10.1097/WNF.0000000000000550","diger_kaynak":null}],"ilgili_ilaclar":["ketiapin","klozapin"],"son_inceleme":"2026-10-28","arastirma_gecmisi":[{"tarih":"2026-10-19","not":"Page published. In this first assessment, 7 studies were reviewed."},{"tarih":"2026-10-21","not":"The full texts of the studies were reread and the information on the page was checked against its sources. Corrected: duration, registration number and product information in the study table. Points that could not be verified from the full text went down from 2 items to 1 item. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-22","not":"The names of the finding labels were simplified: the “No benefit seen” label on this page became “No effect found.” The assessment did not change."},{"tarih":"2026-10-27","not":"Two small controlled studies with the THC-like synthetic drug nabilone were added; the statement “all controlled studies are negative” was limited to CBD-containing products. For CBD, the conclusion and the strength of evidence did not change."},{"tarih":"2026-10-28","not":"Display fix: internal working file names left in the text were removed; content and evidence did not change."},{"tarih":"2026-10-28","not":"PubMed, Cochrane and ClinicalTrials.gov were systematically searched again in October 2026 (1,464 records in PubMed and 270 in ClinicalTrials.gov; together with an independent second check). Added: 2 placebo-controlled randomized studies (a cannabis extract containing THC and CBD for levodopa-related involuntary movements, and pure CBD for REM sleep behavior disorder; neither differed from placebo), 3 systematic reviews and meta-analyses, the position paper of the Brazilian Academy of Neurology (together with the same academy’s 2025 Parkinson’s guideline), 5 studies without a comparison group (high-dose pure CBD, the 6-month extension study of nabilone, smoked marijuana, medical marijuana at doses patients adjusted themselves, a chart review of patients given medical marijuana in routine practice) and an observational comparison of long-term medical marijuana use. There is no Cochrane review on this topic. A small dose-finding study that did not measure efficacy and a guideline that was later withdrawn were not included in the table. Corrected: the CBD and THC amounts of the products in the studies, the numbers for primary outcomes, missing side effect information, company ties in two studies, additional publications and registration numbers of the same trials, and the table order; the explanation of the THC strength of evidence was updated in light of the new study (level unchanged). The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-28","not":"Display fix: internal working notes left over from the earlier cleanup were removed; content and evidence did not change."},{"tarih":"2026-10-28","not":"October 2026 supplementary review: sources found for this page during the searches for other topics were read and added to the page. The row for the study looking at the effect of a single dose of CBD on anxiety during a speaking test (de Faria 2020) was made consistent with the same study’s row on the Social Anxiety page: the placebo-controlled crossover design, the purity of the product (99.9% pure CBD powder), the participants’ sex and disease stage, public funding, and details of the tremor measurements (tremor amplitude went down; its frequency and slowness of movement did not change) were added from the tables of a systematic review; the results for the measured pulse and blood pressure could not be accessed. The same row now notes a CBD derivative patent that three of the authors reported in their other publications, and their university’s agreement with a pharmaceutical company to develop a synthetic CBD product, including for Parkinson’s disease. In the row for the small open-label study in Parkinson’s psychosis (Zuardi 2009), it is now stated clearly that the funding information could not be read from the primary source and came from a review table; it was added that the authors’ CBD patents date from the years after the study (consistent with the same row on the Schizophrenia page). The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-31","not":"The last sentence of the page's short summary was rewritten in a calmer, more guiding tone: instead of \"Talk to your doctor before you start.\", it now says whom you can talk with, and about what, if you are considering CBD. The conclusion and the strength of evidence did not change."}]},{"id":"schizophrenia-psychosis","baslik":"Schizophrenia and psychosis","grup":"Anxiety and mental health","grup_kodu":"kaygi","tr_id":"sizofreni-psikoz","kanit_duzeyi":"zayif","kanit_yonu":"celiskili","kanit_ozet":"Pure CBD has been tested only in addition to an antipsychotic or for short periods. One RCT saw a small reduction in positive symptoms (the difference in total score was not significant), and another saw no improvement at all; in the comparison with amisulpride, equivalence could not be shown statistically. In the maker's unpublished 12-week phase 2 study (77 patients randomized; results only in the registry), 300 and 1000 mg/day were no different from placebo on the PANSS total; the study was stopped early by company decision. Two meta-analyses in 2026 reached different conclusions; a 2026 meta-analysis covering all cannabinoids found no significant effect in psychotic disorders, and the Cochrane review (2014) found the evidence for CBD insufficient; Denmark's 2026 national guideline recommends not using cannabinoids for negative symptoms. Other small controlled studies also found no difference: an 18-person crossover study with results only in the registry (NCT02504151), an open-label pilot study with CBD-rich cannabis cigarettes (Köck 2021) and an attention test with a single dose (Hallak 2010); in a 15-patient single-dose study, the drop in symptoms was larger on the CBD day, but this was a secondary measure tested one-sided (O'Neill 2021). In 33 people at high risk of psychosis, the main outcome of the only placebo-controlled study was brain measurements; it was reported years later in a short letter that symptom scores were lower in the CBD group after 21 days of use (not a pre-registered outcome; Bhattacharyya 2018). In Parkinson's psychosis there is only an open-label series of 6 patients (Zuardi 2009). In people with schizophrenia who also have cannabis use disorder, 1000 mg CBD given before marijuana did not reduce but increased marijuana's memory-impairing and psychosis-increasing effects (30-person crossover RCT); in healthy volunteers, CBD added to cannabis also did not reduce THC's psychosis-like effects (Englund 2023, Lawn 2023); results of earlier small studies were mixed (Freeman 2019). The doses studied (mostly 600–1000 mg/day) are far above the doses of CBD oils on the market; do not stop an antipsychotic and switch to CBD. THC: treatment data are almost nonexistent (an uncontrolled series of 6 patients); experimental studies and their meta-analyses show that THC temporarily increases psychosis symptoms, and large observational studies show that frequent and high-THC use is associated with an increase in psychosis risk (association; causation is debated). October 2026 search (PubMed, Cochrane, ClinicalTrials.gov): 16 controlled studies of cannabinoids on this topic (11 with CBD in patients or people at high risk of psychosis, one of them with CBD-rich cannabis cigarettes; 3 with THC; 2 in healthy volunteers), 4 small uncontrolled series, 12 systematic reviews or meta-analyses (one Cochrane), 2 guidelines or consensus reports and 4 large observational studies were found; all are in the table below. Reviews repeating the same question, and volunteer studies already covered by the reviews in the table, were not listed one by one.","kanit_duzeyi_metin":"Weak (conflicting)","kanit_duzeyi_thc_icerenler":"yetersiz","kanit_duzeyi_thc_icerenler_metin":"Insufficient (for treatment): there are no controlled studies of THC-containing products for treating schizophrenia or psychosis; there is only an uncontrolled series of 6 patients. The evidence of harm is much stronger: in controlled laboratory studies and their meta-analysis, THC temporarily increased psychosis symptoms (high certainty in an umbrella review); in large observational studies, frequent and high-THC use went hand in hand with a higher risk of psychosis (association; does not show cause and effect on its own)","kaynak_dosya":"diger-hastaliklar.md","saf_cbd_sonuc":"Pure CBD (mostly 600–1000 mg/day, added to an antipsychotic) produced a small reduction in positive symptoms in the largest study, but the difference in total symptom score was not significant (McGuire 2018); most other controlled studies saw no benefit (Boggs 2018, NCT04421456, NCT02504151, Hallak 2010). One meta-analysis found a small benefit on total symptoms (Di Francesco 2026), while two that looked at CBD and at all cannabinoids found no significant effect (Marchi 2026, Wilson 2026); the Cochrane review found the evidence insufficient. No effect was seen on symptoms of schizophrenia such as social withdrawal and lack of motivation (negative symptoms) (Di Francesco 2026); Denmark's national guideline recommends not using cannabinoids to treat these symptoms (Norlin Mølgaard 2026). In the only placebo-controlled study in 33 people at high risk of psychosis, those taking CBD for 3 weeks had slightly lower symptom scores, but this was not the pre-specified main outcome and was reported years later in a short letter (Bhattacharyya 2018); in Parkinson's psychosis there is only an uncontrolled series of 6 patients (Zuardi 2009). CBD taken before marijuana did not reduce marijuana's harm in people with schizophrenia (Chesney 2025), nor did it in healthy volunteers in newer studies (Englund 2023, Lawn 2023). The strength of evidence is weak; it does not replace standard treatment.","thc_icerenler_sonuc":"In schizophrenia and psychosis, THC-containing products have been studied mainly for their possible harms. In controlled laboratory studies, a single dose of THC clearly increased psychosis-like symptoms in healthy volunteers (Hindley 2020; an umbrella review rated the certainty of this finding as high: Solmi 2023), temporarily worsened symptoms and memory problems in people with schizophrenia (D'Souza 2005), and increased suspiciousness in 6 people at high risk of psychosis (Vadhan 2017); in patients who used cannabis regularly, 15 mg dronabinol did not increase symptoms within a few hours but impaired learning (Brunette 2025). In observational studies, weekly or more frequent and high-THC use goes hand in hand with a higher risk of psychosis (Robinson 2023, Di Forti 2019); relapses are more common in those who keep using after psychosis begins (Schoeler 2016); among people with medical cannabis authorization, emergency visits and hospital admissions for psychosis are also slightly more common (Dubois 2024). These observational findings are associations; according to experts, there are signs supporting causation, but reverse causation and confounding factors cannot be fully ruled out (D'Souza 2022). Someone with a history of psychosis should not use THC-containing products. As a treatment, no benefit of THC has been shown: Denmark's national guideline recommends not using cannabinoids for negative symptoms, and there are no controlled treatment studies; the only data are an uncontrolled series of 6 patients (Schwarcz 2009).","ruhsat":null,"doz_araligi_ozet":"300–1000 mg/day in treatment studies (mostly 600–1000 mg; median 800 mg/day in a meta-analysis), 3–12 weeks; 300–1000 mg in single-dose studies","titrasyon_ozet":"Leweke 2012: started at 200 mg/day and increased by 200 mg each day (research protocol)","yan_etkiler":["In healthy volunteers, CBD increased the risk of diarrhea (RR 5.85); a non-significant trend toward more abdominal pain and headache (Sawaira 2026, PMID 41789242)","Psychiatric and nervous system side effects more common with THC-containing products (Filippini 2022, PMID 35510826); the likelihood of side effects increased with any cannabinoid (OR 1.75; Wilson 2026)","Sedation (Boggs 2018)","Single-dose THC: psychosis-like symptoms clearly increased in healthy volunteers (Hindley 2020); symptoms and memory temporarily worsened in people with schizophrenia (D'Souza 2005); dronabinol impaired learning and attention (Brunette 2025)"],"izlem":[],"dikkat":["High doses cannot be compared with market doses: in low-dose (≤175 mg/day) studies, plasma levels were 5–100 times lower than with the 20 mg/kg Epidiolex dose (Warren 2026, PMID 42473010)","Anyone taking long-term medicines should consult a doctor before starting; the studies on this page did not systematically assess interactions","Do not stop an antipsychotic and switch to CBD; even if there is an effect, it is small and was tested only in addition to an antipsychotic","THC can increase the risk of psychosis; someone with a history of psychosis should not use THC-containing products","In people with schizophrenia and cannabis use disorder, CBD taken before marijuana did not reduce but increased marijuana's memory-impairing and psychotic effects (Chesney 2025); it should not be used on the idea that \"CBD cancels out the harm of marijuana\"","Among people who keep using cannabis after psychosis begins, relapses and long hospital stays are more common; in those who stop, the relapse rate is close to that of people who never used it (Schoeler 2016, observational meta-analysis)","In adults with medical cannabis authorization, emergency visits or hospital admissions for psychotic disorder are more common than in matched controls (HR 1.38; Dubois 2024, observational)","In people diagnosed with schizophrenia, cannabis use was linked to suicide attempts (odds ratio 1.40) and, in follow-up studies, to the risk of death by suicide (hazard ratio 1.21); the link with attempts comes mostly from cross-sectional studies and fell just short of significance in follow-up studies; no significant link with suicidal thoughts was seen. This finding comes from a meta-analysis of 29 observational studies and does not show cause and effect (Mulligan 2025, PMID 40059733); it is important that a patient who uses cannabis can talk about it openly with their care team","In people who use cannabis, psychosis began an average of 2.5 years earlier than in those who do not; the difference was not seen in samples in which psychosis began, on average, before age 20, and it grew as the average age at onset rose. This finding comes from an observational meta-analysis pooling 18,272 users and 52,801 non-users in 149 studies (Stevens 2026, PMID 42610992); it is an association and does not by itself prove that cannabis brings on psychosis earlier"],"ilac_etkilesim_notlari":["The studies on this page did not systematically assess drug interactions; details are in the site's drug interactions section","Adding 1000 mg/day CBD to antipsychotics was well tolerated; side effect rates were similar to placebo (McGuire 2017/2018)"],"dogrulanamayan":["Unpublished or ongoing studies (October 2026): a 29-patient placebo-controlled crossover CBD study in Cologne (NCT00309413) ended in 2008, no results; a comparison of CBD, olanzapine and placebo in Mannheim (NCT02088060) was stopped in 2024 when funding ran out, no results. CBD in early schizophrenia (NCT02926859, Germany), CBD in early psychosis (NCT04411225, USA), a comparison of CBD with risperidone in early psychosis patients who use cannabis (NCT04105231, Denmark), Oxford's CBD studies in early psychosis, treatment-resistant psychosis and people at high risk of psychosis (NCT06778564, NCT07326124, NCT07434973), CBD in young people at high risk of psychosis (CanARY; protocol PMID 34190422) and CBD in schizophrenia not responding to clozapine (Cancloz; ACTRN12622001112752) are ongoing or have not yet started","Full texts that could not be read: McGuire 2018 (how many authors were employees of the manufacturer could not be determined), Boggs 2018, van Boxel 2023 (symptom results), D'Souza 2005, Wilson 2026 and Marchi 2026 (psychosis subanalyses; Wilson 2026's correction notice was read on October 29, 2026 and does not change the results), Dubois 2024 (product types), Suetani 2026 (which 3 studies were included), Zuardi 2006 and Zuardi 2009 (conflict of interest statement and funding; the publisher's page required bot verification, which was not passed; Zuardi 2009's funding was read only from the table of a systematic review); these rows were written from abstracts and ClinicalTrials.gov records. Supplementary information for the symptom results of the study in people at high risk of psychosis is on a separate website of the authors; it was not read."],"calismalar":[{"ad":"Leweke 2012","tasarim":"Double-blind RCT, active control (amisulpride)","n":"42 (39 mITT)","populasyon":"Schizophrenia","urun":"Pure CBD","urun_turu":"saf_cbd","doz":"800 mg/day (200 mg × 4)","titrasyon":"Started at 200 mg/day and increased by 200 mg each day","sure":"4 weeks","sonuc":"Clear improvement in both groups, no difference between groups; equivalence could not be shown statistically (p=0.27); the study stopped early when funding ran out","yan_etki":"Fewer extrapyramidal symptoms, less weight gain and less prolactin increase with CBD","pmid":"22832859","doi":"10.1038/tp.2012.15","diger_kaynak":"ClinicalTrials.gov NCT00628290; cognition results in a separate publication: Leweke 2021 (PMID 33995015; similar improvement in the CBD and amisulpride groups, no difference between groups; 2 authors are shareholders of the company curantis UG)"},{"ad":"McGuire 2018","tasarim":"Multicenter, double-blind, placebo-controlled, exploratory RCT, add-on treatment","n":"88 (43/45)","populasyon":"Schizophrenia","urun":"Pure CBD","urun_turu":"saf_cbd","doz":"1000 mg/day","titrasyon":"not reported","sure":"6 weeks","sonuc":"Small reduction in positive symptoms (PANSS positive difference −1.4; 95% CI −2.5 to −0.2); the difference in total PANSS score was not significant (−2.8; 95% CI −6.5 to 0.9; p = 0.13; registry results); difference in favor of CBD in the doctor's rating of overall improvement (CGI-I); differences in cognition and functioning not significant. The study's sponsor was the maker of the CBD medicine","yan_etki":"Similar to placebo","pmid":"29241357","doi":"10.1176/appi.ajp.2017.17030325","diger_kaynak":"ClinicalTrials.gov NCT02006628 (results in the registry, July 26, 2019; sponsor: the medicine's maker)"},{"ad":"Boggs 2018","tasarim":"RCT, add-on treatment","n":"41 randomized (21/20); 36 analyzed (18/18)","populasyon":"Chronic schizophrenia","urun":"Pure CBD","urun_turu":"saf_cbd","doz":"600 mg/day","titrasyon":"not reported","sure":"6 weeks","sonuc":"CBD gave no benefit in cognition (MCCB): only the placebo group improved over time (drug × time interaction p = 0.02). Symptoms (PANSS) decreased in both groups, with no difference between groups (p = 0.18)","yan_etki":"Sedation more common with CBD","pmid":"29619533","doi":"10.1007/s00213-018-4885-9","diger_kaynak":"ClinicalTrials.gov NCT00588731 (results in the registry, June 8, 2017)"},{"ad":"NCT04421456 (maker's phase 2 study, registry results)","tasarim":"Double-blind, placebo-controlled, 3-arm phase 2 RCT; 2-week single-blind placebo run-in period; stopped early by the sponsor's business decision; no peer-reviewed publication","n":"95 entered the run-in period; 77 randomized (300 mg 27, 1000 mg 24, placebo 26); 61 analyzed (23/19/19)","populasyon":"Patients with schizophrenia not responding well enough to ongoing antipsychotic treatment (aged 18–55, PANSS 60–110)","urun":"Oral CBD solution (pharmaceutical-grade, pure CBD)","urun_turu":"saf_cbd","doz":"300 or 1000 mg/day (added to an antipsychotic)","titrasyon":null,"sure":"12 weeks","sonuc":"No difference from placebo in PANSS total (least-squares difference 300 mg −1.75, p = 0.45; 1000 mg −1.96, p = 0.42); scores fell in all three groups","yan_etki":"Serious side effects 300 mg 2/27, 1000 mg 2/24, placebo 1/26; no deaths","pmid":null,"doi":null,"diger_kaynak":"ClinicalTrials.gov NCT04421456 (results June 15, 2023)"},{"ad":"NCT02504151 (Yale crossover study, registry results)","tasarim":"Double-blind, placebo-controlled crossover RCT (4 weeks of CBD or placebo, 2-week washout, 4 weeks of the other); no peer-reviewed publication","n":"18 randomized (8 starting with CBD, 10 starting with placebo); 16 people completed the first period","populasyon":"Adults aged 18–65 with a primary psychotic disorder (schizophrenia or schizoaffective disorder); people with substance dependence were not included (USA)","urun":"Oral pure CBD","urun_turu":"saf_cbd","doz":"800 mg/day","titrasyon":"not reported (in the registry)","sure":"2 × 4 weeks (10 weeks with washout)","sonuc":"No difference between CBD and placebo in the primary outcomes: estimated mean difference in PANSS total −0.28 (95% CI −2.28 to 1.71; treatment × time interaction p = 0.08) and in overall illness severity (CGI-S) −0.03 (95% CI −0.12 to 0.07; interaction p = 0.48). In the registry, the p-values refer to the interaction of treatment and time, and the confidence intervals to the mean difference (two separate tests). In secondary outcomes, the mean differences for patients' self-rated functioning (−4.97; 95% CI −9.87 to −0.06) and quality of life (4.13; 95% CI 0.07 to 8.19) narrowly favored CBD, but the interaction tests were not significant (p = 0.49 and 0.99). An 18-person crossover study; results only in the registry, no peer-reviewed publication","yan_etki":"Serious side effects (hospitalization) 2/8 in the group starting with CBD, 0/10 in the group starting with placebo; side effects were recorded by sequence group, not by treatment","pmid":null,"doi":null,"diger_kaynak":"ClinicalTrials.gov NCT02504151 (results September 6, 2022)"},{"ad":"van Boxel 2023","tasarim":"Double-blind, placebo-controlled RCT, add-on treatment; primary outcomes were brain measurements","n":"31 patients (abstract); 32 in the Di Francesco 2026 meta-analysis","populasyon":"Clinically stable patients with psychotic disorder within the first 5 years of diagnosis (Netherlands)","urun":"Oral pure CBD (capsule)","urun_turu":"saf_cbd","doz":"600 mg/day (added to an antipsychotic)","titrasyon":"not reported (in the abstract)","sure":"4 weeks (28 days)","sonuc":"CBD changed connectivity in a resting brain network (the default mode network) differently from placebo (interaction p = 0.037); no difference in frontal brain metabolites or reward processing. The group comparison of symptom and cognition results is not in the abstract; full text could not be read (PANSS data were included in the Di Francesco 2026 meta-analysis)","yan_etki":"not reported (in the abstract)","pmid":"37207437","doi":"10.1016/j.jpsychires.2023.05.019","diger_kaynak":"ClinicalTrials.gov NCT02932605 (no results in the registry)"},{"ad":"Köck 2021","tasarim":"Randomized, open-label pilot study (control: regular cigarettes); participants and researchers knew the group","n":"31 randomized (16 CBD cigarettes / 15 regular cigarettes); 4 and 8 people dropped out during the treatment period","populasyon":"Hospitalized adults with acute psychosis and nicotine dependence (including psychosis due to mood disorder; 52% also used cannabis; Switzerland)","urun":"CBD-rich cannabis cigarettes: 20% cannabis (10% CBD in the flower, less than 1% THC) and 80% tobacco; about 20 mg CBD per cigarette","urun_turu":"cbd_zengin_thc_belirsiz","doz":"~20 mg CBD per cigarette; an average of ~10 cigarettes a day (~200 mg CBD/day, as calculated by Di Francesco 2026); in place of regular cigarettes","titrasyon":"None (participants set their own number of cigarettes)","sure":"4 weeks of treatment, follow-up to week 25","sonuc":"No significant difference between groups in any of the primary outcomes (PANSS, depression, violence, well-being under medication, antipsychotic dose); PANSS and depression scores decreased in both groups, and antipsychotic dose increased in the regular cigarette group. Blood CBD and THC levels were not related to symptoms. A small, unblinded pilot study with a high dropout rate","yan_etki":"Generally well tolerated; 1 person stopped because of a mild headache. 1 patient in the CBD group died during follow-up; at autopsy, the cause of death was opiate poisoning","pmid":"34803760","doi":"10.3389/fpsyt.2021.736822","diger_kaynak":"ClinicalTrials.gov NCT04700930"},{"ad":"Hallak 2010","tasarim":"Double-blind, placebo-controlled single-dose study (three groups; groups matched by sex, education, age and symptom profile, randomization method not stated)","n":"28 (18 men), three groups","populasyon":"Outpatients with schizophrenia, not in an acute episode, taking antipsychotics (Brazil)","urun":"Oral pure CBD","urun_turu":"saf_cbd","doz":"Single dose of 300 or 600 mg (or placebo)","titrasyon":null,"sure":"Single dose (at least 1 month after a first drug-free session)","sonuc":"CBD gave no benefit on a selective attention test (Stroop): all three groups made fewer errors in the second session, but the 600 mg group made more errors than the placebo and 300 mg groups (group effect p = 0.014); no difference in skin conductance responses. Symptoms were not measured after the medicine. Funding partly from Brazilian public funds (CNPq, FAPESP); the CBD was donated by researcher R. Mechoulam of his university in Jerusalem; no company ties were declared in the article. 3 of the 9 authors later became inventors on CBD patents (fluorinated CBD compounds; international application WO/2014/108899)","yan_etki":"not reported","pmid":"20339735","doi":"10.1590/s1516-44462010000100011","diger_kaynak":null},{"ad":"O'Neill 2021","tasarim":"Double-blind, placebo-controlled crossover RCT (single dose, two days at least 1 week apart); primary outcome brain imaging","n":"15 patients completed both days (two scans in 13 patients); 19 healthy volunteers given no medicine for comparison","populasyon":"Patients with psychosis taking antipsychotics (UK)","urun":"Oral pure CBD","urun_turu":"saf_cbd","doz":"Single dose of 600 mg","titrasyon":null,"sure":"Single dose","sonuc":"During a memory task, CBD brought activity in brain regions linked to psychosis to a level between placebo and healthy volunteers (primary outcome). In symptoms, measured as a secondary outcome, the drop in PANSS total 4.5 hours after the dose was 9.5 points on the CBD day and 4.2 points on the placebo day (one-sided p = 0.016); the difference on the positive symptom subscale was not significant. A single-dose, very small study","yan_etki":"not reported (in the abstract)","pmid":"31994476","doi":"10.1017/S0033291719003519","diger_kaynak":"Other publications from the same sample: hippocampal glutamate and symptoms O'Neill 2021b (PMID 33860709); Gunasekera 2023 (PMID 35775365); Lombardi 2026 (PMID 42552898)"},{"ad":"Chesney 2025","tasarim":"Double-blind, placebo-controlled crossover laboratory RCT","n":"37 people took part in at least one experiment (3 only in low-dose pilot experiments); sensitivity analysis (ITT) 34; primary analysis (per-protocol) 30","populasyon":"Schizophrenia or schizoaffective disorder + cannabis use disorder","urun":"Oral CBD, followed 3 hours later by vaporized inhaled marijuana (THC 20–60 mg)","urun_turu":"saf_cbd","doz":"Single dose of 1000 mg 3 hours before marijuana","titrasyon":null,"sure":"Single dose (two sessions)","sonuc":"CBD did not reduce but increased marijuana's harm: delayed verbal recall after CBD 3.5 vs 4.8 words (difference −1.3; p=0.001), positive psychotic symptoms +5.0 vs +2.9 (difference +2.2; p=0.01); blood THC levels did not change","yan_etki":"2 treatment-related side effects, both after CBD pretreatment: in 1 participant, a temporary paranoid delusion after marijuana (resolved on its own the next day; withdrawn from the study); in 1 participant, blood pressure rose to 224/78 mmHg after marijuana (resolved on its own by the end of the experiment)","pmid":"40702165","doi":"10.1038/s41386-025-02175-3","diger_kaynak":"ClinicalTrials.gov NCT04605393"},{"ad":"Bhattacharyya 2018","tasarim":"Double-blind, placebo-controlled parallel RCT; brain imaging after a single dose on the first day, followed by 21 days of daily dosing; the primary outcome in the registry was brain activity (fMRI), symptoms were not among the registered outcomes","n":"33 people at high risk of psychosis (16 CBD / 17 placebo; 15/16 in the imaging analysis); 19 healthy volunteers given no medicine for comparison","populasyon":"Antipsychotic-naive young people and young adults at clinical high risk (CHR) of psychosis (London)","urun":"Oral pure CBD","urun_turu":"saf_cbd","doz":"600 mg a day (single dose on the first day; 21 days in total)","titrasyon":null,"sure":"Single dose and 21 days","sonuc":"Primary outcome: during learning, CBD brought activity in three brain regions linked to psychosis to a level between placebo and healthy people; no difference in task performance. Symptoms (published as a letter in 2024): after 21 days, the total score of at-risk symptoms (CAARMS; F = 7.17; p = 0.012), distress due to psychotic experiences (p = 0.039) and the PANSS total (p = 0.042) were lower in the CBD group than with placebo; the difference in positive at-risk symptoms was not significant (p = 0.14), it was significant in negative symptoms (p = 0.045), and there was no difference in anxiety (p = 0.86). Missing data were filled in with the last observation; with only those with complete data, the CAARMS difference was p = 0.033 and the PANSS difference borderline (p = 0.056). After 1 week of use, the difference between CBD and placebo in cortisol response on a stress test was not significant (Appiah-Kusi 2020). A very small and short study; progression to psychosis was not looked at","yan_etki":"No difference between groups in treatment-emergent side effects; no one dropped out of the CBD group, 2 people dropped out of the placebo group (Bhattacharyya 2024)","pmid":"30167644","doi":"10.1001/jamapsychiatry.2018.2309","diger_kaynak":"ISRCTN46322781; symptom results: Bhattacharyya 2024 (World Psychiatry, PMID 39279373, letter); other publications from the same trial: Appiah-Kusi 2020 (PMID 31915861; 1-week dosing and stress test), Wilson 2019 (PMID 31439831), Davies 2020 (PMID 32921794), Davies 2022 (PMID 34480630), Davies 2023 (PMID 39145348), Davies 2024 (PMID 37845827), Shi 2026 (PMID 41337954)"},{"ad":"Zuardi 2006","tasarim":"Open-label case series (inpatient; 5 days placebo, 30 days CBD, then placebo and olanzapine); no control group","n":"3","populasyon":"Patients with treatment-resistant schizophrenia (Brazil)","urun":"Oral pure CBD (alone, without antipsychotics)","urun_turu":"saf_cbd","doz":"Starting at 40 mg/day, up to 1280 mg/day","titrasyon":"Started at 40 mg/day and increased to 1280 mg/day (research protocol)","sure":"30 days of CBD","sonuc":"Mild improvement in one patient, no improvement in two; the authors concluded that CBD alone may not be effective in treatment-resistant schizophrenia. The conflict of interest statement and funding could not be read (full text not open access); 3 of the 7 authors later became inventors on CBD patents (fluorinated CBD compounds; international application WO/2014/108899)","yan_etki":"Well tolerated; no side effects reported","pmid":"16401651","doi":"10.1177/0269881106060967","diger_kaynak":null},{"ad":"Zuardi 2009","tasarim":"Open-label pilot study (no comparison group)","n":"6","populasyon":"Patients with Parkinson's disease and psychosis for at least 3 months (Brazil)","urun":"Oral pure CBD (added to usual treatment)","urun_turu":"saf_cbd","doz":"Flexible dose starting at 150 mg/day (doses reached not in the abstract)","titrasyon":"Started at 150 mg/day with flexible dose adjustment (research protocol)","sure":"4 weeks","sonuc":"Psychosis symptoms (BPRS and Parkinson Psychosis Questionnaire) decreased significantly; movement symptoms did not worsen. Because there was no placebo group, it is not known how much of the improvement came from CBD; there are no controlled studies of CBD in Parkinson's psychosis. The conflict of interest statement and funding could not be read from the primary source (full text not open access); according to the table of a systematic review, the study was supported by Brazil's national and state science funds, and the table also lists the companies THC-Pharm (Germany) and STI-Pharm as supporters (Thanabalasingam 2021). 3 of the 8 authors later became inventors on CBD patents (fluorinated CBD compounds; international application WO/2014/108899)","yan_etki":"No side effects seen","pmid":"18801821","doi":"10.1177/0269881108096519","diger_kaynak":"Secondary source for funding information: Thanabalasingam 2021 systematic review (PMID 34104218, PMC8161868; Table 2)"},{"ad":"Schipper 2018","tasarim":"Case series (inpatient; no comparison group)","n":"7","populasyon":"Inpatients with psychotic disorder and treatment-resistant cannabis use disorder (Netherlands)","urun":"A low-THC, relatively CBD-rich medical cannabis variety (Bedrolite); instead of street cannabis","urun_turu":"cbd_zengin_thc_belirsiz","doz":"not reported (in the abstract)","titrasyon":"not reported (in the abstract)","sure":"not reported (in the abstract)","sonuc":"According to the authors, this low-THC medical cannabis was not effective in inpatients with psychosis and cannabis use disorder and does not look promising as a harm reduction method; detailed figures not in the abstract","yan_etki":"not reported (in the abstract)","pmid":"29039260","doi":"10.1177/0269881117735684","diger_kaynak":null},{"ad":"Englund 2023","tasarim":"Double-blind, crossover RCT (four sessions, randomized order)","n":"46","populasyon":"Healthy volunteers who use cannabis occasionally (UK)","urun":"Vaporized inhaled cannabis: 10 mg THC with 0, 10, 20 or 30 mg CBD (CBD:THC 0:1, 1:1, 2:1, 3:1)","urun_turu":"thc_iceren","doz":"10 mg THC + 0–30 mg CBD per session","titrasyon":null,"sure":"Single dose (4 sessions)","sonuc":"THC without CBD impaired delayed verbal recall (d = 0.50; p = 0.001) and increased positive psychotic symptoms (PANSS positive, d = 0.69; p < 0.001); these effects were not significantly reduced at any CBD dose. CBD did not change blood THC levels","yan_etki":"not reported (in the abstract)","pmid":"36380220","doi":"10.1038/s41386-022-01478-z","diger_kaynak":"ClinicalTrials.gov NCT05170217"},{"ad":"Lawn 2023","tasarim":"Double-blind, placebo-controlled crossover RCT (three sessions)","n":"48 (24 adolescents, aged 16–17; 24 adults, aged 26–29)","populasyon":"Healthy adolescents and adults using cannabis 0.5–3 days a week (London)","urun":"Vaporized inhaled cannabis: THC, THC + CBD or placebo","urun_turu":"thc_iceren","doz":"8 mg THC or 8 mg THC + 24 mg CBD for 75 kg (adjusted by body weight)","titrasyon":null,"sure":"Single dose (3 sessions)","sonuc":"Compared with placebo, both THC and THC + CBD increased psychosis-like symptoms (Psychotomimetic States Inventory difference 7.8; 95% CI 2.8–12.7 and 10.8; 95% CI 6.2–15.4) and impaired verbal memory; adding CBD did not reduce these effects. Adolescents and adults were affected similarly","yan_etki":"not reported (in the abstract)","pmid":"36750134","doi":"10.1111/add.16154","diger_kaynak":"ClinicalTrials.gov NCT04851392"},{"ad":"D'Souza 2005","tasarim":"Double-blind, placebo-controlled, randomized 3-day laboratory study","n":"13 patients (results compared with healthy volunteers from another publication)","populasyon":"Clinically stable patients with schizophrenia taking antipsychotics (USA)","urun":"Intravenous THC","urun_turu":"thc_iceren","doz":"0, 2.5 and 5 mg (intravenous, single dose)","titrasyon":null,"sure":"3 test days (a single dose each day)","sonuc":"THC temporarily worsened learning and recall, and temporarily increased positive, negative and general schizophrenia symptoms, perceptual disturbances, involuntary movement side effects (akathisia, rigidity), attention problems, and prolactin and cortisol. Patients were more sensitive than healthy people to THC's memory effects; figures not in the abstract","yan_etki":"No serious side effects in the short or long term","pmid":"15780846","doi":"10.1016/j.biopsych.2004.12.006","diger_kaynak":null},{"ad":"Brunette 2025","tasarim":"Double-blind, double-dummy, placebo-controlled RCT (single-dose laboratory study, parallel groups); the primary outcome in the registry was imaging of the brain reward circuit (no difference between cannabis and placebo), symptoms and cognition were the paper's outcomes","n":"130 in total; randomized: schizophrenia + cannabis use disorder 34 (11 cannabis cigarette, 12 dronabinol, 11 placebo) and cannabis use disorder only 51; non-randomized comparison groups: schizophrenia only and healthy volunteers","populasyon":"Adults with schizophrenia and cannabis use disorder (USA); for comparison, people with cannabis use disorder only","urun":"Oral dronabinol (synthetic THC) or a cannabis cigarette with 3.5% THC","urun_turu":"thc_iceren","doz":"15 mg dronabinol or a cannabis cigarette with 3.5% THC (single dose)","titrasyon":null,"sure":"Single dose","sonuc":"In people with schizophrenia + cannabis use disorder, neither the cannabis cigarette nor dronabinol changed positive or negative symptoms differently from placebo at 2 and 5 hours; dronabinol impaired verbal learning (B = −9.89; 95% CI −16.06 to −3.18; p = 0.004) and attention. As blood THC levels rose, negative symptoms also increased (0.40 points per 10 ng/ml; p = 0.001). Participants were regular users accustomed to THC","yan_etki":"Serious side effects in the registry, in the schizophrenia + cannabis use disorder groups: cannabis 1/11, dronabinol 0/12, placebo 1/11","pmid":"38900958","doi":"10.1093/schbul/sbae097","diger_kaynak":"ClinicalTrials.gov NCT01964404 (results December 9, 2025)"},{"ad":"Vadhan 2017","tasarim":"Double-blind, placebo-controlled laboratory study (active and placebo cannabis sessions; dose order randomized)","n":"12 (6 at high risk of psychosis, 6 controls)","populasyon":"Young people at clinical high risk (CHR) of psychosis who used cannabis weekly, and users not at risk (USA)","urun":"Smoked cannabis cigarette (5.5% THC; placebo 0%)","urun_turu":"thc_iceren","doz":"Half a cigarette (5.5% THC)","titrasyon":null,"sure":"Single dose (two sessions)","sonuc":"In the high-risk group, active cannabis temporarily increased suspiciousness, anxiety, visual illusions, a sense of strangeness and inattention compared with placebo, and impaired working memory and impulse control (p < 0.05); these effects were not seen in users not at risk. Auditory or visual hallucination scores did not change. A very small preliminary study","yan_etki":"not reported","pmid":"28803095","doi":"10.1016/j.psychres.2017.07.070","diger_kaynak":"Cognition and reward analysis of the same sample: Madden 2022 (PMID 37287664)"},{"ad":"Schwarcz 2009","tasarim":"Open-label case series (compassionate use; no comparison group)","n":"6","populasyon":"Patients with severe, treatment-resistant chronic schizophrenia who said they improved with marijuana (USA)","urun":"Oral dronabinol (synthetic THC)","urun_turu":"thc_iceren","doz":"not reported (in the abstract)","titrasyon":"not reported (in the abstract)","sure":"not reported (in the abstract)","sonuc":"Improvement was reported in 4 of the 6 patients, in core psychotic symptoms in 3 of them; no clinically significant side effects were reported. A series of selected patients without placebo; in controlled studies, THC temporarily worsened symptoms (D'Souza 2005)","yan_etki":"No clinically significant side effects reported","pmid":"19440079","doi":"10.1097/JCP.0b013e3181a6bc3b","diger_kaynak":null},{"ad":"Marchi 2026","tasarim":"Meta-analysis (8 RCTs; 2 unpublished)","n":"288","populasyon":"Psychotic disorders","urun":"Pure CBD","urun_turu":"saf_cbd","doz":"Median 800 mg/day","titrasyon":null,"sure":"20 min – 12 weeks","sonuc":"No significant effect on psychosis severity (SMD −0.194; CI −0.444 – 0.056); quality of evidence low to very low","yan_etki":"Similar to placebo","pmid":"41948975","doi":"10.1177/02698811261430501","diger_kaynak":null},{"ad":"Di Francesco 2026","tasarim":"Meta-analysis (5 RCTs, add-on treatment)","n":"204 (103 CBD / 101 control; PANSS total analysis)","populasyon":"Schizophrenia spectrum disorders","urun":"Pure CBD","urun_turu":"karma","doz":"Variable","titrasyon":null,"sure":"4–12 weeks","sonuc":"Small but significant reduction in PANSS total (mean difference, MD −1.91; 95% CI −3.73 to −0.10); no effect on negative symptoms. Of the five studies, one was open-label (CBD-rich cannabis cigarettes, compared with regular cigarettes) and one was the maker's unpublished study (NCT04421456). With the open-label study removed, the result was similar (MD −2.07; 95% CI −3.14 to −1.00); the authors rated the risk of bias as low only in McGuire 2018","yan_etki":"Similar dropout rates","pmid":"42047775","doi":"10.1007/s00406-026-02249-3","diger_kaynak":null},{"ad":"McLoughlin 2014 (Cochrane)","tasarim":"Cochrane systematic review (RCTs; up to August 12, 2013)","n":"8 RCTs, 530 participants (cannabinoid treatment: 1 RCT)","populasyon":"People with schizophrenia or a similar illness (including cannabis users)","urun":"CBD (compared with amisulpride); other comparisons were psychological treatments and antipsychotics aimed at reducing cannabis use","urun_turu":"saf_cbd","doz":"Variable","titrasyon":null,"sure":null,"sonuc":"No difference in short-term symptoms (BPRS, PANSS) between CBD and amisulpride; according to the authors, evidence is insufficient to show an antipsychotic effect of CBD. None of the treatments tried to reduce cannabis use (psychological treatments, antipsychotics) was better than another; the studies were few and the data poorly reported","yan_etki":"No clear difference between treatments in the short term","pmid":"25314586","doi":"10.1002/14651858.CD004837.pub3","diger_kaynak":"Previous version: Rathbone 2008 (PMID 18646115)"},{"ad":"Wilson 2026","tasarim":"Systematic review and meta-analysis of RCTs (1980–May 13, 2025; GRADE)","n":"54 RCTs, 2,477 participants (all mental disorders; size of the psychotic disorder subset not in the abstract)","populasyon":"People with mental disorders or substance use disorders (including psychotic disorders)","urun":"All types of cannabinoids (CBD, THC, THC and CBD together, etc.)","urun_turu":"karma","doz":"Variable","titrasyon":null,"sure":null,"sonuc":"No significant effect of cannabinoids on symptoms was found in psychotic disorders (nor in anxiety, anorexia nervosa, PTSD or opioid use disorder). Across all studies, the likelihood of any side effect was higher in those taking cannabinoids (OR 1.75; 95% CI 1.25–2.46); no difference in serious side effects. Certainty of evidence low for most outcomes; high risk of bias in 44% of studies","yan_etki":"Any side effect OR 1.75 (one extra side effect in every 7 people); no difference in serious side effects or study discontinuation","pmid":"41856154","doi":"10.1016/S2215-0366(26)00015-5","diger_kaynak":"Correction: Lancet Psychiatry 2026;13(8):e11, PMID 42302809 (June 16, 2026; the axis of a figure and the study counts in the table were corrected, results unchanged)"},{"ad":"Freeman 2019","tasarim":"Systematic review (no meta-analysis)","n":"16 studies, 466 participants","populasyon":"Human studies in which CBD and THC were given together or one after the other (mostly healthy volunteers)","urun":"CBD given together with or before THC (at different ratios and by different routes)","urun_turu":"karma","doz":"Variable","titrasyon":null,"sure":null,"sonuc":"Results were mixed: in some studies CBD reduced THC's intense anxiety and psychosis-like effects, but this effect was not consistent across studies and measures; no dose-response relationship was seen. 10 of the 16 studies had a low risk of bias","yan_etki":"Not assessed separately","pmid":"31580839","doi":"10.1016/j.neubiorev.2019.09.036","diger_kaynak":null},{"ad":"Hindley 2020","tasarim":"Systematic review and meta-analysis of crossover experimental studies (up to May 21, 2019)","n":"THC: 15 studies (14 studies, 324 participants for positive symptoms); CBD with THC: 4 studies","populasyon":"Healthy volunteers","urun":"Intravenous, oral or intranasal THC; CBD together with THC","urun_turu":"thc_iceren","doz":"Variable (single dose)","titrasyon":null,"sure":"Single dose","sonuc":"Compared with placebo, a single dose of THC increased total psychiatric symptoms (standardized mean change 1.10; 95% CI 0.92–1.28), positive psychotic symptoms (0.91; 95% CI 0.68–1.14) and negative symptoms (0.78; 95% CI 0.59–0.97) with a large effect. Of the 4 studies looking at whether CBD changes the effect of THC, symptoms decreased in only 1; there is no consistent evidence","yan_etki":"Not assessed separately","pmid":"32197092","doi":"10.1016/S2215-0366(20)30074-2","diger_kaynak":null},{"ad":"Robinson 2023","tasarim":"Systematic review and dose-response meta-analysis of observational studies (2010–April 2021)","n":"10 studies (3 cohort, 7 case-control), 7,390 people","populasyon":"Ages 12–65","urun":"Cannabis (containing THC)","urun_turu":"thc_iceren","doz":"Frequency of use (yearly, monthly, weekly, daily)","titrasyon":null,"sure":null,"sonuc":"The risk of psychosis increased significantly with weekly or more frequent use (weekly RR 1.35; 95% CI 1.19–1.52; daily RR 1.76; 95% CI 1.47–2.12); no significant increase with yearly or monthly use. Observational data","yan_etki":"Not applicable (observational)","pmid":"35321777","doi":"10.1017/S0033291722000502","diger_kaynak":null},{"ad":"Suetani 2026","tasarim":"Systematic review (synthesis without meta-analysis, SWiM)","n":"3 studies","populasyon":"People with ADHD who use cannabis (psychosis outcomes)","urun":"Cannabis use","urun_turu":"thc_iceren","doz":"Not applicable","titrasyon":null,"sure":null,"sonuc":"Only 3 studies meeting the criteria were found in four databases (with different designs; one of moderate and two of good quality). Two suggested indirectly that cannabis use does not affect the risk of psychosis in people with ADHD, and one suggested that cannabis affects the risk of psychosis similarly in people with and without ADHD. According to the authors, there is very little evidence that the cannabis-related risk of psychosis is higher in people with ADHD, but the topic has been studied very little; ADHD and cannabis use are each known risk factors for psychosis on their own. Full text could not be read (the names of the included studies are not in the abstract)","yan_etki":"Not applicable","pmid":"41916924","doi":"10.1177/10398562261439662","diger_kaynak":null},{"ad":"Solmi 2023","tasarim":"Umbrella review (meta-analyses of RCTs and observational studies; up to February 9, 2022)","n":"101 meta-analyses (50 observational, 51 RCT)","populasyon":"General population and various patient groups","urun":"Cannabis, cannabinoids and cannabis-based medicines","urun_turu":"karma","doz":"Variable","titrasyon":null,"sure":null,"sonuc":"In meta-analyses of observational studies, the association between cannabis use in adolescence and later psychosis (equivalent OR 1.71; 95% CI 1.47–2.00; no information on adjustment for confounders) was at the 'highly suggestive' (class II) level of evidence in the main analysis, and is given in the abstract as 'convincing' together with the sensitivity analyses; the association between cannabis use and relapse in people with psychosis remained in the weak–suggestive class. In RCTs, cannabis or THC increased positive psychotic symptoms (equivalent OR 5.21; 95% CI 3.36–8.01) and total psychiatric symptoms in the general population (GRADE: high). The authors recommend that people prone to or living with mental illness avoid cannabis","yan_etki":"Nervous system and psychiatric side effects increased with cannabis-based medicines","pmid":"37648266","doi":"10.1136/bmj-2022-072348","diger_kaynak":null},{"ad":"Schoeler 2016","tasarim":"Systematic review and meta-analysis of observational studies (at least 6 months of follow-up)","n":"24 studies, 16,565 patients","populasyon":"Patients with psychotic disorder","urun":"Cannabis (containing THC)","urun_turu":"thc_iceren","doz":"Continued use, stopping, or never using","titrasyon":null,"sure":"At least 6 months of follow-up","sonuc":"In people who kept using cannabis after psychosis began, relapse was more common than in those who never used (d = 0.36; 95% CI 0.22–0.50) and those who stopped (d = 0.28; 95% CI 0.12–0.44); hospital stays were longer. The relapse rate of those who stopped was no different from that of those who never used (d = 0.02). Observational data","yan_etki":"Not applicable (observational)","pmid":"26777297","doi":"10.1016/S2215-0366(15)00363-6","diger_kaynak":null},{"ad":"Kraan 2016","tasarim":"Systematic review and meta-analysis of prospective studies (1996–August 2015)","n":"7 studies, 1,171 people","populasyon":"People at ultra-high risk (UHR) of psychosis","urun":"Cannabis (containing THC)","urun_turu":"thc_iceren","doz":"Lifetime use; current misuse or dependence","titrasyon":null,"sure":null,"sonuc":"Lifetime cannabis use was not significantly associated with progression to psychosis (OR 1.14; 95% CI 0.86–1.52); progression to psychosis was more common in those with current cannabis misuse or dependence (OR 1.75; 95% CI 1.14–2.71; 5 studies). Observational data","yan_etki":"Not applicable (observational)","pmid":"26568030","doi":"10.1017/S0033291715002329","diger_kaynak":null},{"ad":"Javed 2026","tasarim":"Systematic review and meta-analysis of observational studies (up to January 1, 2025)","n":"13 studies, 7,515 patients","populasyon":"People diagnosed with cannabis-induced psychosis","urun":"Cannabis (containing THC)","urun_turu":"thc_iceren","doz":"Not applicable","titrasyon":null,"sure":null,"sonuc":"About one in five people with cannabis-induced psychosis (20%; 95% CI 15.8–29.5) later received a schizophrenia-spectrum diagnosis, and about one in twenty (5%; 95% CI 2.7–6.9) a bipolar disorder diagnosis. Observational data","yan_etki":"Not applicable (observational)","pmid":"41664079","doi":"10.1186/s12888-025-07382-2","diger_kaynak":null},{"ad":"D'Souza 2022 (WFSBP)","tasarim":"Consensus report (World Federation of Societies of Biological Psychiatry task force; literature review, not a systematic review)","n":"Number of studies not in the abstract","populasyon":"People who use cannabis and cannabinoids; patients with psychosis","urun":"Cannabis and cannabinoids","urun_turu":"karma","doz":"Not applicable","titrasyon":null,"sure":null,"sonuc":"Different types of evidence show that cannabis increases the risk of psychosis, from transient psychotic states to chronic psychosis; the risk rises with higher doses and younger age at use. For some outcomes, part of the criteria for causation are met, but reverse causation and confounding factors cannot be ruled out with certainty; cannabis is neither necessary nor sufficient for psychosis, but one of many causes. In people with psychosis, cannabis worsens the course of the illness; delaying or preventing use is recommended, especially in those at risk","yan_etki":"Not applicable","pmid":"35315315","doi":"10.1080/15622975.2022.2038797","diger_kaynak":null},{"ad":"Norlin Mølgaard 2026 (Danish guideline)","tasarim":"National clinical guideline (expert consensus based on 2019–2024 systematic reviews and meta-analyses)","n":"21 recommendations","populasyon":"Children, adolescents and adults with negative symptoms in psychotic disorders","urun":"Cannabinoids (assessed together with other medicines and psychosocial treatments)","urun_turu":"karma","doz":"Not applicable","titrasyon":null,"sure":null,"sonuc":"It recommends not using cannabinoids to treat negative symptoms such as social withdrawal and lack of motivation (conditional approval for adding modafinil; cognitive behavioral therapy and cognitive remediation are recommended)","yan_etki":"Not applicable","pmid":"42482516","doi":"10.1080/08039488.2026.2697960","diger_kaynak":null},{"ad":"Di Forti 2019","tasarim":"Multicenter case-control study (EU-GEI; 11 centers in Europe and Brazil, 2010–2015)","n":"901 patients with first-episode psychosis, 1,237 controls","populasyon":"Ages 18–64","urun":"Cannabis; low-potency (<10%) and high-potency (≥10%) types by THC content","urun_turu":"thc_iceren","doz":"Frequency of use and type of cannabis","titrasyon":null,"sure":null,"sonuc":"Daily cannabis use increased the odds of psychotic disorder compared with never using (adjusted OR 3.2; 95% CI 2.2–4.1); OR 4.8 (95% CI 2.5–6.3) for daily use of high-THC cannabis. Assuming causation, 12.2% of new psychosis cases could have been prevented if high-THC cannabis were not available (30.3% in London, 50.3% in Amsterdam). Observational data","yan_etki":"Not applicable (observational)","pmid":"30902669","doi":"10.1016/S2215-0366(19)30048-3","diger_kaynak":null},{"ad":"Hjorthøj 2023","tasarim":"Nationwide registry-based cohort (Denmark, 1972–2021)","n":"6,907,859 people; 45,327 new schizophrenia diagnoses","populasyon":"Ages 16–49","urun":"Cannabis (diagnosis of cannabis use disorder)","urun_turu":"thc_iceren","doz":"Not applicable","titrasyon":null,"sure":"129.5 million person-years","sonuc":"In people with cannabis use disorder, the risk of schizophrenia was adjusted HR 2.42 (95% CI 2.33–2.52) in men and 2.02 (95% CI 1.89–2.17) in women; IRR 3.84 in men aged 16–20. Assuming causation, about 15% of new schizophrenia cases in men and about 4% in women in 2021 were attributed to cannabis use disorder; this share increased over the years. Observational data","yan_etki":"Not applicable (observational)","pmid":"37140715","doi":"10.1017/S0033291723000880","diger_kaynak":"Earlier analysis of the same registries: Hjorthøj 2021 (PMID 34287621; the share of schizophrenia cases rose from about 2% in 1995 to 6–8% after 2010)"},{"ad":"Young-Wolff 2026","tasarim":"Retrospective cohort (Kaiser Permanente Northern California electronic health records, 2016–2023)","n":"463,396 adolescents","populasyon":"Adolescents aged 13–17 screened at routine checkups and followed up to age 25 (USA)","urun":"Cannabis (use in the past year; reported in confidential screening)","urun_turu":"thc_iceren","doz":"Not applicable","titrasyon":null,"sure":"Mean follow-up 3.7 years","sonuc":"Adolescents who used cannabis in the past year had a higher risk of a later psychotic disorder diagnosis (adjusted HR 2.19; 95% CI 1.97–2.42; 1.92; 95% CI 1.73–2.13 when previous mental illnesses were also taken into account). Observational data","yan_etki":"Not applicable (observational)","pmid":"41719031","doi":"10.1001/jamahealthforum.2025.6839","diger_kaynak":null},{"ad":"Dubois 2024","tasarim":"Retrospective, propensity score–matched cohort (Ontario cannabis clinics and administrative health data, 2014–2019)","n":"54,006 patients with medical cannabis authorization, 161,265 matched controls","populasyon":"Adults authorized to use medical cannabis (Canada)","urun":"Medical cannabis (product type and THC/CBD ratio not in the abstract)","urun_turu":"karma","doz":"not reported (in the abstract)","titrasyon":null,"sure":null,"sonuc":"The rate of emergency visits or hospital admissions for psychotic disorder was 3.00 per 1000 person-years in the cannabis group and 1.88 in controls; adjusted HR 1.38 (95% CI 1.19–1.60), and 1.63 (95% CI 1.40–1.91) in those without previous psychosis. Observational data","yan_etki":"Not applicable (observational)","pmid":"38330686","doi":"10.1016/j.schres.2024.01.029","diger_kaynak":null}],"ilgili_ilaclar":["antipsikotik","risperidon","olanzapin","ketiapin","aripiprazol","klozapin"],"son_inceleme":"2026-10-30","arastirma_gecmisi":[{"tarih":"2026-10-19","not":"Page published. This first assessment reviewed 5 studies."},{"tarih":"2026-10-21","not":"PubMed and ClinicalTrials.gov were searched for newly published and previously missed clinical studies. Study added: Chesney 2025. This information was added to the \"Who should be careful\" list: in people with schizophrenia and cannabis use disorder, CBD taken before marijuana did not reduce but increased marijuana's harm to memory and psychosis (Chesney 2025). The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-27","not":"The medicine maker's 12-week study, with results only in the study registry and no difference from placebo, was added; the number of people and outcome measure of a meta-analysis were corrected; the phrase 'well-designed studies' became 'controlled studies'. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-28","not":"PubMed, Cochrane and ClinicalTrials.gov were systematically searched again in October 2026 (5,768 records in PubMed, 416 in ClinicalTrials.gov; together with an independent second check). Added: 6 controlled studies of CBD in patients and people at high risk of psychosis (one with results only in the registry); very small uncontrolled series with CBD in treatment-resistant schizophrenia and Parkinson's psychosis and with CBD-rich medical cannabis in psychosis with cannabis use disorder; 2 studies in healthy volunteers testing whether CBD added to cannabis reduces THC's effects; 3 studies testing the effect of THC against placebo in patients and people at high risk of psychosis, and a small series in which THC was tried as a treatment; the Cochrane review and 8 more systematic reviews; one national guideline and one expert consensus report; 4 large observational studies on cannabis use and psychosis risk (including medical cannabis users). Reviews repeating the same question and studies covered by the reviews in the table were not added separately. Corrected: it was added that the difference in total symptom score in the largest CBD study was not significant, that the study was exploratory and that it was run by the maker; the later-published symptom results of the study in people at high risk of psychosis were written up with their limitations; the number of people in two studies, the result details and side effects of one study, the product type and sensitivity analysis of one meta-analysis, registry numbers and table order were corrected; a strength of evidence was added to the THC conclusion (insufficient for treatment; experimental and observational data pointing to harm). The conclusion and the strength of the CBD evidence did not change."},{"tarih":"2026-10-28","not":"Display fix: leftover internal working file names were removed from the text; content and evidence did not change."},{"tarih":"2026-10-28","not":"Display fix: internal working notes left over from the previous cleanup were removed; content and evidence did not change."},{"tarih":"2026-10-28","not":"On October 28, 2026, sources found for this page during searches for other topics were processed. A systematic review looking at whether cannabis use further increases the risk of psychosis in people with ADHD (Suetani 2026; only 3 studies were found, and there is very little evidence of such an added risk) was added to the table and the text. Funding and company ties were re-examined for three older CBD studies from the Ribeirão Preto group in Brazil (Hallak 2010, Zuardi 2006, Zuardi 2009): Hallak 2010 was partly supported by public funds, the CBD was donated by a university researcher, and no company ties were declared in the article; the full texts of the other two studies could not be read, and for Zuardi 2009, the table of a systematic review lists public funds and two CBD manufacturers as supporters (the same information as the same row on the Parkinson's page); the CBD patents of three of the authors date from years after these studies. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-30","not":"The correction published in the journal for the Wilson 2026 meta-analysis was read: only the axis of one figure and the study counts in a table were corrected; the results on this page did not change."},{"tarih":"2026-10-30","not":"Information from two large observational meta-analyses was added to the 'Who should be careful' section: the link between cannabis use in people diagnosed with schizophrenia and suicide attempts and, in follow-up studies, the risk of death by suicide (Mulligan 2025), and the onset of psychosis an average of 2.5 years earlier in people who use cannabis (Stevens 2026). Both show an association, not cause and effect; they were not added to the table as rows, and their sources are given within the items. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-30","not":"The last sentence of the page's short summary was rewritten in a calmer, more guiding tone: instead of \"Talk to your doctor before you start.\", it now says whom you can talk with, and about what, if you are considering CBD. The conclusion and the strength of evidence did not change."}]},{"id":"addiction","baslik":"Substance use disorders (cannabis, alcohol, opioids, cocaine, tobacco)","grup":"Anxiety and mental health","grup_kodu":"kaygi","tr_id":"madde-kullanim-bozuklugu","kanit_duzeyi":"zayif","kanit_yonu":"celiskili","kanit_ozet":"In cannabis use disorder, 400–800 mg of pure CBD reduced use when given together with psychological support; but this is a single, small phase 2a study. For other substances, CBD reduced cue-induced craving in some lab studies (heroin, opioids, alcohol; single dose or a few days); in young people, however, no effect on alcohol craving was seen. Outside cannabis, none of the RCTs that measured use or relapse showed CBD to be better than placebo (for smoking, a single small study reported only a within-group reduction): in cocaine use disorder, 800 mg/day (78 people, 12 weeks) did not reduce craving or relapse, and in crack cocaine use, 300 mg/day (31 people, 10 days) did not change craving; in alcohol use, 150 mg/day (44 people, 8 weeks) and 600–1200 mg/day did not change the amount of drinking. In opioid use disorder, use or relapse was not measured in the published RCTs: in 30 people on buprenorphine, 600 mg/day (28 days) was not superior to placebo for craving, withdrawal or mood; in 23 methadone patients with chronic pain, a single dose of 400–1,200 mg CBD did not change opioid craving. In 76 people on methadone or buprenorphine, 4 weeks of CBD gave craving and anxiety similar to placebo and close rates of urine opioids (registry results only, no statistics, no peer-reviewed publication). In a 2026 meta-analysis, there was no significant effect in opioid use disorder; in cocaine use, craving increased more with cannabinoids, but in the 78-person study in this area the difference was not statistically significant (p = 0.069). For cannabis, according to Cochrane 2025, quitting at the end of treatment with THC-containing medicines is no different from placebo (RR 1.04; moderate certainty). There are 6 clinical RCTs of THC-containing or THC-like medicines for cannabis: nabiximols reduced withdrawal (Allsop 2014, 51 people) and reduced use days over 12 weeks (Lintzeris 2019, 128 people; difference 18.6 days, 95% CI 3.5–33.7; it persisted 3 months later), but in a 40-person study there was no significant difference in use between groups (Trigo 2018); dronabinol (Levin 2011, 156 people; with lofexidine, Levin 2016, 122 people) and nabilone (Hill 2017, 18 people) did not increase quitting. In lab or inpatient studies lasting a few days, withdrawal decreased (only some symptoms in Haney 2008; Haney 2013, Schlienz 2018, Herrmann 2019; Trigo 2016, 9 people, with nabiximols; Slagle 2026, conducted by the company with a nabilone + gabapentin combination); the effect on relapse to cannabis smoking in the lab was inconsistent (reduced: Haney 2013, Schlienz 2018; did not reduce: Haney 2008, Herrmann 2019). A single dose of THC reduced craving triggered by marijuana cues in a one-session measurement (Lundahl 2015, 14 people). These are small lab studies; they do not show a treatment effect. A single dose of CBD did not change the reinforcing effects of marijuana (Haney 2016). In opioid withdrawal, dronabinol reduced symptoms but did not change retention in treatment (Bisaga 2015, 60 people); in the lab, its effect was limited and it raised heart rate at 20 mg and above (Lofwall 2016, 12 people). Cannabis use during opioid treatment was not associated with illicit opioid use (Costa 2024; 10 observational studies). In heavy drinkers, THC-containing marijuana reduced alcohol consumption at that moment in the lab but did not change an alcohol craving scale (Metrik 2026, 157 people; single session). For smoking, there are 2 small RCTs with CBD: over one week, the number of cigarettes smoked with an inhaler fell by about 40% in the CBD group and did not change in the placebo group (Morgan 2013, 24 people; within-group change, no direct comparison of the two groups in the abstract); a single 800 mg dose reduced attentional bias but did not change craving or withdrawal (Hindocha 2018, 30 people). On the harm side: cannabis use disorder can develop with THC-containing cannabis products (Gilman 2022 RCT: 17.1% vs. 8.6%; about 25% among medical cannabis users, Dawson 2024 observational meta-analysis, PMID 38493566); CBD itself was found to have low abuse potential (Schoedel 2018, PMID 30286443; Babalonis 2017). Recent reviews point the same way: cannabinoids can ease short-term symptoms (withdrawal, craving) but have not been shown to bring about lasting abstinence (Zammit Dimech 2026; Wilson 2026, evidence quality generally low); CBD alone has not been shown to be effective (Redonnet 2025). It does not replace proven medicines in opioid treatment (e.g., buprenorphine/methadone). October 2026 search (PubMed, Cochrane, ClinicalTrials.gov; separately for each substance): 35 controlled studies with cannabinoids on this topic (34 rows; one reports two separate trials together) and 7 systematic reviews or meta-analyses (one combines only observational studies) were found; all are in the table below. The table also includes 1 patient registry analysis without a control group (Ghosh 2025, 34 people); it does not show cause and effect. Of the controlled studies, 16 are on cannabis (13 with THC-containing or THC-like medicines, 3 with CBD; 8 are single-session or few-day lab, inpatient or short withdrawal studies), 7 on opioids, 7 on alcohol, 2 on cocaine and 2 on tobacco; 1 measures the risk of cannabis use disorder with THC-containing cannabis products; the results of 2 are available only on ClinicalTrials.gov. Lab studies by the same research group using the same method were given in a single row (the other publications are in that row's source information; those whose results do not agree are in separate rows); uncontrolled studies other than the patient registry and reviews repeating the same question were not listed individually. The only Cochrane review on this topic that assesses cannabinoid products is for cannabis use disorder (Spiga 2025); no controlled human studies with cannabinoids were found for methamphetamine or other stimulants.","kanit_duzeyi_metin":"Cannabis: weak (pure CBD reduced use in a single small phase 2a RCT; in Cochrane 2025 and a 2026 network meta-analysis, the evidence for CBD is low certainty; a single-dose lab study and the registry results of a 10-person study without a statistical comparison showed no benefit) · Alcohol, opioids, cocaine, tobacco: weak (craving may decrease in the lab; it has not been shown to reduce use or relapse)","kanit_duzeyi_thc_icerenler":"zayif","kanit_duzeyi_thc_icerenler_metin":"THC-containing medicines for cannabis: may reduce withdrawal (2 clinical RCTs and short lab studies; no difference in 2 RCTs; small effect in a meta-analysis, low quality); reduced use in a single RCT, quit rate no different from placebo (Cochrane 2025, moderate certainty). For opioids and alcohol, a single RCT or lab study; no studies for tobacco","kaynak_dosya":"diger-hastaliklar.md","saf_cbd_sonuc":"Pure CBD reduced cannabis use in a single phase 2a RCT; in cocaine use, craving (and in one, relapse) did not differ from placebo in two RCTs; in alcohol use, despite reduced craving in the lab, it did not reduce drinking; in opioid use, cue-induced craving decreased in two small studies (single dose and 3 days), did not differ from placebo in a 28-day study or in a single-dose pain study, and was also similar in the registry results of a 4-week study; the result of the only RCT that measured use is available only in a trial registry (at week 4, urine opioids 76% vs. 81% in people on methadone and 13% vs. 20% in people on buprenorphine; no statistical analysis). For smoking, a small one-week RCT found fewer cigarettes smoked with a CBD inhaler (within-group change only); a single 800 mg dose did not change craving or withdrawal but reduced attention to cigarette images. For cannabis, the registry results of a 10-person RCT and a single-dose lab study showed no benefit.","thc_icerenler_sonuc":"In cannabis use disorder, CBD+THC together reduced withdrawal and the amount used (Wilson 2026; most of the evidence is low certainty); however, the quit rate at the end of treatment with THC-containing medicines was no different from placebo (Cochrane 2025, RR 1.04, moderate certainty). In individual studies, nabiximols reduced withdrawal and increased retention in treatment (Allsop 2014, 51 people), and reduced cannabis-use days by 18.6 days over 12 weeks (Lintzeris 2019, 128 people; 95% CI 3.5–33.7); in a 40-person study, however, the between-group difference in use was not significant (Trigo 2018). Dronabinol reduced withdrawal in one study (Levin 2011) and did not even change withdrawal when given with lofexidine (Levin 2016); neither increased quitting. Nabilone did not reduce use (Hill 2017, 18 people). In lab studies lasting a few days, withdrawal decreased, while the effect on relapse was inconsistent. In opioid withdrawal, dronabinol eased symptoms but did not change retention in treatment (Bisaga 2015, 60 people); in the lab, its effect was limited and it caused a racing heart at high doses (Lofwall 2016). In heavy drinkers, THC-containing marijuana reduced alcohol consumed in the lab by 19–27% but did not change an alcohol craving scale (Metrik 2026; single session). There are no studies of THC-containing products for tobacco. THC-containing products can also be addictive: among people given a medical cannabis card, cannabis use disorder developed about twice as often within 12 weeks (Gilman 2022). In cocaine use, a meta-analysis found craving increased more with cannabinoids than with placebo; in the 78-person study in this area, the difference was not significant; in alcohol use, full-spectrum CBD containing a little THC reduced craving but did not change the amount of drinking (Mueller 2025).","ruhsat":null,"doz_araligi_ozet":"Cannabis: 400–800 mg/day (4 weeks); cocaine: 800 mg/day (12 weeks); heroin/opioids: 400–800 mg, 1 dose a day (3 days), single dose 600 mg, 600 mg/day (28 days); alcohol: about 150 mg/day (8 weeks), single dose 600–800 mg, 800 mg/day (3 days), 600–1200 mg/day; crack cocaine: 300 mg/day (10 days); tobacco: single dose 800 mg; opioids (registry results): 400 mg/day (4 weeks), then 800 mg/day. THC-containing medicines: for cannabis, nabiximols up to 86.4 mg THC + 80 mg CBD a day, dronabinol 40–60 mg/day, nabilone 2 mg/day; for opioid withdrawal, dronabinol 30 mg/day","titrasyon_ozet":"In the cocaine study, 400 mg/day for 2 days, then 800 mg/day; for alcohol, in Bogenschutz 2026, an increase to 1200 mg/day after 4 weeks","yan_etkiler":["In healthy volunteers, CBD increased the risk of diarrhea (RR 5.85); a non-significant trend toward more abdominal pain and headache (Sawaira 2026, PMID 41789242)","Psychiatric and nervous system side effects are more common with THC-containing products (Filippini 2022, PMID 35510826); the likelihood of side effects increased with any cannabinoid (OR 1.75; Wilson 2026)","In the cocaine study, diarrhea in 35% with CBD 800 mg/day (Mongeau-Pérusse 2021)","Cannabinoid hyperemesis syndrome: recurring nausea, vomiting and abdominal pain with regular (usually daily or weekly) cannabis use; relief from a hot bath or shower is typical, and it goes away when cannabis is stopped (Sorensen 2017, PMID 28000146; American Gastroenterological Association 2024)","Cannabis use disorder with THC-containing products: 17.1% vs. 8.6% within 12 weeks among people given a medical cannabis card (Gilman 2022, RCT); about 25% among medical cannabis users (Dawson 2024, PMID 38493566; meta-analysis of observational studies)","Synthetic THC (dronabinol) in opioid withdrawal: increased heart rate at 20 mg and above; persistent racing heart, anxiety and panic at 40 mg (Jicha 2015 / Lofwall 2016, 12 people); dry mouth, feeling intoxicated and low blood pressure with dronabinol + lofexidine (Levin 2016)","CBD has low abuse potential: at 750 mg the liking score did not differ from placebo, with a small increase at 1,500–4,500 mg (Schoedel 2018, PMID 30286443); no withdrawal was seen in healthy volunteers when it was stopped suddenly after 4 weeks at a high dose (Taylor 2020, PMID 32036242; a study by the drug's manufacturer)"],"izlem":[],"dikkat":["High doses and market doses cannot be compared: in low-dose (≤175 mg/day) studies, plasma levels were 5–100 times lower than with the 20 mg/kg Epidiolex dose (Warren 2026, PMID 42473010)","Anyone taking a medicine long-term should talk to a doctor before starting; the studies on this page did not systematically assess interactions","It does not replace proven medicines in opioid treatment (buprenorphine/methadone); an interaction case with methadone has been reported (details in the site's drug interactions section)","It cannot be said to be 'good for every addiction': in cocaine use disorder, pure CBD did not prevent relapse; in a meta-analysis, cannabinoids increased cocaine craving","A reduction in craving with a single dose or a few days of CBD in the lab does not mean that substance use or relapse goes down","In people who use cannabis frequently over a long time, recurring bouts of severe nausea and vomiting may be cannabinoid hyperemesis syndrome; temporary relief from a hot bath or shower is typical, and the most effective solution is to stop using cannabis (Sorensen 2017 systematic review, PMID 28000146; for diagnosis and treatment, the American Gastroenterological Association 2024 clinical practice update). In two small hospital studies, haloperidol reduced abdominal pain and nausea more than ondansetron (Ruberto 2021, PMID 33160719, 30 people); capsaicin cream applied to the skin reduced nausea more than placebo at minute 60, while at minute 30, the primary measure, the difference was not clear (Dean 2020, PMID 32569429, 30 people). No cannabinoids were used in these treatment studies","Although THC-containing medicines can ease cannabis withdrawal, they are not approved for cannabis addiction; in the studies in the table, they were given under a doctor's supervision and with psychological support. THC-containing cannabis products can themselves be addictive: among adults given a medical cannabis card, cannabis use disorder developed in 17.1% within 12 weeks, compared with 8.6% of those put on a waiting list (Gilman 2022)","The effect of CBD on quitting smoking has not been proven; it does not replace proven smoking cessation treatments","In some people who use cannabis every day, blood pressure can rise when cannabis is stopped suddenly: in a small study of 13 people followed in the hospital for 11 days, blood pressure was significantly higher on days without cannabis than on days with cannabis; the rise was marked in 6 people (average increase of up to 22.8 mmHg in systolic and 12.3 mmHg in diastolic blood pressure), and the authors recommended monitoring blood pressure during the quitting period, especially in people with high blood pressure (Vandrey 2011, PMID 21359104). In 39 people who were admitted to the hospital for treatment and stopped heavy use suddenly, however, no significant change in blood pressure or heart rate was seen (Bonnet 2016, PMID 26761126). Both studies are small and their results differ"],"ilac_etkilesim_notlari":["The studies on this page did not systematically assess drug interactions; details are in the site's drug interactions section","No clear problems were seen with opioids in small studies: in healthy volunteers who had used opioids before, 400–800 mg of CBD by mouth given together with intravenous fentanyl did not cause respiratory depression or heart and blood vessel problems (Manini 2015, PMID 25748562); in 7 people on methadone or buprenorphine, a single dose of 400–1,200 mg CBD did not cause marked sedation (Costa 2026b, open-label, PMID 41496743); no significant interaction was reported with 28 days of CBD in 30 people on buprenorphine (London 2025). These are short, small studies; an interaction case with methadone has been reported"],"dogrulanamayan":["The full texts of London 2025 and Hurzeler 2025 could not be read; the product used in London 2025 was taken from the ClinicalTrials.gov record (cannabis-derived CBD softgel capsule; THC content not stated), and the product in Hurzeler 2025 from the protocol publication (200 mg CBD softgel capsule; purity not stated); the side effects of Hurzeler 2025 are not in the abstract","Corrections that could not be read (October 28, 2026): the correction published for Hurd 2019 (Am J Psychiatry 2020;177(7):641; the journal page required bot verification, which could not be passed) and the correction published for errors in the supplementary file of Lintzeris 2019 (JAMA Intern Med 2023;183(12):1414) could not be read. The correction published for Wilson 2026 (Lancet Psychiatry 2026;13(8):e11) was read on October 29, 2026: only the axis of one figure and the study counts in a table were corrected; the numbers in the row (54 RCTs, 2,477 participants, side effect OR 1.75, NNTH 7) did not change","Of those added in the October 2026 search, read only from the abstract: Allsop 2014, Lintzeris 2019 (the publisher does not allow full-text download; the PMC page and the journal site required bot verification, which could not be passed), Haney 2013, Haney 2016 (the full text of the second publication of the same trial, Babalonis 2017, was read), Morgan 2013 (the dose and product of the CBD inhaler are not in the abstract), Costa 2024 and the Costa 2026 tobacco review. The conflict-of-interest statements of Allsop 2014, Haney 2013, Haney 2016, Morgan 2013 and Costa 2024 could not be read (those of Lintzeris 2019 and the Costa 2026 tobacco review were read from the PubMed record); the other new rows were checked against the full text or the ClinicalTrials.gov record","Studies with unpublished results or results only in a registry (ClinicalTrials.gov and PubMed, October 28, 2026): NCT06206291 (76 people) and NCT03102918 (10 people) are in the table with registry results only; they have no peer-reviewed publications. The registry-only results of the same team's 10-person pilot study in heroin use (NCT01605539) include no statistical comparison; no separate row was made, and it is mentioned in the Hurd 2019 row. NCT01598896, which was terminated early (dronabinol + clonidine in schizophrenia and cannabis addiction; 7 people, no conclusion can be drawn from the registry results), was not included in the table. Completed but without results: NCT05494437 (nabilone + gabapentin combination, 234 people, finished in August 2023), NCT04567784 (brain imaging with CBD in people on methadone, 66 people, finished in June 2025); status unknown: NCT04205682 (CBD in alcohol withdrawal, 52 people), NCT06159387 (low-THC CBD extract in cocaine and crack addiction, 60 people). Ongoing studies: for cannabis, a 250-person CBD study in Australia, and in the US NCT06107062, NCT06569394, NCT06575751 and a 420-person phase 3 study of the nabilone + gabapentin combination (NCT07644052); NCT04105231, comparing CBD with risperidone in psychosis and cannabis use; for alcohol, NCT05613608, NCT05860699 (210 people), NCT07279558, NCT06845124 (CBD + naltrexone, 150 people); for opioids, NCT06940674 (450 people), NCT06544291; for smoking, NCT06218056 (120 people), NCT05445804 (50 people), NCT07001930 (90 people)"],"calismalar":[{"ad":"Freeman 2020","tasarim":"Phase 2a, double-blind, placebo-controlled, adaptive Bayesian RCT","n":"82","populasyon":"Cannabis use disorder","urun":"Pure CBD (+ motivational interviewing)","urun_turu":"saf_cbd","doz":"200 / 400 / 800 mg/day","titrasyon":null,"sure":"4 weeks","sonuc":"200 mg was found ineffective at the interim analysis and dropped; 400 and 800 mg lowered urine THC-COOH levels and increased days without use (400 mg: +0.48 days per week)","yan_etki":"No serious side effects; 94% completed","pmid":"32735782","doi":"10.1016/S2215-0366(20)30290-X","diger_kaynak":"ClinicalTrials.gov NCT02044809; secondary publications of the same trial: Lees 2023 (PMID 36598543; cognition, no difference from placebo on the primary measure) and Hua 2023 (PMID 37085531; blood anandamide)"},{"ad":"Hurd 2019","tasarim":"Double-blind, placebo-controlled exploratory RCT","n":"42 randomized and analyzed (15 placebo / 14 CBD 400 mg / 13 CBD 800 mg); 45 people enrolled in the registry","populasyon":"Heroin use disorder (people who had stopped using)","urun":"Pure CBD (Epidiolex, oral solution)","urun_turu":"saf_cbd","doz":"400 or 800 mg, 1 time a day","titrasyon":null,"sure":"3 days (follow-up 7 days later)","sonuc":"Drug cue-induced craving and anxiety decreased; heart rate and cortisol response fell","yan_etki":"No serious side effects; diarrhea 2/14 at 400 mg, 4/13 at 800 mg, 0/15 with placebo (ClinicalTrials.gov)","pmid":"31109198","doi":"10.1176/appi.ajp.2019.18101191","diger_kaynak":"ClinicalTrials.gov NCT02539823 (n and side effects from the registry); correction: Am J Psychiatry 2020;177(7):641, PMID 32605447 (content could not be read); the same team's earlier 10-person pilot study: NCT01605539 (results only in the registry, 9 people analyzed, no statistical comparison; in the first session, the increase in cue-induced craving was 2.67 with placebo and 0.83 with CBD, similar in later sessions)"},{"ad":"Mongeau-Pérusse 2021","tasarim":"Double-blind, placebo-controlled RCT (single center)","n":"78 (40 CBD / 38 placebo)","populasyon":"Moderate–severe cocaine use disorder (Canada)","urun":"Synthetic pure CBD, oral solution (300 mg/mL)","urun_turu":"saf_cbd","doz":"800 mg/day","titrasyon":"400 mg/day on days 2–3, then 800 mg/day","sure":"10 days of inpatient detox + 12 weeks of outpatient follow-up","sonuc":"Cue-induced cocaine craving (p=0.069) and risk of returning to cocaine (HR 1.20; p=0.51) no different from placebo; by week 12, everyone except 3 people had used again","yan_etki":"Drug-related side effects with CBD 17/40 (42.5%): most often diarrhea 14/40 (35%), nausea 3/40","pmid":"33464660","doi":"10.1111/add.15417","diger_kaynak":"ClinicalTrials.gov NCT02559167; exploratory secondary publications of the same trial: Morissette 2021 (PMID 34331010; inflammatory markers), Mongeau-Pérusse 2022 (PMID 35135986; anxiety and cortisol, no different from placebo), Rizkallah 2022 (PMID 35367279; cognition, no difference), Hebert 2025 (PMID 38770686; anandamide, no difference)"},{"ad":"Mueller 2025","tasarim":"Double-blind, placebo-controlled pilot RCT, 3 arms","n":"44 (13 full-spectrum, 15 broad-spectrum, 16 placebo)","populasyon":"Moderate–severe alcohol use disorder (not seeking treatment)","urun":"Hemp-derived capsule: full-spectrum CBD (~15 mg CBD + 0.41 mg THC per capsule) or broad-spectrum CBD (no THC); placebo hemp seed oil","urun_turu":"karma","doz":"About 150 mg/day CBD (10 capsules a day); also ~4 mg/day THC in the full-spectrum arm","titrasyon":"None (spreading over the day was recommended)","sure":"8 weeks (follow-up at week 16)","sonuc":"Drinks per drinking day did not decrease in any arm; alcohol craving and disorder symptoms decreased more in the full-spectrum arm","yan_etki":"Side effect and dropout rates similar across arms; no serious side effects","pmid":"40357520","doi":"10.3389/fpsyt.2025.1516351","diger_kaynak":"ClinicalTrials.gov NCT04873453"},{"ad":"London 2025","tasarim":"Double-blind, placebo-controlled pilot RCT","n":"35 enrolled, 30 analyzed (18 CBD / 12 placebo)","populasyon":"Opioid use disorder; adults on buprenorphine in inpatient addiction treatment","urun":"Hemp-derived CBD softgel capsule (ATL5, Ananda Scientific; 2 × 300 mg a day); product from the ClinicalTrials.gov record, THC content not stated","urun_turu":"cbd_zengin_thc_belirsiz","doz":"600 mg/day","titrasyon":null,"sure":"28 days","sonuc":"Opioid craving and negative affect decreased in both groups; CBD was not superior to placebo (most comparisons favored placebo, with a trend favoring CBD for cue-induced craving)","yan_etki":"Well tolerated; no serious side effects; most common were gastrointestinal complaints (in both groups); no significant interaction with buprenorphine seen","pmid":"41467610","doi":"10.1097/ADM.0000000000001640","diger_kaynak":"ClinicalTrials.gov NCT03787628 (results in registry: 35 enrolled, 30 started, 17 completed)"},{"ad":"Kirkland 2025","tasarim":"Double-blind, placebo-controlled crossover RCT (single dose)","n":"36","populasyon":"Young people aged 17–22 with alcohol use disorder, not seeking treatment","urun":"Pure CBD (Epidiolex, oral solution), with a fatty snack","urun_turu":"saf_cbd","doz":"Single dose 600 mg","titrasyon":null,"sure":"Single dose (two sessions)","sonuc":"No difference from placebo in brain chemistry (MRS), brain response to alcohol cues, alcohol craving, heart and skin responses, or alcohol use","yan_etki":"No CBD-related side effects seen","pmid":"40500407","doi":"10.1038/s41386-025-02141-z","diger_kaynak":"ClinicalTrials.gov NCT05317546"},{"ad":"Zimmermann 2025 (ICONIC)","tasarim":"Double-blind, placebo-controlled parallel RCT (single dose)","n":"28","populasyon":"Alcohol use disorder (Germany)","urun":"Synthetic pure CBD capsule (99.8%; THC <0.1%)","urun_turu":"saf_cbd","doz":"Single dose 800 mg","titrasyon":null,"sure":"Single session","sonuc":"Lower alcohol craving after stress and alcohol cues and during brain imaging; reduced nucleus accumbens response to cues; drinking was not measured","yan_etki":"No side effects reported in the test session","pmid":"39668256","doi":"10.1038/s41380-024-02869-y","diger_kaynak":"DRKS00029993; second publication of the same trial: Pfisterer 2026 (PMID 40879734; 800 mg CBD reduced amygdala response to negative emotional faces)"},{"ad":"Hurzeler 2025","tasarim":"Double-blind, placebo-controlled crossover RCT","n":"22","populasyon":"Alcohol use disorder, not seeking treatment (Australia)","urun":"Oral CBD softgel capsule (4 × 200 mg; manufacturer Linnea; purity and THC content not stated in the protocol)","urun_turu":"cbd_zengin_thc_belirsiz","doz":"800 mg/day","titrasyon":null,"sure":"3 days","sonuc":"In the lab, anxiety during alcohol cue exposure and alcohol craving afterward were lower; activity of the calming (parasympathetic) nervous system increased; drinking (heavy drinking days) is listed among the primary outcomes in the registry but was not reported in any of the five published articles (NCT05387148)","yan_etki":"No impairment in executive functions; other side effects not in the abstract","pmid":"39891614","doi":"10.1111/acer.15514","diger_kaynak":"ClinicalTrials.gov NCT05387148; protocol Hurzeler 2024 (PMID 39252861). Brain imaging publications of the same trial: PMID 40102270, 40551671, 42678517; risk-taking and autonomic response publication (very likely the same trial): PMID 42873665"},{"ad":"Suzuki 2023","tasarim":"Double-blind, placebo-controlled crossover pilot RCT (single dose)","n":"10 (completers)","populasyon":"Opioid use disorder treated with buprenorphine or methadone","urun":"Pure CBD (Epidiolex, oral solution)","urun_turu":"saf_cbd","doz":"Single dose 600 mg","titrasyon":null,"sure":"Single dose (two sessions at least 1 week apart)","sonuc":"Cue-induced craving (0.2 vs. 1.3; p=0.040) and attentional bias toward drug cues decreased; no difference on other measures","yan_etki":"No side effects reported","pmid":"37065899","doi":"10.3389/fpsyt.2023.1155984","diger_kaynak":"ClinicalTrials.gov NCT04982029; the same team's 8-person open-label pilot study: Suzuki 2022 (PMID 36105269; NCT04192370)"},{"ad":"Wilson 2026","tasarim":"Meta-analysis (54 RCTs; mental and substance use disorders)","n":"2,477","populasyon":"Mental and substance use disorders","urun":"Various cannabinoids","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"In cannabis use, CBD+THC reduced withdrawal and use; no significant effect in opioid use disorder; craving increased in cocaine use; evidence quality generally low","yan_etki":"Risk of any side effect increased (OR 1.75; NNTH=7); serious side effects did not increase","pmid":"41856154","doi":"10.1016/S2215-0366(26)00015-5","diger_kaynak":"Correction: Lancet Psychiatry 2026;13(8):e11, PMID 42302809 (June 16, 2026; the axis of a figure and the study counts in the table were corrected, results unchanged)"},{"ad":"Bogenschutz 2026","tasarim":"Two double-blind, placebo-controlled RCTs","n":"T1: 27 (14 CBD, 13 placebo); T2: 30 (17 CBD, 13 placebo)","populasyon":"Alcohol use disorder (± PTSD)","urun":"Oral CBD capsule (Tilray, 200 mg, oil-based; hemp-derived, THC <0.1%), 2 times a day","urun_turu":"saf_cbd","doz":"T1: 600 mg/day for 4 weeks (400 morning + 200 evening), then 1200 mg/day for 4 weeks (600 × 2); T2: 600 mg/day (same split)","titrasyon":"In T1, dose increase after 4 weeks; the dose could be reduced if not tolerated","sure":"8 / 6 weeks","sonuc":"No advantage over placebo for alcohol use, craving, mood or anxiety. Tilray provided the study drug and funding for part of the pharmacokinetic analysis (according to the publication, the funders had no role in design, conduct or analysis); 2 of 7 authors reported research support from Tilray","yan_etki":"7/31 (22.6%) of those taking CBD reduced or stopped the dose because of side effects; nausea 20% vs. 0% (p=0.025), diarrhea 27% vs. 12%; liver enzymes/bilirubin 1.5–6.5×ULN: 2 CBD, 1 placebo; 1 serious event (diabetic ketoacidosis, 'possibly related')","pmid":"41312717","doi":"10.1111/acer.70212","diger_kaynak":"ClinicalTrials.gov NCT03252756 (Study 1) and NCT03248167 (Study 2; with PTSD), results in registry"},{"ad":"Spiga 2025 (Cochrane)","tasarim":"Cochrane systematic review and meta-analysis (37 RCTs)","n":"3,201","populasyon":"Cannabis use disorder","urun":"Various medicines: THC preparations, CBD, N-acetylcysteine, anticonvulsants, etc.","urun_turu":"karma","doz":"Variable","titrasyon":null,"sure":null,"sonuc":"Abstinence from cannabis at the end of treatment with THC preparations no different from placebo (RR 1.04; 95% CI 0.71–1.52; 4 studies, 290 people; moderate certainty); a single study with CBD (RR 2.23; 0.54–9.32; low certainty); treatment completion with CBD similar to placebo (RR 1.02; moderate certainty). Authors: all medicines should be considered experimental","yan_etki":"Likelihood of side effects with THC preparations (RR 1.05) and CBD (RR 1.01) similar to placebo (moderate certainty)","pmid":"41025421","doi":"10.1002/14651858.CD008940.pub4","diger_kaynak":"Network meta-analysis of the same drug trials (three of the authors are also authors of this review; it compares medicines together with psychosocial treatments): Halicka 2026 (PMID 41924869; evidence that medicines reduce cannabis use is very uncertain; abstinence with CBD OR 2.91, 95% credible interval 0.45–27.98, low certainty; contingency management and dialectical behavior or acceptance and commitment therapies reduced use, low certainty)"},{"ad":"Allsop 2014","tasarim":"Double-blind, placebo-controlled RCT (2 centers; inpatient detox)","n":"51","populasyon":"Treatment-seeking adults with cannabis dependence (DSM-IV) (Australia)","urun":"Nabiximols (THC + CBD mouth spray, Sativex) + standard psychosocial support","urun_turu":"thc_iceren","doz":"Up to 86.4 mg THC + 80 mg CBD a day (6-day schedule)","titrasyon":"6-day predefined schedule (details not in the abstract)","sure":"6 days on drug (9-day inpatient stay); 28 days of follow-up","sonuc":"Primary outcome: overall withdrawal severity decreased compared with placebo (F8,378 = 2.39; p = 0.01), including irritability, depressed mood and cannabis craving. Retention in treatment during the drug period was longer (HR 3.66; 95% CI 1.18–11.37; p = 0.02; NNT 2.84). At 28-day follow-up, cannabis use (p = 0.75), cannabis-related problems (p = 0.14) and dependence (p = 0.89) decreased similarly in both groups: no advantage over placebo after the drug was stopped. Participants could not tell which group they were in; nabiximols did not cause more intoxication. The conflict-of-interest statement could not be read (full text not open access)","yan_etki":"Number (p = 0.59) and severity (p = 0.10) of side effects did not differ between the two groups","pmid":"24430917","doi":"10.1001/jamapsychiatry.2013.3947","diger_kaynak":"ANZCTR ACTRN12611000398909"},{"ad":"Lintzeris 2019","tasarim":"Double-blind, placebo-controlled RCT (4 centers; outpatient)","n":"128 randomized (61 nabiximols / 67 placebo); modified intention-to-treat analysis","populasyon":"Treatment-seeking adults aged 18–64 with cannabis dependence (ICD-10) who had not benefited from previous treatments; people with other substance dependence were excluded (Australia)","urun":"Nabiximols (THC + CBD mouth spray, Sativex) + structured counseling","urun_turu":"thc_iceren","doz":"Flexible dose; up to 32 sprays a day (86.4 mg THC + 80 mg CBD). Average 17.6 sprays (47.5 mg THC + 44.0 mg CBD)","titrasyon":"Flexible; adjusted at weekly clinic visits","sure":"12 weeks (follow-up at week 24)","sonuc":"Primary outcome: over 12 weeks, days of illicit cannabis use averaged 53.1 with placebo and 35.0 with nabiximols (difference 18.6 days; 95% CI 3.5–33.7; p = 0.02). Retention in treatment was similar (49.2% vs. 44.8%); health status improved similarly in both groups, and other substance use did not change. 3 months after treatment ended (week 24), the nabiximols group used on 6.7 fewer days in the last 28 days (p = 0.006); no use at all in the last 28 days 23% vs. 9% (OR 3.0; 95% CI 1.1–9.1; Lintzeris 2020). Conflict of interest: 2 of 19 authors (one holds cannabinoid patents; the other received research support and fees from pharmaceutical companies outside the study)","yan_etki":"According to the abstract, the drug was well tolerated with few side effects; detailed side effect numbers could not be read. A correction for errors in the supplementary file was published in 2023 (its content could not be read)","pmid":"31305874","doi":"10.1001/jamainternmed.2019.1993","diger_kaynak":"ANZCTR ACTRN12616000103460; 3-month post-treatment follow-up: Lintzeris 2020 (PMID 32768992); secondary analyses: Montebello 2022 (PMID 35316689; mood, sleep and pain improved similarly in both groups), Mills 2022 (PMID 36209081); protocol: Bhardwaj 2018 (PMID 29776349); correction: JAMA Intern Med 2023;183(12):1414, PMID 37812434 (errors in the supplementary file; content could not be read)"},{"ad":"Trigo 2018","tasarim":"Double-blind, placebo-controlled pilot RCT","n":"40 randomized (20 nabiximols / 20 placebo); 27 completed","populasyon":"Treatment-seeking adults with cannabis dependence (Canada)","urun":"Nabiximols (THC + CBD mouth spray, Sativex) + motivational interviewing and cognitive behavioral therapy","urun_turu":"thc_iceren","doz":"As needed; up to 42 sprays a day (113.4 mg THC + 105 mg CBD); in practice an average of 8.1 sprays a day (about 21.9 mg THC + 20.3 mg CBD)","titrasyon":"Self-titration; highest dose reached on day 10","sure":"12 weeks","sonuc":"Primary outcomes: the drug was well tolerated; 7-day abstinence 1 week after the drug period was 30.8% with nabiximols (4 people) and 42.9% with placebo (6 people), no significant difference. Cannabis use decreased in both groups (in grams, 70.5% with nabiximols and 42.6% with placebo), but there was no significant difference between groups in the amount used (p = 0.18) or in use days (p = 0.30). Cannabis craving decreased in both groups (no main effect between groups; interaction with time significant, p < 0.05); no difference in withdrawal scores. Participants were paid up to 855 Canadian dollars for their time; the manufacturer donated the drug and placebo (no other role)","yan_etki":"No serious side effects; side effect rates did not differ between the two groups (F1,39 = 0.205)","pmid":"29385147","doi":"10.1371/journal.pone.0190768","diger_kaynak":"ClinicalTrials.gov NCT01747850 (results in registry); blood values publication of the same trial: Wang 2023 (PMID 37692969; values within normal limits); case series by the same team: Trigo 2016b (PMID 27261670)"},{"ad":"Levin 2011","tasarim":"Double-blind, placebo-controlled RCT","n":"156","populasyon":"Adults with cannabis dependence (USA)","urun":"Dronabinol (synthetic THC) + weekly motivational interviewing and relapse prevention therapy","urun_turu":"thc_iceren","doz":"20 mg, 2 times a day (40 mg/day)","titrasyon":"Dose reduced for side effects; tapered off in weeks 9–10","sure":"12 weeks (1-week placebo lead-in, 8 weeks full dose, 2 weeks tapering, 2 weeks placebo)","sonuc":"Primary outcome: 2 weeks of continuous abstinence at the end of the full-dose period was 17.7% with dronabinol and 15.6% with placebo (not significant); use decreased similarly in both groups. Retention in treatment was higher with dronabinol (77% vs. 61%; p = 0.02) and withdrawal symptoms were lower (p = 0.02)","yan_etki":"Any side effect 67% vs. 58% (no difference); 4 serious events (3 dronabinol, 1 placebo); the dose was reduced because of side effects in a small number of people","pmid":"21310551","doi":"10.1016/j.drugalcdep.2010.12.010","diger_kaynak":"ClinicalTrials.gov NCT00217971 (results in registry); dronabinol blood levels: Milman 2014 (PMID 24067260)"},{"ad":"Levin 2016","tasarim":"Double-blind, placebo-controlled RCT","n":"156 enrolled; 122 randomized after a 1-week placebo lead-in","populasyon":"Adults with cannabis use disorder (dependence) (USA)","urun":"Dronabinol (synthetic THC) + lofexidine (an alpha-2 agonist from the blood pressure medicine class) + weekly therapy","urun_turu":"thc_iceren","doz":"Dronabinol 20 mg and lofexidine 0.6 mg, 3 times a day (dronabinol 60 mg/day)","titrasyon":"Tapered over 2 weeks after week 8","sure":"11 weeks","sonuc":"Primary outcome: 3 weeks of continuous abstinence during the full-dose period was 27.9% in the drug group and 29.5% with placebo (no difference); use decreased similarly in both groups; weekly withdrawal scores also did not differ between groups (p = 0.83); authors: the combination was not promising. In a pooled secondary analysis of three trials, those taking the drug were more likely to move from heavy to moderate use after the middle of the trials (Levin 2021). Conflict of interest: the first author received lofexidine from the manufacturer and had previously consulted for GW Pharmaceuticals; 4 of 12 authors reported pharmaceutical company ties (drug supply, consulting)","yan_etki":"Dry mouth, feeling intoxicated and low blood pressure were more common in the drug group (p < 0.001; 0.004; 0.008); less anxiety (p = 0.044); 2 serious events (1 in each group, in the week after the drug was stopped)","pmid":"26711160","doi":"10.1016/j.drugalcdep.2015.11.025","diger_kaynak":"ClinicalTrials.gov NCT01020019 (results in registry); secondary analysis: Levin 2021 (PMID 34087745)"},{"ad":"Hill 2017","tasarim":"Double-blind, placebo-controlled pilot RCT","n":"18 randomized (10 nabilone / 8 placebo); 12 completed","populasyon":"Adults with cannabis dependence (DSM-IV) (USA)","urun":"Nabilone (synthetic THC-like cannabinoid) + medication management sessions","urun_turu":"cbn_diger","doz":"2 mg/day","titrasyon":null,"sure":"10 weeks","sonuc":"Cannabis use decreased in both groups but not significantly; no difference in use days between nabilone and placebo (self-report and urine tests 2 times a week). The manufacturer supplied nabilone; 1 of 7 authors had previously consulted for GW Pharmaceuticals and Indivior","yan_etki":"With nabilone, 8 mild-to-moderate side effects in 2 people; with placebo, 6 in 4 people; no serious side effects","pmid":"28921814","doi":"10.1111/ajad.12622","diger_kaynak":"ClinicalTrials.gov NCT01347762 (results in registry)"},{"ad":"Slagle 2026 (PP-01)","tasarim":"Double-blind, placebo-controlled crossover RCT (phase 1b/2a; inpatient)","n":"14","populasyon":"Adults with moderate–severe cannabis use disorder using at least 1 g a day and not seeking treatment (USA)","urun":"PP-01: combination of nabilone (synthetic THC-like cannabinoid) + gabapentin (investigational drug)","urun_turu":"cbn_diger","doz":"6 mg nabilone + 600 mg gabapentin 1 time a day (4 days)","titrasyon":null,"sure":"Two 5-night inpatient periods; 4 doses in each period","sonuc":"Primary outcome: the severity (p = 0.022) and discomfort (p = 0.006) of cannabis withdrawal decreased compared with placebo; sleep and cannabis craving improved. The study was conducted by the company developing the drug: 3 of 5 authors are company employees (holding shares or options), and 2 are company consultants (one holding shares or options). As of October 28, 2026, the result of a 234-person phase 2 study of the same drug (NCT05494437, finished in August 2023) has not been published","yan_etki":"Side effects in 10 of 13 people (77%) during the PP-01 period and 8 of 13 people (62%) during the placebo period; all mild, no serious side effects","pmid":"42717263","doi":"10.1111/ajad.70202","diger_kaynak":"Phase 2 study of the same drug: ClinicalTrials.gov NCT05494437 (234 people, finished in August 2023; no results); phase 3: NCT07644052 (420 people, ongoing)"},{"ad":"Haney 2008","tasarim":"Placebo-controlled, within-subject inpatient laboratory RCT (4 drug conditions, with outpatient washout periods in between)","n":"8 men","populasyon":"Male volunteers not seeking treatment who smoked an average of 12 marijuana cigarettes a day (USA)","urun":"Dronabinol (synthetic THC), lofexidine (an alpha-2 agonist; not a cannabinoid), both together, or placebo","urun_turu":"thc_iceren","doz":"THC 60 mg/day; lofexidine 2.4 mg/day","titrasyon":null,"sure":"7 inpatient days for each drug condition (3 days of inactive marijuana: withdrawal; 4 days of active marijuana: relapse model)","sonuc":"THC alone reversed withdrawal-related loss of appetite and weight loss and reduced some withdrawal symptoms, but it delayed falling asleep and did not reduce marijuana smoking in the laboratory relapse model. When given with lofexidine, sleep, withdrawal, craving and relapse improved more than with either drug alone (this combination was tested clinically in 122 people and did not increase quitting: Levin 2016). An 8-person laboratory study lasting a few days; it does not show a treatment effect. Funding from NIDA (PMC record); the declaration of interests could not be read (the full text could not be downloaded)","yan_etki":"THC delayed falling asleep; lofexidine caused sleepiness and worsened the loss of appetite during withdrawal; no other details in the abstract","pmid":"18161012","doi":"10.1007/s00213-007-1020-8","diger_kaynak":"ClinicalTrials.gov NCT00373503 (8 people; no results in the registry record). Two other studies from the same center (New York State Psychiatric Institute and Columbia University) testing oral THC with the same laboratory method were not given separate rows; their results point the same way: Hart 2002 (12 people; maintenance on THC for 3 days at a time did not change the choice to smoke marijuana; PMID 12127201) and Haney 2004 (7 people; on marijuana-free days, THC reduced withdrawal symptoms such as anxiety, sleep problems and marijuana craving; PMID 14560320)"},{"ad":"Haney 2013","tasarim":"Placebo-controlled, within-subject lab study (inpatient; dose order counterbalanced)","n":"11 (8 men, 3 women)","populasyon":"Volunteers smoking an average of 8 marijuana cigarettes a day and not seeking treatment (USA)","urun":"Nabilone (synthetic THC-like cannabinoid)","urun_turu":"cbn_diger","doz":"0, 6 or 8 mg/day (1 time a day)","titrasyon":null,"sure":"Three 8-day inpatient periods","sonuc":"Both doses reduced marijuana smoking in the lab relapse model and reversed withdrawal-related irritability and disruptions in sleep and eating (p < 0.05); liking or wanting the capsules did not differ from placebo. The conflict-of-interest statement could not be read (full text could not be downloaded)","yan_etki":"8 mg/day slightly impaired psychomotor performance","pmid":"23443718","doi":"10.1038/npp.2013.54","diger_kaynak":"A study by the same center testing nabilone together with the sleep medicine zolpidem in the same laboratory relapse model was not given a separate row; its result points the same way: Herrmann 2016 (11 people; zolpidem + nabilone reduced withdrawal-related disruptions in mood, sleep and eating, and relapse to marijuana smoking; PMID 27085870). A study with the same method and a different result is in a separate row: Herrmann 2019"},{"ad":"Lundahl 2015","tasarim":"Double-blind, placebo-controlled, within-subject crossover laboratory study (single dose; 3 sessions, dose order counterbalanced)","n":"14 (7 men, 7 women)","populasyon":"Adults with cannabis dependence (DSM-IV) smoking an average of 5.4 marijuana joints a day (USA; all participants were African American)","urun":"Dronabinol (oral synthetic THC capsule)","urun_turu":"thc_iceren","doz":"A single dose of 0, 10 or 20 mg; marijuana cues 120 minutes later","titrasyon":null,"sure":"3 sessions (at least 7 days apart; an overnight stay in the research unit before each session)","sonuc":"Marijuana cues (images, sounds, smell, touch) increased marijuana craving, anxiety and feelings of hunger in the placebo session. 10 and 20 mg of THC reduced the cue-induced urge to smoke marijuana (p = 0.003), the desire to use marijuana (p = 0.013) and anxiety (p = 0.032) compared with placebo; they did not reduce hunger; on one craving scale (MCQ compulsivity subscale), an effect was seen only in women. A 14-person, single-session laboratory measurement; it does not show a treatment effect. Funding from NIDA and the State of Michigan; the authors reported no conflicts of interest","yan_etki":"THC slightly increased pulse and slightly lowered diastolic blood pressure (statistically significant, of no clinical importance according to the authors); on its own it did not produce noticeable subjective effects","pmid":"25725933","doi":"10.1016/j.drugalcdep.2015.01.046","diger_kaynak":"ClinicalTrials.gov NCT00218504 (Wayne State University; no results in the registry record)"},{"ad":"Trigo 2016","tasarim":"Double-blind, placebo-controlled, within-subject study (ABACADAE; the order of drug conditions across four 5-day cannabis-free periods was counterbalanced at random)","n":"16 randomized; 9 completed and were analyzed","populasyon":"Adults from the community with cannabis dependence who were not seeking treatment (Canada; mostly men)","urun":"Nabiximols (THC + CBD mouth spray, Sativex) or placebo spray; fixed or self-titrated dose","urun_turu":"thc_iceren","doz":"Fixed dose: 4 sprays an hour, at most 40 sprays a day (108 mg THC + 100 mg CBD)","titrasyon":"In the self-titrated condition, by the person themselves up to at most 40 sprays a day","sure":"8 weeks (four periods of usual use and four cannabis-free periods, each lasting 1 week)","sonuc":"The high fixed dose reduced withdrawal scores during the cannabis-free period compared with placebo (p < 0.01) and did not change cannabis craving; self-titrated doses stayed lower and had a limited effect. A 9-person pilot study; quitting or reducing use was not tested. In the same team’s 40-person RCT (Trigo 2018), there was no significant difference in use between groups. Funding from the Canadian Institutes of Health Research; the manufacturer donated the drug and the placebo; the authors reported no conflicts of interest","yan_etki":"No serious side effects; the number of side effects did not differ between conditions; expected side effects such as nausea, sleep problems and diarrhea were seen","pmid":"26925704","doi":"10.1016/j.drugalcdep.2016.02.020","diger_kaynak":"ClinicalTrials.gov NCT01748799 (16 people; results in the registry record)"},{"ad":"Haney 2016 (CBD)","tasarim":"Double-blind, placebo-controlled, within-subject lab RCT (multicenter)","n":"31 completed (17 men, 14 women); 50 people enrolled according to the registry","populasyon":"Healthy volunteers who regularly smoked marijuana and were not seeking treatment (USA)","urun":"Oral pure synthetic CBD capsule (STI Pharmaceuticals); 90 minutes later, a marijuana cigarette (5.3–5.8% THC) or a THC-free placebo cigarette","urun_turu":"saf_cbd","doz":"Single dose 0, 200, 400 or 800 mg CBD","titrasyon":null,"sure":"8 outpatient sessions (single dose)","sonuc":"No dose of CBD changed the reinforcing effects of marijuana (choosing to self-administer), 'high' and 'good effect' ratings, liking of the cigarette or the rise in heart rate compared with placebo; authors: oral CBD does not reduce the reinforcing, physiological or positive subjective effects of smoked marijuana. In the abuse analysis of the same trial, CBD itself also did not differ from placebo on any measure (Babalonis 2017). Funding NIDA (Babalonis 2017); the conflict-of-interest statement of Haney 2016 could not be read (full text could not be downloaded)","yan_etki":"CBD alone had no notable psychiatric or cardiovascular effects","pmid":"26708108","doi":"10.1038/npp.2015.367","diger_kaynak":"ClinicalTrials.gov NCT01844687 (results in registry); secondary analysis of the same trial: Babalonis 2017 (PMID 28088032)"},{"ad":"Schlienz 2018","tasarim":"Placebo-controlled, within-subject crossover study (inpatient; order counterbalanced)","n":"13","populasyon":"Adults who used cannabis daily and were not seeking treatment (USA)","urun":"Dronabinol (synthetic THC); option of a 5.7% THC or <1% THC marijuana cigarette","urun_turu":"thc_iceren","doz":"Placebo, 120 mg/day (40 mg × 3) or 180–240 mg/day (60–80 mg × 3)","titrasyon":null,"sure":"3 × 12 days","sonuc":"When active marijuana was offered, self-administered marijuana smoking decreased during the dronabinol periods compared with placebo; no difference between the low and high doses. Dronabinol also suppressed withdrawal. Conflict of interest: 1 of 4 authors reported consulting fees from cannabinoid drug companies and cannabis businesses","yan_etki":"Not in the abstract","pmid":"29689485","doi":"10.1016/j.drugalcdep.2018.02.022","diger_kaynak":"ClinicalTrials.gov NCT01394185 (results in registry); two other studies by teams that included the same researcher (Vandrey), measuring the effect of oral THC on withdrawal during cannabis-free periods with a dose comparison, were not given separate rows; their results point the same way (THC reduced withdrawal in a dose-dependent way): Budney 2007 (8 people, outpatient; PMID 16769180) and Vandrey 2013 (13 people, inpatient; PMID 22921474)"},{"ad":"Herrmann 2019","tasarim":"Placebo-controlled lab study: randomized parallel groups for varenicline, within-subject crossover for nabilone (inpatient)","n":"62 completed the outpatient phase, 46 the inpatient phase","populasyon":"Volunteers who used both tobacco and cannabis and were not seeking treatment (USA)","urun":"Nabilone (synthetic THC-like cannabinoid) ± varenicline (smoking cessation drug)","urun_turu":"cbn_diger","doz":"Nabilone 4 mg, 2 times a day (8 mg/day); varenicline 1 mg, 2 times a day","titrasyon":"Varenicline increased over the first 8 days; nabilone stopped without tapering","sure":"15 days outpatient + 16 days inpatient (two 8-day nabilone periods)","sonuc":"Nabilone reduced cannabis withdrawal in both groups but did not reduce cannabis smoking in the lab relapse model (relapse 44% and 36% with nabilone, 38% and 40% with placebo). Quitting tobacco was more common in those taking varenicline (46% vs. 24%). Conflict of interest: 2 of 8 authors reported partial salary support from a cannabinoid drug company for another study","yan_etki":"Not in the abstract","pmid":"30378231","doi":"10.1111/adb.12664","diger_kaynak":"A study by the same center using the same method, with a different result (nabilone reduced relapse to smoking), is in a separate row: Haney 2013"},{"ad":"NCT03102918 (McLean Hospital, registry results)","tasarim":"Double-blind, placebo-controlled RCT (phase 1; registry results, no peer-reviewed publication)","n":"10 randomized (5 CBD / 5 placebo); 9 analyzed","populasyon":"Adults with cannabis use disorder (USA)","urun":"Pure CBD (Epidiolex, oral solution) + medical support sessions","urun_turu":"saf_cbd","doz":"Up to 800 mg a day","titrasyon":null,"sure":"6 weeks (follow-up at weeks 10 and 14)","sonuc":"Primary outcome (daily cannabis puffs, self-reported): in the CBD group 26.0 (SD 22.0) at baseline and 26.7 (SD 27.0; 4 people) at week 6; with placebo 21.0 (SD 26.6) at baseline and 5.3 (SD 4.3; 5 people) at week 6. No statistical comparison in the registry, and the registry states that the sample is too small for a definitive result; urine THC level, mentioned in the registry summary as a second primary measure, is not in the results. No peer-reviewed publication (PubMed search by registry number gave 0 results, October 28, 2026)","yan_etki":"No serious or other side effects reported in either group (registry)","pmid":null,"doi":null,"diger_kaynak":"ClinicalTrials.gov NCT03102918 (results posted to the registry on January 25, 2019)"},{"ad":"Ghosh 2025 (UK Medical Cannabis Registry)","tasarim":"Uncontrolled patient registry analysis (no comparison group), 6-month follow-up","n":"34","populasyon":"Adults prescribed cannabis-based medicinal products for substance use disorder (UK); 79% men, 85% using illegal cannabis at baseline; most often opioid use disorder (18 people, 53%)","urun":"Prescription cannabis-based medicinal products: oil (4 people), dried flower (14) or both (16); THC and CBD content not in the abstract","urun_turu":"karma","doz":"Not in the abstract (the full text could not be accessed)","titrasyon":null,"sure":"6 months (assessments at months 1, 3 and 6)","sonuc":"Uncontrolled: compared with baseline, anxiety (GAD-7), sleep quality and health-related quality of life (EQ-5D-5L) scores improved at months 1, 3 and 6 (p < 0.050); the amount of prescribed opioids (oral morphine equivalent, median) was 274.95 mg/day at baseline and 204.45 mg/day at month 6 (p = 0.043), with no difference at months 1 and 3. Because there is no comparison group, these changes cannot be said to come from the cannabis product; the authors also write that RCTs are needed to show cause and effect. Substance use itself (illegal use, quitting) is not reported in the abstract. 11 of the 12 authors are affiliated with a private medical cannabis clinic that prescribes these products to patients; the declaration of interests could not be read (the full text could not be accessed)","yan_etki":"3 of 34 people (8.8%) reported a total of 17 side effects; their types and severity are not in the abstract","pmid":"40738021","doi":"10.1159/000547696","diger_kaynak":null},{"ad":"Bisaga 2015","tasarim":"Double-blind, placebo-controlled RCT","n":"60 (40 dronabinol / 20 placebo)","populasyon":"Opioid dependence; inpatient detox and transition to long-acting naltrexone injection (USA)","urun":"Dronabinol (synthetic THC)","urun_turu":"thc_iceren","doz":"30 mg/day","titrasyon":null,"sure":"8 weeks (inpatient detox + 5 weeks outpatient)","sonuc":"Primary outcomes: during the inpatient period, opioid withdrawal was milder with dronabinol (p = 0.006); successful transition to naltrexone (66% vs. 55%) and completing 8 weeks (35% vs. 35%) did not differ. In a post hoc analysis, those who regularly smoked marijuana during the outpatient period (32%) completed treatment more often (not a randomized comparison)","yan_etki":"Any side effect 91% with placebo and 96% with dronabinol; most often insomnia, nausea-vomiting and diarrhea (consistent with prolonged withdrawal due to naltrexone); 3 serious events","pmid":"26187456","doi":"10.1016/j.drugalcdep.2015.05.013","diger_kaynak":"ClinicalTrials.gov NCT01024335 (results in registry)"},{"ad":"Lofwall 2016","tasarim":"Double-blind, placebo-controlled, within-subject lab RCT (5 weeks inpatient)","n":"12","populasyon":"Adults physically dependent on short-acting opioids; maintained on oxycodone, with withdrawal induced by 21 hours of placebo before each session (USA)","urun":"Dronabinol (synthetic THC); comparison oxycodone and placebo","urun_turu":"thc_iceren","doz":"Single dose 5, 10, 20 or 30 mg (reduced from 40 mg)","titrasyon":null,"sure":"5 weeks; 7 experimental sessions","sonuc":"5 and 10 mg were similar to placebo; 20 and 30 mg suppressed withdrawal slightly and briefly but caused dose-dependent \"high,\" drowsiness, bad effects and a feeling of racing heart; they were not liked more than placebo. Authors: dronabinol does not appear to be a suitable candidate for opioid withdrawal. Conflict of interest: 2 of 5 authors reported fees or research support from addiction medicine companies","yan_etki":"40 mg caused persistent racing heart (sinus tachycardia), anxiety and panic, and the dose was reduced to 30 mg; 20 and 30 mg raised heart rate for about 2 hours (Jicha 2015)","pmid":"27234658","doi":"10.1016/j.drugalcdep.2016.05.002","diger_kaynak":"Safety publication of the same study: Jicha 2015 (PMID 26483357)"},{"ad":"Costa 2026 (opioids and pain)","tasarim":"Double-blind, placebo-controlled, within-subject crossover lab RCT (opioid maintenance model)","n":"23 (11 women)","populasyon":"Adults on methadone with opioid use disorder and chronic pain (USA)","urun":"Pure CBD (Epidiolex, oral solution); placebo sesame oil","urun_turu":"saf_cbd","doz":"Single dose 400, 800 or 1,200 mg","titrasyon":null,"sure":"Single-dose sessions","sonuc":"Primary outcomes were pain modulation: before the methadone dose, CBD increased descending pain inhibition in a dose-dependent way (p = 0.034); after methadone, 1,200 mg lowered the heat pain threshold (increased pain sensitivity; p = 0.017). Cue-induced opioid craving, the question of this topic (an exploratory measure), did not differ from placebo at any dose (p = 0.728; a numerical decrease after methadone, largest at 800 mg, p = 0.127); cognitive performance was preserved. In the registry (NCT04587791), the primary outcomes were safety, abuse potential and cognition; in the article, the pain measures are primary. The manufacturer supplied CBD and placebo; 1 of 6 authors reported drug supply and consulting fees from pharmaceutical companies","yan_etki":"All side effects were mild and resolved on their own","pmid":"42162267","doi":"10.1038/s41386-026-02443-w","diger_kaynak":"ClinicalTrials.gov NCT04587791; the same team's 7-person open-label pilot study: Costa 2026b (PMID 41496743; NCT05076370, no marked sedation in the registry results)"},{"ad":"NCT06206291 (Mount Sinai, registry results)","tasarim":"Quadruple-blind, placebo-controlled RCT (phase 2): CBD or placebo for the first 4 weeks, CBD for everyone for the next 4 weeks; registry results, no peer-reviewed publication","n":"76 (methadone: 32 CBD / 30 placebo; buprenorphine: 8 / 6)","populasyon":"Opioid use disorder treated with methadone or buprenorphine (USA)","urun":"CBD capsule (BSPG Laboratories; purity not stated in the registry)","urun_turu":"cbd_zengin_thc_belirsiz","doz":"First 4 weeks 2 × 200 mg a day or placebo; next 4 weeks 2 × 400 mg a day for everyone (description in the registry)","titrasyon":null,"sure":"8 weeks on drug (first 4 weeks randomized to CBD or placebo, next 4 weeks CBD for everyone) + 4 weeks of drug-free follow-up","sonuc":"Primary outcomes (week 4): change in cue-induced craving in those on methadone was 0.07 with CBD and 0.04 with placebo; in those on buprenorphine, 0.13 vs. −1.20 (0–10 scale); similar small differences in anxiety; illicit opioids in urine in 75.9% vs. 80.8% of those on methadone and 12.5% vs. 20% of those on buprenorphine. No statistical comparison in the registry. No peer-reviewed publication (PubMed search by registry number gave 0 results, October 28, 2026)","yan_etki":"No serious side effects; other side effects in the first 4 weeks among those on methadone 12/32 with CBD and 21/30 with placebo; most often abdominal pain, diarrhea and fatigue","pmid":null,"doi":null,"diger_kaynak":"ClinicalTrials.gov NCT06206291 (results posted to the registry on June 18, 2026)"},{"ad":"Meneses-Gaya 2021","tasarim":"Double-blind, placebo-controlled exploratory RCT (inpatient)","n":"31 men","populasyon":"Inpatient men with crack cocaine addiction (Brazil)","urun":"Pure CBD capsule (99.9% pure CBD powder in corn oil; 150 mg capsule)","urun_turu":"saf_cbd","doz":"300 mg/day","titrasyon":null,"sure":"10 days","sonuc":"Craving decreased in both groups over 10 days; no difference between CBD and placebo. The craving induction procedure worked similarly in both groups; anxiety, depression and sleep measures did not differ. Conflict of interest: 3 of 8 authors are inventors on a patent for a CBD derivative, and 2 received consulting fees and travel support from a CBD manufacturer","yan_etki":"Drowsiness/long sleep 5 vs. 3, nausea 2 vs. 1, headache 2 vs. 1 (all no difference)","pmid":"33146345","doi":"10.1590/1516-4446-2020-1416","diger_kaynak":null},{"ad":"Metrik 2026","tasarim":"Double-blind, placebo-controlled, within-subject crossover RCT (lab)","n":"157 randomized; 138 completed at least two sessions","populasyon":"Adults who drank heavily, used cannabis at least 2 times a week and did not want to quit or be treated (USA; mean age 25.6; 35% women; 43% had alcohol use disorder and 76% cannabis use disorder)","urun":"Marijuana cigarette: 7.2% THC, 3.1% THC or 0.03% THC (placebo); plant material from the US National Institute on Drug Abuse","urun_turu":"thc_iceren","doz":"One cigarette per session","titrasyon":null,"sure":"3 experiment days (one-time smoking)","sonuc":"Primary outcomes: no difference on the alcohol craving scale (ACQ-SF-R); 7.2% THC reduced the single-item urge to drink only right after smoking. Secondary outcome: alcohol consumed in an alcohol choice task was 19% lower with 3.1% THC and 27% lower with 7.2% THC. A single-session lab effect after overnight cannabis abstinence; it does not show a treatment effect. Conflict of interest: 1 of 6 authors reported company ties unrelated to cannabis","yan_etki":"According to the registry, no serious side effects; 1 other side effect among 157 people","pmid":"41254853","doi":"10.1176/appi.ajp.20250115","diger_kaynak":"ClinicalTrials.gov NCT02983773 (results in registry)"},{"ad":"Morgan 2013","tasarim":"Double-blind, placebo-controlled pilot RCT","n":"24 (12 CBD / 12 placebo)","populasyon":"Tobacco smokers who wanted to quit (England)","urun":"CBD inhaler (used when the urge to smoke came; product details not in the abstract)","urun_turu":"cbd_zengin_thc_belirsiz","doz":"Not in the abstract","titrasyon":"As needed","sure":"1 week (then follow-up)","sonuc":"During one week of treatment, the number of cigarettes smoked in the CBD group fell by about 40% from its own baseline and did not change in the placebo group; the effect was reported to persist partly at follow-up. These are within-group changes; a direct comparison of the two groups and the length of follow-up are not in the abstract. Quit rate was not measured. The conflict-of-interest statement could not be read (full text not open access)","yan_etki":"Not in the abstract","pmid":"23685330","doi":"10.1016/j.addbeh.2013.03.011","diger_kaynak":null},{"ad":"Hindocha 2018","tasarim":"Double-blind, placebo-controlled crossover RCT (lab; first a fixed satiated session, then two overnight abstinence sessions)","n":"30","populasyon":"Dependent cigarette smokers not seeking treatment (England)","urun":"Pure synthetic CBD capsule (STI Pharmaceuticals); placebo lactose","urun_turu":"saf_cbd","doz":"Single dose 800 mg","titrasyon":null,"sure":"2 single-dose abstinence sessions","sonuc":"With placebo, overnight abstinence increased attentional bias toward cigarette images; CBD reversed this (p = 0.007) and reduced how pleasant the images seemed (p = 0.011). Cigarette craving and withdrawal were not affected by CBD (Bayes factors 7.08 and 6.95: evidence for no effect). In the second publication of the same trial, CBD did not improve working memory or impulsivity and increased errors on an impulse control task (Hindocha 2018b)","yan_etki":"No subjective side effects; during abstinence, systolic blood pressure fell with CBD","pmid":"29714034","doi":"10.1111/add.14243","diger_kaynak":"Second publication of the same trial: Hindocha 2018b, Sci Rep (PMID 29765102; impulsivity and memory)"},{"ad":"Gilman 2022","tasarim":"Pragmatic RCT (getting a medical cannabis card right away or after 12 weeks; 2:1; participants not blinded, only assessors blinded)","n":"269 randomized; 186 analyzed (105 immediate, 81 waiting; those with a baseline and at least one follow-up measurement; in the immediate group, only those who got the card: 53 of the 173 people assigned to this group did not get a card)","populasyon":"Adults aged 18–65 who wanted to use medical cannabis for chronic pain, insomnia or anxiety/depression symptoms (Boston, USA)","urun":"Cannabis products chosen by participants themselves from dispensaries (THC and/or CBD; product, dose and frequency unrestricted; proportions in a supplementary table, not read)","urun_turu":"karma","doz":"Unrestricted","titrasyon":null,"sure":"12 weeks (9 months of extra follow-up)","sonuc":"Those who got the card right away had more cannabis use disorder symptoms (mean difference 0.28; 95% CI 0.15–0.40), and cannabis use disorder developed in 17.1% vs. 8.6% within 12 weeks (adjusted OR 2.88; 95% CI 1.17–7.07); 28.3% vs. 10.8% among those who applied for anxiety or depression. Insomnia symptoms decreased; no difference in pain, anxiety or depression. In the uncontrolled 9-month follow-up, cannabis use disorder developed in 11.7% of participants and in 17.1% of those who used daily or almost daily (Cooke 2023)","yan_etki":"The main outcome is a harm measure (cannabis use disorder); other side effects are not in this row","pmid":"35302633","doi":"10.1001/jamanetworkopen.2022.2106","diger_kaynak":"ClinicalTrials.gov NCT03224468 (results in registry); 9-month follow-up: Cooke 2023 (PMID 36960460); daily survey analysis of the same trial: Tervo-Clemmens 2023 (PMID 36638745; 181 people; frequency of cannabis use increased over 12 weeks in those who got the card, but not in those waiting; according to the authors, this increase raises the risk of cannabis use disorder)"},{"ad":"Zammit Dimech 2026","tasarim":"Systematic review, narrative synthesis without meta-analysis (weighted by design; 1975–2025)","n":"97 studies; 41,954 participants","populasyon":"Opioid, alcohol, cocaine, tobacco and methamphetamine use disorders","urun":"Any cannabinoid exposure (medicines and cannabis use)","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"Of 195 outcomes, 45.6% were beneficial, 41.0% null, 6.2% mixed and 7.2% harmful. Most beneficial findings were in short-term symptoms (craving, withdrawal, consumption; 76.4%) and mostly from weakly designed studies; for lasting outcomes (complete abstinence, relapse prevention, retention in treatment) there was mostly no effect, most clearly in opioid use disorder. Authors: cannabinoids provide short-term symptom benefit; they have not been shown to bring about lasting abstinence","yan_etki":null,"pmid":"42466639","doi":"10.1192/j.eurpsy.2026.12236","diger_kaynak":"PROSPERO CRD420251151193"},{"ad":"Redonnet 2025","tasarim":"Umbrella review (22 systematic reviews, 5 with meta-analysis; AMSTAR 2)","n":"22 systematic reviews","populasyon":"Substance use disorders (cannabis, tobacco, alcohol, opioids and others)","urun":"Pure CBD or CBD together with THC","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"The evidence on CBD's effectiveness in substance use disorders is mixed. Nabiximols, containing THC and CBD, showed a positive effect on cannabis withdrawal and craving. The effect of CBD alone on quitting, reducing or staying abstinent from cannabis, tobacco, alcohol, opioids and other substances is limited and uncertain; the authors conclude that CBD alone does not appear to be effective","yan_etki":null,"pmid":"39947878","doi":"10.1111/add.16745","diger_kaynak":null},{"ad":"Costa 2024","tasarim":"Systematic review and meta-analysis (10 longitudinal observational studies)","n":"8,367 participants (38% women); mean follow-up 9.7 months","populasyon":"Opioid use disorder treated with methadone, buprenorphine or naltrexone","urun":"Cannabis used by participants on their own (no product information)","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"Cannabis use during treatment was not associated with illicit opioid use (OR 1.00; 95% CI 0.97–1.04); moderate heterogeneity and publication bias. Observational; it does not show benefit or harm of cannabis as a treatment. An earlier systematic review (Lake 2020, 41 studies) also found no significant association in most studies","yan_etki":null,"pmid":"38225727","doi":"10.1080/00952990.2023.2287406","diger_kaynak":"Earlier systematic review: Lake 2020 (PMID 33130527)"},{"ad":"Costa 2026 (alcohol review)","tasarim":"Systematic review and meta-analysis of animal and human studies (human studies narrative)","n":"63 studies","populasyon":"Alcohol use disorder","urun":"Drugs acting on the endocannabinoid system (CB1 blockers, CB1 agonists, CBD)","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"In animals, CBD reduced alcohol intake (SMD −0.70) and CB1 agonists increased it (SMD +0.66). In human studies, results were inconsistent and generally null; most were with rimonabant (not in the table on this site) or CBD. 1 of 8 authors reported drug supply and consulting fees from pharmaceutical companies","yan_etki":null,"pmid":"41760917","doi":"10.1038/s41380-026-03523-5","diger_kaynak":null},{"ad":"Costa 2026 (tobacco review)","tasarim":"Systematic review and meta-analysis of animal, observational and experimental human studies (through January 2026)","n":"52 studies; 18 studies, 229,034 people in the observational meta-analysis","populasyon":"Tobacco use disorder","urun":"Cannabis use and drugs acting on the endocannabinoid system (including CBD)","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"In observational studies, people who used cannabis were less likely to quit smoking (OR 0.75; 95% CI 0.67–0.83; high heterogeneity). In experimental human studies, CBD reduced cigarette consumption, reduced attention to smoking cues and eased withdrawal (Morgan 2013, Hindocha 2018 and one uncontrolled study); CB1 inverse agonists were abandoned because of psychiatric side effects. The numbers differed in the non-peer-reviewed preprint (OR 0.65). 1 of 8 authors reported drug supply and consulting fees from pharmaceutical companies","yan_etki":null,"pmid":"42863773","doi":"10.1016/j.neubiorev.2026.107032","diger_kaynak":"Non-peer-reviewed preprint: medRxiv 2026 (PMID 41728311); PROSPERO CRD420250652724"}],"ilgili_ilaclar":["metadon","opioid"],"son_inceleme":"2026-10-30","arastirma_gecmisi":[{"tarih":"2026-10-19","not":"Page published. In this first review, 4 studies were examined."},{"tarih":"2026-10-21","not":"The full texts of the studies were reread and the information on the page was checked against its sources. Corrected: participant numbers, side effects, product and registry number details in the study table. No points remain that could not be verified from the full text (previously 1 item). The year of a publication named on the page was corrected to the journal's print year instead of the online publication year. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-21","not":"PubMed and ClinicalTrials.gov were searched for newly published and previously missed clinical studies. 7 studies added: Mongeau-Pérusse 2021, Mueller 2025, London 2025, Kirkland 2025, Zimmermann 2025 (ICONIC), Hurzeler 2025 and Suzuki 2023. The page title was broadened to match the substances it covers: cannabis, alcohol, opioids and cocaine. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-23","not":"A new publication from the team behind the Hurzeler 2025 trial (McGuire 2026; risk-taking and autonomic nervous system response) was not counted as a separate study because it is very likely based on the same participants; it was added as a note to that study's row. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-27","not":"The Cochrane review (2025) of medicines for cannabis use disorder was added: the quit rate at the end of treatment with THC-containing medicines is no different from placebo. The wording on cocaine craving was refined; it was noted that use and relapse were not measured in the opioid studies. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-28","not":"Display fix: internal working file names left in the text were removed; content and evidence did not change."},{"tarih":"2026-10-28","not":"Display fix: internal working notes left over from the previous cleanup were removed; content and evidence did not change."},{"tarih":"2026-10-28","not":"PubMed, Cochrane and ClinicalTrials.gov were searched again in October 2026, separately for each substance (3,814 records in PubMed and 985 on ClinicalTrials.gov; an independent audit search was also done). The scope was broadened, adding a tobacco (smoking) section and cannabinoid hyperemesis syndrome (harm information) to the page; tobacco was added to the title. 26 rows added: in cannabis addiction, 6 clinical studies and 4 short lab or inpatient studies with THC-containing or THC-like medicines (a mouth spray containing THC and CBD, synthetic THC, nabilone), 1 lab study with CBD alone and 1 small CBD study with results only in a registry; for opioids, 2 studies with CBD (one with results only in a registry) and 2 with synthetic THC; for crack cocaine, 1 CBD study; for alcohol, 1 lab study with THC-containing marijuana; for smoking, 2 small controlled studies with CBD; 1 controlled study measuring the risk of cannabis use disorder with THC-containing cannabis products; 5 systematic reviews and meta-analyses. Small lab studies repeating the same method, uncontrolled studies and reviews repeating the same question were not added to the table individually; studies on CBD's own addiction potential were cited with their sources in the text. Corrected: the statement that use was never measured in the opioid studies was updated in light of the 76-person study with results only in a registry; product information for two studies was added from the registry and protocol; registry numbers, secondary publications, correction notices and one company tie were added to existing rows; it was noted that in one alcohol study a drinking measure listed in the registry was not published; the conclusion and strength-of-evidence text for THC-containing products was rewritten to match the table; the search numbers were added to the evidence summary. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-28","not":"On October 28, 2026, sources found for this page during the searches for other topics were processed. In the medical cannabis card study (Gilman 2022), the number of people was corrected: 269 people were randomly assigned to groups and 186 were analyzed; the daily survey analysis of the same trial (Tervo-Clemmens 2023) was added. The evidence description for CBD in cannabis addiction was lowered from 'weak–moderate' to 'weak,' so that it now matches the evidence label on the page (weak). Three small studies testing non-cannabinoid ADHD medicines for cannabis addiction in people who also have ADHD, and a caution note that blood pressure can rise in some people when cannabis is stopped suddenly, were added. A finding on cannabis use and quitting smoking in cancer patients was not added because its numbers could not be verified from the primary source. The conclusion and the evidence label did not change."},{"tarih":"2026-10-30","not":"The correction to the Wilson 2026 meta-analysis published in the journal was read: only the axis of one figure and the study counts in a table were corrected; the results on this page did not change."},{"tarih":"2026-10-30","not":"Four studies were added to the table. From the UK medical cannabis patient registry, 6-month data on 34 people prescribed a cannabis product for substance use disorder (most often opioid use disorder): anxiety, sleep and quality of life scores improved, and the amount of prescribed opioids was lower at month 6; because there was no comparison group, these changes cannot be said to come from cannabis. Three small controlled studies with THC-containing medicines in cannabis dependence: in a laboratory study lasting a few days, oral THC reduced some withdrawal symptoms but did not reduce relapse to marijuana smoking (8 people); a single dose of THC reduced craving triggered by marijuana cues (14 people); a high dose of a mouth spray containing THC and CBD reduced withdrawal on cannabis-free days and did not change craving (9 people). The rule for laboratory studies is this: studies done by the same research group with the same method are given in a single row, and the other publications are mentioned in that row's source information; studies whose results do not agree stay in separate rows. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-30","not":"The last sentence of the page's short summary was rewritten in a calmer, more guiding tone: instead of \"Talk to your doctor before you start.\", it now says whom you can talk with, and about what, if you are considering CBD. The conclusion and the strength of evidence did not change."}]},{"id":"skin-conditions","baslik":"Skin conditions (acne, atopic dermatitis, psoriasis)","grup":"Other","grup_kodu":"diger","tr_id":"cilt-hastaliklari","kanit_duzeyi":"cok_zayif","kanit_yonu":"celiskili","kanit_ozet":"No effect on itching attributable to CBD or THC has been shown. Two sources previously described on this page as a signal of a small reduction were reread, found not to have been done with a cannabinoid product, and removed from the table. The small reduction (SMD −0.29) in a 2025 meta-analysis (Sermsaksasithorn 2025, PMID 41181596) came from 6 studies with products that contained no CBD or THC (PEA creams, hemp seed oil, and the synthetic research compounds HU-210 and lenabasum). The cream in the 60-person study that reduced itching in dialysis patients 1.1 points more than placebo (Anumas 2024, PMID 39328960) was made with hemp seed oil pressed from the seeds (1.27 mg of CBD and 0.13 mg of THC per kilogram of oil), and the difference in reduction from baseline was not significant. In the only RCT with a cannabinoid in dialysis itch, the THC-like nabilone was no better than placebo (14 people, crossover). In recurrent canker sores, a 0.1% CBD product shrank the sores faster than placebo (69 people, 7 days). In atopic dermatitis, in the manufacturer's 200-person RCT, a 4% synthetic CBD solution was no better than vehicle at 12 weeks (clear or almost clear: 12% vs. 19%; results only on ClinicalTrials.gov, no statistical comparison); in a small RCT completed by 57 people, the cream containing CBD alone was no different from placebo, and improvement was seen only with the combination of CBD and aspartame. In psoriasis, oral CBD oil did not improve PASI (28 people). Two reviews report that a placebo-controlled study comparing the two halves of the body in 51 people with a 2.5% CBD ointment applied to the skin (Puaratanaarunkon 2022, PMID 35536599) had a positive result; the publication has no abstract, its full text could not be obtained, and the result could not be verified. In a secondary analysis of an RCT with a CBD-rich, low-THC extract in people with Parkinson's disease, there was also no difference in seborrheic dermatitis (53 people, 16 days). In acne there is no peer-reviewed published RCT result; in the results of the only 368-person RCT (BTX 1503), available only on ClinicalTrials.gov, the CBD arms were no better than vehicle. The 2026 systematic review in acne (Komane) found the evidence preliminary; this review screened only 50 records and does not include the BTX 1503 registration. In epidermolysis bullosa, in an 8-person crossover RCT with THC+CBD oil under the tongue, the main measure (emotional burden of pain) did not change; in an uncontrolled study of 10 children taking pure CBD by mouth, itching and pain decreased. For finger ulcers in systemic sclerosis, CBD oil reduced pain in a non-randomized comparison; for scalp psoriasis, seborrheic dermatitis and hair loss there are only uncontrolled series. The studies are small and short; the effect of cosmetic products cannot be attributed to CBD because of the other ingredients they contain. October 2026 search (PubMed, Cochrane, ClinicalTrials.gov, Europe PMC): 9 controlled studies (8 randomized), 5 uncontrolled studies and 2 systematic reviews with cannabis products and cannabinoids on this topic were found; all are in the table below. There is no Cochrane review. Not included in the table: reviews examining cannabinoids in dermatology as a whole (most of the controlled studies they pooled were done with PEA creams, hemp seed oil or synthetic lenabasum; the CBD studies within them are separate rows in the table), studies with hemp seed oil (seed oil is not a CBD or THC product; it contains cannabinoids only in trace amounts), lenabasum, a synthetic drug candidate tested in systemic sclerosis and dermatomyositis (not a plant cannabinoid; in a 365-patient phase 3 study it was no different from placebo on the main measure), studies of cosmetic and wound products that contain CBD together with ginger, salicylic acid or other active ingredients and have no CBD-only group or no comparison group, and 2 randomized studies whose results could not be read or have not been released (see unverifiable points).","kanit_duzeyi_metin":"Very weak; conflicting (RCTs with CBD applied to the skin in acne and atopic dermatitis, with oral CBD in psoriasis, and with a CBD-rich extract in seborrheic dermatitis were negative; positive results come from a single small RCT in canker sores, a cream in which CBD was combined with another substance, a psoriasis RCT whose result could not be verified, and small non-randomized or uncontrolled studies)","kanit_duzeyi_thc_icerenler":"cok_zayif","kanit_duzeyi_thc_icerenler_metin":"Very weak (two small RCTs, both negative, one only a secondary analysis; a small RCT with the THC-like drug nabilone was also negative; the rest uncontrolled series)","kaynak_dosya":"diger-hastaliklar.md","saf_cbd_sonuc":"Controlled evidence for CBD in the skin is very limited and conflicting: in canker sores, a 0.1% CBD product shrank the sores quickly; in psoriasis, 60 mg/day of oral CBD did not improve PASI; in atopic dermatitis, no significant difference was reported for the CBD-only arm. In the manufacturer's RCTs, a CBD solution applied to the skin was no better than the solution without CBD in acne (368 people) and atopic dermatitis (200 people) (results only in the registry, no statistical comparison). Two reviews report that a 51-person controlled study of a 2.5% CBD ointment applied to the skin in psoriasis was positive; the publication itself could not be read. Other positive results come from small, non-randomized or uncontrolled studies: finger ulcer pain in systemic sclerosis (45 people) and itching and pain in children with epidermolysis bullosa (10 people).","thc_icerenler_sonuc":"There are two small randomized studies with THC-containing products, and neither found a difference from placebo: in epidermolysis bullosa, THC+CBD oil under the tongue did not change the emotional burden of pain, the main measure, differently from placebo (8 people; pain and painkiller use decreased on secondary measures); in people with Parkinson's disease, a CBD-rich extract that also contained a little THC did not change seborrheic dermatitis differently from placebo in a secondary analysis (53 people). The synthetic THC-like nabilone was also no better than placebo for itching in dialysis patients (14 people). For hair loss, there are only uncontrolled series with hemp extracts containing trace amounts of THC. The dialysis itch cream previously described in this box was made with hemp seed oil pressed from the seeds (0.13 mg of THC per kilogram of oil); because seed oil is not considered a THC product, it is no longer assessed here.","ruhsat":null,"doz_araligi_ozet":"Oral 60 mg/day (psoriasis); 0.075–5% CBD shampoo, solution or cream on the skin 1–2 times a day (acne, eczema, scalp); oral 5–20 mg/kg/day in children (epidermolysis bullosa, uncontrolled); 0.1% CBD 3 times a day (canker sores); concentration not reported for some cosmetic products","titrasyon_ozet":null,"yan_etkiler":["Cases of rash linked to oral CBD use have been reported (Souza 2022, PMID 35662726, case series)"],"izlem":[],"dikkat":["Most cosmetic products contain CBD together with other active ingredients (aspartame, ginger, CBG, retinol, salicylic acid, etc.); the effect of these products cannot be attributed to CBD","In the canker sore study, CBD was applied to sores inside the mouth; this result cannot be carried over to skin diseases or to swallowed CBD","Some products sold as \"hemp oil\" are oil pressed from the seeds and contain very little CBD or THC; the cream in the dialysis itch study was like this. Check whether the label and the certificate of analysis show the amount of CBD"],"ilac_etkilesim_notlari":[],"dogrulanamayan":["In Umpreecha 2023, the CBD was prepared from a 5% hemp extract donated by a company; the purity and THC content of the extract are not stated in the publication","A two-center, placebo-controlled RCT of a 2.5% CBD ointment applied to the skin in psoriasis (Puaratanaarunkon 2022, Thailand; letter to the journal) could not be included in the table: it has no abstract and its full text could not be accessed. According to two reviews, in 51 people with mild psoriasis the ointment was applied to one half of the body and an inactive ointment to the other half twice a day for 12 weeks, and the psoriasis severity score was significantly lower on the side treated with CBD (p = 0.026); this result could not be verified from the source itself","A 19-person randomized phase 2 study of a CBN cream (INM-755) in epidermolysis bullosa (NCT04908215) ended in April 2023; as of October 2026 there are no results in the registry and no peer-reviewed publication. There are also no results for a CBD study in chronic urticaria (NCT04439955, 15 people, ended in 2021)","Full texts that could not be read (publisher access blocked or paywalled): Schräder 2026 and Mayrand 2026 (results from the publication's short abstract and the registry), Vincenzi 2020, Gao 2022 and Roongpisuthipong 2026 (from the abstract)","Ongoing or not yet started studies (October 2026): 1% CBD lotion for itch in systemic sclerosis (NCT07245238), CBD compared with a steroid cream in eczema (NCT06994520), oral and topical CBD:CBG:THC in psoriasis (NCT07839455), THC:CBD oil for severe itch (NCT06435299, start January 2027 according to the registry); no results"],"calismalar":[{"ad":"Roongpisuthipong 2026","tasarim":"Double-blind, placebo-controlled RCT","n":"28","populasyon":"Psoriasis","urun":"Oral CBD oil","urun_turu":"saf_cbd","doz":"60 mg/day","titrasyon":"not reported","sure":"Not reported (results up to week 8)","sonuc":"No significant improvement in PASI; itching decreased at week 8, and time to fall asleep was temporarily shortened","yan_etki":"Mild to moderate, similar between groups","pmid":"41459647","doi":"10.1080/09546634.2025.2604448","diger_kaynak":null},{"ad":"Umpreecha 2023","tasarim":"Randomized controlled trial, 3 arms (CBD / steroid / placebo)","n":"69 patients with canker sores (plus 100 and 50 healthy volunteers for safety)","populasyon":"Recurrent canker sores (mouth ulcers)","urun":"0.1% CBD oral paste applied to the sore (CBD from a 5% hemp extract donated by a company; purity and THC content not reported)","urun_turu":"cbd_zengin_thc_belirsiz","doz":"3 times a day","titrasyon":null,"sure":"7 days","sonuc":"Sore size decreased more with CBD and with the steroid than with placebo on all measurement days; pain was lower with CBD than placebo only on day 5; no difference in quality of life","yan_etki":"No allergy or side effects seen; blood values did not change","pmid":"36803360","doi":"10.1186/s12906-023-03886-0","diger_kaynak":"TCTR20220802004 (retrospective registration)"},{"ad":"Gao 2022","tasarim":"Randomized, double-blind, placebo-controlled, 3 groups (CBD+aspartame / CBD alone / placebo)","n":"57 (completed)","populasyon":"Atopic dermatitis","urun":"Topical: CBD+aspartame (JW-100), CBD alone, placebo","urun_turu":"saf_cbd","doz":"not reported","titrasyon":null,"sure":"14 days","sonuc":"Significant improvement only with the CBD+aspartame combination; no significant difference reported for the CBD-alone arm (clear/almost clear: CBD 20%, placebo 15%; decrease in ISGA score 0.81 with CBD alone and 0.71 with placebo). 3 of the 13 authors were linked to a US company (Applied Biology)","yan_etki":"Not reported (in the abstract)","pmid":"34056830","doi":"10.1111/jocd.14263","diger_kaynak":null},{"ad":"Palmieri 2019","tasarim":"Retrospective, uncontrolled anecdotal series","n":"20 (5 psoriasis, 5 atopic dermatitis, 10 scars)","populasyon":"Skin conditions","urun":"CBD ointment (THC-free)","urun_turu":"saf_cbd","doz":"Twice a day","titrasyon":null,"sure":"3 months","sonuc":"Improvement reported (no control)","yan_etki":"No irritation/allergy reported","pmid":"30993303","doi":"10.7417/CT.2019.2116","diger_kaynak":null},{"ad":"BTX 1503 (Botanix)","tasarim":"Phase 2, randomized, quadruple-blind, vehicle-controlled (3 CBD arms + vehicle); no peer-reviewed publication (October 2026), results from the ClinicalTrials.gov record","n":"368 (92 in each arm)","populasyon":"Moderate to severe acne","urun":"Topical CBD solution (2.5% or 5% CBD)","urun_turu":"saf_cbd","doz":"5% twice a day, 5% once a day, or 2.5% once a day","titrasyon":null,"sure":"84 days","sonuc":"The primary outcome was safety only. At day 84, the reduction in inflammatory lesions was −8.5 / −12 / −11.7 in the CBD arms and −11.3 with vehicle; CBD not better than vehicle (statistical comparison not published)","yan_etki":"No serious side effects; dropping out more common in the CBD arms (23, 15, 22 vs. 11 with vehicle)","pmid":null,"doi":null,"diger_kaynak":"ClinicalTrials.gov NCT03573518 (clinicaltrials.gov/study/NCT03573518)"},{"ad":"BTX 1204 (Botanix)","tasarim":"Phase 2, randomized, quadruple-blind, vehicle-controlled, multicenter (USA); sponsor Botanix, the owner of the product; no peer-reviewed publication (October 2026), results from the ClinicalTrials.gov record","n":"200 randomized (100 + 100); 99 and 95 in the primary analysis","populasyon":"Ages 12–70, moderate atopic dermatitis (5–30% of body surface area)","urun":"BTX 1204: synthetic CBD solution applied to the skin (4%)","urun_turu":"saf_cbd","doz":"Twice a day","titrasyon":null,"sure":"84 days","sonuc":"Primary outcome (clear or almost clear on the investigator's global assessment at day 85 and at least a 2-grade improvement): 12 of 99 people (12%) with CBD, 18 of 95 (19%) with vehicle; CBD not better than vehicle (no statistical comparison in the registry). Completed the study: 65 vs. 55 of 100 people","yan_etki":"Serious side effects in 2 of 99 people with CBD (postoperative complication, pneumonia), 0 of 98 with vehicle; application-site redness 7 vs. 1, eczema flare 11 vs. 15","pmid":null,"doi":null,"diger_kaynak":"ClinicalTrials.gov NCT03824405 (ended March 2020; results entered in the registry on September 27, 2022)"},{"ad":"Collister 2026 (DISCO-POT)","tasarim":"Double-blind, placebo-controlled, crossover RCT (2 × 4 weeks, with a 2-week break); two centers (Canada); investigator-initiated","n":"14 randomized; 12 completed","populasyon":"Adults (aged 25 and over) on hemodialysis with at least moderate uremic pruritus","urun":"Nabilone (synthetic THC-like cannabinoid), oral capsule","urun_turu":"cbn_diger","doz":"0.5 mg at night for 1 week, then 0.5 mg twice a day for 3 weeks","titrasyon":"From 1 capsule to 2 capsules a day after 1 week","sure":"4 weeks nabilone, 4 weeks placebo","sonuc":"On the primary outcome (worst itch in the past 24 hours, 0–100 mm), nabilone was no different from placebo; if anything, 4.9 mm worse (95% CI −3.6 to 13.4; p = 0.26, 0.28 in the abstract). No difference in average itch, sleep or overall quality of life; the score for the impact of skin disease on life (DLQI) was 1.4 points worse with nabilone (95% CI 0.4 to 2.5; p = 0.01). Public funding (Canadian Institutes of Health Research); the authors reported no conflicts of interest","yan_etki":"Sleepiness (4 vs. 5 of 14 people) and dizziness (3 vs. 2) similar in the two periods; no falls, fractures or serious side effects","pmid":"42889824","doi":"10.1016/j.xkme.2026.101451","diger_kaynak":"ClinicalTrials.gov NCT05180968 (no results in the registry)"},{"ad":"Weber 2024","tasarim":"Secondary analysis of a double-blind, placebo-controlled, parallel RCT (the main study was on movement symptoms in Parkinson's disease; facial photos were assessed blind by two dermatologists)","n":"53 (26 CBD, 27 placebo); 12 and 15 people with seborrheic dermatitis at baseline","populasyon":"Adults aged 40–85 with Parkinson's disease (USA)","urun":"Oral CBD-rich cannabis extract (100 mg/mL CBD and 3.3 mg/mL THC in sesame oil; supplied by the US National Institute on Drug Abuse)","urun_turu":"thc_iceren","doz":"1.25 mg per kilogram per day (4 days), then 2.5 mg (about 10 days); on the last day, a mean of 188 mg CBD and 6.3 mg THC","titrasyon":"Single morning dose for 4 days, then twice a day","sure":"About 16 days","sonuc":"No significant difference from placebo in the presence and severity of seborrheic dermatitis (SEDASI) (treatment effect p = 0.12 and 0.38); people with seborrheic dermatitis fell from 12 to 9 in the CBD group and rose from 15 to 18 in the placebo group. The disease was mild at baseline, and the study was not large enough for this outcome. Funding: Colorado state medical marijuana research fund and NIH","yan_etki":"No notable changes in blood pressure, pulse, temperature or blood tests (side-effect details in the main study)","pmid":"38466972","doi":"10.2196/49965","diger_kaynak":"ClinicalTrials.gov NCT03582137 (main Parkinson's study; results in the registry)"},{"ad":"Schräder 2026 (C4EB)","tasarim":"Double-blind, placebo-controlled, crossover RCT (2 × 14 days, with a 2-week break); single center (Netherlands); investigator-initiated","n":"8 adults","populasyon":"Patients with inherited epidermolysis bullosa and chronic pain","urun":"Cannabis oil under the tongue (Transvamix: 10% THC, 5% CBD; a prescription product compounded in pharmacies in the Netherlands)","urun_turu":"thc_iceren","doz":"Dose increased until side effects appeared, divided into 4 doses a day; at most 0.75 mL/day (75 mg THC + 37.5 mg CBD) (according to the protocol)","titrasyon":"From 0.05 mL/day to 0.75 mL/day over 14 days; one step back if side effects appeared (according to the protocol)","sure":"14 days THC+CBD, 14 days placebo","sonuc":"No significant difference from placebo on the primary outcome (emotional burden of pain, SF-MPQ2). 6 of 8 people (75%) reported at least a 30% reduction in overall pain, and painkiller use was halved during the active period (secondary outcomes). Numbers from the publication's short abstract; full text could not be read. Funding: DEBRA UK (patient association)","yan_etki":"Mild side effects common (details in the full text; could not be read)","pmid":"41742693","doi":"10.1093/bjd/ljag072","diger_kaynak":"Netherlands Trial Register NL9347; protocol: Schräder 2022, PLoS One 17:e0277512 (PMID 36508401)"},{"ad":"Spinella 2023","tasarim":"Comparative, non-randomized (the publication says both \"randomized\" and \"retrospective evaluation\"); no blinding; single center (Italy)","n":"45 (25 CBD, 20 standard care)","populasyon":"Painful, opioid-resistant finger ulcers in systemic sclerosis","urun":"CBD oil applied to the ulcer (according to the publication, 10% CBD in acid form + 90% hemp seed oil, THC-free); according to the table, the CBD group also took CBD oil by mouth","urun_turu":"cbd_zengin_thc_belirsiz","doz":"4 drops once a day on the ulcer, with dressing","titrasyon":null,"sure":"1–2 months (CBD mean 1.2 months)","sonuc":"At 1 month, ulcer pain (0–10) fell from 8.4 to 6.0 with CBD and from 8.44 to 7.88 with standard care (between groups p < 0.0001); sleep duration and daily function (HAQ-DI) improved in the CBD group. Extra painkillers needed in 12 of 25 people vs. 20 of 20; ulcer completely healed in 18 of 25 vs. 6 of 20. Some numbers in the publication do not agree (final HAQ-DI given as 1.61 and 0.79 in two different places). The authors reported no financial relationships","yan_etki":"Mild itching or redness around the ulcer in 7 of 25 people; no serious side effects","pmid":"36537770","doi":"10.1097/01.ASW.0000891856.08360.61","diger_kaynak":null},{"ad":"Komane 2026","tasarim":"Systematic review (PRISMA, PROSPERO-registered; no meta-analysis)","n":"13 studies (mostly cell and laboratory studies; clinical studies few and mostly uncontrolled)","populasyon":"Acne","urun":"CBD-containing hemp extracts and pure CBD","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"Found the clinical evidence preliminary: small, mostly non-randomized studies, different products and frequent use together with other active ingredients. Limitations: it screened only 50 records, does not mention the BTX 1503 registration, the only controlled study in acne, and one source it presents as a clinical finding is actually a cell study. No funding; the authors reported no conflicts of interest","yan_etki":"Well tolerated in the short term; mild irritation in less than 10% (according to the review)","pmid":"42357416","doi":"10.3390/molecules31122017","diger_kaynak":"PROSPERO CRD420251272093"},{"ad":"Niyangoda 2024","tasarim":"Systematic review (PROSPERO-registered; no meta-analysis)","n":"18 studies: 11 animal, 7 human (92 people)","populasyon":"Skin wounds and skin infections (human studies: epidermolysis bullosa, pyoderma gangrenosum, calciphylaxis and venous leg ulcers, pressure ulcer, canker sores)","urun":"THC- and CBD-containing products applied to the skin or taken by mouth/under the tongue, crude extracts","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"Of the human studies, 1 was an RCT (canker sores) and the rest were case reports and small uncontrolled series; positive results were reported for pain and wound healing, but the evidence is of low quality and better studies are needed. 4 of the 10 authors reported company ties; one (Maida) is the chief scientific officer of a company developing cannabinoid products for wounds, and one works for a medical cannabis company","yan_etki":null,"pmid":"39204426","doi":"10.3390/pharmaceutics16081081","diger_kaynak":"PROSPERO CRD42021255413"},{"ad":"Mayrand 2026","tasarim":"Prospective, single-group, open-label pilot study (no comparison group); Paris","n":"10 children (according to the registry)","populasyon":"Children with recessive dystrophic epidermolysis bullosa","urun":"Oral pure CBD solution (Epidyolex)","urun_turu":"saf_cbd","doz":"According to the registry, divided into 3 doses a day; started at 5 mg per kilogram per day and, if insufficient, increased to 10 and 20 mg (at most 800 mg/day)","titrasyon":"5 mg/kg/day (days 0–4) → 10 (days 5–9) → 20 mg/kg/day (days 10–29), according to the registry","sure":"30 days (according to the registry)","sonuc":"Mean chronic itch and pain, and itch and pain during dressing changes, decreased; quality of life and sleep clearly improved. Numbers could not be read (from the publication's short abstract and the registry; full text not accessible). No comparison group","yan_etki":"No serious side effects reported","pmid":"41105816","doi":"10.1093/bjd/ljaf400","diger_kaynak":"ClinicalTrials.gov NCT05651607 (AP-HP Necker, September–November 2023, primary outcome itch at day 30; no results in the registry; the registry number could not be seen in the publication, and the link is based on matching institution, disease and design)"},{"ad":"Vincenzi 2020","tasarim":"Prospective, single-group, open-label (no comparison group)","n":"50","populasyon":"Mild to moderate scalp psoriasis or seborrheic dermatitis","urun":"Shampoo containing 0.075% broad-spectrum CBD (THC content not in the abstract)","urun_turu":"cbd_zengin_thc_belirsiz","doz":"Used in place of the usual shampoo (frequency not in the abstract)","titrasyon":null,"sure":"14 days","sonuc":"Over 14 days, vascular findings and scaling scores on trichoscopy (0–5) fell from 2.3–3.6 to 0.5–0.8; itching fell from 6.9 to 1.5, burning from 4.5 to 1.0, redness from 5.5 to 1.3 and scaling from 7.0 to 1.6 (0–10) (all p < 0.0001); satisfaction was high. Because there was no comparison group, the effect cannot be attributed separately to the shampoo itself or to CBD. Manufacturer and funding not in the abstract; one of the authors is a consultant to various pharmaceutical and cosmetic companies (relationship to CBD not stated)","yan_etki":"Tolerability reported as very good","pmid":"33313051","doi":"10.1159/000510896","diger_kaynak":null},{"ad":"Smith 2021","tasarim":"Case series (single group, no comparison group); single center (USA)","n":"35","populasyon":"Adults with androgenetic alopecia (inherited hair loss) not using minoxidil or finasteride","urun":"Hemp oil applied to the scalp (from CBD-rich hemp flower powder; 10.78% CBD, 0.21% THC)","urun_turu":"thc_iceren","doz":"Once a day; mean 3–4 mg CBD/day","titrasyon":null,"sure":"6 months","sonuc":"Over 6 months, hair count in the area of greatest loss increased by a mean of 93.5%; some increase was reported in everyone. No comparison group, assessment not blinded; participants were recruited through a Facebook ad and received the product free of charge. No funding; the authors reported no conflicts of interest","yan_etki":"Mild increase in shedding in one-third during the first month; no other side effects reported","pmid":"37287996","doi":"10.26828/cannabis/2021.01.003","diger_kaynak":null},{"ad":"Smith 2023","tasarim":"Case series (single group, no comparison group); single center (USA)","n":"31","populasyon":"Adults with androgenetic alopecia (Norwood-Hamilton 3V and above)","urun":"Hemp extract foam applied to the scalp (CBD 60%, CBDV 12.6%, THCV 3.7%, THC 0.18%) + menthol and peppermint oil","urun_turu":"thc_iceren","doz":"Once a day; mean 33 mg extract/day","titrasyon":null,"sure":"6 months","sonuc":"Over 6 months, hair count per 1 cm² rose from 9.5 to 25.0 (mean increase 246% in men and 127% in women; p < 0.00001); an increase was reported in everyone. No comparison group; the sole author's institution is a company (Nex Therapeutics), and the publication states there is no conflict of interest; some numbers in the publication are inconsistent (e.g., the ethnic breakdown of participants differs between the abstract and the methods)","yan_etki":"No side effects reported","pmid":"37305187","doi":"10.4103/ijt.ijt_34_22","diger_kaynak":"ClinicalTrials.gov NCT04842383 (the same author's April–October 2021 registration: 40 people randomized to two dose groups; the publication describes a single group of 31; the link could not be verified; no results in the registry)"}],"ilgili_ilaclar":["siklosporin"],"son_inceleme":"2026-10-31","arastirma_gecmisi":[{"tarih":"2026-10-19","not":"Page published. In this first assessment, 5 studies were reviewed."},{"tarih":"2026-10-21","not":"The full texts of the studies were reread and the information on the page was checked against its sources. Corrected: registry number, study design, participant numbers and side-effect information in the study table; evidence summary. No points remain that could not be verified from full texts (previously 1 item). The results of the BTX 1503 study were added from its ClinicalTrials.gov record. The year of 2 publications named on the page was corrected to the journal's print year instead of the online publication year. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-21","not":"PubMed and ClinicalTrials.gov were searched for newly published and previously missed clinical studies. 2 studies added: Anumas 2024 and Umpreecha 2023. With the new studies, the strength of evidence changed from \"Insufficient\" to \"Very weak\", and the conclusion from \"Not studied enough\" to \"Mixed results\". The strength of evidence for THC-containing products was written for the first time, as \"Very weak\"."},{"tarih":"2026-10-28","not":"In October 2026, PubMed, Cochrane, ClinicalTrials.gov and Europe PMC were systematically searched; 11 studies were added: 4 randomized studies (the manufacturer's 200-person study in atopic dermatitis, nabilone for dialysis itch, seborrheic dermatitis in people with Parkinson's disease, THC+CBD oil in epidermolysis bullosa), a non-randomized comparison in systemic sclerosis ulcers, 2 systematic reviews (acne, skin wounds) and 4 uncontrolled studies (epidermolysis bullosa, scalp, hair loss). Two existing rows were reread and removed from the table: the itch reduction in the 2025 meta-analysis came from products containing no CBD or THC (PEA creams, hemp seed oil, synthetic research compounds), and the cream in the dialysis itch study was hemp seed oil pressed from the seeds and contained only trace amounts of CBD. The positive account, in two reviews, of a psoriasis study whose results could not be obtained (a CBD ointment applied to the skin) was added to the unverifiable points; product sources, company ties and publication dates were corrected. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-30","not":"The last sentence of the page's short summary was rewritten in a calmer, more guiding tone: instead of \"Talk to your doctor before you start.\", it now says whom you can talk with, and about what, if you are considering CBD. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-31","not":"The small RCT with the THC-like nabilone in itching related to dialysis (Collister 2026) was also added to the evidence level text for THC-containing products; the level did not change."}]},{"id":"diabetes","baslik":"Diabetes and metabolism","grup":"Other","grup_kodu":"diger","tr_id":"diyabet-metabolizma","kanit_duzeyi":"yetersiz","kanit_yonu":"yarar_gosterilmedi","kanit_ozet":"CBD did not improve blood sugar or insulin results compared with placebo; no human RCT was found that supports the claim that \"CBD regulates blood sugar.\" In fatty liver disease, in the manufacturer's small 8-week RCT (25 people; results only in the ClinicalTrials.gov record, no peer-reviewed publication), three different doses of CBD did not significantly reduce liver fat compared with placebo. After a single dose of CBD, more food was eaten at lunch; the promise of weight control is unsupported by evidence. Pharmaceutical-grade CBD, on the other hand, can reduce appetite: in a meta-analysis combining RCTs of approved cannabinoids in different conditions, decreased appetite was more common with CBD than with placebo (OR 2.46; moderate certainty). According to the US prescribing information for the approved CBD medicine, losing at least 5% of body weight was also more common in people taking CBD in high-dose controlled epilepsy studies (16% vs 8% in Lennox–Gastaut and Dravet syndromes, 31% vs 8% in tuberous sclerosis). This is an unwanted side effect; it is not evidence supporting use for weight loss. There are three small RCTs reporting positive results with THC-containing products and other substances in cannabis (a very low-dose CBD:THC spray in type 2 diabetes, an oral strip containing THCV and CBD in obesity, and the THC-like drug nabilone); all three have serious limitations: inconsistent numbers in the publication, analysis of only those who completed the study, or early stopping because of poor tolerability. In single-dose or 4-week studies compared with placebo or a control condition, THC, nabilone or marijuana did not clearly change blood sugar regulation (in a single-dose mechanistic study in healthy men, nabilone slightly increased insulin sensitivity). In population studies, type 2 diabetes and fatty liver are seen less often in cannabis users, but most of these studies are cross-sectional; for type 2 diabetes, the results of three large studies that followed people for years disagree, and genetic analyses did not support the idea that cannabis use changes the risk of type 2 diabetes or body weight. These observational data do not show cause and effect. In type 1 diabetes, ketoacidosis was more common in cannabis users (three observational studies; the largest with 2,108 adolescents and young adults with type 1 diabetes in the US) and HbA1c was higher (observational). Delayed stomach emptying due to diabetes (diabetic gastroparesis) is covered on the site's Irritable Bowel and Stomach Problems page: in a 4-week single-center RCT of 44 patients with gastroparesis, 12 of them diabetic, pharmaceutical-grade CBD reduced symptoms more than placebo but did not speed up gastric emptying (it slowed it on some measurements); no separate result was reported for people with diabetes, and the finding has not yet been tested in another study (Zheng 2023, PMID 37482172). In people with type 1 diabetes who use cannabis daily, cannabinoid hyperemesis syndrome can be mistaken for gastroparesis (Akturk 2025, PMID 40741458). No treatment study with a cannabis or CBD product was found for diabetic eye damage (diabetic retinopathy). The only controlled study in this condition with a drug targeting cannabinoid receptors tested an experimental synthetic drug that is not a cannabis product and binds selectively to the CB2 receptor (vicasinabin): in 139 patients, after 36 weeks of treatment, the rate of at least a two-step improvement in retinopathy severity was no different from placebo (the manufacturer-funded CANBERRA study, PMID 39802207). Because selective synthetic drugs are not counted as cannabis products on this site, it is not in the table. Diabetes medicines should not be replaced with CBD. October 2026 search (PubMed, Cochrane, ClinicalTrials.gov): 14 controlled studies of cannabinoids on this topic (12 randomized, one with registry results only; between 7 and 125 people, the longest 13 weeks), 6 systematic reviews on CBD or cannabis use and 9 observational studies were found (including one meta-analysis and one observational study added in the completion round on October 28, 2026); all are in the table below.","kanit_duzeyi_metin":"Insufficient (negative)","kanit_duzeyi_thc_icerenler":"yetersiz","kanit_duzeyi_thc_icerenler_metin":"Insufficient (small, short and conflicting studies)","kaynak_dosya":"diger-hastaliklar.md","saf_cbd_sonuc":"In type 2 diabetes, in overweight people and in fatty liver disease, pure CBD did not affect blood sugar, blood lipid or liver fat results clearly differently from placebo; in a single-dose study in overweight men, only insulin and triglyceride values right after a meal were briefly measured lower (all small, short studies; the fatty liver study's results are only in the registry).","thc_icerenler_sonuc":"Controlled studies of THC-containing products are very small and short. The numbers in the only study reporting a positive result in type 2 diabetes, with a very low-dose CBD:THC spray, are inconsistent; the obesity study of the THC-like drug nabilone was stopped early because of poor tolerability; dronabinol over 4 weeks did not change metabolic values, and a single use of marijuana or an edible product did not change insulin sensitivity. Some population studies report less type 2 diabetes in cannabis users, but these do not show cause and effect and were not supported by genetic analyses; in type 1 diabetes, ketoacidosis was more common in cannabis users (observational).","ruhsat":null,"doz_araligi_ozet":"In studies, 30 mg as a single dose or 2 times a day, 100 mg 2 times a day, 298 mg single dose, and 200–800 mg a day in fatty liver","titrasyon_ozet":null,"yan_etkiler":[],"izlem":[],"dikkat":["Diabetes medicines should not be replaced with CBD","High doses and over-the-counter doses cannot be compared: in low-dose (≤175 mg/day) studies, plasma levels were 5–100 times lower than with the 20 mg/kg Epidiolex dose (Warren 2026, PMID 42473010)","Anyone taking long-term medication should consult a physician before starting; the studies on this page did not systematically assess interactions","In type 1 diabetes, diabetic ketoacidosis was about twice as common in cannabis users (three observational studies, the largest with 2,108 adolescents and young adults with type 1 diabetes in the US; does not show cause and effect)","In type 1 diabetes, recurrent episodes of nausea and vomiting during daily cannabis use may be cannabinoid hyperemesis syndrome; because gastric emptying tests can also come back delayed in this syndrome, it can be mistaken for diabetic gastroparesis. In a single-center retrospective review, all 11 patients diagnosed with gastroparesis while using cannabis daily met the criteria for this syndrome (Akturk 2025, PMID 40741458). Telling the physician about cannabis use is important for a correct diagnosis"],"ilac_etkilesim_notlari":["The studies on this page did not systematically assess drug interactions; details are in the site's Drug interactions section"],"dogrulanamayan":["A meta-analysis reporting that cannabis and its \"by-products\" reduced body weight by an average of 1.87 kg (Reis 2024, PMID 37935909) was not included in the table: in addition to a few studies of cannabis products, the publication's reference list includes 8 publications on rimonabant, a weight-loss drug that is not a cannabis product and, on the contrary, blocks the CB1 receptor that THC binds to. The European Medicines Agency recommended suspending the sale of rimonabant in 2008 because it roughly doubled the risk of psychiatric disorders; the drug's marketing authorization was withdrawn in 2009. Because the full text could not be accessed, it could not be confirmed which studies went into this result; therefore the result cannot be counted as evidence that cannabis products cause weight loss.","A study in which a drug company tested THCV added to metformin for 12 weeks in 207 people with type 2 diabetes (ClinicalTrials.gov NCT02053272) was completed in February 2016; as of October 2026, its results are neither in the registry nor in a published article. The result of the largest THCV study on this topic is therefore unknown."],"calismalar":[{"ad":"Jadoon 2016","tasarim":"Double-blind, placebo-controlled, 5-arm pilot RCT","n":"62 randomized (CBD 13, THCV 12, CBD:THCV 1:1 11, 20:1 12, placebo 14); 56 completed","populasyon":"Type 2 diabetes","urun":"Pure CBD; THCV; combinations","urun_turu":"saf_cbd","doz":"CBD 100 mg × 2/day","titrasyon":null,"sure":"13 weeks","sonuc":"No difference between CBD and placebo in the primary outcome, HDL (difference −0.03 mmol/L; 95% CI −0.10 to 0.04; p = 0.41; registry results); no significant glycemic effect of CBD compared with placebo was reported either (only resistin and GIP changed from baseline); a drop in fasting glucose only in the THCV group (−1.2 mmol/L vs placebo; p < 0.05)","yan_etki":"Well tolerated","pmid":"27573936","doi":"10.2337/dc16-0650","diger_kaynak":"ClinicalTrials.gov NCT01217112 (results in the registry)"},{"ad":"Ewell 2026","tasarim":"Double-blind, placebo-controlled pilot RCT","n":"16","populasyon":"Overweight/obese, without diabetes","urun":"Pure CBD","urun_turu":"saf_cbd","doz":"30 mg × 2/day","titrasyon":null,"sure":"4 weeks","sonuc":"Did not affect glucose tolerance","yan_etki":"Not reported (in the abstract)","pmid":"41167732","doi":"10.1177/25785125251391085","diger_kaynak":"ClinicalTrials.gov NCT05285449 (no registry number in the publication's abstract; investigator, institution, dose, duration and title match this record; the registry enrolled 30 people, the publication has 16)"},{"ad":"Johnson 2026","tasarim":"Double-blind, crossover RCT","n":"15","populasyon":"Healthy","urun":"CBD isolate","urun_turu":"saf_cbd","doz":"298 mg single dose","titrasyon":null,"sure":"Single dose","sonuc":"No difference in postprandial glucose or fat metabolism; 193 kcal more eaten at lunch","yan_etki":"Not reported (in the abstract)","pmid":"41825697","doi":"10.1016/j.appet.2026.108531","diger_kaynak":"ClinicalTrials.gov NCT05618756 (no registry number in the publication's abstract; institution, dose, design, number of participants and primary outcomes match this record)"},{"ad":"Afshar 2022","tasarim":"Double-blind, placebo-controlled RCT (phase 1 according to the authors)","n":"50 randomized (25/25); 46 analyzed (24/22, completers only)","populasyon":"Type 2 diabetes (HbA1c ≤ 9%), added to existing treatment (Iran)","urun":"Under-the-tongue spray, CBD:THC 10:1 (100 µg CBD + 10 µg THC per spray; CBDEX10, Yas Daru)","urun_turu":"thc_iceren","doz":"2 sprays twice a day; according to the methods section, a total of about 0.4 mg CBD + 0.04 mg THC a day (the results section says '200 mg/20 mg')","titrasyon":null,"sure":"8 weeks","sonuc":"According to the publication, at week 8 total cholesterol (−19.7 mg/dL), triglycerides (−27.8 mg/dL), LDL (−5.4 mg/dL), fasting blood sugar (−12 mg/dL), HbA1c and insulin fell significantly compared with placebo (p < 0.05). However, the numbers in the publication are inconsistent in many places: according to the table, HbA1c fell from 7.94% to 7.8% in the spray group (about 0.14 points) and from 7.41% to 7.35% in the placebo group, but the same table gives these changes as −8.5% and +1.3%; in the spray group LDL is 98.5 mg/dL both at baseline and at week 8, yet a 4.7% drop is written; the abstract gives the HbA1c difference in 'mg/dL' units; the dose is in micrograms in the methods and milligrams in the results; the number of people analyzed differs between tables (46 and 42). Only completers were analyzed, and the result has not been confirmed in another study. Because of these inconsistencies, the result cannot be considered reliable","yan_etki":"No serious side effects reported; 1 person in the spray group was withdrawn from the study because of dizziness","pmid":"36945340","doi":"10.5812/ijpr-132647","diger_kaynak":"Iranian Registry of Clinical Trials IRCT20121021011192N10"},{"ad":"NCT01284634 (manufacturer's fatty liver study, registry results)","tasarim":"Randomized, placebo-controlled, dose-ranging pilot study (phase 2; partially blinded according to the registry title)","n":"25 randomized (CBD 200 mg: 7, 400 mg: 6, 800 mg: 7, placebo: 5); 21 completed","populasyon":"Adults with fatty liver disease (liver fat measured by MRI)","urun":"Purified plant-derived CBD capsule (GWP42003, GW Research)","urun_turu":"saf_cbd","doz":"A total of 200, 400 or 800 mg a day (in 100 mg capsules, twice a day)","titrasyon":null,"sure":"8 weeks","sonuc":"For the primary outcome, liver fat (liver triglyceride by MRI, percent change from baseline), none of the three doses differed significantly from placebo: differences vs placebo −6.9 (95% CI −16.4 to 2.6; p = 0.22), −9.4 (−19.7 to 1.0; p = 0.13) and −6.5 (−17.2 to 4.1; p = 0.30). For blood lipids, the registry has only mean changes, with no statistical comparison. No peer-reviewed publication; a very small study","yan_etki":"No serious side effects; the most common was diarrhea (12 of 20 people in the CBD groups, none of 5 on placebo); stopping due to side effects 3 of 20 on CBD, 1 of 5 on placebo","pmid":null,"doi":null,"diger_kaynak":"ClinicalTrials.gov NCT01284634 (results in the registry; no publication found in PubMed in October 2026)"},{"ad":"Smith 2025","tasarim":"Randomized (2:1:1), double-blind, placebo-controlled parallel study","n":"56 applied; 52 assigned to groups; 44 completed and were analyzed (low dose 24, high dose 10, placebo 10)","populasyon":"Adults with obesity (BMI ≥ 30) without diabetes; mean age 52 (US)","urun":"An oral adhesive strip containing THCV and CBD isolate (THCV is another cannabinoid found in cannabis; no THC was detected in independent testing)","urun_turu":"cbn_diger","doz":"Once a day: 8 mg THCV + 10 mg CBD (1 strip) or 16 mg THCV + 20 mg CBD (2 strips)","titrasyon":null,"sure":"90 days","sonuc":"According to the publication, over 90 days weight fell by 2.6 kg at the low dose, 4.1 kg at the high dose and 0.1 kg with placebo (comparison with placebo p = 0.025 and 0.003); LDL fell more than with placebo at the high dose (p = 0.024); no difference in fasting blood sugar, HbA1c changes 0–0.1 points. Only completers were analyzed, a one-sided test was used, and the high-dose and placebo groups had 10 people each; some numbers in the publication are inconsistent (in the low-dose group, LDL in the table rises from 101.5 to 103.0 mg/dL while a 7.4 mg/dL drop is written). Single author; the author's affiliation is a company, the study was self-funded and no conflict of interest was declared; not confirmed in another study","yan_etki":"No serious side effects reported; the most common was finding the taste unpleasant (38–40%); in the active groups, mild ALT elevation in 2 people and mild AST elevation in 1 (ALT also in 1 person on placebo). Of the 9 people in the high-dose group who took a urine THC test, 7 tested positive (rapid home test; no test was done before the study)","pmid":"39968488","doi":"10.26828/cannabis/2024/000206","diger_kaynak":"ClinicalTrials.gov NCT05574049 (no results in the registry)"},{"ad":"Lopez 2020","tasarim":"Double-blind, placebo-controlled RCT","n":"65","populasyon":"Overweight (mean BMI 28.5) but otherwise healthy adults","urun":"Commercial hemp extract oil (PlusCBD Extra Strength; 60 mg extract a day, 15 mg hemp-derived CBD)","urun_turu":"cbd_zengin_thc_belirsiz","doz":"60 mg extract a day (15 mg CBD)","titrasyon":null,"sure":"6 weeks","sonuc":"The study's main focus was stress resilience and well-being; there was no significant difference from placebo in these. Of the metabolic values, only HDL (\"good cholesterol\") rose significantly in the hemp group (group × time p = 0.004); no significant between-group differences were reported in body composition or other blood lipids","yan_etki":"Well tolerated; liver, kidney and blood values stayed within normal limits (in the abstract)","pmid":"32456572","doi":"10.1080/19390211.2020.1765941","diger_kaynak":"ClinicalTrials.gov NCT04294706"},{"ad":"Matheson 2025","tasarim":"Double-blind, placebo-controlled, 3-group pilot RCT; stopped early","n":"18 randomized; 15 took at least one dose; 8 completed (low dose 4, placebo 4, high dose 0)","populasyon":"Adults aged 25–45 with obesity but otherwise healthy; no cannabinoid use in the past 6 months (Canada)","urun":"Nabilone (THC-like synthetic cannabinoid, oral capsule)","urun_turu":"cbn_diger","doz":"2 mg (low dose) or 6 mg (high dose) a day","titrasyon":"Dose increased gradually (registry: titrated to 2 mg or 6 mg); schedule not in the abstract","sure":"12 weeks","sonuc":"The study was stopped early because the drug was poorly tolerated (reason in the registry: poor tolerability and no preliminary efficacy seen). In an analysis of only the 8 completers, the publication reported a significant reduction in weight and BMI at the low dose compared with placebo (p < 0.001); with groups of 4 people each, this result is not reliable. Blood sugar and insulin were secondary outcomes; the registry has no statistical comparison","yan_etki":"All 4 people on the high dose stopped because of side effects; drowsiness (low dose 3 of 5, high dose 4 of 4, placebo 0 of 6), dizziness (3 of 5, 3 of 4, 0 of 6) and feeling intoxicated (1 of 5, 3 of 4, 0 of 6) were common; dry mouth was also common in the placebo group (3 of 6); no serious side effects","pmid":"40353878","doi":"10.1089/can.2025.0034","diger_kaynak":"ClinicalTrials.gov NCT04801641 (results in the registry, April 9, 2026)"},{"ad":"Reichenbach 2015","tasarim":"Double-blind, placebo-controlled pilot RCT","n":"13 completed (dronabinol 7, placebo 6)","populasyon":"Adults with non-cardiac chest pain (esophageal hypersensitivity) without heart disease or serious comorbidities; this publication looks at metabolic values","urun":"Dronabinol (synthetic THC, by mouth)","urun_turu":"thc_iceren","doz":"5 mg twice a day","titrasyon":null,"sure":"28 days","sonuc":"There was no significant change in either group after 4 weeks in BMI, HDL, triglycerides, LDL, fasting blood sugar, insulin, leptin, liver enzymes or CRP; a very small study","yan_etki":"Not reported (in the abstract)","pmid":"26283236","doi":"10.1016/j.clinthera.2015.07.023","diger_kaynak":"ClinicalTrials.gov NCT01598207"},{"ad":"Chia 2026","tasarim":"Randomized, double-blind, placebo-controlled, 4-period crossover physiology study","n":"34 randomized; 21 completed all four visits","populasyon":"Healthy, non-obese men with normal glucose tolerance (ages 21–55, US)","urun":"Nabilone (THC-like synthetic cannabinoid); for comparison, the experimental CB1 receptor-blocking drug CP-945,598","urun_turu":"cbn_diger","doz":"Nabilone 2 mg single dose; CP-945,598 15 or 45 mg","titrasyon":null,"sure":"Single dose (at each visit; visits at least 6 weeks apart)","sonuc":"In glucose and insulin clamp measurements, insulin secretion did not differ from placebo with any drug. Nabilone increased insulin sensitivity (glucose use) compared with placebo in the last 20 minutes of the euglycemic clamp (p = 0.039); the CB1 blocker decreased it at the high dose. A single-dose mechanistic study; it does not show a treatment effect in patients","yan_etki":"Not reported (no side effect data found in the full text)","pmid":"41869774","doi":"10.1152/ajpendo.00391.2025","diger_kaynak":"ClinicalTrials.gov NCT01517100 (no results in the registry)"},{"ad":"Abbotts 2022","tasarim":"Randomized, placebo-controlled crossover study (two visits with a meal test; per the registry, only outcome assessors were blinded)","n":"14 men","populasyon":"Overweight or obese (BMI ≥ 25) adult men with no known metabolic disease (US)","urun":"Pure CBD (water-soluble powder formulation; CBD from the company funding the study)","urun_turu":"saf_cbd","doz":"30 mg single dose (with a meal)","titrasyon":null,"sure":"Single dose (at each visit)","sonuc":"In the meal test, CBD did not affect the blood sugar response differently from placebo (p = 0.31); insulin was lower at minutes 10 and 20 after the meal (p = 0.013), and triglycerides at minute 30 (p = 0.010); the meal-induced increase in energy expenditure did not change. The study's main aim was to compare how well different CBD products are absorbed; a small, single-dose study. Funded by the company that supplied the CBD (according to the authors, it had no role in design or analysis)","yan_etki":"Side effects not reported separately; liver and kidney values stayed within normal limits","pmid":"35631293","doi":"10.3390/nu14102152","diger_kaynak":"ClinicalTrials.gov NCT04971837"},{"ad":"Ewell 2021","tasarim":"Randomized-order crossover study with a cannabis-free control product (blinding not reported; participants bought and used the products themselves)","n":"7","populasyon":"Adults who use cannabis regularly (US)","urun":"5 commercially sold edible cannabis products (each 10 mg THC) and a cannabis-free control product","urun_turu":"thc_iceren","doz":"10 mg THC single dose","titrasyon":null,"sure":"Single dose (6 separate mornings, at least 1 week apart)","sonuc":"In a glucose tolerance test done 30 minutes after taking the product, insulin sensitivity (Matsuda index) did not differ from the control condition (p > 0.395); blood sugar and insulin (measured for two products) did not differ either. The study's main aim was to compare how the products are absorbed in the body; a 7-person study without blinding. Funded by the maker of some of the products tested","yan_etki":"Not reported (in the abstract)","pmid":"34451914","doi":"10.3390/ph14080817","diger_kaynak":null},{"ad":"Bryan 2026 (single-use study)","tasarim":"Quasi-randomized (with the right to refuse the assigned product), placebo-free experimental study comparing three products; before-and-after measurement","n":"108 started (34 CBD-dominant, 28 THC-dominant, 46 THC + CBD); per the registry, 98 completed follow-up","populasyon":"Healthy young adults without diabetes who had not used cannabis in the past 3 months (but had tried it at least once), of varying body weights (US; ages 21–40 in the methods, 25–45 in the abstract, mean 29.7)","urun":"Cannabis flower from the legal market: CBD-dominant, THC-dominant or containing THC + CBD (smoked or vaporized at home)","urun_turu":"karma","doz":"Amount chosen by each person; blood levels were measured","titrasyon":null,"sure":"Single use","sonuc":"Insulin sensitivity (Matsuda index) after use did not differ from baseline; inflammatory markers rose as blood THC levels rose. According to the table in the registry, mean blood sugar in the glucose tolerance test was 8–13 mg/dL higher after use in all three groups (there are no statistics for this change in the registry or the publication). There was no placebo group and no true randomization (a limitation noted by the authors)","yan_etki":"Not reported (in this publication)","pmid":"42463843","doi":"10.1038/s41598-026-62837-0","diger_kaynak":"ClinicalTrials.gov NCT04114903 'Study A' (results in the registry, August 6, 2026); methods publication Skrzynski 2026, PMID 41820717"},{"ad":"Bryan 2025 (4-week use study)","tasarim":"Controlled, non-randomized comparison: users were quasi-randomly assigned to one of three products and compared with non-users; no placebo","n":"125 started: 97 cannabis users (9 CBD-dominant, 47 THC-dominant, 41 THC + CBD) and 28 non-users; 116 completed","populasyon":"Healthy adults aged 21–40 without diabetes who had used cannabis at least once a week for at least a year or had not used it at all in the past year (US)","urun":"Cannabis flower from the legal market: THC-dominant (23% THC, 0% CBD), THC + CBD (10% THC, 8% CBD) or CBD-dominant (20% CBD, 1% THC)","urun_turu":"karma","doz":"Amount chosen by each person, 4 weeks","titrasyon":null,"sure":"4 weeks","sonuc":"After 4 weeks, the THC:CBD ratio of the products did not change insulin sensitivity (Matsuda index) compared with non-users; inflammatory markers were lower in users than in non-users. Because cannabis use was not randomly assigned, cause and effect cannot be established","yan_etki":"Not reported (in the abstract)","pmid":"40324550","doi":"10.1016/j.amjmed.2025.05.002","diger_kaynak":"ClinicalTrials.gov NCT04114903 'Study B' (results in the registry, August 6, 2026)"},{"ad":"Pinto and Martel 2022 (systematic review)","tasarim":"Systematic review (no meta-analysis)","n":"11 RCTs","populasyon":"Placebo-controlled RCTs of CBD reporting appetite or weight (mostly as a side effect); most were epilepsy studies","urun":"CBD (mostly pharmaceutical-grade pure CBD; in one study a CBD-dominant cannabis extract, in one CBD-rich inhaled cannabis)","urun_turu":"karma","doz":"Between 5 mg/kg and 1,500 mg a day","titrasyon":null,"sure":"Search up to July 31, 2022","sonuc":"In the abstract, the authors conclude that CBD reduces appetite and that this is associated with weight loss; however, according to the discussion section, only three studies measured weight (one of them a type 2 diabetes study), and none of the three found a weight difference compared with placebo. In seven studies, decreased appetite was more common in people taking CBD (as a dose-related side effect in the epilepsy studies); in one study appetite increased. Most studies had a risk of bias at the 'some concerns' level; no meta-analysis was done","yan_etki":null,"pmid":"36180814","doi":"10.1007/s40261-022-01205-y","diger_kaynak":null},{"ad":"Spanagel and Bilbao 2021 (meta-analysis)","tasarim":"Comparative systematic review and meta-analysis (RCTs only; registered in PROSPERO; Cochrane risk-of-bias tool and GRADE)","n":"For appetite, 15 RCTs, 1,974 people (for sleep, 17 RCTs, 1,479 people); how many studies went into the CBD analysis is not in the abstract","populasyon":"People with physical or mental illness; unwanted effects of approved cannabinoids on sleep and appetite","urun":"Approved cannabinoids: dronabinol, nabilone and CBD","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"Decreased appetite was more common with CBD than with placebo (OR 2.46; 95% CI 1.74–4.01; moderate certainty); THC given as a medicine (dronabinol, nabilone) did not decrease appetite, and neither had a negative effect on sleep. According to the authors, the side effect of decreased appetite with approved cannabinoids appears to come from CBD. It examines appetite, not body weight; it does not answer the question of treatment for weight loss. Fixed-effect model; because the full text could not be read, the studies and conditions included in the CBD analysis could not be confirmed","yan_etki":null,"pmid":"34181977","doi":"10.1016/j.neuropharm.2021.108680","diger_kaynak":"PROSPERO CRD42021229932. Full text could not be read (paywalled; subscription required on Europe PMC); row based on the PubMed abstract. The same study also appears in the non-cancer appetite loss table"},{"ad":"Porr 2020 (rapid review)","tasarim":"Rapid systematic review (for Diabetes Canada)","n":"6 observational studies (2 full articles, 4 conference abstracts)","populasyon":"People aged 13 and over with type 1 or type 2 diabetes","urun":"Recreational cannabis use","urun_turu":"thc_iceren","doz":"Not applicable","titrasyon":null,"sure":"Search January 2008–January 2019","sonuc":"In type 1 diabetes, five studies reported higher HbA1c in cannabis users; in one study, use in the past 12 months was associated with about twice the risk of diabetic ketoacidosis (OR 1.98; 95% CI 1.01–3.91). In type 2 diabetes, increases in vascular blockage, heart attack and kidney problems were reported. The methodological quality of the studies was weak or moderate","yan_etki":null,"pmid":"32807222","doi":"10.1186/s13643-020-01411-9","diger_kaynak":"PROSPERO CRD42019122829"},{"ad":"Ravi 2018 (systematic review)","tasarim":"Systematic review (observational studies; strength of evidence graded)","n":"13 studies for risk factors (11 for outcomes)","populasyon":"Adults who use marijuana in any form","urun":"Marijuana use","urun_turu":"thc_iceren","doz":"Not applicable","titrasyon":null,"sure":"Search 1975–September 2017","sonuc":"All 6 studies suggesting a metabolic benefit were cross-sectional and were not supported by prospective studies; the evidence on marijuana's effect on diabetes and blood lipids was found to be insufficient","yan_etki":null,"pmid":"29357394","doi":"10.7326/M17-1548","diger_kaynak":"PROSPERO CRD42016051297"},{"ad":"Mousavi 2023 (meta-analysis)","tasarim":"Systematic review and meta-analysis (observational studies)","n":"7 publications (11 cross-sectional surveys, 4 cohorts)","populasyon":"General population","urun":"Cannabis use","urun_turu":"thc_iceren","doz":"Not applicable","titrasyon":null,"sure":"Search up to July 1, 2022","sonuc":"The odds of type 2 diabetes were lower in cannabis users (OR 0.48; 95% CI 0.39–0.59); however, heterogeneity between studies was very high and most of the data come from cross-sectional surveys: in a cross-sectional design it cannot be known which came first, and cause and effect is not shown","yan_etki":null,"pmid":"37526051","doi":"10.1002/ptr.7973","diger_kaynak":null},{"ad":"Quinapanta Castro 2025 (meta-analysis)","tasarim":"Systematic review and meta-analysis (observational studies)","n":"11 studies, about 6 million people","populasyon":"Adults; fatty liver (MASLD/NAFLD) identified by different methods","urun":"Cannabis use","urun_turu":"thc_iceren","doz":"Not applicable","titrasyon":null,"sure":"Search up to January 2025","sonuc":"The odds of fatty liver were lower in cannabis users (OR 0.58; 95% CI 0.42–0.81), but heterogeneity between studies was very high (I² 97%) and no significant association was seen in frequent users. There was no difference in directly measured liver fat (two studies), liver enzymes or triglycerides. Most studies were cross-sectional with a high risk of bias; cause and effect cannot be established","yan_etki":null,"pmid":"41141207","doi":"10.7759/cureus.93183","diger_kaynak":"PROSPERO CRD42025025065"},{"ad":"Bancks 2015 (CARDIA)","tasarim":"Prospective cohort (18-year follow-up) and cross-sectional analysis","n":"3,151 people (follow-up analysis); 3,034 people (year-25 cross-sectional analysis)","populasyon":"US community sample followed from young adulthood to middle age (no diabetes or prediabetes at the start of follow-up)","urun":"Marijuana use (self-reported)","urun_turu":"thc_iceren","doz":"Not applicable","titrasyon":null,"sure":"18 years","sonuc":"People who had used marijuana 100 or more times in their lifetime had a higher risk of prediabetes (HR 1.39; 95% CI 1.13–1.71); no association with diabetes was found. In the cross-sectional analysis at year 25, current users also had higher odds of prediabetes (OR 1.65; 1.15–2.38)","yan_etki":null,"pmid":"26364621","doi":"10.1007/s00125-015-3740-3","diger_kaynak":null},{"ad":"Danielsson 2016","tasarim":"Population-based prospective cohort (Sweden)","n":"17,967 people; 608 new cases of type 2 diabetes","populasyon":"Swedish women and men aged 18–84","urun":"Cannabis use (questionnaire)","urun_turu":"thc_iceren","doz":"Not applicable","titrasyon":null,"sure":"About 9 years (2002–2011)","sonuc":"In the crude analysis, the risk of type 2 diabetes appeared lower in cannabis users (OR 0.68; 95% CI 0.47–0.99), but the association disappeared once age was taken into account (OR 0.94; 0.63–1.39)","yan_etki":null,"pmid":"27843955","doi":"10.1155/2016/6278709","diger_kaynak":null},{"ad":"Zhou 2026 (UK Biobank)","tasarim":"Prospective cohort (UK Biobank)","n":"91,002 people (without metabolic disease at baseline)","populasyon":"UK general population sample (UK Biobank participants)","urun":"Cannabis use (self-reported)","urun_turu":"thc_iceren","doz":"Not applicable","titrasyon":null,"sure":"Follow-up duration not in the abstract","sonuc":"After accounting for other factors, the risk of type 2 diabetes was slightly lower in cannabis users (aHR 0.82; 95% CI 0.69–0.99); the risk of obesity was lower in frequent users (aHR 0.57; 0.41–0.78); there was no association with high cholesterol or fatty liver. The association varied by body weight: the inverse association was seen mostly in people of normal weight; in people with obesity (BMI > 30), moderate use was associated with a higher risk of metabolic disease (aHR 1.26) and high blood pressure (aHR 1.40). Observational study; does not show cause and effect","yan_etki":null,"pmid":"42115075","doi":"10.1016/j.numecd.2026.104762","diger_kaynak":null},{"ad":"Baumeister 2021 (Mendelian randomization)","tasarim":"Two-sample Mendelian randomization (an analysis that uses genetic predisposition as a natural experiment)","n":"Genome studies: cannabis use 184,765 people; type 2 diabetes 74,124 cases, 824,006 controls","populasyon":"Summary data from large genome studies","urun":"Genetic predisposition to cannabis use","urun_turu":"thc_iceren","doz":"Not applicable","titrasyon":null,"sure":"Not applicable","sonuc":"Genetic predisposition to lifetime cannabis use (OR 1.00; 95% CI 0.93–1.09) and to cannabis use disorder (OR 1.03; 0.99–1.08) did not change the risk of type 2 diabetes; according to the authors, cannabis use does not play a causal role in type 2 diabetes","yan_etki":null,"pmid":"33580533","doi":"10.1111/adb.13020","diger_kaynak":null},{"ad":"Alshaarawy 2019 (NESARC)","tasarim":"Nationally representative prospective study (US)","n":"About 33,000 people","populasyon":"US population aged 18 and over","urun":"Cannabis use (reported in interview)","urun_turu":"thc_iceren","doz":"Not applicable","titrasyon":null,"sure":"3 years (2001–02 → 2004–05)","sonuc":"Over three years, BMI rose in all groups; in cannabis users (those who quit, new users and persistent users), the increase was slightly smaller than in never-users (persistent users β = −1.26; 95% CI −1.81 to −0.72). Height and weight self-reported; cause and effect cannot be established","yan_etki":null,"pmid":"30879064","doi":"10.1093/ije/dyz044","diger_kaynak":null},{"ad":"Alayash 2021 (Mendelian randomization)","tasarim":"Two-sample Mendelian randomization","n":"Cannabis use genome study 184,765 people; BMI up to 322,154 people; waist circumference and waist-to-hip ratio 210,088 people","populasyon":"Genome study participants of European ancestry","urun":"Genetic predisposition to cannabis use","urun_turu":"thc_iceren","doz":"Not applicable","titrasyon":null,"sure":"Not applicable","sonuc":"Genetic predisposition to lifetime cannabis use was not associated with BMI (β −0.018; 95% CI −0.05 to 0.015); a causal relationship was not supported for waist circumference or waist-to-hip ratio either","yan_etki":null,"pmid":"34304124","doi":"10.1016/j.drugalcdep.2021.108863","diger_kaynak":null},{"ad":"Wang 2020 (Mendelian randomization)","tasarim":"Two-sample Mendelian randomization","n":"Cannabis use genome study 184,765 people; fatty liver in UK Biobank 1,122 cases, 399,900 controls","populasyon":"Genome study participants of European ancestry","urun":"Genetic predisposition to cannabis use","urun_turu":"thc_iceren","doz":"Not applicable","titrasyon":null,"sure":"Not applicable","sonuc":"Genetic predisposition to lifetime cannabis use, cannabis dependence or cannabis use disorder did not significantly change the risk of fatty liver (NAFLD) (p > 0.05 in all tests). Only 1,122 people had a fatty liver diagnosis; the authors also note that the study may have been underpowered, so the result cannot be read as \"no effect\"","yan_etki":null,"pmid":"32922442","doi":"10.3389/fgene.2020.00949","diger_kaynak":null},{"ad":"Kinney 2020 (T1D Exchange)","tasarim":"Cross-sectional analysis of patient registry data","n":"932 adults with type 1 diabetes (61 of them moderate cannabis users)","populasyon":"Adults with type 1 diabetes (US, T1D Exchange registry)","urun":"Cannabis use (self-reported on a substance use scale)","urun_turu":"thc_iceren","doz":"Not applicable","titrasyon":null,"sure":"Past 12 months (retrospective)","sonuc":"After accounting for sex, age and HbA1c, cannabis use was associated with about 2.5 times the odds of having diabetic ketoacidosis in the past 12 months (OR 2.5; 95% CI 1.0–5.9). The confidence interval is wide; the association does not show cause and effect","yan_etki":null,"pmid":"31628116","doi":"10.2337/dc19-0365","diger_kaynak":null},{"ad":"Roberts 2025 (SEARCH)","tasarim":"Cross-sectional analysis at the SEARCH 4 follow-up visit of a multicenter cohort (SEARCH for Diabetes in Youth, US; visits 2016–2019)","n":"2,465 people (type 1 diabetes 2,108, type 2 diabetes 357)","populasyon":"Adolescents and young adults aged 10–36 diagnosed with type 1 or type 2 diabetes in childhood or adolescence (US); in those with type 1 diabetes, mean age 21, diabetes duration 11 years, HbA1c 9.1%","urun":"Cannabis (marijuana) use, self-reported","urun_turu":"thc_iceren","doz":"Not applicable","titrasyon":null,"sure":"Cannabis use lifetime and past 30 days; outcomes over the past 12 months (self-reported)","sonuc":"Of those with type 1 diabetes, 19.5% currently used cannabis and 19.0% had used it in the past (22.1% and 21.8% in type 2 diabetes). In type 1 diabetes, after accounting for race, income, parental education, age and sex, the odds of having diabetic ketoacidosis in the past 12 months were about twice as high in current users (aOR 2.01; 95% CI 1.49–2.70) and also higher in past users (aOR 1.72; 1.25–2.36); HbA1c was 0.61 points (95% CI 0.32–0.90) higher in current users. Hospitalization was significantly higher only in past users (aOR 1.46; 1.03–2.07; in current users 1.39; 0.99–1.95); there was no association with severe hypoglycemia. 17.3% of current users with type 1 diabetes said cannabis made it harder to remember diabetes care \"sometimes or on most days.\" In type 2 diabetes, the number of people was too small to build a model; no association with HbA1c was seen. Cannabis use and outcomes are self-reported; a cross-sectional analysis does not show cause and effect (according to the authors, mental health problems such as depression may mediate part of the association)","yan_etki":null,"pmid":"39959518","doi":"10.2337/ds24-0019","diger_kaynak":"PMC11825399 (read from the PMC article page; the Europe PMC full-text service and NCBI efetch did not return the article body). SEARCH 4: supported by NIH (NIDDK) and the US Centers for Disease Control; the authors reported no relevant conflicts of interest"}],"ilgili_ilaclar":["diyabet_ilaci"],"son_inceleme":"2026-10-28","arastirma_gecmisi":[{"tarih":"2026-10-19","not":"Page published. This first review looked at 3 studies."},{"tarih":"2026-10-21","not":"The year of a publication named on the page was corrected to the journal's print year instead of the online publication year. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-22","not":"The names of the finding labels were simplified: the \"No benefit seen\" label on this page became \"No effect found\". The assessment did not change."},{"tarih":"2026-10-27","not":"In October 2026, PubMed, Cochrane and ClinicalTrials.gov were searched systematically; 24 studies were added: 11 controlled studies (9 randomized; registry results of the manufacturer's unpublished CBD study in fatty liver, a spray containing CBD and THC in type 2 diabetes, a strip containing THCV and CBD and nabilone in obesity, CBD and CBD-rich cannabis extract in overweight people, and controlled studies of THC, nabilone and marijuana on blood sugar and insulin), 5 systematic reviews and 8 observational studies (cannabis use and type 2 diabetes, body weight, fatty liver, and ketoacidosis in type 1 diabetes). Group numbers and the primary outcome from the registry results were added to the type 2 diabetes study's row; the topic text was updated for the new studies; the conclusion and strength of evidence for THC-containing products were written for the first time ('Insufficient'). The conclusion and the strength of evidence for CBD did not change."},{"tarih":"2026-10-28","not":"Display fix: internal working file names left in the text were removed; content and evidence did not change."},{"tarih":"2026-10-28","not":"Display fix: internal working notes left over from the previous cleanup were removed; content and evidence did not change."},{"tarih":"2026-10-28","not":"October 2026 additional review: sources found for this page during the searches for other topics were read and added to the page. A US cohort examining cannabis use in adolescents and young adults with type 1 and type 2 diabetes (SEARCH; its full text could not be accessed in the first search) and a meta-analysis combining the effect of approved cannabinoids on appetite were added to the table. The weight-loss figures from the US prescribing information for the approved CBD medicine, a note that diabetic gastroparesis and cannabinoid hyperemesis syndrome can be confused, and the fact that there is no treatment study with a cannabis product in diabetic retinopathy were written into the text; the FAQ answer about weight was corrected based on these figures. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-30","not":"The last sentence of the page's short summary was rewritten in a calmer, more guiding tone: instead of \"Talk to your doctor before you start.\", it now says whom you can talk with, and about what, if you are considering CBD. The conclusion and the strength of evidence did not change."}]},{"id":"blood-pressure","baslik":"High blood pressure and cardiovascular health","grup":"Other","grup_kodu":"diger","tr_id":"tansiyon-kalp-damar","kanit_duzeyi":"zayif","kanit_yonu":"olasi_kucuk_yarar","kanit_ozet":"In small RCTs, pure CBD lowered blood pressure by a few mmHg (about 5 mmHg in 24-hour systolic pressure); increasing the dose gave no additional benefit. In healthy men, the drop after the first dose disappeared within 7 days (tolerance), and a single dose raised heart rate. The results of the other small RCTs in healthy volunteers are mixed: in 17 people who did not use cannabis, a single dose of 200–800 mg CBD lowered blood pressure slightly; in four studies that gave 100 mg a day for 12 weeks, a single 100 mg dose by mouth or vaporized, a single 300 mg dose, and a single 200–800 mg dose in people who regularly smoke marijuana, blood pressure and heart rate did not change differently from placebo. A 2026 systematic review of four RCTs that measured blood pressure says the drop was seen at higher doses and especially under stress or during sleep, and that the studies were small and short. The two RCTs in patients with high blood pressure came from the same research group; both used a patented CBD formulation designed for better absorption, and both were funded by the company that owns the formulation. In the abstract of the 70-person study, it is not clear whether the 4.76 mmHg drop was compared with placebo or with baseline. The effect is small and short-lived; there are no data showing an effect on heart events (stroke, heart attack). This is not evidence of a treatment. In heart inflammation, pharmaceutical-grade CBD (up to 20 mg/kg/day) was tested in two phase 2 studies: in acute myocarditis (109 people, 12 weeks), the primary MRI measurements were no different from placebo; in recurrent pericarditis (27 people, uncontrolled), pain and CRP decreased. Both studies were funded by the drug's manufacturer; in the myocarditis study, the registered primary outcome, extracellular volume percentage, also showed no difference. A placebo-controlled phase 3 study in recurrent pericarditis is ongoing (NCT06708299, October 2026). The same medicine was also compared with placebo in 90 people hospitalized with COVID-19 who had cardiovascular disease or risk factors; the study was stopped early because not enough patients could be enrolled, and it was not published in a peer-reviewed journal. According to the registry results, the combined outcome of death, intensive care or breathing support, and cardiovascular complications occurred in 3 of 45 people in the CBD group and in 2 of 45 in the placebo group (the difference was not significant; the study was not large enough to show a difference). Serious side effects occurred in 5 people in the CBD group and 4 in the placebo group; among those in the CBD group there was one case each of heart failure and QTc prolongation, and 2 people in the placebo group died (the groups were not compared statistically for side effects; the numbers are small). These are not approved uses. No study has aimed to treat blood pressure or heart disease with THC-containing products. In controlled studies, THC raised heart rate (by an average of 8 beats/min in a pooled analysis) and could cause a drop in blood pressure on standing up (relative risk 3.16 in RCTs of medical cannabinoids); in a 1975 study of 10 patients with angina that did not use a placebo, it brought on chest pain earlier during exercise. In a few small studies of patients with high blood pressure, blood pressure fell or did not change after THC products; these are very small studies or studies without a comparison group. In meta-analyses of observational studies, cannabis use was linked to acute coronary syndrome (relative risk 1.29), stroke (1.20; 1.37 in another meta-analysis) and atrial rhythm disorders (odds ratio 1.71); in a meta-analysis based on cohorts with long follow-up, the link was not significant for heart attack and stroke individually, and in some cohorts with long follow-up (CARDIA, Swedish conscripts, veterans with heart disease, UK Biobank), no link was found. These studies do not show cause and effect. Similar links are seen in people who use medical cannabis: in Denmark, among chronic pain patients starting medical cannabis by prescription, new heart rhythm problems in the first 6 months (0.8% vs. 0.4%), and in Canada, among people authorized to use medical cannabis, emergency visits or admissions for heart attack-like events or stroke (hazard ratio 1.44) were more common. October 2026 search (PubMed, Cochrane, ClinicalTrials.gov): 19 controlled studies with cannabinoids on this topic (11 with CBD, one of which used a product with an unclear THC content; 8 with THC-containing products) and 9 systematic reviews were found; these appear in the table below, together with 2 uncontrolled studies and 10 observational studies. There is no Cochrane review on this topic; the many older laboratory studies measuring THC's effect on heart rate and the blood pressure data measured in CBD anxiety laboratory studies are included not one by one but through the meta-analyses that combine them.","kanit_duzeyi_metin":"Weak (2 small RCTs with pure CBD in high blood pressure, 16 and 70 people, at most 5 weeks, both from the same research group and with the same company's formulation; 7 small RCTs with CBD in healthy volunteers, with mixed results; 1 phase 2 RCT in heart muscle inflammation, with a negative main result; 1 phase 2/3 RCT in patients hospitalized with COVID-19 who had cardiovascular risk, stopped early and with results only in the registry, with no difference in the main outcome)","kanit_duzeyi_thc_icerenler":"yetersiz","kanit_duzeyi_thc_icerenler_metin":"Insufficient: there are no treatment studies of THC-containing products for blood pressure or heart disease. Information pointing to harm comes from controlled laboratory studies (raised heart rate, a drop in blood pressure on standing) and large observational studies; observational findings are associations and do not show cause and effect","kaynak_dosya":"diger-hastaliklar.md","saf_cbd_sonuc":"Pure CBD may lower blood pressure by a few mmHg: there are 2 small RCTs in high blood pressure (16 and 70 people, at most 5 weeks; both from the same research group, using the same company's patented formulation). In healthy people, results are mixed: in some studies blood pressure fell slightly (in one, the effect disappeared within a week), and in others it did not change at all. In heart muscle inflammation, a 109-person phase 2 RCT found the main MRI measurements no different from placebo. This is not evidence of a treatment; for people taking blood pressure medicine, it is a drug interaction issue.","thc_icerenler_sonuc":"No study has aimed to treat high blood pressure or heart disease with THC-containing products; the information we have is about safety. In controlled studies, THC raised heart rate (by an average of 8 beats/min in a pooled analysis) and, in some people, caused a drop in blood pressure on standing up and dizziness. In a few small studies of patients with high blood pressure, blood pressure fell or did not change after THC products; because these studies were very small or had no comparison group, they do not count as evidence of a treatment. In a 1975 study of 10 patients with chest pain (angina) that did not use a placebo, one marijuana cigarette cut in half the time patients could exercise before the pain began. In most large observational studies, cannabis use was linked to heart attack, stroke and atrial rhythm problems (in a 2025 meta-analysis, relative risk 1.29 for heart attack and similar events and 1.20 for stroke); in two large cohorts there was no link with new high blood pressure, and in some studies with long follow-up there was no link with heart events. These are association studies; they do not show cause and effect, and most concern smoked cannabis.","ruhsat":null,"doz_araligi_ozet":"In the studies, 600 mg as a single dose, 600 mg/day (7 days), 450 mg/day (24 hours), 225–450 mg/day (5 weeks); in the heart inflammation studies, 5–20 mg/kg/day; in the other studies in healthy volunteers, a single dose of 100–800 mg and 100 mg/day (12 weeks)","titrasyon_ozet":"In Dujic 2024, an increase from 225–300 mg/day to 375–450 mg/day (no additional benefit)","yan_etkiler":["Increased heart rate after a single dose (Jadoon 2017)","With THC-containing products, increased heart rate and a drop in blood pressure on standing (Sultan 2018; Watanabe 2021: orthostatic hypotension RR 3.16)"],"izlem":["In people taking blood pressure medicine, monitoring of blood pressure and dizziness (with a doctor)","In people using THC-containing products, monitoring of pulse and dizziness on standing; with a doctor in people with heart disease"],"dikkat":["For someone who takes blood pressure medicine or has low blood pressure, CBD may carry a risk of dizziness and a drop in blood pressure; this is a drug interaction issue, and a doctor should be consulted","High doses and market doses cannot be compared: in low-dose (≤175 mg/day) studies, plasma levels were 5–100 times lower than with the 20 mg/kg Epidiolex dose (Warren 2026, PMID 42473010)","Anyone taking long-term medicines should consult a doctor before starting; the studies on this page did not systematically assess interactions","THC-containing products raise heart rate and can cause a drop in blood pressure on standing up (Sultan 2018, PMID 29385080; Watanabe 2021, PMID 33952424). This drop can resemble fainting: in a 1982 case report, within 10 minutes of smoking marijuana, the blood pressure of 3 glaucoma patients fell suddenly on standing, their pulse did not speed up, and the symptoms went away when they lay down (Merritt 1982, PMID 6283454). Marijuana shortened exercise time in angina (Aronow 1975, 10 patients, no placebo; PMID 1126112). Observational studies show a link with heart attack, stroke and atrial rhythm problems, but cause and effect has not been shown (Storck 2025, PMID 40527600; Chye 2026, PMID 40472951); extra care is needed in people with heart disease","People who use cannabis regularly and are thinking of stopping, especially those with high blood pressure: in a small study in which 13 people who used cannabis daily were monitored in hospital, blood pressure rose when they stopped cannabis; in 6 people, the average increase reached up to 22.8 mmHg in systolic and 12.3 mmHg in diastolic blood pressure, and the authors recommended monitoring blood pressure during the stopping period (Vandrey 2011, PMID 21359104). In 39 people who stopped heavy use, however, no significant change in blood pressure or pulse was seen (Bonnet 2016, PMID 26761126). Both studies are small, and their results differ."],"ilac_etkilesim_notlari":["The studies on this page did not systematically assess drug interactions; details are in the site's drug interactions section","Losartan: a CBD-dominant extract (which also contained 20 mg THC) increased losartan AUC by 77% (Bansal 2023, PMID 37313955)"],"dogrulanamayan":["The 1974 study comparing marijuana cigarettes with placebo cigarettes in patients with angina (Aronow 1974, NEJM) and the hemodynamic study in coronary disease (Prakash 1975) have no abstracts; their full texts could not be read. The angina row in the table is based on the abstract of the same group's 1975 study","Unpublished or ongoing studies (October 2026): a placebo-controlled phase 3 study of CBD in recurrent pericarditis (NCT06708299) is recruiting; an open-label phase 1 study of CBD in heart failure (NCT03634189, Mexico) has not been updated since 2020 and has no results; the phase 2/3 study with the same CBD medicine in 90 people hospitalized with COVID-19 who had cardiovascular disease or risk factors (NCT04615949), which was stopped early, has no peer-reviewed publication; its registry results are in the table; a blood pressure study with synthetic THC, NCT07231965, is not yet recruiting","A 2025 meta-analysis on CBD and blood pressure (Candeloro 2025, a journal published in Brazil) is cited in a 2026 review; it could not be found in PubMed or Europe PMC and could not be read","The full texts of Jadoon 2017, Sultan 2020, Dragun 2023, Dujic 2024, Haney 2016, Arout 2022, Sellers 2013, Mathew 2003, Laurentino 2026, Elias 2026, Crawford and Merritt 1979, Aronow 1975, Watanabe 2021, Storck 2025, Sebastian 2025, Chye 2026, Abuhasira 2021, Holt 2024, Mittleman 2001, Haleem 2021, Falkstedt 2017 and Teraoka 2024 are not open access or could not be read; these rows are based on abstracts, ClinicalTrials.gov records and other open-access publications of the same studies. For this reason, in the 70-person high blood pressure study (Dujic 2024), it could not be verified whether the 4.76 mmHg drop in blood pressure was compared with placebo or with baseline"],"calismalar":[{"ad":"Jadoon 2017","tasarim":"Double-blind, crossover RCT","n":"9","populasyon":"Healthy men","urun":"Pure CBD","urun_turu":"saf_cbd","doz":"600 mg single dose","titrasyon":null,"sure":"Single dose","sonuc":"Resting systolic pressure fell by about 6 mmHg; heart rate rose. In the handgrip and cold water stress tests, systolic blood pressure was also about 5–6 mmHg lower than with placebo. CBD and placebo were supplied by GW Pharma, which did not fund the study","yan_etki":null,"pmid":"28614793","doi":"10.1172/jci.insight.93760","diger_kaynak":null},{"ad":"Sultan 2020","tasarim":"Double-blind, parallel RCT","n":"26 (13 CBD, 13 placebo)","populasyon":"Healthy men","urun":"Pure CBD","urun_turu":"saf_cbd","doz":"600 mg/day","titrasyon":null,"sure":"7 days","sonuc":"After the first dose, resting mean arterial pressure fell by 2 mmHg compared with placebo (95% CI −3.6 to −0.3); by day 7 this effect had disappeared (tolerance); there was also no difference in 24-hour ambulatory blood pressure measured on day 6. Systolic blood pressure during stress was 6 mmHg lower after the first dose and 5.7 mmHg lower on day 7. In the CBD group, arterial stiffness decreased and the function of the inner lining of blood vessels (endothelial function) improved on day 7; this is a within-group comparison with day 1 (6 people each for blood vessel function)","yan_etki":null,"pmid":"32128848","doi":"10.1111/bcp.14225","diger_kaynak":null},{"ad":"Dragun 2023","tasarim":"Double-blind, crossover pilot RCT","n":"16 (8 women)","populasyon":"Untreated hypertension","urun":"Oral CBD (patented formulation designed for better absorption, DehydraTECH)","urun_turu":"saf_cbd","doz":"150 mg × 3/day (every 8 hours)","titrasyon":null,"sure":"24 hours","sonuc":"24-hour systolic pressure about 5 mmHg, mean arterial pressure about 3 mmHg and arterial stiffness about 0.7 m/s lower (p < 0.05); the drop was more pronounced during sleep. A pilot study lasting only 24 hours. According to the Europe PMC record, the funder was the company that owns the formulation, Lexaria Bioscience (the full text could not be read); same research group as Dujic 2024 (University of Split)","yan_etki":"No new arrhythmia, well tolerated","pmid":"37291376","doi":"10.1007/s12325-023-02560-8","diger_kaynak":null},{"ad":"Dujic 2024 (HYPER-H21-4)","tasarim":"Triple-blind, crossover RCT","n":"70","populasyon":"Mild to moderate primary hypertension (untreated or taking blood pressure medicine), aged 40–70, Croatia","urun":"Patented oral CBD capsule designed for better absorption (DehydraTECH 2.0 CBD)","urun_turu":"saf_cbd","doz":"225–300 mg a day by body weight (split into three) for 2.5 weeks, then 375–450 mg a day for 2.5 weeks","titrasyon":"Dose increase","sure":"2 × 5 weeks","sonuc":"24-hour systolic pressure −4.76 mmHg at 2.5 weeks; the dose increase gave no additional benefit; arterial stiffness did not change. The abstract does not say whether −4.76 mmHg is a difference from placebo or a change from baseline during the CBD period (the full text could not be read; secondary publications from the same trial report CBD's effects relative to baseline within the CBD period). The study was funded by the company that owns the formulation (Lexaria Bioscience); same research group as Dragun 2023 (University of Split)","yan_etki":"No change in liver enzymes and no serious side effects","pmid":"37093160","doi":"10.1089/can.2022.0320","diger_kaynak":"ClinicalTrials.gov NCT05346562 (no results in the registry); protocol Kumric 2022, PMID 35887534; secondary publications from the same trial: Kumric 2023, PMID 36780785 (catestatin), Kumric 2023, PMID 37321059 (urotensin-II), Batinic 2023, PMID 37373421 (blood CBD level), Dujic 2025, PMID 39187263 (daytime sleepiness and quality of life), Kumric 2025, PMID 41203237 (endocannabinoids)"},{"ad":"McNamara 2026 (ARCHER)","tasarim":"Phase 2, multicenter, double-blind, placebo-controlled RCT","n":"109 randomized (56 CBD / 53 placebo); primary analysis in 99 patients with centrally confirmed myocarditis, extracellular volume measurable in 71 patients","populasyon":"Acute myocarditis (inflammation of the heart muscle) within 10 days of diagnosis","urun":"Pharmaceutical-grade oral CBD solution","urun_turu":"saf_cbd","doz":"From 2.5 mg/kg twice daily to 10 mg/kg twice daily (20 mg/kg/day)","titrasyon":"Weekly increases; 10 mg/kg × 2 at week 3","sure":"12 weeks","sonuc":"Primary MRI measurements not significant: extracellular volume −3.7 mL (95% CI −7.4 to 0.1; p = 0.054; measurable in only 71 patients because of MRI quality), no difference in strain (p = 0.90). In the ClinicalTrials.gov record, the primary outcome is listed as extracellular volume percentage, and it too showed no difference (−0.87 points; p = 0.26); the mL analysis is listed in the registry as an analysis not prespecified (post hoc). The design paper does not state a unit, and the registry's version history could not be accessed; the article describes the percentage measure in a footnote as 'not an appropriate outcome measure'. Left ventricular mass was 9.2 g lower with CBD (p = 0.012; prespecified exploratory outcome). The study was funded by the manufacturer, Cardiol Therapeutics; 15 of 16 authors have ties to the company (3 are company employees)","yan_etki":"At least one side effect in 76.8% with CBD and 60.4% with placebo, mostly mild; serious events with CBD included a recurrence of myocarditis, ventricular tachycardia and a rise in liver enzymes (one patient each)","pmid":"41711722","doi":"10.1093/eschf/xvaf034","diger_kaynak":"ClinicalTrials.gov NCT05180240 (results in the registry, June 17, 2026); design paper McNamara 2024, PMID 38937900"},{"ad":"NCT04615949 (COVID-19 study, registry results)","tasarim":"Multicenter, double-blind, placebo-controlled, parallel phase 2/3 RCT (1:1); stopped early because not enough patients could be enrolled; results only in the ClinicalTrials.gov registry record, no peer-reviewed publication","n":"90 randomized (45 CBD / 45 placebo); 78 completed (41 / 37); side effect analysis 45 / 44","populasyon":"Adults hospitalized for COVID-19 in the previous 24 hours, not needing a ventilator, and with cardiovascular disease or a risk factor (over 65, diabetes, high blood pressure, blood lipid disorder, obesity, smoking); mean age 61; 20 centers in the USA, Brazil and Mexico","urun":"Pharmaceutical-grade oral CBD solution (THC < 5 ppm; CardiolRx)","urun_turu":"saf_cbd","doz":"From 2.5 mg/kg twice a day to 7.5 mg/kg twice a day (15 mg/kg/day), with food","titrasyon":"Days 1–2: 2.5, days 3–4: 5, days 5–28: 7.5 mg/kg × 2; if not tolerated, back to the previous dose","sure":"28 days of treatment; follow-up to day 60","sonuc":"The primary composite outcome (death, need for intensive care or breathing support, and cardiovascular complications within 28 days) occurred in 3 of 45 people in the CBD group and 2 of 45 in the placebo group (Fisher p = 0.68; difference not significant). On the secondary ordinal clinical status scale, the day-28 mean was 1.40 vs 1.51 (p = 0.77; in 35 / 35 people because the scale was added after a protocol change). Because the study stopped early, as not enough patients could be found due to vaccination and milder virus variants, it is not large enough to show or rule out an effect. Results only in the registry record, no peer-reviewed publication; the study was run by the drug’s manufacturer, Cardiol Therapeutics","yan_etki":"Serious side effects in 5 / 45 people with CBD and 4 / 44 with placebo. The serious events in the CBD group were one case each of heart failure, QTc prolongation (a lengthening on a heart rhythm measurement), pneumonia, worsening kidney function and respiratory failure; in the placebo group, one case each of tachycardia, septic shock, a rise in a liver enzyme (ALT), acute kidney injury and respiratory failure. Deaths: 0 with CBD, 2 with placebo. Among non-serious events, nausea in 5 vs 2 people, low blood pressure in 2 vs 0, high blood pressure in 3 vs 1, tachycardia (fast heartbeat) in 0 vs 3. The groups were not compared statistically for side effects; the numbers are small","pmid":null,"doi":null,"diger_kaynak":"ClinicalTrials.gov NCT04615949 (results 25.07.2025, last update 21.04.2026; protocol and statistical analysis plan in the registry record); no peer-reviewed publication found in PubMed (October 29, 2026)"},{"ad":"Haney 2016","tasarim":"Double-blind, placebo-controlled, within-subject (crossover) laboratory RCT; multicenter","n":"31 completed (17 men, 14 women); 50 enrolled according to the registry","populasyon":"Non-treatment-seeking, healthy volunteers who regularly smoke marijuana (US)","urun":"Oral CBD capsule (according to the registry, 200 mg CBD and lactose per capsule); 90 minutes later, a marijuana cigarette (5.3–5.8% THC) or a THC-free placebo cigarette","urun_turu":"saf_cbd","doz":"A single dose of 0, 200, 400 or 800 mg CBD","titrasyon":null,"sure":"8 sessions, a single dose in each session","sonuc":"CBD alone (with the placebo cigarette) did not significantly change cardiovascular measurements or subjective effects. Active marijuana raised heart rate (in the registry results, 15 minutes after smoking, 79 beats/min without CBD and 79–81 with 200–800 mg CBD; 64–65 beats/min with the placebo cigarette); no dose of CBD changed this rise or marijuana's pleasurable effects. Blood pressure values are not in the abstract or the registry","yan_etki":"No serious side effects in the registry; other side effects in 1–8 of 50 people per condition","pmid":"26708108","doi":"10.1038/npp.2015.367","diger_kaynak":"ClinicalTrials.gov NCT01844687 (results in the registry); secondary analysis of the same trial: Babalonis 2017, PMID 28088032 (CBD no different from placebo on abuse measures)"},{"ad":"Bell 2025","tasarim":"Randomized, crossover, placebo-controlled pilot study (triple-blind according to the registry; according to the article, all 12 people correctly guessed which day they took CBD)","n":"12 (4 men, 8 women)","populasyon":"Healthy young adults who run regularly (US)","urun":"CBD isolate capsules (100 mg CBD per capsule, no THC; in grape seed oil; Procana)","urun_turu":"saf_cbd","doz":"A single dose of 300 mg (3 capsules), 2 hours before running","titrasyon":null,"sure":"Single dose, on two separate days","sonuc":"Resting systolic blood pressure measured before the run was numerically lower on the CBD day, but the difference was not significant (p = 0.10); diastolic blood pressure (p = 0.50) and heart rate variability were also no different from placebo. Ratings of feeling calmer and more relaxed were higher on the CBD day; no difference in running time. A very small study, and blinding was broken (all 12 people correctly guessed the CBD day)","yan_etki":"No difference in digestive complaints","pmid":"41515147","doi":"10.3390/nu18010029","diger_kaynak":"ClinicalTrials.gov NCT06364254 (no results in the registry)"},{"ad":"Mastrofini 2024","tasarim":"Double-blind, placebo-controlled, parallel RCT","n":"56 randomized (28/28); 54 completed","populasyon":"Healthy young adults (mean age 25; people with uncontrolled or controlled high blood pressure were not enrolled), US","urun":"Hemp-derived CBD oil (50 mg CBD per mL, THC less than 0.3%)","urun_turu":"cbd_zengin_thc_belirsiz","doz":"2 × 50 mg a day (100 mg/day), under the tongue","titrasyon":null,"sure":"12 weeks (90 days)","sonuc":"No time- or group-related differences in heart rate or systolic and diastolic blood pressure (p > 0.05). Immune and inflammation markers, stress, sleep and mood were no different from placebo; a pain indicator measured in urine rose less in the CBD group. The study was funded by a CBD company (CBD Industries); a CBD brand is mentioned in the acknowledgments","yan_etki":"Safe and well tolerated according to the article","pmid":"38904150","doi":"10.1080/15502783.2024.2370430","diger_kaynak":null},{"ad":"Arout 2022","tasarim":"Double-blind, placebo-controlled, within-subject (crossover) outpatient laboratory study (PubMed publication type: RCT)","n":"17 (8 men, 9 women)","populasyon":"Healthy volunteers who do not use cannabis (US)","urun":"Oral CBD (product details not in the abstract)","urun_turu":"saf_cbd","doz":"A single dose of 0, 200, 400 or 800 mg","titrasyon":null,"sure":"A single dose in each session (4 dose conditions)","sonuc":"The primary question was pain: in the cold water pain test, CBD did not consistently change pain threshold or tolerance compared with placebo, and it increased pain intensity ratings at all doses. CBD was safe and well tolerated and caused a small drop in blood pressure (P < 0.01); the size of the drop, at which doses and in which measurement it was seen are not in the abstract (the full text could not be read). Funding and conflict of interest statements are not in the abstract","yan_etki":"Safe and well tolerated according to the abstract","pmid":"34223660","doi":"10.1111/bcp.14973","diger_kaynak":null},{"ad":"Spindle 2020","tasarim":"Double-blind, double-dummy, placebo-controlled, within-subject (crossover) laboratory study; session order randomized","n":"18 (9 men, 9 women)","populasyon":"Healthy adults with cannabis experience but no use in the past 30 days (US)","urun":"Oral CBD (capsule, approved CBD solution or syrup) and vaporized pure synthetic CBD; also vaporized CBD-rich cannabis (10.5% CBD, 0.39% THC)","urun_turu":"saf_cbd","doz":"A single dose of 100 mg CBD (by mouth or vaporized); in the CBD-rich cannabis condition, 100 mg CBD + 3.7 mg THC","titrasyon":null,"sure":"4 sessions, a single dose in each; at least 1 week between sessions","sonuc":"100 mg of pure CBD taken by mouth or vaporized did not change blood pressure or heart rate differently from placebo (peak systolic blood pressure 127.4 with placebo, 125.8 with oral CBD and 126.0 mmHg with vaporized CBD; peak heart rate 70.0, 71.0 and 68.7 beats/min). CBD-rich cannabis containing a little THC, however, raised heart rate (peak 76.2 beats/min; significant vs. placebo). No cognitive or psychomotor impairment. The row's product type reflects the pure CBD conditions; the result for CBD-rich cannabis is written separately. Government (NIDA, SAMHSA) funding; 1 of 9 authors had consulted for cannabis and cannabinoid companies","yan_etki":"No unexpected or serious side effects","pmid":"32247649","doi":"10.1016/j.drugalcdep.2020.107937","diger_kaynak":null},{"ad":"Luis 2026","tasarim":"Phase 2, open-label, multicenter (no control group)","n":"27","populasyon":"Symptomatic recurrent pericarditis (inflammation of the sac around the heart)","urun":"Pharmaceutical-grade oral CBD solution (100 mg/mL)","urun_turu":"saf_cbd","doz":"Up to 10 mg/kg twice daily (74% of patients at this dose, the others 5–7.5 mg/kg × 2)","titrasyon":"Increase up to the highest tolerated dose","sure":"8 weeks + 18-week extension (with existing medicines tapered)","sonuc":"Peak pain fell from 5.8 to 2.1; CRP returned to normal in 8 of 10 patients with high CRP; in the extension, 17 of 24 patients (71%) had no new attack; no control group. The study was funded by the manufacturer, Cardiol Therapeutics; 7 of 15 authors have ties to the company (3 are company employees; the statistical analyses were done by an organization funded by the company)","yan_etki":"Serious side effects in 2 patients: in one, CBD was stopped because of a severe drug reaction (DRESS) possibly related to the drug; the events in the other were considered unrelated to the drug. 2 patients stopped because of side effects before week 8; across the whole study, the drug was stopped in 4 patients with side effects and reduced or paused in 8. Most common were diarrhea (56%), chest pain (37%) and rash (30%); no clinically important change in QTc","pmid":"42432451","doi":"10.1161/JAHA.125.047605","diger_kaynak":"ClinicalTrials.gov NCT05494788 (results in the registry, October 20, 2025; in the registry, CRP normal at week 8 in 7 of 12 patients, in the article in 8 of 10 patients with high CRP); the placebo-controlled phase 3 MAVERIC study NCT06708299 is ongoing (October 2026)"},{"ad":"Sellers 2013 (QT study)","tasarim":"Double-blind, placebo- and active drug (moxifloxacin)-controlled, four-arm parallel RCT (thorough QT study)","n":"258","populasyon":"Healthy volunteers","urun":"THC+CBD mouth spray (nabiximols, Sativex)","urun_turu":"thc_iceren","doz":"8 sprays a day (recommended dose) or 24–36 sprays a day (3–4.5 times the recommended dose); comparisons: placebo spray, a single dose of 400 mg moxifloxacin","titrasyon":null,"sure":"5 days","sonuc":"At the recommended and very high doses, no effect on the QT/QTc interval, which reflects the heart's electrical recovery; no clinically important changes in heart rate, conduction or ECG morphology. The sponsor is the drug's manufacturer (Jazz Pharmaceuticals in the registry today); the authors' company ties are not given because the full text could not be read","yan_etki":"In the very high dose arm, 19 people (25%) stopped because of intolerable side effects; 4 serious psychiatric events at the highest dose, so the dose was lowered to 24 sprays a day; at the recommended dose, side effects were similar to earlier studies","pmid":"27121791","doi":"10.1002/cpdd.36","diger_kaynak":"ClinicalTrials.gov NCT01322139 (no results in the registry)"},{"ad":"Mathew 2003","tasarim":"Randomized, double-blind, placebo-controlled laboratory study","n":"29","populasyon":"Volunteers","urun":"Intravenous THC and marijuana cigarette","urun_turu":"thc_iceren","doz":"Dose not in the abstract","titrasyon":null,"sure":"Single administration","sonuc":"Both intravenous THC and the marijuana cigarette caused dizziness on standing; it was severe in 28% of participants. In those with severe dizziness, brain blood flow and blood pressure while standing fell the most, and pulse first rose and then fell. Dizziness was not related to the blood THC level","yan_etki":null,"pmid":"12873621","doi":"10.1016/s0091-3057(03)00086-8","diger_kaynak":null},{"ad":"Laurentino 2026","tasarim":"Randomized, double-blind, placebo-controlled, crossover study","n":"18","populasyon":"Healthy adults (mean age 26; per the protocol, no cannabis use in the past 6 months), Brazil","urun":"Oral THC oil and full-spectrum CBD+THC oil","urun_turu":"thc_iceren","doz":"A single dose of 12.5 mg THC or 12.5 mg CBD + 12.5 mg THC","titrasyon":null,"sure":"Single dose, on three separate days","sonuc":"Both oils raised heart rate compared with placebo (p < 0.05). Only with the THC oil did cardiac index increase and vascular resistance fall; responses were more limited with the CBD+THC oil. The abstract does not report blood pressure change separately","yan_etki":null,"pmid":"42660566","doi":"10.1002/bcp.70793","diger_kaynak":"Protocol: Fagundes 2025, PMID 41226928 (the protocol planned five conditions with two dose levels of 12.5 and 18.75 mg; the published analysis has three conditions); Brazilian registry RBR-3jsvtbr"},{"ad":"Cheung 2024","tasarim":"Controlled crossover laboratory study (randomized and single-blind according to the registry; each participant received all three conditions)","n":"22","populasyon":"Healthy young adults who use cannabis regularly (Canada)","urun":"THC-rich cannabis (13.6% THC, less than 1% CBD) smoked or vaporized; CBD-rich cannabis (14.5% CBD, less than 1% THC) vaporized","urun_turu":"thc_iceren","doz":"100 mg of dried cannabis in each condition","titrasyon":null,"sure":"Single administration, on three separate days","sonuc":"THC-rich cannabis by either route raised heart rate (about +16–17 beats/min) and mean arterial pressure (+5–7 mmHg) (p < 0.0001); CBD-rich cannabis did not (+1 beat/min, +3 mmHg; p > 0.05). After inhalation, arterial stiffness increased and the heart's relaxation function decreased; these changes were related to the rise in heart rate. No difference between smoking and vaporizing","yan_etki":null,"pmid":"39575727","doi":"10.1161/JAHA.124.037731","diger_kaynak":"ClinicalTrials.gov NCT04693884 (no results in the registry); a second publication from the same trial: Cheung 2025, PMID 41115058 (pulse pressure after exercise rose when THC-rich cannabis was smoked)"},{"ad":"Elias 2026 (MARY-JANE)","tasarim":"Prospective, randomized crossover pragmatic trial (a daily text message instructing \"use\" or \"don't use\"; no blinding)","n":"108 people; 713 cannabis days, 616 non-use days","populasyon":"Adults who regularly smoke or vape cannabis, with no history of heart rhythm problems (US)","urun":"Inhaled cannabis that participants used themselves","urun_turu":"thc_iceren","doz":"The participant's usual use","titrasyon":null,"sure":"14 days, continuous ECG recording","sonuc":"The primary outcome, the daily number of premature beats, was 9% lower on cannabis days (ratio 0.91; 95% CI 0.85–0.98; p = 0.02); atrial premature beats decreased by 10%, and ventricular premature beats did not change. No difference in steps, sleep or glucose values. Adherence to the instructions was not complete; a withdrawal effect on non-use days in regular users may explain the result","yan_etki":null,"pmid":"42584385","doi":"10.1016/j.jacc.2026.07.014","diger_kaynak":"ClinicalTrials.gov NCT06021613 (no results in the registry)"},{"ad":"Rosa 2022 (SativexStroke)","tasarim":"Secondary analysis of an RCT (double-blind, placebo-controlled, crossover); blood pressure and pulse were compared only between the first and last 5 days of the drug period (not with placebo; no comparison group); patients measured and recorded the values themselves every day","n":"34 (41 enrolled); 31 were taking blood pressure medicine, 12 a beta blocker","populasyon":"Patients with muscle stiffness (spasticity) after stroke (Italy)","urun":"THC+CBD mouth spray (nabiximols)","urun_turu":"thc_iceren","doz":"Up to the highest tolerated dose, at most 12 sprays a day; a mean of 9 sprays at the end of the period (about 24 mg THC + 22 mg CBD)","titrasyon":"Gradual increase over 14 days","sure":"1-month drug period","sonuc":"Blood pressure (systolic, diastolic and pulse pressure) and heart rate did not change during the drug period (all p ≥ 0.2); no relationship with the number of sprays. No heart rhythm problems, cardiovascular or cerebrovascular events were seen. In the main trial, there was no difference in muscle stiffness compared with placebo. The manufacturer (GW Pharma) supplied the drug and placebo free of charge; a drug company (Almirall) covered the insurance and 40% of the total cost; an investigator-initiated study, and 1 of 9 authors had received support from Almirall for other research","yan_etki":"2 serious events in the main trial, unrelated to the heart","pmid":"36386386","doi":"10.3389/fcvm.2022.990188","diger_kaynak":"Main trial: Marinelli 2022, PMID 35812088 (EudraCT 2016-001034-10)"},{"ad":"Crawford and Merritt 1979","tasarim":"Controlled clinical study (comparison with a placebo cigarette; randomization not in the abstract)","n":"16 glaucoma patients (8 with high blood pressure)","populasyon":"Patients with open-angle glaucoma; 8 with normal blood pressure, 8 with high blood pressure","urun":"Marijuana cigarette (2.8% THC)","urun_turu":"thc_iceren","doz":"One cigarette (amount not in the abstract)","titrasyon":null,"sure":"Single administration, 3–4 hours of monitoring","sonuc":"There was no significant change with placebo. After inhaling THC, heart rate rose in every patient (by 20–62 beats per minute), then systolic blood pressure fell by 12–52 mmHg and diastolic by 6–28 mmHg; the drop was larger and longer (3–4 hours) in those with high blood pressure. The drop in eye pressure paralleled the drop in blood pressure","yan_etki":null,"pmid":"468444","doi":null,"diger_kaynak":null},{"ad":"Aronow 1975","tasarim":"Controlled comparison study (marijuana cigarette vs. high-nicotine tobacco cigarette; no placebo, randomization not in the abstract)","n":"10","populasyon":"Patients with exercise-induced chest pain (angina pectoris)","urun":"Marijuana cigarette","urun_turu":"thc_iceren","doz":"One cigarette (amount of THC not in the abstract)","titrasyon":null,"sure":"Single administration","sonuc":"One marijuana cigarette increased the resting product of systolic blood pressure × heart rate (an indicator of the heart's oxygen demand) by 54% and shortened the exercise time until chest pain began by 50% compared with the measurement before smoking; with the high-nicotine cigarette, these figures were 36% and 23% (greater shortening with marijuana, p < 0.001). No placebo was used; an old study of 10 patients","yan_etki":null,"pmid":"1126112","doi":"10.1002/cpt1975175549","diger_kaynak":"The same group's study comparing marijuana with placebo marijuana: Aronow 1974, NEJM, PMID 4599385 (no abstract, full text could not be read); psychological outcomes in 10 angina patients with the same design: Gottschalk 1977, PMID 870096; hemodynamics in coronary disease: Prakash 1975, PMID 1097149 (no abstract)"},{"ad":"Gonzalez 2026","tasarim":"Single-blind, placebo-controlled, fixed-order (placebo night first, then THC night) exploratory study; secondary analysis of a pilot study","n":"17 (9 who do not use cannabis, 8 regular users)","populasyon":"Healthy adults (US)","urun":"Oral synthetic THC (dronabinol)","urun_turu":"thc_iceren","doz":"10 mg 1 hour before bedtime","titrasyon":null,"sure":"3 nights in the laboratory; each administration a single dose","sonuc":"Resting blood pressure and pulse the next morning did not change. In people who do not use cannabis, on the morning after THC, dizziness was more common in the tilt-table (standing) test, and the response of diastolic blood pressure and heart rate to standing was reduced compared with the placebo morning; this difference was not seen in regular users. Very small and exploratory","yan_etki":null,"pmid":"42665978","doi":"10.14814/phy2.71076","diger_kaynak":"Sleep and heart rate variability in the same participants: Gonzalez 2026, PMID 41692699 (THC clearly reduced heart rate variability)"},{"ad":"Roberts 2026","tasarim":"Systematic review (RCTs; numbers were not pooled because the studies differed)","n":"4 RCTs, 120 participants","populasyon":"Adults with normal or high blood pressure","urun":"Oral CBD","urun_turu":"saf_cbd","doz":"225–600 mg/day in the studies","titrasyon":null,"sure":"Search September 2024; studies 2 hours–5 weeks","sonuc":"According to the review, all four RCTs (Jadoon 2017, Sultan 2020, Dragun 2023, Dujic 2024) reported a significant drop in systolic blood pressure compared with placebo; the drop was seen especially under stress and during sleep, and the largest effect was in short studies of 600 mg/day. In the review's own table, 24-hour blood pressure on day 6 in Sultan 2020 showed no difference and the resting effect had disappeared by day 7; for Dujic 2024, it is not stated that the values given are differences from placebo. Risk of bias mostly low. According to the authors, the studies were small, short and used different doses; liver safety is unclear; large, long studies are needed to establish its place in blood pressure treatment. The other healthy-volunteer RCTs in this table (Haney 2016, Arout 2022, Spindle 2020, Mastrofini 2024, Bell 2025) are not in the review; Bell 2025 was published after the search date. No funding, no conflicts of interest","yan_etki":"Side effects mostly mild or moderate (nausea, diarrhea, fatigue); no serious cardiovascular events reported","pmid":"42321899","doi":"10.1186/s42238-026-00463-3","diger_kaynak":"A meta-analysis published in Brazil that the review cites (Candeloro 2025) could not be found in PubMed or Europe PMC"},{"ad":"Sultan 2017","tasarim":"Systematic review and meta-analysis (animal and human studies)","n":"25 publications; human data for 36 people for blood pressure and 87 for heart rate","populasyon":"Studies in six species; in humans, healthy volunteers and some patient groups","urun":"CBD","urun_turu":"saf_cbd","doz":"In humans, a single dose between 320 μg/kg and 1,200 mg","titrasyon":null,"sure":"Mostly single dose","sonuc":"Under normal conditions, single or repeated CBD did not change blood pressure or heart rate. In stress models (mostly animals), CBD reduced the stress-induced rise in blood pressure (mean difference −3.54 mmHg; 95% CI −5.19 to −1.9) and in heart rate. In humans, a single dose of CBD did not change blood pressure or heart rate in healthy volunteers under normal conditions or under stress (12 studies). Most studies were in animals; human data are scarce","yan_etki":null,"pmid":"28286481","doi":"10.3389/fphar.2017.00081","diger_kaynak":null},{"ad":"Sultan 2018","tasarim":"Systematic review and meta-analysis (animal and human studies)","n":"31 studies; 6 publications for heart rate in humans","populasyon":"Animals and healthy volunteers who had not used cannabis","urun":"THC","urun_turu":"thc_iceren","doz":"Varied by study","titrasyon":null,"sure":"Single dose and repeated dose","sonuc":"In humans, a single dose of THC raised heart rate (mean difference +8.16 beats/min; 95% CI 4.99–11.33; p < 0.00001), and the increase was dose-related; there were not enough data to pool blood pressure in humans. In animals, by contrast, THC lowered blood pressure and heart rate. According to the authors, human data are limited","yan_etki":null,"pmid":"29385080","doi":"10.3390/ph11010013","diger_kaynak":"The PubMed title says \"Δ8\"; the article's own title and text say Δ9-THC"},{"ad":"Watanabe 2021","tasarim":"Systematic review and meta-analysis (RCTs)","n":"47 RCTs, 2,800 patients","populasyon":"Patients given cannabinoids for medical purposes; 45% of the studies had excluded people with cardiovascular disease","urun":"Medical cannabinoids (several product types)","urun_turu":"karma","doz":"Varied by study","titrasyon":null,"sure":"Median duration of cannabinoid use 15.8 days (1–322 days)","sonuc":"Compared with placebo, cannabinoids increased the risk of a drop in blood pressure on standing (relative risk 3.16; 95% CI 2.27–4.40) and of low blood pressure (3.55; 1.45–8.71); the trend toward more palpitations/tachycardia was not significant (1.94; 0.81–4.64). No study reported a serious cardiovascular event; the studies were short, and heart patients were mostly excluded","yan_etki":null,"pmid":"33952424","doi":"10.1016/j.japh.2021.03.013","diger_kaynak":null},{"ad":"Storck 2025","tasarim":"Systematic review and meta-analysis (observational studies; risk of bias with ROBINS-E)","n":"24 studies (17 cross-sectional, 6 cohort, 1 case-control)","populasyon":"People who use and do not use cannabis (one study of medical cannabis)","urun":"Cannabis use","urun_turu":"thc_iceren","doz":"Not applicable","titrasyon":null,"sure":"Publications 2016–January 2023; search September 2023","sonuc":"Cannabis use was associated with acute coronary syndrome (including heart attack; relative risk 1.29; 95% CI 1.05–1.59), stroke (1.20; 1.13–1.26) and cardiovascular death (2.10; 1.29–3.42); the result was similar with cohort studies only (1.32; 1.01–1.73). Most studies were cross-sectional; the association does not show cause and effect","yan_etki":null,"pmid":"40527600","doi":"10.1136/heartjnl-2024-325429","diger_kaynak":"PROSPERO CRD42023401401"},{"ad":"Sebastian 2025","tasarim":"Systematic review and meta-analysis (observational cohort data)","n":"17 studies, 1,902,481 people","populasyon":"Adults aged 18–74; people who had ever used cannabis and people who had not","urun":"Cannabis use","urun_turu":"thc_iceren","doz":"Not applicable","titrasyon":null,"sure":"Mean follow-up 8.5 years; search April 2024","sonuc":"No significant association for heart attack (relative risk 1.25; 95% CI 0.91–1.71; p = 0.17) or stroke (1.38; 0.88–2.16; p = 0.16); a significant association for the combined outcome of any cardiovascular event (1.48; 1.16–1.90; p = 0.002). Large variation between studies","yan_etki":null,"pmid":"39800612","doi":"10.1016/j.disamonth.2024.101849","diger_kaynak":"PROSPERO CRD42024530366"},{"ad":"Ravi 2018 (systematic review)","tasarim":"Systematic review (observational studies; strength of evidence graded)","n":"11 studies for cardiovascular outcomes (13 for risk factors)","populasyon":"Adults using marijuana in any form","urun":"Marijuana use","urun_turu":"thc_iceren","doz":"Not applicable","titrasyon":null,"sure":"Search 1975–September 2017","sonuc":"The evidence on the association of marijuana with heart attack, stroke, cardiovascular death and death in heart patients was found to be insufficient; studies with long follow-up were limited by recall bias, poor measurement of use, low levels of use and low-risk participants","yan_etki":null,"pmid":"29357394","doi":"10.7326/M17-1548","diger_kaynak":"PROSPERO CRD42016051297"},{"ad":"Chye 2026","tasarim":"Systematic review and meta-analysis (large population studies)","n":"14 observational studies (5 prospective), 81,230,930 participants","populasyon":"Adults in North America, Europe and Oceania","urun":"Cannabis use","urun_turu":"thc_iceren","doz":"Not applicable","titrasyon":null,"sure":"Search April 2024","sonuc":"Cannabis use was associated with atrial rhythm disorders (atrial fibrillation, flutter and tachycardia, supraventricular tachycardia) (odds ratio 1.71; 95% CI 1.1–2.6; p = 0.01); the association was stronger in people who also used other drugs (1.91). The association does not show cause and effect","yan_etki":null,"pmid":"40472951","doi":"10.1016/j.hrthm.2025.05.062","diger_kaynak":"PROSPERO CRD42023428219"},{"ad":"Ritson 2026","tasarim":"Systematic review and meta-analysis (observational studies) with genetic (Mendelian randomization) analysis","n":"32 studies, more than 100 million participants","populasyon":"People who use and do not use illicit substances (administrative, hospital and population data)","urun":"Cannabis use (and other substances)","urun_turu":"thc_iceren","doz":"Not applicable","titrasyon":null,"sure":"Search date not in the abstract","sonuc":"Cannabis use was associated with stroke risk (odds ratio 1.37; 95% CI 1.14–1.65); there was variation between studies and a small-study effect. In the genetic analysis, a predisposition to cannabis use disorder was associated with any stroke (1.11; 1.01–1.51) and with large-artery stroke (1.35; 1.01–1.80)","yan_etki":null,"pmid":"41566428","doi":"10.1177/17474930261418926","diger_kaynak":"PROSPERO CRD420251053702"},{"ad":"Abuhasira 2021","tasarim":"Prospective observational study (no comparison group; each patient compared with their own baseline)","n":"26 completed (38 enrolled)","populasyon":"Patients over 60 with high blood pressure who were started on medical cannabis by a doctor (mean age 70; Israel)","urun":"Medical cannabis (mostly oil; in a 15-person subgroup, all products contained THC and CBD, THC 1–20%)","urun_turu":"thc_iceren","doz":"Product, route and dose were set by the treating doctor; in the 15-person subgroup, median daily THC 22 mg and CBD 30 mg, mostly oral oil (Abuhasira 2022)","titrasyon":null,"sure":"3 months","sonuc":"At 3 months, 24-hour systolic blood pressure fell by 5.0 mmHg and diastolic by 4.5 mmHg (both p < 0.001); the lowest values were 3 hours after cannabis. The proportion of people whose blood pressure dipped normally at night rose from 27% to 46%. No significant changes in blood tests, body measurements or ECG. Because there was no control group, it cannot be said that the drop was due to cannabis","yan_etki":null,"pmid":"33483174","doi":"10.1016/j.ejim.2021.01.005","diger_kaynak":"15-person subgroup of the same cohort: Abuhasira 2022, PMID 36294974 (endocannabinoid levels did not change; THC/CBD ratios of the products)"},{"ad":"Zongo 2021","tasarim":"Retrospective matched cohort (administrative health data and cannabis clinic records)","n":"18,653 medical cannabis patients, 51,243 matched controls","populasyon":"Adults in Ontario (Canada) authorized to use medical cannabis and controls from the general population","urun":"Medical cannabis (product type and THC/CBD content not reported)","urun_turu":"karma","doz":"Not reported","titrasyon":null,"sure":"Median follow-up 242 days (2014–2017)","sonuc":"Emergency visits or admissions for heart attack-like events (acute coronary syndrome) or stroke were more common in the cannabis group: 7.19 vs. 5.67 per 1,000 person-years (adjusted hazard ratio 1.44; 95% CI 1.08–1.93); for any cardiovascular event, 1.47 (1.26–1.72). In a 2026 analysis of the same data source, visits or admissions for heart failure were also more common (54,006 patients, 161,265 controls; hazard ratio 1.15; 1.06–1.25). Factors such as smoking, alcohol and blood pressure could not be adjusted for. Government (CIHR) funding; 2 of 7 authors have financial ties to a cannabis company or cannabis clinics; one of these authors and another author are on a grant partnered with a cannabis company, and one author is a former postdoctoral researcher supported by such a grant (these two authors state that they have no financial interests)","yan_etki":null,"pmid":"34507536","doi":"10.1186/s12872-021-02229-6","diger_kaynak":"Heart failure in the same data source: Dubois 2026, PMID 41497552 (Am J Med Open 2026;15:100120; 2014–2019 cohort)"},{"ad":"Holt 2024","tasarim":"Nationwide register-based matched cohort","n":"5,391 starting medical cannabis, 26,941 matched controls (from among 1.88 million chronic pain patients)","populasyon":"Patients in Denmark starting prescription medical cannabis for the first time for chronic pain (median age 59; 63% women)","urun":"Prescription medical cannabis (product types not in the abstract)","urun_turu":"karma","doz":"Not reported (in the abstract)","titrasyon":null,"sure":"180 days and 1 year of follow-up (2018–2021)","sonuc":"In the first 180 days, new heart rhythm problems (atrial fibrillation/flutter, conduction disorders, tachycardias) were more common in the cannabis group: 0.8% vs. 0.4% (risk ratio 2.07; 95% CI 1.34–2.80); at 1 year, 1.36 (1.00–1.73). No significant difference for acute coronary syndrome (1.20 at 180 days; 0.35–2.04). Observational; absolute risk low","yan_etki":null,"pmid":"38200679","doi":"10.1093/eurheartj/ehad834","diger_kaynak":null},{"ad":"Keyhani 2025","tasarim":"Prospective cohort (THC Cohort; adjusted with survey weights and propensity scores)","n":"4,285 veterans; in the analysis, 1,015 who had smoked cannabis in the past 30 days and 3,122 who had not","populasyon":"US veterans with coronary heart disease born 1950–1952 (aged 66–68) (2% women)","urun":"Smoking cannabis (any cannabis use in a separate analysis)","urun_turu":"thc_iceren","doz":"Not applicable","titrasyon":null,"sure":"Mean follow-up 3.3 years","sonuc":"563 events occurred. Smoking cannabis in the past 30 days was not associated with the combined outcome of heart attack, stroke and cardiovascular death (adjusted hazard ratio 0.87; 95% CI 0.61–1.24); there was also no association for any cannabis use. Use is self-reported","yan_etki":null,"pmid":"40686207","doi":"10.1161/CIRCULATIONAHA.124.073193","diger_kaynak":null},{"ad":"Mittleman 2001","tasarim":"Case-crossover study (each patient compared with themselves); multicenter heart attack onset study (Determinants of MI Onset Study)","n":"3,882 heart attack patients; 124 had smoked marijuana within the previous 1 year, 9 within 1 hour before the attack","populasyon":"Patients with an acute heart attack (US)","urun":"Smoking marijuana","urun_turu":"thc_iceren","doz":"Not applicable","titrasyon":null,"sure":"Interview a mean of 4 days after the attack","sonuc":"In the 60 minutes after smoking marijuana, the risk of a heart attack starting was 4.8 times the usual level (95% CI 2.4–9.5); this estimate is based on 9 patients who had smoked marijuana within 1 hour before the attack, and the risk then fell quickly. According to the authors, marijuana is a rare trigger of heart attack. In 18-year follow-up of the same cohort (2,097 patients aged 63 or younger, 109 of them marijuana users), death was 29% more common in marijuana users, but the difference was not significant (hazard ratio 1.29; 0.81–2.05; p = 0.28)","yan_etki":null,"pmid":"11401936","doi":"10.1161/01.cir.103.23.2805","diger_kaynak":"Long-term follow-up of the same cohort: Frost 2013, PMID 23351819; first follow-up analysis Mukamal 2008, PMID 18294478"},{"ad":"Jeffers 2024","tasarim":"Population-based cross-sectional study (US BRFSS health survey, 2016–2020)","n":"434,104 people (4% use cannabis daily, 7.1% occasionally)","populasyon":"US adults aged 18–74 (27 states and 2 territories)","urun":"Cannabis use in the past 30 days (number of days)","urun_turu":"thc_iceren","doz":"Not applicable","titrasyon":null,"sure":"Cross-sectional","sonuc":"After adjusting for tobacco use and other factors, daily cannabis use was associated with heart attack (adjusted odds ratio 1.25; 95% CI 1.07–1.46), stroke (1.42; 1.20–1.68) and the combined outcome (1.28; 1.13–1.44); for coronary heart disease, the association was borderline (1.16; 0.98–1.38). Among people who had never used tobacco, there were also associations with heart attack (1.49) and stroke (2.16); the odds rose as the number of days of use increased. Cross-sectional and self-reported; does not show cause and effect","yan_etki":null,"pmid":"38415581","doi":"10.1161/JAHA.123.030178","diger_kaynak":null},{"ad":"Corroon 2025 (CARDIA)","tasarim":"Prospective cohort (CARDIA; weighted models for time-dependent factors)","n":"4,328 people at baseline, 2,810 at year 35","populasyon":"Black and White US young adults enrolled at age 18–30 without cardiovascular disease at baseline","urun":"Cumulative lifetime cannabis use (cannabis-years)","urun_turu":"thc_iceren","doz":"Not applicable (use was low: median 0.2 cannabis-years)","titrasyon":null,"sure":"35 years of follow-up","sonuc":"High blood pressure developed in 2,478 people; cumulative cannabis use was not associated with the risk of high blood pressure (hazard ratio 0.99; 95% CI 0.97–1.00; p = 0.18); the result did not change in sensitivity analyses. In a 2017 analysis of the same cohort (5,113 people, median 26.9 years, 215 events), cannabis use was also not associated with cardiovascular disease, stroke or cardiovascular death. Most participants used little. The first author is a paid board member of a company that makes CBD products from hemp (CV Sciences); the other 9 authors reported no ties; CARDIA is supported by the government (NHLBI)","yan_etki":null,"pmid":"40785536","doi":"10.1161/HYPERTENSIONAHA.125.25005","diger_kaynak":"Cardiovascular events in the same cohort: Reis 2017, PMID 28207342"},{"ad":"Haleem 2021","tasarim":"Population-based prospective survey cohort (NESARC, two waves)","n":"26,844 (people without high blood pressure at baseline)","populasyon":"US adults","urun":"Cannabis use (lifetime, past 12 months and frequency)","urun_turu":"thc_iceren","doz":"Not applicable","titrasyon":null,"sure":"3 years","sonuc":"In the unadjusted analysis, new high blood pressure was less common in cannabis users, but this was due to age. After adjustment, neither lifetime use (odds ratio 0.89; 95% CI 0.77–1.02), nor use in the past 12 months (0.78; 0.56–1.09), nor frequency of use was associated with new high blood pressure. The blood pressure diagnosis is self-reported","yan_etki":null,"pmid":"33644920","doi":"10.1111/dar.13266","diger_kaynak":null},{"ad":"Falkstedt 2017","tasarim":"Population-based cohort (Swedish military conscription cohort, national registers)","n":"49,321 men","populasyon":"Swedish men born 1949–1951 who underwent military conscription at age 18–20","urun":"Cannabis use in youth (conscription questionnaire)","urun_turu":"thc_iceren","doz":"Not applicable","titrasyon":null,"sure":"Follow-up to about age 60","sonuc":"Cannabis use more than 50 times was associated neither with stroke before age 45 (hazard ratio 0.93; 95% CI 0.34–2.57) nor with stroke over the whole follow-up (0.95; 0.59–1.53). Although the risk of ischemic stroke appeared roughly doubled, it decreased after adjusting for tobacco and was not significant (1.47; 0.83–2.56). Smoking 20 or more cigarettes a day, by contrast, clearly increased the risk of stroke","yan_etki":null,"pmid":"28028147","doi":"10.1161/STROKEAHA.116.015565","diger_kaynak":null},{"ad":"Teraoka 2024","tasarim":"Prospective cohort (UK Biobank)","n":"150,554 (22.2% had used cannabis at least once)","populasyon":"Middle-aged and older adults in the United Kingdom (mean age 63)","urun":"Cannabis use (number of lifetime uses)","urun_turu":"thc_iceren","doz":"Not applicable","titrasyon":null,"sure":"Mean follow-up 6.1 years","sonuc":"In the adjusted analysis, neither occasional use (fewer than 100 times; hazard ratio 0.98; 95% CI 0.89–1.08) nor frequent use (1.03; 0.81–1.32) was associated with new atrial fibrillation. The route and amount of use could not be measured","yan_etki":null,"pmid":"38142832","doi":"10.1016/j.hrthm.2023.12.008","diger_kaynak":null}],"ilgili_ilaclar":["losartan","tansiyon_ilaci"],"son_inceleme":"2026-10-31","arastirma_gecmisi":[{"tarih":"2026-10-19","not":"Page published. This first review examined 4 studies."},{"tarih":"2026-10-21","not":"The year of a publication named on the page was corrected to the journal's print year instead of its online publication year. The conclusion and strength of evidence did not change."},{"tarih":"2026-10-21","not":"Newly published and previously missed clinical studies were searched in PubMed and ClinicalTrials.gov. 2 studies added: McNamara 2026 (ARCHER) and Luis 2026. The conclusion and strength of evidence did not change."},{"tarih":"2026-10-22","not":"The names of the finding labels were simplified: the label \"Small benefit possible\" on this page became \"May help a little\". The assessment did not change."},{"tarih":"2026-10-27","not":"In October 2026, PubMed, Cochrane, ClinicalTrials.gov and Europe PMC were searched systematically; 33 studies were added: 5 RCTs with CBD in healthy volunteers (in four, blood pressure and heart rate were no different from placebo; in one, blood pressure fell slightly), 9 studies with THC-containing products (heart rate, a drop in blood pressure on standing, heart rhythm, blood vessel function, angina, stroke patients taking blood pressure medicine; 8 of them controlled), 9 systematic reviews and meta-analyses, and 10 observational studies examining cannabis use and medical cannabis in relation to heart attack, stroke, heart rhythm problems, heart failure and high blood pressure. In the existing rows, the product, dose, registry number and funding of the high blood pressure studies were added; it was noted that both studies were carried out by the same research group, with the same company's patented product and with that company's funding, and that in the larger one the abstract does not make clear whether the drop was compared with placebo or with baseline. For the myocarditis study, the registered primary outcome, the funding of the heart inflammation studies, the authors' company ties and the side effects were added. The conclusion for THC-containing products was written for the first time (strength of evidence: 'Insufficient'). For pure CBD, the conclusion and strength of evidence did not change."},{"tarih":"2026-10-28","not":"Information on blood pressure when stopping cannabis use was added to the \"Who should be careful\" section: in a 13-person study of daily users, blood pressure rose in some of them after stopping (Vandrey 2011), and in another study of 39 people there was no change (Bonnet 2016). The conclusion and strength of evidence did not change."},{"tarih":"2026-10-28","not":"Display fix: internal working file names left in the text were removed; content and evidence did not change."},{"tarih":"2026-10-28","not":"Display fix: internal working notes left over from the previous cleanup were removed; content and evidence did not change."},{"tarih":"2026-10-28","not":"October 2026 additional review: sources found for this page during the searches for other topics were read and added to the page. A 1982 case report was added to the warning about a drop in blood pressure on standing with THC-containing products: after smoking marijuana, blood pressure fell suddenly in 3 glaucoma patients, the picture resembled fainting, and the symptoms went away when they lay down. The information that blood pressure fell in some people in a 1977 study in which THC was given into a vein was not added, because it could not be verified in the study's own abstract. In the warning about blood pressure rising when stopping cannabis, it was stated clearly that 22.8 and 12.3 mmHg are the amount of the increase, not the blood pressure itself. The conclusion and strength of evidence did not change."},{"tarih":"2026-10-31","not":"The ClinicalTrials.gov results of the study comparing pharmaceutical-grade CBD with placebo in 90 people hospitalized for COVID-19 who had cardiovascular disease or a risk factor were added to the table. The study was stopped early because not enough patients could be found and was not published in a peer-reviewed journal; on the main outcome, made up of death, intensive care or breathing support, and cardiovascular complications, there was no significant difference between the groups. Serious side effects occurred in 5 people in the CBD group and 4 in the placebo group; among those in the CBD group there was one case each of heart failure and QTc prolongation, and 2 people died in the placebo group (the groups were not compared for side effects). It had previously been mentioned only in the 'unverifiable' section; the number of studies in the evidence summary was updated accordingly. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-31","not":"The last sentence of the page's short summary was rewritten in a calmer, more guiding tone: instead of \"Talk to your doctor before you start.\", it now says whom you can talk with, and about what, if you are considering CBD. The conclusion and the strength of evidence did not change."}]},{"id":"glaucoma","baslik":"Glaucoma (high eye pressure)","grup":"Other","grup_kodu":"diger","tr_id":"glokom","kanit_duzeyi":"yetersiz","kanit_yonu":"yarar_gosterilmedi","kanit_ozet":"In a small study of 6 patients, a CBD-dominant cannabis extract given under the tongue did not lower the pressure inside the eye at all; 4 hours after the 40 mg dose, pressure rose temporarily (23.2 → 25.9 mmHg; p = 0.028), but in a 2022 meta-analysis comparing the same data with placebo, the difference was not significant (p = 0.08). Animal data are mixed: CBD eye drops showed opposing effects in mice, lowered pressure or left it unchanged in other mice, and in a study of horses given CBD by mouth with no comparison group, pressure fell. Animal findings do not show the effect in humans. THC's lowering of eye pressure is short-lived and comes with psychoactive effects: in older studies, the fall in eye pressure went hand in hand with a fall in blood pressure and lasted 3–4 hours; a racing heart, a drop in blood pressure on standing up and mental changes were common; all 9 patients with advanced glaucoma stopped treatment within 1–9 months. A single dose of synthetic THC (dronabinol) increased blood flow at the head of the optic nerve without changing eye pressure: at 10 mg in a 23-patient study of glaucoma (5 mg had no effect), and at 5 mg in 24 healthy volunteers; the long-term effect is unknown. In a placebo-controlled study of 120 cancer patients receiving chemotherapy, pressures inside the eye stayed within normal limits after oral THC; an unexpected rise was seen only in the 5 mg group. THC given as eye drops did not lower pressure in three controlled studies, one of them in patients with glaucoma; a drop that turns into THC in the eye was also not clearly different from placebo after two weeks in 56 patients with glaucoma or ocular hypertension (results only in the ClinicalTrials.gov record; no peer-reviewed publication). In a 2026 meta-analysis that pooled THC studies (5 studies, 99 people), the largest drop averaged 14.7%, but in the four studies with a comparison group the difference from control was not significant (6.9%; p = 0.41). The European Glaucoma Society's 2025 guideline (low level of evidence, strong recommendation) and the American Glaucoma Society do not recommend cannabinoids for treating glaucoma; the US National Academies' 2017 report concluded that there is limited evidence that cannabinoids are ineffective in improving the pressure inside the eye in glaucoma. A genetic analysis found no cause-and-effect link between cannabis use and the risk of glaucoma. CBD is not a treatment recommendation for glaucoma. October 2026 search (PubMed, Cochrane, ClinicalTrials.gov, Europe PMC): 12 controlled human studies of cannabinoids in glaucoma or on the pressure inside the eye and optic nerve blood flow were found: 6 in patients with glaucoma or ocular hypertension (one with results only in the ClinicalTrials.gov record; for one, the sources conflict on whether it was placebo-controlled), 5 in healthy volunteers and 1 in cancer patients receiving chemotherapy. Only 1 looked at CBD (6 patients, single dose). There are also 2 uncontrolled studies, 2 systematic reviews and meta-analyses, 1 expert committee report, 2 guidelines or professional society position statements and 2 observational studies; there is no Cochrane review. All that met the criteria, together with 3 animal studies, are in the table below.","kanit_duzeyi_metin":"Insufficient (in a single small study, CBD did not lower pressure; the temporary rise after 40 mg is not significant in the comparison with placebo)","kanit_duzeyi_thc_icerenler":"yetersiz","kanit_duzeyi_thc_icerenler_metin":"Insufficient (THC: drops lasting hours in small, short studies; the longest controlled study lasted 2 weeks and found no clear difference from placebo; no long-term studies; guidelines do not recommend it)","kaynak_dosya":"diger-hastaliklar.md","saf_cbd_sonuc":"There is no human glaucoma study of pure CBD. In the only human study, a CBD-dominant extract derived from cannabis, given under the tongue, did not lower the pressure inside the eye; the temporary rise seen 4 hours after the 40 mg dose was not significant in the comparison with placebo.","thc_icerenler_sonuc":"THC lowered the pressure inside the eye temporarily (for about 4 hours) and brought psychoactive effects; it also caused a drop in blood pressure and a racing heart; in an uncontrolled program, all 9 patients stopped within 1–9 months. THC given as eye drops did not lower pressure; a drop that turns into THC in the eye, used for two weeks by patients with glaucoma, was also not clearly different from placebo (results only in the registry). In the 2026 meta-analysis pooling THC studies, the difference from control was not significant in the studies with a comparison group; the European Glaucoma Society (2025) and the American Glaucoma Society do not recommend it for treating glaucoma. There is no study showing that it keeps pressure low over the long term or slows vision loss.","ruhsat":null,"doz_araligi_ozet":"In humans, a single dose of 20 and 40 mg CBD (6 patients)","titrasyon_ozet":null,"yan_etkiler":["With THC-containing products: increased heart rate, a drop in blood pressure on standing up, a racing heart and mental changes (Crawford and Merritt 1979; Merritt 1980; Cooler and Gregg 1977)"],"izlem":["If someone with glaucoma is going to use CBD, their eye doctor should monitor the pressure inside the eye","THC-containing products can make the pressure inside the eye read low for a few hours; if one was used before an eye exam, the eye doctor should be told"],"dikkat":["The statement 'CBD raises eye pressure in animals' is not correct on its own; the animal data are mixed","CBD is not a treatment recommendation for glaucoma"],"ilac_etkilesim_notlari":[],"dogrulanamayan":["The full texts of studies from the 1970s and 1980s (Flom 1975, Cooler and Gregg 1977, Newell 1979, Crawford and Merritt 1979, Merritt 1980, Merritt 1981, Levitt 1981, Green and Roth 1982, Jay and Green 1983) and of Tomida 2006 could not be read. Details come from the PubMed abstract; participant numbers and design details not in the abstract were taken from the Passani 2020 review. Reviews describe differently whether Merritt 1980 was placebo-controlled (according to one, patients also smoked placebo cigarettes; according to the other, it was a single-arm study). For Tomida 2006, the THC content of the extracts used, the authors' ties to the drug company, and whether the rise after 40 mg of CBD was calculated against baseline or against placebo could not be verified.","The Canadian Ophthalmological Society's position statement on medical marijuana in glaucoma (2010) and its 2019 editorial could not be read because the publisher's site required bot verification. The official assessment text of the American Academy of Ophthalmology on cannabis in glaucoma could not be accessed. The full text of the 2026 meta-analysis (Dhivagaran 2026) could not be read; which 5 studies it pooled is not known.","A small randomized study of smoked cannabis in healthy volunteers (Mosaed 2020; 11 people cannabis, 3 people placebo) is not in PubMed and could not be read because the journal page required a login; according to one review, pressure fell from baseline but there was no consistent difference from placebo. An Israeli registry tracking the pressure inside the eye in medical cannabis users (NCT02080676) has not been updated since 2015 and has no results (October 2026)."],"calismalar":[{"ad":"Tomida 2006","tasarim":"Double-masked, placebo-controlled, 4-arm crossover pilot RCT","n":"6","populasyon":"Ocular hypertension / early glaucoma","urun":"Sublingual THC and CBD extract","urun_turu":"karma","doz":"Single dose: 5 mg THC, 20 mg CBD, 40 mg CBD","titrasyon":null,"sure":"Single dose","sonuc":"2 hours after THC, eye pressure was lower than with placebo (23.5 vs 27.3 mmHg; p = 0.026) and returned to baseline after the 4th hour; CBD did not lower it at any measurement; 4 hours after 40 mg CBD, pressure rose from 23.2 to 25.9 mmHg (p = 0.028; the abstract does not say what it was compared against). Reviews read this trial differently: according to Whiting 2015 (as reported by NASEM 2017), there was no difference in eye pressure between placebo and cannabinoids; according to Bilbao 2022, temporary improvement in the THC arm (p = 0.02) and a non-significant temporary worsening in the CBD arm compared with placebo (p = 0.08)","yan_etki":"A mild panic-like reaction in one patient with THC. According to one review, side effects were seen in 3 patients with THC, 2 with 20 mg CBD, 5 with 40 mg CBD and 2 with placebo; most were mild (mouth discomfort, dizziness, throat irritation), with no serious side effects","pmid":"16988594","doi":"10.1097/01.ijg.0000212260.04488.60","diger_kaynak":null},{"ad":"Miller 2018","tasarim":"Animal (mouse), topical","n":null,"populasyon":"Mouse","urun":"THC, CBD","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"CBD has two opposing effects on eye pressure and blocks the pressure-lowering effect of THC","yan_etki":null,"pmid":"30550613","doi":"10.1167/iovs.18-24838","diger_kaynak":null},{"ad":"Rebibo 2022","tasarim":"Animal (mouse), topical nanoemulsion","n":null,"populasyon":"Mouse","urun":"CBD (0.4–1.6%)","urun_turu":"saf_cbd","doz":null,"titrasyon":null,"sure":"2 weeks","sonuc":"Lowered eye pressure or had no effect on it","yan_etki":null,"pmid":"35245638","doi":"10.1016/j.ijpharm.2022.121627","diger_kaynak":null},{"ad":"Bazzano 2025","tasarim":"Animal (healthy horse), oral; no placebo, compared with the same horses' measurements from the previous day","n":"8","populasyon":"Healthy adult horse (no glaucoma)","urun":"CBD (20% oil)","urun_turu":"saf_cbd","doz":"1 mg/kg","titrasyon":null,"sure":"Single dose, 8 hours of follow-up","sonuc":"Eye pressure fell","yan_etki":null,"pmid":"40435047","doi":"10.1371/journal.pone.0325191","diger_kaynak":null},{"ad":"Crawford and Merritt 1979","tasarim":"Controlled clinical study (compared with placebo)","n":"16","populasyon":"Open-angle glaucoma; 8 patients with normal blood pressure, 8 with high blood pressure","urun":"Inhaled THC (2.8%)","urun_turu":"thc_iceren","doz":"Single inhalation","titrasyon":null,"sure":"Single administration","sonuc":"Eye pressure fell by 6–21 mmHg; in every patient the drop paralleled the drop in blood pressure and lasted 3–4 hours","yan_etki":"Heart rate increase of 20–62 beats/min; systolic pressure drop of 12–52 mmHg","pmid":"468444","doi":null,"diger_kaynak":null},{"ad":"Merritt 1980","tasarim":"Labeled in PubMed as a randomized controlled trial; the abstract does not mention a placebo and the full text could not be read. According to one review, patients smoked marijuana with 2% THC or a placebo cigarette; according to another, it was a single-arm study","n":"18","populasyon":"Various types of glaucoma","urun":"Smoked marijuana","urun_turu":"thc_iceren","doz":"not reported (in the abstract); according to the review, a single cigarette, 900 mg, 2% THC (about 18 mg THC)","titrasyon":null,"sure":"Single administration","sonuc":"Eye pressure and blood pressure fell at 60–90 minutes; the drop in eye pressure followed the drop in blood pressure","yan_etki":"Drop in blood pressure on standing up, tachycardia, palpitations and mental changes, frequent enough to prevent routine use according to the authors","pmid":"7053160","doi":"10.1016/s0161-6420(80)35258-5","diger_kaynak":null},{"ad":"Flach 2002","tasarim":"Uncontrolled, open, non-randomized compassionate-use program","n":"9","populasyon":"Advanced open-angle glaucoma not responding to treatment","urun":"Oral THC capsule or inhaled marijuana (added to existing treatment)","urun_turu":"thc_iceren","doz":"not reported (in the abstract)","titrasyon":null,"sure":"1–9 months","sonuc":"Eye pressure initially fell in all patients, and the target was reached in 4 patients; the drop did not last, and all 9 patients stopped treatment within 1–9 months (tolerance and systemic side effects)","yan_etki":"Marked systemic toxicity according to the author","pmid":"12545695","doi":null,"diger_kaynak":"PMC1358964"},{"ad":"Lindner 2026","tasarim":"Randomized, double-masked, placebo-controlled crossover pilot study","n":"25 enrolled; 23 analyzed (5 mg: 11, 10 mg: 12)","populasyon":"Patients with primary open-angle glaucoma under treatment (mean age 68)","urun":"Oral synthetic THC (dronabinol)","urun_turu":"thc_iceren","doz":"Single dose of 5 or 10 mg","titrasyon":null,"sure":"Single dose (two days)","sonuc":"10 mg increased blood flow at the head of the optic nerve for up to 4 hours (about 11%; p = 0.018 vs placebo); 5 mg had no effect on blood flow. Eye pressure and mean blood pressure did not change. The long-term effect is unknown. Supported by the Austrian Science Fund (FWF)","yan_etki":"Mild to moderate side effects possibly or probably related to the drug in 9 of 25 patients; all resolved the same or the next day. No serious side effects and no stopping because of side effects","pmid":"40772417","doi":"10.1111/aos.17573","diger_kaynak":"ClinicalTrials.gov NCT04596826"},{"ad":"Hommer 2020","tasarim":"Randomized, double-masked, placebo-controlled, two-way crossover RCT (healthy volunteers)","n":"24 (12 women)","populasyon":"Healthy young adults (aged 20–35, Austria); no glaucoma","urun":"Oral synthetic THC (dronabinol) capsule","urun_turu":"thc_iceren","doz":"Single dose 5 mg","titrasyon":null,"sure":"Single dose (two separate days)","sonuc":"Primary outcome: blood flow at the head of the optic nerve at rest rose by 9.5 ± 8.1% 1 hour after dronabinol and did not change with placebo (0.3 ± 7.4%; p < 0.001 between days). Eye pressure, blood pressure and ocular perfusion pressure did not change; the regulation that keeps blood flow steady when pressure rises with exercise (autoregulation) also did not change. In healthy volunteers, not in patients with glaucoma; the long-term effect is unknown. Supported by the Austrian Science Fund (FWF); no conflicts of interest were reported","yan_etki":"No side effects or psychoactive effects reported; heart rate did not change","pmid":"31977076","doi":"10.1002/cpt.1797","diger_kaynak":"Most likely ClinicalTrials.gov NCT03907163 (same institution, design, number of people and primary outcome; no registration number in the paper; no results in the registry). The same group's paper measuring retinal blood flow with the same design (24 healthy volunteers, 5 mg): Hommer 2021, J Ocul Pharmacol Ther (PMID 33999707): total retinal blood flow rose from 38.9 to 40.7 µL/min (p < 0.001) and did not change with placebo; whether it is from the same trial could not be verified"},{"ad":"Merritt 1981","tasarim":"Randomized, balanced, double-masked controlled study (abstract); according to the review, THC in one eye and vehicle oil alone in the other","n":"6","populasyon":"Primary open-angle glaucoma","urun":"THC eye drops (in light mineral oil)","urun_turu":"thc_iceren","doz":"0.05% and 0.1% THC drops","titrasyon":null,"sure":"not reported (in the abstract); single drop according to the review","sonuc":"THC given as eye drops did not lower eye pressure at either concentration. The authors note that smoked or oral THC lowers pressure but comes with a marked drop in systolic blood pressure","yan_etki":"not reported (in the abstract)","pmid":"6271841","doi":"10.1002/j.1552-4604.1981.tb02626.x","diger_kaynak":"The same group's second THC eye drop study in 8 patients: Merritt 1981, J Pharm Pharmacol 33:40–41 (PMID 6114151); no abstract, could not be read; no difference from placebo according to the Passani 2020 review"},{"ad":"Jay and Green 1983","tasarim":"Randomized, vehicle oil-controlled study (healthy volunteers)","n":"28 men randomized; 23 completed","populasyon":"Healthy male volunteers; no glaucoma","urun":"1% THC eye drops (in light mineral oil) or vehicle oil alone","urun_turu":"thc_iceren","doz":"1% THC drops, four times a day","titrasyon":null,"sure":"1 week (four times a day)","sonuc":"In the 23 people who completed, there was no difference in eye pressure between eyes receiving THC drops and controls","yan_etki":"5 people stopped because of burning and eyelid swelling; 4 of them were using the vehicle oil alone","pmid":"6301412","doi":"10.1001/archopht.1983.01040010591012","diger_kaynak":null},{"ad":"Green and Roth 1982","tasarim":"Randomized, vehicle oil-controlled study (applied to one eye; healthy volunteers)","n":"not reported (in the abstract); 16 according to the Passani 2020 review","populasyon":"Healthy paid volunteers; no glaucoma","urun":"THC eye drops (in light mineral oil) or vehicle oil alone","urun_turu":"thc_iceren","doz":"Single drop (concentration not in the abstract; 1% according to the review)","titrasyon":null,"sure":"Single drop","sonuc":"There was no drop in eye pressure. A small (1 mm) pupil dilation was seen in both eyes, not related to the drug","yan_etki":"Mild eye redness, mild burning or watering lasting less than 60 minutes; similar with the drug and the vehicle","pmid":"6279061","doi":"10.1001/archopht.1982.01030030267006","diger_kaynak":null},{"ad":"Flom 1975","tasarim":"Controlled clinical study (PubMed publication type); double-blind with placebo cigarettes according to the review","n":"not reported (in the abstract); 15 according to the Passani 2020 review","populasyon":"Volunteers with normal eye pressure (marijuana users with different frequencies of use)","urun":"Smoked marijuana","urun_turu":"thc_iceren","doz":"Single cigarette, 12 mg THC","titrasyon":null,"sure":"Single cigarette","sonuc":"Eye pressure fell only in light-to-moderate users who felt a marked high and relaxation from the experimental dose; the authors suggested this might be an indirect effect due to relaxation rather than a direct effect of the drug. According to the review, the drop was significant only at minute 80 (an average of 2.1 mmHg from 14.6 mmHg) and was small or absent in frequent users","yan_etki":"not reported (in the abstract)","pmid":"1089090","doi":null,"diger_kaynak":null},{"ad":"Cooler and Gregg 1977","tasarim":"Controlled clinical study (compared with placebo and diazepam; randomized according to the review)","n":"10","populasyon":"People with normal eye pressure","urun":"Intravenous THC","urun_turu":"thc_iceren","doz":"Single dose 0.022 or 0.044 mg/kg","titrasyon":null,"sure":"Single administration","sonuc":"Eye pressure fell by up to 51% from baseline, 37% on average (according to the review, 29% at the low dose and 37% at the high dose; 2% with placebo, 10% with diazepam). Heart rate rose 22–65% above resting values; anxiety increased with THC compared with placebo and diazepam; no pain-relieving effect was seen. In people without glaucoma; intravenous administration is not a route used in treatment","yan_etki":"22–65% rise in heart rate, increased anxiety; according to the review, marked drops in blood pressure and feeling faint in 3 people","pmid":"329423","doi":"10.1097/00007611-197708000-00016","diger_kaynak":null},{"ad":"NCT06144918 (SBI-100 eye drops, registry results)","tasarim":"Multicenter, double-masked, placebo-controlled, randomized parallel phase 2 study; results only in the registry (no peer-reviewed publication); sponsor is the drug's developer (Skye Bioscience)","n":"56 randomized (19 / 19 / 18); all completed","populasyon":"Adults with primary open-angle glaucoma or ocular hypertension (eye pressure 21–36 mmHg; 42 of the 56 people were 65 or older)","urun":"SBI-100 emulsion eye drops (a synthetic THC prodrug that turns into THC in the eye) or placebo drops without the active ingredient","urun_turu":"thc_iceren","doz":"0.5% or 1%, 1 drop in each eye twice a day","titrasyon":null,"sure":"14 days","sonuc":"Primary outcome (change in eye pressure from baseline at day 14, least squares mean): −1.99 mmHg with 0.5%, −1.12 mmHg with 1%, −0.83 mmHg with placebo; that is, only 0.3–1.2 mmHg more drop than with placebo, and less at the higher dose. No statistical test in the registry; according to the company's June 2024 announcement, a significant drop compared with placebo was not achieved and development of the drug was stopped","yan_etki":"No serious side effects; non-serious side effects in 14 of 19 patients in the 0.5% group, 19 of 19 in the 1% group and 8 of 18 with placebo (most common burning and stinging on instillation); vivid dreams in one patient in the 0.5% group","pmid":null,"doi":null,"diger_kaynak":"ClinicalTrials.gov NCT06144918 (SBI-100-201; November 2023–February 2024; results in the registry, January 14, 2026; no publication in PubMed as of October 2026)"},{"ad":"Levitt 1981","tasarim":"Randomized controlled study (6 arms: no treatment, placebo, prochlorperazine, 3 THC doses); main aim chemotherapy nausea, with eye pressure as a physiological measure","n":"120 randomized (number per arm not in the abstract)","populasyon":"Cancer patients about to receive potentially nausea-causing chemotherapy for the first time; no glaucoma","urun":"Oral THC","urun_turu":"thc_iceren","doz":"5, 10 or 15 mg THC, 4 times 4 hours apart (starting 2 hours before chemotherapy)","titrasyon":null,"sure":"1 day (4 doses 4 hours apart)","sonuc":"All eye pressures stayed within normal limits before and after treatment; the abstract reports no drop in pressure with THC; on the contrary, an unexpected, statistically significant rise was seen in the 5 mg THC group (the numbers and what the comparison was made against are not in the abstract). Full text could not be read","yan_etki":"According to the abstract, no marked physiological side effects were seen in patients (blood pressure and lung function were also measured)","pmid":"6271814","doi":"10.1002/j.1552-4604.1981.tb02583.x","diger_kaynak":null},{"ad":"Newell 1979","tasarim":"Uncontrolled clinical study (no comparison group in the abstract); plus a rabbit experiment","n":"not reported (in the abstract); 18 according to the Passani 2020 review (14 open-angle glaucoma, 4 ocular hypertension)","populasyon":"Open-angle glaucoma","urun":"Oral nabilone (a synthetic THC-like cannabinoid)","urun_turu":"cbn_diger","doz":"Single dose 0.5–2 mg","titrasyon":null,"sure":"Single dose (3 weeks in one patient, according to the review)","sonuc":"Eye pressure fell by 10–54%, 28% on average. In rabbits, nabilone given as eye drops lowered pressure, which returned to baseline in 3 hours, and tolerance developed within a week. No control group; the only human data with nabilone in glaucoma","yan_etki":"not reported (in the abstract); few and self-limiting according to the review","pmid":"530560","doi":"10.1016/s0161-6420(79)35539-7","diger_kaynak":null},{"ad":"Dhivagaran 2026","tasarim":"Systematic review and meta-analysis (PROSPERO CRD420251007916; MEDLINE, EMBASE, Web of Science; random-effects model)","n":"5 studies; 99 people (69 received THC)","populasyon":"Studies reporting the drop in eye pressure after THC","urun":"THC (intravenous, oral, eye drops)","urun_turu":"thc_iceren","doz":null,"titrasyon":null,"sure":"not reported (in the abstract)","sonuc":"The largest drop in eye pressure after THC averaged 14.7% (95% CI 3.4–25.9). By route: intravenous 33.3% (95% CI 20.4–46.2); oral 10.7% (−7.6 to 28.9) and eye drops 9.4% (−8.9 to 27.6), not significant. In the 4 studies with a comparison group, the drop after THC (6.9%; 95% CI −9.6 to 23.3; p = 0.41) was not different from control. Because the full text could not be read, which 5 studies were pooled is not known","yan_etki":null,"pmid":"42069343","doi":"10.1016/j.jcjo.2026.04.003","diger_kaynak":null},{"ad":"Bilbao 2022","tasarim":"Systematic review and meta-analysis (PROSPERO CRD42021229932; RCTs of dronabinol, nabilone, CBD and nabiximols in 22 conditions; GRADE)","n":"152 RCTs (12,123 people); 1 RCT in glaucoma (6 people)","populasyon":"All medical indications; the glaucoma section covers ocular hypertension or early glaucoma","urun":"Dronabinol, nabilone, CBD, nabiximols","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"In glaucoma, only a single small crossover RCT (Tomida 2006) was found: temporary improvement in the THC arm, which the review classed as dronabinol (SMD −1.28; 95% CI −2.36 to −0.20; p = 0.02); a non-significant temporary worsening in the arm the review classed as 'CBD containing a small amount of THC' (p = 0.08). Because there was only one study, the evidence in glaucoma was not graded. No conflicts of interest were reported","yan_etki":null,"pmid":"35982439","doi":"10.1186/s12916-022-02459-1","diger_kaynak":null},{"ad":"NASEM 2017 (US National Academies report)","tasarim":"Expert committee report (assessment based on good-quality systematic reviews and later primary studies)","n":"In glaucoma, 1 good-quality systematic review (Whiting 2015), which itself contained a single RCT (6 people)","populasyon":"Glaucoma","urun":"Cannabinoids (sublingual THC and CBD)","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"In the single crossover RCT found by Whiting 2015 (Tomida 2006), no difference was found in eye pressure between placebo and cannabinoids. Studies reporting positive results showed only drops lasting hours. The committee's conclusion (4-14): there is limited evidence that cannabinoids are ineffective in improving glaucoma-related eye pressure","yan_etki":null,"pmid":"28182367","doi":"10.17226/24625","diger_kaynak":"NCBI Bookshelf NBK423845; source of the glaucoma finding Whiting 2015, JAMA 313:2456–2473 (PMID 26103030)"},{"ad":"EGS 2025 (European Glaucoma Society guideline)","tasarim":"Clinical guideline, 6th edition (evidence-based questions; level of evidence and strength of recommendation stated)","n":null,"populasyon":"Glaucoma and ocular hypertension","urun":"Cannabinoids","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"There is no evidence supporting a place for cannabinoids, acupuncture or other alternative therapies in treating glaucoma (low level of evidence, strong recommendation). The treatment section also states that there is no evidence that nutritional supplements or cannabinoids have a place in glaucoma (based on Whiting 2015)","yan_etki":null,"pmid":"41026937","doi":"10.1136/bjophthalmol-2025-egsguidelines","diger_kaynak":"Br J Ophthalmol 2025;109(Suppl 1)"},{"ad":"Jampel 2010 (American Glaucoma Society position)","tasarim":"Professional society position statement (approved by the board of directors on October 23, 2009; author H. Jampel)","n":null,"populasyon":"Glaucoma","urun":"Marijuana and THC (smoked, oral, sublingual, eye drops)","urun_turu":"thc_iceren","doz":null,"titrasyon":null,"sure":null,"sonuc":"Although marijuana lowers eye pressure, the effect lasts 3–4 hours (keeping it low all day would require smoking every 3 hours) and it affects mood and attention; 9 of 9 patients using oral THC or marijuana stopped within 9 months because of side effects; drops cannot get into the eye in sufficient amounts; lowering blood pressure may reduce blood flow to the optic nerve and cause harm. Because of its side effects, short duration of action and the lack of evidence that it changes the course of glaucoma, it is not recommended in any form","yan_etki":null,"pmid":"20160576","doi":"10.1097/IJG.0b013e3181d12e39","diger_kaynak":"Text on the society's website (americanglaucomasociety.net/about/statements; read on October 28, 2026)"},{"ad":"Katsimpris 2023 (Mendelian randomization)","tasarim":"Two-sample Mendelian randomization (an analysis that uses genetic predisposition like a natural experiment)","n":"Lifetime cannabis use GWAS 184,765 people; cannabis use disorder 17,068 cases and 357,219 controls; glaucoma GWAS 16,677 cases and 199,580 controls","populasyon":"Adults of European ancestry (genetic databases)","urun":"Cannabis use (genetic predisposition)","urun_turu":"thc_iceren","doz":null,"titrasyon":null,"sure":null,"sonuc":"No cause-and-effect link was found between cannabis use and primary open-angle glaucoma: OR 1.04 for lifetime use (95% CI 0.88–1.23), OR 0.97 for cannabis use disorder (0.92–1.03). Sensitivity analyses pointed the same way. The genetic markers used explain only a very small part of the variation in cannabis use (0.08–0.09%)","yan_etki":null,"pmid":"37949880","doi":"10.1038/s41598-023-45872-z","diger_kaynak":"Preprint: Research Square (Europe PMC PPR585420)"},{"ad":"Lehrer 2022 (UK Biobank)","tasarim":"Cross-sectional analysis (UK Biobank)","n":"815 people with glaucoma and cannabis information; the paper gives two different numbers for the eye pressure analysis (38,816 and 29,388)","populasyon":"Middle-aged adults in the UK (mean age 56)","urun":"Cannabis use (self-reported)","urun_turu":"thc_iceren","doz":null,"titrasyon":null,"sure":null,"sonuc":"After accounting for age and smoking, cannabis use was not linked with primary open-angle glaucoma (OR 1.03; 95% CI 0.91–1.17; p = 0.66). In those who had used it 100 times or more, glaucoma had been diagnosed on average 10 years younger than in those who had never used it (p = 0.05). Eye pressure was lower in those who had used it 11–100 times. Participants had not used it for an average of 24 years; based on one-time information and simple analyses, it does not show cause and effect","yan_etki":null,"pmid":"35093258","doi":"10.1016/j.jfo.2021.12.012","diger_kaynak":null}],"son_inceleme":"2026-10-28","arastirma_gecmisi":[{"tarih":"2026-10-19","not":"Page published. This first review examined 4 studies."},{"tarih":"2026-10-22","not":"The names of the finding labels were simplified: on this page, the \"Possible harm\" label became \"May be harmful\". The assessment did not change."},{"tarih":"2026-10-27","not":"We clarified that the CBD in the human study was not pure but a CBD-dominant extract derived from cannabis; added that the horse study had no placebo; added four THC studies to the table; and corrected the year of one source. The finding and the strength of evidence did not change."},{"tarih":"2026-10-28","not":"The October 2026 search added 16 sources: two controlled studies of THC eye drops in patients with glaucoma or ocular hypertension (one of them the 2-week study of a new drop that turns into THC in the eye in 56 patients, with results only on ClinicalTrials.gov); studies of smoked, intravenous and oral THC and of THC eye drops in healthy volunteers, and an RCT measuring optic nerve blood flow; a placebo-controlled study of oral THC in cancer patients receiving chemotherapy that also measured the pressure inside the eye; an uncontrolled study with nabilone; two systematic reviews and meta-analyses; the US National Academies report; the European Glaucoma Society guideline and the American Glaucoma Society position statement; and two observational studies on cannabis use and glaucoma risk. The Tomida 2006, Lindner 2026 and Merritt 1980 rows were corrected from the primary source; we added that the temporary pressure rise seen after 40 mg of CBD in the single human study was not significant in sources that re-analyzed this study against placebo; we noted in the 'fell in horses' sentence that the study had no placebo; and the THC findings and search counts were worked into the text. The finding and the strength of evidence did not change."},{"tarih":"2026-10-28","not":"The finding label changed from 'May be harmful' to 'No effect found'; the strength of evidence stayed 'Insufficient'. The label had been based on the temporary pressure rise seen 4 hours after 40 mg of CBD in the single human study (Tomida 2006, 6 patients, single dose). In the October 2026 search, sources that re-analyzed this study against placebo (Bilbao 2022, NASEM 2017) found no significant difference between CBD and placebo; in most animal studies, CBD also did not raise pressure. Nor has CBD been shown to lower eye pressure. Because the evidence rests on a single, very small study, it is 'Insufficient'."},{"tarih":"2026-10-31","not":"The last sentence of the page's short summary was rewritten in a calmer, more guiding tone: instead of \"Talk to your doctor before you start.\", it now says whom you can talk with, and about what, if you are considering CBD. The conclusion and the strength of evidence did not change."}]},{"id":"dementia-alzheimers","baslik":"Behavioral symptoms in dementia and Alzheimer’s disease (agitation, aggression)","grup":"Other","grup_kodu":"diger","tr_id":"demans-alzheimer","kanit_duzeyi":"cok_zayif","kanit_yonu":"veri_yok","kanit_ozet":"Controlled studies with cannabinoids for behavioral symptoms in dementia (agitation, aggression) are small (15–75 people), short (2 weeks to 6 months) and contradict each other. There are only two RCTs with pure CBD: in vascular dementia, a 30-person study with 300 mg of CBD a day showing borderline superiority over placebo on the NPI and BPRS (three of the eight authors are inventors on CBD-related patents), and in Alzheimer’s, a 15-person feasibility study with up to 600 mg of CBD a day that did not test efficacy (dizziness 63%). With CBD-rich products that also contain THC, the results point both ways: in a 60-person, manufacturer-supported RCT with an oil reaching an average of 528 mg of CBD and 22 mg of THC a day, agitation response was 60% vs. 30% (p = 0.06 with the continuity correction prespecified in the statistical plan; all dropouts in the treatment group; memory loss and hallucinations numerically more common); with a THC:CBD 1:2 oil (25 people, crossover), a mouth spray containing THC and CBD (29 people, feasibility) and a THC:CBD 3:2 oil (21 people, crossover), no difference on behavioral measures (in the last, a reduction in agitation only at the end of treatment); in a 28-person study with a very low-dose THC-CBD extract, only the MMSE favored the drug. THC and nabilone: two RCTs with a low-dose THC tablet were negative; in a 75-person multicenter RCT with dronabinol, only one of two co-primary measures was positive; in a 39-person crossover RCT with nabilone, agitation went down and sedation went up (45% vs. 16%); a very small 1997 dronabinol study with 15 Alzheimer’s patients who refused to eat reported positive signs for weight and behavior. Studies without a comparison group (19–60 people) reported marked improvement; these designs cannot separate out the effect of expectation and of improvement that happens on its own over time, and the same team’s later controlled study (Geneva) did not confirm the positive observation. Cochrane 2021 (4 RCTs, 126 people) wrote that it cannot be said with confidence whether there is benefit or harm, with low certainty for behavioral symptoms and very low certainty for cognition. Three meta-analyses in 2026 reached different conclusions: one found no effect (9 RCTs; moderate certainty for behavior), one found a significant reduction in agitation only when studies at high risk of bias were included (10 RCTs), and the third, limited to Alzheimer’s, found a small to moderate benefit (6 RCTs and 1 open-label study); in all three, sleepiness was about twice as common (RR 2.03–2.25). The 2025 guideline of the Canadian Coalition for Seniors’ Mental Health gives synthetic cannabinoids a conditional place, based on low-quality evidence, in severe agitation that has not responded to other medicines (the guideline authors include two investigators from the nabilone study in the table); the 2026 assessment by Canada’s Drug Agency found the nabilone evidence uncertain; the Brazilian Academy of Neurology (2021) does not recommend use in dementia; cannabinoids are not included in the Korean (2025) and Taiwanese (2026) guidelines or in the recommendations of Canada’s 5th consensus conference on dementia (2020). There is no human study with published results that used a cannabinoid to prevent or slow dementia; in large observational studies, having used cannabis was not significantly linked to cognitive decline, and cannabis use disorder was not significantly linked to dementia risk (UK Biobank, US veterans; no causality in Mendelian randomization), but middle-aged and older adults who received emergency care because of cannabis were diagnosed with dementia more often over the next 5 years (Ontario; observational). October 2026 search (PubMed, Cochrane, ClinicalTrials.gov): on this topic we found 12 randomized controlled studies with cannabinoids (the largest 75 people; only 2 small studies with pure CBD), 1 non-randomized controlled study, 5 studies without a comparison group, 2 large observational studies looking at dementia risk, 6 systematic reviews (2 of them Cochrane, 1 a safety review in older adults), 1 guideline, 1 position paper and 1 health technology assessment; all are in the table below. 3 controlled studies that were completed but whose results have not been released, and ongoing trials, are listed under “unverified”; open-label studies with fewer than 15 people, case reports, a crossover study completed with only 2 patients, and a 24-person study that did not report the dronabinol result separately were not included in the table.","kanit_duzeyi_metin":"Very weak: there are only two small RCTs with pure CBD (30 and 15 people, 4–6 weeks); one is borderline positive and three of its authors are inventors on CBD-related patents, the other is a feasibility study that did not test efficacy; there is one non-randomized 20-person comparison with CBD drops of unknown THC content. Results for products rich in CBD but also containing THC were assessed under the THC evidence","kanit_duzeyi_thc_icerenler":"zayif","kanit_duzeyi_thc_icerenler_metin":"Weak: 10 small, short controlled studies with THC-containing products and nabilone (the largest 75 people, 3 weeks), with conflicting results; certainty low to very low according to Cochrane; the most consistent finding is that sleepiness was about twice as common","kaynak_dosya":null,"saf_cbd_sonuc":"There are only two small controlled studies with pure CBD: in 30 people with vascular dementia, 300 mg of CBD a day for four weeks reduced behavioral symptoms slightly more than placebo (right at the edge of statistical significance; three of the eight authors among the inventors on two CBD-related patents); a six-week pilot study with 15 Alzheimer’s patients (up to 600 mg a day) was not designed to test whether it works, and dizziness was common. A 20-person study that did not assign people to groups by chance reported improvement with CBD drops; whether the product contained THC is not stated. As of October 2026, several controlled studies with pure CBD are under way. The strength of evidence is very weak.","thc_icerenler_sonuc":"The results of 10 small controlled studies with THC-containing products and with the THC-like synthetic drug nabilone are conflicting. Two studies with a low-dose THC tablet (50 and 22 people) found no difference; in a 75-person multicenter study with dronabinol, benefit was seen on only one of the two main scales (there were differences between the groups at the start); in a 39-person crossover study with nabilone, agitation went down and sleepiness went up. In a 60-person study with an oil rich in CBD but reaching an average of 22 mg of THC a day, agitation went down, but with the statistical correction the authors had set in advance the difference on the main measure was borderline (p = 0.06), and everyone who dropped out was in the treatment group; four studies with oils, sprays and extracts containing THC and CBD found no clear difference in agitation (in one, a reduction only at the end of treatment). The Cochrane review rated the certainty of the evidence low or very low; three meta-analyses in 2026 reached different conclusions, and in all of them sleepiness was about twice as common. Canada’s 2025 guideline lists synthetic cannabinoids such as nabilone among the last options for severe agitation that has not responded to other treatments, as a conditional recommendation based on low-quality evidence; the 2026 assessment by Canada’s Drug Agency, however, found the benefit of nabilone uncertain because it rests on a single small study.","ruhsat":null,"doz_araligi_ozet":"Pure CBD 300 mg/day and from 200 mg up to 600 mg/day; CBD-rich oil avg. ~528 mg CBD + 22 mg THC/day; THC:CBD 1:2 oil at most 20 mg THC + 40 mg CBD/day; THC:CBD mouth spray at most 10.8 mg THC + 10 mg CBD/day; THC:CBD 3:2 oil at most 50 mg THC/day (protocol); very low-dose extract 0.35 mg THC + 0.245 mg CBD/day; dronabinol 2.5–10 mg/day; low-dose THC tablet 1.5–4.5 mg/day; nabilone 0.5–2 mg/day","titrasyon_ozet":"In most studies, treatment started at a low dose and was raised to the target dose over 1–6 weeks (over 15 days with the THC:CBD 1:2 oil; with the CBD-rich oil, by adding one drop every two days over at most 6 weeks; with dronabinol, 5 mg in week 1, then 10 mg/day); these are research protocols","yan_etkiler":["Sleepiness about twice as common with cannabinoids: RR 2.03 (Tudella 2026), 2.09 (Pan 2026), 2.25 (da Silva 2026); with nabilone 45% vs. 16% (Herrmann 2019)","With the CBD-rich, THC-containing oil: memory loss 32% vs. 10%, hallucinations 22% vs. 5%, sleepiness 49% vs. 30%; all 8 patients who dropped out were in the treatment group (Hermush 2022)","With pure CBD (up to 600 mg a day): dizziness 63% vs. 0% (8 and 7 people); falls 25% vs. 43%; raised liver enzymes (Velayudhan 2024, CANBiS-AD)","With dronabinol: serious events 2 vs. 0 (delirium, broken arm bone), diarrhea 5 vs. 0, falls 3 vs. 5 (NCT02792257 registry results; Rosenberg 2026)","With the low-dose THC tablet, body sway with the eyes closed increased; no falls (Ahmed 2015; van den Elsen 2017)","46 RCTs in people over 50: THC alone (IRR 1.42) and THC:CBD (IRR 1.58) increased all side effects, while pure CBD did not (IRR 1.02) (Velayudhan 2021)"],"izlem":["If a cannabinoid is used in a person with dementia, sleepiness, falls, confusion, blood pressure and appetite should be monitored with the doctor","With high-dose or long-term CBD use, liver tests are the doctor’s decision (raised liver enzymes were reported with up to 600 mg of pure CBD a day; Velayudhan 2024)","If other medicines are taken, drug interactions should be assessed with the pharmacist and doctor"],"dikkat":["Sleepiness and falls: in three meta-analyses pooling dementia studies, sleepiness was about twice as common with cannabinoids (Tudella 2026, Pan 2026, da Silva 2026); in the dronabinol study, a broken arm bone and an episode of sudden confusion (delirium) were recorded as serious events in the treatment group, while the number of falls was similar in the two groups (3 vs. 5 people; NCT02792257 registry results)","THC, memory and hallucinations: with the CBD-rich oil that reached an average of 22 mg of THC a day, memory loss (32% vs. 10%) and hallucinations (22% vs. 5%) were numerically more common; the difference was right at the edge of statistical significance (Hermush 2022)","Labeling: a 94-year-old woman whose family gave her a product sold as “pure CBD” developed THC-related confusion and hallucinations (case report; Moussa 2023, PMID 37223146)","High-dose pure CBD: with up to 600 mg of CBD a day, dizziness (63%) and raised liver enzymes were seen (Velayudhan 2024, CANBiS-AD)","Blood pressure: blood pressure changes beyond the protocol limit were recorded more often during the period on the oil containing THC and CBD than during the placebo period (71 vs. 28 events; about half were drops and half were rises in blood pressure, average values did not change in either period, and no statistical test was done; Bianchi 2026)","Psychiatric medicines: most patients in the studies continued their antidepressants, antipsychotics or sedatives; it has not been shown that cannabinoids can replace these medicines. In one controlled study, the use of sedatives given as needed went down (Bianchi 2026)"],"ilac_etkilesim_notlari":["In 15 patients with severe dementia who used an oil containing THC and CBD for months, the activity of the enzymes CYP1A2 and CYP2C19 was slightly reduced; these enzymes help break down certain medicines in the body (Pautex 2022)","In a controlled study with an oil containing THC and CBD for 8 weeks in patients with severe dementia taking many medicines, no problem due to drug interactions was reported (Bianchi 2026)","Dementia studies did not systematically examine interactions with antidepressants, antipsychotics and sedatives; details are in the site’s Drug interactions section (antidepressants, antipsychotics and lithium, anxiety and sleep medicines)"],"dogrulanamayan":["Full text could not be read (October 28, 2026): van den Elsen 2015b and 2017, Herrmann 2019, Rosenberg 2026 (full text under publisher embargo until November 10, 2026; only the abstract and ClinicalTrials.gov results), Timler 2023 (abstract and protocol), Cury 2025 (abstract and a commentary), Pessoa 2026, Volicer 1997, Alexandri 2024, Woodward 2014, Sawicki 2023, Palmieri 2023, the 2009 Cochrane review and the three meta-analyses from 2026 (abstract only). Details of Volicer 1997 were taken from the tables of systematic reviews; its dose is given differently across reviews, and according to the study table of the 2021 Cochrane review it was 2.5 mg in the morning and at noon (5 mg a day).","Controlled studies completed but with no results released as of October 2026: NCT06570928 (Brazil; 0.2 mL a day of an oil containing 50 mg of CBD and 5 mg of THC per mL, that is, 10 mg of CBD and 1 mg of THC; main measure a mental test; 72 people with Alzheimer’s; finished in March 2025), NCT05644262 (US; oil containing THC and CBD; agitation in 120 people with dementia in the last stage of life who were eligible for hospice care; finished in April 2026), NCT04749563 (IGC-AD1 containing low-dose THC; 12-person safety study; 2021). Stopped early: NCT05742698 (nabilone in frontotemporal dementia; only 3 people randomized, terminated), NCT06217146 (cannabis oil; only the open-label first part was completed). Status unknown: NCT05239390 (SCI-110 containing dronabinol), NCT05022186 (CBD in mild cognitive impairment), NCT06514066 (CBD in vascular and mixed dementia).","Ongoing or not yet started studies (October 28, 2026): NAB-IT NCT04516057 (nabilone for agitation in Alzheimer’s, phase 3, estimated April 2027), NCT05543681 (IGC-AD1 containing low-dose THC, 164 people, estimated November 2026), NCT05822362 (CBD in mild cognitive impairment, 236 people, estimated 2029), CALM-IT NCT06014424 (CBD for agitation, 40 people, estimated December 2026), NCT04436081 (THC-free CBD oil, 40 people; registry entry not updated since 2023), NCT04075435 (CBD-rich solution with low THC, open-label, 12 people), NCT07422311 (dronabinol, 140 people, not yet started), NCT07091747 (open-label extension of NCT06570928, 61 people). Those without a registration number found or listed in other registries: pure CBD in early-stage dementia in Australia (ACTRN12621001364864; protocol Bartschi 2023) and a mouth spray containing THC and CBD for pain and agitation in severe dementia in Italy (protocol Scuteri 2022).","The dementia chapter of the 2017 US National Academies report and the full text of Canada’s Drug Agency 2026 report could not be read because NCBI Bookshelf required bot verification; only the summary of the latter was used.","The status of dronabinol and nabilone in Turkey was read from two lists of TİTCK (Turkish Medicines and Medical Devices Agency): the List of Licensed Medicinal Products for Human Use (October 16, 2026) and the List of Active Substances from Abroad (September 28, 2026), both downloaded on October 29, 2026. Whether a drug that is not on the list could be brought in some other way was not investigated in this review; because no current version of the Turkish Pharmacists' Association's list of medicines from abroad could be found, that list was not searched."],"calismalar":[{"ad":"Rosenberg 2026 (THC-AD)","tasarim":"Phase 2, multicenter (5 centers), double-blind, placebo-controlled parallel RCT","n":"75 randomized (37/38); 63 completed","populasyon":"Agitation due to Alzheimer’s disease (IPA criteria; NPI-C agitation/aggression ≥4), severe cognitive impairment; most were taking an antidepressant or antipsychotic (US)","urun":"Dronabinol (synthetic THC) capsule, added to existing treatment","urun_turu":"thc_iceren","doz":"Week 1: 2.5 mg twice a day (5 mg/day); weeks 2–3: 5 mg twice a day (10 mg/day)","titrasyon":"To 10 mg/day within 1 week","sure":"3 weeks","sonuc":"On one co-primary outcome, the Pittsburgh Agitation Scale (PAS), the weekly decline was greater than with placebo (slope difference −0.74; 95% CI −1.33 to −0.15; p = 0.015); on the other co-primary outcome, NPI-C agitation/aggression, the difference was not significant (−1.26; 95% CI −2.73 to 0.21; p = 0.094); the abstract nonetheless reports a “clinically meaningful” reduction on both measures. No difference on any secondary outcome (sleep, activities of daily living, CMAI, cognition, intoxication, as-needed lorazepam or trazodone use). At baseline, PAS was higher in the dronabinol group (7.1 vs. 5.6; at week 3, 4.0 vs. 5.1) and fewer were taking antidepressants (7 of 37 people vs. 25 of 38; baseline table in the registry). Supported by the US National Institute on Aging (NIA); one of the 22 authors declares consulting or advisory board roles with cannabinoid companies (Charlotte's Web, Jazz, Syqe)","yan_etki":"According to the abstract, no difference in side effects other than sleepiness. In the registry results: serious side effects 2 vs. 0 (delirium, broken arm bone), diarrhea 5 vs. 0, falls 3 vs. 5, sleepiness reported as a side effect 2 vs. 5; no difference in the number of side effects (event rate ratio 1.14; 95% CI 0.73–1.79; p = 0.57)","pmid":"41350162","doi":"10.1016/j.jagp.2025.10.011","diger_kaynak":"ClinicalTrials.gov NCT02792257 (results in the registry, May 9, 2025; 84 participants in the registry, 75 randomized in the publication); design and baseline data: Cohen 2024 (PMID 34629131); editorial: Tampi 2026 (PMID 41350163)"},{"ad":"Hermush 2022","tasarim":"Single-center, double-blind, placebo-controlled parallel RCT (2:1)","n":"60 started treatment (40/20; 64 randomized, 4 withdrew immediately); 52 completed","populasyon":"Major neurocognitive disorder with behavioral disturbance (all types of dementia; NPI-NH agitation ≥3, MMSE <26), aged ≥60; mostly at home under 24-hour supervision (Israel)","urun":"Avidekel: broad-spectrum cannabis oil, sublingual drops (30% CBD, 1% THC; 295 mg CBD + 12.5 mg THC per mL; 11.8 mg CBD + 0.5 mg THC per drop; also CBC, CBG, CBDV; contains THC)","urun_turu":"thc_iceren","doz":"Avg. 527.5 mg CBD + 22.3 mg THC/day (3 times a day)","titrasyon":"Started at 1 drop per dose, 3 times a day; increased by 1 drop per dose every two days up to at most 21 drops/dose; at most 6 weeks","sure":"16 weeks (dose adjustment for up to 6 weeks, then fixed dose)","sonuc":"On the primary outcome (≥4-point drop in CMAI at week 16), 60% vs. 30% (χ² p = 0.03; p = 0.06 with the continuity correction prespecified in the statistical plan; in the 52 completers 69% vs. 30%, p = 0.01 with correction); ≥8-point drop 50% vs. 15% (p = 0.011); CMAI drop 10.7 vs. 2.5 points (p = 0.03). Data from dropouts were analyzed by carrying the last measurement forward (LOCF). On the NPI-NH, agitation/aggression and sleep disturbance were lower in the treatment group; no difference on the MMSE. The intention-to-treat analysis had 60% power; funded by the company that owns the product; two of the 9 authors are company employees (with share options), and one is the inventor on a patent for this use","yan_etki":"All 8 patients who dropped out were in the treatment group (not because of side effects, according to the authors); memory loss 32% vs. 10% (p = 0.06), hallucinations 22% vs. 5% (p = 0.08), sleepiness 49% vs. 30% (p = 0.17), confusion 46% vs. 30%; serious events 9 vs. 4; 2 deaths in the treatment group (investigators did not find them related to the product)","pmid":"36148467","doi":"10.3389/fmed.2022.951889","diger_kaynak":"ClinicalTrials.gov NCT03328676 (no results in the registry)"},{"ad":"van den Elsen 2015a","tasarim":"Phase 2, multicenter, double-blind, placebo-controlled parallel RCT","n":"50 (24/26)","populasyon":"Dementia with clinically relevant neuropsychiatric symptoms (Alzheimer’s, vascular or mixed; Netherlands)","urun":"THC tablet (Namisol)","urun_turu":"thc_iceren","doz":"1.5 mg 3 times a day (4.5 mg/day)","titrasyon":"None (fixed dose)","sure":"3 weeks","sonuc":"No difference from placebo on the primary outcome (NPI) (mean difference 3.2; 95% CI −3.6 to 10.0); symptoms went down in both groups. No difference in CMAI (4.6; −3.0 to 12.2), quality of life or activities of daily living either","yan_etki":"Number of patients with mild to moderate side effects similar (16 vs. 14; p = 0.36); no effect on vital signs, weight or episodic memory","pmid":"25972490","doi":"10.1212/WNL.0000000000001675","diger_kaynak":"ClinicalTrials.gov NCT01608217 (no results in the registry); patients with pain or suspected pain (29 people) were also given paracetamol (acetaminophen); the drug was supplied by the manufacturer (Echo Pharmaceuticals), funding from the EU Regional Development Fund and the province of Gelderland"},{"ad":"Herrmann 2019","tasarim":"Phase 2/3, double-blind, placebo-controlled crossover RCT (2 × 6 weeks, with a 1-week washout in between)","n":"39 randomized","populasyon":"Moderate-to-severe Alzheimer’s disease (sMMSE ≤24) with agitation (NPI-NH agitation/aggression ≥3); long-term care facilities and geriatric psychiatry outpatient clinics; mean age 87, 77% men (Canada)","urun":"Nabilone (THC-like synthetic cannabinoid) capsule","urun_turu":"cbn_diger","doz":"Target 1–2 mg/day (mean 1.6 ± 0.5 mg)","titrasyon":"Per the protocol, from 0.5 mg to 2 mg","sure":"14 weeks","sonuc":"Difference favoring nabilone on the primary outcome (CMAI) (b = −4.0; 95% CI −6.5 to −1.5; p = 0.003); NPI-NH total −4.6 (−7.5 to −1.6), caregiver distress −1.7 (−3.4 to −0.07; p = 0.041) and sMMSE +1.1 (0.1 to 2.0) favored nabilone; in the 25 people who completed the severe impairment battery, the result favored placebo (p = 0.003); improvement on the clinician’s global impression of change 47% vs. 23% (p = 0.09, not significant)","yan_etki":"Sleepiness (sedation) 45% during the nabilone period, 16% during the placebo period (p = 0.02); difference in treatment-limiting sedation not significant (p = 0.22)","pmid":"31182351","doi":"10.1016/j.jagp.2019.05.002","diger_kaynak":"ClinicalTrials.gov NCT02351882 (no results in the registry); protocol: Ruthirakuhan 2019 (PMID 31338476); secondary analyses of the same trial: Ruthirakuhan 2019 (PMID 31322567; 24S-hydroxycholesterol), Ruthirakuhan 2020 (PMID 31547752; oxidative stress and cytokines), Feldman 2026 (PMID 41530008; in a post hoc analysis, response was larger in those with marked pain, appetite and eating problems, or apathy), Wang 2026 (PMID 41220257; predicting response with blood markers, exploratory); editorial: Rosenberg 2019 (PMID 31196620)"},{"ad":"Pessoa 2026","tasarim":"Double-blind, placebo-controlled parallel RCT","n":"30","populasyon":"Vascular dementia (caused by blood vessel problems) with clinically significant behavioral and psychological symptoms, older adults (Brazil)","urun":"CBD, by mouth (the abstract says only “CBD 300 mg/day”; the product’s source and purity are not in the abstract, and the ReBEC registry entry could not be accessed)","urun_turu":"saf_cbd","doz":"300 mg/day","titrasyon":"Not reported (in the abstract)","sure":"4 weeks","sonuc":"Primary outcomes favored CBD: time × group interaction on the NPI F = 3.61, p = 0.05 (partial eta squared 0.11) and on the BPRS F = 4.02, p < 0.05 (partial eta squared 0.13); no difference in cognition (MMSE, IQCODE) or function (Katz, Lawton). Three of the 8 authors are co-inventors on patents for fluorinated CBD compounds and an oral drug formulation containing cannabinoids (the University of São Paulo licensed the first patent to a company and has an agreement with a pharmaceutical company to develop a synthetic CBD product); two of these three authors have received consulting fees from cannabinoid companies","yan_etki":"Mild and similar in the two groups (UKU scale)","pmid":"41277041","doi":"10.1177/02698811251390974","diger_kaynak":"ReBEC RBR-686kmpz"},{"ad":"Cury 2025","tasarim":"Phase 2, double-blind, placebo-controlled parallel RCT","n":"29 randomized; 28 received treatment; 14 per group analyzed (precalculated target 37)","populasyon":"Dementia due to Alzheimer’s disease, aged 60–80 (Brazil)","urun":"Balanced THC-CBD cannabis extract, by mouth (contains THC)","urun_turu":"thc_iceren","doz":"0.350 mg THC + 0.245 mg CBD/day","titrasyon":"Not reported (in the abstract)","sure":"26 weeks","sonuc":"On the primary outcome at week 26, the MMSE total score was higher in the cannabis group than with placebo (mixed model; size of the difference not in the abstract); no difference in secondary outcomes, including function and behavior. Two of the 13 authors are partners in a contract research company that runs cannabis studies","yan_etki":"No significant difference in side effect frequency; according to a commentary, sleepiness about twice and suspiciousness (paranoia) five times as common (not significant; numbers could not be read)","pmid":"41160460","doi":"10.1177/13872877251389608","diger_kaynak":"ReBEC U1111-1258-2058; commentary: Dos Santos Silva 2026 (PMID 42216668)"},{"ad":"Albertyn 2025 (STAND)","tasarim":"Double-blind, placebo-controlled feasibility RCT (nursing homes in England)","n":"29 randomized (target 60)","populasyon":"Probable Alzheimer’s disease with clinically significant agitation; moderate-to-severe or severe stage, mostly frail nursing home residents","urun":"Nabiximols (Sativex) mouth spray; 2.7 mg THC + 2.5 mg CBD per spray (contains THC)","urun_turu":"thc_iceren","doz":"Target 4 sprays/day (10.8 mg THC + 10 mg CBD)","titrasyon":"1 spray/day for the first 3 days, then up to at most 4 sprays/day; only half of participants followed the schedule fully","sure":"4 weeks of treatment + 4 weeks of follow-up","sonuc":"Feasibility: the 60-person target was not reached (29 people in 7.5 months); retention and adherence 100%. The prespecified CMAI effect size threshold (d ≥ 0.3) was not met: d = 0.23 at week 4 (95% CI −0.2 to 0.7), 0.08 at week 8; adjusted CMAI difference 6.77 (−6.71 to 20.25). CMAI went down in both groups; at baseline, agitation was more severe in the nabiximols group (CMAI 95.5 vs. 71.5)","yan_etki":"No side effects attributed to the product; mild side effects 4 vs. 2 people, serious events 1 vs. 1 person (unrelated to the product); no falls, deaths or withdrawals","pmid":"40479610","doi":"10.1093/ageing/afaf149","diger_kaynak":"ISRCTN 7163562 (as written in the publication); drug and placebo from Jazz Pharmaceuticals (formerly GW Pharmaceuticals), funding from Alzheimer's Research UK; one of the 12 authors has served on advisory boards of cannabis companies (EmpowerPharm/SanteCannabis, NW PharmaTech) or received research support through their institution"},{"ad":"Bianchi 2026 (MedCanDem)","tasarim":"Multicenter, double-blind, placebo-controlled crossover RCT (2 × 8 weeks, 1-week washout)","n":"25 randomized; 19 completed both periods","populasyon":"Severe dementia with behavioral or psychological symptoms; 5 long-term care facilities in Geneva; mean age 83; patients taking many medicines","urun":"Standardized cannabis oil, oral drops (Cannapharm; 1% THC, 2% CBD; THC:CBD 1:2; contains THC); placebo: hemp seed oil","urun_turu":"thc_iceren","doz":"After titration avg. 17.85 mg THC + 35.7 mg CBD/day (at most 20 mg THC + 40 mg CBD)","titrasyon":"Started at 2.5 mg THC + 5 mg CBD/day, increased every two days to at most 20 mg THC + 40 mg CBD/day within 15 days","sure":"2 × 8 weeks","sonuc":"No difference on the primary outcome (CMAI) (crossover difference 5.0; SD 33.8; p = 0.53); no difference in NPI, pain (Doloplus) or the team’s global impression of change either. As-needed psychiatric medicine was given less during the active period (0.06 vs. 0.14 per person per day; p < 0.0001). At baseline there was a CMAI difference between the sequence groups, and the 1-week washout was too short (active breakdown products were found in some patients’ blood at the switch to the placebo period)","yan_etki":"No serious drug-related side effects; sleepiness 3 vs. 2 events, falls 1 vs. 0; blood pressure changes beyond the protocol limit (±15%) 71 events in the active period and 28 in the placebo period (no statistical test reported)","pmid":"42613673","doi":"10.1093/ageing/afag239","diger_kaynak":"ClinicalTrials.gov NCT05432206 (no results in the registry); protocol: Bianchi 2023 (PMID 37293434); product and placebo provided free by the manufacturer; two authors are former board members of the Swiss Society for Cannabis in Medicine; the same team’s uncontrolled follow-up: Pautex 2022"},{"ad":"van den Elsen 2015b","tasarim":"Phase 2, multicenter, double-blind, placebo-controlled, repeated crossover RCT (6 blocks × 2 weeks: in each block 3 days of THC and 3 days of placebo, with 4-day washouts in between)","n":"22 (20 completed)","populasyon":"Dementia with clinically relevant neuropsychiatric symptoms; mean age 76; 2 hospitals (Netherlands)","urun":"THC tablet (Namisol)","urun_turu":"thc_iceren","doz":"Blocks 1–3: 0.75 mg twice a day; blocks 4–6: 1.5 mg twice a day (1.5–3 mg/day)","titrasyon":"Dose escalation (to 1.5 mg after 6 weeks)","sure":"12 weeks","sonuc":"No difference from placebo on the primary outcome (NPI) (blocks 1–3: 1.8; 97.5% CI −2.1 to 5.8; blocks 4–6: −2.8; −7.4 to 1.8)","yan_etki":"Side effect frequency similar in the two periods; 4 serious events unrelated to the drug. In substudies of the same trial: of 98 side effects reported in 10 patients, 6 were found to be related to THC, and at 1.5 mg body sway with the eyes closed increased (Ahmed 2015); in 18 patients, 1.5 mg twice a day increased sway with the eyes closed and stride length when walking, with no falls (van den Elsen 2017)","pmid":"26560511","doi":"10.1016/j.jagp.2015.07.011","diger_kaynak":"ClinicalTrials.gov NCT01302340 (no results in the registry); safety and pharmacokinetics publication from the same trial: Ahmed 2015 (PMID 25752889); balance and gait publication: van den Elsen 2017 (PMID 27624148; a secondary analysis of the same trial according to the Bahji 2022 review, could not be verified from the full text)"},{"ad":"Timler 2023","tasarim":"Double-blind, placebo-controlled crossover RCT (2 × 6 weeks of treatment, with 2-week washouts)","n":"21","populasyon":"Older nursing home residents diagnosed with dementia; 77% women, mean age 85 (Australia)","urun":"CogniCann: THC:CBD 3:2 oil, sprayed into the mouth (per the protocol, 25 mg THC + 17 mg CBD per mL; contains THC)","urun_turu":"thc_iceren","doz":"Per the protocol, the highest dose the person tolerated, at most 50 mg THC (+34 mg CBD)/day; doses given are not in the abstract","titrasyon":"Per the protocol, started at 2.5 mg THC and increased over a few weeks","sure":"18 weeks","sonuc":"No difference from placebo in behavior (NPI-Q, CMAI), quality of life or pain; only a reduction in agitation favoring the drug at the end of treatment. A later calculation showed 50 people would have been needed for the NPI (21 could be enrolled against a target of 50)","yan_etki":"According to the abstract, few side effects; another team writes that total side effects were clearly more common in the active group in this study (Albertyn 2025); full text could not be read","pmid":"37321847","doi":"10.1111/ajag.13224","diger_kaynak":"ANZCTR ACTRN12619000474156; protocol: Timler 2020 (PMID 32059690; funded by the product’s manufacturer, MGC Pharmaceuticals)"},{"ad":"Velayudhan 2024 (CANBiS-AD)","tasarim":"Phase 2a, single-center, double-blind, placebo-controlled parallel feasibility RCT (published as a letter to the editor)","n":"16 randomized; 15 received treatment (8/7)","populasyon":"Possible or probable Alzheimer’s disease with behavioral symptoms (NPI ≥4), aged ≥55; 93% women, mean age 78 (London)","urun":"CBD capsule (200 mg; pure CBD)","urun_turu":"saf_cbd","doz":"From 200 mg/day to 600 mg/day (3 capsules a day)","titrasyon":"From 1 capsule a day to 3 capsules (details in the publication’s supplementary file, which could not be read)","sure":"6 weeks","sonuc":"Primary outcomes were feasibility: treatment adherence 100%, retention 94%. Change from baseline in NPI-C total −29.9 ± 51.5 in the CBD group and −10.1 ± 38.2 in the placebo group; no statistical test was done because the study was not designed to test efficacy; delusions were more severe at baseline in the placebo group","yan_etki":"34 side effects in total; dizziness 63% vs. 0%, falls 25% vs. 43%; the most common drug-related side effects were mild, temporary dizziness, sleepiness and raised liver enzymes; no withdrawals or deaths; 1 serious fall in the placebo group after treatment ended; according to the same team’s later publication, dizziness attributed to treatment was 12.5% in the CBD group (1 of 8 people; Albertyn 2025)","pmid":"38584388","doi":"10.1017/S1041610224000516","diger_kaynak":"EudraCT 2019-002106-52; study drug provided free by Beckley Canopy Therapeutics/Canopy Growth (investigator-initiated study); one of the 7 authors has served on advisory boards of cannabis companies (EmpowerPharm/SanteCannabis) or received speaker fees; funding from King's Health Partners, Psychiatry Research Trust and Rosetrees Trust"},{"ad":"Volicer 1997","tasarim":"Placebo-controlled crossover study (2 × 6 weeks; controlled clinical trial in PubMed; randomized and double-blind according to reviews)","n":"15 (11 completed; 1 patient who died was included in the analysis)","populasyon":"Patients with probable Alzheimer’s who refused to eat (hospital dementia unit, US)","urun":"Dronabinol (synthetic THC)","urun_turu":"thc_iceren","doz":"2.5 mg in the morning and at noon (5 mg a day; according to the study table of Cochrane 2021; one review gives 2.5 mg a day)","titrasyon":"None (fixed dose)","sure":"12 weeks","sonuc":"Body weight went up more during the dronabinol period than during the placebo period; the severity of disturbed behavior decreased, and in those who took dronabinol first this effect continued into the placebo period (abstract). Reviews report the CMAI result differently; the full text could not be read","yan_etki":"Euphoria (an excessively elated mood), sleepiness and fatigue more common during the dronabinol period, treatment not stopped; study ended in 1 patient because of a major seizure and in 2 patients because of severe infection; 1 patient died of a heart attack","pmid":"9309469","doi":null,"diger_kaynak":"The only study included in the Krishnan 2009 Cochrane review (its data could not be analyzed); also in the Bosnjak Kuharic 2021 Cochrane review. According to Cochrane 2021, supported by the US Department of Veterans Affairs and the dronabinol manufacturers (Roxane Laboratories, UNIMED)"},{"ad":"Bosnjak Kuharic 2021 (Cochrane)","tasarim":"Cochrane systematic review and meta-analysis (RCTs only; GRADE; search July 8, 2021)","n":"4 RCTs, 126 people","populasyon":"Dementia (mostly Alzheimer’s; some vascular or mixed)","urun":"THC tablet, dronabinol, nabilone","urun_turu":"karma","doz":"Varies by study","titrasyon":"Varies by study","sure":"3–14 weeks","sonuc":"Mean difference in behavioral symptoms (NPI) −1.97 (95% CI −3.87 to −0.07; 3 studies, 110 people; low certainty): there may be no clinically important effect. Cognition (sMMSE) +1.1 (0.1 to 2.1; 1 study, 28 people; very low certainty). Authors’ conclusion: it is uncertain whether they are helpful or harmful; any benefit may be too small to be clinically meaningful","yan_etki":"Side effects not reported in a form suitable for meta-analysis; sedation more common with nabilone (OR 2.83; 1.07–7.48); certainty of side effect evidence low to very low","pmid":"34532852","doi":"10.1002/14651858.CD012820.pub2","diger_kaynak":"Summary: Lane-Harris 2022 (PMID 35778327)"},{"ad":"Tudella 2026","tasarim":"Systematic review and meta-analysis of RCTs (PubMed, Embase, Web of Science, Cochrane; up to November 2025; RoB 2, GRADE, Bayesian analysis)","n":"9 RCTs, 334 people","populasyon":"Alzheimer’s disease or dementia","urun":"Various cannabinoids","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"No effect on the CMAI (SMD −0.58; 95% CI −1.71 to 0.55; I² 84%), NPI-NH total (−0.02; −1.00 to 0.96), NPI-NH agitation (−0.44; −1.45 to 0.57) or MMSE; Bayesian estimates close to zero. Certainty of evidence moderate for behavioral outcomes, low for cognition","yan_etki":"Total side effects similar to placebo; sleepiness more common (RR 2.03; 1.29–3.20)","pmid":"42704497","doi":"10.1007/s10072-026-09347-z","diger_kaynak":null},{"ad":"Pan 2026","tasarim":"Systematic review and meta-analysis of RCTs (MEDLINE, Embase, PsycINFO, CINAHL, Cochrane, ClinicalTrials.gov; up to August 2025; RoB 2)","n":"10 RCTs, 328 people","populasyon":"Neuropsychiatric symptoms in dementia","urun":"Various cannabinoids","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"No difference in total neuropsychiatric symptoms (SMD −0.18; −0.48 to 0.12); reduction in agitation (SMD −0.52; −1.00 to −0.05; p = 0.03; I² 77%), but significance was lost when studies at high risk of bias were removed (−0.35; −0.79 to 0.10). In subgroups, the effect was larger at doses above 10 mg THC equivalent and in severe dementia. Two of the 8 authors (Ruthirakuhan, Lanctôt) are authors of the nabilone study (Herrmann 2019); no company ties reported; the list of included studies could not be verified because the full text could not be read","yan_etki":"No difference in total side effects; sedation more common (RR 2.09; 1.22–3.57)","pmid":"41748849","doi":"10.1007/s40263-026-01277-w","diger_kaynak":null},{"ad":"da Silva 2026","tasarim":"Systematic review and meta-analysis (PROSPERO-registered; PubMed, Embase, CENTRAL; up to April 2025; Bayesian analysis and trial sequential analysis)","n":"6 RCTs and 1 open-label cohort; 221 people","populasyon":"Agitation and neuropsychiatric symptoms in Alzheimer’s disease","urun":"Various cannabinoids","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"In randomized comparisons, NPI total (SMD −0.31; −0.47 to −0.15; 4 studies), CMAI short form (−0.40; −0.69 to −0.10; 3 studies) and NPI agitation/aggression (−0.47; −0.69 to −0.25; 3 studies) lower than with placebo; no consistent benefit on the MMSE. According to the authors, interpretation is limited by the small number of studies, different products and scales, short follow-up and the weight being concentrated in a few studies. One of the 14 authors is a consultant to a medical cannabis company (Sensia Labs)","yan_etki":"Main safety signal sleepiness (RR 2.25; 1.43–3.54); falls and fatigue could not be estimated precisely","pmid":"42315374","doi":"10.1016/j.jagp.2026.05.016","diger_kaynak":null},{"ad":"Krishnan 2009 (Cochrane)","tasarim":"Cochrane systematic review (double- or single-blind, placebo-controlled RCTs; search April 11, 2008)","n":"1 study (its data could not be analyzed)","populasyon":"Dementia","urun":"Dronabinol (the only included study)","urun_turu":"thc_iceren","doz":null,"titrasyon":null,"sure":null,"sonuc":"The data of the only study meeting the criteria (Volicer 1997) had not been reported in a form suitable for analysis; no evidence was found that cannabinoids are effective for disturbed behavior or other symptoms in dementia","yan_etki":"Not reported (in the abstract)","pmid":"19370677","doi":"10.1002/14651858.CD007204.pub2","diger_kaynak":"The topic was covered by a new Cochrane review in 2021 (Bosnjak Kuharic 2021, CD012820)"},{"ad":"Velayudhan 2021 (safety)","tasarim":"Systematic review and meta-analysis of RCTs (mean age ≥50, all indications; 1990–October 2020; GRADE)","n":"46 RCTs, 6,216 people (3,469 took a cannabinoid; mean age 58.6)","populasyon":"Adults over 50 (dementia, Parkinson’s, MS, cancer, etc.)","urun":"THC, THC:CBD, CBD","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"Safety review: THC alone (all-cause side effects IRR 1.42; 1.12–1.78) and THC:CBD (1.58; 1.26–1.98) increased side effects; pure CBD did not (1.02; 0.90–1.16). Serious side effects and deaths did not increase; with THC:CBD, stopping because of side effects increased (RR 1.40; 1.08–1.80), and stopping was linked to the THC dose","yan_etki":"Dry mouth, dizziness and sleepiness more common with THC-containing products","pmid":"33780450","doi":"10.1371/journal.pmed.1003524","diger_kaynak":"Update: Velayudhan 2024 (PMID 39602500; 58 RCTs, 6,611 people; THC dose-dependently increased dizziness, balance and coordination problems, thinking and perception problems, and sleepiness)"},{"ad":"Hatch 2025 (Canadian CCSMH guideline)","tasarim":"Clinical practice guideline (Canadian Coalition for Seniors’ Mental Health; review of existing guidelines and systematic reviews; GRADE)","n":null,"populasyon":"Behavioral and psychological symptoms of dementia (agitation, depression, anxiety, psychosis)","urun":"Synthetic cannabinoids (e.g., nabilone)","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"In severe agitation, synthetic cannabinoids may be used when other drug treatments have not worked (conditional recommendation, low-certainty evidence; C, L). For moderate agitation the first choice is citalopram; for severe agitation aripiprazole, brexpiprazole and risperidone; quetiapine, low-dose typical antipsychotics, synthetic cannabinoids and carbamazepine only if other treatments have not worked. Two of the 17 authors (Herrmann, Lanctôt) are authors of the nabilone study in the table; no author reports ties to a cannabinoid company","yan_etki":null,"pmid":"40051590","doi":"10.5770/cgj.28.820","diger_kaynak":null},{"ad":"CDA-AMC 2026 (Canada’s Drug Agency nabilone assessment)","tasarim":"Health technology assessment (focused literature search, stakeholder input, 2 clinical experts)","n":"1 RCT (Herrmann 2019) and 1 guideline","populasyon":"Behavioral and psychological symptoms of dementia","urun":"Nabilone","urun_turu":"cbn_diger","doz":null,"titrasyon":null,"sure":null,"sonuc":"Based on a single small study, nabilone may moderately reduce agitation in some Alzheimer’s patients; the evidence is uncertain and it is unclear whether the effect is meaningful for patients; no cost-effectiveness study","yan_etki":"Clinically significant sedation more common","pmid":"42485476","doi":null,"diger_kaynak":"CADTH Health Technology Review; NCBI Bookshelf NBK623689"},{"ad":"Brucki 2021","tasarim":"Position paper of a national academy of neurology (literature assessment by its scientific departments)","n":"Not applicable","populasyon":"Neurological diseases; dementia section","urun":"Cannabinoids","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"No evidence supporting clinical use in dementia; use not recommended in Alzheimer’s and related diseases; no evidence that cannabinoids slow the progression of Alzheimer’s, possible benefits are only for symptoms","yan_etki":null,"pmid":"34133518","doi":"10.1590/0004-282X-ANP-2020-0432","diger_kaynak":"PMC9231442; according to the conflict of interest statement, one of the 49 authors is an executive at a CBD company (HempMeds)"},{"ad":"Alexandri 2024","tasarim":"Controlled, non-randomized open comparison (CBD vs. usual treatment; how allocation was done is not in the abstract)","n":"20 (10/10)","populasyon":"Dementia with severe behavioral symptoms (NPI >30; patients of an Alzheimer’s association in Greece)","urun":"3% CBD drops (THC content not in the abstract)","urun_turu":"cbd_zengin_thc_belirsiz","doz":"Not reported (in the abstract)","titrasyon":"Not reported (in the abstract)","sure":"6 months","sonuc":"NPI improved significantly in all patients taking CBD, with no or limited improvement in the usual treatment group; groups were not formed by chance","yan_etki":"Not reported (in the abstract)","pmid":"37153956","doi":"10.1080/07317115.2023.2209563","diger_kaynak":null},{"ad":"Navarro 2024","tasarim":"Single-center, open-label prospective cohort; no control group","n":"60 started; 59 followed for at least 3 months, 51 for at least 12 months","populasyon":"Alzheimer’s starting after age 65 and neuropsychiatric symptoms not treated with antidepressants, antipsychotics or benzodiazepines; all were taking a cholinesterase inhibitor (Bogotá, Colombia)","urun":"CBD-rich compounded (magistral) formula, under the tongue (100 mg CBD + <1.9 mg THC per mL; Khiron; contains THC)","urun_turu":"thc_iceren","doz":"Median 111 mg CBD/day (IQR 79–144.5; at most 196 mg)","titrasyon":"Started at 0.1 mL every 8–12 hours and increased weekly","sure":"Avg. 23.2 months of treatment; primary outcome at week 12","sonuc":"NPI-Q severity score fell from a median of 24 to 12 at month 3 (p < 0.001); >30% reduction in 94.9%; caregiver distress from 29 to 14; improvement persisted up to 24 months. No comparison group; only those who could pay for the treatment were enrolled; the first author had worked at a clinic owned by the product’s manufacturer","yan_etki":"Sleepiness in 1 patient (product stopped); no other side effects reported","pmid":"39474242","doi":"10.1159/000541364","diger_kaynak":null},{"ad":"Pautex 2022","tasarim":"Prospective observational study (long-term care facility; treatment prescribed by a physician); no control group","n":"19","populasyon":"Severe dementia, behavior problems and rigidity; older adults taking many medicines (mean age 81.4; 17 women; Geneva)","urun":"Standardized cannabis extract, oil or tincture (10 mg THC + 20 mg CBD per mL; THC:CBD 1:2)","urun_turu":"thc_iceren","doz":"At baseline avg. 7.2 mg THC + 14.4 mg CBD/day; at month 13 avg. 12.4 mg THC + 24.8 mg CBD/day (divided into 3 doses a day)","titrasyon":"Individualized (“start low, go slow”)","sure":"Up to 13 months","sonuc":"Marked and sustained improvement in behavior, agitation and rigidity scores and a reduction in other medicines were reported; no comparison group. In 15 patients, CYP1A2 and CYP2C19 enzyme activity was slightly reduced","yan_etki":"117 side effects, 3 serious events (judged unrelated to treatment); no one stopped because of side effects","pmid":"36247984","doi":"10.3389/fnagi.2022.957665","diger_kaynak":"2-month pilot phase of the same cohort: Broers 2019 (PMID 34676334; 10 women, avg. 9.0 mg THC + 18.0 mg CBD/day at month 2; NPI and CMAI fell by about 40%, other psychiatric medicines were reduced or stopped in half); correction (funding sentence only): PMID 36967825; the same team’s controlled study: Bianchi 2026"},{"ad":"Sawicki 2023","tasarim":"Retrospective chart review (single center, geriatric psychiatry); no control group","n":"50 (THC recommended); 38 used it","populasyon":"Dementia with neuropsychiatric symptoms (Chicago, US)","urun":"THC products bought from retail outlets (dispensaries) (the title of the authors’ reply letter mentions edible THC gummies)","urun_turu":"thc_iceren","doz":"Not reported (in the abstract)","titrasyon":"Not reported (in the abstract)","sure":"Records from 2017–2021; follow-up duration not in the abstract","sonuc":"76% of caregivers bought and gave the product; according to caregivers, symptoms improved in 79% of users (30/38); of the 20 people taking an antipsychotic at baseline, the antipsychotic was reduced or stopped in 12 (60%). No comparison group; assessment based on caregiver reports","yan_etki":"Dizziness, increased agitation and suspiciousness (paranoia); stopped because of side effects in 2 patients","pmid":"37728481","doi":"10.4088/JCP.23m14791","diger_kaynak":"Authors’ reply letter: Zahradnik 2024 (PMID 38836868)"},{"ad":"Woodward 2014","tasarim":"Retrospective systematic chart review (inpatient unit); no control group","n":"40","populasyon":"Inpatients with severe dementia given dronabinol for behavior or appetite problems (geriatric neuropsychiatry unit, US)","urun":"Dronabinol (added to existing treatment)","urun_turu":"thc_iceren","doz":"Not reported (in the abstract)","titrasyon":"Not reported (in the abstract)","sure":"Up to 7 days after starting dronabinol","sonuc":"Improvement in all domains of the Pittsburgh Agitation Scale, in the clinical global impression, in sleep duration and in the share of meals eaten; no comparison group","yan_etki":"26 side effects, none led to stopping treatment","pmid":"23597932","doi":"10.1016/j.jagp.2012.11.022","diger_kaynak":null},{"ad":"Palmieri 2023","tasarim":"Retrospective observational study; no control group","n":"30","populasyon":"Mild, moderate or severe Alzheimer’s, aged 65–90 (Italy, second-opinion clinic)","urun":"Bedrocan cannabis extract diluted in olive oil (22% THC, 0.5% CBD)","urun_turu":"thc_iceren","doz":"Twice a day; amount not in the abstract","titrasyon":"Not reported (in the abstract)","sure":"12 weeks","sonuc":"On the NPI-Q filled in by relatives, reductions in agitation, apathy, irritability, sleep and eating disorders, and on the CMAI, in aggressive behavior (p < 0.0001); the MMSE was reported to have improved in 45% of patients. The authors note the lack of a control group and the fact that the scales were filled in by relatives as limitations","yan_etki":"Not reported (in the abstract)","pmid":"36655645","doi":"10.7417/CT.2023.5009","diger_kaynak":null},{"ad":"Myran 2025","tasarim":"Population-based, retrospective, matched cohort (Ontario health records, 2008–2021)","n":"6,086,794 people; 16,275 with an emergency visit or hospital admission due to cannabis","populasyon":"Ontario residents aged 45–105 without dementia at baseline","urun":"Cannabis use (at a level requiring emergency care)","urun_turu":"thc_iceren","doz":"Not applicable","titrasyon":null,"sure":"Follow-up of up to 5 years (to 2022)","sonuc":"Dementia diagnosis within 5 years: 5.0% in those receiving emergency care due to cannabis, 3.6% in those receiving emergency care for other reasons, 1.3% in the general population. Adjusted hazard ratio 1.23 (1.09–1.39) vs. emergency care for other reasons, 1.72 (1.38–2.15) vs. the general population; 0.69 (0.62–0.76) vs. alcohol-related emergency care. Observational: does not show cause and effect; confounding factors cannot be ruled out","yan_etki":"Not applicable","pmid":"40227745","doi":"10.1001/jamaneurol.2025.0530","diger_kaynak":null},{"ad":"Ishrat 2026","tasarim":"Observational cohort analyses (UK Biobank, US Million Veteran Program) and bidirectional Mendelian randomization","n":"In UK Biobank, up to 18,975 people who had used cannabis and 60,598 who had not; in the MVP, 12,222 people diagnosed with cannabis use disorder","populasyon":"Older adults","urun":"Cannabis use (lifetime) and cannabis use disorder","urun_turu":"thc_iceren","doz":"Not applicable","titrasyon":null,"sure":"Longitudinal follow-up of cognition and dementia (duration not in the abstract)","sonuc":"People who had used cannabis did slightly better at baseline on numeric memory and reasoning tests; no difference in longitudinal cognitive change. Cannabis use disorder not significantly linked to dementia risk (HR 1.11; 0.97–1.26). Mendelian randomization showed no causal link between cannabis use and cognition or dementia","yan_etki":"Not applicable","pmid":"41741130","doi":"10.1136/bmjment-2025-302290","diger_kaynak":null}],"ilgili_ilaclar":["antipsikotik","benzodiazepin","uyku_ilaci"],"son_inceleme":"2026-10-30","arastirma_gecmisi":[{"tarih":"2026-10-28","not":"Page published. In this first assessment, 29 studies were reviewed."},{"tarih":"2026-10-30","not":"It was added to the question about Turkey that dronabinol and nabilone, which were tested in dementia studies, are not licensed in Turkey: there is no cannabinoid-containing medicine on the Turkish Medicines and Medical Devices Agency's list of licensed medicines (October 16, 2026), and neither drug appears on the agency's list of active substances from abroad (September 28, 2026). The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-30","not":"The last sentence of the page's short summary was rewritten in a calmer, more guiding tone: instead of \"Talk to your doctor before you start.\", it now says whom you can talk with, and about what, if you are considering CBD. The conclusion and the strength of evidence did not change."}]},{"id":"spasticity-non-ms","baslik":"Muscle stiffness (spasticity): causes other than MS — spinal cord injury, stroke, cerebral palsy, ALS","grup":"Other","grup_kodu":"diger","tr_id":"spastisite-diger","kanit_duzeyi":"yetersiz","kanit_yonu":"veri_yok","kanit_ozet":"Pure CBD has not been tested on its own for muscle stiffness (spasticity) from causes other than MS: in the only controlled study that tested pure CBD as a separate group (Denmark, 134 people, at most 45 mg a day), 119 patients had MS and 15 had spinal cord injury; muscle stiffness was no different from placebo, and no separate result was given for those with spinal cord injury. Nearly all the evidence concerns THC-containing products or THC-like medicines, and it varies by cause. In ALS and primary lateral sclerosis, THC:CBD mouth spray slightly reduced muscle stiffness as measured by the doctor over 6 weeks in a 60-person phase 2 study (difference −0.32; 95% CI −0.57 to −0.07), but side effects were about three times as common in the spray group; for cramps in ALS, THC by mouth (27 people) was ineffective, and Cochrane reviews wrote that THC is probably ineffective for cramps; a 2022 meta-analysis combining these two controlled studies in ALS found no difference in favor of cannabinoids on ALS-specific overall scales (daily functioning, quality of life) (pooled standardized mean difference 0.31; 95% CI −0.02 to 0.63; p = 0.07; leaning slightly toward placebo according to the authors). The results of the only controlled study examining the effect of cannabinoids on the course of ALS (17 people, an oil rich in CBD and containing a small amount of THC) had not been published as of October 2026. After stroke, in the only controlled study (41 people, crossover), the spray did not change muscle stiffness differently from placebo, whether as felt by the patient or as shown by the doctor's and electrical measurements. In children with cerebral palsy or brain injury, two placebo-controlled studies (72 people, THC:CBD spray, 12 weeks; 53 people, oil containing 10 times more CBD than THC, 6 weeks) found no difference in muscle stiffness; 3 cases of hallucination were reported with the spray and marked sleepiness with the 10:1 oil; a 25-child study without placebo comparing two CBD-rich oils reported improvement in both groups. In spinal cord injury the results are mixed: nabilone (12 people) and a mostly open-label study of THC by mouth (25 people) reported a reduction in doctor-measured muscle stiffness; 1:1 THC:CBD oil (16 people) did not change the doctor's measurement and only slightly improved patients' own ratings; in a 116-person nerve pain study by the maker of the THC:CBD spray, with results available only in the registry, there was no difference in muscle stiffness and spasms. In upper motor neuron syndrome, nabilone (13 people) reduced related pain, not muscle stiffness itself. England's NICE evidence review (2019) found only 3 controlled studies for causes other than MS and made no recommendation for these causes; the product information for the THC:CBD spray does not recommend use under age 18. Two real-world studies without a comparison group (spray in spinal cord injury; synthetic THC in 63 severely ill hospitalized children) reported improvement in muscle stiffness from baseline or by subjective rating, but they cannot separate out the effect of expectation; in the children's series, standard 24-hour records did not show a reduction in restlessness and seizures, and 3 serious breathing problems were seen with synthetic THC; in the records of 344 ALS patients, medical marijuana was not associated with improvement in muscle stiffness. October 2026 search (PubMed, Cochrane, ClinicalTrials.gov, Europe PMC): 12 controlled studies of cannabinoids for muscle stiffness from causes other than MS and for cramps in ALS were found (10 randomized and placebo-controlled, 1 a two-product comparison without placebo, 1 with a 13-person controlled part; one available only in the ClinicalTrials.gov record; in one, most patients had MS); all of them, together with 5 topic-specific systematic reviews, a general meta-analysis that gives a separate analysis for ALS, and 3 observational studies, are in the table below. One more study in which most patients had MS and that gave no separate result for non-MS patients (24 people, 6 without MS) is in the table on the MS spasticity page; small uncontrolled series and satisfaction surveys were not included in the table. In none of these studies was pure CBD assessed separately in non-MS patients; 4 controlled studies with unreported results (two completed, two listed with status 'unknown' in the registry) are being followed; no studies from Turkey were found. In an additional October 2026 search (ALS only; PubMed, Cochrane, ClinicalTrials.gov, Europe PMC), no other controlled study or registry entry with results for cannabinoids in ALS was found; the meta-analysis combining the two ALS studies was added to the table; surveys, case reports and a 9-patient single-dose drug level study (its safety finding is in the warnings) were not included in the table.","kanit_duzeyi_metin":"Pure CBD: Insufficient (pure CBD has not been tested on its own for causes other than MS; in the only study with a pure CBD group, most patients had MS and muscle stiffness was no different from placebo)","kanit_duzeyi_thc_icerenler":"zayif","kanit_duzeyi_thc_icerenler_metin":"THC-containing products: Weak (1–4 small controlled studies depending on the cause; in ALS, small benefit in doctor-measured muscle stiffness in a single 60-person study; no difference after stroke in 41 people or in children with cerebral palsy in studies of 72 and 53 people; mixed results in spinal cord injury); THC-like nabilone: Very weak (two studies of 12 and 13 people)","kaynak_dosya":null,"saf_cbd_sonuc":"There is no separate controlled study of pure CBD oil for muscle stiffness from causes other than MS. In the only study that tested pure CBD (at most 45 mg a day, 6 weeks) as a separate group (Denmark, 134 people), 119 patients had MS and 15 had spinal cord injury; muscle stiffness was no different from placebo, and no separate result was given for patients with spinal cord injury. All the CBD-dominant oils tested in children also contained THC (see the section on THC-containing products). In ALS, the result of a 17-person study of a CBD-rich oil that also contains a small amount of THC (50 mg CBD per mL, less than 2 mg THC) had not been published as of October 2026.","thc_icerenler_sonuc":"A mouth spray containing roughly equal amounts of THC and CBD reduced muscle stiffness as measured by the doctor slightly more than placebo over 6 weeks in 60 patients with ALS or primary lateral sclerosis (difference on the Modified Ashworth Scale −0.32; 95% CI −0.57 to −0.07); the same spray was no different from placebo for muscle stiffness after stroke (41 people, crossover) or in children with cerebral palsy or brain injury (72 people, 12 weeks); in the study of nerve pain due to spinal cord injury (116 people, registry results only), there was also no difference in muscle stiffness and spasms. In spinal cord injury, a 25-patient study of THC by mouth, most of it open-label, reported benefit (the comparison for the 13-person controlled part is not in the publication's abstract); an oil containing equal THC and CBD did not change the doctor's measurement in a 16-person crossover study and only slightly improved patients' own ratings. An oil containing 10 times more CBD than THC did not reduce muscle stiffness in 53 people with severe cerebral palsy. For cramps in ALS, THC by mouth (10 mg a day) was no different from placebo (27 people); in a meta-analysis combining the two controlled studies in ALS, there was no difference in favor of cannabinoids on overall ALS scales (daily functioning, quality of life). The synthetic THC-like medicine nabilone reduced muscle stiffness as measured by the doctor in spinal cord injury in a 12-person crossover study; in 13 patients with upper motor neuron syndrome, however, it reduced the related pain, not the muscle stiffness itself. In children, hallucinations and marked sleepiness were reported with THC-containing products.","ruhsat":"There is no approved CBD or cannabinoid medicine for muscle stiffness from causes other than MS. The mouth spray containing THC and CBD (nabiximols; 2.7 mg THC + 2.5 mg CBD per spray) is licensed in the United Kingdom only in adults, for moderate to severe MS spasticity that has not responded well enough to other spasticity medicines and that shows clear improvement during a trial period; it is not recommended under age 18 because efficacy was not shown in a placebo-controlled study in children with cerebral palsy or brain injury (UK product information, text revision April 2, 2026, §4.1, §4.2, §5.1). According to NICE's 2019 evidence review, this spray is not licensed for motor neuron disease or spinal cord injury, and the guideline made no recommendation for cannabinoid products for causes other than MS. Turkey: the spray's active substance (tetrahydrocannabinol and cannabidiol, oromucosal spray) is on the TİTCK (Turkish Medicines and Medical Devices Agency) List of Active Substances from Abroad (September 28, 2026), among medicines that require a red prescription and can be imported with the agency's written approval.","doz_araligi_ozet":"THC:CBD mouth spray at most 12 sprays a day (at most 32.4 mg THC + 30 mg CBD; an average of 8 sprays/day in ALS and a median of 9 after stroke; the maker's spinal cord study allowed at most 48 sprays a day); THC by mouth 10 mg/day (ALS cramps) and an average of 31 mg/day (spinal cord injury); 1:1 THC:CBD oil an average of 11.6 mg THC/day; nabilone 0.5–1 mg/day; pure CBD at most 45 mg/day (multi-arm study in which most patients had MS); synthetic THC in severely ill hospitalized children an average of 0.21 mg per kilogram a day (started in the unit) and 0.48 mg (already using it)","titrasyon_ozet":"Gradual increase over about 14 days in the spray studies (9 weeks in the children's study); in the stroke study, 1 spray every 2 days for the first 4 days, then an increase of 1 each day; nabilone started at 0.5 mg/day and increased to 1 mg/day; 1 week of dose adjustment with the 1:1 oil; THC by mouth started with a single 10 mg dose, then individually adjusted; these are research protocols","yan_etkiler":["THC:CBD spray in ALS: any side effect RR 2.84 (1.52–5.33), drug-related side effect RR 5.43 (2.12–13.90); no serious side effects (Riva 2019; NICE 2019)","THC:CBD spray in spinal cord injury: side effects 46/56 vs 29/60; dizziness 14 vs 5, sleepiness 7 vs 0; stopping due to side effects 5 vs 0 (NCT01606202)","1:1 THC:CBD oil (spinal cord injury): mild side effects 5 vs 1; symptomatic drop in blood pressure, slowed heart rate and raised liver enzymes (Boonthanakorn 2026)","THC:CBD spray after stroke: 4 patients stopped because of side effects (all during the spray period); 2 serious side effects (severe nausea; a seizure judged unrelated to the medicine); no meaningful change in blood pressure or pulse (Marinelli 2022; Rosa 2022)","In children: 3 hallucinations with THC:CBD spray, one an auditory hallucination with a suicide attempt (Fairhurst 2020); sleepiness significantly more common than with placebo with CBD:THC 10:1 oil (Stefanović 2025); with CBD:THC 20:1 and 6:1 oils, 2 cases of increased seizures, 2 behavior changes, 1 sleepiness (Libzon 2018)","In 63 children receiving synthetic THC in palliative care, 3 serious side effects (respiratory failure or reduced breathing rate), fatigue 22%, behavior problems 14% (Hauch 2024)"],"izlem":["EMERALD (NCT03690791, Australia): effect of a CBD-rich oil (50 mg CBD per mL, less than 2 mg THC) on disease progression in ALS; 17 people, double-blind, placebo-controlled; estimated completion January 2024; the registry entry has not been updated since April 2023 and its status is 'unknown'; no results in the registry and no publication found in PubMed in October 2026 (protocol: Urbi 2019, PMID 31719072); its 7-person open-label extension (NCT04997954) also has no results","NCT01222468 (Canada): nabilone (at most 3 mg a day) in spinal cord injury, muscle stiffness and nerve pain; 12 people, crossover; completed in February 2015; no results in the registry and no publication in PubMed","NCT04057456 (Canada): nabilone and an anti-inflammatory diet in spinal cord injury; primary outcome nerve pain, muscle stiffness secondary; 14 people; completed in December 2024; no results in October 2026","NCT06190470 (Thailand): THC-containing cannabis extract in spinal cord injury; nerve pain and muscle stiffness; 20 people planned, crossover; estimated completion June 2024; the record has not been updated since March 2024, no results"],"dikkat":["Product information for the mouth spray containing THC and CBD: licensed only for MS spasticity in adults; not recommended under age 18 (efficacy was not shown in a placebo-controlled study in children with cerebral palsy or brain injury); not used if the person or their family has a history of schizophrenia or other psychosis, or during breastfeeding; not recommended in serious cardiovascular disease; once spasticity goes down, the risk of falls may increase in people without enough muscle strength (UK product information, April 2, 2026, §4.1–4.4)","Children: hallucinations (with a suicide attempt in one case), marked sleepiness and increased seizures were reported with THC-containing products; suppressed breathing was seen with synthetic THC in severely ill children taking several seizure and sedative medicines (Fairhurst 2020, Stefanović 2025, Libzon 2018, Hauch 2024)","After stroke: in the only controlled study, blood pressure and pulse did not change, but people at very high cardiovascular risk and smokers were not included; according to the product information, changes in pulse and blood pressure during initial dose adjustment and fainting during use have been seen with the spray (Marinelli 2022; UK product information §4.4)","ALS: in a 9-patient single-dose study, 10 mg THC clearly increased sleepiness, euphoria, dizziness, drop in blood pressure on standing, and weakness compared with 5 mg (Joerger 2012, PMID 22594565)"],"ilac_etkilesim_notlari":["The studies on this page did not systematically assess drug interactions; details are in the site's drug interactions section","Product information for the THC:CBD spray (§4.5): with muscle relaxants (baclofen, benzodiazepines), muscle tone and strength may decrease and the risk of falls may increase; with sleep-inducing and sedative medicines and alcohol, the sedative effect may increase; strong CYP3A4 inhibitors such as ketoconazole raise THC and CBD levels (the dose may need readjusting if itraconazole, ritonavir or clarithromycin is started or stopped); fluconazole increases THC exposure; strong inducers such as rifampin, carbamazepine, phenytoin, phenobarbital and St. John's wort are avoided where possible","Children with cerebral palsy and people with severe neurological disease often take several seizure medicines; CBD can interact with some seizure medicines (details on the epilepsy pages and in the drug interactions section)"],"dogrulanamayan":["The full texts of Riva 2019, Fairhurst 2020, Stefanović 2025, Libzon 2018, Weber 2010, Hagenbach 2007, Pooyania 2010, Wissel 2006, Nielsen 2019 and Austin 2024 could not be read (paywalled, or the publisher's page required bot verification); the figures come from the abstracts, the UK product information (Fairhurst 2020), the NICE 2019 evidence tables (Riva 2019, Pooyania 2010, Wissel 2006) and ClinicalTrials.gov records","The dose actually taken in Stefanović 2025 is not in the abstract; the dosing schedule comes from the study's registry entry (NCT04634136). In Libzon 2018, the doses and the patients' diagnoses are not in the abstract (according to one review, 19 of the 25 children had cerebral palsy: Murni 2023); the study's registry entry may be NCT02470325 (same center and same two products), but that record has not been updated since 2015 and the match could not be confirmed","In Hagenbach 2007, the comparison for the randomized phase itself (6 THC, 7 placebo) is not given separately in the abstract; the p = 0.001 in the abstract is a comparison between the open THC period and the placebo period in the same 7 people","The number of people and side effects in Martins Braga 2025 are not in the abstract; the full text is not open access. Hansen 2023 has no separate results for patients with spinal cord injury","The maker's THC:CBD spray study in spinal cord injury (NCT01606202) was not published in a peer-reviewed journal; its results are only in the ClinicalTrials.gov record","In Hauch 2024, the denominator for the muscle stiffness percentages (9.5% for those started in the unit, 38.1% for those already using it) is not clear in the publication; the text uses the total rate the authors gave in the discussion (47.6%). The comparison for the randomized phase of Hagenbach 2007 appears only in the table of one review (Nabata 2021)"],"calismalar":[{"ad":"Stefanović 2025","tasarim":"Randomized, double-blind, placebo-controlled parallel study (6 weeks), followed by a 6-week open-label period; preceded by an open-label pilot (feasibility) study of 7 patients","n":"53 randomized (1:1); plus a 7-person pilot study","populasyon":"Children, teenagers and young adults aged 5–25 with severe spastic cerebral palsy (GMFCS IV–V) (Slovenia)","urun":"Full-spectrum cannabis oil, CBD:THC 10:1 (HemPhar), by mouth","urun_turu":"thc_iceren","doz":"Dose taken not in the abstract; per the registry, THC was started at 0.08 mg per kilogram a day and increased gradually, with an upper limit of 1 mg per kilogram a day (NCT04634136)","titrasyon":"Per the registry, started with a dose divided into 2 a day and increased in steps of 0.08 mg THC per kilogram","sure":"6 weeks double-blind + 6 weeks open-label","sonuc":"There was no significant difference between the oil and placebo in muscle stiffness (Modified Ashworth Scale), the primary outcome; there was also no difference in gross motor function (GMFM-88) or quality of life (the authors mentioned a possible benefit in quality of life). The oil and placebo were supplied by the manufacturer (PharmaHemp), which appears as a study partner in the registry; the authors declared no conflicts of interest. Full text could not be read","yan_etki":"Sleepiness significantly more common in the oil group than with placebo; side effects mild to moderate, no life-threatening events (abstract)","pmid":"39626543","doi":"10.1016/j.ejpn.2024.11.007","diger_kaynak":"ClinicalTrials.gov NCT04634136 (University Medical Centre Ljubljana; partner: PharmaHemp, which supplied the product; 55 people enrolled; October 2020–February 2024; no results in the registry); editorial: Grunt 2025, PMID 40057427"},{"ad":"Fairhurst 2020","tasarim":"Multicenter, double-blind, placebo-controlled parallel RCT (2:1), followed by a 24-week open-label extension","n":"72 randomized (47 spray, 25 placebo)","populasyon":"Children and teenagers aged 8–18 (mean age 12) with spasticity due to cerebral palsy or traumatic central nervous system injury not responding well enough to current treatment; most with severe mobility limitation (GMFCS IV–V)","urun":"THC:CBD mouth spray (nabiximols, Sativex; 2.7 mg THC + 2.5 mg CBD per spray), added to current treatment","urun_turu":"thc_iceren","doz":"At most 12 sprays a day depending on clinical response and tolerability (at most 32.4 mg THC + 30 mg CBD); average dose taken not in the abstract","titrasyon":"Gradual increase over 9 weeks (UK product information §5.1)","sure":"12 weeks","sonuc":"Caregiver-rated muscle stiffness on a 0–10 scale decreased by 1.85 points with the spray and 1.57 points with placebo; the difference was not significant (−0.17; 95% CI −1.12 to 0.79; p = 0.73). There was no difference in any secondary outcome, including sleep, pain, quality of life, comfort and depression. The manufacturer's study (2 of the 5 authors were GW Research employees)","yan_etki":"Side effects mostly mild to moderate; 3 cases of hallucination, one with an auditory hallucination and a suicide attempt","pmid":"32342496","doi":"10.1111/dmcn.14548","diger_kaynak":"ClinicalTrials.gov NCT01898520 (December 2013–March 2017; sponsor today Jazz Pharmaceuticals; no results in the registry); figures from section §5.1 of the UK product information (text revision April 2, 2026); commentary: Nielsen 2020, PMID 32562496"},{"ad":"Riva 2019 (CANALS)","tasarim":"Multicenter, double-blind, placebo-controlled parallel phase 2 RCT","n":"60 randomized (30 spray, 30 placebo); 59 analyzed (29 and 30)","populasyon":"Patients aged 18–80 with ALS or primary lateral sclerosis, spasticity for at least 3 months and stable muscle stiffness treatment (Italy, 4 centers)","urun":"THC:CBD mouth spray (nabiximols; 2.7 mg THC + 2.5 mg CBD per spray), added to current treatment","urun_turu":"thc_iceren","doz":"At most 12 sprays a day; an average of 8.0 sprays/day in the spray group (NICE 2019 evidence table)","titrasyon":"Increased by the patient on a preset schedule over the first 14 days, then fixed for 4 weeks","sure":"6 weeks (14 days of dose adjustment + 4 weeks at a fixed dose)","sonuc":"On the Modified Ashworth Scale, the primary outcome, muscle stiffness decreased by an average of 0.11 points in the spray group and increased by 0.16 points in the placebo group (adjusted difference −0.32; 95% CI −0.57 to −0.07; p = 0.013). The authors considered this a preliminary (proof-of-concept) result and called for confirmation in larger studies. Investigator-initiated study funded by an ALS research foundation","yan_etki":"No serious side effects; no one stopped during the double-blind period. Per NICE 2019, the risk of any side effect was higher in the spray group (RR 2.84; 95% CI 1.52 to 5.33; drug-related side effects RR 5.43); common ones were weakness, sleepiness, dizziness and nausea","pmid":"30554828","doi":"10.1016/S1474-4422(18)30406-X","diger_kaynak":"ClinicalTrials.gov NCT01776970; commentary: de Visser 2019, PMID 30554829"},{"ad":"Marinelli 2022 (SativexStroke)","tasarim":"Single-center, double-blind, placebo-controlled crossover pilot RCT","n":"41 started; 34 completed and were analyzed","populasyon":"Adults who had a stroke at least 3 months earlier and have spasticity in an arm or leg (median age 68); people at very high cardiovascular risk (CHA2DS2-VASc ≥ 7) and smokers were not included (Italy)","urun":"THC:CBD mouth spray (nabiximols, Sativex), added to current treatment","urun_turu":"thc_iceren","doz":"At most 12 sprays a day (morning and evening); during the medicine period a median of 9 (4–12) sprays/day","titrasyon":"1 spray every 2 days for the first 4 days, then increasing by 1 each day to the highest tolerated dose within 14 days","sure":"Two 4-week periods, with a 2-week drug-free break in between (10 weeks in total)","sonuc":"There was no difference between the spray and placebo in the two primary outcomes (patient-reported muscle stiffness on a 0–10 scale and electrical measurement of the stretch reflex in the wrist flexor muscles) (p = 0.7 and p = 0.2); there was also no difference in pain, sleep, bladder, number of spasms or doctor-measured muscle stiffness (Modified Ashworth). Those whose stiffness decreased by at least 20%: 32.4% in the spray period, 29.4% in the placebo period. Small pilot study; medicine and placebo provided free by the manufacturer, part of the costs from Almirall","yan_etki":"7 people withdrew (4 because of side effects, all during the spray period: feeling that movements were getting worse, palpitations, sleepiness, confusion, fatigue, nausea); 2 serious side effects during the spray period (an overnight hospital stay for severe nausea; a first seizure judged by the investigators to be unrelated to the medicine); no meaningful change in blood pressure or pulse, no new stroke or cardiovascular event","pmid":"35812088","doi":"10.3389/fneur.2022.892165","diger_kaynak":"EudraCT 2016-001034-10; protocol: Marinelli 2017, PMID 28882919; additional analysis of blood pressure and pulse: Rosa 2022, PMID 36386386 (31 of the 34 patients were taking blood pressure medicine; blood pressure and pulse did not change during the spray period)"},{"ad":"Boonthanakorn 2026","tasarim":"Single-center, double-blind, placebo-controlled crossover pilot RCT","n":"16 randomized; 16 completed","populasyon":"Adults aged 20–65 with spinal cord injury for at least 1 year whose muscle stiffness persisted despite the highest tolerated baclofen (16/16) and tizanidine (13/16); 15 men, 10 with tetraplegia; no previous cannabis use (Thailand)","urun":"1:1 THC:CBD oil (27 mg THC + 25 mg CBD per mL; about 1 mg THC and 1 mg CBD per drop; Thai Government Pharmaceutical Organization), by mouth, added to current treatment","urun_turu":"thc_iceren","doz":"Protocol ceiling 12 mg THC a day; an average of 11.6 mg THC a day (and a similar amount of CBD); 15 patients reached the ceiling","titrasyon":"Gradual increase over 1 week (details in a supplementary file)","sure":"Two 4-week periods (1 week of dose adjustment + 3 weeks fixed), with a 2-week drug-free break in between","sonuc":"There was no difference between the oil and placebo in the primary outcome (total Ashworth score of all affected muscle groups) (adjusted difference −1.2; 95% CI −5.9 to 3.5; p = 0.31); there was also no difference in spasm frequency, doctor-rated stiffness or H-reflex measurement. Only the stiffness patients rated themselves on a 0–100 scale decreased more with the oil (−13.9; 95% CI −25.5 to −2.3; p = 0.010). Very small; funded by the state body that makes the product","yan_etki":"No serious side effects or dropouts; mild side effects 5 during the oil period, 1 during the placebo period (p = 0.073): with the oil, 1 symptomatic drop in blood pressure (70/40 mmHg), 1 asymptomatic slowed heart rate, 3 raised liver enzymes (2 times normal)","pmid":"42544174","doi":"10.1177/17562864261468464","diger_kaynak":"Thai Clinical Trials Registry TCTR20220329001"},{"ad":"NCT01606202 (maker's spinal cord injury study, registry results)","tasarim":"Double-blind, placebo-controlled, parallel phase 3 RCT; primary outcome nerve pain, spasticity a secondary outcome; results only in the registry (no peer-reviewed publication)","n":"116 randomized (56 active, 60 placebo); spasticity severity analyzed in 35 and 43 people, Modified Ashworth in 40 and 44","populasyon":"Adults with central neuropathic pain due to spinal cord injury not relieved by current treatment (spasticity was not an entry criterion)","urun":"Oromucosal spray: THC 27 mg/ml + CBD 25 mg/ml (GW-1000-02, Sativex), added to current treatment","urun_turu":"thc_iceren","doz":"2.7 mg THC + 2.5 mg CBD per spray; at most 8 sprays in 3 hours and 48 sprays a day","titrasyon":null,"sure":"At most 51 days (about 7 weeks)","sonuc":"No difference in spasticity: the difference in patient-reported spasticity severity on a 0–10 scale was 0.07 (95% CI −0.61 to 0.75; p = 0.83), in doctor-measured Modified Ashworth score −0.14 (−0.33 to 0.05; p = 0.14), in spasm severity 0.05 (−0.54 to 0.65; p = 0.86); no difference either in the percentage of days with spasticity and spasms. No difference in the primary outcome of pain (−0.08; −0.51 to 0.35); those saying their overall condition had improved: 30/56 vs 12/60 (p < 0.001). The manufacturer's study; no peer-reviewed publication","yan_etki":"Reported side effects 46/56 vs 29/60 (dizziness 14 vs 5, sleepiness 7 vs 0); stopping due to side effects 5 vs 0; serious side effects 3 vs 2","pmid":null,"doi":null,"diger_kaynak":"ClinicalTrials.gov NCT01606202 (July 2002–January 2005; results in the registry, September 28, 2012; sponsor today Jazz Pharmaceuticals); the same study is in the neuropathic-pain table with its pain result"},{"ad":"Weber 2010","tasarim":"Randomized, double-blind, placebo-controlled crossover RCT","n":"27 randomized; complete data for 22 people","populasyon":"ALS patients with moderate to severe daily muscle cramps (at least 4 on a 0–10 scale) (20 men, 7 women; mean age 57; Switzerland)","urun":"Oral THC (dronabinol according to the registry)","urun_turu":"thc_iceren","doz":"5 mg 2 times a day (10 mg/day)","titrasyon":"Fixed dose","sure":"Two 2-week treatment periods, each preceded by a 2-week drug-free period","sonuc":"No difference was seen between THC and placebo in cramp severity (primary outcome), daily number of cramps, severity of muscle twitching (fasciculations), or quality of life, sleep, appetite and depression scales","yan_etki":"Well tolerated (abstract)","pmid":"20498181","doi":"10.1136/jnnp.2009.200642","diger_kaynak":"ClinicalTrials.gov NCT00812851 (24 people in the registry; no results)"},{"ad":"Libzon 2018","tasarim":"Pilot study comparing two products; no placebo group (tagged as a randomized controlled trial in PubMed, and its likely registry entry NCT02470325 is randomized and triple-blind; no details on randomization and blinding in the abstract; the Murni 2023 review counted it as a non-randomized study)","n":"25 (19 with cerebral palsy; diagnosis breakdown from Murni 2023 Table 1, secondary source)","populasyon":"Children aged 1–17 with moderate to severe complex movement disorders in which different types of abnormal movements occur together (Israel, Wolfson Medical Center); according to one review, 19 had cerebral palsy (Murni 2023, secondary source)","urun":"Two CBD-rich cannabis oils (5% CBD): with 0.25% THC (CBD:THC 20:1) and with 0.83% THC (6:1)","urun_turu":"thc_iceren","doz":"Not in the abstract (full text could not be read)","titrasyon":"Not in the abstract","sure":"5 months","sonuc":"Significant improvement in spasticity, dystonia, sleep difficulty, pain severity and quality of life was reported in the whole group, regardless of which oil was taken. Because there was no placebo group, it cannot be known how much of the improvement came from the oil. Very small; 3 of the 8 authors were from the research department of a cannabis company (Tikun Olam)","yan_etki":"Rare: increased seizures in 2 children, behavior change in 2, sleepiness in 1","pmid":"29766748","doi":"10.1177/0883073818773028","diger_kaynak":"Likely registry entry: ClinicalTrials.gov NCT02470325 (Wolfson Medical Center; 6:1 and 20:1 CBD:THC oils; 40 people planned; record not updated since 2015, status 'unknown'); match not confirmed"},{"ad":"Pooyania 2010","tasarim":"Randomized, double-blind, placebo-controlled crossover pilot RCT","n":"12 (11 completed; all men; 6 with tetraplegia, 5 with paraplegia)","populasyon":"Adults with spinal cord injury and spasticity (Canada)","urun":"Nabilone (synthetic THC-like cannabinoid), by mouth","urun_turu":"cbn_diger","doz":"0.5 mg as 1 dose a day; if needed, 0.5 mg 2 times a day","titrasyon":"Could be increased to 2 doses a day in weeks 3–4 (NICE 2019 evidence table)","sure":"Two 4-week periods with a 2-week drug-free break in between","sonuc":"The Ashworth score measured by the doctor in the most affected muscle group decreased more with nabilone than with placebo (difference 0.91 ± 0.85; p = 0.003); there was also a significant difference in the total Ashworth score (p = 0.001). There was no difference in patient-reported spasm frequency and stiffness, the pendulum test or global impression measures. Very small; the registry lists a drug company (Valeant Canada) as an industry partner","yan_etki":"Mild and tolerable (abstract); per NICE 2019, sleepiness, dry mouth, weakness, mild dizziness, mild balance problems, headache","pmid":"20434606","doi":"10.1016/j.apmr.2009.12.025","diger_kaynak":"ClinicalTrials.gov NCT00623376 (University of Manitoba; partner: Valeant Canada; July–December 2007; no results in the registry)"},{"ad":"Hagenbach 2007","tasarim":"Three-phase study: two open-label dose-finding phases (oral THC; rectal THC-hemisuccinate), followed by a small, randomized, double-blind, placebo-controlled parallel phase","n":"25 (open oral THC phase 22, 15 completed; rectal phase 8, 7 completed; randomized phase 6 THC, 7 placebo)","populasyon":"Adults with spinal cord injury and spasticity; spasticity medicines were stopped before the study (Switzerland)","urun":"Oral THC and rectal THC-hemisuccinate","urun_turu":"thc_iceren","doz":"An average of 31 mg a day (oral THC) and 43 mg (rectal THC-hemisuccinate); started with a single 10 mg dose","titrasyon":"Individual dose adjustment","sure":"6 weeks per phase","sonuc":"In the open-label oral THC phase, the total spasticity score (Modified Ashworth) fell from 16.7 to 8.9 on day 43; similar improvement with rectal use. The p = 0.001 in the abstract is not a comparison between randomized groups but between two periods in the same 7 people, who first took THC in the open phase and then placebo in the randomized phase; the comparison for the randomized phase itself (6 THC, 7 placebo) is not in the abstract. The supplementary table of Nabata 2021 gives, for this phase, an effect size on the Modified Ashworth of −0.66 (95% CI −1.73 to 0.50; not significant) and a difference in favor of THC in the patient's own rating only on day 1 (p = 0.033) (secondary source; could not be confirmed from the publication). According to the authors, at least 15–20 mg a day was needed for an effect. Most of the study was open-label","yan_etki":"The main reasons for stopping were increased pain and psychological side effects","pmid":"17043680","doi":"10.1038/sj.sc.3101982","diger_kaynak":"Commentary: Villan 2008, PMID 18332890"},{"ad":"Wissel 2006","tasarim":"Randomized, double-blind, placebo-controlled crossover RCT","n":"13 (11 completed)","populasyon":"Adults with chronic upper motor neuron syndrome and spasticity-related pain not relieved by standard treatment (due to brain or spinal cord damage; at least 1 patient with MS; per NICE, Austria, Germany, Switzerland)","urun":"Nabilone (synthetic THC-like cannabinoid), by mouth","urun_turu":"cbn_diger","doz":"1 mg a day","titrasyon":"Started at 0.5 mg a day and increased to 1 mg","sure":"Two 4-week periods with a 1-week break in between (NICE 2019 evidence table)","sonuc":"Pain related to muscle stiffness (11-point box test) decreased significantly more with nabilone than with placebo (p < 0.05); spasticity, motor function and activities of daily living did not change. Very small; NICE 2019 rated the risk of bias as high because of missing information on randomization and blinding","yan_etki":"Side effects in 5 patients: with nabilone, 1 case of moderate temporary leg weakness (withdrew) and 2 of mild sleepiness; with placebo, 1 of sleepiness and 1 of mild difficulty swallowing; 1 patient was withdrawn during the nabilone period because of an MS relapse","pmid":"16988792","doi":"10.1007/s00415-006-0218-8","diger_kaynak":null},{"ad":"Hansen 2023","tasarim":"Multicenter, double-blind, placebo-controlled, 4-arm parallel RCT (THC / CBD / THC+CBD / placebo)","n":"134 (MS 119, spinal cord injury 15; CBD 31, THC 32, THC+CBD 31, placebo 40)","populasyon":"Neuropathic pain and/or spasticity due to MS or spinal cord injury (Denmark)","urun":"Oral capsules: synthetic pure CBD; THC; both combined","urun_turu":"saf_cbd","doz":"CBD at most 45 mg/day, THC at most 22.5 mg/day (divided into 3 doses a day, at most 9 capsules)","titrasyon":"Standard increase over 3 weeks; a lower dose was kept if there was enough effect or side effects","sure":"6 weeks + 1 week tapering","sonuc":"119 patients had MS and 15 had spinal cord injury (73% of those with spinal cord injury had both pain and spasticity); no separate result was given for patients with spinal cord injury. Spasticity was assessed in the 100 patients who met the criterion (both conditions together): improvement in the pure CBD group was no different from placebo (difference 0.46 points; 95% CI −0.74 to 1.65); there was also no difference in the THC (0.24; −0.67 to 1.45) and THC+CBD (0.10; −1.18 to 1.39) groups. Only 134 of the targeted 448 people could be enrolled","yan_etki":"Side effects most common in the THC arms; dry mouth 29% with CBD, 27.5% with placebo; 1 hospitalization in the CBD arm (gallstone attack)","pmid":"37630995","doi":"10.3390/ph16081079","diger_kaynak":"EudraCT 2018-002315-98; protocol: Hansen 2021, PMID 34573231; pharmacokinetic substudy in 23 MS patients: Hansen 2024, PMID 38054364; the same study is in the ms-spasticity and neuropathic-pain tables"},{"ad":"NICE 2019 (evidence review C: spasticity)","tasarim":"Systematic review and meta-analysis (GRADE) for a national guideline, England (NICE NG144)","n":"15 RCTs (12 parallel, 3 crossover); non-MS: 2 motor neuron disease or upper motor neuron syndrome, 1 spinal cord injury; no studies in children","populasyon":"Adults and children with spasticity from any cause","urun":"THC:CBD mouth spray, synthetic THC capsule, cannabis extract capsule, nabilone","urun_turu":"karma","doz":"Varied by study","titrasyon":null,"sure":"Varied by study","sonuc":"Evidence for causes other than MS was found to be very limited: in motor neuron disease, a small reduction in doctor-measured muscle stiffness with THC:CBD spray (1 study, 59 people; difference −0.27; 95% CI −0.51 to −0.03; high quality) but a higher risk of side effects (RR 2.84); in spinal cord injury, a reduction in Ashworth score with nabilone (1 small crossover study; moderate quality). The committee found sufficient evidence only for MS; it made no recommendation for cannabinoid products for other causes, recommended research, and specifically mentioned people with cerebral palsy as a group that might benefit","yan_etki":"Common in motor neuron disease: weakness, sleepiness, dizziness, nausea","pmid":"35107908","doi":null,"diger_kaynak":"NCBI Bookshelf NBK577084; guideline: NICE NG144 (PMID 31909928); PDF: nice.org.uk/guidance/ng144/evidence (final version November 2019)"},{"ad":"Nielsen 2019","tasarim":"Systematic review (narrative synthesis)","n":"32 studies (adults and children)","populasyon":"Spasticity from any cause; focused on applicability to children","urun":"Various cannabinoids","urun_turu":"karma","doz":"Varied by study","titrasyon":null,"sure":"Varied by study","sonuc":"In adults with MS, cannabinoids are slightly more effective than placebo for spasticity, with benefit mostly on patient-reported measures and small; for causes other than MS there are few studies and none are large; studies in children are of low quality and not at a level to guide practice","yan_etki":"Cannabinoids have a narrow therapeutic window in spasticity; benefit should be weighed together with side effects (abstract)","pmid":"30680713","doi":"10.1111/dmcn.14165","diger_kaynak":"Commentary: O'Callaghan 2019, PMID 30993669"},{"ad":"Nabata 2021","tasarim":"Systematic review (no meta-analysis; effect sizes calculated for RCTs)","n":"34 studies (26 on patterns of use, 8 on treatment effect; 7 RCTs)","populasyon":"People with spinal cord injury","urun":"Dronabinol, oral THC, inhaled cannabis, oromucosal spray extracts, nabilone","urun_turu":"karma","doz":"Varied by study","titrasyon":null,"sure":"Varied by study","sonuc":"Pain, muscle stiffness and recreation stand out among reasons for use. All experimental studies reported a reduction in spasticity, but looking at RCTs only, effect sizes for spasticity ranged from −0.95 to 0.09; the size and clinical importance of the effect are uncertain; long-term, double-blind studies are needed","yan_etki":"Cannabinoid use was associated with fatigue and cognitive impairment","pmid":"32310048","doi":"10.2174/1570159X18666200420085712","diger_kaynak":null},{"ad":"Murni 2023","tasarim":"Systematic review (PRISMA 2020; no meta-analysis; PROSPERO CRD42022358383)","n":"3 studies, 133 participants (2 experimental: 1 RCT and 1 counted as non-randomized; 1 observational)","populasyon":"Children with cerebral palsy","urun":"THC:CBD mouth spray, CBD-rich oils with THC, prescription cannabinoids","urun_turu":"karma","doz":"Varied by study","titrasyon":null,"sure":"Varied by study","sonuc":"Muscle stiffness results were inconsistent: no difference in the only placebo-controlled study (Fairhurst 2020), improvement in the study without placebo (Libzon 2018). Although the authors summarized overall efficacy and safety as 'good', they wrote that efficacy has not been studied enough and that larger studies are needed. Conducted before Stefanović 2025","yan_etki":"Side effects mostly mild to moderate; serious events reported included changes in seizure characteristics and disorientation","pmid":"37991091","doi":"10.31744/einstein_journal/2023RW0387","diger_kaynak":null},{"ad":"Baldinger 2012 (Cochrane)","tasarim":"Cochrane systematic review and meta-analysis","n":"20 studies, 4,789 participants (the only study looking at cramps as the primary outcome was a THC study)","populasyon":"Muscle cramps in ALS / motor neuron disease","urun":"Medicines tested for cramps; THC as the only cannabinoid","urun_turu":"thc_iceren","doz":"Varied by study","titrasyon":null,"sure":"Varied by study","sonuc":"No intervention was shown to benefit cramps in ALS; most studies were too small for firm conclusions. Cochrane's 2017 overview of symptomatic treatments in ALS (Ng 2017) wrote that THC is probably ineffective for cramps (moderate-quality evidence)","yan_etki":"Not reported (in the abstract)","pmid":"22513921","doi":"10.1002/14651858.CD004157.pub2","diger_kaynak":"Cochrane overview: Ng 2017, PMID 28072907 (CD011776.pub2)"},{"ad":"Austin 2024","tasarim":"Retrospective cohort (comparison group: people with the same symptoms who did not receive a medical marijuana prescription)","n":"344 ALS patients","populasyon":"Patients followed at a single ALS clinic (Texas, USA)","urun":"Medical marijuana (product type and THC/CBD content not in the abstract)","urun_turu":"karma","doz":"Not reported (in the abstract)","titrasyon":null,"sure":"2-year chart review","sonuc":"Medical marijuana use was associated with short-term reductions in pain, loss of appetite and anxiety; there was no association with muscle stiffness, insomnia or weight maintenance. ALS progressed faster in users, but these patients' symptoms were already more severe and their disease was progressing faster before the marijuana prescription (association; cause and effect not shown). The authors recommended a randomized study","yan_etki":"Not reported (in the abstract)","pmid":"39307005","doi":"10.1016/j.jns.2024.123243","diger_kaynak":null},{"ad":"Hauch 2024","tasarim":"Retrospective chart review (single center, inpatient pediatric palliative care unit)","n":"63 children and young people (out of 1,219 patients admitted to the unit); 26 were started in the unit, 37 were already using it; in 42, one of the reasons for giving the medicine was muscle stiffness","populasyon":"Children with life-limiting illness, 96.8% with severe neurological disease (mean age 10.4; Germany)","urun":"Dronabinol (semi-synthetic THC), oral drops","urun_turu":"thc_iceren","doz":"Effective dose averaged 0.21 mg per kilogram a day (started in the unit) and 0.48 mg (already using it)","titrasyon":null,"sure":"Admissions 2011–2021","sonuc":"The rate of at least moderate response in muscle stiffness, by subjective assessment of doctors, nurses or families, was 47.6% in total as given by the authors in the discussion (given in the Results as '9.5%/38.1% for groups A/B, n = 42'; response was reported by doctors and nurses for those started in the unit and by families for those already using it). In the standard 24-hour records of those started in the unit, seizures, restlessness and need for extra medicine did not decrease (muscle stiffness was not in these records); the authors wrote that the subjective positive impression was not confirmed by objective data. No comparison group","yan_etki":"3 serious side effects (respiratory failure, one needing non-invasive breathing support; reduced breathing rate), all resolved when the medicine was stopped; fatigue 22.2%, behavior problems 14.3%","pmid":"39334587","doi":"10.3390/children11091054","diger_kaynak":null},{"ad":"Martins Braga 2025","tasarim":"Prospective, single-arm (uncontrolled) observational study","n":"Not reported (in the abstract); full text could not be read","populasyon":"Adults with spinal cord injury for at least 6 months and moderate to severe spasticity resistant to conventional treatment (Guttmann Institute, Spain)","urun":"THC:CBD mouth spray (nabiximols, Sativex)","urun_turu":"thc_iceren","doz":"Weekly individual dose adjustment (no details in the abstract)","titrasyon":"Weekly individual adjustment","sure":"2 months (assessments at months 1 and 2)","sonuc":"Spasticity decreased significantly from baseline at month 1 (30% reduction on the patient scale, 60% on the Modified Ashworth) and at month 2 (30% and 52%); 67% of patients reported overall improvement. Spasm frequency, functional independence, nerve pain and sleep quality did not change. No comparison group; supported by Almirall","yan_etki":"Not reported (in the abstract)","pmid":"40675989","doi":"10.1038/s41394-025-00712-2","diger_kaynak":"EudraCT 2022-001777-31"},{"ad":"Bilbao 2022","tasarim":"Systematic review and meta-analysis of RCTs split by drug type (8 databases, up to May 2021, updated in October 2021; PROSPERO CRD42021229932; GRADE); separate analysis for ALS","n":"152 RCTs, 12,123 participants (all indications); in the ALS analysis, 2 RCTs: Weber 2010 (dronabinol, 22 people) and Riva 2019 (nabiximols, 59 people)","populasyon":"All medical indications; the ALS analysis covers adults with ALS or motor neuron disease","urun":"In the ALS analysis: dronabinol (synthetic THC) and a THC:CBD mouth spray (nabiximols); across the whole review, dronabinol, nabilone, pure CBD and nabiximols (smoked cannabis excluded)","urun_turu":"thc_iceren","doz":"In the ALS studies, dronabinol 10 mg/day (2 weeks) and nabiximols up to 32.4 mg THC + 30 mg CBD a day (6 weeks) (Table 2 of the review)","titrasyon":null,"sure":null,"sonuc":"Only two RCTs were found in ALS. The review pooled general ALS-specific scales (according to the supplementary tables, the ALS quality of life questionnaire in Weber 2010 and the ALS functional rating scale in Riva 2019): neither study showed improvement; according to the authors, the pooled effect pointed toward placebo but was not significant (SMD 0.31; 95% CI −0.02 to 0.63; p = 0.07; the publication does not say how the direction of the two scales was aligned). Separately: dronabinol SMD 0.26 (95% CI −0.17 to 0.68), nabiximols SMD 0.38 (−0.13 to 0.90). Comparisons with a single RCT were not graded with GRADE. This analysis uses the general ALS scales, not the doctor-measured muscle stiffness that was the primary outcome of Riva 2019. The authors reported no conflicts of interest. The search ended in October 2021; from then until October 2026, no new controlled study with published results has appeared in ALS","yan_etki":"No side effect analysis specific to ALS was given","pmid":"35982439","doi":"10.1186/s12916-022-02459-1","diger_kaynak":"PROSPERO CRD42021229932; PMC9389720 (ALS forest plot: Appendix 4, Figure S10; measures: Appendix 2 tables); the same review is also a row in the glaucoma, irritable bowel, appetite loss, generalized anxiety and Parkinson’s tables"}],"ilgili_ilaclar":["diazepam","benzodiazepin","tizanidin","antiepileptik_diger"],"son_inceleme":"2026-10-31","arastirma_gecmisi":[{"tarih":"2026-10-28","not":"Page published. This first assessment reviewed 20 studies."},{"tarih":"2026-10-31","not":"The last sentence of the page's short summary was rewritten in a calmer, more guiding tone: instead of \"Talk to your doctor before you start.\", it now says whom you can talk with, and about what, if you are considering CBD. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-31","not":"The ALS section was expanded: all controlled studies with cannabinoids in ALS, registry records with results and large observational data sets were searched again. No new controlled study or registry record with published results was found; a 2022 meta-analysis pooling the two controlled studies in ALS (Bilbao 2022; no difference in favor of cannabinoids on ALS scales of daily function and quality of life) was added to the table. The quality of life, sleep and appetite results of the cramp study and the status of a 17-person study looking at the course of the disease (results not published as of October 2026) were added to the ALS section. The conclusion and the strength of evidence did not change."}]},{"id":"tourette-syndrome","baslik":"Tourette syndrome and chronic tic disorders","grup":"Neurodevelopmental","grup_kodu":"norogelisimsel","tr_id":"tourette-tik","kanit_duzeyi":"yetersiz","kanit_yonu":"veri_yok","kanit_ozet":"All six randomized controlled trials of cannabinoids in Tourette syndrome and chronic tic disorders used THC. The largest (CANNA-TICS; 97 adults, mouth spray containing THC and CBD, 13 weeks) did not show superiority on the primary outcome: at least a 25% reduction in tic score in 21.9% versus 9.1% (p = 0.076; results in the EU clinical trials register); the protocol had set the response threshold at 30%, according to the register the 25% threshold was set during a blinded data review before the groups were unblinded, and with the 30% threshold the difference was also not significant (12.5% versus 3.0%; p = 0.063); secondary measures showed a trend toward improvement, and at one site 17% of participants asked afterward said they had found out which group they were in. In a crossover study of 22 adults with severe Tourette syndrome, an oil containing THC and CBD lowered the tic score more than placebo (8.9 versus 2.5 points; p = 0.008), but 8 people had cognitive side effects. Two small studies with pure THC in 2002 and 2003 (12 and 24 people) reported reductions on some scales; based on these two, a Cochrane review (2009) found the evidence insufficient, and it has not been updated since. In the 12-person study testing single doses of inhaled marijuana, there was no difference on the primary measure; the THC-rich product did better on secondary measures (urge before tics, distress, overall impression), no benefit was reported for the CBD-rich product, and most participants could tell the product from placebo. In teens (ages 12–18) there are only two pilot studies of 10 people each: one a placebo-controlled crossover feasibility study (according to an editorial, no statistical test of effectiveness was done), the other uncontrolled. Meta-analyses conflict: a 2026 meta-analysis covering 54 RCTs in mental health conditions found a reduction in tic severity (the abstract does not make clear how many studies and which products it is based on; certainty low for most outcomes); another 2026 meta-analysis covering adults found a negligible effect in Tourette syndrome (certainty mostly very low); a 2026 meta-analysis specific to Tourette syndrome compared only before and after treatment. The American Academy of Neurology's 2019 guideline, based on two older pure-THC studies, gave THC 'low confidence', counted cannabis-based medicines as an option that may be considered only in adults who have not improved with other treatments, and recommended avoiding them in children and adolescents and not using them in pregnancy, breastfeeding and psychosis; the European Tourette guideline (2022) lists cannabis-based medicines among options that may be considered only in treatment-resistant cases and recommends education and behavioral therapy as first-line treatment. Uncontrolled studies and clinic records (10–98 people) reported improvement in tics and quality of life; in a 70-person registry there was no significant improvement in tics, and in long-term users the THC dose rose from year to year; in Israel, more than half of children under 12 with Tourette syndrome who were prescribed medical cannabis oil stopped within the first three months. There are no controlled studies with oral CBD oil. October 2026 search (PubMed, Cochrane, ClinicalTrials.gov, EU clinical trials register, Europe PMC): 6 randomized controlled trials of cannabinoids on this topic (177 randomized participants; about 170 people, because two older studies shared patients; all with THC-containing products, one of which also had a CBD-dominant arm), 3 uncontrolled prospective studies, 5 systematic reviews and meta-analyses (1 Cochrane, 1 the evidence review behind the American Academy of Neurology guideline), 1 clinical guideline and 4 observational studies were found; all are in the table below. There is one RCT planned with 60 people whose results were never published (THC and palmitoylethanolamide; according to the EU register, terminated early in Germany in 2019); no studies from Turkey were found.","kanit_duzeyi_metin":"Pure CBD: Insufficient (no studies with CBD oil; CBD-dominant inhaled marijuana was tested only as a single dose, in a 12-person study)","kanit_duzeyi_thc_icerenler":"zayif","kanit_duzeyi_thc_icerenler_metin":"THC and THC+CBD: Weak (6 small controlled studies, 10–97 people; the largest did not show superiority on the main measure; meta-analyses conflict, certainty low to very low; only two pilot studies in children and adolescents)","kaynak_dosya":null,"saf_cbd_sonuc":"There are no controlled studies of pure CBD or oral CBD oil in Tourette syndrome. CBD-dominant vaporized marijuana (which also contains a small amount of THC) was tested only as a single dose given once, in a study of 12 adults (9 completed); no clear difference from placebo in tics was reported. Positive results seen with products that also contain CBD cannot be separated from THC: in studies that measured blood levels, improvement was linked to THC and its breakdown products, not to CBD. In Israel, most of the products given to children under 12 with Tourette syndrome who were prescribed medical cannabis oil were CBD-rich, but almost all of them also contained THC (96% of the first bottles dispensed); more than half of these children stopped treatment within the first three months, and the registry did not measure effectiveness.","thc_icerenler_sonuc":"The results of six small controlled studies (about 170 people in total) with pure THC, a mouth spray or oil containing THC and CBD, and inhaled marijuana are not consistent: in a 22-person crossover study, the tic score fell more with the THC and CBD oil than with placebo; in two small studies with pure THC, a reduction was seen only on some scales; in the largest study, with 97 people (mouth spray, 13 weeks), the share of people whose tics fell by at least a quarter was 21.9% versus 9.1%, but the difference was not statistically significant (nor was it with the 30% threshold in the study plan); with a single dose of inhaled marijuana there was no difference on the main measure. In teens there are only two pilot studies of 10 people each. Of two meta-analyses in 2026, one found fewer tics and the other a negligible effect; the certainty of the evidence is low or very low. THC caused slowed thinking, dizziness and sleepiness; in one study most participants could tell which group they were in.","ruhsat":null,"doz_araligi_ozet":"Pure THC single dose 5–10 mg and at most 10 mg/day (6 weeks); nabiximols 1–12 sprays/day (at most 32.4 mg THC + 30 mg CBD); THC+CBD oil (5+5 mg/mL) 1–4 mL/day (at most 20 mg THC + 20 mg CBD); in teens THC+CBD oil (10+15 mg/mL) at most 10 or 20 mg THC/day; dronabinol at most 10 mg/day + palmitoylethanolamide 800 mg/day; inhaled marijuana single dose 0.25 g; no studies with CBD oil","titrasyon_ozet":"Nabiximols: started at 1 spray a day and raised, depending on the person, to at most 12 over 4 weeks (CANNA-TICS protocol); THC+CBD oil: from 1 mL/day, increased by 1 mL a week to at most 4 mL (Mosley 2023); in teens from 1 mg THC/day to 5 or 10 mg over about 3 weeks, and if there was no response, increased for 3 more weeks to 10 or 20 mg (Eapen 2025); dronabinol from 2.5 mg to 10 mg over 1 week (Bloch 2021); these are research protocols","yan_etkiler":["With the oil containing THC and CBD, slowed thinking, forgetfulness and trouble concentrating in 8 of 22 people; during the placebo period the most common side effect was headache (7 people) (Mosley 2023)","With a single dose of inhaled marijuana, side effects were more common than with placebo for all products, most of all with the THC-rich product (cognitive and psychomotor effects) (Abi-Jaoude 2023)","In teens: in the placebo-controlled pilot study the most common was dizziness (67%), no serious side effects (Efron 2025); in the uncontrolled study the most common were tiredness and sleepiness, followed by dry mouth; blurred vision, increased appetite and lack of motivation 22% (Eapen 2025)","With THC combined with palmitoylethanolamide over 12 weeks: tiredness or sleepiness and feeling high in all 16 people, dry mouth in 15, trouble concentrating in 13, anxiety in 11, forgetfulness in 10, suspiciousness (paranoia) in 6, panic attacks in 4; no serious side effects (Bloch 2021, registry results)","With medical cannabis (mostly smoked): dry mouth 67%, tiredness 53%, sleepiness and dizziness 47%; mental side effects in 6 of 15 people; worsening OCD, panic attacks or anxiety in 3 people (Anis 2022)","88% of people who used medical cannabis for years reported at least one side effect (Anis 2024)","Across all mental health condition studies, the chance of side effects rose with any cannabinoid (OR 1.75; no difference in serious side effects; Wilson 2026); stopping because of side effects was more common with THC (OR 2.78; Bharat 2026)","With the mouth spray containing THC and CBD over 13 weeks, any side effect 95.3%, with placebo 78.8%; most common were feeling strange (40.6% versus 3.0%), dizziness (35.9% versus 33.3%) and tiredness (29.7% versus 24.2%); palpitations 5/64 versus 0; stopping because of side effects 5/64 versus 1/33; a serious side effect in 1 person in each group (CANNA-TICS, EU clinical trials register results)"],"izlem":["In a person using a THC-containing product, thinking, attention, mood and obsessive-compulsive symptoms should be monitored with a doctor; these side effects were common in the studies","In the study with teens, kidney function and electrolytes were checked at baseline, and liver tests and a urine drug screen were done at baseline and on day 85 (Eapen 2025)","Planned study: a crossover study comparing THC (dronabinol) combined with palmitoylethanolamide against placebo in 164 adults (NCT05126888) is listed in the registry as 'not yet recruiting' as of October 2026 (planned start June 2026, completion February 2028)"],"dikkat":["The positive results in Tourette studies came from THC-containing products; they cannot be cited as evidence for the CBD oils sold in Turkey","Children and adolescents: the American Academy of Neurology guideline recommends avoiding cannabis-based medicines because of the limited evidence and the possible harms of cannabis exposure in adolescence to thinking and mood in adulthood (Pringsheim 2019). With THC-containing products there are only two pilot studies of 10 people each, and long-term safety is unknown; an expert editorial points to the link between regular THC use in adolescence and the risk of psychosis, and says behavioral therapy should be offered first (Abi-Jaoude 2026, PMID 41556111)","Personal or family history of psychosis: this was an exclusion criterion in the study with teens (Eapen 2025); the American Academy of Neurology guideline recommends not using cannabis-based medicines in people with psychosis (Pringsheim 2019); according to an expert editorial, psychotic symptoms were seen with THC in Tourette studies, though rarely (Abi-Jaoude 2026)","Obsessive-compulsive symptoms and anxiety: worsening OCD, panic attacks and anxiety were reported with THC-containing medical cannabis (Anis 2022)","With long-term use, the THC dose rose from year to year; tolerance may develop (Anis 2024)","Anyone taking a medicine long term should talk to a doctor before starting; the studies on this page did not systematically assess interactions","Pregnancy and breastfeeding: the American Academy of Neurology guideline recommends not using cannabis-based medicines during these periods (Pringsheim 2019)"],"ilac_etkilesim_notlari":["The studies on this page did not systematically assess drug interactions; details are in the site's drug interactions section","Most participants were taking other medicines for tics, ADHD or OCD: in the studies, the doses of these medicines were kept stable for at least 30 days beforehand (CANNA-TICS protocol) or had to be unchanged for the past 4 weeks (Eapen 2025)"],"dogrulanamayan":["The full text of none of the six controlled studies could be read; the figures were taken from abstracts, the CANNA-TICS protocol and statistics paper, the CANNA-TICS results posted in the EU clinical trials register, ANZCTR and ClinicalTrials.gov records, and the tables of reviews.","CANNA-TICS response threshold: in the protocol (2020) and in the statistics paper published while the study was running (2021), it was defined as at least a 30% reduction in tic score; the abstract of the results paper says at least 25%. According to the EU clinical trials register, the 25% threshold was set during a blinded data review before the groups were unblinded; why it was changed could not be verified, because the full text of the results paper could not be read. According to the results in the register, the difference was also not significant with the original 30% threshold.","The tic scores of the placebo-controlled pilot study in teens (Efron 2025), the fact that one teen was rated 'much worse' during the oil period, and the information that no statistical test of effectiveness was done were taken only from an editorial (Abi-Jaoude 2026); the full text of the study could not be read.","The full texts of the two 2026 meta-analyses (Wilson 2026, Bharat 2026) and of the 2026 meta-analysis specific to Tourette syndrome could not be read: how many studies and which products the tic result is based on could not be verified; Wilson 2026's correction in the journal was read on October 29, 2026: only the axis of one figure and the study counts in a table were corrected, and the results did not change.","A study whose results were not published: an RCT planned with 60 adults comparing THC (dronabinol) combined with palmitoylethanolamide against placebo (NCT03651726; in the EU register EudraCT 2018-000014-38, 'ENTOURAGE'; sponsored by the company developing the drug, at two sites in Germany): the ClinicalTrials.gov record has not been updated since 2018 and its status is 'unknown'; in the EU register the study appears as terminated early on July 29, 2019, without stating how many people were enrolled or why it was stopped; no results or publication (October 2026).","The THC-containing medicines used in Tourette studies (nabiximols, dronabinol) are not licensed in Turkey: the TİTCK (Turkish Medicines and Medical Devices Agency) List of Licensed Human Medicinal Products (October 16, 2026) contains no cannabinoid medicine. The active substance of the mouth spray containing THC and CBD is on the TİTCK Foreign Active Substance List (September 28, 2026) among medicines that require a red prescription (Turkey's controlled-drug prescription) and can be imported from abroad with the agency's written approval; dronabinol is not on this list. Whether the agency has approved importing these medicines for Tourette syndrome could not be verified in this search."],"calismalar":[{"ad":"Müller-Vahl 2023 (CANNA-TICS)","tasarim":"Multicenter, double-blind, placebo-controlled, parallel-group phase 3b RCT (2:1 randomization; Germany)","n":"97 randomized (64 nabiximols / 33 placebo); 72 completed (48 / 24)","populasyon":"Adults with Tourette syndrome or chronic motor tic disorder (mean age 37.4 according to the Serag 2024 table; 73 men, 24 women); tic and co-occurring condition medicines stable for at least 30 days","urun":"Nabiximols (Sativex), oromucosal spray; each spray 2.7 mg THC + 2.5 mg CBD; placebo spray","urun_turu":"thc_iceren","doz":"1–12 sprays a day (at most 32.4 mg THC + 30 mg CBD/day); no target dose, individualized","titrasyon":"Per protocol, started at 1 spray a day and increased by 1 spray every 2 days for the first 4 days, then every day (slower increases allowed); 4 weeks of adjustment, 9 weeks of stable dose; stopped without tapering at the end","sure":"13 weeks (4 weeks dose adjustment + 9 weeks stable dose)","sonuc":"Primary outcome (at least a 25% reduction in YGTSS total tic score at week 13): 14/64 (21.9%) with nabiximols, 3/33 (9.1%) with placebo; risk difference 12.8 percentage points (95% CI −1.3 to 26.9; p = 0.076), superiority not shown. In the protocol (2020) and in the 2021 statistics paper, the response threshold was at least a 30% reduction; according to the results in the EU clinical trials register, the 25% threshold was set during a blinded data review before the groups were unblinded, and with the original 30% threshold the response was 8/64 (12.5%) versus 1/33 (3.0%) (p = 0.063; again not significant). On secondary measures, a trend toward improvement in tics, depression and quality of life; no difference in premonitory urge (as reported by Czech 2026). Clearer improvement in men, in those with severe tics and in those with ADHD comes from exploratory subgroup analyses (difference not significant in the ADHD subgroup; as reported by Czech 2026). During the pandemic, assessments moved to video calls (Lasch 2021). Of the 54 participants at the Hannover site, 9 of the 53 reached (17%) reported having found out which group they were in (7 during treatment; through a THC urine test or by accident). Funded by the German Research Foundation (DFG); the drug and placebo were supplied by the manufacturer (GW Pharma); the driving substudy was supported by the company holding the drug's European marketing rights (Almirall). According to the study's conflict-of-interest statement, 2 of 16 authors report ties with cannabinoid companies: the principal investigator declares research support from companies including the drug's manufacturer and marketing-rights holder, consulting, advisory board and speaker fees from many cannabis companies, and shares in a pharmaceutical company; another author declares research support from companies including one developing a THC-containing drug (Therapix)","yan_etki":"According to the results in the EU clinical trials register, a serious side effect occurred in 1 person in each group (worsening tics in the nabiximols group, not considered drug-related). Any side effect 61/64 (95.3%) with nabiximols, 26/33 (78.8%) with placebo; most common were 'feeling strange' (40.6% versus 3.0%), dizziness (35.9% versus 33.3%), tiredness (29.7% versus 24.2%), dryness at the application site in the mouth (18.8% versus 9.1%) and fatigue (12.5% versus 3.0%); palpitations 5/64 versus 0, panic attacks 4/64 versus 1/33; stopping because of side effects 5/64 versus 1/33. In the driving substudy (64 people), the share judged fit to drive rose from 55.8% to 71.8% with nabiximols and fell from 66.7% to 52.6% with placebo (risk difference 0.17; 95% CI −0.08 to 0.43)","pmid":"36878177","doi":"10.1016/j.psychres.2023.115135","diger_kaynak":"ClinicalTrials.gov NCT03087201 (98 people registered; no results in the registry); EU clinical trials register EudraCT 2016-000564-42 (results posted on December 31, 2023: primary outcome, dropouts, side effect table). Protocol: Jakubovski 2020 (PMID 33324255); statistics and COVID impact: Lasch 2021 (PMID 33594741); driving substudy: Müller-Vahl 2024 (PMID 38265476); blinding analysis: Müller-Vahl 2022 (PMID 36213751)"},{"ad":"Mosley 2023","tasarim":"Double-blind, placebo-controlled, randomized crossover study (Australia)","n":"22 (8 women)","populasyon":"Adults with severe Tourette syndrome","urun":"Oral oil: 5 mg THC + 5 mg CBD per mL; placebo, an inactive oil with matched excipients","urun_turu":"thc_iceren","doz":"From 1 mL/day up to at most 4 mL/day (at most 20 mg THC + 20 mg CBD/day), in divided doses","titrasyon":"Increased by 1 mL a week if the tic score fell by less than 2 points (ANZCTR record)","sure":"6 weeks active + 6 weeks placebo (order assigned at random; 4-week washout between)","sonuc":"The YGTSS total tic score (0–50) fell at week 6 by 8.9 (± 7.6) points in the active period and 2.5 (± 8.5) points in the placebo period; in the mixed model, the treatment × visit interaction was −2.28 (95% CI −3.96 to −0.60; p = 0.008). On secondary measures, tic-related impairment, anxiety and obsessive-compulsive symptoms were reported to possibly decrease. The plasma level of a THC breakdown product (11-carboxy-THC) was linked to the primary outcome; the link weakened when an outlier was removed. Funded by a hospital research institute and a university initiative funded by philanthropic donation","yan_etki":"In the active period the most common was cognitive difficulty (slowed thinking, forgetfulness, trouble concentrating; 8 people); in the placebo period the most common was headache (7 people)","pmid":"38320199","doi":"10.1056/EVIDoa2300012","diger_kaynak":"ANZCTR ACTRN12618000545268 (target 24, enrolled 22; first participant March 2019, last data April 2022; funding Wesley Medical Research Institute, collaborator Lambert Initiative)"},{"ad":"Abi-Jaoude 2023","tasarim":"Double-blind, placebo-controlled, randomized crossover pilot study; single dose of each product (Canada, Toronto)","n":"12 randomized; 9 completed (15 people enrolled according to the registry)","populasyon":"Adults with Tourette syndrome (ages 18–65)","urun":"Vaporized marijuana: 10% THC; 9% THC + 9% CBD; 13% CBD (14% CBD and 0.6% THC according to the registry); placebo (THC and CBD below 0.3%)","urun_turu":"thc_iceren","doz":"Single dose of 0.25 g per session","titrasyon":null,"sure":"Single dose, 4 sessions 2 weeks apart; 5 hours of monitoring per session","sonuc":"Primary outcome (video-based modified Rush tic scale): no significant difference versus placebo for any product. On secondary measures, the 10% THC product (and, to a lesser extent, the THC+CBD product) did better than placebo on premonitory urge (PUTS), distress (SUDS) and clinical global impression (CGI-I); no significant benefit was reported for the CBD-rich product (abstract). Plasma levels of THC and its breakdown products were linked to improvement on all measures, but CBD levels were not. Most participants correctly guessed whether they had received marijuana or placebo. In the registry, the study appears as terminated because recruitment took too long","yan_etki":"Side effects more common than placebo with all marijuana products; most with the 10% THC product, especially cognitive and psychomotor effects","pmid":"36040329","doi":"10.1089/can.2022.0091","diger_kaynak":"ClinicalTrials.gov NCT03247244 (University Health Network, Toronto; January 2018–January 2020; terminated: recruitment took long; no results in the registry)"},{"ad":"Efron 2025","tasarim":"Double-blind, placebo-controlled, randomized crossover phase 1/2 pilot (feasibility) study (Australia, Melbourne)","n":"10 randomized; 7 completed","populasyon":"Adolescents aged 12–18 with Tourette syndrome (mean age 14.8; 50% male)","urun":"Oral oil: 10 mg THC + 15 mg CBD per mL (in mint-flavored medium-chain triglyceride oil); matched placebo","urun_turu":"thc_iceren","doz":"By weight: under 50 kg at most 10 mg THC/day, 50 kg and over at most 20 mg THC/day","titrasyon":"According to the registry, started at 0.1 mL (1 mg THC) a day and increased in 0.1 mL steps to 0.5 mL (under 50 kg) or 1 mL (50 kg and over) by day 21; response assessed on day 29, and if no response, increased to 1 mL or 2 mL by day 49","sure":"10 weeks per period; 4 weeks between (1-week taper + 3-week washout)","sonuc":"The primary outcomes were feasibility: 100% of visits and blood tests and 97.6% of questionnaires were completed; adherence to the medicine was at an acceptable level in 63.6% of the teens; families found the study schedule acceptable. At week 10, on the clinical global impression (CGI-I), 3 teens were rated 'much improved' during the oil period and 1 during the placebo period. According to an editorial assessing the study (Abi-Jaoude 2026; the full text of the study could not be read), no statistical test of effectiveness was done, the numerical improvement in tic scores was very small, and one teen was rated 'much worse' during the oil period (none on placebo). The authors write that an adequately powered study is needed for effectiveness","yan_etki":"Most common was dizziness (67%); no serious side effects; 2 teens stopped because of side effects (1 during the oil period, 1 during the placebo period), and 1 was lost to follow-up","pmid":"40082070","doi":"10.1089/can.2024.0188","diger_kaynak":"ClinicalTrials.gov NCT05184478 (Murdoch Children's Research Institute; May 2022–January 2024; drug made by Cann Group; no results in the registry). The same team's uncontrolled study: Eapen 2025. Assessment: Abi-Jaoude 2026 editorial, BJPsych Open (PMID 41556111; the author led the Abi-Jaoude 2023 study in adults; no declared conflicts)"},{"ad":"Müller-Vahl 2003","tasarim":"Double-blind, placebo-controlled, parallel-group RCT (Germany, Hannover)","n":"24 randomized; 7 dropped out or were withdrawn (1 because of side effects)","populasyon":"Patients with Tourette syndrome (DSM-III-R; mean age 33 according to the Serag 2024 table)","urun":"Oral pure THC (2.5 and 5 mg gelatin capsules)","urun_turu":"thc_iceren","doz":"At most 10 mg THC/day","titrasyon":"Gradual increase to a target of 10 mg/day (details not in the abstract)","sure":"6 weeks (+ follow-up after the drug was stopped)","sonuc":"On clinician scales (TS-CGI, STSSS, YGTSS, video scale), a significant difference versus placebo (p < 0.05) or a near-significant trend (p < 0.10) at some treatment visits; on the patient-completed tic list (TSSL), a significant difference on 10 days between days 16 and 41; p = 0.037 in the analysis of variance. According to Cochrane 2009, the improvement was small and seen only on some measures; the number of dropouts and withdrawals was high, and the reported analyses were done only with patients who stayed in the study. The American Academy of Neurology review (2019) rated the study Class III on its four-tier evidence classification","yan_etki":"No serious side effects; 1 patient stopped because of side effects. In the same trial's cognitive safety analysis, no worsening was seen in learning, memory or divided attention","pmid":"12716250","doi":"10.4088/jcp.v64n0417","diger_kaynak":"Cognitive safety publication of the same trial: Müller-Vahl 2003, Neuropsychopharmacology (PMID 12589392)"},{"ad":"Müller-Vahl 2002","tasarim":"Double-blind, placebo-controlled, randomized crossover single-dose study (Germany)","n":"12","populasyon":"Adults with Tourette syndrome","urun":"Oral pure THC","urun_turu":"thc_iceren","doz":"Single dose of 5, 7.5 or 10 mg","titrasyon":null,"sure":"Single dose (in each period)","sonuc":"On the patient-completed list (TSSL), tics (p = 0.015) and obsessive-compulsive behaviors (p = 0.041) decreased more than with placebo; on clinician ratings only the 'complex motor tics' subscore was significant (p = 0.015), with trends for motor tics, simple motor tics and vocal tics (p = 0.065–0.093). Improvement in tics was linked to the peak blood level of 11-hydroxy-THC. Single dose; the authors recommended a longer study","yan_etki":"Mild, transient side effects in 5 patients; no serious side effects. In the same trial's cognitive publication, no impairment in memory, reaction time or attention, but on a symptom scale (SCL-90-R) a trend toward worsening obsessive-compulsive behaviors and increased phobic anxiety","pmid":"11951146","doi":"10.1055/s-2002-25028","diger_kaynak":"Cognitive safety publication of the same trial: Müller-Vahl 2001, Pharmacopsychiatry (PMID 11229617)"},{"ad":"Eapen 2025","tasarim":"Open-label, single-arm pilot (feasibility) study (Australia, Sydney)","n":"10 (9 completed)","populasyon":"Adolescents aged 12–18 with Tourette syndrome and a YGTSS tic score of at least 20 (mean age 14.4; of the 10, 6 had ADHD, 5 OCD, 9 anxiety, 4 autism); all had previously not benefited enough from medication, and 6 had also received behavioral treatment; those with a personal or family history of psychosis were excluded","urun":"Oral oil: 10 mg THC + 15 mg CBD per mL","urun_turu":"thc_iceren","doz":"Starting dose 1 mg THC/day; first step 5 mg THC/day under 50 kg and 10 mg THC/day at 50 kg and over; if no response, at most 10 or 20 mg THC/day","titrasyon":"Increased over 21 days (under 50 kg by 1 mg every 4–5 days, above that every 2–3 days); if no response on day 29, to the second step over 21 days; once a day, in the evening; split into two doses with side effects","sure":"85 days (about 12 weeks)","sonuc":"The parent-rated tic scale (PTQ) fell from 69.8 to 40.1 on day 85 (p = 0.0038); the clinician-rated YGTSS score also fell (p = 0.0035); quality of life (parent and teen report) and behavioral-emotional problems (SDQ) improved; no significant difference in premonitory urge or ADHD symptoms. 7 of 10 teens did not respond adequately to the low dose. No comparison group and no blinding; no correction for multiple comparisons (two measures remained significant after Bonferroni correction)","yan_etki":"No serious side effects; in reports outside the scale, most common were tiredness and sleepiness (40%), followed by dry mouth (30%); on the side effect scale, blurred vision, dry mouth, increased appetite and lack of motivation 22%; in 2 teens the dose was lowered to the lower step because of side effects","pmid":"40636988","doi":"10.1192/bjo.2025.35","diger_kaynak":"ANZCTR ACTRN12622000031763. The manufacturer (Cann Group) supplied the drug free of charge; according to the article, the company had no role in the study; no private funding. The same team's placebo-controlled study: Efron 2025"},{"ad":"Anis 2022","tasarim":"Open-label, prospective, uncontrolled study (single center, Tel Aviv)","n":"18 (15 completed 12 weeks)","populasyon":"Adults with Tourette syndrome (Israel; baseline YGTSS total 60.3 ± 17.1)","urun":"Medical cannabis: smoked or vaporized dried flower, or sublingual oil; initially 10% THC and 2% CBD","urun_turu":"thc_iceren","doz":"Mean 16.8 g/month (week 4) and 18 g/month (week 12); mean THC:CBD ratio at the end of the study 12.3:3.6","titrasyon":"Started at 1 drop or 1 puff a day and increased one at a time as needed; adjusted by the patient","sure":"12 weeks","sonuc":"Over 12 weeks, the YGTSS total score fell by an average of 38% (p = 0.002), the tic score by 35%, and the premonitory urge scale (PUTS) by 20% (p = 0.043); 93% of completers chose to use it by smoking or inhaling. No comparison group and no blinding","yan_etki":"Dry mouth 67%, tiredness 53%, sleepiness and dizziness 47%; mental side effects in 6 of 15 people (sense of time, orientation, confusion, slowed thinking, attention); psychiatric side effects in 3 people: worsening OCD (stopped), panic attacks and anxiety","pmid":"35310886","doi":"10.1155/2022/5141773","diger_kaynak":"Most likely ClinicalTrials.gov NCT05115318 (same center, 18 people, 10% THC and 2% CBD, weeks 4 and 12; no registration number found in the article). The authors declare no conflicts of interest"},{"ad":"Bloch 2021","tasarim":"Open-label, uncontrolled phase 2 pilot study (US, Yale University)","n":"According to the registry, 17 started and 16 completed (the abstract says 16 people and 2 early dropouts; 12 moved into the 24-week extension)","populasyon":"Adults with treatment-resistant Tourette syndrome (ages 18–56, mean 35)","urun":"THX-110: dronabinol (synthetic THC) + palmitoylethanolamide (PEA; a fatty acid amide also found in the body)","urun_turu":"thc_iceren","doz":"Dronabinol at most 10 mg/day + PEA 800 mg/day","titrasyon":"Dronabinol 2.5 mg for 3 days, 5 mg for 4 days, then 10 mg if tolerated; with side effects the dose was lowered, the increase slowed or the dose moved to the evening","sure":"12 weeks (+ 24-week open extension)","sonuc":"The YGTSS total tic score fell by an average of 7.6 points over 12 weeks (95% CI 2.5–12.8; registry results), more than 20% on average according to the authors; improvement began in the first week. No comparison group; the authors stress that blinding is difficult because of THC's intoxicating effect. Sponsor: the university, with the company developing the drug (Neurothera Labs) as a collaborator","yan_etki":"According to the registry, tiredness or sleepiness and feeling high in all 16 people; dry mouth in 15, dizziness and trouble concentrating in 13, anxiety and headache in 11, forgetfulness in 10, suspiciousness (paranoia) in 6, panic attacks in 4; no serious side effects; side effects were managed by lowering the dose, increasing it slowly and taking it in the evening","pmid":"34340527","doi":"10.1176/appi.neuropsych.19080178","diger_kaynak":"ClinicalTrials.gov NCT03066193 (results in the registry, December 19, 2019). A company-sponsored 60-person placebo-controlled RCT of the same combination (NCT03651726) did not produce results"},{"ad":"Wilson 2026","tasarim":"Systematic review and meta-analysis of RCTs (1980–May 13, 2025; PROSPERO CRD42023392718; GRADE)","n":"54 RCTs, 2,477 participants (all mental health conditions and substance use disorders; the number of tic studies is not in the abstract)","populasyon":"People with a mental health condition or substance use disorder (including tic disorders and Tourette syndrome)","urun":"CBD, THC, THC and CBD combinations and other cannabinoids","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"In people with tics or Tourette syndrome, tic severity decreased compared with placebo (SMD −0.68; 95% CI −1.03 to −0.34); from the sentence in the abstract it is not clear whether this result applies only to THC and CBD combinations or to all cannabinoids, and the number of studies it is based on is not stated (the full text could not be read). The certainty of the evidence is low for most outcomes, and 44% of the studies have a high risk of bias. According to the authors, routine use of cannabinoids in mental health conditions can rarely be justified for now","yan_etki":"People taking cannabinoids were more likely to have any side effect (OR 1.75; 95% CI 1.25–2.46; number needed to harm 7); no difference in serious side effects or study withdrawal","pmid":"41856154","doi":"10.1016/S2215-0366(26)00015-5","diger_kaynak":"Correction: Lancet Psychiatry 2026;13(8):e11 (PMID 42302809; June 16, 2026: the axis of a figure and the study counts in the table were corrected, results unchanged). The same review is also in the tables of the anxiety, psychosis, depression, bipolar, sleep, substance use and autism topics"},{"ad":"Bharat 2026","tasarim":"Systematic review and meta-analysis of experimental and observational studies (up to May 2025; PROSPERO CRD42023467536; GRADE)","n":"82 experimental and 118 observational studies (all diagnoses; the number of Tourette studies is not in the abstract)","populasyon":"Adults (aged 18 and over) with ADHD, anxiety, depression, PTSD, psychosis, Tourette syndrome or substance use disorder","urun":"THC, CBD, combinations of the two and other cannabinoids; medical cannabis","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"In RCTs, cannabinoids had a negligible or no effect on Tourette syndrome (numerical result not in the abstract); small reduction in anxiety (SMD −0.40), no significant effect in depression. Observational studies suggest improvement, but the risk of bias is high. The certainty of the evidence is mostly very low; the authors do not support cannabinoids as a first-line treatment. The full text could not be read","yan_etki":"The only significant safety finding: stopping because of side effects was more common with THC (OR 2.78; 95% CI 1.66–4.65)","pmid":"42617303","doi":"10.1016/j.psychres.2026.117380","diger_kaynak":"The same review is also in the table of the Depression topic"},{"ad":"Curtis 2009 (Cochrane)","tasarim":"Cochrane systematic review (RCTs; CENTRAL 2008 issue 4, MEDLINE, EMBASE, PsycINFO and other databases)","n":"2 RCTs, 28 patients","populasyon":"Patients with Gilles de la Tourette syndrome","urun":"THC (alone or added to another medicine)","urun_turu":"thc_iceren","doz":null,"titrasyon":null,"sure":null,"sonuc":"The two studies found (one single-dose crossover, one 6-week parallel; 8 patients took part in both) reported a positive effect of THC, but the improvement in tic frequency and severity was small, was seen only on some measures, and many comparisons had been made; dropouts and withdrawals were high in the 6-week study. No quality-of-life data. According to the authors, there is not enough evidence to support the use of cannabinoids for tics and obsessive-compulsive behaviors. Not updated since 2009; it does not include the four later RCTs","yan_etki":null,"pmid":"19821373","doi":"10.1002/14651858.CD006565.pub2","diger_kaynak":"Previous version: CD006565 (protocol). PMC7387115"},{"ad":"Mann 2026","tasarim":"Systematic review and meta-analysis (PROSPERO CRD420251088633; up to July 2, 2025; cohorts and RCTs; before-and-after comparison)","n":"8 studies (7 in the meta-analysis), 306 adults","populasyon":"Adults with Tourette syndrome","urun":"Cannabis-based medicines (various; most containing THC)","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"After treatment, the YGTSS score fell compared with before (mean difference −13.29; 95% CI −21.67 to −4.91; p = 0.002); premonitory urge scale (PUTS) −4.09 (−7.24 to −0.93; p = 0.01). The comparison is not against placebo but between the same people's scores before and after; this method cannot separate the placebo effect from tics easing on their own. The authors call for large placebo-controlled studies. The full text could not be read; which studies were pooled could not be verified","yan_etki":null,"pmid":"42229830","doi":"10.1016/j.neuroscience.2026.05.044","diger_kaynak":"Preprint: Europe PMC PPR911764 (2024)"},{"ad":"Pringsheim 2019 (American Academy of Neurology)","tasarim":"Systematic review (evidence review for the American Academy of Neurology tic treatment guideline; search August 2016, updated September 2017; RCTs with at least 20 people, or at least 10 in crossover designs)","n":"66 RCTs and 12 safety studies (all tic treatments); for THC, 2 RCTs (Müller-Vahl 2002 and 2003)","populasyon":"Tourette syndrome and chronic tic disorders (children and adults)","urun":"All tic treatments; among cannabinoids, THC","urun_turu":"thc_iceren","doz":null,"titrasyon":null,"sure":null,"sonuc":"'Low confidence' was given that THC reduces tics more than placebo (SMD 0.62; 95% CI 0.01–1.22; two studies, one Class II and one Class III; adults only); pimozide, ziprasidone, metoclopramide, guanfacine and topiramate are at the same level. 'High confidence' for behavioral therapy for tics (CBIT); 'moderate confidence' for haloperidol, risperidone, aripiprazole, tiapride, clonidine and botulinum toxin. According to the same guideline's recommendation text (PMID 31061208), evidence is insufficient for nabiximols, nabilone, CBD and different cannabis strains; cannabis-based medicines may be considered in adults who have not improved with other treatments (Level C recommendation), the lowest effective dose should be used, and patients should be told they may affect driving; they should be avoided in children and adolescents because of the limited evidence and the possible harms of cannabis exposure in adolescence to thinking and mood in adulthood; they should not be used in pregnancy, breastfeeding or psychosis. Done before CANNA-TICS and Mosley 2023. One of the authors (Müller-Vahl) declares consulting fees, speaker fees and research support from cannabinoid companies","yan_etki":null,"pmid":"31061209","doi":"10.1212/WNL.0000000000007467","diger_kaynak":"Recommendation text of the guideline: Pringsheim 2019, Neurology 92:896–906 (PMID 31061208; PMC6537133). Correction: Neurology 2019;93(9):415 (PMID 31451598): only the supplementary data link was corrected. Canadian guideline (Pringsheim 2012, PMID 22397999): weak recommendation for cannabinoids, in adults only"},{"ad":"Roessner 2022 (European Tourette guideline, ESSTS)","tasarim":"Clinical guideline (European Society for the Study of Tourette Syndrome, 2nd version, pharmacological treatment section; literature search after 2011 and a preference survey of 50 experts)","n":null,"populasyon":"Tourette syndrome and other tic disorders (children, adolescents and adults)","urun":"Cannabis-based medicines (cannabis flower, cannabis extracts, pure THC)","urun_turu":"thc_iceren","doz":null,"titrasyon":null,"sure":null,"sonuc":"First choice is education and behavioral approaches; if medicine is needed, the most evidence is for dopamine blockers (preferably aripiprazole). Cannabis-based medicines are listed, together with pimozide, haloperidol, topiramate and botulinum toxin, among options that may be considered only in treatment-resistant cases. According to the guideline, no new RCTs had been published since 2011, and a meta-analysis pooling two small RCTs did not show a significant benefit of THC over placebo. Written before the CANNA-TICS results. One of the authors (the principal investigator of CANNA-TICS) declares consulting and research-support ties with cannabis companies","yan_etki":null,"pmid":"34757514","doi":"10.1007/s00787-021-01899-z","diger_kaynak":"Summary statement of the guideline: Müller-Vahl 2022 (PMID 34244849)"},{"ad":"Treves 2025","tasarim":"National retrospective cohort (Israeli Medical Cannabis Agency prescription and dispensing data, April 2018–March 2022)","n":"1,341 children (165 with Tourette syndrome; ages 2–11)","populasyon":"Children under 12 prescribed medical cannabis oil (autism, epilepsy, Tourette syndrome, cancer); adolescents and young adults for comparison","urun":"Cannabis oils with standard THC and CBD ratios, dispensed in Israel under a patient's medical cannabis permit. Of the 250 bottles given to children with Tourette syndrome at first dispensing, 176 (70%) were CBD-rich (most often 1% THC + 20% CBD; only 9 bottles were THC-free), 55 (22%) contained equal THC and CBD, and 19 (8%) contained more THC; in other words, 96% of the bottles contained THC (Supplementary Table S1)","urun_turu":"thc_iceren","doz":"Not reported (separately for Tourette syndrome)","titrasyon":null,"sure":"First 3–6 months","sonuc":"In children under 12 with Tourette syndrome, fewer than 50% continued treatment through the first 3 months (from the figure); across all indications, about 60–70% of children stopped within the first 6 months, and for most, the THC ratio or amount was changed in the first months; the risk of stopping was lower in young adults than in children (HR 0.83; 95% CI 0.71–0.96). Effectiveness was not measured; reasons for stopping are given only in the open study of autistic children (mostly side effects and lack of benefit), with no separate reasons for Tourette syndrome","yan_etki":null,"pmid":"41357860","doi":"10.3389/fphar.2025.1646560","diger_kaynak":"PMC12678362; THC and CBD ratios of the first products dispensed are in Supplementary Table S1, dose and ratio changes in the first 6 months in Supplementary Figure S3 (Europe PMC supplementary file, October 28, 2026)"},{"ad":"Barchel 2024","tasarim":"Prospective survey study from a patient registry (before treatment and after 6 months; no control group)","n":"70 registered patients; 57 answered the month-6 survey (3 aged 15–16)","populasyon":"Patients with Tourette syndrome in a cannabis producer's (Tikun Olam) patient registry (Israel)","urun":"Licensed medical cannabis (THC and CBD)","urun_turu":"thc_iceren","doz":"Mean daily 123 mg THC and 50.5 mg CBD","titrasyon":null,"sure":"6 months","sonuc":"Among the 57 people who answered the survey at month 6, improvement in quality of life (p < 0.005), work status (p = 0.027) and number of medicines used (p < 0.005); motor tics (p = 0.375), vocal tics (p > 0.999), tic frequency (p = 0.062) and general mood (p = 0.129) did not improve significantly. Tics were asked about not with a scale but by patient report, as present/absent and daily/weekly. 67% of those with OCD and 89% of those with anxiety reported improvement. No control group. No funding; 1 of 7 authors is an employee of the cannabis company that owns the registry (Tikun Olam Cannbit)","yan_etki":"Most common were dizziness (4 people) and increased appetite (3 people)","pmid":"36342913","doi":"10.1089/can.2022.0112","diger_kaynak":"Israeli Ministry of Health registry 0185-19-ASF. PMC10874815"},{"ad":"Anis 2024","tasarim":"Retrospective long-term follow-up and structured survey (single center; no control group)","n":"25","populasyon":"Patients with treatment-resistant Tourette syndrome using licensed medical cannabis (Israel, Tel Aviv; 84% male)","urun":"Licensed medical cannabis; 96% mostly by smoking or vaporizing","urun_turu":"thc_iceren","doz":"Steady increase in monthly THC dose over the years (on average 0.6–0.7 g per year; p < 0.0001)","titrasyon":"Adjusted by the patient","sure":"Mean 4.0 ± 2.3 years (0.5–10 years)","sonuc":"Patients reported an average 75% reduction in tics and improvement in co-occurring symptoms (self-rated); according to the authors, the dose increases made by patients themselves suggest that tolerance may develop. No control group; only those who continued long-term use were studied","yan_etki":"88% reported at least one side effect (details not in the abstract)","pmid":"37172308","doi":"10.1089/can.2022.0281","diger_kaynak":"From the same center (Movement Disorders Unit, Tel Aviv Sourasky Medical Center): the 12-week prospective study Anis 2022; whether patients in the two groups overlap is not stated"},{"ad":"Milosev 2019","tasarim":"Retrospective chart review and online survey (single center; no control group)","n":"98 (chart review); 40 (online survey)","populasyon":"Adults at the Tourette clinic in Hannover who had used cannabis-based medicines at any time (Germany)","urun":"Street marijuana (most common), nabiximols, dronabinol and prescription medical cannabis","urun_turu":"thc_iceren","doz":"According to Table 2 (prescription products), on average medical cannabis 2.2 g/day, dronabinol 43.2 mg/day, nabiximols 10.6 sprays/day; doses varied widely from person to person","titrasyon":null,"sure":"Long term (duration varied by patient)","sonuc":"Of 38 patients able to compare, 66% preferred medical cannabis (THC-rich varieties), 18% dronabinol, 11% nabiximols and 5% street marijuana. According to patients' accounts, tics improved by about 60% in 85% of users, co-occurring problems improved in 55% and quality of life in 93%; the online survey pointed the same way. 31 of 98 patients (33%) stopped treatment (reasons unknown); in about half (51%) of the reports on prescription products, the effect had faded over time before the dose was adjusted. Retrospective and uncontrolled; only people who came to the clinic and used cannabis. 1 of 5 authors (the senior author) declares consulting fees, speaker fees and research support from cannabinoid companies","yan_etki":"Side effects in half of patients; tolerable according to the authors","pmid":"31872061","doi":"10.1089/can.2018.0050","diger_kaynak":"PMC6922065. The same center ran CANNA-TICS"}],"ilgili_ilaclar":["aripiprazol","antipsikotik"],"son_inceleme":"2026-10-30","arastirma_gecmisi":[{"tarih":"2026-10-28","not":"Page published. This first assessment reviewed 19 studies."},{"tarih":"2026-10-28","not":"October 2026 additional review: sources found for this page during searches for other topics were read and added to the page. The supplementary table of the study examining national data on children receiving medical cannabis oil in Israel (Treves 2025) was read: most of the products given to children with Tourette syndrome were CBD-rich, but 96% of the bottles also contained THC; the row's product type was corrected to 'Contains THC' (the same publication is classified that way on the Autism page too), and the wording in the pure CBD section was clarified. The status of THC-containing medicines in Turkey was verified from TİTCK (Turkish Medicines and Medical Devices Agency) lists: they are not licensed in Turkey; the active substance of the mouth spray containing THC and CBD is on the list of medicines that can be imported from abroad with the agency's written approval, and dronabinol is not on this list. The conclusion and strength of evidence did not change."},{"tarih":"2026-10-30","not":"The correction to the Wilson 2026 meta-analysis published in the journal was read: only the axis of one figure and the study counts in a table were corrected; the results on this page did not change."},{"tarih":"2026-10-30","not":"The last sentence of the page's short summary was rewritten in a calmer, more guiding tone: instead of \"Talk to your doctor before you start.\", it now says whom you can talk with, and about what, if you are considering CBD. The conclusion and the strength of evidence did not change."}]},{"id":"ibs-stomach","baslik":"Irritable bowel syndrome and functional stomach problems (functional dyspepsia, gastroparesis)","grup":"Other","grup_kodu":"diger","tr_id":"huzursuz-bagirsak-mide","kanit_duzeyi":"zayif","kanit_yonu":"celiskili","kanit_ozet":"In gastroparesis (44 patients with gastric emptying measured as delayed; 32 idiopathic, 12 diabetic), pharmaceutical-grade CBD used at up to 20 mg per kilogram a day for 4 weeks clearly lowered the total symptom score compared with placebo (p = 0.008); inability to finish a normal meal (p = 0.029), number of vomiting episodes a day (p = 0.006) and overall severity (p = 0.034) were also better, and in the nutrient drink test the volume to comfortable fullness and the maximum tolerated volume increased. In the same study, CBD slowed the emptying of solid food (time to 10% emptying 101 versus 77 minutes, p = 0.030; emptied at hour 4, 52% versus 63%, p = 0.045; for the main measure, half-emptying time, p = 0.088), and diarrhea was common (12/21 versus 2/23). The study was single-center and supported by the US National Institutes of Health (the authors declared no relevant conflicts of interest); at the start, the symptom score in the CBD group was numerically higher, and the result has not been repeated. In the publication, the total symptom score appears as one of the main outcomes, but it is not in the study's ClinicalTrials.gov registration (February 2024 version): the main measures in the registration are gastric emptying, gastric volume and the nutrient drink test, and among symptoms only overall severity and number of vomiting episodes are secondary measures. In the unadjusted week-4 medians in the registration, overall severity was similar in the two groups (1.8 versus 1.6), and daily vomiting was lower in the CBD group (0 versus 0.2). After an interim analysis, the target sample size was lowered from 48 to 44. In a study run at the same time under the same registration (NCT03941288) in 48 people with functional dyspepsia and normal gastric emptying, CBD did not change symptoms, gastric emptying, gastric volumes or the satiation test differently from placebo. In a crossover RCT of 50 mg CBD gum in irritable bowel syndrome (40 randomized, 32 women analyzed), the difference in pain reduction was 0.1 points (95% CI −0.3 to 0.5; p = 0.61), and there was no difference in quality of life either; the gums were used little, and the publication does not state the purity of the CBD in the gum. A meta-analysis of cannabinoids in chronic primary pain (2022), based on this study, wrote that CBD may not reduce pain in irritable bowel syndrome (low certainty). In irritable bowel syndrome, there are 3 short physiology RCTs with dronabinol and THC: a single dose of dronabinol reduced colon contractions on an empty stomach (75 patients; marked in the diarrhea and alternating types), 2 days of dronabinol did not change bowel transit (36 patients with diarrhea), and THC did not change rectal sensitivity (10 patients, 12 healthy volunteers); in a 2022 meta-analysis, the effect was zero (very low certainty), and the US National Academies (2017) found the evidence insufficient. In healthy volunteers, THC (13 people) and dronabinol (30 people) slowed the emptying of solid food from the stomach, dronabinol (52 people) relaxed the colon and raised pain scores in response to stretching; low-dose THC given into a vein did not change liquid emptying (7 people). In gastroparesis, there is no controlled study of THC-containing products: in an uncontrolled series of 24 patients, symptom scores fell with dronabinol or medical marijuana; in a multicenter patient registry, 12% of patients used marijuana and most users reported benefit (user reports). Observational studies conflict: cannabis use was linked to more emergency visits and admissions in a patient registry (406 people) and in a matched analysis of electronic records of 41,374 people, while in US hospital data length of stay and in-hospital death were lower; in irritable bowel syndrome, hospital records showed more frequent admission and less readmission with cannabis use disorder. These do not show cause and effect. In people with type 1 diabetes, all 11 patients diagnosed with gastroparesis by gastric emptying test while using cannabis every day met the criteria for cannabinoid hyperemesis syndrome. The American Gastroenterological Association (2025) conditionally suggests that CBD not be used as a first-line treatment for gastroparesis; the Gastroenterological Society of Australia (2026) found the evidence insufficient to recommend; Germany's functional dyspepsia guideline (2026) recommends that cannabinoids not be used routinely, and ESPGHAN/NASPGHAN (2025) recommends that cannabis not be used for irritable bowel syndrome and functional abdominal pain in children. The Canadian Association of Gastroenterology's 2019 position statement, on the other hand, writes that short-term use may help with persistent nausea, vomiting, diarrhea or abdominal pain when standard treatments are not enough, but that long-term effectiveness and safety in functional bowel disorders are unknown and cannabinoids should not be considered first-line treatment (3 of the 7 authors have ties to companies that make cannabis or cannabinoid products). October 2026 search (PubMed, Cochrane, ClinicalTrials.gov, Europe PMC): 6 controlled studies with cannabinoids were found in these three conditions: 3 with pharmaceutical-grade or pure CBD (one each in gastroparesis, functional dyspepsia and irritable bowel syndrome; the longest 4 weeks) and 3 short physiology studies with dronabinol or THC in irritable bowel syndrome (single dose or 2 days). There are also 4 controlled studies measuring the effect of THC on stomach and colon movement in healthy volunteers, 3 systematic reviews, 1 expert committee report, 5 guidelines or position statements, 2 uncontrolled studies and 7 observational studies; all are in the table below. Six of the controlled studies (the gastroparesis and dyspepsia studies and the four dronabinol studies in patients and healthy volunteers) come from the same research group (Mayo Clinic, US). There is no Cochrane review; all 3 studies with results posted on ClinicalTrials.gov have been published; in October 2026, no ongoing cannabinoid study was found in these conditions; there are no studies from Turkey. Not included in the table: an irritable bowel syndrome study with the selective synthetic CB2 drug olorinab and stomach studies with the CB1 blocker rimonabant (site rule: not a cannabis or CBD product), substances that are not cannabinoid products such as PEA and hemp husk fiber, other US hospital database analyses with similar results, a retracted nabilone series, studies of chronic pancreatitis or postoperative abdominal pain, a small dronabinol study in functional chest pain, a single-center survey asking about use and perceived benefit in gastroparesis, and a review that examines the effect of CBD on bowel movement mostly through animal studies.","kanit_duzeyi_metin":"Weak; differs by condition (in each condition, a single small RCT with pure or pharmaceutical-grade CBD, the longest 4 weeks: in gastroparesis, improvement in symptoms, but on a measure not defined in the registration and not repeated; in functional dyspepsia and irritable bowel syndrome, no difference from placebo)","kanit_duzeyi_thc_icerenler":"yetersiz","kanit_duzeyi_thc_icerenler_metin":"Insufficient (no controlled THC study following symptoms in patients over weeks; in irritable bowel syndrome, only 3 single-dose or 2-day physiology RCTs, with negative or unclear results; in gastroparesis, only an uncontrolled series and user reports; in healthy volunteers, THC slowed stomach emptying)","kaynak_dosya":null,"saf_cbd_sonuc":"In gastroparesis, pharmaceutical-grade CBD (up to 20 mg per kilogram a day, 4 weeks, 44 people) clearly lowered the total symptom score compared with placebo (p = 0.008; this score is not among the measures in the study's ClinicalTrials.gov registration) and reduced vomiting; but it slowed the emptying of solid food from the stomach slightly more, and diarrhea was common (12 of 21 people, 2 of 23 on placebo); the result is from a single center and has not been repeated. The same dose was no different from placebo in symptoms, stomach measurements or quality of life in functional dyspepsia with normal stomach emptying (48 people). In irritable bowel syndrome, gum containing 50 mg CBD (32 women, crossover design, 3 weeks each) was no different from placebo gum in pain or quality of life. The American Gastroenterological Association (2025) suggests that CBD not be used as a first-line treatment for gastroparesis (conditional recommendation).","thc_icerenler_sonuc":"In irritable bowel syndrome, there are only short physiology studies with THC: a single dose of dronabinol reduced colon contractions on an empty stomach in 75 patients, dronabinol taken for 2 days did not change bowel transit time in 36 patients with diarrhea, and THC did not change bowel sensitivity in 10 patients; in a meta-analysis pooling the single-dose studies, the effect was zero (very low certainty). There is no controlled THC study following symptoms over weeks; no THC study was found in functional dyspepsia. In gastroparesis, there is only an uncontrolled series (24 patients, improvement in symptoms) and user reports in a patient registry; in healthy volunteers, THC and dronabinol slowed the emptying of solid food from the stomach. In a patient registry and in a large analysis of electronic records, cannabis users with gastroparesis had more frequent emergency visits and hospital admissions (in coded in-hospital data, however, length of stay was shorter; these do not show cause and effect). Long-term heavy cannabis use can cause recurring bouts of vomiting that can be mistaken for gastroparesis.","ruhsat":null,"doz_araligi_ozet":"Pharmaceutical-grade pure CBD: from 2.5 mg up to 20 mg per kilogram a day, two doses a day, 4 weeks (gastroparesis, functional dyspepsia); 50 mg CBD gum as needed, at most 6 a day (300 mg), 3 weeks (irritable bowel syndrome; use less than 1 a day); THC-containing: dronabinol single dose 2.5–7.5 mg or 2.5–5 mg twice a day for 2 days, THC single dose 5–10 mg and 10 mg/m² (physiology studies); in the uncontrolled gastroparesis series, dronabinol 2–10 mg 2–4 times a day and medical marijuana of variable ratio","titrasyon_ozet":"In the gastroparesis and functional dyspepsia studies, started at 2.5 mg/kg/day and raised by 2.5–5 mg/kg every two days up to 20 mg/kg/day; at the end of 4 weeks, tapered off over 10 days (study dose; not a personal recommendation)","yan_etkiler":["Diarrhea with high-dose pharmaceutical-grade CBD: in gastroparesis, 12/21 versus 2/23 (Zheng 2023); in functional dyspepsia, 8/25 versus 1/23 (NCT03941288 registry results); tiredness and nausea similar between groups","With dronabinol, mental fogginess (at 5 mg, 6 of 24 people; on placebo, none of 27) and dizziness (Wong 2011; NCT01786109); with 10 mg THC, central effects such as light-headedness and sleepiness in all participants, and increased heart rate (Klooker 2011)","Cannabinoid hyperemesis syndrome: recurring bouts of nausea and vomiting with long-term regular cannabis use; it goes away when cannabis is stopped (Sorensen 2017, systematic review, PMID 28000146)"],"izlem":["Cannabis and cannabinoid use should be reported to the physician before a gastric emptying test; the American College of Gastroenterology's 2022 gastroparesis guideline writes that, among medicines that may affect the result, stopping cannabinoids 48 hours before the test is usual practice (Camilleri 2022, PMID 35926490)","In the gastroparesis study in which high-dose pharmaceutical-grade CBD was tested, liver tests were measured at the start and at week 4, and no change was seen; with longer use, monitoring liver tests is the physician's decision (Zheng 2023)"],"dikkat":["THC slows stomach emptying: in healthy volunteers, THC and dronabinol delayed the emptying of solid food from the stomach (McCallum 1999; Esfandyari 2006). In people with gastroparesis, whose stomach already empties slowly, THC-containing products may make symptoms worse; in the gastroparesis study, CBD also slowed emptying slightly (Zheng 2023)","Cannabinoid hyperemesis syndrome: people who use cannabis for a long time, usually every day or every week, can have recurring bouts of severe nausea, vomiting and abdominal pain; relief from a hot shower or bath is typical, and the complaints go away when cannabis is stopped (Sorensen 2017, systematic review, PMID 28000146). This picture can be mistaken for gastroparesis: in a series cited by the review, emptying was delayed in 30% of 61 patients who had a gastric emptying test; in a review of people with type 1 diabetes, all 11 patients diagnosed with gastroparesis while using cannabis every day met the criteria for this syndrome (Akturk 2025)","High doses cannot be compared with market doses: the gastroparesis study used pharmaceutical-grade CBD at up to 20 mg per kilogram a day; in low-dose (≤175 mg/day) studies, blood CBD levels were found to be 5–100 times lower than at this dose (Warren 2026, PMID 42473010)","Diarrhea: diarrhea was the most common side effect of high-dose CBD in these studies; in diarrhea-predominant irritable bowel syndrome, this side effect could make complaints worse (this is a precautionary note; high-dose CBD has not been tested in irritable bowel syndrome)","Children: in their 2025 guideline, the European and North American pediatric gastroenterology societies recommend that cannabis not be used for irritable bowel syndrome and functional abdominal pain in children aged 4–18 (Groen 2025)"],"ilac_etkilesim_notlari":["The studies on this page did not systematically assess drug interactions; details are in the site's drug interactions section"],"dogrulanamayan":["The full text of the functional dyspepsia study (Atieh 2022) could not be read (publisher access is paid): numbers of participants, side effects and median values of measurements are from the ClinicalTrials.gov registration (NCT03941288), and statistical results are from the abstract. The values given in the registration as week-4 gastric half-emptying time for the gastroparesis groups (medians 246 and 198 minutes) are the same as the values in the publication's baseline table; which is correct could not be verified. The gastroparesis publication gives the average dose as 9.43 mg/kg; whether this is daily or per dose is not clear. The abstract says 5 patients, and the main text says 4, could not reach the full dose. The registration's change history could not be opened (access blocked); so whether the total symptom score was ever entered in the registration could not be verified","The full texts of the THC studies of the stomach and colon (McCallum 1999, Esfandyari 2006 and 2007, Klooker 2011, Bateman 1983) could not be read; details are from the abstracts. In McCallum 1999 and Klooker 2011, the abstract does not say how THC was given. The American Gastroenterological Association's 2025 guideline, the electronic records analysis of 41,374 people (Kilani 2026), the irritable bowel syndrome hospital record analyses (Patel 2020, Choi 2022) and the fibromyalgia study (Santonicola 2025) are also from the abstracts only; the certainty of evidence and the rationale behind the AGA guideline's CBD recommendation could not be read","The single-dose dronabinol study (Wong 2011) is cited in the publication under number NCT01253408; however, the results in this registration belong to the 36-person 2-day study (Wong 2012), while the results of the 75-person single-dose study belong to registration NCT01786109. The purity and THC content of the CBD in the CBD gum study are not stated in the publication","The NCBI copy of the US National Academies report could not be opened because it asked for bot verification; the report was read on the publisher's (National Academies Press) website. For cannabinoid hyperemesis syndrome, the American Gastroenterological Association's 2024 clinical practice update and the Rome Foundation's 2025 consensus on idiopathic gastroparesis could be seen only as abstracts; the abstracts contain no recommendation on cannabinoid treatment"],"calismalar":[{"ad":"Zheng 2023","tasarim":"Phase 2, double-blind, placebo-controlled, parallel RCT (single center)","n":"44 randomized (21 CBD / 23 placebo); 42 completed","populasyon":"Idiopathic (32) or diabetic (12; 6 type 1, 6 type 2) gastroparesis with gastric emptying delayed on scintigraphy; 89% women (US, Mayo Clinic)","urun":"Approved (licensed), pharmaceutical-grade pure CBD oral solution (Epidiolex, 100 mg/mL)","urun_turu":"saf_cbd","doz":"Target 20 mg/kg/day, two equal doses a day; 4 patients (5 in the abstract) could not reach the full dose and continued at the highest dose they tolerated; according to the publication, the average dose was 9.43 mg/kg (whether daily or per dose is not clear)","titrasyon":"Started at 2.5 mg/kg/day and raised by 2.5–5 mg/kg every two days; at the end of 4 weeks, tapered off over 10 days","sure":"4 weeks","sonuc":"On the primary symptom outcome (GCSI daily symptom diary total score), CBD was better than placebo (p = 0.008); inability to finish a normal meal (p = 0.029), number of vomiting episodes a day (p = 0.006) and overall symptom severity (p = 0.034) were also better, and upper abdominal pain was borderline (p = 0.076); effect size for the total score 0.46. In the nutrient drink test, comfortable fullness (817 versus 665 kcal; p = 0.028) and maximum volume drunk (1115 versus 889 kcal; p = 0.018) increased. CBD slowed the emptying of solid food: time to 10% emptying 101 versus 77 min (p = 0.030), emptied at hour 2, 19% versus 28% (p = 0.032), at hour 4, 52% versus 63% (p = 0.045); on the main emptying measure, half-emptying time, the difference was not significant (268 versus 227 min; p = 0.088); gastric volumes did not change. At the start, the total symptom score was numerically higher in the CBD group (median 2.0 versus 1.4; p = 0.37); the analysis was adjusted for baseline. In the publication, the GCSI total score is one of the primary outcomes; in the ClinicalTrials.gov registration (February 2024 version), the primary measures are only gastric measurements (half-emptying and lag time, gastric volumes, nutrient drink test), and the GCSI total score is not among the registered measures (overall severity and vomiting are secondary). Unadjusted week-4 medians in the registration: overall severity 1.8 versus 1.6, daily vomiting 0 versus 0.2. After an interim analysis following 24 patients, the target sample was lowered from 48 to 44. Single-center, short, not repeated","yan_etki":"Diarrhea 12/21 with CBD, 2/23 with placebo (p < 0.001); tiredness 4 versus 4, nausea 3 versus 4; no change in liver enzymes, creatinine or HbA1c over 4 weeks; 2 serious events in the CBD group (abdominal injury in a domestic fight, appendectomy), not attributed to the drug","pmid":"37482172","doi":"10.1016/j.cgh.2023.07.008","diger_kaynak":"ClinicalTrials.gov NCT03941288 (same registration as the functional dyspepsia study; results in the registry, February 13, 2024); PMC10800684. NIH support (R01-DK122280); the authors declared no relevant conflicts of interest"},{"ad":"Atieh 2022","tasarim":"Phase 2, double-blind, placebo-controlled, parallel RCT (single center; run at the same time as the gastroparesis study, same registration)","n":"48 randomized (25 CBD / 23 placebo); 43 completed (in the registry)","populasyon":"Functional dyspepsia of the postprandial distress type (Rome IV) with normal gastric emptying (US, Mayo Clinic)","urun":"Pharmaceutical-grade pure CBD oral solution (according to the registration, the same product and schedule as the gastroparesis study)","urun_turu":"saf_cbd","doz":"Target 20 mg/kg/day, two doses a day (following the FDA dose-escalation guidance)","titrasyon":"According to the registration, started at 2.5 mg/kg/day and raised by 2.5–5 mg/kg every two days","sure":"4 weeks","sonuc":"No clear difference between CBD and placebo in symptoms (daily pain, nausea, bloating), weekly adequate relief, the Leuven Postprandial Distress Scale or quality of life; gastric emptying, gastric volumes and the nutrient drink satiation test did not differ either. According to the results in the registry, adequate relief was reported by 12/25 versus 11/23; median daily symptom score 1.2 versus 1.1; median volume drunk to comfortable fullness 373 versus 622 mL (no statistical test in the registry). In carriers of a CNR1 gene variant, a borderline treatment-gene interaction for after-meal complaints (p = 0.06; exploratory)","yan_etki":"According to the registration, diarrhea 8/25 with CBD, 1/23 with placebo; tiredness 8 versus 8, nausea 8 versus 8; no serious side effects","pmid":"35537858","doi":"10.14309/ajg.0000000000001805","diger_kaynak":"ClinicalTrials.gov NCT03941288 (results in the registry, February 13, 2024); full text could not be read"},{"ad":"van Orten-Luiten 2022","tasarim":"Double-blind, placebo-controlled, crossover RCT (exploratory; use as needed for pain)","n":"40 randomized; 32 analyzed (all women)","populasyon":"Irritable bowel syndrome by Rome III/IV criteria, with at least 3 moderate-to-severe pain attacks a week (Netherlands)","urun":"Gum containing 50 mg CBD (CBD in purified food-grade hemp seed oil; the placebo gum contained only the seed oil; the purity of the CBD and THC content not stated in the publication); manufacturer Axim Biotechnologies","urun_turu":"saf_cbd","doz":"1 piece of gum when pain started (chewed for at least 30 min), at most 6 a day (300 mg CBD); on average 18.2 CBD gums over 3 weeks (range 1–71)","titrasyon":"None (use according to symptoms)","sure":"2 × 3 weeks (1-week washout in between; 8 weeks in total)","sonuc":"No difference between CBD and placebo on the primary outcome (pain reduction during a 30-minute pain attack): difference 0.1 points (0–10 scale; 95% CI −0.3 to 0.5; p = 0.61); both gums reduced pain a little. No difference in quality of life (−1.0; 95% CI −6.8 to 4.9; p = 0.74). The gum was used less than expected (on average 5.9 a week). The manufacturer supplied the gums and covered logistics costs; according to the authors, it was not involved in the design or writing; one of the authors sat on the company's scientific board until 2018 (unpaid)","yan_etki":"2 people stopped because swallowing air while chewing bothered them; otherwise well tolerated","pmid":"33998882","doi":"10.1089/can.2020.0087","diger_kaynak":"ClinicalTrials.gov NCT03003260 (the registration given in the publication; no results in the registry; the registration also listed daily adequate relief and stool frequency among its measures, but the publication gives no results for them); PMC9418368"},{"ad":"Wong 2012","tasarim":"Double-blind, placebo-controlled, parallel RCT (pharmacodynamic study measuring bowel transit)","n":"36 randomized (13 placebo / 10 dronabinol 2.5 mg / 13 dronabinol 5 mg); 1 person stopped because of side effects","populasyon":"Diarrhea-predominant irritable bowel syndrome (Rome III); 34 women, cannabinoid-naive (US, Mayo Clinic)","urun":"Dronabinol (synthetic THC), by mouth","urun_turu":"thc_iceren","doz":"2.5 mg or 5 mg twice a day","titrasyon":"None","sure":"2 days","sonuc":"No overall effect of dronabinol on the primary outcome (colonic transit at 24 hours by scintigraphy) or on gastric and small bowel transit. In carriers of a variant of the CB1 receptor gene (CNR1 rs806378 CT/TT), a trend toward slightly delayed colonic transit (p = 0.13; exploratory). Symptoms were not measured","yan_etki":"Side effects did not differ between groups; according to the registration, dizziness 4/13 at 5 mg, 1/13 on placebo; 1 person in the 5 mg group stopped because of side effects","pmid":"22288893","doi":"10.1111/j.1365-2982.2011.01874.x","diger_kaynak":"ClinicalTrials.gov NCT01253408 (results in the registry); PMC3775711"},{"ad":"Wong 2011","tasarim":"Double-blind, placebo-controlled, parallel RCT (single-dose pharmacodynamic and pharmacogenetic study)","n":"75 randomized (27 placebo / 24 dronabinol 2.5 mg / 24 dronabinol 5 mg); 72 completed","populasyon":"Irritable bowel syndrome: 35 constipation-predominant, 35 diarrhea-predominant, 5 alternating; more than 90% women, cannabinoid-naive (US, Mayo Clinic)","urun":"Dronabinol (synthetic THC), by mouth","urun_turu":"thc_iceren","doz":"Single dose of 2.5 mg or 5 mg","titrasyon":"None","sure":"Single dose","sonuc":"On the primary measure in the registration opened later (colonic wall compliance), dronabinol showed only a borderline increase (p = 0.058). It reduced the fasting motility index in the upper part of the left colon compared with placebo (overall p = 0.05; p = 0.046 for 5 mg); both effects were more marked in the diarrhea and alternating types (contractions p = 0.022; compliance p = 0.03). Sensitivity to pain and gas, colonic tone and the after-meal response did not change. Symptoms were not measured; single dose","yan_etki":"Most common were sleepiness (23%), hot flushes (19%), headache (13%) and dizziness (11%); only mental fogginess was more common with dronabinol (p = 0.009; according to the registration, 6/24 at 5 mg, 0/27 on placebo)","pmid":"21803011","doi":"10.1053/j.gastro.2011.07.036","diger_kaynak":"ClinicalTrials.gov NCT01786109 (registered in February 2013, after publication; the 75-person single-dose results in the registration belong to this study; the publication gives NCT01253408, but the results of that registration belong to Wong 2012); PMC3202649"},{"ad":"Klooker 2011","tasarim":"Double-blind, placebo-controlled, randomized crossover study (rectal barostat test)","n":"22 (10 patients with irritable bowel syndrome, 12 healthy volunteers)","populasyon":"Irritable bowel syndrome and healthy volunteers (Netherlands)","urun":"Δ9-THC (dronabinol); route of administration not in the abstract","urun_turu":"thc_iceren","doz":"5 and 10 mg in healthy volunteers, 10 mg in patients","titrasyon":"None","sure":"Single dose (3 separate days in healthy volunteers, 2 in patients)","sonuc":"THC did not change baseline sensitivity to balloon distension of the rectum or the discomfort threshold after sigmoid colon stimulation differently from placebo (in healthy volunteers and in patients). According to the authors, the findings argue against using centrally acting cannabinoids to reduce visceral hypersensitivity","yan_etki":"At the highest dose, central side effects in all participants (heightened awareness of surroundings, light-headedness, sleepiness); none with placebo. Heart rate increased, most in patients; blood pressure did not change","pmid":"20718944","doi":"10.1111/j.1365-2982.2010.01587.x","diger_kaynak":"Full text could not be read (abstract)"},{"ad":"Esfandyari 2007","tasarim":"Double-blind, placebo-controlled, parallel RCT (colonic barostat-manometry)","n":"52","populasyon":"Healthy volunteers (US, Mayo Clinic)","urun":"Dronabinol (synthetic THC), by mouth","urun_turu":"thc_iceren","doz":"Single dose of 7.5 mg","titrasyon":"None","sure":"Single dose","sonuc":"Dronabinol relaxed the colon: wall compliance increased (p = 0.045), borderline relaxation of fasting tone (p = 0.096), and after-meal tone (p = 0.048) and fasting and fed contraction pressures (p = 0.008 and p = 0.030) decreased. First gas and pain thresholds did not change, but pain scores during random distensions increased (p = 0.024). Physiology study in healthy volunteers","yan_etki":"Not reported (in the abstract)","pmid":"17395895","doi":"10.1152/ajpgi.00565.2006","diger_kaynak":"Full text could not be read (abstract)"},{"ad":"Esfandyari 2006","tasarim":"Double-blind, placebo-controlled, parallel RCT","n":"30","populasyon":"Healthy volunteers (US, Mayo Clinic)","urun":"Dronabinol (synthetic THC), by mouth","urun_turu":"thc_iceren","doz":"5 mg twice a day, 3 doses in total (according to the abstract)","titrasyon":"None","sure":"3 doses (twice a day)","sonuc":"Dronabinol delayed gastric emptying overall (p = 0.018); the effect was marked in women (p = 0.011) and not significant in men (p = 0.184). Gastric volumes, maximum tolerated nutrient drink volume, post-drink symptoms and small and large bowel transit did not change; in men, fasting gastric volume was larger with dronabinol (238 versus 185; p = 0.04). Physiology study in healthy volunteers","yan_etki":"Not reported (in the abstract)","pmid":"16918762","doi":"10.1111/j.1365-2982.2006.00834.x","diger_kaynak":"Full text could not be read (abstract); the full text of Wong 2012 reports the dose in this study as 7.5 mg twice a day, while the abstract says 5 mg"},{"ad":"McCallum 1999","tasarim":"Double-blind, randomized, placebo-controlled crossover study","n":"13","populasyon":"Healthy volunteers (US)","urun":"Δ9-THC; route of administration not in the abstract","urun_turu":"thc_iceren","doz":"10 mg/m² body surface area (the dose used for chemotherapy nausea)","titrasyon":"None","sure":"Single dose (2 separate days)","sonuc":"THC slowed the emptying of solid food from the stomach compared with placebo in every participant: the proportion remaining in the stomach was higher from minute 30 onward (94.2% versus 85.5%; p < 0.05), and at minute 120 it was 73.9% versus 45.6% (p < 0.001). The delay was not related to blood THC levels","yan_etki":"Not reported (in the abstract)","pmid":"9892882","doi":"10.1046/j.1365-2036.1999.00441.x","diger_kaynak":"Full text could not be read (abstract)"},{"ad":"Bateman 1983","tasarim":"Placebo-controlled study (randomization not stated in the abstract)","n":"7","populasyon":"Healthy volunteers","urun":"Δ9-THC, intravenous","urun_turu":"thc_iceren","doz":"0.5 and 1 mg","titrasyon":"None","sure":"Single dose","sonuc":"Despite clear changes in pulse and psychological measures consistent with a cannabis effect, no clear change versus placebo in the emptying of liquid from the stomach","yan_etki":"Increased pulse and psychological changes (abstract)","pmid":"6307330","doi":"10.1111/j.1365-2125.1983.tb01561.x","diger_kaynak":"PMC1427915 (scanned page images only; text could not be read)"},{"ad":"Bilbao 2022","tasarim":"Systematic review and meta-analysis of RCTs, separated by drug type (up to October 2021; GRADE)","n":"152 RCTs (all indications, 12,123 participants); in irritable bowel syndrome, 2 RCTs with dronabinol (Wong 2011, Klooker 2011)","populasyon":"All medical indications (including an irritable bowel syndrome subgroup)","urun":"Dronabinol, nabilone, pure CBD and nabiximols (natural products such as smoked cannabis excluded)","urun_turu":"karma","doz":"Variable (single-dose dronabinol in irritable bowel syndrome)","titrasyon":null,"sure":null,"sonuc":"In irritable bowel syndrome, the results of the two single-dose dronabinol studies pointed in opposite directions; the pooled effect was zero (SMD 0), with very low certainty of evidence. Wong 2012 and the CBD gum study were not included in this analysis; the gastroparesis and functional dyspepsia RCTs were published after the search date","yan_etki":"Across all indications, the chance of any side effect with CBD was higher than with placebo (OR 1.82; 95% CI 1.08–3.07; 22 RCTs); no side effect analysis specific to irritable bowel syndrome","pmid":"35982439","doi":"10.1186/s12916-022-02459-1","diger_kaynak":"PROSPERO CRD42021229932; PMC9389720"},{"ad":"Giossi 2022","tasarim":"Systematic review and meta-analysis (RCTs and observational studies in chronic primary pain searched; PubMed, EMBASE, Cochrane, up to October 31, 2021; GRADE)","n":"8 RCTs, 240 people (all chronic primary pain); in irritable bowel syndrome, 2 RCTs, 68 people (Wong 2012 and the CBD gum study)","populasyon":"Chronic primary pain: fibromyalgia, irritable bowel syndrome, complex regional pain syndrome type I, functional chest pain","urun":"Cannabinoids (nabilone, dronabinol, THC-rich oil, vaporized cannabis, CBD gum)","urun_turu":"karma","doz":"Variable","titrasyon":null,"sure":null,"sonuc":"In irritable bowel syndrome, pain could be analyzed only from the CBD gum study: difference versus placebo 0.34 points (on a 0–10 scale; 95% CI −1.06 to 1.73; 1 RCT, 32 people; low certainty); difference in quality of life −1.0 (−6.8 to 4.9; 1 RCT, 30 people; low certainty). According to the authors, CBD may not reduce pain in irritable bowel syndrome. Across all chronic primary pain, pain reduction with cannabinoids was not significantly different from placebo (−0.64; −1.30 to 0.02)","yan_etki":"No significant difference from placebo in stopping because of side effects (OR 2.15; 0.44–10.65; all chronic primary pain); no side effect analysis specific to irritable bowel syndrome","pmid":"36129666","doi":"10.1007/s40122-022-00434-5","diger_kaynak":"PMC9633894; also a row in the fibromyalgia topic. One of the authors reported receiving conference support from Jazz Pharmaceuticals (the maker of Epidiolex)"},{"ad":"Volz 2016","tasarim":"Systematic review (up to March 2015; CENTRAL, PubMed, cannabis-med.org, ClinicalTrials.gov; at least 4 weeks and at least 10 people per arm; Cochrane risk-of-bias tool)","n":"1 RCT in IBD (21 people); no RCT meeting the criteria in irritable bowel syndrome","populasyon":"Gastroenterology: inflammatory bowel disease, irritable bowel syndrome, chronic pancreatitis","urun":"Herbal cannabis and pharmaceutical cannabinoids","urun_turu":"karma","doz":"Not applicable","titrasyon":null,"sure":null,"sonuc":"No RCT lasting at least 4 weeks and enrolling at least 10 people per arm was found in irritable bowel syndrome. The only suitable RCT was in Crohn's disease (21 people); the authors wrote that methodologically sound, sufficiently large and long studies are needed","yan_etki":"Not applicable","pmid":"26809974","doi":"10.1007/s00482-015-0087-0","diger_kaynak":"In German; full text could not be read (English abstract)"},{"ad":"NASEM 2017 (US National Academies report)","tasarim":"Expert committee report (assessment based on good- and fair-quality systematic reviews and subsequent primary studies)","n":"No suitable systematic review in irritable bowel syndrome; 1 RCT (Wong 2012, 36 patients)","populasyon":"Irritable bowel syndrome","urun":"Cannabinoids (only dronabinol in irritable bowel syndrome)","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"The committee found no good- or fair-quality systematic review on medical cannabis in irritable bowel syndrome; in the single suitable study (Wong 2012), 2 days of dronabinol did not change bowel transit; the evidence is insufficient because of the short duration, small sample and lack of patient-reported outcomes. Conclusion 4-5: there is insufficient evidence to say whether dronabinol is effective for the symptoms of irritable bowel syndrome","yan_etki":null,"pmid":"28182367","doi":"10.17226/24625","diger_kaynak":"National Academies Press, chapter 4 (nap.nationalacademies.org/read/24625/chapter/6; read on October 28, 2026); the NCBI Bookshelf copy could not be opened because of bot verification"},{"ad":"AGA 2025 (Staller)","tasarim":"Clinical guideline (American Gastroenterological Association; GRADE)","n":null,"populasyon":"Idiopathic and diabetic gastroparesis","urun":"CBD","urun_turu":"saf_cbd","doz":null,"titrasyon":null,"sure":null,"sonuc":"One of 12 recommendations: a conditional recommendation against using CBD (together with domperidone, prucalopride, aprepitant, nortriptyline and buspirone) as first-line treatment. A conditional recommendation for metoclopramide or erythromycin as first-line. The certainty of evidence and the rationale are not in the abstract","yan_etki":null,"pmid":"40976635","doi":"10.1053/j.gastro.2025.08.004","diger_kaynak":"Full text could not be read (the publisher page redirects with a script; text-mining rights reserved)"},{"ad":"GESA 2026 (Kellar)","tasarim":"Professional society position statement (Gastroenterological Society of Australia; literature review and modified Delphi consensus; 20 statements, with level of evidence and strength of recommendation)","n":null,"populasyon":"Idiopathic gastroparesis","urun":"Cannabinoids","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"Statement 17: cannabinoids slow gastric emptying but can paradoxically improve gastroparesis symptoms, including fullness; the evidence is insufficient to recommend their use (low-quality evidence; conditional recommendation; 100% consensus). Basis: the single 44-patient placebo-controlled CBD study (Zheng 2023) and large epidemiological studies showing greater healthcare use among cannabinoid users","yan_etki":null,"pmid":"42235947","doi":"10.1111/jgh.70456","diger_kaynak":"PMC13326989"},{"ad":"DGNM 2026 (Storr)","tasarim":"Clinical guideline, S1 level (expert consensus; German Society of Neurogastroenterology and Motility), English edition","n":null,"populasyon":"Functional dyspepsia","urun":"Cannabinoids","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"Pain relievers such as nonsteroidal anti-inflammatory drugs, acetaminophen (paracetamol), cannabinoids and opioids should not be used routinely to treat functional dyspepsia. It notes that cannabinoids used recreationally can cause dyspepsia-like complaints with nausea and, in more severe cases, cannabinoid hyperemesis syndrome or cyclic vomiting","yan_etki":null,"pmid":"42095009","doi":"10.1155/grp/2610765","diger_kaynak":"PMC13140302; original German text: Storr 2025, Z Gastroenterol (PMID 40199346)"},{"ad":"ESPGHAN/NASPGHAN 2025 (Groen)","tasarim":"Clinical guideline (European and North American pediatric gastroenterology, hepatology and nutrition societies; GRADE; 86 RCTs reviewed)","n":null,"populasyon":"Irritable bowel syndrome and functional abdominal pain in children aged 4–18","urun":"Cannabis and cannabinoids","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"The guideline group recommends that cannabis not be used to treat functional disorders with abdominal pain in children: there is no high-quality evidence supporting safety and effectiveness in children, the developing nervous system may be harmed, and the quality and content of products are inconsistent","yan_etki":null,"pmid":"40444524","doi":"10.1002/jpn3.70070","diger_kaynak":"PMC12314588"},{"ad":"CAG 2019 (Andrews)","tasarim":"Professional society position statement (Canadian Association of Gastroenterology; non-comprehensive literature review and expert opinion; no formal grading of evidence in the statements)","n":null,"populasyon":"Digestive and liver diseases (including functional disorders such as irritable bowel syndrome and functional dyspepsia)","urun":"Cannabis and cannabinoids","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"Statement on digestive symptoms: short-term use in particular may help with persistent nausea, vomiting, diarrhea or abdominal pain when standard treatments have not worked. Comment: effectiveness in other chronic pain cannot be transferred to functional disorders such as irritable bowel syndrome or functional dyspepsia; long-term effectiveness and safety in these disorders are unknown; cannabinoids should not be considered first-line treatment for non-chemotherapy nausea-vomiting or other off-label digestive symptoms. They should not be used in place of approved treatment; in cannabinoid hyperemesis syndrome, the main treatment is stopping cannabis","yan_etki":null,"pmid":"31294362","doi":"10.1093/jcag/gwy064","diger_kaynak":"PMC6507278. According to the declaration of interests, 3 of the 7 authors have ties to companies that make cannabis or cannabinoid products (advisory board and management roles; research support and product donations; speaker fees)"},{"ad":"Barbash 2019","tasarim":"Prospective, uncontrolled before-and-after study (single center)","n":"24","populasyon":"Gastroparesis not responding to standard treatment (idiopathic 11, diabetic 8, other 5; 20 women; US, New York)","urun":"Dronabinol (6 patients), medical marijuana (10; vaporized or sublingual drops, variable THC:CBD ratio) or dronabinol first and then marijuana (8)","urun_turu":"thc_iceren","doz":"Dronabinol 2–10 mg 2–4 times a day; marijuana as needed, ratio decided by the dispensary","titrasyon":"Not reported","sure":"At least 60 days of use","sonuc":"The GCSI total symptom score fell by 12.8 points after treatment (95% CI 10.4–15.2; p < 0.001); the nausea-vomiting, fullness and bloating subscores and the abdominal pain score also fell; marijuana was linked to more improvement than dronabinol. No control group, blinding or standard product; treatment durations varied; the effect of expectation cannot be separated","yan_etki":"Not reported","pmid":"31993268","doi":"10.7759/cureus.6430","diger_kaynak":"PMC6970440"},{"ad":"Santonicola 2025","tasarim":"Prospective observational study; no control group","n":"60","populasyon":"Fibromyalgia; 46 (77%) with a disorder of gut-brain interaction according to Rome IV (10 irritable bowel syndrome, 17 functional dyspepsia, 19 both) (Italy)","urun":"Medical marijuana (Bedrocan; contains THC; route of use and dose not in the abstract)","urun_turu":"thc_iceren","doz":"Not reported (in the abstract)","titrasyon":"Not reported (in the abstract)","sure":"6 months","sonuc":"Over 6 months, the fibromyalgia severity score fell (p < 0.001); scores for stomach pain, heartburn, abdominal pain, abdominal tension and bloating decreased (p < 0.01). No control group, small sample; the authors also stress these limitations","yan_etki":"Not reported (in the abstract)","pmid":"40556630","doi":"10.55563/clinexprheumatol/o5ck22","diger_kaynak":"Full text could not be read (abstract)"},{"ad":"Parkman 2025","tasarim":"Multicenter patient registry, cross-sectional analysis (NIDDK Gastroparesis Clinical Research Consortium, GpR3)","n":"406","populasyon":"Patients with gastroparesis symptoms (gastric emptying delayed in 72%; US, 7 centers)","urun":"Cannabis products (for any purpose; patient-reported)","urun_turu":"karma","doz":"Not reported","titrasyon":null,"sure":"1 year before registry enrollment","sonuc":"24% of patients (96 people) used cannabis products. In multivariable analysis, cannabis use was independently linked to emergency visits (OR 2.31; 95% CI 1.33–4.03) and hospital admission (OR 2.01; 95% CI 1.03–3.94) in the past year. Cross-sectional; people with more severe symptoms using more cannabis could explain this link; does not show cause and effect","yan_etki":"Not applicable","pmid":"40286861","doi":"10.1016/j.cgh.2025.01.033","diger_kaynak":"ClinicalTrials.gov NCT01696747 (observational registry); PMC12353374"},{"ad":"Kilani 2026","tasarim":"Retrospective cohort, 1:1 propensity score matched (TriNetX electronic health records)","n":"41,374 (20,687 cannabis users, 20,687 non-users)","populasyon":"Adults with a diagnosis of gastroparesis (US)","urun":"Cannabis (use according to records; no product information)","urun_turu":"thc_iceren","doz":"Not reported","titrasyon":null,"sure":"Not reported (in the abstract)","sonuc":"After matching, cannabis users had more frequent emergency visits (adjusted OR 1.73; 95% CI 1.66–1.80) and hospital admissions (OR 1.44; 1.39–1.50), and slightly less frequent upper endoscopy (OR 0.93; 0.88–0.98). Users were younger; diabetes, mood and anxiety disorders and opioid use were more common. Observational; does not show cause and effect","yan_etki":"Not applicable","pmid":"40197432","doi":"10.14309/ajg.0000000000003479","diger_kaynak":"Full text could not be read (abstract)"},{"ad":"McCarty 2022","tasarim":"Retrospective cross-sectional analysis (US National Inpatient Sample, 2008–2014)","n":"1,473,363 admissions with a diagnosis of gastroparesis; cannabis use disorder in 33,085 (2.25%)","populasyon":"Hospitalized patients with gastroparesis (US)","urun":"Cannabis (cannabis use disorder diagnosis codes)","urun_turu":"thc_iceren","doz":"Not reported","titrasyon":null,"sure":"Length of hospital stay","sonuc":"After adjusting for age, sex, coexisting illnesses and socioeconomic factors, those with cannabis use disorder had less in-hospital death (OR 0.45; 95% CI 0.33–0.60) and fewer long stays (OR 0.36; 0.33–0.39), and were more often discharged home (OR 1.26; 1.22–1.30) (Table 5; the numbers in the text differ from the table). Cannabis users were younger and mostly male; mental illnesses were more common. In-hospital data only, based on diagnosis codes; does not show cause and effect","yan_etki":"Not applicable","pmid":"33780213","doi":"10.1097/MCG.0000000000001526","diger_kaynak":"PMC8435035"},{"ad":"Akturk 2025","tasarim":"Retrospective chart review, case-control comparison (single center)","n":"813 charts reviewed; 86 with cannabinoid hyperemesis syndrome, 94 with diabetic gastroparesis","populasyon":"Adults with type 1 diabetes (US, Colorado)","urun":"Cannabis (use confirmed by urine test or chart notes)","urun_turu":"thc_iceren","doz":"Not reported","titrasyon":null,"sure":"Records from January 2019–January 2024","sonuc":"People with cannabinoid hyperemesis syndrome were younger than those with diabetic gastroparesis (29 versus 54 years), had a shorter duration of diabetes (16 versus 41 years) and a higher HbA1c (9.2% versus 7.4%); the proportions of women and of neuropathy were lower. All 11 patients diagnosed with gastroparesis by gastric emptying test while using cannabis every day met the criteria for the hyperemesis syndrome. A model built with age, duration of diabetes, sex and HbA1c separated the two conditions well (area under the curve 0.98). According to the authors, the gastric emptying test cannot tell the two conditions apart","yan_etki":"Not applicable","pmid":"40741458","doi":"10.2337/cd24-0096","diger_kaynak":"PMC12304556 (read from the PMC page); short paper by the same group: Karakus 2025, Can J Diabetes (PMID 39984123; no abstract, not read)"},{"ad":"Parkman 2020","tasarim":"Multicenter patient registry, cross-sectional analysis (NIDDK Gastroparesis Clinical Research Consortium, GpR2)","n":"506","populasyon":"Patients with gastroparesis symptoms (gastric emptying delayed in 72%; 86% women; US, 7 centers)","urun":"Marijuana (patient-reported use)","urun_turu":"thc_iceren","doz":"Not reported","titrasyon":null,"sure":"Registry enrollment visit","sonuc":"11.7% of patients (59 people) used marijuana; the rate was similar in those with delayed and normal gastric emptying and in idiopathic and diabetic patients. Users had higher nausea-vomiting (2.7 versus 2.1; p = 0.002) and upper abdominal pain scores (3.5 versus 2.9; p = 0.003). 81% of users reported that marijuana improved their symptoms and 10% (6 people) that it worsened them; 81% of ondansetron users also reported similar benefit. User reports; no control","yan_etki":"Not applicable","pmid":"31758430","doi":"10.1007/s10620-019-05963-2","diger_kaynak":"ClinicalTrials.gov NCT01696747 (observational registry); PMC7242137"},{"ad":"Patel 2020","tasarim":"Retrospective cross-sectional analysis (US National Inpatient Sample, 2010–2014)","n":"31,272 irritable bowel syndrome admissions (ages 15–54; out of 6.8 million admissions in total)","populasyon":"Hospitalized patients with irritable bowel syndrome (US)","urun":"Cannabis (cannabis use disorder diagnosis codes)","urun_turu":"thc_iceren","doz":"Not reported","titrasyon":null,"sure":"Hospital stay","sonuc":"Cannabis use disorder was present in 3.7% of irritable bowel syndrome admissions; after adjusting for demographics, mental and medical illnesses and other substance use, cannabis use disorder was linked to admission for irritable bowel syndrome (OR 1.41; 95% CI 1.32–1.50). Irritable bowel syndrome admissions with cannabis use disorder rose by 32.8% between 2010 and 2014. Based on diagnosis codes; does not show cause and effect","yan_etki":"Not applicable","pmid":"31573379","doi":"10.1080/10826084.2019.1664591","diger_kaynak":"Full text could not be read (abstract)"},{"ad":"Choi 2022","tasarim":"Retrospective cohort (US Nationwide Readmissions Database, 2016)","n":"7,163 irritable bowel syndrome admissions; cannabis use recorded in 357","populasyon":"Inpatients with a principal diagnosis of irritable bowel syndrome (US)","urun":"Cannabis (use according to diagnosis codes)","urun_turu":"thc_iceren","doz":"Not reported","titrasyon":null,"sure":"30 days","sonuc":"No difference in the primary outcome (readmission related to irritable bowel syndrome within 30 days): 1.5% versus 1.1% (p = 0.53). Readmission for any reason was lower in cannabis users (8.1% versus 12.7%; adjusted OR 0.53; 95% CI 0.28–0.99). The most common diagnoses in cannabis users' readmissions were cyclic vomiting and diarrhea-predominant irritable bowel syndrome. Observational; does not show cause and effect","yan_etki":"Not applicable","pmid":"33471483","doi":"10.1097/MCG.0000000000001498","diger_kaynak":"Full text could not be read (abstract)"}],"ilgili_ilaclar":["ppi","amitriptilin"],"son_inceleme":"2026-10-28","arastirma_gecmisi":[{"tarih":"2026-10-28","not":"Page published. This first review examined 28 studies."},{"tarih":"2026-10-31","not":"The last sentence of the page's short summary was rewritten in a calmer, more guiding tone: instead of \"Talk to your doctor before you start.\", it now says whom you can talk with, and about what, if you are considering CBD. The conclusion and the strength of evidence did not change."}]},{"id":"cancer-risk","baslik":"Cannabis, CBD and cancer risk","grup":"Cancer","grup_kodu":"kanser","tr_id":"kanser-riski","kanit_duzeyi":"yetersiz","kanit_yonu":"veri_yok","kanit_ozet":"On the question of cannabis and cancer risk, there are no randomized controlled trials and none are expected; the evidence comes from case-control, cohort and Mendelian randomization studies and reviews of them. Testis: in meta-analyses of the same three US case-control studies, current use (OR 1.62), at least weekly use (1.92) and use for more than 10 years (1.50; 1.36 and 'low' strength of evidence in Ghasemiesfe 2019) were linked to testicular germ cell tumors, especially the nonseminoma type; in the Swedish cohort, HR 2.57 (1.02–6.50) with heavy use; in the 2026 French study, the link was with seminoma; no link in UK Biobank (HR 0.85; 29 cases, participants aged 40–69); NASEM 2017 saw 'limited' evidence for the nonseminoma type. Lung: in the ILCCO pool (2159 cases), OR 0.96 (0.66–1.38) for habitual use and 1.03 in never-tobacco-smokers; in the Swedish cohort, HR 2.12 (1.08–4.14) with heavy use; in the US registry cohort, RR 3.87 (3.43–4.38; method disputed) with use disorder; in the North African pool, OR 2.4 (all cannabis smokers also smoked tobacco); in Mendelian randomization, OR 1.22 for the squamous type; Ghasemiesfe 2019 found the evidence insufficient, and NASEM 2017 saw moderate evidence of no association (both before the registry cohorts). Head and neck: in the INHANCE pool (4029 cases), OR 0.88 (0.67–1.16); NASEM 2017: moderate evidence of no association; 1.02 and 1.26 in meta-analyses (not significant); 1.24 for the oropharynx (0.99 with HPV adjustment), 0.47 for tongue cancer; 0.66 in an oral cancer meta-analysis; in US registry cohorts, RR 3.49 and OR 3.25 with use disorder, but in one hospital registry the link disappeared after adjusting for alcohol and smoking; in North Africa, OR 1.83 for nasopharyngeal cancer (1.54 after adjusting for cigarette smoking, not significant). Bladder, kidney, prostate: a decrease in prospective cohorts (bladder HR 0.55; kidney 0.61; prostate 0.83), an increase in a registry cohort (bladder RR 4.21; kidney 3.70; prostate 2.80). Glioma: 2.8-fold in a single cohort. Childhood cancers: in five small case-control studies between 1989 and 2006, 2–11-fold associations with the mother's or father's marijuana use (in one, any mind-altering drug) (not significant for astrocytoma; NASEM 2017: insufficient evidence); in the largest leukemia study, no link or a link in the opposite direction. In chronic pancreatitis, pancreatic cancer HR 0.26 (less detection). In most Mendelian randomization studies, no link or a very small one. Umbrella reviews summarize the evidence as 'suggestive rather than conclusive' (Nargis 2025) and find no strong evidence class for cancer (Solmi 2023). Pure CBD: no studies of cancer risk in people; in 2-year animal studies of the approved medicine, according to the US label, an increase in hepatocellular adenoma in male mice at the highest dose and no significant increase in tumors in rats; according to the European product information, hepatocellular adenoma increased in male mice at all doses and in female mice at the highest dose, Leydig cell hyperplasia and adenoma increased in male rats at all doses, and 1 Leydig cell carcinoma was seen at the highest dose (according to the document, the relevance of Leydig tumors in rats to humans is generally limited); genotoxicity tests negative; EFSA 2026 wrote that data gaps remain for genotoxicity and long-term use. THC itself was not carcinogenic in a 2-year rat study and equivocal in mice (thyroid adenoma, not dose-related). October 2026 search (PubMed, Cochrane, ClinicalTrials.gov, Europe PMC): no randomized controlled trials on this question; no human study of cancer risk with pure CBD was found. For smoked cannabis, 2 umbrella reviews, 1 institutional assessment (NASEM 2017), 8 systematic reviews and meta-analyses, 4 Mendelian randomization studies, 12 cohort or registry studies, 4 pooled case-control analyses and 7 case-control studies were found; for pure CBD, 1 institutional assessment and 1 animal study (the approved medicine's US and European product information); for THC, 1 animal study; all are in the table below. Two 2026 meta-analyses were not included in the table: the results of the testicular meta-analysis were identical to earlier meta-analyses of the same three studies, and the cohort result of the lung meta-analysis rested on two numbers that did not match the source study. No Cochrane review, no study from Turkey and no ongoing study on ClinicalTrials.gov examining this question was found.","kanit_duzeyi_metin":"Pure CBD: Insufficient (no human studies of cancer risk; only two-year animal studies of the approved medicine and the European Food Safety Authority assessment)","kanit_duzeyi_thc_icerenler":"zayif","kanit_duzeyi_thc_icerenler_metin":"Smoked cannabis and THC-containing products: Weak evidence on whether they raise cancer risk (only observational studies and Mendelian randomization; the most consistent signal is for testicular cancer, with low strength of evidence; conflicting and very weak for lung and head and neck; insufficient for bladder, prostate, kidney, brain and childhood cancers; no human data for oral THC)","kaynak_dosya":null,"saf_cbd_sonuc":"No study was found that looked at cancer risk from pure CBD or CBD oil in people. The US and European product information summarize the two-year animal studies of the approved pure CBD medicine in different detail. According to the US label, benign liver tumors (hepatocellular adenoma) increased in male mice at the highest dose (300 mg per kilogram per day), and there was no statistically significant increase in tumors in rats. According to the European product information, however, these liver tumors increased in male mice at all doses and in female mice at the highest dose; in male rats, overgrowth and benign tumors of the Leydig cells in the testis increased at all doses, and a malignant Leydig cell tumor was seen in one rat at the highest dose; the document states that the relevance of these rat tumors to humans is generally considered limited. CBD and its two main breakdown products were negative in genotoxicity (genetic damage) tests. The European Food Safety Authority (2026) wrote that, despite publications suggesting that pure CBD itself does not cause genetic damage, manufacturing and formulation may introduce new hazards, and that the effects of long-term use are unknown. It has not been shown that CBD either raises or lowers cancer risk.","thc_icerenler_sonuc":"The findings come almost entirely from smoking marijuana and differ by type of cancer. Testis: a link with testicular germ cell tumors after long-term (more than 10 years) or frequent use; meta-analyses of the same three US case-control studies (OR about 1.4–1.9), the Swedish cohort (HR 2.57 with heavy use) and the 2026 French study showed an increase, but the tumor type affected differed between studies, and there was no link in the UK cohort with older participants and few cases; the US National Academies in 2017 saw 'limited' evidence for the nonseminoma type (weak evidence). Lung: no increase in the pooled analysis of 2159 patients or in never-smokers, and the US National Academies (2017) saw moderate evidence of no association; an increase with heavy use in the Swedish cohort (HR 2.12) and the US registry cohort (RR 3.87); hard to separate from tobacco (mixed, very weak). Head and neck and oral: no increase in large pooled analyses and meta-analyses, a lower risk in some (US National Academies 2017: moderate evidence of no association); in US registry cohorts, with use disorder, any head and neck cancer about 3.5-fold and oral cancer 2.5–3.3-fold, but in one hospital registry the link disappeared after adjusting for alcohol and smoking (conflicting, very weak). Bladder, prostate, kidney: findings in two directions (insufficient). Brain (glioma): a single cohort (insufficient). Childhood cancers (use during pregnancy): small and conflicting case-control studies (insufficient). There are no human cancer data for THC taken by mouth (as a medicine); THC did not cause cancer in a two-year rat study, and in mice there was an equivocal finding in the thyroid that was not dose-related.","ruhsat":null,"doz_araligi_ozet":"No treatment dose (risk page). Exposure measures in human studies: ever having used; joint-years (≥10, ≥60); number of lifetime uses (>50 times, ≥2000 times); at least weekly or daily use; ≥10 years of use; a diagnosis of cannabis use disorder in records. Animal studies (2 years): pure CBD 30–300 mg/kg/day in mice and 15–150 mg/kg/day in rats; THC 12.5–50 mg/kg in rats and 125–500 mg/kg in mice (5 days a week); these are study doses, not personal recommendations","titrasyon_ozet":"Not applicable: the studies measured a usage habit, not a treatment; there is no dose adjustment","yan_etkiler":["Cannabis use and low birth weight in pregnancy (equivalent OR 1.43) and small-for-gestational-age babies (1.61), crashes among drivers (1.27) and psychosis with use in adolescence in the general population (1.71): the strongest evidence class in the umbrella review; the pregnancy estimates were not adjusted for confounders, and for psychosis this class was reached only with cohorts (Solmi 2023)","In randomized trials of cannabis-based medicines, an increase in nervous system (equivalent OR 2.84) and psychiatric side effects (3.07) (Solmi 2023)","Pure CBD: consistent liver effects in animals; in people, a possibility of liver harm, especially together with other medicines (EFSA 2026)","Pure CBD, animals: an increase in benign liver tumors (hepatocellular adenoma) in mice in 2-year studies (according to the US label, in males at the highest dose; according to the European product information, in males at all doses and in females at the highest dose); in rats, no significant increase in tumors according to the US label, but according to the European product information, an increase in Leydig cell overgrowth and benign tumors in the testis in males (relevance to humans generally considered limited)","THC, animals: no carcinogenic effect in rats over 2 years, an equivocal finding in the thyroid in mice that was not dose-related; convulsions and seizures at high doses, testicular shrinkage at 13 weeks (NTP 1996)","In chronic pancreatitis, a slight increase in acute pancreatitis attacks with cannabis use disorder (HR 1.10; Maan 2026)"],"izlem":["No ongoing or planned study measuring the cancer risk of cannabis or CBD use was found on ClinicalTrials.gov (October 2026)","It has been suggested that routine oral exams may be useful in people with cannabis use disorder (Cuomo 2025)","The European Food Safety Authority wants genetic damage in CBD products to be assessed product by product; data gaps for long-term use remain (EFSA 2026)"],"dikkat":["Almost all of the cancer findings on this page come from smoked marijuana; they cannot be carried over to CBD oil as evidence of either harm or benefit","Smoking marijuana mixed with tobacco: in the North African study, the odds of lung cancer were highest in people who smoked both tobacco and cannabis (a single pooled analysis entangled with tobacco; Berthiller 2008)","Pregnancy and breastfeeding: avoiding cannabis is recommended (Solmi 2023); the safety of CBD in people who are pregnant or breastfeeding could not be established (EFSA 2026)","Young men: the link with testicular cancer was seen in young men with long-term, frequent or heavy use (weak evidence; Gurney 2015; Callaghan 2017; Coste 2026)","If you have been diagnosed with cancer: the effect of cannabis and CBD on the course of cancer is covered on the 'Cancer Treatment and CBD' page; talk to your oncologist before using them during treatment","People who take medicines regularly: CBD interacts with the liver enzymes that break down medicines (EFSA 2026)"],"ilac_etkilesim_notlari":["The studies on this page did not examine drug interactions; details are in the site's drug interactions section","CBD interacts with the enzymes in the liver that break down medicines; people being treated for cancer should consult their oncologist before starting (EFSA 2026)"],"dogrulanamayan":["The full text of most studies in the table is not open access; the numbers were taken from the abstracts. Full texts read: Ghasemiesfe 2019, Zhang 2015, Berthiller 2009, Marks 2014, Gurney 2015, Callaghan 2017 (methods), Huang 2023 (UK Biobank), Clark 2021, Solmi 2023, Gallagher 2024, Cuomo 2025, Maan 2026, Feng 2009 and the European Food Safety Authority statement. The cancer chapter of the 2017 report of the US National Academies was read on the publisher's website.","The content of the commentaries and letters criticizing the 2024 head and neck and 2026 lung registry studies (five texts in total) and of the correction to the 2025 cancer-specific umbrella review could not be read; only their titles are known.","A 2026 meta-analysis reporting an increase in lung cancer (Karimi 2026) was not included in the table: the relative risks listed in its table for the 1997 cohort (10.3 and 9.8) do not match the cannabis results in that study's own abstract and in the 2019 review (RR 0.9 and 1.1), and when one of these two numbers is removed, the increase in the cohorts is no longer significant.","One table of the comprehensive 2019 review (Ghasemiesfe 2019) lists 'low' strength of evidence for head and neck cancer and an increase with use of more than 8 joint-years; the text and abstract, however, say no association was found. This page is based on the text and abstract. The review's published correction changes only one table comment.","A non-peer-reviewed 2026 preprint (Mendelian randomization) was not included in the table.","The licensing status in Turkey of THC-containing medicines such as dronabinol and nabiximols was not verified in this search."],"calismalar":[{"ad":"Nargis 2025","tasarim":"Umbrella review (review of the global epidemiological evidence on cannabis and cancer risk)","n":"Not reported (in the abstract; full text could not be read)","populasyon":"Cannabis users in the general population","urun":"Cannabis use (mostly recreational, smoked)","urun_turu":"thc_iceren","doz":"Not applicable","titrasyon":null,"sure":"Varies by publication","sonuc":"According to the authors, the links between cannabis and cancer risk are 'suggestive rather than conclusive'. The cancer most closely linked to cannabis use is nonseminoma testicular cancer; 'emerging evidence' of an increase was reported for squamous cell lung and head and neck cancers and for oral, breast, liver, cervical, laryngeal, pancreatic, thyroid and childhood cancers. The authors wrote that new studies free of confounding, misclassification and errors in exposure measurement are needed","yan_etki":null,"pmid":"39427677","doi":"10.1016/S2468-2667(24)00223-8","diger_kaynak":"Correction: PMID 40921170 (Lancet Public Health 2025;10:e814; its content could not be read)"},{"ad":"Solmi 2023","tasarim":"Umbrella review (101 meta-analyses: 50 observational, 51 of RCTs; evidence classes for observational evidence, GRADE for RCTs)","n":"101 meta-analyses; cancer-related results from 4 meta-analyses (Ghasemiesfe 2019, Gurney 2015, de Carvalho 2015, Zhang 2015)","populasyon":"General population and various patient groups; cancer risk results in the general population","urun":"Cannabis, cannabinoids and cannabis-based medicines","urun_turu":"karma","doz":"Not applicable","titrasyon":null,"sure":"Search through February 9, 2022","sonuc":"Of 119 cannabis-related associations in the general population, those concerning cancer were in the 'weak' or no-evidence class in the main analysis; when the criterion of more than 1000 cases was removed, three associations for testicular cancer moved up to the 'suggestive' class. The strongest ('convincing') evidence class included use during pregnancy with small-for-gestational-age babies (equivalent OR 1.61; 95% CI 1.41–1.83) and low birth weight (1.43; 1.27–1.62; both estimates not adjusted for confounders), and crashes among drivers (1.27; 1.21–1.34); psychosis in adolescents (1.71; 1.47–2.00) was 'highly suggestive' in the main analysis and 'convincing' when only cohorts were included. The authors supported avoiding cannabis during adolescence and young adulthood, in people prone to mental illness, during pregnancy, and before and while driving","yan_etki":null,"pmid":"37648266","doi":"10.1136/bmj-2022-072348","diger_kaynak":"PROSPERO CRD42018093045; editorial: Freeman 2023 (PMID 37722728). The same study also appears in the Bipolar Depression and Schizophrenia tables"},{"ad":"Ghasemiesfe 2019","tasarim":"Systematic review and meta-analysis (observational studies; strength-of-evidence grading)","n":"25 studies (19 case-control, 5 cohort, 1 cross-sectional); only 2 at low risk of bias","populasyon":"Adult cannabis users and nonusers","urun":"Cannabis (mostly smoked)","urun_turu":"thc_iceren","doz":"Exposure: ever use (at least 1 joint-year; 1 joint-year = one joint a day for a year) and duration of use","titrasyon":null,"sure":"Publications 1973–April 2019","sonuc":"Testis: use for more than 10 years was associated with testicular germ cell tumors (OR 1.36; 95% CI 1.03–1.81; 3 case-control studies), more clearly for the nonseminoma type (1.85; 1.10–3.11); no association for seminoma (0.98; 0.47–2.06); ever use not associated (1.11; 0.81–1.53); strength of evidence 'low'. For head and neck squamous cancer (1.26; 0.88–1.80; 4 studies) and oral cancer (1.22; 0.95–1.56; 2 studies), ever use was not associated. Lung: the results of 8 studies were mixed and could not be pooled; evidence 'insufficient'. Bladder, prostate, cervical, glioma, lymphoma, Kaposi sarcoma, nasopharyngeal, laryngeal, esophageal and other cancers: only isolated studies; evidence 'insufficient' for all. Very few people smoked only cannabis, exposure was low and poorly defined","yan_etki":null,"pmid":"31774524","doi":"10.1001/jamanetworkopen.2019.16318","diger_kaynak":"Correction: PMID 31940033 (the comment column of the Sidney 1997 row in Table 1 was corrected; does not change the results). PROSPERO CRD42018102457"},{"ad":"Clark 2021","tasarim":"Scoping review and meta-analysis (observational studies; US-focused)","n":"55 risk ratios from 34 studies (50 in the analysis)","populasyon":"Cannabis users and nonusers; various cancer types","urun":"Cannabis use","urun_turu":"thc_iceren","doz":"Not applicable","titrasyon":null,"sure":"Search through August 2019","sonuc":"When all data were combined, cancer risk did not differ significantly in cannabis users (RR 0.90; p > 0.06; high heterogeneity, I² 72%). When the authors excluded the North African data (where cannabis is smoked mixed with tobacco) and data not adjusted for tobacco or with few cases, the risk came out lower (RR 0.86; p < 0.017; 24 data points); RR 0.83 for head and neck cancers. For testicular cancer, RR 1.12 (not significant). Heterogeneity remained high, and separate results from the same study (e.g., men and women) were counted as independent data points; the authors wrote that they had 'low confidence' in the result. The excluded North African studies (including Berthiller 2008, Voirin 2006 and Feng 2009) had reported increases; this inverse result is sensitive to the selection decisions","yan_etki":null,"pmid":"33998861","doi":"10.1089/can.2019.0095","diger_kaynak":null},{"ad":"NASEM 2017 (US National Academies report)","tasarim":"Expert committee report (US National Academies of Sciences, Engineering, and Medicine; assessment based on good- and fair-quality systematic reviews and selected primary studies; five-level evidence grading)","n":"In the cancer chapter, 3 systematic reviews (one a pooled analysis) and 3 primary studies; primary case-control studies for childhood cancers","populasyon":"Adult cannabis users; children whose mother or father used cannabis","urun":"Cannabis (mostly smoked)","urun_turu":"thc_iceren","doz":null,"titrasyon":null,"sure":null,"sonuc":"The committee's conclusions: moderate evidence of no statistical association between smoking cannabis and lung cancer (5-1) and between cannabis use and head and neck cancers (5-2); limited evidence of an association between current, frequent or chronic cannabis smoking and nonseminoma testicular germ cell tumors (5-3); insufficient evidence for esophageal, prostate, cervical cancer, glioma, non-Hodgkin lymphoma, penile, anal and bladder cancer and Kaposi sarcoma (5-4, 5-5), and for parental cannabis use and leukemia, rhabdomyosarcoma, astrocytoma and neuroblastoma in the child (5-6). The newest publications in the chapter date from 2015; the registry cohorts and Mendelian randomization studies published after 2017 are not in the report","yan_etki":null,"pmid":"28182367","doi":"10.17226/24625","diger_kaynak":"National Academies Press, chapter 5 'Cancer' (nationalacademies.org/read/24625/chapter/7; read on October 28, 2026); the NCBI Bookshelf copy (NBK425767) could not be opened because of bot verification. The same report also appears in the Glaucoma and Irritable Bowel and Stomach Problems tables"},{"ad":"Mehra 2006","tasarim":"Systematic review (no meta-analysis)","n":"19 studies","populasyon":"Cannabis smokers over 18","urun":"Smoking cannabis","urun_turu":"thc_iceren","doz":"Not applicable","titrasyon":null,"sure":"Publications 1966–October 2005","sonuc":"Increased tar exposure, impaired lung macrophage function, oxidative stress and precancerous changes in the bronchial lining were reported in cannabis smokers; however, observational studies could not show a significant association between cannabis and lung cancer after adjustment for tobacco. Main problems: selection bias, small samples, young participants (not enough time for cancer to develop) and lack of adjustment for tobacco","yan_etki":null,"pmid":"16832000","doi":"10.1001/archinte.166.13.1359","diger_kaynak":null},{"ad":"de Carvalho 2015","tasarim":"Systematic review and meta-analysis (matched case-control studies)","n":"6 articles (9 case-control studies)","populasyon":"Patients with head and neck cancer and controls; 12.6% of cases and 14.3% of controls had used cannabis","urun":"Cannabis (lifetime use)","urun_turu":"thc_iceren","doz":"Exposure: ever use","titrasyon":null,"sure":"Not reported (in the abstract)","sonuc":"In models adjusted for age, sex, race and tobacco, lifetime cannabis use was not associated with head and neck cancer (OR 1.02; 95% CI 0.91–1.14; p = 0.72). Because the data were presented in different ways, no dose or duration analysis could be done","yan_etki":null,"pmid":"26433192","doi":"10.1016/j.archoralbio.2015.09.009","diger_kaynak":"Evaluation summary: Osazuwa-Peters 2016 (PMID 27449844; title 'insufficient evidence to support or refute the association')"},{"ad":"Ibrahim Mohammad 2025","tasarim":"Systematic review and meta-analysis (case-control studies; random effects)","n":"6 case-control studies; 4686 cases, 10,370 controls","populasyon":"People with oral cancer (ICD-10 C00–C06) and controls","urun":"Cannabis use","urun_turu":"thc_iceren","doz":"Exposure: ever use; subgroups by duration and age at starting","titrasyon":null,"sure":"Search through August 2025","sonuc":"Cannabis use was associated with a lower risk of oral cancer (OR 0.66; 95% CI 0.50–0.87; p = 0.003; I² 47%); three studies showed a significant decrease, three showed no significant difference; no dose-response relationship was seen. The authors wrote that the results should be interpreted with caution because of methodological limitations, differences in exposure measurement and conflicting new evidence. An inverse (lower-risk) finding; case-control studies do not show cause and effect","yan_etki":null,"pmid":"41236922","doi":"10.1080/15332640.2025.2581692","diger_kaynak":null},{"ad":"Song 2020","tasarim":"Systematic review and meta-analysis (epidemiological studies; random effects)","n":"4 studies for cannabis, 12 for tobacco","populasyon":"People with testicular germ cell tumors and controls","urun":"Cannabis use (tobacco smoking for comparison)","urun_turu":"thc_iceren","doz":"Exposure: ever use","titrasyon":null,"sure":"Not reported (in the abstract)","sonuc":"Ever cannabis use was associated with nonseminoma testicular tumors (summary OR 1.71; 95% CI 1.12–2.60); tobacco smoking was associated with all testicular germ cell tumors (1.18; 1.05–1.33). According to the authors, the data are consistent with a role for both cannabinoids and other substances in smoke; studies are needed that separate combined tobacco and cannabis use and smokeless sources of cannabinoids","yan_etki":null,"pmid":"32409200","doi":"10.1016/j.urolonc.2020.03.013","diger_kaynak":null},{"ad":"Gurney 2015","tasarim":"Systematic review and meta-analysis (case-control studies; random effects)","n":"3 case-control studies; 719 cases, 1419 controls (all US, data mostly from the 1990s)","populasyon":"Men aged 18–50","urun":"Cannabis use (self-reported)","urun_turu":"thc_iceren","doz":"Exposure: current use, at least weekly use and use for more than 10 years","titrasyon":null,"sure":"Publications January 1, 1980–May 13, 2015","sonuc":"Current use (OR 1.62; 95% CI 1.13–2.31), at least weekly use (1.92; 1.35–2.72) and use for more than 10 years (1.50; 1.08–2.09) were associated with testicular germ cell tumors; the result for ever use was uncertain (1.19; 0.72–1.95). The association was stronger for the nonseminoma type (2.09; 1.29–3.37 for current use; 2.59; 1.60–4.19 for at least weekly use); evidence for seminoma was insufficient. In two studies, response rates differed greatly between cases and controls; use is based on self-report","yan_etki":null,"pmid":"26560314","doi":"10.1186/s12885-015-1905-6","diger_kaynak":"Pooled studies: Daling 2009 (PMID 19204904), Trabert 2011 (PMID 20925043), Lacson 2012 (PMID 22965656; commentaries PMID 23233189, 23233231). Kardoust Parizi 2026 (PMID 41188200), which re-pooled the same studies, was not given a separate row: its current-use result (OR 1.62; 1.13–2.31) is identical to this meta-analysis and its nonseminoma result (1.71; 1.12–2.60) is identical to Song 2020"},{"ad":"Mehrnoush 2022","tasarim":"Systematic review (qualitative synthesis; Newcastle-Ottawa scale)","n":"3 studies (the search was not limited to human studies)","populasyon":"Bladder cancer","urun":"Cannabis use","urun_turu":"thc_iceren","doz":"Not applicable","titrasyon":null,"sure":"Not reported (in the abstract)","sonuc":"The relationship between cannabis and bladder cancer has been studied very little; the results of the few studies found are contradictory: both carcinogenic and protective effects were reported. The authors wrote that new, well-designed studies are needed","yan_etki":null,"pmid":"35775355","doi":"10.4081/aiua.2022.2.248","diger_kaynak":null},{"ad":"Baumeister 2021","tasarim":"Two-sample Mendelian randomization (a 'natural experiment' using genetic liability)","n":"Genetic data on lifetime use from 184,765 people; use disorder 17,068 cases and 357,219 controls; lung cancer 29,266 cases and 56,450 controls","populasyon":"Adults of European ancestry (international consortia, 23andMe, UK Biobank)","urun":"Genetic liability to lifetime cannabis use and to cannabis use disorder","urun_turu":"thc_iceren","doz":"Not applicable","titrasyon":null,"sure":"Not applicable (genetic data)","sonuc":"Genetic liability to lifetime cannabis use was associated with an increased risk of squamous cell lung cancer (OR 1.22; 95% CI 1.07–1.39; p = 0.003, q = 0.025); pleiotropy-robust methods and control analyses showed no bias. No other significant associations are reported in the abstract. According to the authors, the finding suggests a possible causal relationship; it needs confirmation by observational studies and other methods","yan_etki":null,"pmid":"33852959","doi":"10.1016/j.jtho.2021.03.025","diger_kaynak":null},{"ad":"Niu 2024","tasarim":"Two-sample Mendelian randomization","n":"Genetic data: ICC, UK Biobank and 23andMe (lifetime use); Psychiatric Genomics Consortium, iPSYCH and deCODE (use disorder); 9 cancer types","populasyon":"Adults of European ancestry","urun":"Genetic liability to lifetime cannabis use and to cannabis use disorder","urun_turu":"thc_iceren","doz":"Not applicable","titrasyon":null,"sure":"Not applicable (genetic data)","sonuc":"Genetic liability to lifetime use was not associated with cancers other than breast cancer; in breast cancer the risk was slightly lower (OR 0.981; p = 0.016). Liability to use disorder was associated with an increased risk of breast (OR 1.007; p = 0.007) and lung cancer (OR 1.122; p = 0.014). Effect sizes are small; no confidence intervals in the abstract. It uses largely the same genetic data sources as Huang 2023 (Mendelian randomization); for breast cancer the two studies' results point in opposite directions","yan_etki":null,"pmid":"37947877","doi":"10.1007/s00508-023-02303-3","diger_kaynak":null},{"ad":"Huang 2023 (Mendelian randomization)","tasarim":"Two-sample Mendelian randomization","n":"Genetic data on cannabis use (genome-wide meta-analysis in people of European ancestry); cancer data from UK Biobank and GliomaScan; 9 cancer types","populasyon":"Adults of European ancestry","urun":"Genetic liability to cannabis use","urun_turu":"thc_iceren","doz":"Not applicable","titrasyon":null,"sure":"Not applicable (genetic data)","sonuc":"Genetic liability to cannabis use was associated with cervical cancer (OR 1.0013; 95% CI 1.0004–1.0022; p = 0.005); suggestive evidence for laryngeal (OR 1.0004; p = 0.03) and breast cancer (1.0037; p = 0.047); no evidence of a causal relationship for melanoma, colorectal, oral, oropharyngeal or esophageal cancer, or glioma. The reported odds ratios are very close to 1; their clinical meaning is unclear","yan_etki":null,"pmid":"37099198","doi":"10.1007/s00432-023-04807-x","diger_kaynak":null},{"ad":"Su 2025","tasarim":"Two-sample Mendelian randomization (FinnGen and UK Biobank)","n":"Not reported (in the abstract)","populasyon":"Adults of European ancestry","urun":"Genetic liability to cannabis use disorder (opioid use disorder was also studied)","urun_turu":"thc_iceren","doz":"Not applicable","titrasyon":null,"sure":"Not applicable (genetic data)","sonuc":"No evidence of a causal relationship was found between cannabis use disorder and any of the cancer types studied (p > 0.05 for all). The associations found for opioid use disorder (an increase in bladder cancer, decreases in acute myeloid leukemia and ovarian cancer) were not significant after correction for multiple comparisons","yan_etki":null,"pmid":"40178608","doi":"10.1007/s00213-025-06781-3","diger_kaynak":null},{"ad":"Gallagher 2026","tasarim":"Retrospective matched cohort (US electronic health records, 67 health care organizations, 20 years; propensity score matching)","n":"149,632 per group (with and without a cannabis use disorder diagnosis)","populasyon":"Adults over 18","urun":"Cannabis (heavy use; use disorder diagnosis in the record)","urun_turu":"thc_iceren","doz":"Exposure: cannabis use disorder diagnosis in the record (amount and route of use unknown)","titrasyon":null,"sure":"20 years of records; plus analyses after 1 and 5 years","sonuc":"People with cannabis use disorder had a higher risk of lung and bronchus cancer (RR 3.87; 95% CI 3.43–4.38); the risk remained higher after 1 and 5 years; increases in all types: small cell (2.70; 1.31–5.58), adenocarcinoma (2.54; 1.59–4.08) and squamous cell (2.90; 1.41–5.95). Matching was based on demographics and lung cancer risk factors; because it is record-based, the amount of tobacco and how cannabis was used cannot be measured. Two letters published in the same journal questioned the clarity of the methods and the interpretation; the authors replied","yan_etki":null,"pmid":"42044619","doi":"10.1016/j.lungcan.2026.109421","diger_kaynak":"Letters: Tashkin 2026 (PMID 42172736), Topkan 2026 (PMID 42442866); authors' reply: Gallagher 2026 (PMID 42372382). The full texts of the article and the letters could not be read"},{"ad":"Gallagher 2024","tasarim":"Retrospective multicenter cohort (US electronic health records, 64 health care organizations; propensity score matching)","n":"116,076 people diagnosed with a cannabis-related disorder and 3,985,286 without the diagnosis; 115,865 per group after matching","populasyon":"US adults with an outpatient record and no previous head and neck cancer","urun":"Cannabis (cannabis-related disorder diagnosis in the record)","urun_turu":"thc_iceren","doz":"Exposure: cannabis-related disorder diagnosis in the record (amount, frequency and form unknown)","titrasyon":null,"sure":"20 years of records (through April 2024)","sonuc":"People with a cannabis-related disorder had a higher risk of any head and neck cancer (RR 3.49; 95% CI 2.78–4.39): oral (2.51; 1.81–3.47), oropharyngeal (4.90; 2.99–8.02) and laryngeal (8.39; 4.72–14.90). Matching included age, race and ethnicity, alcohol use disorder and tobacco use (by diagnosis code); the amount of tobacco and alcohol, HPV and tumor type were not included. The authors noted that dose-response could not be examined and that cannabis use may be underrecorded in the records. A commentary was published in the same issue, followed by two letters asking for clarification","yan_etki":null,"pmid":"39115834","doi":"10.1001/jamaoto.2024.2419","diger_kaynak":"Correction: PMID 40014339 (the phrase 'without head and neck cancer' in the abstract was corrected to 'without cannabis-related disorder'). Commentary: Califano 2024 (PMID 39115811); letters: Tashkin 2025 (PMID 39636626), Katz 2025 (PMID 39636627); reply: Gallagher 2025 (PMID 39636616); the texts of the commentary and letters could not be read"},{"ad":"Davis 2025","tasarim":"Retrospective matched cohort (US, TriNetX health records, 2004–2024; separate propensity score matching for each cancer)","n":"74,642 people diagnosed with cannabis abuse or dependence and 4,709,585 without the diagnosis (numbers after matching vary by cancer)","populasyon":"US adults with no previous genitourinary cancer","urun":"Cannabis (abuse or dependence diagnosis in the record)","urun_turu":"thc_iceren","doz":"Exposure: diagnosis code in the record (amount unknown)","titrasyon":null,"sure":"Records from 2004–2024","sonuc":"After matching, cannabis abuse or dependence was associated with an increased risk of bladder (0.14% vs 0.03%; RR 4.21; 95% CI 2.70–6.57), kidney (RR 3.70; 2.52–5.43) and prostate cancer (RR 2.80; 2.19–3.58); no significant association with upper urinary tract, testicular or penile cancer (because these cancers are rare, an association cannot be ruled out). Matching was based on demographics, tobacco use, nicotine dependence, other substance use disorders and each cancer's risk factors; no dose information","yan_etki":null,"pmid":"40484779","doi":"10.1016/j.urolonc.2025.05.010","diger_kaynak":null},{"ad":"Maan 2026","tasarim":"Retrospective multicenter matched cohort (TriNetX; propensity score matching)","n":"6858 patients with chronic pancreatitis per group after matching (before matching, 10,864 with and 42,160 without cannabis use disorder)","populasyon":"Adults with chronic pancreatitis (a group already at high risk of pancreatic cancer)","urun":"Cannabis (use disorder diagnosis in the record)","urun_turu":"thc_iceren","doz":"Exposure: diagnosis code in the record","titrasyon":null,"sure":"Mean follow-up 736 days (with the disorder) and 896 days (without)","sonuc":"Fewer pancreatic cancers were detected during follow-up in people with cannabis use disorder (67 vs 274 cases; HR 0.26; 95% CI 0.20–0.34); there was a slight increase in acute pancreatitis attacks (HR 1.10; 1.04–1.17). Follow-up was shorter in people with the use disorder; the authors interpret the finding as 'less detection during follow-up' and call for prospective confirmation. An inverse (lower-risk) finding, in a specific patient group","yan_etki":null,"pmid":"41533288","doi":"10.1007/s12029-025-01383-w","diger_kaynak":"Authors' reply: PMID 41779300 (text could not be read)"},{"ad":"Cuomo 2025","tasarim":"Retrospective cohort (health records of 6 academic centers of the University of California)","n":"45,129 people; 949 (2.1%) diagnosed with cannabis use disorder during follow-up","populasyon":"Adults screened for substance use disorder with no previous oral cancer","urun":"Cannabis (use disorder diagnosis in the record)","urun_turu":"thc_iceren","doz":"Exposure: new diagnosis code during follow-up","titrasyon":null,"sure":"5-year follow-up (baseline 2012–2019; records through December 2024)","sonuc":"Oral (lip or tongue) cancer occurred in 0.74% of people with cannabis use disorder and 0.23% of those without; after adjustment for age, sex, body mass index and smoking, the odds were about three times higher (OR 3.25; 95% CI 1.47–7.17; HR 3.25; 1.48–7.13). Few cases in the disorder group (0.74% of 949 people); there were no data on alcohol, HPV or socioeconomic status. The authors wrote that routine oral exams may be useful in this group","yan_etki":null,"pmid":"40746396","doi":"10.1016/j.pmedr.2025.103185","diger_kaynak":null},{"ad":"Katz 2026","tasarim":"Retrospective hospital database study (i2b2, ICD-10 codes; logistic regression)","n":"Not reported (in the abstract)","populasyon":"Patients with head and neck cancer and cannabis users in a hospital database","urun":"Cannabis use (diagnosis code)","urun_turu":"thc_iceren","doz":"Not applicable","titrasyon":null,"sure":"Not reported (in the abstract)","sonuc":"In cannabis users, the odds of oropharyngeal cancer were 3.12 times and of oral cancer 2.38 times higher in the crude analysis; they remained significant after adjustment for age, sex and race, but significance was lost after adjustment for alcohol (oropharynx 1.07; oral 0.7) or smoking (0.87; 0.62); with adjustment for HPV vaccination, oropharynx 1.02. According to the authors, alcohol and smoking rather than cannabis may explain the association","yan_etki":null,"pmid":"40935384","doi":"10.1111/jop.70055","diger_kaynak":null},{"ad":"Huang 2023 (UK Biobank)","tasarim":"Prospective population cohort (UK Biobank) and Mendelian randomization","n":"151,945 people (33,449 had used cannabis); testicular and prostate analyses in 64,730 men","populasyon":"UK adults aged 40–69","urun":"Cannabis use (questionnaire; past and current use separated)","urun_turu":"thc_iceren","doz":"Exposure: 1–2, 3–10, 11–100 or more than 100 lifetime uses; in the analysis, never vs past use","titrasyon":null,"sure":"Enrollment 2006–2010, follow-up through May 2020","sonuc":"Past use was associated with a lower risk of kidney cancer (HR 0.61; 95% CI 0.40–0.93) and prostate cancer (HR 0.83; 0.74–0.94; 0.82 in the abstract); a nonsignificant decrease in bladder cancer (0.77; 0.58–1.02), significant in women (0.43; 0.21–0.86); no association with testicular cancer (0.85; 0.37–1.97; only 29 cases, participants aged 40–69). All urological cancers were more common in current users; according to the authors, this may reflect use for treatment after diagnosis (reverse causation). Mendelian randomization suggested a possible decrease in kidney cancer. Tobacco smokers were more common among cannabis users; the bladder and kidney analyses were adjusted for tobacco, the prostate analysis only for age and family history. An inverse (lower-risk) finding","yan_etki":null,"pmid":"35975633","doi":"10.1002/cam4.5132","diger_kaynak":null},{"ad":"Callaghan 2017","tasarim":"Prospective population cohort (Swedish military conscription, 42-year follow-up; linkage with national registries)","n":"49,343 men (45,250 in the analysis; 119 testicular cancers)","populasyon":"Swedish men aged 18–21 who underwent military conscription in 1969–1970","urun":"Cannabis use (non-anonymous questionnaire at conscription)","urun_turu":"thc_iceren","doz":"Exposure: lifetime use; more than 50 times counted as 'heavy'","titrasyon":null,"sure":"1970–2011","sonuc":"Ever use was not significantly associated with testicular cancer (adjusted HR 1.42; 95% CI 0.83–2.45); more than 50 uses was associated with an increased risk of testicular cancer (HR 2.57; 1.02–6.50). Analyses were adjusted for tobacco, alcohol and other factors. Use was asked about only once, in youth; use in later years is unknown","yan_etki":null,"pmid":"29093004","doi":"10.1158/1055-9965.EPI-17-0428","diger_kaynak":null},{"ad":"Callaghan 2013","tasarim":"Prospective population cohort (Swedish military conscription, 40-year follow-up; linkage with national registries)","n":"49,321 men (44,284 in the analysis)","populasyon":"Swedish men aged 18–20","urun":"Smoking cannabis (questionnaire at conscription)","urun_turu":"thc_iceren","doz":"Exposure: more than 50 lifetime uses counted as 'heavy' (1.7% of participants)","titrasyon":null,"sure":"1969–1970 to 2009","sonuc":"Heavy use (more than 50 lifetime uses) was associated with a more than twofold increase in lung cancer risk over 40 years (HR 2.12; 95% CI 1.08–4.14); adjusted for baseline tobacco and alcohol use, respiratory conditions and socioeconomic status. Results for lower levels of use are not in the abstract. Use was asked about only once; tobacco and cannabis use in later years is unknown","yan_etki":null,"pmid":"23846283","doi":"10.1007/s10552-013-0259-0","diger_kaynak":null},{"ad":"Thomas 2015","tasarim":"Prospective cohort (California Men's Health Study; questionnaire and electronic health records)","n":"84,170 men; 279 bladder cancers","populasyon":"Multiethnic men aged 45–69","urun":"Cannabis use (questionnaire, 2002–2003)","urun_turu":"thc_iceren","doz":"Exposure: ever use","titrasyon":null,"sure":"11 years","sonuc":"In people who used cannabis only, bladder cancer risk was 45% lower (HR 0.55; 95% CI 0.31–1.00); in those who smoked tobacco only, it was higher (1.52; 1.12–2.07); in those who used both, not significant (1.28; 0.91–1.80). According to the authors, cause and effect cannot be established; adjustment was limited to age, race and body mass index (according to Ghasemiesfe 2019, there was not enough adjustment for important confounders). An inverse (lower-risk) finding","yan_etki":null,"pmid":"25623697","doi":"10.1016/j.urology.2014.08.060","diger_kaynak":"Editorial comment (PMID 25623698), authors' reply (PMID 25623699), commentary: Penson 2015 (PMID 26292856); their texts could not be read"},{"ad":"Efird 2004","tasarim":"Prospective cohort (Kaiser Permanente, Northern California)","n":"133,811 people","populasyon":"Health plan members over 25 with no previous brain tumor","urun":"Smoking cannabis (questionnaire)","urun_turu":"thc_iceren","doz":"Exposure: smoking cannabis at least once a month","titrasyon":null,"sure":"Up to 21 years of follow-up (enrollment 1977–1985)","sonuc":"In people who smoked cannabis at least once a month, after adjustment for cigarettes and other factors, the risk of adult-onset malignant glioma (a type of brain tumor) was 2.8 times higher (95% CI 1.3–6.2); no dose-response relationship was seen. Ghasemiesfe 2019 rated the evidence as insufficient, noting that the amount of use was not measured","yan_etki":null,"pmid":"15174522","doi":"10.1023/b:neon.0000024746.87666.ed","diger_kaynak":null},{"ad":"Sidney 1997","tasarim":"Retrospective cohort (Kaiser Permanente health checkups, San Francisco and Oakland)","n":"64,855 people","populasyon":"People aged 15–49 attending health checkups","urun":"Cannabis use (questionnaire)","urun_turu":"thc_iceren","doz":"Exposure: ever or current use; fewer than 7 lifetime uses counted as 'experimentation'","titrasyon":null,"sure":"Mean follow-up 8.6 years (enrollment 1979–1985, follow-up through 1993)","sonuc":"No increase in all cancers combined (men RR 0.9; women 1.0; 95% CI 0.8–1.1); no association with tobacco-related cancers or with colorectal, lung, melanoma, prostate, breast or cervical cancer. Among nonsmokers of tobacco, prostate cancer (RR 3.1; 1.0–9.5) and, borderline, cervical cancer (1.4; 1.0–2.1) were more common in cannabis users. Participants were young and follow-up was short","yan_etki":null,"pmid":"9328194","doi":"10.1023/a:1018427320658","diger_kaynak":"The Ghasemiesfe 2019 correction corrected the comment in this study's row (PMID 31940033)"},{"ad":"Zhang 2015","tasarim":"Pooled case-control analysis (International Lung Cancer Consortium; individual data from 6 studies)","n":"2159 lung cancer cases, 2985 controls (370 cases and 1358 controls had never smoked tobacco)","populasyon":"Adults from the US, Canada, the United Kingdom and New Zealand","urun":"Smoking cannabis","urun_turu":"thc_iceren","doz":"Exposure: habitual use; at least 1 joint-equivalent a day; at least 10 joint-years","titrasyon":null,"sure":"Studies 1999–2013","sonuc":"Habitual cannabis smokers did not have an increased risk of lung cancer (OR 0.96; 95% CI 0.66–1.38); no increase for at least one joint a day (0.88; 0.63–1.24) or at least 10 joint-years (0.94; 0.67–1.32) either. No association in people who had never smoked tobacco (1.03; 0.51–2.08). A nonsignificant trend toward an increase in adenocarcinoma (1.73; 0.75–4.00 and 1.74; 0.85–3.55); according to the authors, possible harm from heavy use cannot be ruled out. The New Zealand study in the pool had on its own reported an increase with heavy use (more than 10.5 joint-years) (RR 5.7; 1.5–21.6)","yan_etki":null,"pmid":"24947688","doi":"10.1002/ijc.29036","diger_kaynak":"Studies in the pool include the Los Angeles (Hashibe 2006, PMID 17035389) and New Zealand (Aldington 2008, PMID 18238947; commentaries PMID 18238942, 18591344, 18757709) studies"},{"ad":"Marks 2014","tasarim":"Pooled case-control analysis (INHANCE consortium; individual data from 9 studies)","n":"1921 oropharyngeal cancer cases, 356 tongue cancer cases, 7639 controls","populasyon":"Adults from the US and Latin America","urun":"Smoking cannabis","urun_turu":"thc_iceren","doz":"Exposure: ever use; frequency and duration","titrasyon":null,"sure":"Varies by study","sonuc":"People who had ever smoked cannabis had a slightly higher risk of oropharyngeal cancer (tonsil and base of tongue area) (adjusted OR 1.24; 95% CI 1.06–1.47) and a lower risk of tongue cancer (0.47; 0.29–0.75). In a sensitivity analysis adjusted for HPV, the oropharyngeal association disappeared (0.99); in the 4 studies with known HPV antibody status there was no association to begin with (0.89; 0.65–1.19). In people who had never used tobacco or alcohol, 2.11 (0.97–4.62) for the oropharynx. According to the authors, the association may vary by tumor site; confounding by HPV and misclassification of exposure need to be ruled out","yan_etki":null,"pmid":"24351902","doi":"10.1158/1055-9965.EPI-13-0181","diger_kaynak":null},{"ad":"Berthiller 2009","tasarim":"Pooled case-control analysis (INHANCE consortium; individual data from 5 studies)","n":"4029 head and neck cancer cases, 5015 controls","populasyon":"Studies from Los Angeles, Seattle, Tampa, Houston and Latin America","urun":"Smoking cannabis (self-reported)","urun_turu":"thc_iceren","doz":"Exposure: ever use; frequency, duration and cumulative use","titrasyon":null,"sure":"Varies by study (1985–2000s)","sonuc":"Ever smoking cannabis did not increase head and neck cancer risk (OR 0.88; 95% CI 0.67–1.16); risk did not rise with frequency, duration or cumulative use. No increase in people who had never used tobacco (0.93; 0.63–1.37) or who had never used tobacco or alcohol (1.06; 0.47–2.38). Because frequent users were few in most studies, a moderate increase cannot be ruled out","yan_etki":null,"pmid":"19423532","doi":"10.1158/1055-9965.EPI-08-0845","diger_kaynak":"Studies in the pool include Los Angeles (Hashibe 2006, PMID 17035389) and Seattle (Rosenblatt 2004, PMID 15173020)"},{"ad":"Berthiller 2008","tasarim":"Pooled case-control analysis (Tunisia, Morocco, Algeria; 3 hospital-based studies)","n":"430 lung cancer cases, 778 controls (men only)","populasyon":"Men from North African countries where cannabis is widely used and produced","urun":"Smoking cannabis (in the region, mostly mixed with tobacco)","urun_turu":"thc_iceren","doz":"Exposure: ever use; joint-years","titrasyon":null,"sure":"Not reported (in the abstract)","sonuc":"All cannabis smokers also smoked tobacco. After adjustment for country, age, tobacco and occupational exposure, ever smoking cannabis was associated with an increased risk of lung cancer (OR 2.4; 95% CI 1.6–3.8; 2.3; 1.5–3.6 with adjustment for lifetime pack-years). In tobacco smokers who did not smoke cannabis, OR 10.9 (6.0–19.7); in those who smoked both tobacco and cannabis, 18.2 (8.0–41.0). Risk rose with joint-years, but not with dose or duration. According to the authors, residual confounding by tobacco may explain part of the increase","yan_etki":null,"pmid":"19057263","doi":"10.1097/JTO.0b013e31818ddcde","diger_kaynak":"The Tunisian data were also published separately in Voirin 2006 (PMID 17409920; OR 4.1, Ghasemiesfe 2019 Table 1). Commentary: Mandrekar 2008 (PMID 19057257)"},{"ad":"Coste 2026 (TESTIS)","tasarim":"Nationwide hospital-based case-control study (France)","n":"454 cases, 670 controls","populasyon":"Men with testicular germ cell tumors and controls","urun":"Cannabis use (timing and frequency in adolescence and young adulthood)","urun_turu":"thc_iceren","doz":"Exposure: weekly equivalent score; daily, weekly and persistent use","titrasyon":null,"sure":"Not reported (in the abstract)","sonuc":"Overall, cannabis use was not consistently associated with testicular tumor risk. Daily use in young adulthood was associated with increased risk (OR 1.50; 95% CI 1.02–2.19), especially for seminoma (OR adjusted for tobacco, alcohol and education 1.93; 1.13–3.31); weekly use throughout ages 12–25 had an adjusted OR of 1.85 (1.11–3.07). There was a dose-response relationship in young adulthood (p = 0.046; 0.016 for seminoma). No association with use in adolescence or with the nonseminoma type; this does not match the association with nonseminoma seen in older US studies; the authors wrote that the subtype results need independent confirmation","yan_etki":null,"pmid":"42447513","doi":"10.1016/j.ejca.2026.116939","diger_kaynak":null},{"ad":"Feng 2009","tasarim":"Multicenter case-control study (Algeria, Morocco, Tunisia)","n":"636 patients, 615 controls (cannabis analysis in men)","populasyon":"People with nasopharyngeal cancer and controls","urun":"Cannabis (mostly smoked as 'kif', mixed with tobacco)","urun_turu":"thc_iceren","doz":"Exposure: ever use; more than 30 times a month; more than 2000 times in a lifetime","titrasyon":null,"sure":"2002–2005","sonuc":"In men, ever cannabis use was associated with nasopharyngeal cancer (OR 1.83; 95% CI 1.04–3.22), but significance was lost after adjustment for cigarettes per day (1.54; 0.86–2.76); 2.62 (1.00–6.86) for more than 2000 lifetime uses. A stratified permutation analysis showed an association independent of cigarettes. 97% of cannabis users also smoked cigarettes; the trend toward an increase was in those who smoked cannabis mixed with tobacco (kif) (adjusted for cigarettes 1.94; 0.96–3.92), not in those who smoked it without tobacco (0.97; 0.37–2.52)","yan_etki":null,"pmid":"19724280","doi":"10.1038/sj.bjc.6605281","diger_kaynak":null},{"ad":"Bluhm 2006","tasarim":"Case-control study (US, Children's Oncology Group)","n":"Mothers of 538 children with neuroblastoma and 504 controls","populasyon":"Children diagnosed with neuroblastoma (a childhood cancer of nerve tissue) and age-matched controls","urun":"Maternal use of marijuana and other recreational drugs around pregnancy (self-reported)","urun_turu":"thc_iceren","doz":"Exposure: the month before pregnancy and the periods of pregnancy","titrasyon":null,"sure":"Diagnosed 1992–1994","sonuc":"Use of any illegal drug around pregnancy was associated with an increased risk of neuroblastoma (OR 1.82; 95% CI 1.13–3.00); the clearest was marijuana use in the first trimester (4.75; 1.55–16.48). Use in the month before pregnancy did not increase risk; the association was stronger in children diagnosed before age one. Adjustment was only for age at diagnosis and income; use is based on retrospective recall","yan_etki":null,"pmid":"16633913","doi":"10.1007/s10552-005-0580-3","diger_kaynak":null},{"ad":"Trivers 2006","tasarim":"Matched case-control study (US and Canada, Children's Cancer Group)","n":"517 cases, 610 controls","populasyon":"Children under 18 diagnosed with acute myeloid leukemia (AML)","urun":"Maternal and paternal marijuana use (telephone interview)","urun_turu":"thc_iceren","doz":"Exposure: lifetime; 3 months before and during pregnancy","titrasyon":null,"sure":"Diagnosed 1989–1993","sonuc":"Maternal lifetime marijuana use was not associated with AML in the child (OR 0.89; 95% CI 0.66–1.19); use in the 3 months before or during pregnancy was inversely associated (0.43; 0.23–0.80); paternal use was not associated. The previously reported increase was not confirmed; the authors wrote that the low odds ratios may be due to recall bias (ORs adjusted for misclassification 0.82–1.40)","yan_etki":null,"pmid":"16466429","doi":"10.1111/j.1365-3016.2006.00700.x","diger_kaynak":null},{"ad":"Grufferman 1993","tasarim":"Matched case-control study (US, national)","n":"322 cases, 322 controls","populasyon":"Children and young people aged 0–20 diagnosed with rhabdomyosarcoma (a soft tissue cancer)","urun":"Maternal and paternal marijuana and cocaine use (telephone interview)","urun_turu":"thc_iceren","doz":"Exposure: the year before the child's birth","titrasyon":null,"sure":"Not reported (in the abstract)","sonuc":"Maternal marijuana use in the year before birth was associated with a 3-fold (OR 3.0; 95% CI 1.4–6.5) and paternal use with a 2-fold (2.0; 1.3–3.3) increase in rhabdomyosarcoma risk. Marijuana and cocaine use, and maternal and paternal use, were highly correlated with each other; the effects could not be separated","yan_etki":null,"pmid":"8318638","doi":"10.1007/BF00051316","diger_kaynak":null},{"ad":"Kuijten 1990","tasarim":"Matched case-control study (US; Pennsylvania, New Jersey, Delaware)","n":"163 matched pairs","populasyon":"Children under 15 diagnosed with astrocytoma (a brain tumor)","urun":"Marijuana exposure during pregnancy (reported by the mother)","urun_turu":"thc_iceren","doz":"Exposure: use during pregnancy","titrasyon":null,"sure":"Diagnosed 1980–1986","sonuc":"Marijuana exposure during pregnancy was associated with a borderline, not statistically significant increase in childhood astrocytoma (OR 2.8; p = 0.07). Use of antinausea medicine during pregnancy (OR 2.0) and a family history of cancer were also risk factors; alcohol and tobacco during pregnancy were not","yan_etki":null,"pmid":"2328486","doi":null,"diger_kaynak":null},{"ad":"Robison 1989","tasarim":"Matched case-control study (US, Children's Cancer Study Group)","n":"204 case-control pairs","populasyon":"Children diagnosed with acute nonlymphoblastic leukemia (ANLL)","urun":"Maternal use of mind-altering drugs just before or during pregnancy (marijuana in the title)","urun_turu":"thc_iceren","doz":"Exposure: just before and during pregnancy","titrasyon":null,"sure":"Not reported (in the abstract)","sonuc":"Maternal use of mind-altering drugs just before or during pregnancy was associated with an 11-fold increase in risk of this type of leukemia in the child (p = 0.003); children exposed to marijuana were diagnosed at a younger age and were concentrated in certain subtypes (myelomonocytic, monocytic). Small number of cases; the larger 2006 study (Trivers 2006) did not confirm this association","yan_etki":null,"pmid":"2649219","doi":null,"diger_kaynak":null},{"ad":"EFSA 2026 (European Food Safety Authority statement)","tasarim":"Agency assessment (safety of CBD as a novel food; animal and human literature and application dossiers from the 2022 statement through June 2024)","n":"Literature review; for the dose calculation, 5 good laboratory practice (GLP) 90-day rat studies","populasyon":"General population who would use CBD as a food supplement","urun":"Pure CBD (purity at least 98%)","urun_turu":"saf_cbd","doz":"Not applicable (agency assessment)","titrasyon":null,"sure":"Studies published through June 2024","sonuc":"The panel wrote that the data gaps it identified in 2022 remain. Genetic damage (genotoxicity): although a new study suggests that pure CBD itself does not cause genetic damage, the panel concluded that each product needs to be assessed separately, because the manufacturing process, contaminants and formulation (e.g., nanoparticles) may introduce new hazards. The effects of long-term use on the liver, nervous system, reproduction and immune system are uncertain; because the dose calculation is based on 90-day studies, an additional uncertainty factor (2) was applied for extrapolation to long-term use. The statement does not separately address carcinogenicity or cancer risk. Safety could not be established in people under 25, pregnant and breastfeeding people, and people taking medicines","yan_etki":"Consistent liver effects in animal studies; in human studies, possible liver injury, especially with other medicines; gastrointestinal effects at high doses","pmid":"41668771","doi":"10.2903/j.efsa.2026.9862","diger_kaynak":"EFSA Journal 2026;24(2):e9862; previous statement: EFSA NDA Panel 2022"},{"ad":"Epidiolex US label 2026 (animal studies)","tasarim":"Animal: 2-year carcinogenicity studies (mouse and rat) and genotoxicity (genetic damage) tests; US label of the approved pure CBD medicine, Section 13.1, and European product information, Section 5.3; the manufacturer's studies, only summarized in the label; no peer-reviewed publications were found in this search","n":"Number of animals not stated in the label","populasyon":"Mice and rats (not human data)","urun":"Pure CBD (approved oral solution, Epidiolex)","urun_turu":"saf_cbd","doz":"Mice 30, 100 and 300 mg/kg/day; rats 15, 50 and 150 mg/kg/day, by mouth (animal study dose; not a personal recommendation)","titrasyon":null,"sure":"2 years","sonuc":"According to the US label, in mice, oral CBD for 2 years increased the incidence of benign liver tumors (hepatocellular adenoma) in males at the highest dose (300 mg/kg/day); at the middle dose (100 mg/kg/day), blood exposure was about 1–2 times that at the highest recommended human doses of the medicine. In rats, there was no significant increase in tumor incidence over 2 years (exposure at the highest dose about 10–12.5 times the human dose). The European product information reports the same studies differently: in mice, benign liver tumors increased in males at all doses and in females at the highest dose (exposure at the highest dose about 3 times the human dose); in the 104-week rat study, focal Leydig cell hyperplasia and Leydig cell adenoma increased in males at all doses (exposure at the lowest dose below the human dose), and at the highest dose (exposure about 10 times) a Leydig cell carcinoma was seen in one male rat; the document states that Leydig tumors in rats are generally considered of limited relevance to humans. Neither document explains the reason for the difference. CBD and its two main metabolites were negative in genotoxicity tests (bacterial mutation, rat Comet and bone marrow micronucleus). The label contains no information on cancer risk in humans","yan_etki":null,"pmid":null,"doi":null,"diger_kaynak":"DailyMed setid 8bf27097-4870-43fb-94f0-f3d0871d1eec (version 35, June 15, 2026), Section 13.1 Carcinogenesis and Mutagenesis; European product information: EMA, Epidyolex EPAR product information, Section 5.3 Preclinical safety data (read on October 29, 2026; server date October 8, 2026; revision date in Section 10 is blank)"},{"ad":"NTP 1996 (THC, animal study)","tasarim":"Animal: 2-year carcinogenicity study (US National Toxicology Program, Technical Report 446; oral, by gavage)","n":"60–70 rats and 60–62 mice per dose group per sex","populasyon":"F344/N rats and B6C3F1 mice","urun":"THC (97% pure), in corn oil","urun_turu":"thc_iceren","doz":"Rats 12.5, 25 and 50 mg/kg; mice 125, 250 and 500 mg/kg; 5 days a week (animal study dose; not a personal recommendation)","titrasyon":null,"sure":"2 years (104–106 weeks); plus 13-week studies","sonuc":"No evidence of carcinogenic activity of THC in rats. 'Equivocal' evidence in mice: thyroid follicular adenomas increased at the lowest dose (125 mg/kg), but the increase was not dose-related. Mammary gland, uterine, pituitary, pancreatic, testicular interstitial cell and liver tumors were less common in the THC groups; the report attributed this decrease most likely to the animals' lower body weight. THC did not cause mutations in bacteria and did not increase micronucleus frequency in mice","yan_etki":"Convulsions and seizures after dosing or handling; lower body weight; in the 13-week study, testicular shrinkage and reduced uterine and ovarian development at high doses","pmid":"12594529","doi":null,"diger_kaynak":"Journal publication of the same study: Chan 1996 (PMID 8812248). The US label of dronabinol (synthetic THC) also states that 2-year rat and mouse studies showed no evidence of carcinogenicity (DailyMed setid fd8c5d57-0173-4f62-8ff0-d8147986a976, Section 13.1)"}],"son_inceleme":"2026-10-31","arastirma_gecmisi":[{"tarih":"2026-10-28","not":"Page published. This first review examined 41 studies."},{"tarih":"2026-10-30","not":"The information on the two-year animal studies of the approved pure CBD medicine was completed with the European product information. The previous text relied only on the US label: in mice, an increase in benign liver tumors in males at the highest dose; in rats, no significant increase in tumors. The European product information writes that, in the same studies, these liver tumors increased in male mice at all doses and in female mice at the highest dose, and that in male rats, overgrowth and benign tumors of the Leydig cells in the testis increased, with a malignant tumor seen in one rat at the highest dose; it adds that the relevance of these rat tumors for humans is generally considered limited. These are animal findings; there is still no study examining cancer risk with pure CBD in humans. The conclusion and the strength of evidence did not change."},{"tarih":"2026-10-31","not":"The number of critical texts in the unverifiable items was corrected: one commentary and four letters were published in response to the registry studies, five texts in total (PMID 39115811, 39636626, 39636627, 42172736, 42442866). The conclusion and the evidence level did not change."},{"tarih":"2026-10-31","not":"A note was added that the psychosis rate in the side effects refers to cannabis use in adolescence (Solmi 2023, PMID 37648266, full text). The conclusion and the evidence level did not change."}]},{"id":"appetite-weight-loss","baslik":"Loss of appetite and weight loss not related to cancer (HIV/AIDS, older age, anorexia nervosa)","grup":"Other","grup_kodu":"diger","tr_id":"istahsizlik-kilo-kaybi","kanit_duzeyi":"cok_zayif","kanit_yonu":"veri_yok","kanit_ozet":"Most randomized studies of cannabinoids in loss of appetite and weight loss not related to cancer were done in HIV/AIDS and with THC-containing products. In the largest (Beal 1995; 139 randomized, 88 evaluable, 6 weeks), dronabinol 2.5 mg twice a day increased appetite more than placebo (38% vs 8%; p = 0.015), while the difference in weight was not significant (p = 0.14); the US approval is based on this study. In Struwe 1993 (12 randomized, 5 completed), only body fat percentage increased; in Timpone 1997 (52 patients, open-label), megestrol produced much more weight gain than dronabinol and adding dronabinol did not increase it; in Abrams 2003 (67 patients, 21 days), smoked cannabis and dronabinol did not adversely affect viral load or CD4 count, and weight, a secondary outcome, rose more than with placebo (as reported by reviews). Three laboratory studies of people with HIV who regularly smoked cannabis (Haney 2005 and 2007, Bedi 2010; 7–30 people) showed that cannabis and dronabinol increased calorie intake, and that at the highest dose this effect disappeared after 8 days. The Cochrane review (Lutge 2013; 7 RCTs) found the evidence on efficacy and safety insufficient; the Mücke 2018 meta-analysis found superiority over placebo in HIV for weight (2 RCTs: Abrams 2003 and Beal 1995; SMD 0.57) and appetite (Beal 1995 only; SMD 0.57) but rated the quality of evidence for the HIV outcomes as very low; NASEM 2017 found the evidence limited for HIV/AIDS and insufficient for anorexia nervosa; Bilbao 2022 found a benefit of moderate certainty for appetite with dronabinol (SMD −0.51; high heterogeneity between studies) and no difference in comparisons with active drugs. In the only placebo-controlled study of CBD in people living with HIV (Barré 2024; 80 people, 12 weeks, CBD-rich full-spectrum oil), the main quality-of-life scores did not change and appetite was not measured; in the safety publication, viral load did not change. In older age: in patients over 65 with reduced appetite, a spray containing THC and CBD did not change calorie intake over one day (Nielsen 2025; 17 of 73 completed; +10 kcal, 95% CI −55 to 75); in 15 people with Alzheimer's disease who refused to eat, weight rose more with dronabinol (Volicer 1997); two uncontrolled chart reviews (28 and 40 people) reported improvement. In systemic sclerosis, an oil containing THC and CBD was no different from placebo for appetite, weight and calories over 4 weeks (Pisprasert 2025; 27 patients); in the records of 344 patients with ALS who did or did not use medical marijuana, use was linked with fewer complaints of poor appetite in the short term but not with maintaining weight (Austin 2024). In anorexia nervosa, dronabinol produced a small weight gain over 4 weeks compared with placebo without changing symptoms (Andries 2014; 25 women); THC was no different from diazepam and 3 patients had severe dysphoria (Gross 1983; 11 women); pure CBD was well tolerated in a 3-week pilot study, with a small difference in body mass index (p = 0.046) and no difference in the prespecified behavioral measures (Sahota 2026; 32 women); a 2026 meta-analysis pooling 54 RCTs in mental health conditions found no significant effect on outcomes related to anorexia nervosa (Wilson 2026). CBD's effect on appetite: in the epilepsy studies of the approved CBD medicine, reduced appetite was 16–22% vs 5% (US prescribing information); two reviews showed that reduced appetite was more common with CBD (Spanagel 2021: OR 2.46; Pinto 2022); in 15 healthy volunteers, 193 kcal more was eaten after a single dose of pure CBD (Johnson 2026). October 2026 search (PubMed, Cochrane, ClinicalTrials.gov, Europe PMC): on this topic we found 15 randomized controlled trials with cannabinoids (12 placebo-controlled, 3 with an active drug or comparing two products; 11 with THC-containing products, 2 with pure CBD [one in healthy volunteers], 1 with a CBD-rich oil, 1 comparing pure CBD with THC:CBD), 1 non-randomized controlled laboratory study, 2 retrospective cohorts with a comparison group, 3 observational studies without a comparison group and 10 systematic reviews, meta-analyses or expert reports (1 Cochrane); all are in the table below. Of these, 12 concern HIV/AIDS, 5 older age, 5 anorexia nervosa, 3 other illnesses not related to cancer, 3 CBD's general effect on appetite and 3 more than one area. The results of a dronabinol study in HIV treatment-related nausea, which enrolled 103 people and ended in 2005, were never published; no studies from Turkey were found.","kanit_duzeyi_metin":"Pure CBD: very weak (in patients with loss of appetite, the only pure CBD study is a 3-week pilot study of 32 people with anorexia nervosa; in HIV, a CBD-rich oil was tested for quality of life, not appetite; in the epilepsy studies, CBD lowered appetite)","kanit_duzeyi_thc_icerenler":"zayif","kanit_duzeyi_thc_icerenler_metin":"THC-containing products: weak (in HIV/AIDS, 4 small-to-medium RCTs and 3 small laboratory studies: appetite rose, the effect on weight was small and inconsistent, weaker than megestrol; most done before effective HIV treatment; no difference in one small RCT each in older adults and in systemic sclerosis; in anorexia nervosa, one of two small RCTs found a small weight gain and the other found no difference; insufficient evidence according to Cochrane, limited according to the US National Academies)","kaynak_dosya":null,"saf_cbd_sonuc":"There is only one controlled study of pure CBD in patients with loss of appetite or weight loss: in a 3-week pilot study of 32 people with anorexia nervosa, approved (licensed) pure CBD was well tolerated and there was a small difference in body mass index compared with placebo (p = 0.046), but no difference in the main outcomes measured, anxiety and eating disorder symptoms. In 80 people living with HIV, a CBD-rich full-spectrum oil (THC below 0.3%) did not change the main quality-of-life scores over 12 weeks; appetite and weight were not measured; viral load and immune values were not affected. Pure CBD has not been tested for loss of appetite in older age, HIV-related wasting or other illnesses not related to cancer. In the epilepsy studies of the approved CBD medicine, CBD lowered appetite and increased weight loss (dose-dependent); in 15 healthy volunteers, on the other hand, people ate slightly more after a single dose of pure CBD.","thc_icerenler_sonuc":"In HIV/AIDS, dronabinol (synthetic THC) increased appetite more than placebo in a 6-week study of 139 people (38% vs 8%; p = 0.015), but the difference in weight was not significant (stable weight vs −0.4 kg; p = 0.14); in a comparison of 52 people, megestrol led to much more weight gain (+6.5 kg vs −2.0 kg). Smoked cannabis and high-dose dronabinol increased calories eaten in the laboratory among people with HIV who regularly smoked cannabis; in a 21-day study, weight rose slightly more than with placebo and viral load did not change. Most of these studies were small, short and done before the era of effective HIV treatment. The Cochrane review found the evidence insufficient and the US National Academies found it limited; a meta-analysis based on two small studies found better results than placebo for appetite and weight in HIV but rated the quality of evidence as very low. In 17 patients over 65 with reduced appetite, a spray containing THC and CBD did not change the amount eaten over one day; in 15 people with Alzheimer's disease who refused to eat, weight rose more with dronabinol. In a study of 27 patients with systemic sclerosis, an oil containing THC and CBD was no different from placebo. In anorexia nervosa, dronabinol produced a small weight gain in a study of 25 people but did not change symptoms; an older 11-person study with THC found no difference and three people had severe restlessness; a 2026 meta-analysis pooling mental health studies also found no significant effect in anorexia nervosa.","ruhsat":"Pure CBD is not approved for loss of appetite or weight loss. Dronabinol, a synthetic THC (capsule and oral solution), is approved in the US in adults for AIDS-related loss of appetite with weight loss (the drug's first US approval was in 1985; this use was added in 1992). The starting dose in the prescribing information is 2.5 mg twice a day (1 hour before lunch and dinner); for older adults or if side effects occur, starting with 2.5 mg once a day in the evening or at bedtime is recommended; the maximum is 10 mg twice a day. The approval is based on the 6-week study of 139 people (Beal 1995). Source: US prescribing information (DailyMed: dronabinol capsule, versions February 14, 2023 and May 13, 2026; dronabinol oral solution, version April 21, 2026) §1, §2.1, §14.1. The prescribing information reviewed lists no use for loss of appetite in older age, anorexia nervosa or other illnesses not related to cancer. Turkey: dronabinol, nabilone and any other THC or CBD medicine are not on the Licensed Human Medicinal Products List of TİTCK (Turkish Medicines and Medical Devices Agency) (October 16, 2026); dronabinol and nabilone do not appear on the Foreign Active Substance List (September 28, 2026), where only cannabidiol oral solution and a mouth spray containing THC and CBD are listed among medicines that require a red prescription (Turkey's controlled-drug prescription) and can be imported with TİTCK's written approval.","doz_araligi_ozet":"Dronabinol in HIV/AIDS 2.5 mg twice a day (2.5 mg/day with side effects; label maximum 10 mg twice a day); in HIV laboratory studies 10–30 mg single dose and 5–10 mg four times a day; in Alzheimer's disease 5 mg/day; in anorexia nervosa dronabinol 2.5 mg twice a day, THC 7.5–30 mg/day; smoked cannabis 1.8–3.95% THC; nabiximols (older adults) 2 × 3 sprays in one day (each 8.1 mg THC + 7.5 mg CBD); THC:CBD oil (systemic sclerosis) 2.92 mg THC + 3.24 mg CBD/day; pure CBD in anorexia nervosa 2.5–12.5 mg/kg/day (3 weeks); CBD-rich oil in HIV 2 mg/kg/day; pure CBD in the open HIV study 200–800 mg/day","titrasyon_ozet":"Dronabinol: per the prescribing information, start at 2.5 mg twice a day, or 2.5 mg in the evening for older adults or with side effects; increased slowly if needed. In anorexia nervosa, CBD was increased weekly: 1.25 → 3.75 → 6.25 mg per kilogram twice a day; in systemic sclerosis, THC:CBD oil from 1 drop to 2 drops twice a day after 1 week; in the open HIV study, participants increased the dose themselves as tolerated; with the CBD-rich oil (HIV), the dose was not increased. These are research protocols, not personal recommendations","yan_etkiler":["Dronabinol, AIDS studies: nervous system side effects 33% (mostly in the first 2 weeks); feeling good or high at low doses 8%; dizziness, euphoria, paranoid reaction, sleepiness and abnormal thinking 3–10% (US prescribing information §6.1)","Beal 1995: euphoria, dizziness, abnormal thinking; stopping treatment 8.3% vs 4.5%","Timpone 1997: serious side effects attributed to dronabinol were confusion, anxiety, emotional lability, euphoria and hallucinations","Gross 1983: severe dysphoria in 3 patients during the THC period; they were withdrawn from the study","Nielsen 2025 (spray containing THC and CBD in older adults): all possibly related side effects were mild and temporary; no related serious side effects","Pisprasert 2025 (oil containing THC and CBD): severe hyponatremia and sleepiness in 1 patient (hospitalization); sleepiness and dizziness in 2 patients each","Mboumba Bouassa 2022: sleepiness 50%; life-threatening acute hepatitis in 1 person on 800 mg/day CBD","Barré 2024 (CBD-rich oil): side effects similar to placebo; the most common treatment-related one was throat discomfort","Sahota 2026 (pure CBD): mild abdominal complaint in 1 person","Velayudhan 2021: in people over 50, THC (IRR 1.42) and THC:CBD (IRR 1.58) increased side effects, while pure CBD did not"],"izlem":["When starting dronabinol and when increasing the dose, blood pressure, pulse and fainting are monitored; fall precautions are taken in older adults (dronabinol prescribing information §5.2, §8.5)","Liver enzymes should be monitored in people using high-dose CBD; hidden liver disease should be looked for (Mboumba Bouassa 2022)","In people living with HIV: studies found no harmful change in viral load or CD4 count in the short term (Abrams 2003; Barré 2024 and Couton 2026; Mboumba Bouassa 2022); there are no long-term data","Ongoing trials (October 2026): studies are under way in people living with HIV looking at the effect of THC and CBD on cognitive function (NCT04883255; 138 people, recruiting), gut microbiota and brain inflammation (NCT05514899; 90 people, recruiting) and blood levels of HIV medicines (NCT04800159; 40 people); no ongoing CBD study with appetite or weight as the main outcome was found (although the anorexia nervosa study's registration appears ongoing, its results have been published)"],"dikkat":["The positive results on this page came from prescription medicines containing THC; they cannot be cited as evidence for CBD oils sold in Turkey","People whose appetite is already low: CBD can lower appetite; in the epilepsy studies of the approved CBD medicine, reduced appetite was 16–22% vs 5%, and weight loss of at least 5% was 16% vs 8% (US prescribing information, May 29, 2026); two reviews point the same way (Spanagel 2021, Pinto 2022)","Older adults: THC-containing products can cause dizziness, sleepiness, confusion and a drop in blood pressure on standing up, and can increase the risk of falls; the prescribing information recommends fall precautions in older adults with dementia and starting at a low dose (dronabinol prescribing information §8.5; Velayudhan 2021)","History of mental illness: dronabinol can worsen mania, depression and schizophrenia (prescribing information §5.1); in anorexia nervosa, intense restlessness and feeling unwell (dysphoria) were seen with THC in three patients (Gross 1983)","History of seizures: seizures have been reported with dronabinol (prescribing information §5.3); in the study of people with Alzheimer's disease who refused to eat, one patient had a major seizure (Volicer 1997)","Liver disease or high-dose CBD: in people living with HIV, one person developed life-threatening acute hepatitis on 800 mg of CBD a day; the researchers recommend monitoring liver enzymes (Mboumba Bouassa 2022)","Pregnancy and breastfeeding: dronabinol can harm the baby and is not recommended during pregnancy; mothers living with HIV are advised not to breastfeed (dronabinol prescribing information §8.1, §8.2)","Smoked cannabis: the smoke is thought to harm the lungs; safety data in people living with HIV are limited (Charron 2019)","Anyone taking long-term medicines should consult a doctor before starting; the studies on this page did not systematically assess drug interactions"],"ilac_etkilesim_notlari":["The studies on this page did not systematically assess drug interactions; details are in the site's Drug interactions section","Dronabinol is broken down in the body by the enzymes CYP2C9 and CYP3A4: ritonavir, ketoconazole, itraconazole, clarithromycin, erythromycin and grapefruit juice (CYP3A4), as well as amiodarone and fluconazole (CYP2C9), can raise dronabinol levels and its side effects (US prescribing information §7.3)","Sleep-inducing medicines, alcohol, benzodiazepines and opioids: sleepiness and dizziness increase when combined with dronabinol (prescribing information §5.1, §7.1)","Highly protein-bound drugs with a narrow therapeutic range (warfarin, cyclosporine, amphotericin B): side effects should be monitored when starting dronabinol; this interaction has not been confirmed in the body (prescribing information §7.4)","HIV protease inhibitors: smoked cannabis lowered the peak blood level of indinavir by 14% over 14 days, with no significant change for nelfinavir; the researchers judged this to have no clinical importance in the short term (Kosel 2002, Abrams 2003 trial)","CBD and HIV medicines: no systematic data; in a case of hepatitis seen with high-dose CBD, the researchers also counted a possible interaction with HIV medicines among the factors (Mboumba Bouassa 2022)","In people whose CYP2C9 enzyme works poorly, blood levels of dronabinol may rise (prescribing information §8.6)"],"dogrulanamayan":["Studies whose full text could not be read: Beal 1995 and 1997, Struwe 1993, Timpone 1997, Abrams 2003 (the publisher's page required bot verification) and its secondary publications, Haney 2005 and 2007, Andries 2014 and its secondary publications, Nielsen 2025 (the full text of its secondary analysis was read), Volicer 1997, Gross 1983 (no abstract on PubMed either; details from reviews), Johnson 2026, Couton 2026, DeJesus 2007, Wilson 2007, Woodward 2014, Costiniuk 2008, Lutge 2013 (Cochrane), Charron 2019, Rosager 2021, Spanagel 2021, Wilson 2026 and Austin 2024. The numbers in these rows were taken from abstracts, registry records, the US prescribing information and as reported by reviews. The weight result of Abrams 2003 comes only from reviews (the Cochrane review as reported in the US National Academies report, and the Mücke 2018 full text).","A study with unpublished results: a 103-person phase 2 study comparing dronabinol with placebo in nausea and vomiting caused by HIV treatment (NCT00642499; sponsored by the drug's license holder at the time, completed in April 2005); the registry lists no results and no publication.","In the systemic sclerosis study (Pisprasert 2025), the concentration of the cannabis oil is written in two different ways in the paper (2.7 mg THC + 2.5 mg CBD per mL and 27 mg THC + 30 mg CBD per mL); the table uses the paper's per-drop doses. In the registry the product is called CBD oil, but it also contains THC.","The registration of the anorexia nervosa CBD study (NCT04878627) still appears ongoing and targets 40 people; the publication gives an analysis of 32 people and states that data collection ended in December 2024. It is not known whether results for the remaining people will be published separately.","Turkey: the statement that dronabinol and nabilone are not licensed in Turkey is based on their absence from the TİTCK (Turkish Medicines and Medical Devices Agency) lists (Licensed Human Medicinal Products List October 16, 2026; Foreign Active Substance List September 28, 2026); whether they could be imported by some other route was not investigated in this search."],"calismalar":[{"ad":"Beal 1995","tasarim":"Multicenter, double-blind, placebo-controlled, parallel-group RCT (USA)","n":"139 randomized; efficacy could be evaluated in 88 people","populasyon":"Patients with AIDS-related loss of appetite and weight loss of at least 2.3 kg (the era before effective HIV treatment became widespread)","urun":"Dronabinol (synthetic THC, capsule); placebo","urun_turu":"thc_iceren","doz":"2.5 mg twice a day (1 hour before lunch and dinner); 2.5 mg once a day for those with side effects (13 of 72 people, according to the US prescribing information)","titrasyon":"None; dose lowered with side effects","sure":"6 weeks","sonuc":"Appetite (100 mm visual scale) rose 38% from baseline with dronabinol and 8% with placebo (p = 0.015); mood improvement 10% vs −2% (p = 0.06), reduction in nausea 20% vs 7% (p = 0.05). Weight stayed stable with dronabinol and fell by an average of 0.4 kg with placebo (difference not significant, p = 0.14); those gaining at least 2 kg were 22% vs 10.5% (p = 0.11). According to the Cochrane review, RR 2.09 for gaining at least 2 kg (95% CI 0.72–6.06); randomization was done by center, and methodological quality could not be assessed. Dronabinol's US approval for loss of appetite in AIDS is based on this study (prescribing information §14.1). In the 12-month open-label extension (94 patients, no placebo), the increase in appetite continued and weight stayed stable for at least 7 months","yan_etki":"Mostly mild to moderate: euphoria (an excessively high mood), dizziness, abnormal thinking; stopping treatment 8.3% vs 4.5%","pmid":"7730690","doi":"10.1016/0885-3924(94)00117-4","diger_kaynak":"12-month open-label extension: Beal 1997 (PMID 9223837). Funding not stated in the abstract (PubMed: non-US government support); the authors' ties to the manufacturer are not in the sources read"},{"ad":"Barré 2024","tasarim":"Double-blind, placebo-controlled, parallel-group RCT (France; the trial's primary aim was genes for intracellular cleanup [autophagy])","n":"80 randomized; 79 analyzed (39 CBD, 40 placebo)","populasyon":"Adults living with HIV whose virus had been suppressed for a long time (median 12 years; median age 54.6 in the table, 56.4 in the text; 30% women); not selected for loss of appetite or weight loss","urun":"Full-spectrum CBD oil (50 mg CBD per mL; Little Green Pharma, CBD 50 LGP Classic; THC below 0.3%, amount not stated); placebo medium-chain oil","urun_turu":"cbd_zengin_thc_belirsiz","doz":"1 mg per kilogram of body weight twice a day (2 mg/kg/day)","titrasyon":"None (the dose was not increased slowly; the authors note this as a limitation)","sure":"12 weeks + 4 weeks follow-up","sonuc":"No difference in the primary outcomes (physical and mental summary scores of the SF-36 quality-of-life scale); among the subscales, only physical function was higher with CBD at week 12 (+7.72; 95% CI 0.55–14.89; p = 0.035). Appetite and weight were not measured. In the safety publication of the same trial (Couton 2026), viral load, intracellular HIV DNA and the CD4/CD8 ratio did not change; no clinically meaningful difference in creatinine and liver enzymes; total bilirubin decreased with CBD (p = 0.046); in men, heart rate was about 8 beats/min lower (exploratory analysis)","yan_etki":"Number of side effects similar in the two groups (56 vs 53; treatment-related 7 vs 8); most common treatment-related: throat discomfort, tiredness, worse sleep quality, nausea","pmid":"39296339","doi":"10.1093/ofid/ofae492","diger_kaynak":"ClinicalTrials.gov NCT05306249 (primary outcome autophagy gene expression; to be published separately). Safety publication: Couton 2026 (PMID 41934259). The manufacturer supplied the product and placebo free of charge; one author is an employee of the manufacturing company"},{"ad":"Abrams 2003","tasarim":"Randomized, placebo-controlled, three-arm study (USA; 21 days as hospital inpatients)","n":"67 randomized; 62 in the primary analysis (20 cannabis, 22 dronabinol, 20 placebo)","populasyon":"Adults on protease inhibitor-based HIV treatment (viral load <50 copies/mL in 58%; median CD4 340); not selected for loss of appetite","urun":"Smoked cannabis cigarette (3.95% THC), dronabinol capsule 2.5 mg or placebo capsule","urun_turu":"thc_iceren","doz":"Three times a day, before meals","titrasyon":"None","sure":"21 days","sonuc":"The primary outcome was safety: at day 21, the change in viral load compared with placebo was −0.07 log10 with cannabis (95% CI −0.30 to 0.13) and −0.04 with dronabinol (−0.20 to 0.14); CD4 and CD8 counts were not adversely affected; a small drop in protease inhibitor levels with no clinical importance (Kosel 2002). Weight was a secondary outcome: according to the Cochrane review as reported in the US National Academies report, median weight gain was 3.0 kg with cannabis (p = 0.021), 3.2 kg with dronabinol (p = 0.004) and 1.1 kg with placebo","yan_etki":"Not reported (in the abstract); full text could not be read","pmid":"12965981","doi":"10.7326/0003-4819-139-4-200308190-00008","diger_kaynak":"Secondary publications of the same trial: Kosel 2002 (protease inhibitor levels; PMID 11872997), Bredt 2002 (immune cells; PMID 12412840). Supported by the US National Institutes of Health (NIDA, NIMH, NCRR)"},{"ad":"Timpone 1997 (DATRI 004)","tasarim":"Randomized, open-label, multicenter, four-arm study (phase I/II; no placebo, compared with megestrol)","n":"52 randomized; 47 attended at least one follow-up visit; 39 completed 12 weeks","populasyon":"Patients with HIV-related wasting syndrome (mean CD4 59; the era before effective HIV treatment became widespread)","urun":"Dronabinol tablet and the appetite-boosting hormone medicine megestrol acetate, alone or together","urun_turu":"thc_iceren","doz":"Dronabinol 2.5 mg twice a day; megestrol 750 mg/day; megestrol 750 mg/day + dronabinol; megestrol 250 mg/day + dronabinol","titrasyon":"None","sure":"12 weeks","sonuc":"Mean weight change at 12 weeks: dronabinol alone −2.0 kg, megestrol 750 mg +6.5 kg, megestrol 750 mg + dronabinol +6.0 kg, megestrol 250 mg + dronabinol −0.3 kg (p = 0.0001 between groups); adding dronabinol did not increase megestrol's effect on weight. No significant difference between groups in side effects, stopping treatment, new AIDS-defining illness or CD4 change. Weight and hunger were linked to the blood level of megestrol, not of dronabinol","yan_etki":"Serious side effects attributed to dronabinol involved the nervous system: confusion, anxiety, emotional lability, euphoria, hallucinations; with megestrol, shortness of breath, changes in liver enzymes and raised blood sugar","pmid":"9071430","doi":"10.1089/aid.1997.13.305","diger_kaynak":"ClinicalTrials.gov NCT00000737 (56 people registered; sponsor US National Institute of Allergy and Infectious Diseases; collaborators Roxane Laboratories and Bristol-Myers Squibb)"},{"ad":"Sahota 2026","tasarim":"Double-blind, placebo-controlled, parallel-group pilot RCT (USA; main aims were safety, tolerability and blood drug levels)","n":"32 analyzed (16 CBD, 16 placebo); in addition, 1 person from each group was withdrawn at visit 2 because of a rash and not included in the analysis (the total number randomized is not clear in the text)","populasyon":"Women aged 18–40 diagnosed with restrictive-type anorexia nervosa or atypical anorexia nervosa (mean age 22.7; some were in an intensive outpatient program)","urun":"Approved (licensed) pure CBD medicine (Epidiolex; 100 mg CBD per mL); the manufacturer supplied the drug and placebo","urun_turu":"saf_cbd","doz":"Per kilogram of body weight, twice a day: week 1 1.25 mg, week 2 3.75 mg, week 3 6.25 mg, with food (up to 12.5 mg/kg/day; total daily 515–861 mg in the last week)","titrasyon":"Weekly increase (schedule above)","sure":"21 days","sonuc":"Safety and tolerability were good. No significant difference between groups on the prespecified behavioral measures (anxiety, depression, eating disorder symptoms, desire to eat, meal consumption); both groups improved in the first week (the authors note an expectancy effect). The group × time interaction for body mass index was small but significant in favor of CBD (p = 0.046); this measure was not the study's main aim. Effect sizes for body shape concern and feeling a loss of control over eating were large in favor of CBD but not significant. The authors write that a larger study is needed because of the small sample and short duration","yan_etki":"Limited and not serious: mild abdominal complaint in 1 person in the CBD group; a resolving rash of unclear cause in 1 person in each group (withdrawn from the study as a precaution)","pmid":"41906184","doi":"10.1002/eat.70034","diger_kaynak":"ClinicalTrials.gov NCT04878627 (registry status still 'active, not recruiting', target 40 people, planned completion June 2026; according to the publication, data collection ended on December 31, 2024). Funded by the University of California San Diego Center for Medicinal Cannabis Research; the authors reported no conflicts of interest"},{"ad":"Nielsen 2025","tasarim":"Triple-blind, placebo-controlled, crossover RCT (Denmark; investigator-initiated)","n":"73 people enrolled; 17 completed both study days (17 analyzed)","populasyon":"Patients over 65 with reduced appetite admitted from the emergency department for a medical reason (study days after discharge; median age 78, 76.5% women)","urun":"Nabiximols (Sativex; a mouth spray containing THC and CBD, 2.7 mg THC + 2.5 mg CBD per spray); placebo spray","urun_turu":"thc_iceren","doz":"2 doses on the study day, each 3 sprays (8.1 mg THC + 7.5 mg CBD per dose): the first 25 min before breakfast, the second 25 min before an ad libitum lunch","titrasyon":"None (fixed single-day dose)","sure":"Two separate study days (14 days apart)","sonuc":"Primary outcome (calories taken in at meals): no significant difference between spray and placebo (+10 kcal; 95% CI −55 to 75). In a secondary analysis of the same trial (Bornæs 2026), appetite-related hormones (GLP-1, ghrelin) and self-reported appetite were also no different from placebo (composite appetite score −5.2 mm; 95% CI −24.4 to 4.0). Blood THC levels varied widely from person to person (Storgaard 2026). Because only 17 of 73 people completed, the result cannot be generalized to the wider older population","yan_etki":"16 possibly related side effects (5 on the placebo day, 1 before the drug); all mild and temporary; no related serious side effects","pmid":"40069983","doi":"10.1016/j.clnu.2025.02.024","diger_kaynak":"ClinicalTrials.gov NCT05503147; EudraCT 2021-002318-15. Protocol: Nielsen 2023 (PMID 37314893); hormone and appetite secondary analysis: Bornæs 2026 (PMID 42514343); blood drug levels: Storgaard 2026 (PMID 40974011). Danish public and foundation funding; the authors reported no conflicts of interest"},{"ad":"Pisprasert 2025","tasarim":"Placebo-controlled, parallel-group RCT (Thailand; triple-blind according to the registry)","n":"27 randomized (14 oil, 13 placebo); 26 analyzed","populasyon":"Patients with systemic sclerosis (scleroderma) and loss of appetite or malnutrition, aged 18–70 (mean 55.9; most with diffuse skin involvement)","urun":"Cannabis oil made by the university, with roughly equal THC and CBD (0.73 mg THC + 0.81 mg CBD per drop), under the tongue; placebo drops","urun_turu":"thc_iceren","doz":"Week 1: 1 drop twice a day, then 2 drops twice a day (2.92 mg THC + 3.24 mg CBD a day)","titrasyon":"Dose doubled after 1 week if tolerated","sure":"4 weeks (+2 weeks follow-up)","sonuc":"At week 4, no significant difference between groups in appetite measures (hunger, enjoyment of food, ability to eat a lot), weight (+0.15 vs −0.3 kg; p = 0.36), daily calorie and protein intake, inflammation markers or quality of life. Only in within-group comparison did the hunger score rise in the oil group (p < 0.001) and not with placebo; calorie intake also rose from baseline in the oil group (p = 0.046). At baseline, calorie intake was higher in the oil group (the authors note the imbalance as a limitation). The paper gives the product concentration in two different ways (2.7 mg THC + 2.5 mg CBD per mL and 27 mg THC + 30 mg CBD per mL); the per-drop doses fit the latter","yan_etki":"Side effects in 10 patients in the oil group and 7 with placebo (difference not significant); in 1 patient, thirst, drinking a lot of water, severely low sodium (hyponatremia) and sleepiness after the first drop, leading to hospitalization and withdrawal from the study; sleepiness in 2 patients, dizziness in 2 patients","pmid":"41137182","doi":"10.1186/s42238-025-00342-3","diger_kaynak":"ClinicalTrials.gov NCT05416697 (the intervention is listed as 'CBD oil' in the registry; the product also contains THC). Sleep publication of the same trial: So-Ngern 2025 (PMID 40430155; difference in sleep quality not significant, p = 0.09). Khon Kaen University funded the study and made the product"},{"ad":"Andries 2014","tasarim":"Double-blind, placebo-controlled, crossover RCT (Denmark; added to standard treatment)","n":"25 randomized; 24 completed","populasyon":"Adult women with anorexia nervosa for at least 5 years (under treatment at a specialist eating disorder center)","urun":"Dronabinol (synthetic THC); placebo","urun_turu":"thc_iceren","doz":"2.5 mg twice a day","titrasyon":"None","sure":"4 weeks of dronabinol + 4 weeks of placebo (with a 4-week washout in between)","sonuc":"Primary outcome (body weight): a small but significant increase during the dronabinol period compared with placebo (0.73 kg; p < 0.01). No change on the scale measuring eating disorder symptoms (EDI-2). In secondary publications of the same trial, the intensity of physical activity rose by 20% during the dronabinol period (daily energy expenditure higher than with placebo) and the stress hormone cortisol in urine decreased; the growth factor IGF-I did not change","yan_etki":"No serious psychiatric side effects were seen (abstract)","pmid":"24105610","doi":"10.1002/eat.22173","diger_kaynak":"ClinicalTrials.gov NCT00760695 (24 people). Secondary publications: Andries 2015, physical activity (PMID 24890912); Andries 2015, hormones (PMID 26248813)"},{"ad":"Haney 2005","tasarim":"Double-blind, double-dummy, placebo-controlled, within-subject laboratory study (drug order randomized; USA)","n":"30 (15 with marked loss of muscle mass, 15 without)","populasyon":"Adults living with HIV who regularly smoke cannabis","urun":"Dronabinol capsule (0, 10, 20, 30 mg) and smoked cannabis (0%, 1.8%, 2.8%, 3.9% THC)","urun_turu":"thc_iceren","doz":"Single dose per session (doses above)","titrasyon":"None","sure":"Eight separate 7-hour sessions (single dose per session)","sonuc":"Cannabis and dronabinol clearly increased calories eaten compared with placebo in the group with muscle mass loss, but not in those with normal muscle mass. Cannabis (all doses) and the low dronabinol doses (10 and 20 mg) were well tolerated; effects on cognitive performance were small. According to the authors, these doses were at least 4–8 times the recommended starting dose","yan_etki":"30 mg dronabinol was poorly tolerated by some participants","pmid":"15778874","doi":"10.1007/s00213-005-2242-2","diger_kaynak":"ClinicalTrials.gov NCT00079560 (30 people; primary outcome daily calorie intake; sponsor US National Institute on Drug Abuse)"},{"ad":"Volicer 1997","tasarim":"Placebo-controlled crossover study (2 × 6 weeks; a controlled clinical trial in PubMed; randomized and double-blind according to reviews)","n":"15 (11 completed; 1 patient who died was included in the analysis)","populasyon":"Patients with probable Alzheimer's disease who refused to eat (hospital dementia unit, USA)","urun":"Dronabinol (synthetic THC)","urun_turu":"thc_iceren","doz":"2.5 mg in the morning and at noon (5 mg a day; per the study table of Cochrane 2021; one review says 2.5 mg a day)","titrasyon":"None (fixed dose)","sure":"12 weeks","sonuc":"Body weight rose more during the dronabinol period than during the placebo period (number not in the abstract); the severity of disturbed behavior also decreased, and in those who took dronabinol first, this effect continued into the placebo period. The only controlled study of food refusal in older adults; full text could not be read","yan_etki":"Euphoria (an excessively high mood), sleepiness and tiredness more common during the dronabinol period, treatment not stopped; the study was stopped in 1 patient because of a major seizure and in 2 patients because of severe infection; 1 patient died of a heart attack","pmid":"9309469","doi":null,"diger_kaynak":"The only study included in the Krishnan 2009 Cochrane review (data could not be analyzed); also in the Bosnjak Kuharic 2021 Cochrane review. According to Cochrane 2021, supported by the US Department of Veterans Affairs and the dronabinol manufacturers (Roxane Laboratories, UNIMED)"},{"ad":"Struwe 1993","tasarim":"Double-blind, placebo-controlled, crossover RCT (USA)","n":"12 randomized; 5 completed","populasyon":"Patients with symptomatic HIV infection and weight loss of at least 2.25 kg","urun":"Dronabinol; placebo","urun_turu":"thc_iceren","doz":"5 mg twice a day, before meals","titrasyon":"None","sure":"2 × 5 weeks (with a 2-week washout in between)","sonuc":"During the dronabinol period, body fat percentage rose by 1% (p = 0.04) and symptom distress decreased (p = 0.04); weight (+0.5 kg; p = 0.13), appetite score (p = 0.14) and prealbumin (p = 0.11) showed only a trend. 7 people dropped out: 2 could not tolerate the drug, 2 had disease progression, 2 were nonadherent and 1 switched to an experimental HIV treatment","yan_etki":"2 people stopped because they could not tolerate the drug; side effect details not in the abstract","pmid":"8395916","doi":"10.1177/106002809302700701","diger_kaynak":"Supported by the US National Institutes of Health (NCRR)"},{"ad":"Gross 1983","tasarim":"Double-blind, crossover randomized study (USA; compared with an active drug, no placebo)","n":"11 women","populasyon":"Women with anorexia nervosa (mean age 23.6)","urun":"THC (delta-9-tetrahydrocannabinol) capsule; comparison: the sedative drug diazepam","urun_turu":"thc_iceren","doz":"THC from 2.5 mg three times a day up to a maximum of 10 mg (7.5–30 mg/day); diazepam from 1 mg three times a day up to a maximum of 5 mg","titrasyon":"Doses were increased gradually","sure":"Period lengths are not in the sources read (no abstract in the PubMed record)","sonuc":"The primary outcome (weight) was similar in the THC and diazepam periods (the paper has no abstract; as reported by reviews: Lim 2017, Rosager 2021). In a meta-analysis (Bilbao 2022), the effect size was SMD −0.06 (95% CI −0.65 to 0.53). In one review, risk of bias was rated high with the Cochrane tool (Lim 2017)","yan_etki":"During the THC period, 3 patients were withdrawn from the study because of severe dysphoria (intense restlessness and feeling unwell)","pmid":"6308069","doi":null,"diger_kaynak":"No abstract in the PubMed record; details from reviews (Lim 2017, Rosager 2021, Bilbao 2022)"},{"ad":"Mboumba Bouassa 2022 (CTN PT028)","tasarim":"Randomized, open-label pilot study (Canada; two products compared, no placebo)","n":"10 randomized (5 THC:CBD, 5 CBD); 8 completed (the target was 26 people; closed early when the capsule supply ran out and participants could not be found)","populasyon":"Adults on effective HIV treatment with a suppressed virus (median age 57.5; 80% men); not selected for loss of appetite","urun":"Oral capsule (>98% purified cannabinoid in oil): THC:CBD 1:1 (2.5 mg + 2.5 mg per capsule) or CBD alone (200 mg per capsule)","urun_turu":"karma","doz":"THC:CBD up to 15 mg + 15 mg/day; CBD up to 800 mg/day (lowered in the protocol to a maximum of 400 mg/day after two liver events)","titrasyon":"Participants increased the dose themselves as tolerated","sure":"12 weeks","sonuc":"Primary outcome (no significant toxicity on the WHO toxicity scale): 7 of 10 people. CD4 count, CD4/CD8 ratio and viral load did not change; no significant change on quality-of-life scales. Appetite was not measured; in the THC:CBD group, increased appetite was recorded as a side effect in 1 person","yan_etki":"Most common was sleepiness (50%). 2 people in the CBD group were withdrawn for safety reasons at week 6: in one, pre-existing anemia worsened (with a temporary rise in liver enzymes); in the other, life-threatening acute hepatitis developed on 800 mg/day CBD (pancreatic cancer was diagnosed at the time; diabetes, fatty liver, heavy alcohol use and a possible interaction with HIV medicines were also counted among the factors)","pmid":"36551926","doi":"10.3390/biomedicines10123168","diger_kaynak":"ClinicalTrials.gov NCT03550352 (terminated early). Protocol: Costiniuk 2019 (PMID 30659041); secondary publications: inflammation markers (PMID 37508476), feasibility (PMID 39063999), gut microbiota (PMID 40879543). The manufacturer (Tilray) supplied the capsules free of charge; one author reports receiving research support from this company"},{"ad":"Haney 2007","tasarim":"Double-blind, placebo-controlled, within-subject laboratory study (two 16-day inpatient stays; USA)","n":"10","populasyon":"Adults living with HIV who regularly smoke cannabis","urun":"Dronabinol (5 and 10 mg) and smoked cannabis (2.0% and 3.9% THC); placebo","urun_turu":"thc_iceren","doz":"Each dose four times a day for 4 days (only one active on any given day)","titrasyon":"None","sure":"2 × 16 days as inpatients (each active condition 4 days)","sonuc":"Compared with placebo, cannabis and dronabinol increased daily calorie intake and body weight in a dose-dependent way; the effects of the two products were similar; only the 3.9% THC cannabis improved sleep scores. All active conditions except low-dose dronabinol produced a marked high (participants rated this positively); cognitive performance was not impaired","yan_etki":"Feeling high except with low-dose dronabinol; few signs of discomfort","pmid":"17589370","doi":"10.1097/QAI.0b013e31811ed205","diger_kaynak":"Supported by the US National Institute on Drug Abuse"},{"ad":"Johnson 2026","tasarim":"Double-blind, placebo-controlled, crossover RCT (United Kingdom)","n":"15 (4 women)","populasyon":"Healthy adults (volunteers without loss of appetite)","urun":"CBD isolate (pure CBD); placebo","urun_turu":"saf_cbd","doz":"298 mg single dose","titrasyon":"None","sure":"Single dose (two separate days)","sonuc":"At an ad libitum lunch served 3 hours after CBD, 193 kcal more was eaten (95% CI 80–306; p = 0.003); no difference in self-reported appetite measures such as hunger; the hunger hormone ghrelin was lower with CBD; no difference in post-meal sugar and fat metabolism. Not tested in patients","yan_etki":"Not reported (in the abstract)","pmid":"41825697","doi":"10.1016/j.appet.2026.108531","diger_kaynak":"ClinicalTrials.gov NCT05618756 (15 people; no registration number in the abstract; institution, dose and design match the registry). In the conflict-of-interest statement, 4 of the 10 authors report ties to food, beverage and supplement companies; one (L. James) states receiving financial support from Bridge Farm Nurseries Ltd"},{"ad":"Bedi 2010","tasarim":"Double-blind, placebo-controlled, within-subject laboratory study (two 16-day inpatient stays; order counterbalanced, randomization not stated; USA)","n":"7 men","populasyon":"Men taking HIV medicines who smoked cannabis on average 4 days a week (not selected for weight loss)","urun":"Dronabinol (from the manufacturer Unimed); placebo","urun_turu":"thc_iceren","doz":"5 mg four times a day for the first 2 days, then 10 mg four times a day for 14 days (40 mg/day; 8 times the recommended starting dose)","titrasyon":"Dose doubled after 2 days","sure":"2 × 16 days as inpatients","sonuc":"Dronabinol increased daily calorie intake in the first 8 days (mean 3,580 vs 3,228 kcal) but not on days 9–16; weight rose 1.0 kg in the first 8 days but this was not significant. The increase in desire to eat and the improvement in mood lasted 16 days. The authors think tolerance to the appetite effect developed at the high dose; according to the US prescribing information, however, tolerance to the appetite effect does not develop at recommended doses, and the effect lasted up to 5 months in patients with AIDS","yan_etki":"Well tolerated; few negative subjective or cognitive effects; dry mouth and thirst more common","pmid":"20824270","doi":"10.1007/s00213-010-1995-4","diger_kaynak":"Supported by the US National Institute on Drug Abuse; the authors reported no conflicts of interest"},{"ad":"Lutge 2013 (Cochrane)","tasarim":"Cochrane systematic review (no meta-analysis performed; search up to July 2012)","n":"7 RCTs (8 publications)","populasyon":"Adults living with HIV/AIDS","urun":"Dronabinol and smoked cannabis","urun_turu":"thc_iceren","doz":null,"titrasyon":null,"sure":"Studies 21–84 days","sonuc":"Evidence on effects on illness and death is limited; studies were short, small and focused on short-term outcomes; randomization and allocation concealment were adequate in only four publications (three studies); THC's quickly noticeable effects made blinding difficult. In the single large study (Beal 1995; 88 evaluable), the chance of gaining at least 2 kg was twice as high with dronabinol (RR 2.09; 95% CI 0.72–6.06; not significant), mean +0.1 kg vs −0.4 kg. Authors: there is no evidence for the efficacy and safety of cannabis and cannabinoids in this area; there are no long-term data in people on effective HIV treatment","yan_etki":null,"pmid":"23633327","doi":"10.1002/14651858.CD005175.pub3","diger_kaynak":"Update of an earlier version (CD005175.pub2). Full text could not be read; abstract was read"},{"ad":"NASEM 2017 (US National Academies report)","tasarim":"Expert committee report (assessment based on good- and fair-quality systematic reviews and later primary studies)","n":"For HIV, 2 systematic reviews (Whiting 2015: 4 RCTs, 255 patients; Lutge 2013: 7 RCTs); for anorexia nervosa, no suitable review, 1 RCT (Andries 2014)","populasyon":"HIV/AIDS-related wasting, loss of appetite and cachexia in cancer, and anorexia nervosa","urun":"Cannabis and oral cannabinoids","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"Conclusion 4-4(a): there is limited evidence that cannabis and oral cannabinoids are effective in increasing appetite and decreasing weight loss in HIV/AIDS. Conclusion 4-4(b): there is insufficient evidence to say whether they are effective for loss of appetite and cachexia in cancer and for anorexia nervosa. All four HIV studies in Whiting 2015 had a high risk of bias. According to the committee, AIDS-related wasting nearly disappeared once effective HIV treatment became widespread in the mid-1990s; this is why the committee found no good-quality new studies published after that","yan_etki":null,"pmid":"28182367","doi":"10.17226/24625","diger_kaynak":"National Academies Press, Chapter 4 (nationalacademies.org/read/24625/chapter/6; read on October 28, 2026). Also a row in the Irritable Bowel and Stomach Problems and Glaucoma topics (results for those topics there)"},{"ad":"Bilbao 2022","tasarim":"Systematic review and meta-analysis split by pharmacology (GRADE; search up to October 2021)","n":"152 RCTs, 12,123 participants (10 RCTs, 599 people in the dronabinol–placebo comparison for appetite)","populasyon":"All medical indications (appetite: studies of nausea, vomiting or loss of appetite; also anorexia nervosa)","urun":"Dronabinol, nabilone, CBD and nabiximols (smoked cannabis excluded)","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"Appetite: dronabinol increased appetite scores compared with placebo (SMD −0.51; 95% CI −0.87 to −0.15; moderate certainty; high heterogeneity between studies, I² 81%); there was no difference compared with active drugs (3 RCTs, 795 people; SMD −0.02; low certainty); no significant effect with nabilone, CBD (single study; SMD 0.10; p = 0.80) or nabiximols. In anorexia nervosa, dronabinol vs placebo SMD −0.47 (−0.89 to −0.05; single study), THC vs diazepam SMD −0.06 (−0.65 to 0.53; single study). Which disease groups the appetite studies came from is not given separately in the main text (supplementary tables were not read)","yan_etki":null,"pmid":"35982439","doi":"10.1186/s12916-022-02459-1","diger_kaynak":"Also a row in the Tourette Syndrome, Irritable Bowel and Stomach Problems, Parkinson's Disease and Glaucoma topics"},{"ad":"Mücke 2018","tasarim":"Systematic review and meta-analysis (palliative medicine; search up to March 15, 2017)","n":"9 RCTs, 1,561 participants (3 studies in HIV, 258 people)","populasyon":"Palliative care: patients with cancer, HIV/AIDS and Alzheimer's disease","urun":"Cannabinoids (dronabinol, smoked cannabis, THC extracts)","urun_turu":"karma","doz":null,"titrasyon":null,"sure":"HIV studies median 6 weeks (3–12)","sonuc":"In HIV, compared with placebo, cannabinoids were superior for weight gain (2 RCTs: Abrams 2003 and Beal 1995, 192 people; SMD 0.57; 95% CI 0.22–0.92; p = 0.001) and appetite (Beal 1995 only; SMD 0.57; 0.11–1.03; p = 0.02), and no different for nausea and vomiting; Timpone 1997 was not in the placebo analysis but in the megestrol comparison; psychiatric side effects were more common (risk difference 0.05; 0.00–0.11). Megestrol produced more weight gain than dronabinol. Quality of evidence for the HIV outcomes was very low (low or very low across the review as a whole); according to the authors, there is no convincing, unbiased, high-quality evidence that cannabinoids are of value for loss of appetite and cachexia in cancer or HIV","yan_etki":"Psychiatric side effects increased in HIV; no difference in stopping because of side effects","pmid":"29400010","doi":"10.1002/jcsm.12273","diger_kaynak":"First German version: Mücke 2016 (PMID 26809975). Also a row in the cancer-related topics (cancer results there)"},{"ad":"Rosager 2021 (systematic review)","tasarim":"Systematic review (PROSPERO-registered; PRISMA)","n":"4 publications: 2 original RCTs (Gross 1983, Andries 2014) and 2 secondary publications of the same RCT","populasyon":"Anorexia nervosa","urun":"THC and dronabinol","urun_turu":"thc_iceren","doz":null,"titrasyon":null,"sure":null,"sonuc":"Few studies and a low level of evidence. The only well-designed study (Andries 2014) found a small weight gain with dronabinol compared with placebo over 4 weeks; the other study, which used high-dose THC (Gross 1983), found no effect, and according to the authors the side effects may have masked the effect. More research is needed on the effect on eating disorder symptoms","yan_etki":null,"pmid":"32240516","doi":"10.1007/s40519-020-00891-x","diger_kaynak":null},{"ad":"Wilson 2026","tasarim":"Systematic review and meta-analysis of RCTs (mental disorders and substance use disorders; 1980–May 13, 2025; PROSPERO CRD42023392718; GRADE)","n":"54 RCTs; 2,477 participants (all mental disorders; the number of studies and people in the anorexia nervosa analysis is not in the abstract)","populasyon":"People with a mental disorder or substance use disorder (including anorexia nervosa)","urun":"Cannabinoids (THC, CBD and products containing both)","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"No significant difference was found between cannabinoids and placebo on outcomes related to anorexia nervosa (which studies and measures were pooled is not in the abstract; Sahota 2026 is not included because the search ended in May 2025). Significant benefit was seen only in cannabis use disorder, insomnia, tics and Tourette syndrome, and autism; certainty of evidence was low for most outcomes, and 44% of studies had a high risk of bias. The correction published in the journal (June 16, 2026) corrected the axis of a figure and the study counts in the table; the results did not change","yan_etki":"Any side effect more common with cannabinoids (OR 1.75; 95% CI 1.25–2.46); serious side effects and dropping out did not increase","pmid":"41856154","doi":"10.1016/S2215-0366(26)00015-5","diger_kaynak":"Correction: Lancet Psychiatry 2026;13(8):e11, PMID 42302809 (June 16, 2026; the axis of a figure and the study counts in the table were corrected, results unchanged)"},{"ad":"Velayudhan 2021 (safety)","tasarim":"Systematic review and meta-analysis of RCTs (mean age ≥50, all indications; 1990–October 2020; GRADE)","n":"46 RCTs, 6,216 people (3,469 received cannabinoids; mean age 58.6)","populasyon":"Adults over 50 (dementia, Parkinson's, MS, cancer, etc.)","urun":"THC, THC:CBD, CBD","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"Safety review: THC alone (all-cause side effects IRR 1.42; 1.12–1.78) and THC:CBD (1.58; 1.26–1.98) increased side effects; pure CBD did not (1.02; 0.90–1.16). Serious side effects and deaths did not increase; with THC:CBD, stopping because of side effects increased (RR 1.40; 1.08–1.80), and stopping was linked to the THC dose","yan_etki":"Dry mouth, dizziness and sleepiness more common with THC-containing products","pmid":"33780450","doi":"10.1371/journal.pmed.1003524","diger_kaynak":"Update: Velayudhan 2024 (PMID 39602500; 58 RCTs, 6,611 people; THC dose-dependently increased dizziness, balance and coordination difficulties, thinking and perception problems and sleepiness)"},{"ad":"Spanagel and Bilbao 2021 (systematic review and meta-analysis)","tasarim":"Comparative systematic review and meta-analysis (PROSPERO-registered; GRADE)","n":"15 RCTs for appetite, 1,974 people","populasyon":"People with physical or mental illness (unwanted effects of approved cannabinoids on sleep and appetite)","urun":"Dronabinol, nabilone and CBD","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"Approved THC medicines (dronabinol, nabilone) did not adversely affect appetite; reduced appetite was more common with CBD than with placebo (OR 2.46; 95% CI 1.74–4.01; moderate certainty). According to the authors, the side effect of reduced appetite with approved cannabinoids appears to come from CBD","yan_etki":null,"pmid":"34181977","doi":"10.1016/j.neuropharm.2021.108680","diger_kaynak":"Full text could not be read (paywalled); abstract and as reported in the Bilbao 2022 discussion"},{"ad":"Pinto and Martel 2022 (systematic review)","tasarim":"Systematic review (no meta-analysis)","n":"11 RCTs","populasyon":"Placebo-controlled RCTs of CBD reporting appetite or weight (mostly as a side effect); mostly epilepsy studies","urun":"CBD (mostly pharmaceutical-grade pure CBD; in one study a CBD-dominant cannabis extract, in one inhaled CBD-rich cannabis)","urun_turu":"karma","doz":"Between 5 mg/kg and 1,500 mg a day","titrasyon":null,"sure":"Search up to July 31, 2022","sonuc":"The authors conclude that CBD reduces appetite and that this is linked to weight loss; in seven studies reduced appetite was more common in those taking CBD (as a dose-related side effect in epilepsy), and in one study appetite increased. Only three studies measured weight, and none of the three found a weight difference compared with placebo. There are no studies in patients with loss of appetite; risk of bias was at the 'some concerns' level in most","yan_etki":null,"pmid":"36180814","doi":"10.1007/s40261-022-01205-y","diger_kaynak":null},{"ad":"Charron 2019 (systematic review)","tasarim":"Systematic review (narrative synthesis)","n":"Not reported (in the abstract)","populasyon":"People living with HIV","urun":"Cannabis and cannabinoids (THC, CBD)","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"Findings on cannabis's effect on the immune system in HIV are conflicting; cannabis smoke is thought to harm the lungs, and respiratory symptoms are more common in people who smoke cannabis. Safety data specific to people living with HIV regarding the lungs, cognitive function, cancer risk and cardiovascular disease are limited. The authors recommend that people living with HIV not use it until more safety data are available","yan_etki":null,"pmid":"31332397","doi":"10.24875/AIDSRev.19000060","diger_kaynak":null},{"ad":"Austin 2024","tasarim":"Retrospective cohort (comparison group: those with the same symptoms who did not receive a medical marijuana prescription; not randomized)","n":"344 patients with ALS","populasyon":"Patients followed at a single ALS clinic with target symptoms including loss of appetite (Texas, USA)","urun":"Medical marijuana (product type and THC/CBD content not in the abstract)","urun_turu":"karma","doz":"Not reported (in the abstract)","titrasyon":null,"sure":"2-year chart review","sonuc":"Medical marijuana use was linked in the short term with fewer complaints of poor appetite, pain and anxiety; there was no link with maintaining body mass index. ALS progressed faster in users, but these patients' symptoms were already more severe before the marijuana prescription (association; cause and effect not shown). The authors recommended a randomized study","yan_etki":"Not reported (in the abstract)","pmid":"39307005","doi":"10.1016/j.jns.2024.123243","diger_kaynak":null},{"ad":"Costiniuk 2008","tasarim":"Retrospective cohort (comparison group: those not taking oral cannabinoid medicines; not randomized)","n":"191 patients (25 took oral cannabinoid medicines)","populasyon":"Patients receiving chronic hepatitis C treatment with interferon and ribavirin; in those taking the medicines, the main reasons were treatment-related loss of appetite (72%) and nausea (32%) (Canada)","urun":"Oral prescription medicines containing cannabinoids (which medicines were used is not in the abstract)","urun_turu":"karma","doz":"Not reported (in the abstract)","titrasyon":null,"sure":"Throughout hepatitis C treatment (those starting between August 2003 and January 2007)","sonuc":"64% of those taking the medicines reported subjective improvement in symptoms; before starting there was a median weight loss of 4.5 kg, and one month after starting the medicine weight loss slowed (an additional median 0.5 kg). Interferon dose reductions were similar (8% vs 5%); the proportion who completed hepatitis C treatment and achieved a lasting cure of the virus was higher among those taking the medicines. Retrospective and small; prior cannabis smoking was more common among those taking the medicines (24% vs 10%)","yan_etki":"Not reported (in the abstract)","pmid":"18414712","doi":"10.1155/2008/725702","diger_kaynak":null},{"ad":"DeJesus 2007","tasarim":"Retrospective chart review (no comparison group)","n":"117 (those with weight loss before starting)","populasyon":"Patients with HIV/AIDS started on dronabinol (USA)","urun":"Dronabinol","urun_turu":"thc_iceren","doz":"Not reported (in the abstract)","titrasyon":null,"sure":"3–12 months of dronabinol (between 1993 and 2003)","sonuc":"63% of patients maintained or gained weight; in those using it for 1 year, mean weight gain was 3.7 ± 10.6 pounds (about 1.7 kg). Those reporting loss of appetite fell from 71% to 26% at month 1 (p < 0.001); nausea decreased from 38% (p = 0.031 at month 6). Because there was no comparison group, how much of the improvement was due to the drug cannot be known","yan_etki":"Not reported (in the abstract)","pmid":"17538000","doi":"10.1177/1545109707300157","diger_kaynak":"Funding not in the abstract (PubMed: non-US government support)"},{"ad":"Woodward 2014","tasarim":"Retrospective systematic chart review (inpatient unit); no control group","n":"40","populasyon":"Inpatients with severe dementia given dronabinol for behavioral or appetite problems (geriatric neuropsychiatry unit, USA)","urun":"Dronabinol (added to existing treatment)","urun_turu":"thc_iceren","doz":"Not reported (in the abstract)","titrasyon":"Not reported (in the abstract)","sure":"Up to 7 days after starting dronabinol","sonuc":"Improvement in the proportion of meals eaten, sleep duration, all domains of the Pittsburgh Agitation Scale and clinical global impression (numbers not in the abstract); no comparison group","yan_etki":"26 side effects, none led to stopping treatment","pmid":"23597932","doi":"10.1016/j.jagp.2012.11.022","diger_kaynak":null},{"ad":"Wilson 2007","tasarim":"Retrospective observational study (no comparison group)","n":"28 (22 women)","populasyon":"Long-term care residents with loss of appetite and marked weight loss not responding to nutritional support (five facilities, USA; mean age 79.5, range 46–98)","urun":"Dronabinol","urun_turu":"thc_iceren","doz":"Not reported (in the abstract)","titrasyon":null,"sure":"12 weeks of dronabinol","sonuc":"15 people (53.5%) gained weight (10 gained more than 5 pounds, 6 more than 10 pounds); 11 people lost weight. Mean change +3 ± 8 pounds (about 1.4 kg; not significant, p = 0.2). Those who lost weight were younger; 64% of those who lost weight and 26% of those who gained weight died during follow-up. No comparison group","yan_etki":"Well tolerated (abstract; no details)","pmid":"17435963","doi":null,"diger_kaynak":null}],"son_inceleme":"2026-10-30","arastirma_gecmisi":[{"tarih":"2026-10-28","not":"Page published. This first review examined 31 studies."},{"tarih":"2026-10-30","not":"The correction to the Wilson 2026 meta-analysis published in the journal was read: only the axis of one figure and the study counts in a table were corrected; the results on this page did not change."},{"tarih":"2026-10-30","not":"The frequently asked questions now explain why the strength of evidence for THC-containing products is “Weak” on this page and “Very weak” on the Appetite Loss in Cancer page: in loss of appetite related to HIV/AIDS, appetite or the amount eaten increased in a few small controlled studies; in two large studies with cancer patients, however, THC-containing products did no better than either placebo or the appetite stimulant megestrol. No new study was added; the conclusion and the strength of evidence did not change."},{"tarih":"2026-10-30","not":"The last sentence of the page's short summary was rewritten in a calmer, more guiding tone: instead of \"Talk to your doctor before you start.\", it now says whom you can talk with, and about what, if you are considering CBD. The conclusion and the strength of evidence did not change."}]},{"id":"adhd","baslik":"Attention-deficit/hyperactivity disorder (ADHD)","grup":"Neurodevelopmental","grup_kodu":"norogelisimsel","tr_id":"dehb","kanit_duzeyi":"yetersiz","kanit_yonu":"veri_yok","kanit_ozet":"In the only randomized controlled trial of cannabinoids in ADHD (Cooper 2017; 30 adults, mouth spray containing THC and CBD, 6 weeks), there was no difference from placebo on the primary outcome (QbTest cognitive performance and activity) (estimate −0.17; 95% CI −0.40 to 0.07; p = 0.16); the improvement in hyperactivity-impulsivity (p = 0.03) and on an inhibition measure (p = 0.05) did not remain significant after correction for multiple testing. There are no controlled studies with pure CBD. In studies of Tourette syndrome and chronic tic disorder, ADHD was examined only as a co-occurring condition and with THC-containing products; these studies are in the table of the site's Tourette Syndrome page: in the 97-adult RCT (CANNA-TICS; mouth spray containing THC and CBD, 13 weeks), the reduction in tics looked larger versus placebo in those with ADHD but was not statistically significant (exploratory subgroup analysis; Müller-Vahl 2023, PMID 36878177; subgroup result Czech 2026, PMID 42123126), and the result of the ADHD symptom scale planned as a secondary outcome in the protocol appears neither in the article's abstract nor in the EU clinical trials register; in the uncontrolled study with 10 adolescents with Tourette syndrome (oil containing THC and CBD, 12 weeks), the parent-rated ADHD score fell from 32.8 to 25.4, but the change was not significant (p = 0.063; Eapen 2025, PMID 40636988). Uncontrolled data: in 53 children and young people with autism and ADHD symptoms, improvement in teacher ratings over 3–6 months with CBD-rich cannabis oil (Barchel 2026; the product in the same center's autism program was CBD:THC 20:1, meaning it contains a small amount of THC); in a manufacturer-supported, 12-week study in 14 children with pediatric acute-onset neuropsychiatric syndrome (PANS) using a CBDA-dominant extract with a small amount of THC, the ADHD symptom scale (Conners), one of the secondary measures, also improved (p = 0.028); all of the children had OCD symptoms and continued their other medicines (Keating 2026, PMID 41513541; the study is in the table of the site's OCD and Hair Pulling page); in the UK Medical Cannabis Registry, in 68 adults prescribed it for ADHD (mostly inhaled flower; median 209 mg THC and 15 mg CBD/day), improvement in anxiety and sleep scores up to 12 months and in quality of life up to 6 months; ADHD symptoms were not measured, 49% of patients were assessed at month 12, the registry belongs to a private chain of clinics, and 5 of the 6 authors have business ties to this chain or to the cannabis company that makes the most commonly prescribed products (Ittiphakorn 2023). A 2026 meta-analysis pooling cannabinoid RCTs in mental health conditions did not find enough data to run a pooled analysis for ADHD (Wilson 2026); a 2026 meta-analysis pooling experimental and observational studies reported that the effect in adult ADHD was negligible or absent, with certainty mostly very low (Bharat 2026); according to a 39-study scoping review, in most studies cannabis worsened ADHD symptoms or had no effect on them (Francisco 2023). Cannabis use in people with ADHD: lifetime prevalence of cannabis use disorder 26.9%, risk 2.85 times the general population (Froude 2024; 14 studies); childhood ADHD is associated with later cannabis use (OR 2.78; 95% CI 1.64–4.74) and with cannabis abuse or dependence (OR 2.29; 1.32–3.99) (Lee 2011); in the long-term follow-up of the multicenter MTA study, weekly use in adulthood was 32.8% versus 21.3% (Molina 2018); Mendelian randomization suggested a causal effect running from ADHD predisposition to cannabis use (OR 7.9; 95% CI 3.72–15.51) and found no effect in the reverse direction (Soler Artigas 2020); in a survey, 75% of adults with ADHD had used cannabis at least once, and use disorder was more common among daily users (62% versus 38%; Ryan 2026); under the influence of cannabis, impulsivity decreased in people with ADHD, but performance dropped on five cognitive measures (Stueber 2026); 31.3% of parents of children diagnosed with ADHD, autism or anxiety had given an unapproved CBD product (Schwaller 2023). In 11 studies looking at the effects of cannabis on the brain and cognition in young people with ADHD, no interacting harm of ADHD and cannabis was seen on executive function tests; early onset was associated with worse test results in one study (exploratory analysis) and with differences in brain structure in another; 5 of the 11 studies came from the same (MTA) cohort (Cawkwell 2021); there is little evidence that cannabis-related psychosis risk is additionally raised in people with ADHD (Suetani 2026; 3 studies). In adolescents (studies not specific to ADHD, and therefore not included in the table): cannabis use is associated with a later diagnosis of psychotic disorder (adjusted HR 2.19; Young-Wolff 2026, PMID 41719031), the risk of addiction in young people who use regularly is 33% (Leung 2020, PMID 32485547), inhaled THC also impaired memory in adolescents aged 16–17 and CBD did not reduce this (Lawn 2023, PMID 36750134), and cognitive decline in frequent users is small and not clear after more than 72 hours of abstinence (Scott 2018, PMID 29710074). Cannabis use in pregnancy is slightly associated with ADHD in the child (adjusted OR 1.13; Bassalov 2024); in the largest screened cohort there is no association (Young-Wolff 2025). October 2026 search (PubMed, Cochrane, ClinicalTrials.gov, Europe PMC): 1 controlled study of cannabinoids on this topic was found (mouth spray containing THC and CBD, 30 adults; Tourette studies that measured ADHD only as a co-occurring condition were not counted and are mentioned above); there are no controlled studies with pure CBD, no Cochrane review of cannabinoids in ADHD, and no registered unpublished studies with results. In addition, the table includes 2 uncontrolled studies, 3 reviews that also cover ADHD, 9 observational studies and reviews on cannabis use and its risks in people with ADHD, and 2 studies on cannabis use in pregnancy and ADHD in the child; all are in the table below. 4 sources on the risks of cannabis in adolescence that are not specific to ADHD are mentioned only in the text. There is one study that was stopped with 8 people because participants could not be found, with no results released; 3 controlled studies are ongoing or of unknown status (no results); no studies of cannabinoid treatment in ADHD from Turkey were found.","kanit_duzeyi_metin":"Pure CBD: Insufficient (no controlled studies with pure CBD or CBD oil in ADHD; in the only study without a comparison group, in autistic children, the CBD-rich oil used also contained a small amount of THC; a planned controlled study with THC-free CBD oil has no results)","kanit_duzeyi_thc_icerenler":"cok_zayif","kanit_duzeyi_thc_icerenler_metin":"THC and THC+CBD: Very weak (a single small 6-week controlled study with 30 adults with ADHD, no difference on the main measure; other data come from uncontrolled studies (CBD-rich oil with a little THC in autistic children; UK patient registry), observational studies and surveys; no controlled studies in children and adolescents)","kaynak_dosya":null,"saf_cbd_sonuc":"There are no controlled studies of pure CBD or CBD oil in ADHD. In a study without a comparison group in children and young people with autism and ADHD symptoms, the CBD-rich oil also contained a small amount of THC (a CBD to THC ratio of 20 to 1 in the same center's autism program); so its result is in the THC-containing products section. A 120-person study in children and teens comparing a THC-free CBD oil with added terpenes against placebo is registered in Israel under a company's sponsorship; the record has not been updated since August 2024, and as of October 2026 it has no results.","thc_icerenler_sonuc":"There is only one controlled study of THC-containing products in ADHD: in 30 adults over 6 weeks, a mouth spray containing THC and CBD was not clearly different from placebo on the main measure; the signs of improvement in hyperactivity and impulsivity did not survive correction for multiple comparisons. In 53 children and young people with autism and ADHD symptoms, improvement in teacher ratings over 3–6 months was reported with a CBD-rich oil that also contains a small amount of THC, but there was no comparison group. In a registry of 68 adults, most using inhaled cannabis, anxiety and sleep improved, but ADHD symptoms were not measured. In adults with ADHD using their own cannabis, impulsivity decreased somewhat, but performance dropped on many attention and memory tests. Two large reviews found insufficient evidence of benefit; according to a 39-study scoping review, in most studies cannabis worsened ADHD symptoms or had no effect on them. There are no controlled ADHD studies of THC-containing products in children and adolescents; cannabis use in adolescence is linked to risks of psychosis and addiction (observational).","ruhsat":null,"doz_araligi_ozet":"Nabiximols (mouth spray containing THC and CBD) at most 37.8 mg THC + 35 mg CBD/day, 6 weeks (the only controlled study; highest dose from review tables); in the UK registry the median prescribed amount was 209 mg THC + 15 mg CBD/day (mostly inhaled flower); no ADHD studies with pure CBD or CBD oil","titrasyon_ozet":null,"yan_etkiler":["Nabiximols, 6 weeks: 1 serious side effect (muscle cramps and spasms) and 3 mild side effects in the spray group; 1 serious side effect (cardiovascular problems) in the placebo group (Cooper 2017)","UK registry, 12 months: 11 of 68 patients reported 61 side effects (16 severe); most common were insomnia, trouble concentrating, sleepiness, fatigue and dry mouth; no life-threatening side effects (Ittiphakorn 2023)","Under the influence of cannabis, a drop in performance on five cognitive measures in adults with and without ADHD (Stueber 2026)","Inhaled THC and THC + CBD impaired verbal memory and increased psychosis-like symptoms in adolescents aged 16–17 and in adults; adding CBD did not reduce this (healthy volunteers who use cannabis; Lawn 2023, PMID 36750134)","Across all mental health condition RCTs, the chance of any side effect rose with cannabinoids (OR 1.75; number needed to harm 7), with no difference in serious side effects (Wilson 2026); stopping because of side effects was more common with THC (OR 2.78; Bharat 2026)"],"izlem":["Screening for cannabis use disorder and co-occurring mental health diagnoses is recommended in people with ADHD who use cannabis (Froude 2024; Ryan 2026)","Because both ADHD medicines and CBD can reduce appetite, weight and height are monitored by a doctor in children; details are on the site's ADHD medications page (methylphenidate and atomoxetine product information, product information for approved CBD)","Ongoing studies (October 2026): in Israel, THC-free CBD oil with added terpenes versus placebo in 120 children and teens aged 6–18 (NCT06542445; according to the record it started in August 2024, estimated completion September 2026; the record has not been updated since August 2024 and its status is 'unknown'); in the US, a single 80 mg dose of cannabigerol (CBG) versus placebo in 76 adults aged 18–55, with attention and memory tests (NCT06115603; the record was last updated in May 2026 and appears as 'recruiting'; planned completion was July 2026); in Brazil, a full-spectrum oil containing CBG, CBD and THC versus placebo in 60 young people aged 12–17, 12 weeks (NCT07592390; recruiting, estimated completion December 2026). None has results yet"],"dikkat":["The only controlled study in ADHD was done with a THC-containing spray and showed no benefit on the main measure; CBD oils have never been tested in a controlled study in ADHD (Cooper 2017)","Children and adolescents: there are no controlled ADHD studies of cannabinoids in children; in observational studies not specific to ADHD, cannabis use in adolescence was linked to a later diagnosis of psychotic disorder (adjusted HR 2.19; Young-Wolff 2026, PMID 41719031), and about one in three young people who used it regularly developed addiction (Leung 2020, PMID 32485547)","People with ADHD: cannabis use disorder is more common (lifetime about 27%, about 2.9 times the general population; Froude 2024); in an exploratory analysis of one study, those who started cannabis before age 16 did worse on some thinking tests; according to a review, however, it has not been shown that cannabis additionally impairs test performance in young people with ADHD, and the evidence is limited (Cawkwell 2021)","Personal or family history of psychosis: in a controlled study with healthy adolescents and adults who use cannabis, THC increased psychosis-like symptoms and adding CBD did not prevent this (Lawn 2023, PMID 36750134); there is little evidence that this risk is additionally raised in people with ADHD (Suetani 2026). A person with a history of psychosis should not use cannabis products without consulting a doctor (this is a precautionary recommendation, not a direct study finding)","Pregnancy: cannabis use in pregnancy was slightly associated with ADHD in the child (adjusted OR 1.13; Bassalov 2024), while no association was seen in the largest cohort (Young-Wolff 2025); the safety of CBD in pregnancy was not examined in these studies","Schoolwork and tasks that need attention: under the influence of cannabis, performance dropped on five attention and memory measures (Stueber 2026); inhaled THC also impaired verbal memory in adolescents (Lawn 2023, PMID 36750134)","Unapproved CBD products: in a US survey, 31% of parents of children diagnosed with ADHD, autism or anxiety had given their child an unapproved CBD product; the survey did not measure the products' contents or THC amounts (Schwaller 2023)"],"ilac_etkilesim_notlari":["Detailed information and monitoring recommendations are on the 'ADHD medications' page in the site's drug interactions section (methylphenidate and atomoxetine)","Methylphenidate: in 12 healthy volunteers, 750 mg of approved CBD twice a day for 3 days raised the total blood exposure of a single 10 mg dose of methylphenidate by 9% on average (geometric mean ratio 1.09; 90% CI 0.89–1.32); the researchers considered this clinically insignificant (Markowitz 2022, PMID 36467779). Laboratory and modeling studies predict a larger increase with repeated high CBD doses; this has not been confirmed in humans (Qian 2022, PMID 35512806)","Atomoxetine: no human studies have examined it together with CBD; CBD slowed CYP2D6, the enzyme that breaks down atomoxetine, in the laboratory, but a CBD-dominant cannabis extract did not slow it in healthy volunteers (PMID 21821735; PMID 37313955)","THC and methylphenidate: in 16 volunteers without mental illness who used cannabis occasionally, increases in heart rate added up when 10 mg of oral THC was taken together with 10 or 40 mg of methylphenidate (peak heart rate averaged 89, 96 and 102 beats/min when 0, 10 and 40 mg of methylphenidate were added to THC); THC increased the number of errors on an attention test (Kollins 2015, PMID 25175495)","No human studies were found examining CBD with amphetamine derivatives (lisdexamfetamine, dexamfetamine), guanfacine or clonidine (October 2026 search). There are a few small laboratory studies with THC: in volunteers, cannabis smoked after 10 mg of dextroamphetamine added to the increases in heart rate and blood pressure (Evans 1976, PMID 782773); in volunteers who used cannabis regularly, guanfacine (2–3 mg a day) was well tolerated together with smoked cannabis or 20 mg of oral THC, a small drop in blood pressure was seen, and THC's heart-rate-raising effect did not change (Haney 2019, PMID 29659126; Mathai 2018, PMID 28641496); in a 15-patient open-label study testing atomoxetine together with dronabinol (synthetic THC) for sleep apnea, side effects were common and one third of patients stopped treatment (Messineo 2023, PMID 36805833)","In the UK registry, over 12 months, 5 of 13 people taking lisdexamfetamine and 3 of 20 taking methylphenidate stopped their medicine; during the same period 3 people newly started methylphenidate and 2 started dexamfetamine (Ittiphakorn 2023); this is an uncontrolled observation, not evidence of benefit or of an interaction"],"dogrulanamayan":["The full text of the only controlled study (Cooper 2017) is not open access: the highest daily dose (37.8 mg THC + 35 mg CBD) was taken from the tables of two reviews dated 2022 and 2026, and the age range and duration from the ClinicalTrials.gov record (NCT02249299); how the dose was adjusted, the average dose used and the funding could not be read.","The full text of the study with autistic children (Barchel 2026) could not be read: the dose of the oil used and side effects are not in the abstract. The study appears to be part of the autism program that the same center launched in the same period, on which the studies on the site's Autism page are also based (ClinicalTrials.gov NCT05212493; two oils with a CBD to THC ratio of 20 to 1); the oil's ratio is not stated in this article's abstract.","Wilson 2026, Bharat 2026, Francisco 2023, Froude 2024, Suetani 2026, Ryan 2026, Stueber 2026, Leung 2020 and Bassalov 2024 were read from the abstract only. The content of the corrections published in the journal for Molina 2018 and Soler Artigas 2020 could not be read; the correction for Wilson 2026 was read on October 29, 2026: only the axis of one figure and the study counts in a table were corrected, and the results did not change.","A study whose results were not released: a study in Israel that was to compare different cannabinoid oils (CBD, THC, CBDV or CBG) with placebo in adult ADHD (NCT05219370) was stopped in December 2022 with 8 people because of difficulty finding participants; there are no results in the registry. The record of the CBD oil study in children (NCT06542445) has not been updated since August 2024 (checked in October 2026).","The licensing status in Turkey of the mouth spray containing THC and CBD (nabiximols) used in the ADHD study was not verified in this search."],"calismalar":[{"ad":"Cooper 2017 (EMA-C)","tasarim":"Double-blind, placebo-controlled, parallel-group pilot RCT (single center, London)","n":"30 randomized (15 nabiximols / 15 placebo); 15 / 11 in the primary analysis","populasyon":"Adults diagnosed with ADHD (ages 18–55; England)","urun":"Nabiximols (Sativex), oromucosal spray; each spray 2.7 mg THC + 2.5 mg CBD; placebo spray","urun_turu":"thc_iceren","doz":"Highest daily dose 37.8 mg THC + 35 mg CBD (secondary source: tables of the Bilbao 2022 and Cooling 2026 reviews; the full text of the study could not be read); the average dose used is not in the abstract","titrasyon":"Not reported (in the abstract; the full text could not be read)","sure":"6 weeks","sonuc":"No difference from placebo on the primary outcome (QbTest: cognitive performance and activity measures) (estimate −0.17; 95% CI −0.40 to 0.07; p = 0.16). On secondary measures, nominal improvement in hyperactivity-impulsivity (p = 0.03) and on a cognitive inhibition (impulse control) measure (p = 0.05), with trends in inattention (p = 0.10) and emotional lability (p = 0.11); none significant after correction for multiple testing. Effects were larger in those who followed the protocol. The authors interpret the result as preliminary evidence, not a firm one","yan_etki":"1 serious (muscle cramps and spasms) and 3 mild side effects in the nabiximols group; 1 serious side effect (cardiovascular problems) in the placebo group","pmid":"28576350","doi":"10.1016/j.euroneuro.2017.05.005","diger_kaynak":"ClinicalTrials.gov NCT02249299 (30 people; August 2014–June 2015; no results in the registry). Highest dose from the tables of two reviews: Bilbao 2022 (PMID 35982439, Table 2) and Cooling 2026 (PMID 41343139, Table 2)"},{"ad":"Wilson 2026","tasarim":"Systematic review and meta-analysis of RCTs (1980–May 13, 2025; PROSPERO CRD42023392718; GRADE)","n":"54 RCTs, 2,477 participants (all mental health conditions and substance use disorders); not enough studies in ADHD for a meta-analysis","populasyon":"People with a mental health condition or substance use disorder (including ADHD)","urun":"Cannabinoids (CBD, THC, combinations of the two and other cannabinoids)","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"There were not enough data to run a meta-analysis for ADHD (abstract). Across all diagnoses, the certainty of the evidence is low for most outcomes; 44% of the studies have a high risk of bias. According to the authors, routine use of cannabinoids in mental health conditions can rarely be justified for now","yan_etki":"The chance of any side effect was higher with cannabinoids (OR 1.75; 95% CI 1.25–2.46; number needed to harm 7); no difference in serious side effects or study withdrawal","pmid":"41856154","doi":"10.1016/S2215-0366(26)00015-5","diger_kaynak":"Correction: Lancet Psychiatry 2026;13(8):e11 (PMID 42302809; June 16, 2026: the axis of a figure and the study counts in the table were corrected, results unchanged). The same review is also in the site's anxiety, psychosis, depression, bipolar, sleep, substance use, autism and Tourette syndrome tables"},{"ad":"Bharat 2026","tasarim":"Systematic review and meta-analysis of experimental and observational studies (up to May 2025; PROSPERO CRD42023467536; GRADE)","n":"82 experimental and 118 observational studies (all diagnoses; the number of ADHD studies is not in the abstract)","populasyon":"Adults (aged 18 and over) with ADHD, anxiety, depression, PTSD, psychosis, Tourette syndrome or substance use disorder","urun":"THC, CBD, combinations of the two and other cannabinoids; medical cannabis","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"In RCTs, cannabinoids had a negligible or no effect on ADHD (the numerical result and the number of studies it is based on are not in the abstract). Across all diagnoses, observational studies suggest improvement, but the risk of bias is high. The certainty of the evidence is mostly very low; the authors do not support cannabinoids as a first-line treatment. The full text could not be read","yan_etki":"The only significant safety finding: stopping the study because of side effects was more common with THC (OR 2.78; 95% CI 1.66–4.65)","pmid":"42617303","doi":"10.1016/j.psychres.2026.117380","diger_kaynak":"The same review is also in the site's Depression and Tourette Syndrome tables"},{"ad":"Francisco 2023","tasarim":"Scoping review (systematic search: MEDLINE, EMBASE, EMCARE, PsycINFO, Web of Science, Cochrane, ClinicalTrials.gov; up to June 27, 2022)","n":"39 studies (1 RCT; most cross-sectional)","populasyon":"People with ADHD (experimental and observational studies)","urun":"Cannabis and cannabinoid products (THC and CBD amounts not measured in most studies)","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"In the only study directly measuring the effect of cannabis against placebo in ADHD (Cooper 2017), no difference on the primary outcome. Most of the literature consists of cross-sectional studies looking at the relationship between ADHD severity and cannabis use; 15 studies used neuropsychological tests or brain imaging. Although some studies reported improvement, most showed that cannabis worsened ADHD symptoms or had no effect on them. According to the authors, cannabis is not recommended for people with ADHD based on the current evidence; there are no objective measures of cannabis exposure and symptoms, and samples are small","yan_etki":null,"pmid":"36508935","doi":"10.1016/j.jpsychires.2022.11.029","diger_kaynak":null},{"ad":"Barchel 2026","tasarim":"Prospective, single-arm, open-label study (single center; no control group)","n":"109 enrolled (November 2019–April 2021); 53 were rated by teachers before and after treatment","populasyon":"Children and young adults with autism spectrum disorder and ADHD symptoms (Israel, Shamir Medical Center)","urun":"CBD-rich cannabis oil; ratio and product name not in the abstract. The same center's autism program in the same period (ClinicalTrials.gov NCT05212493; Hacohen 2022, Stolar 2022, Treves 2026) used whole-plant oils with a CBD:THC ratio of 20:1","urun_turu":"thc_iceren","doz":"Not reported (in the abstract). In another publication from the same cohort (Treves 2026), the mean maximum CBD dose was 2.8–3.1 mg/kg/day","titrasyon":"Not reported (in the abstract)","sure":"3–6 months","sonuc":"On the teacher-completed Conners scale, significant improvement in anxious-shy, perfectionism, ADHD index, emotional lability and hyperactivity-impulsivity (p < 0.001); a trend toward improvement in oppositional behavior, cognitive inattention, hyperactivity, global index and DSM-IV inattention scores (p = 0.003–0.009). Dose or blood cannabinoid levels were not associated with improvement (only for emotional lability did higher CBD levels predict more improvement). Of the 109 people enrolled, 53 (about half) were assessed with the teacher scale before and after treatment. No control group; the placebo effect and improvement over time cannot be separated. The article's funding and conflict-of-interest statements could not be read; the program's registry record lists two medical cannabis companies (Seach Sarid, Canndoc) as collaborators","yan_etki":"Not reported (in the abstract)","pmid":"41503912","doi":"10.2174/011570159X390368251014072051","diger_kaynak":"In the PubMed and Crossref records, first name and surname are swapped (first author Dana Barchel; 'Dana B' in PubMed). The same cohort (Shamir Medical Center, November 2019–April 2021, 109 people): ClinicalTrials.gov NCT05212493 (started on November 14, 2019; two CBD:THC 20:1 oils) and Hacohen 2022, Stolar 2022, Treves 2026 in the site's Autism table"},{"ad":"Ittiphakorn 2023 (UK Medical Cannabis Registry)","tasarim":"Uncontrolled case series (prospective patient registry; months 1, 3, 6 and 12)","n":"68 (33 people assessed at month 12)","populasyon":"Adults whose primary reason for a medical cannabis prescription was ADHD (England; mean age 35.6; 81% male; 81% were already using cannabis when they started)","urun":"Prescription cannabis products: inhaled dried flower only 56%, sublingual oil only 6%, both 38% (most commonly prescribed flower: Adven EMT1)","urun_turu":"thc_iceren","doz":"Median prescribed daily THC 208.75 mg (IQR 120.6–291.4), CBD 15 mg (5.1–55.0); in the 4 patients using oil only, median 5 mg THC + 17.5 mg CBD","titrasyon":"Not reported","sure":"12 months","sonuc":"Anxiety (GAD-7: from 10.85 to 8.44 at month 12) and sleep quality scores improved from baseline at months 1, 3, 6 and 12; overall quality of life (EQ-5D-5L) improved at months 1, 3 and 6, with no difference at month 12. ADHD symptoms were not measured separately; 49% of patients (33/68) were assessed at month 12. Over 12 months, 5 of 13 people taking lisdexamfetamine and 3 of 20 taking methylphenidate stopped their medicine; during the same period 3 people newly started methylphenidate and 2 started dexamfetamine. Missing data were filled with baseline values; no control group, and according to the authors causality cannot be established. The registry belongs to a private chain of clinics (Sapphire Medical Clinics); 5 of the 6 authors have company ties: three work at this chain (head of research, chief clinical pharmacist, director of operations), one is a former director of the chain, and the senior author is chief medical officer of Curaleaf International, the maker of the most commonly prescribed products (Adven); no external funding","yan_etki":"11 of 68 patients (16.2%) reported a total of 61 side effects (19 mild, 26 moderate, 16 severe); most common were insomnia, trouble concentrating, sleepiness, fatigue and dry mouth (5 each); no life-threatening or disabling side effects","pmid":"38058251","doi":"10.1002/npr2.12400","diger_kaynak":"PMC10739081 (full text)"},{"ad":"Froude 2024","tasarim":"Systematic review and meta-analysis (PubMed, PsycINFO, Web of Science)","n":"14 studies","populasyon":"People with ADHD (clinical and community samples)","urun":"Cannabis (diagnosis of cannabis use disorder)","urun_turu":"thc_iceren","doz":"Not applicable","titrasyon":null,"sure":null,"sonuc":"In people with ADHD, the lifetime prevalence of cannabis use disorder was 26.9% and the current prevalence 19.2% (wide prediction intervals: 12.4–48.8% and 5.5–39.1%). The risk of lifetime and current cannabis use disorder in people with ADHD was 2.85 and 2.91 times that of the general population. The authors recommend screening for cannabis use disorder as part of ADHD care. Observational data","yan_etki":"Not applicable (observational)","pmid":"38452637","doi":"10.1016/j.jpsychires.2024.02.050","diger_kaynak":null},{"ad":"Lee 2011","tasarim":"Meta-analysis of prospective follow-up studies","n":"27 studies (cannabis trial use: 7 studies, 600 with ADHD and 2,661 comparison; cannabis use disorder: 943 with ADHD and 1,885 comparison)","populasyon":"People with and without an ADHD diagnosis in childhood","urun":"Cannabis (later use and use disorder)","urun_turu":"thc_iceren","doz":"Not applicable","titrasyon":null,"sure":"From childhood to adolescence or adulthood (mean age at follow-up 18.9)","sonuc":"People with childhood ADHD were more likely to later use cannabis at least once (OR 2.78; 95% CI 1.64–4.74; marked heterogeneity between studies) and more likely to develop cannabis abuse or dependence (OR 2.29; 95% CI 1.32–3.99). No sign of publication bias. Co-occurring conduct disorder makes it hard to isolate the effect of ADHD itself. Observational data","yan_etki":"Not applicable (observational)","pmid":"21382538","doi":"10.1016/j.cpr.2011.01.006","diger_kaynak":"PMC3180912 (author manuscript)"},{"ad":"Molina 2018 (MTA follow-up)","tasarim":"Prospective multicenter cohort (observational long-term follow-up of a treatment RCT; comparison: children without ADHD from the same classrooms)","n":"547 children with ADHD and 258 classmates","populasyon":"People diagnosed with combined-type ADHD in childhood (at a mean age of 8.5)","urun":"Cannabis (self-report, confidential questionnaire)","urun_turu":"thc_iceren","doz":"Not applicable","titrasyon":null,"sure":"From a mean age of 10 to age 25 (up to 8 assessments)","sonuc":"Weekly cannabis use in adulthood was 32.8% in the ADHD group and 21.3% in the comparison group; daily use 22% versus 11%. More people in the ADHD group started substance use (alcohol, tobacco, cannabis) early in adolescence; early onset predicted heavier use in adulthood in both groups. Observational data","yan_etki":"Not applicable (observational)","pmid":"29315559","doi":"10.1111/jcpp.12855","diger_kaynak":"PMC5985671 (author manuscript). Correction: J Child Psychol Psychiatry 2018;59(11):e1 (PMID 30339284; content could not be read). The share of early starters in adolescence is 57.9% versus 41.9% in the abstract and 57.6% versus 40.3% in the author manuscript"},{"ad":"Soler Artigas 2020","tasarim":"Genetic study: genetic correlation and bidirectional, two-sample Mendelian randomization using genome-wide association data","n":"53,293 people for ADHD; 32,330 people for lifetime cannabis use (summary statistics)","populasyon":"Summary data from large genetic studies (ADHD and cannabis use)","urun":"Cannabis (lifetime use)","urun_turu":"thc_iceren","doz":"Not applicable","titrasyon":null,"sure":null,"sonuc":"Genetic correlation between ADHD and cannabis use (rg = 0.29). Mendelian randomization suggested a causal effect of ADHD predisposition increasing cannabis use (estimated OR 7.9 for having ADHD; 95% CI 3.72–15.51); no effect was found in the reverse direction (from cannabis use to ADHD), but the authors note that this analysis may have had low power. Mendelian randomization relies on assumptions that are hard to verify","yan_etki":"Not applicable","pmid":"30610198","doi":"10.1038/s41380-018-0339-3","diger_kaynak":"PMC8025199 (author manuscript). Correction: Mol Psychiatry 2021;26(7):3663 (PMID 33627840; content could not be read)"},{"ad":"Suetani 2026","tasarim":"Systematic review (synthesis without meta-analysis, SWiM)","n":"3 studies","populasyon":"People with ADHD who use cannabis (psychosis outcomes)","urun":"Cannabis","urun_turu":"thc_iceren","doz":"Not applicable","titrasyon":null,"sure":null,"sonuc":"Only 3 studies meeting the criteria were found (with different designs; one of moderate and two of good quality). Two indirectly suggested that cannabis use does not additionally affect psychosis risk in people with ADHD, and one that cannabis affects psychosis risk similarly in people with and without ADHD. According to the authors, there is very little evidence that cannabis-related psychosis risk is higher in people with ADHD; ADHD and cannabis use are separately known risk factors for psychosis. The full text could not be read","yan_etki":"Not applicable","pmid":"41916924","doi":"10.1177/10398562261439662","diger_kaynak":null},{"ad":"Cawkwell 2021","tasarim":"Systematic review (PRISMA; PubMed, Embase, PsycINFO, Cochrane CENTRAL; up to January 1, 2020)","n":"11 studies (7 brain imaging)","populasyon":"Adolescents and young adults with ADHD (under 25); users and non-users of cannabis or synthetic cannabinoids","urun":"Cannabis (10 studies) and synthetic cannabinoids (1 study, Turkey)","urun_turu":"karma","doz":"Not applicable","titrasyon":null,"sure":null,"sonuc":"Imaging studies found differences in activity and structure in some brain regions in young people with ADHD who use cannabis; no study showed an additive or interacting harm of ADHD and cannabis on executive function tests. According to the authors, the limited and possibly underpowered evidence does not support the hypothesis that cannabis impairs neuropsychological test performance in young people with ADHD. Starting cannabis early was associated with negative differences in two studies: in an exploratory analysis of one, those who started before age 16 did worse on decision-making, working memory and impulsive error tests; in the other, there were differences in brain structure. 5 of the 11 studies (all three fMRI studies) were done with participants from the same cohort (MTA follow-up); the evidence is limited and the studies small, and the authors call for larger and longer studies. One of the studies was done in Turkey in adolescents aged 14–18 who used synthetic cannabinoids","yan_etki":"Not applicable","pmid":"34138796","doi":"10.1097/HRP.0000000000000303","diger_kaynak":"PMC9129887 (author manuscript). The study in Turkey: Çolak 2019 (PMID 31523140). Substance use results of the MTA cohort are in this table in the Molina 2018 row"},{"ad":"Stueber 2026","tasarim":"Quasi-experimental, repeated-measures observational study (two sessions; users used their own products under observation in the second session)","n":"104 adults (26 per group: cannabis users and non-users, with and without ADHD)","populasyon":"Adults with and without ADHD (US)","urun":"Participants' own cannabis products (THC and CBD amounts not in the abstract)","urun_turu":"thc_iceren","doz":"Amount chosen by the participant (not in the abstract)","titrasyon":null,"sure":"Two sessions","sonuc":"Regular cannabis users with ADHD reported milder mental sluggishness than non-users with ADHD, but did worse on two objective cognitive tests (like users without ADHD). People with ADHD under the influence of cannabis reported reduced impulsivity, irritability and anxiety and improved mood, and gave less impulsive responses on two tests; but their performance dropped on five other cognitive measures. Not randomized; products differed from person to person. 1 of 4 authors (the senior author) declares receiving materials, outside the study, from a vaporizer manufacturer (Storz & Bickel) and research funding from four companies (Huxley Health, Healer, CReDO Science, Terra Mater Botanicals); the study was supported by the university's alcohol-substance and cannabis research funds","yan_etki":"Drop in performance on five cognitive measures under the influence of cannabis","pmid":"41062851","doi":"10.1007/s00213-025-06921-9","diger_kaynak":null},{"ad":"Ryan 2026","tasarim":"Cross-sectional online survey (single health system; self-report)","n":"Sent to 9,274 people, 900 responses","populasyon":"Adults with an ADHD diagnosis in their health records (US)","urun":"Cannabis (self-report)","urun_turu":"thc_iceren","doz":"Not applicable","titrasyon":null,"sure":"April–July 2023","sonuc":"75% of participants had used cannabis at least once and 41% in the past 30 days; 42% of those who had ever used it (278 people) said they used cannabis for ADHD symptoms. Among daily users, cannabis use disorder (62% versus 38%; OR 2.67; 95% CI 1.69–4.22) and diagnoses of anxiety, depression, bipolar disorder and PTSD were more common than among occasional users. Daily users more often reported that cannabis reduced mental restlessness and impulsivity but worsened inattention. Low response rate (about 10%), self-report; does not show cause and effect","yan_etki":"Not applicable (survey)","pmid":"40874736","doi":"10.1177/10870547251364575","diger_kaynak":null},{"ad":"Schwaller 2023","tasarim":"Cross-sectional online survey (nationwide parent panel)","n":"518 parents","populasyon":"Parents of children aged 7–18 diagnosed with ADHD, autism or generalized anxiety disorder (US)","urun":"Unapproved CBD products (contents and THC amount unknown)","urun_turu":"cbd_zengin_thc_belirsiz","doz":"Not applicable","titrasyon":null,"sure":null,"sonuc":"31.3% of parents (162 people) had given their child an unapproved CBD product; use was most common in children with generalized anxiety disorder or multiple diagnoses and in the western US. Parents who gave CBD had more positive views about the safety of these products. The rate for children with ADHD alone is not in the abstract; the survey does not measure effectiveness","yan_etki":"Not applicable (survey)","pmid":"37795288","doi":"10.5863/1551-6776-28.4.323","diger_kaynak":null},{"ad":"Bassalov 2024","tasarim":"Systematic review and meta-analysis of observational studies (up to January 22, 2024; PRISMA, MOOSE)","n":"18 studies (17 in the meta-analysis), 534,445 participants","populasyon":"Children of mothers who did and did not use cannabis in pregnancy","urun":"Cannabis (medical or recreational; any route and trimester)","urun_turu":"thc_iceren","doz":"Not applicable","titrasyon":null,"sure":null,"sonuc":"After accounting for confounding factors, cannabis use in pregnancy was slightly associated with ADHD in the child (OR 1.13; 95% CI 1.01–1.26); associations with autism, psychotic symptoms, anxiety and depression were not clear; it was associated with the child's later cannabis use (OR 1.20; 1.01–1.42). Observational data","yan_etki":"Not applicable (observational)","pmid":"38908654","doi":"10.1016/j.ajog.2024.06.014","diger_kaynak":null},{"ad":"Young-Wolff 2025","tasarim":"Retrospective birth cohort (Kaiser Permanente Northern California; universal screening at about weeks 8–10 of pregnancy: self-report and urine test)","n":"141,570 children (117,130 pregnant women)","populasyon":"Children of mothers screened for cannabis use in pregnancy (US)","urun":"Cannabis (self-report or urine test)","urun_turu":"thc_iceren","doz":"Not applicable","titrasyon":null,"sure":"Up to age 11 (born 2011–2018)","sonuc":"Cannabis use was detected in 4.6% of pregnant women. After accounting for other substance use and sociodemographic factors, cannabis use in pregnancy was not associated with an ADHD diagnosis in the child (adjusted HR 0.84; 95% CI 0.70–1.01); there was an inverse association with disruptive behavior disorders (0.83; 0.71–0.97); frequency of use was not associated with the outcome. Observational data","yan_etki":"Not applicable (observational)","pmid":"39400201","doi":"10.1097/DBP.0000000000001323","diger_kaynak":"PMC11832326"}],"ilgili_ilaclar":["metilfenidat","atomoksetin"],"son_inceleme":"2026-11-01","arastirma_gecmisi":[{"tarih":"2026-10-28","not":"Page published. This first assessment reviewed 17 studies."},{"tarih":"2026-10-28","not":"October 2026 additional review: sources found for this page during searches for other topics were read and added to the page. Secondary ADHD findings from Tourette syndrome and tic disorder studies were added to the text: in the 97-adult controlled study, the larger reduction in tics in those with ADHD was not statistically significant, and the result for ADHD symptoms was not published; in the uncontrolled study with 10 adolescents, the drop in ADHD score was not significant. These studies are in the table of the Tourette Syndrome page; the number of controlled studies in ADHD (1) did not change. The conclusion and strength of evidence did not change."},{"tarih":"2026-10-30","not":"The correction to the Wilson 2026 meta-analysis published in the journal was read: only the axis of one figure and the study counts in a table were corrected; the results on this page did not change."},{"tarih":"2026-10-30","not":"The last sentence of the page's short summary was rewritten in a calmer, more guiding tone: instead of \"Talk to your doctor before you start.\", it now says whom you can talk with, and about what, if you are considering CBD. The conclusion and the strength of evidence did not change."},{"tarih":"2026-11-01","not":"A study in 14 children with PANS that measured ADHD symptoms as a secondary measure was added to the uncontrolled data (Keating 2026, PMID 41513541, full text: Conners p = 0.028); in the previous search it had been left out because it was thought not to measure ADHD symptoms. Because there is no control group, the conclusion and the evidence level did not change."}]},{"id":"rare-developmental-syndromes","baslik":"Rare developmental syndromes: Rett syndrome, 22q11.2 deletion syndrome and Prader-Willi syndrome","grup":"Neurodevelopmental","grup_kodu":"norogelisimsel","tr_id":"nadir-gelisim-sendromlari","kanit_duzeyi":"cok_zayif","kanit_yonu":"veri_yok","kanit_ozet":"Rett syndrome: the only RCT with purified CBD (NCT03848832; 29 girls, aged 2–18, 24 weeks, 5 or 15 mg/kg/day) was stopped early because of difficulty finding participants and COVID-19; 17 girls completed it and the planned statistics were not done; results are only in the ClinicalTrials.gov record: change in RSBQ total score −12.1 with 15 mg/kg/day (SD 13.6; n = 9), −6.1 with placebo (SD 7.2; n = 10), +0.4 with 5 mg/kg/day; CGI-I and CGI-S values similar between groups (no testing); in the placebo group, 4 of 10 girls completed the 24 weeks. In the open-label extension (NCT04252586; 21 girls, up to 20 mg/kg/day, none completed), RSBQ −7.4; serious side effects in 5 girls, 2 deaths, none considered treatment-related. With a full-spectrum, CBDA-dominant extract with 0.08% THC (Keating 2025; 11 girls, 12 weeks, open-label, manufacturer-funded), improvement from baseline in CGI-I (p = 0.028), RSBQ (p = 0.0005) and quality of life. In a phase 1 study with CBDV (Hurley 2022; 5 girls with drug-resistant epilepsy, 10 mg/kg/day), no clear change in non-seizure symptoms; seizures decreased (seizures are described on the Drug-Resistant Epilepsy page). A systematic review covering Rett, autism and fragile X together (Boeri 2026; 17 studies, 2 RCTs) reports, for Rett, only a descriptive reduction in seizures and finds the evidence insufficient for routine use. 22q11.2 deletion syndrome: in an open-label phase 2 study with a synthetic CBD gel applied to the skin (Heussler 2026, INSPIRE; 20 children and teens, aged 4–15, 250 or 500 mg a day, 14 weeks + 24-week extension; manufacturer-funded), the PARS-R anxiety score fell from 14.7 to 8.5 (−41.9%; p = 0.0001), ADAMS total −60.0% (p = 0.0014), ABC-C irritability −45.8% (p = 0.006); CGI-S change in the registry record 0.0; no THC in plasma; the only treatment-related side effects were pain and itching where applied; in the registry record, serious side effects in 3 people across the whole study. In a cross-sectional study of 434 people with the syndrome, regular cannabis use was clearly lower than in healthy controls and people with psychosis, and among people with the syndrome there was no link between any substance use and psychotic disorder (OR 0.80; 95% CI 0.54–1.20; cannabis not looked at separately); the group difference in illegal drug use was not significant after accounting for sex and IQ; in the syndrome group, data came from medical records (Vingerhoets 2019). Prader-Willi syndrome: all three placebo-controlled studies were stopped early, with no peer-reviewed publication: synthetic CBD 40 mg/kg/day in 7 young people (NCT02844933; HQ-CT median −4.5 vs −2; 2 people completed), synthetic CBD 10–40 mg/kg/day in 4 people (NCT05098509; all in the CBD groups, no efficacy data), CBDV 10 mg/kg/day in 6 people (NCT03848481; ABC irritability 22.3 vs 24.0 at baseline, 10.0 vs 10.3 at week 12; groups very different at baseline in age and some scores). The selective CB1 blocker rimonabant (not a cannabis product) had been stopped early with 10 people because of psychiatric side effects (Motaghedi 2011; background, not in the table). The 'Not studied enough' label is based on the evidence for pure CBD: placebo-controlled studies exist, but all were stopped early with few people (4–29), and their direction cannot be read. October 2026 search (PubMed, Cochrane, ClinicalTrials.gov, Europe PMC): in these three syndromes, it found 4 studies started to compare cannabinoids with placebo (1 in Rett, 3 in Prader-Willi; one with CBDV rather than CBD; all stopped early, one could not enroll anyone in the placebo group, none published in a peer-reviewed journal, results in the registry records), 4 uncontrolled studies (3 in Rett, 1 in 22q11.2), 1 systematic review covering Rett and 1 observational study looking at cannabis use in 22q11.2; all are in the table below. There is no controlled study in 22q11.2 deletion syndrome, no Cochrane review of cannabinoids in these syndromes and no study from Turkey. A 40-person placebo-controlled study with the low-THC extract in Rett is registered but has not started enrolling patients; a 14-person open-label study with the same extract ended in December 2025 and has no results.","kanit_duzeyi_metin":"Pure CBD: Very weak (the placebo-controlled studies that started with 29 people in Rett and with 7 and 4 people in Prader-Willi were all stopped early, no statistical tests were done, and the results are only in the registry records; in 22q11.2 deletion syndrome, the only data come from a manufacturer-funded skin gel study in 20 children without a control group). CBDV was not used as a basis for this level because it is a cannabinoid distinct from CBD; THC-containing products were assessed under the THC evidence","kanit_duzeyi_thc_icerenler":"cok_zayif","kanit_duzeyi_thc_icerenler_metin":"Very weak (with THC-containing products, only a single 12-week, manufacturer-funded study without a control group in 11 girls with Rett syndrome, using an extract with 0.08% THC made up mainly of CBDA; no treatment studies with THC-containing products in 22q11.2 deletion and Prader-Willi syndromes)","kaynak_dosya":null,"saf_cbd_sonuc":"In Rett syndrome, the only placebo-controlled study with purified CBD (29 girls, 24 weeks; NCT03848832) was stopped early and published only in the registry record, without statistics: the behavior score fell by an average of 12.1 points with high-dose CBD and 6.1 points with placebo (9 and 10 girls); the doctors' overall impression scores were similar between groups. In its open-label extension (21 girls), the score fell by an average of 7.4 points. In Prader-Willi, two studies with synthetic CBD (7 and 4 people) were stopped early; in one, the overeating score fell by a median of 4.5 points with CBD and 2 points with placebo, and in the other no efficacy data were collected at all. In 22q11.2 deletion syndrome, in 20 children and teens using a pure CBD gel applied to the skin, without a comparison group, the anxiety score fell by about 42% (INSPIRE, manufacturer-funded). With CBDV, a cannabinoid close to but distinct from CBD, no clear change in non-seizure symptoms was seen in 5 girls with Rett; in a 6-person placebo-controlled study in Prader-Willi, irritability was similar. The evidence is very weak: no study is large enough to show or rule out an effect.","thc_icerenler_sonuc":"With THC-containing products, there is only one study, in Rett syndrome: with a full-spectrum cannabis extract containing 0.08% THC and made up mainly of CBDA, the doctor's overall impression (p = 0.028), the behavior scale, anxiety and quality of life improved after 12 weeks in 11 girls aged 5–16; the study had no comparison group and was funded by the companies that developed the product. There are no treatment studies with THC-containing products in 22q11.2 deletion syndrome or Prader-Willi syndrome. The risk of psychosis is high in 22q11.2 deletion syndrome; regular cannabis use was uncommon among people with this syndrome, and within the group no link was found between substance use and psychosis (434 people, cross-sectional), but the safety of THC-containing products in this group has not been studied.","ruhsat":null,"doz_araligi_ozet":"Rett: purified CBD by mouth 5 or 15 mg/kg/day (24 weeks; up to 20 mg/kg/day in the extension); Prader-Willi: synthetic CBD by mouth 10–40 mg/kg/day; 22q11.2: synthetic CBD gel applied to the skin, 250 or 500 mg a day by body weight; CBDV 10 mg/kg/day (Rett and Prader-Willi); the dose of the low-THC extract is not in the abstract","titrasyon_ozet":"In the Rett extension, started at 5 mg/kg/day and increased by 5 mg/kg each week; with CBDV, started at 2.5 mg/kg/day and increased by 2.5 mg/kg each week; for the skin gel, no dose adjustment according to the article (fixed by body weight; the registry record states it could be raised to 500 or 750 mg a day if needed); doses twice a day","yan_etkiler":["Purified CBD, Rett, 24 weeks: serious side effects 2/11 (5 mg/kg), 2/9 (15 mg/kg), 1/9 (placebo); raised ALT and AST and dyskinesia with 15 mg/kg; lethargy 3/9, vomiting and decreased appetite 2/9, diarrhea 2/11 and 2/9 (0 on placebo) (NCT03848832)","Purified CBD, Rett, open-label extension: side effects in 19/21, 7 of them treatment-related; serious side effects in 5 people (respiratory failure, respiratory arrest, seizure and status epilepticus, infection), 2 deaths, none considered treatment-related; vomiting 7, diarrhea 4, decreased appetite 3; ALT >3×ULN 1; QTcB >480 ms 1 (NCT04252586)","Synthetic CBD, Prader-Willi: no serious side effects; diarrhea 2/4 vs placebo 1/3, rash 2/4 vs 0/3 (NCT02844933); with 40 mg/kg/day, diarrhea in both of the 2 people (NCT05098509)","Synthetic CBD gel applied to the skin, 22q11.2: mild side effects in 7/20 people over 14 weeks; the only treatment-related ones were pain (2) and itching (1) where applied; in the registry record, 4 serious side effects in 3 people across the whole study (low calcium, testicular torsion and blood collecting in the scrotum, viral lower respiratory tract infection; the record does not state whether they were related to the gel) (Heussler 2026; NCT05149898)","CBDV: in Rett, definitely related excessive sleepiness (2 events) and increased drooling (1 event) (Hurley 2022); in Prader-Willi, dissociative symptoms in 1/3 people (NCT03848481)","Low-THC, CBDA-dominant extract, Rett: the abstract only says 'safe'; the type and frequency of side effects could not be read (Keating 2025)"],"izlem":["In the studies, blood tests including liver enzymes, ECG and vital signs were monitored at baseline and at visits (NCT04252586; Heussler 2026; Hurley 2022)","In the Rett extension study, weight, QTc interval, menstrual pattern, pubertal stage and IGF-1 were also checked, and participants were asked about suicidal thoughts or self-harm (NCT04252586)","The skin gel was applied to clean, dry, intact skin (upper arm or shoulder); at each visit, side effects and signs of not tolerating the drug were assessed (Heussler 2026)","With CBDV, while the dose was being increased: weekly examinations for the first 28 days and a phone call on days 2 and 4 after each examination; then monthly visits and weekly phone calls for 90 days, followed by a visit every 3 months (Hurley 2022)","Ongoing studies awaiting results (October 2026): in Rett, a 14-person open-label study with the low-THC extract (NCT06621043; ended in December 2025, no results in the registry record) and a 40-person placebo-controlled crossover study (NCT07257978; not yet enrolling, estimated completion October 2028)"],"dikkat":["22q11.2 deletion syndrome: in this syndrome, the risk of psychosis and schizophrenia in adolescence and young adulthood is clearly higher (about 20–25% at ages 18–25, according to an earlier study cited by Vingerhoets 2019); the safety of THC-containing products in this group has never been studied. If the person or their family has a history of psychosis, cannabis products should not be used without consulting a doctor (this is a precautionary recommendation, not a direct study finding)","Use with epilepsy medicines: the 22q11.2 study excluded people taking clobazam, phenobarbital, ethosuximide, felbamate, carbamazepine, phenytoin or vigabatrin and those taking strong CYP3A4 inhibitors or inducers (Heussler 2026); most of the girls in the CBDV study in Rett were also taking valproate or clobazam (Hurley 2022)","Liver: in the controlled study in Rett, a rise in ALT and AST in 1 girl in the high-dose (15 mg/kg/day) CBD group was recorded as a serious side effect (NCT03848832); in the long-term extension, ALT rose above 3 times normal in one of 21 girls (NCT04252586)","Breathing in Rett syndrome: in the extension study, respiratory failure and respiratory arrest were recorded as serious side effects, and there were 2 deaths; they were not considered related to the treatment, but without a control group it is hard to tell (NCT04252586)","People who had used cannabis or cannabinoid products in the past 3 months, or who tested positive for cannabinoids in a urine test, were not enrolled in the studies in these syndromes (Hurley 2022; Heussler 2026)","Product type: the product tested in 22q11.2 and fragile X is a lab-made gel applied to the skin; the product in the positive open-label study in Rett is an extract that contains a little THC and is made up mainly of CBDA. These results cannot be directly applied to CBD oils on the market"],"ilac_etkilesim_notlari":["Detailed information and monitoring recommendations are on the 'epilepsy medicines', 'clobazam' and 'valproate' pages in the site's drug interactions section","The 22q11.2 study (Heussler 2026) excluded people taking the following medicines (a study safety limit, not evidence of an interaction): clobazam, phenobarbital, ethosuximide, felbamate, carbamazepine, phenytoin, vigabatrin; strong CYP3A4 inhibitors or inducers and medicines sensitive to CYP3A4; more than 2 stable psychiatric medicines","In the CBDV study in Rett, 3 of the 5 girls were also taking valproate, 3 clobazam and 3 levetiracetam; whether side effects were related to the treatment was assessed in this multi-drug setting (Hurley 2022)"],"dogrulanamayan":["The full text of the study with the low-THC extract in Rett (Keating 2025) could not be read (publisher access blocked): the dose, side effects and effect sizes are not in the abstract. It could not be verified whether the open-label registry record with the same product, which enrolled 14 girls and ended in December 2025 (NCT06621043; according to the record, the dose started at 5 mg/kg/day and rose to at most 20 mg/kg/day over 4 weeks), is the same study as this article.","The full text of the systematic review that also covers Rett (Boeri 2026) could not be read: which Rett studies it included, how many patients with Rett there were and the certainty-of-evidence levels are not known.","The cannabis-specific percentages of the cannabis use study in 22q11.2 deletion syndrome (Vingerhoets 2019) are in the article's tables; the tables could not be read, so only the comparison given in the text is used on this page.","The percentages in the abstract of the 22q11.2 study (Heussler 2026) differ from those in the main text (e.g., 40.6% and 41.9% for the anxiety score; 36.3% and 45.8% for irritability); this page uses the numbers in the main text. The article states that there were no serious side effects in the first 14 weeks, while the registry record states that 3 people had serious side effects across the whole study; whether they were related to the treatment is not given in the record.","The open-label extension of the synthetic CBD program in Prader-Willi (NCT03458416) was ended with 2 people, and no data were reported in the registry record, citing confidentiality. In the CBDV study in Rett, the monthly seizure reduction is given as 79% in the abstract and 82% in the main text."],"calismalar":[{"ad":"NCT03848832 (Rett syndrome, registry results)","tasarim":"Double-blind, placebo-controlled, 3-arm parallel RCT (phase 3). Stopped early because of difficulty finding participants and the COVID-19 pandemic; because the groups were small, the planned statistical comparisons were not done. As of October 2026, no peer-reviewed publication; results from the ClinicalTrials.gov record. Run by the manufacturer (Jazz Pharmaceuticals / GW)","n":"29 randomized (10 CBD 5 mg/kg/day, 9 CBD 15 mg/kg/day, 10 placebo); 17 completed (7 / 6 / 4)","populasyon":"Rett syndrome, aged 2–18 (mean 9.7), all girls","urun":"Purified, plant-derived CBD oral solution (GWP42003-P, 100 mg/mL); placebo solution","urun_turu":"saf_cbd","doz":"CBD 5 or 15 mg/kg/day, divided into two doses a day","titrasyon":"No details in the registry record","sure":"24 weeks","sonuc":"Primary outcome (change at week 24 in the total score of the caregiver-completed Rett Syndrome Behaviour Questionnaire, RSBQ, 15 mg/kg/day vs placebo): mean −12.1 (SD 13.6; 9 people) vs −6.1 (SD 7.2; 10 people); no statistical testing was done. +0.4 (SD 12.5) in the 5 mg/kg/day group. Baseline score 45.9 in the 15 mg/kg group, 50.0 on placebo, 39.8 in the 5 mg/kg group. In the placebo group, only 4 of the 10 girls completed the 24 weeks; the registry record still gives the week 24 change for 10 girls and does not say which measurement was used for those who left early. Doctor's overall impression (CGI-I, week 24; 15 mg/kg / 5 mg/kg / placebo) 2.9 / 3.2 / 3.1; change in illness severity (CGI-S) −0.1 / −0.1 / 0.0. On the sleep scale (CSHQ; same order) −5.0 / −1.6 / −3.7; on the anxiety-fear subscale −1.3 (15 mg/kg) vs placebo −1.7. Because the groups were very small and no statistics were done, no conclusion about effect can be drawn","yan_etki":"Serious side effects 2/11 (5 mg/kg), 2/9 (15 mg/kg), 1/9 (placebo): one COVID-19 case in each group; lower respiratory tract infection in the 5 mg/kg group; raised liver enzymes (ALT and AST) and involuntary movements (dyskinesia) in the 15 mg/kg group. Diarrhea 2/11, 2/9, 0/9; lethargy 0, 3/9, 0 (sleepiness in 1 person in the 5 mg/kg group); vomiting and decreased appetite only in the 15 mg/kg group (2/9). 1 person stopped because of side effects. Because 1 person assigned to placebo was mistakenly given CBD, the groups in the side effect table have 11 / 9 / 9 people. No deaths","pmid":null,"doi":null,"diger_kaynak":"ClinicalTrials.gov NCT03848832 (GWND18064; results December 29, 2021, last updated September 2, 2022). Its open-label extension NCT04252586 is in a separate row. No peer-reviewed publication found in PubMed (October 30, 2026)"},{"ad":"NCT02844933 (Prader-Willi syndrome, registry results)","tasarim":"Double-blind, placebo-controlled parallel RCT (phase 2). Terminated early with 7 people because the original manufacturer (Insys Therapeutics) went bankrupt and stopped all its studies. As of October 2026, no peer-reviewed publication; results from the ClinicalTrials.gov record (the responsible manufacturer is now Radius Pharmaceuticals)","n":"7 randomized (4 CBD / 3 placebo); 2 completed (1 / 1)","populasyon":"Prader-Willi syndrome, aged 8–17 (mean 12.7), overeating (hyperphagia) behavior","urun":"Oral CBD solution (according to the program's extension record NCT03458416, non-plant-derived, pharmaceutical-grade synthetic CBD); matched placebo","urun_turu":"saf_cbd","doz":"40 mg/kg/day, divided into two doses a day, with food","titrasyon":"No details in the registry record","sure":"13 weeks (planned)","sonuc":"Primary outcome (HQ-CT hyperphagia questionnaire, change from baseline at week 13): median −4.5 (lowest −14, highest −3; 4 people) vs placebo −2 (−12 to 2; 3 people); no statistical testing; the registry record gives week 13 values for all 7 people and does not say which measurement was used for those who left early. Median change in body weight −1.05 kg vs +1.3 kg (median baseline weight 88.4 kg vs 56.7 kg); responders 1/4 vs 1/3. Other measures (overall impression, eating questionnaire, quality of life, physical activity) were not collected because of early termination. With only 7 people and 2 completers, no conclusion can be drawn","yan_etki":"No serious side effects. Diarrhea 2/4 (CBD) vs 1/3 (placebo); rash 2/4 vs 0/3; abdominal cramps, skin infections (impetigo, cellulitis) and ear infection in one person each in the CBD group; seizure in 1 person in the placebo group","pmid":null,"doi":null,"diger_kaynak":"ClinicalTrials.gov NCT02844933 (results August 1, 2023). Its open-label extension NCT03458416 (2 people enrolled; no data reported, citing confidentiality). No peer-reviewed publication found in PubMed (October 30, 2026)"},{"ad":"NCT03848481 (Prader-Willi syndrome, CBDV, registry results)","tasarim":"Double-blind, placebo-controlled parallel RCT (phase 2; single center, Montefiore Medical Center, New York). Stopped early with 6 people because adequate funding could not be found; no robust statistical analysis was done (only an effect size for one secondary outcome). As of October 2026, no peer-reviewed publication; results from the ClinicalTrials.gov record. Investigator-initiated; collaborators were a Prader-Willi research foundation and GW Pharmaceuticals, which supplied the product","n":"6 randomized (3 CBDV / 3 placebo); 5 completed (2 / 3)","populasyon":"Prader-Willi syndrome, aged 5–30 (mean 14.7; 19.3 in the CBDV group, 10 in the placebo group)","urun":"Cannabidivarin (CBDV): a separate cannabinoid close to CBD, derived from the cannabis plant; THC below 0.2%; matched placebo","urun_turu":"cbn_diger","doz":"10 mg/kg/day","titrasyon":"No details in the registry record","sure":"12 weeks","sonuc":"Primary outcome (irritability subscale of the ABC behavior scale): mean 22.3 (CBDV, 3 people) and 24.0 (placebo, 3 people) at baseline, 10.0 (SD 5.7; 2 people) and 10.3 (SD 4.2; 3 people) at week 12; a similar decrease in both groups. Overeating score (HQ-CT) 17.3 and 15.7 at baseline, 11.0 and 14.3 at week 12; in repetitive behaviors (CY-BOCS), from 11.7 to 7.0 (1 person) and from 13.7 to 13.5. On the rigidity scale (MERS-R-PWS; with missing data filled in for the CBDV group), 28.3 and 28.0 at baseline, 13.7 and 28.3 at week 12 (effect size in the registry record d = 1.89). The lethargy and social withdrawal score was much higher in the CBDV group at baseline (16.3 vs 4.0) and stayed higher at week 12 (12.5 vs 3.7). No statistical testing was done; the groups had 2–3 people and differed greatly at baseline in age (mean 19.3 vs 10 years) and in some scores, so no conclusion can be drawn","yan_etki":"No serious side effects. Dissociative symptoms (feeling detached) in 1/3 people in the CBDV group; no side effects in the placebo group. 1 person in the CBDV group withdrew from the study","pmid":null,"doi":null,"diger_kaynak":"ClinicalTrials.gov NCT03848481 (results May 7, 2026). No peer-reviewed publication found in PubMed (October 30, 2026)"},{"ad":"NCT05098509 (Prader-Willi syndrome, registry results)","tasarim":"Planned as a double-blind, placebo-controlled, 4-arm RCT (phase 2/3). The manufacturer (Radius Pharmaceuticals) stopped it because company priorities changed, for reasons unrelated to safety; all 4 people enrolled were assigned to the CBD groups, no one was enrolled in the placebo group, and no efficacy analysis was done. As of October 2026, no peer-reviewed publication; results from the ClinicalTrials.gov record","n":"4 (1 person 10 mg/kg, 1 person 20 mg/kg, 2 people 40 mg/kg; placebo 0); none completed","populasyon":"Prader-Willi syndrome, aged 8–65 (age and sex not reported, citing confidentiality)","urun":"Oral solution containing synthetic CBD (RAD011); matched placebo","urun_turu":"saf_cbd","doz":"10, 20 or 40 mg/kg/day, with food","titrasyon":"No details in the registry record","sure":"34 weeks planned; longest treatment 68 days","sonuc":"No efficacy data: the overeating (HQ-CT), irritability and overall impression measures were not analyzed because of early termination. The row is in the table only for safety information and so that the result of an unpublished study is transparent","yan_etki":"No serious side effects. Diarrhea in both of the 2 people in the 40 mg/kg group; one person each with skin inflammation (dermatitis; 10 mg/kg), lethargy (20 mg/kg), restlessness, headache, tiredness and ear discomfort (40 mg/kg)","pmid":null,"doi":null,"diger_kaynak":"ClinicalTrials.gov NCT05098509 (results October 19, 2023). The planned open-label extension NCT05387798 was withdrawn before it ever started (program terminated). No peer-reviewed publication found in PubMed (October 30, 2026)"},{"ad":"Heussler 2026 (INSPIRE)","tasarim":"Open-label, multicenter phase 2 study (Australia and 1 US center; February 2020–November 2022); no control group. After 14 weeks of treatment, an optional 24-week extension for participants whose irritability improved by at least 35% or whom the physician considered suitable. Sample size based on feasibility, not on a power calculation. Funded by the manufacturer (Harmony Biosciences), which also paid for writing support; 2 of the 5 authors are manufacturer employees and 3 received research funding from the manufacturer (all five have ties to the manufacturer). Registered on ClinicalTrials.gov about 20 months after the study started (October 2021)","n":"20 started, 17 completed; 16 in the efficacy analysis; 13 moved into the extension, 11 analyzed","populasyon":"Genetically confirmed 22q11.2 deletion syndrome, aged 4–15 (mean 9.9; inclusion criterion 4–17 years), 60% male; illness severity at least moderate (CGI-S ≥4) and high anxiety score (PARS-R ≥10); at most 2 psychiatric medicines, stable for 6 months","urun":"ZYN002: lab-made (synthetic) CBD gel applied to the skin (upper arm or shoulder); no THC detected in plasma","urun_turu":"saf_cbd","doz":"125 mg every 12 hours (250 mg a day) for those weighing ≤35 kg, 250 mg every 12 hours (500 mg a day) for those >35 kg","titrasyon":"None according to the article (fixed dose by body weight, added to existing treatment); the product description in the registry record states it could be raised to 500 or 750 mg a day if needed","sure":"14 weeks + optional 24 weeks (38 weeks in total)","sonuc":"The primary outcome was safety and tolerability (in the side effects column). Efficacy (secondary, no control group): the PARS-R anxiety scale fell on average from 14.7 to 8.5 (−41.9%; p = 0.0001; in the abstract −40.6%, p = 0.0005); ADAMS total score −60.0% (p = 0.0014; in the abstract −45.3%); ABC-C irritability −45.8% (p = 0.006; in the abstract −36.3%, p = 0.0055) and inappropriate speech −43.3% (p = 0.040); the reductions in withdrawal, stereotypy and hyperactivity were not significant. In the doctors' assessment, 75% of participants improved and 62.5% improved markedly; in contrast, the illness severity score (CGI-S) in the registry record did not change at week 14 (mean 0.0). In the extension (only those whose irritability had improved by at least 35% at week 14 or whom the physician considered suitable continued; 11 people analyzed), the reductions in anxiety and irritability were maintained. Because there was no placebo group, it is not known how much of the improvement is due to the gel; the authors write that a placebo-controlled study is needed","yan_etki":"In the first 14 weeks, 13 side effects in 7 of 20 people (35%), all mild; 3 treatment-related side effects: pain (2) and itching (1) where applied; 1 person stopped because of side effects not related to treatment; no meaningful changes in lab tests, ECG or vital signs. In the registry record, across the whole study (about 306 days), side effects in 12/20 people and serious side effects in 3 people (low calcium, testicular torsion, blood collecting in the scrotum, viral lower respiratory tract infection); their relationship to treatment is not stated in the record","pmid":"41888667","doi":"10.1186/s11689-026-09687-z","diger_kaynak":"PMC13141530. ClinicalTrials.gov NCT05149898 (ZYN2-CL-031; results March 9, 2026; collaborator Zynerba). The percentages in the abstract and the main text differ (e.g., PARS-R 40.6% and 41.9%); both are given in the row"},{"ad":"NCT04252586 (Rett syndrome, open-label extension, registry results)","tasarim":"Open-label extension study (phase 3; 21 girls who had taken part in the main study NCT03848832; the main study's flow chart appears to show 17 girls completing the 24 weeks, and the registry record does not explain this difference); no control group. Stopped early because of difficulties in the main study and COVID-19; no one completed it. As of October 2026, no peer-reviewed publication; results from the ClinicalTrials.gov record. Run by the manufacturer (Jazz Pharmaceuticals / GW)","n":"21 (moved over from the main study; 0 completed)","populasyon":"Rett syndrome, aged 2–18 (mean 10.2), all girls","urun":"Purified, plant-derived CBD oral solution (GWP42003-P, 100 mg/mL)","urun_turu":"saf_cbd","doz":"Started at 5 mg/kg/day, up to at most 15 mg/kg/day; up to at most 20 mg/kg/day if needed","titrasyon":"After 1 week, increases of 5 mg/kg/day per week based on response and tolerability (at the investigator's discretion)","sure":"Up to 104 weeks planned; side effects were tracked from the start of the main study to day 767","sonuc":"The primary outcomes were safety (in the side effects column). Secondary (uncontrolled): mean change in RSBQ total score from the start of the main study −7.4 (SD 14.9); doctor's overall impression (CGI-I) mean 3.3 (between 'minimally improved' and 'no change'), illness severity (CGI-S) 4.3; −3.0 on the sleep scale; +0.7 on the motor behavior scale. Because there was no placebo group and everyone left early, no conclusion about effect can be drawn","yan_etki":"Side effects in 19 of 21 people; treatment-related in 7; 3 stopped because of side effects (1 treatment-related). Serious side effects in 5 people (respiratory failure 2, respiratory arrest 1, seizure and status epilepticus, lower respiratory tract infection, COVID-19, surgical wound infection, worsening of Rett syndrome); none considered treatment-related. The registry record lists 2 deaths. Most common: vomiting 7, diarrhea 4, fever 4, decreased appetite 3, restlessness 3, seizure 3. ALT above 3 times normal in 1 person. On ECG, QTcB >450 ms at some visits in at most 4 people, >480 ms in 1; none >500 ms","pmid":null,"doi":null,"diger_kaynak":"ClinicalTrials.gov NCT04252586 (results August 8, 2022). The main study NCT03848832 is in a separate row. No peer-reviewed publication found in PubMed (October 30, 2026)"},{"ad":"Keating 2025 (NTI164, Rett syndrome)","tasarim":"Open-label phase 1/2 study; no control group; baseline and week 12 compared with a paired t test. Funded by the manufacturer (Fenix Innovation Group and Neurotech International); 4 of the 8 authors work at these companies (3 at Fenix, 1 at Neurotech); no declaration of interests in the PubMed record","n":"11","populasyon":"Girls with Rett syndrome carrying a disease-causing change in the MECP2 gene, aged 5–16 (Australia)","urun":"NTI164: full-spectrum cannabis plant extract, 0.08% THC; according to the article on the autism study with the same product, the main component is CBDA, the acid form of CBD","urun_turu":"thc_iceren","doz":"Twice a day; dose not in the abstract (full text could not be read)","titrasyon":"Not reported (in the abstract; the full text could not be read)","sure":"12 weeks","sonuc":"The primary outcome (doctor's impression of overall improvement, CGI-I) improved at week 12 (p = 0.028); improvement also in communication, mental alertness, eye contact, attention and anxiety. Illness severity (CGI-S, p = 0.008), RSBQ total score (p = 0.0005), the general mood, breathing problems, repetitive face movements and fear-anxiety subscales, quality of life (p = 0.0002) and caregiver burden (p = 0.006) also improved. Effect sizes are not in the abstract. Because there was no placebo group, the caregivers and doctors knew which product was used and the study was manufacturer-funded, it is not known how much of the improvement is due to the extract","yan_etki":"The abstract only says 'safe'; the type and frequency of side effects are not in the abstract (full text could not be read)","pmid":"40568811","doi":"10.1111/jpc.70122","diger_kaynak":"Two studies with the same product are registered in Rett: open-label NCT06621043 (14 girls, aged 5–20, ended in December 2025, no results in the registry record; its relationship to this article could not be verified) and placebo-controlled crossover NCT07257978 (40 people, not yet enrolling). That the product is CBDA-dominant: Keating 2026 (autism, PMID 42561512; a row on the site's Autism page)"},{"ad":"Hurley 2022 (CBDV, Rett syndrome)","tasarim":"Investigator-initiated; open-label, single-center phase 1 dose-escalation study (Sydney Children's Hospital, February 2019–August 2020); no control group. Funded by the NSW Ministry of Health; product supplied by GW Research; the authors declared no conflicts of interest","n":"6 found eligible, 5 started and were analyzed","populasyon":"Girls with Rett syndrome with an MECP2 change and drug-resistant epilepsy, aged 6–13.7 (median 12.6)","urun":"Cannabidivarin (CBDV) oral solution, plant extract, 50 mg/mL; THC below 0.2% by weight","urun_turu":"cbn_diger","doz":"Target 10 mg/kg/day (average reached 9.9; 9.6–10.1), divided into two doses a day","titrasyon":"Started at 2.5 mg/kg/day and increased by 2.5 mg/kg every 7 days","sure":"13.75–15.5 months (treatment duration varied by patient)","sonuc":"No clear change was seen in Rett's non-seizure symptoms, the question for this page: in the 3 girls with both a baseline and a final RSBQ score, median 34 to 33; slight improvement of 3% and 5% in two, 20% worsening in one; most domains of the Rett symptom severity scale did not change, with small improvements in mental alertness, attention and eye contact. Seizures (secondary outcome): monthly seizure counts fell in all 5 girls, median reduction 79% in the abstract and 82% in the main text; no clear change on EEG. Because the study is very small and uncontrolled, no conclusion can be drawn","yan_etki":"77 side effects, 77.9% mild; 3 definitely related events: excessive sleepiness (2) and increased drooling (1); 24 events possibly related; none of the 16 serious side effects was considered definitely related (the 5 possibly related ones were attributed by experts to Rett itself or other causes); no one stopped the drug. The dose was briefly reduced in 3 patients","pmid":"35364618","doi":"10.1111/epi.17247","diger_kaynak":"PMC9544893. The seizure result is the subject of the Drug-Resistant Epilepsy page. On May 16, 2022, a correction was made that only added an open-access funding sentence"},{"ad":"Boeri 2026","tasarim":"Systematic review (PRISMA 2020; GRADE and design-specific bias tools); randomized and non-randomized studies; descriptive pooled rates only","n":"17 studies (2 RCTs; the rest observational studies and case series); number of Rett studies and patients not in the abstract","populasyon":"Autism, fragile X and Rett syndrome under 18 years of age","urun":"CBD, CBDV, THC or mixtures of these","urun_turu":"karma","doz":null,"titrasyon":null,"sure":null,"sonuc":"For Rett syndrome, the abstract reports only a reduction in seizures (descriptive pooled rates); there is no separate result in the abstract for Rett's behavioral and other symptoms. Across all diagnoses, side effects were mostly mild to moderate and the dropout rate was low. The authors' conclusion: there is possible benefit for some behavioral symptoms and co-occurring epilepsy, but the current evidence is not enough to support routine use; well-designed RCTs are needed","yan_etki":"Mild to moderate side effects, low dropout rate (all diagnoses together)","pmid":"42339654","doi":"10.1177/10445463261462382","diger_kaynak":"The full text is not open access; which Rett studies it included and the GRADE levels could not be read. The authors declared no conflicts of interest. For autism and fragile X, there are more comprehensive reviews on the site's Autism page"},{"ad":"Vingerhoets 2019","tasarim":"Cross-sectional comparative study. Substance use was collected in the 22q11.2 group from medical records (asked systematically in the psychiatric interview) and self-report, and in the comparison groups with a structured interview (Composite International Diagnostic Interview, CIDI); the groups were selected from different centers and in different ways. In the 22q11.2 group, psychiatric diagnosis, IQ and COMT genotype were also determined. Supported by the Netherlands health research organization (ZonMw); the authors declared no conflicts of interest","n":"833: 434 people with 22q11.2 deletion syndrome, 265 patients with psychosis without the deletion, 134 healthy controls","populasyon":"People with 22q11.2 deletion syndrome over 15 years of age (4 centers in the Netherlands, Belgium and Canada; 165 of them, 38.1%, had a psychotic disorder); comparison groups from a psychosis study in Amsterdam (aged 15–60)","urun":"Cannabis and other substances (alcohol, nicotine, illegal drugs; self-reported)","urun_turu":"thc_iceren","doz":null,"titrasyon":null,"sure":null,"sonuc":"Any substance use: 36.9% in 22q11.2 deletion syndrome; 83.6% in healthy controls, 87.9% in patients with psychosis (p < 0.001). Substance use disorder 1.2%. Regular (daily or weekly) cannabis use was clearly lower in the 22q11.2 group than in the other two groups (χ² = 48.2; p < 0.001); none of the substances other than cannabis was used weekly. The group difference in illegal drug use, including cannabis, was no longer significant after accounting for sex and IQ (p = 0.162). Within the 22q11.2 group, no link was found between any substance use and psychotic disorder (OR 0.80; 95% CI 0.54–1.20); this analysis does not look at cannabis separately. Cross-sectional study, and the samples were collected from clinics (according to the authors, not fully representative of the population): it does not show whether cannabis raises the risk of psychosis in this syndrome. According to an earlier study cited by the authors in the introduction, schizophrenia spectrum disorders occur in about 20–25% of people with this syndrome at ages 18–25 and in about 40% over age 25","yan_etki":null,"pmid":"30604657","doi":"10.1192/bjp.2018.258","diger_kaynak":"The cannabis-specific percentages are in Table 2 and the supplementary tables of the article; these tables could not be read (no numbers in the text). A smaller US study points the same way: Amir 2023, PMID 37151981 (tobacco, alcohol and cannabis use lower than in controls in 89 deletion carriers)"}],"son_inceleme":"2026-10-31","arastirma_gecmisi":[{"tarih":"2026-10-31","not":"Page published. This first assessment reviewed 10 studies."}]}]}