title: Sativex-induced neurobehavioral effects: causal or concausal? A practical advice!
abstract: Nabiximols (Sativex) is an oromucosal spray, containing delta-9 tetrahydrocannabinol (THC) and cannabidiol (CBD), used as treatment for unresponsive spasticity in multiple sclerosis (MS) patients. Sativex is thought to not affect cognition or induce any psychiatric problem at the doses generally used. Nonetheless, it is known that the concomitant use of more than one muscle-relaxant drugs can result in additive neuropsychiatric effects. Herein we describe a case of a woman affected by MS and treated with baclofen and methylprednisolone, who developed important behavioral changes, including suicidal ideation, after 4 weeks of Sativex administration. We are not completely able to state if Sativex alone was responsible for our patient's psychiatric symptoms, in reason of the concomitant use of the other drugs.In conclusion, physicians should pay more attention when prescribing drugs to MS patients affected by spasticity, including Sativex, since neurobehavioral side effects may emerge especially in predisposed individuals.
authors.affiliation: IRCCS Centro Neurolesi "Bonino-Pulejo", Contrada Casazza, 98124, Messina, Italy. margheritarusso@virgilio.it.
authors.forename: Margherita
authors.initials: M
authors.lastname: Russo
authors.affiliation: IRCCS Centro Neurolesi "Bonino-Pulejo", Contrada Casazza, 98124, Messina, Italy. carmel.rifici@gmail.com.
authors.forename: Carmela
authors.initials: C
authors.lastname: Rifici
authors.affiliation: IRCCS Centro Neurolesi "Bonino-Pulejo", Contrada Casazza, 98124, Messina, Italy. edoardo.sessa@virgilio.it.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Sessa
authors.affiliation: IRCCS Centro Neurolesi "Bonino-Pulejo", Contrada Casazza, 98124, Messina, Italy. gdaleo@gmail.com.
authors.forename: Giangaetano
authors.initials: G
authors.lastname: D'Aleo
authors.affiliation: IRCCS Centro Neurolesi "Bonino-Pulejo", Contrada Casazza, 98124, Messina, Italy. pbramanti@virgilio.it.
authors.forename: Placido
authors.initials: P
authors.lastname: Bramanti
authors.affiliation: IRCCS Centro Neurolesi "Bonino-Pulejo", Contrada Casazza, 98124, Messina, Italy. Salbro77@tiscali.it.
authors.forename: Rocco Salvatore
authors.initials: RS
authors.lastname: Calabrò
mesh_terms: D002185:Cannabidiol / Q000008:administration & dosage / Q000009:adverse effects*; D013759:Dronabinol / Q000008:administration & dosage / Q000009:adverse effects*; D004338:Drug Combinations; D005260:Female; D006801:Humans; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000188:drug therapy / Q000523:psychology*; D016728:Self-Injurious Behavior / Q000209:etiology*; D059020:Suicidal Ideation
chemical_list: D004338:Drug Combinations; D002185:Cannabidiol; D013759:Dronabinol; C587251:nabiximols