| Symptom | Other considerations | Practical clinical recommendation |
| Most common[1] |
| Drowsiness/fatigue | - Exacerbated by mixing with other sedating medications.[2]
| - Start at a low THC dose and increase slowly when initiating.
- Reduce THC dose and increase CBD dosing.
- Do not mix with other sedating medications.
|
| Dizziness | | - Start at a low THC dose and increase slowly when initiating.[3]
- Reduce THC dose.
|
| Dry mouth | - Risk reduced when starting at a low THC dose and increasing slowly.[3]
| |
| Anxiety | - Dose-dependent effect driven by THC; lower THC doses may reduce anxiety, while high doses worsen anxiety.[4] CBD has been shown to reduce anxiety.[5]
| - Start at a low THC dose and increase slowly when initiating.
- Use a product with more CBD.
|
| Cough, phlegm, bronchitis | - With inhaled cannabis only.
- Worsened when inhaled in papers that contain nicotine (eg, cigar papers) or if loose leaf tobacco is added to cannabis due to nicotine/tobacco exposure.
- Vaporized cannabis may produce fewer toxins than combusted cannabis and be safer.[6]
| - Avoid inhaled cannabis if possible
- If using inhaled cannabis, vaporized may be safer than combusted.
- Eliminate any tobacco products coadministered with cannabis.
|
| Nausea | | - Start at a low THC dose and increase slowly when initiating.
- Reduce THC dose.
|
| Cognitive effects | - Resolves after days to weeks of abstinence.
| - Start at a low THC dose and increase slowly when initiating.
- Reduce THC dose and increase CBD dose.
- Reduce polypharmacy.
|
| Common[1] |
| Intoxication | - Dose dependent and driven by THC.
| - Start at a low THC dose and increase slowly when initiating.
- Reduce THC dose.
|
| Blurred vision | | - Start at a low THC dose and increase slowly when initiating.
- Reduce THC dose.
|
| Headache | | - Start at a low THC dose and increase slowly when initiating.
- Reduce THC dose.
|
| Cannabis use disorder | - Occurs in 8 to 12% of people who use unregulated cannabis for adult-use purposes.[7,8]
| - Initiate/refer for treatment.
- Discuss harm reduction options.
|
| Rare[1] |
| Orthostatic hypotension | | - Start at a low THC dose and increase slowly when initiating.
- Reduce THC dose and increase CBD dose.
- Reduce polypharmacy.
|
| Psychosis/paranoia | - Dose dependent and caused by high doses of THC.
- Combining THC with CBD associated with less psychosis.
| - Starting at a low THC dose and increasing slowly when initiating reduces the risk of developing psychosis.
- Reduce THC dose versus cease THC use.
|
| Depression | | |
| Ataxia/dyscoordination | | - Start at a low THC dose and increase slowly when initiating.
- Reduce THC dose.
|
| Tachycardia | | - Start at a low THC dose and increase slowly when initiating.
- Reduce THC dose.
|
| Cannabis hyperemesis | - Should be diagnosed using the Venkatesan criteria.[9]
| - Treatment is abstinence from cannabis for months.
- Clinicians should be aware of and manage symptoms of cannabis withdrawal.
|
| Diarrhea | | |
