Nabiximols Did Not Affect Blood Pressure or Heart Rate in Post-Stroke Patients | Research

The takeaway

In a randomized crossover trial of 34 post-stroke patients, nabiximols (cannabis-based spray) for spasticity did not cause blood pressure changes, heart rate changes, or any cardiovascular events, supporting its cardiac safety.

Neurologists treating post-stroke spasticity; cardiologists assessing cannabis medication safety; rehabilitation physicians.

Zero cardiovascular events in 34 post-stroke patients on nabiximols

What the researchers found

No arrhythmic events were recorded. Blood pressure and heart rate showed no pathological fluctuations. No cardiovascular or cerebrovascular events occurred. Blood pressure and heart rate did not change during nabiximols treatment compared to baseline, even at the highest dosage.

Why it matters

Post-stroke patients are at high cardiovascular risk, making safety data for any medication critical. This study provides reassurance that nabiximols can be used for spasticity in this vulnerable population without cardiac complications.

The numbers in context

34 patients completed the study. 31 on antihypertensives, 12 on beta-blockers. Zero arrhythmic events. Zero cardiovascular or cerebrovascular events. Blood pressure and heart rate unchanged from baseline to highest dose.

How the study worked

Ancillary cardiovascular safety analysis from SativexStroke trial: randomized, double-blind, placebo-controlled, crossover study. 34 post-stroke patients (31 on antihypertensives, 12 on beta-blockers) received nabiximols or placebo for 1-month periods. Blood pressure and heart rate compared between lowest and highest dosage periods.

What this study cannot tell us

Small sample size (34). One-month treatment period may not capture long-term cardiovascular effects. Most patients were on antihypertensives that could mask cannabis cardiovascular effects. The controlled dosing of nabiximols may not reflect real-world cannabis use patterns.

How to read the evidence

Moderate: randomized crossover design from a registered trial, but small sample and limited duration.

When this study was published

Published in 2022.

The bigger picture

Cannabis-related cardiovascular concerns have limited its use in high-risk populations. This study suggests that pharmaceutical-grade nabiximols, with controlled dosing and slow absorption, may be safer than recreational cannabis for cardiovascular patients.

Questions still open

Would similar cardiovascular safety be seen with other cannabis formulations? Is the slow absorption of oromucosal nabiximols key to its cardiac safety? Would longer treatment periods reveal delayed cardiovascular effects?

Common questions

Is cannabis medicine safe after a stroke?

In this trial, nabiximols (a pharmaceutical cannabis spray) did not cause any blood pressure, heart rate, or cardiovascular problems in 34 post-stroke patients over one month. However, this applies to controlled pharmaceutical dosing, not recreational cannabis.

Does nabiximols affect blood pressure?

Not in this study. Blood pressure remained unchanged from baseline even at the highest nabiximols dose, including in patients already taking blood pressure medications.

Read the original research

Nabiximols effect on blood pressure and heart rate in post-stroke patients of a randomized controlled study.

Frontiers in cardiovascular medicine, 9, 990188

View on PubMed ↗Publisher’s paper ↗

Citation

Rosa, Gian Marco; Puce, Luca; Mori, Laura; Currà, Antonio; Fattapposta, Francesco; Porto, Italo; Bragazzi, Nicola Luigi; Trompetto, Carlo; Marinelli, Lucio. (2022). Nabiximols effect on blood pressure and heart rate in post-stroke patients of a randomized controlled study.. Frontiers in cardiovascular medicine, 9, 990188. https://doi.org/10.3389/fcvm.2022.990188