Eventos adversos relacionados a terapêutica com canabinoides em pacientes com insônia: uma revisão de escopo

Abstract

Introduction: Insomnia is a prevalent disorder associated with a negative impact on quality of life and various comorbidities. Conventional pharmacological treatments have significant limitations, such as dependence, tolerance, and adverse effects. In this context, cannabinoids have been studied as a therapeutic alternative, although they can also trigger adverse events (AEs). Objectives: To map the AEs related to the use of cannabinoids in the treatment of insomnia, considering their frequency, severity, relationship with different compounds (THC, CBD, CBN), and potential dose-dependency. Methodology: This is a scoping review conducted according to PRISMA-ScR guidelines. The search was performed in January 2025 in the PubMed, LILACS, Cochrane Library, and Web of Science databases, in addition to gray literature. Studies on adults diagnosed with insomnia treated with cannabinoids were included, with no language or year restrictions. Data selection and extraction were performed by two independent reviewers. Results: A total of 767 articles were identified, of which 5 met the inclusion criteria, covering 182 participants. The interventions involved formulations containing THC, CBD, and CBN. Most studies described an improvement in insomnia symptoms. AEs were frequent but generally mild and transient, such as dry mouth, fatigue, dizziness, and nausea. THC-containing preparations showed a higher incidence of neurological and gastrointestinal effects, while isolated CBD showed a more favorable safety profile. In some studies, a dose-dependent relationship was observed, with higher doses of THC associated with dizziness, vertigo, and tachycardia. Conclusion: Cannabinoids have therapeutic potential in the management of insomnia and are generally well-tolerated. Although the reported AEs are predominantly mild, there are relevant differences between the compounds, with THC associated with a higher number of adverse effects and CBD demonstrating better safety. The methodological heterogeneity and the reduced number of studies highlight the need for more robust and long-term clinical trials to comprehensively evaluate the long-term safety of cannabinoids.