CBD / drug interactions

CBD / Drug Interactions

As demand for cannabidiol (CBD) increases, it is gaining significant attention for its potential to relieve symptoms of insomnia, anxiety, chronic pain and a host of other health problems.

Research to date has progressively shown that CBD is very safe to use even at high doses and has few side effects, which are minor. However, there is one caveat: CBD can interact with certain drugs. The question is how the body metabolizes certain substances.

Before trying CBD, it is therefore essential to talk to your doctor about all the prescription and prescription and over-the-counter medications you are taking. CBD is considered harmless, but there are many drug interactions to avoid with prescription drugs.

Here is an overview of the importance of this topic.

CAN CBD INTERACT WITH MY MEDICATIONS?

The answer is yes. CBD inhibits the enzyme cytochrome P450which is involved in the metabolism of many drugs.

This is also the case with grapefruit, which inhibits the same group of enzymes. For this reason, doctors advise patients not to eat grapefruit shortly before or after taking a drug [11]. By inhibiting cytochrome P450, CBD can either reduce or increase the effects of other medications. In some situations, the doctor may be advised to monitor the patient's blood levels of other medications while taking CBD. See CBD and Drug Interactions: The Role of Cytochrome P450 for more information.

CBD is therefore normally safe, but it can cause some adverse effects, especially if taken in large quantities.

WHY IS CYP450 IMPORTANT WITH RESPECT TO CBD AND DRUGS?

The CYP450 family of enzymes is responsible for the metabolism of several cannabinoids, including CBD, as research shows. Specifically, CYP3A4, an important enzyme within the CYP450 family, performs this task. But in the process, CBD also interferes with CYP3A4.

The CYP3A4 enzyme is responsible for metabolizing approximately 60% of clinically prescribed drugs. prescribed in the clinic. But if CBD inhibits CYP3A4it can't work as effectively to break down drugs in your system.[2]

The reverse can also occur. Many drugs inhibit CYP3A4. If you then take CBD while taking these drugs, your body cannot process CBD as effectively.

If your body metabolizes a drug too slowly, you may have more drug in your system than you expected - even if you have been taking your dosage correctly. An increase in the level of a drug in your system could exaggerate its effects, including unwanted or harmful side effects. exaggerate its effects, including unwanted or harmful side effects.

Some substances also speed up the work of the CYP450 family of enzymes. If your body is metabolizing a drug too quickly because another substance is inducing the enzymes you may not have enough drug in your system at any given time to treat a health problem.

THE GRAPEFRUIT TEST

The grapefruit test

The grapefruit test is a very simple way to find out if CBD can interact with your medications. According to the book, Healing with CBD: How Cannabidiol Transforms Your Health Without the High by Eileen Konieczny and Lauren Wilson: CBD interacts with other medications in the body in the same way as grapefruit. So if your doctor recommends that you don't eat grapefruit during your treatment, it's likely to avoid CBD. [3]

“Le CBD interagit avec les médicaments de la même manière que le pamplemousse. Mais le CBD a des effets beaucoup plus puissants. Donc si la réponse est oui, vous saurez que l’interaction pourrait être un problème pour vous.”Dr Jordan Tishler, M.D. et président de l’InhaleMD, médecins spécialistes du cannabis au Massachusetts [12]

Indeed, one of the components of grapefruit interferes with the cytochrome 450 enzyme, which is also the case for CBD. This interference hinders the metabolization of certain drugs.

Just ask your doctor if you can eat grapefruit during your treatment. Keep in mind that if he or she advises against it, it's best not to use CBD.

CANNABIDIOL ITS DRUG INTERACTIONS AND USES

You will have understood that CBD can develop drug interactions in a moderate way. A recent research by Carola Ronga researcher at theUniversity of Toronto, developed the idea that the potency of many drugs increases. This effect may at the same time prevent certain types of drugs from exhibiting a beneficial effect. Many factors can influence or determine interactions between drugs or active substances:

  1. Liver-modified drugs (cytochrome P450 1A1 - CYP1A1- substrates):

Cannabidiol could decrease the speed with which the liver breaks down certain drugs. Indeed, the use of cannabidiol and certain drugs broken down by the liver could increase the effects and side effects of some of them. If this is your case, talk to your doctor before using CBD. A decrease in the dosage of your treatment may then be necessary. [7]

Here is a non-exhaustive list of some common drugs that are degraded by the liver and could interact with taking CBD in significant amounts [13] :

  • Heart disease: warfarin (Coumadin®).
  • Hypertension: losartan (Cozaar®), propranolol (Hemangiol®, Adrexan® ...), verapamil (Isoptine®, Verapamil®), metoprolol (Lopressor®), amlodipine (Amlor®), nifedipine (Adalat®)
  • Tachycardia: flecainide (Flecain®)
  • Type 2 diabetes: glipizide (Glucotrol®)
  • Alcohol dependence: disulfiram (Esperal®)
  • Corticoid: dexamethasone (Celestene®)
  • Gastric reflux: omeprazole (Mopral®, Zoltum®), lansoprazole (Lanzor®, Ogast®), pantoprazole (Eupantol®, Inipomp®)
  • Hormonal treatment: progesterone (Menaelle®, Utrogestan®), testosterone (Avodart®, Nebido®), progesterone (Estima®, Progestan®)
  • Antidepressant: amitriptyline (Elavil®), paroxetine (Dorexat®)
  • Anti-fungal: ketoconazole (Ketoderm®), itraconazole (Sporanox®)
  • Antiepileptic: valproic acid (Depakine®), phenobarbital (Gardenal®)
  • Anxiolytic: diazepam (Valium®), alprazolam (Xanax®)
  • Antihistamine: fexofenadine (Telfast®)
  • Antipsychotics: amitriptyline (Elavil® , Laroxyl® ..), haloperidol (Haldol® , Vesadol®), risperidone (Risperdal®), venlafaxine (Effexor®)
  • Non-steroidal anti-inflammatory drugs: diclofenac (Cataflam®, Voltaren®), ibuprofen (Advil®, Brufen®), meloxicam (Mobic®) and piroxicam (Feldene®); celecoxib (Celebrex®)
  • Anaesthetic: methoxyflurane (Penthrox®), halothane (Fluothane®)
  • Analgesic: tramadol (Contramal®, Topalgic®, Zulmagic®)
  • Bronchodilator/BPCO : theophylline (Dilatrane® , Xanthium® ...).
  • Schizophrenia: clozapine (Leponex®, clozapine®) Anti-emetic: ondansetron (Zofran®)
  • Muscle relaxants: Chlorzoxazone (Lorzone® , Parafon® ...)
  • Anesthetic: ketamine (Ketamine®)
  • Sedative: chlormethiazole (Heminevrin®),
  • Anti-rejection: cyclosporine (Neoral®, Sandimmun®)
  • Anti-cholesterol: lovastatin®.
  • Antibiotic: clarithromycin (Zoclar®), erythromycin (Egery®)
  • Colon / collorectal cancer: oxaliplatin (Eloxatin® )
  • Prostate cancer: flutamide (Eulexin®)
  • Non-small cell lung cancer: erlotinib (Tarceva®)
  • HIV: nelfinavir (Viracept®)

 

  • Sedative drugs 

Also, it is important to know that cannabidiol can increase the potential for drowsiness and lethargy when taken with sedative drugs such as morphine, propofol (Diprivan®) or phenobarbital (Gardenal®). It is therefore essential to be attentive to this. [1]

Interactions with natural plants and food supplements 

Combined with some dietary supplements and herbs with sedative properties, Cannabidiol can develop significant fatigue. Here are some of them : Sassafras,Jamaican dogwood, kava, L-tryptophan, melatonin, sage, St. John's wort... See Dietary Supplements and CBD Oil: All You Need to Knowfrom Vitamin A to Zinc [9]

SAFETY AND SIDE EFFECTS 

Under the careful supervision of your doctor, you may be able to continue to use CBD safely with medications, even those that carry a grapefruit warning.

If necessary, your doctor may monitor the plasma serum levels of the medication you are taking. He or she may also choose to monitor your liver function.

If you are taking CBD with medications, it is important to stay aware of any potential changes in how the medication or CBD affects you.

PERHAPS YOU HAVE MORE SPECIFIC QUESTIONS ABOUT CBD AND ITS USES?

Through our articles, we try to answer you:

SOURCES

[1] - Medical Cannabis Adverse Effects & Drug Interactions - DOH

[2] - CBD and Drug Interactions: What You Need to Know - Healthline

[3] - CBD May Possibly Interfere With Your Daily Medication - Huffpost

[4] - Book "How Cannabidiol Transforms Your Health Without the High" by Eileen Konieczny, RN, and Lauren Wilson

[5] - CBD Interactions with Prescription Drugs - Active Ingredients

[6] -CBD interactions and uses - Green Hexagon

[7] -Drug-drug interactions as a result of co-administering Δ9-THC and CBD with other psychotropic agents. - Mood Disorders Psychopharmacology Unit (MDPU) , University Health Network, University of Toronto, June 2018

[9] - Dietary Supplements and CBD Oil: All You Need to Know from Vitamin A to Zinc - CBD Oil Review

[10] -Cannabidiol-antiepileptic drug comparisons and interactions in experimentally induced seizures in rats. -J Pharmacol Exp Ther. 1977 Apr;201(1)

[11] — Interactions CBD-Médicaments: Rôle du cytochrome P450 – Bulletin UFCM (l’Union francophone pour les Cannabinoïdes en Médecine)

[12] - What you need to know about CBD products - Teresa Bergen, March 4, 2020

[13] - Cannabidiol (CBD) Report - WHO (World Health Organization)

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