Can CBD Interact With Other Prescription Medication?
A drug interaction refers to a biological or chemical reaction between medicines and other substances, including supplements, foods, or drinks. In addition, it may also refer to the reaction between several drugs. Experts reveal that you can have a drug reaction or interaction after taking medication to alleviate a certain health condition. For instance, physicians can prescribe a nasal decongestant to alleviate high blood pressure symptoms.
Despite medicines helping us to treat various conditions and improve the quality of life, drug interaction could hinder positive treatment. Besides leading to harmful side effects, drug interaction can alter the effectiveness of the medicine. Some critics reveal that the over-reliance on OTC and prescription is adversely affecting Americans. The critics point out that the US is one of the most heavily medicated societies.
Experts refer to the practice of using multiple drugs and supplements as polypharmacy. In the medical community, physicians use the phrase or term when an individual uses more than five different medications per day to treat various health complications or concerns. A study by Qato and other researchers in 2016 shows that the condition adversely affects Americans. The findings that researchers published in the JAMA Internal Medicine journal show that approximately 36% of Americans fall into this category.
Besides the temptation or urge to use more medication to treat a certain condition, the increased life expectancy is another triggering factor. Studies link increased life expectancy to increasing excessive drug or medicine consumption. Health conditions, like cardiovascular diseases and osteoporosis, are becoming more prevalent than in the past days. Most physicians consider prescription medication the effective, easy, useful, and fast way to treat them.
How About CBD?
CBD is one of the most popular and most studied cannabidiol in marijuana that has multiple health benefits. The medical community considers it the latest and most effective treatment alternative for various ailments. Despite the medical benefits and evidence of alleviating different health complications, the FDA is yet to approve the treatment for humans.
Thus, the manufacturers or suppliers must ensure that they provide hemp-derived CBD products and avoid making medical or treatment claims about the drugs to get approval. Despite the restrictions and strict conditions, some studies show that many patients are considering cannabidiol-infused products to treat various health complications. The marijuana component has properties that can help to treat osteoporosis, depression, anxiety, and chronic pain.
Although it alleviates these conditions, the nature or composition of the chemical compound makes it interact and react with various substances. Despite the few adverse effects that result from using CBD, only healthy individuals using marijuana will experience the reduced effects of the interaction of the cannabinoid with other substances.
Cannabidiol (CBD) is the most prevalent non-intoxicating compound present in industrial hemp or marijuana. The compound interacts with the cannabinoid receptors in the body through the endocannabinoid system. In addition, CBD can inhibit the body's cytochrome P450(liver enzymes) activity.
How Does CBD Affect Cytochrome P450?
Studies show that the cytochrome P450 ( CYP450) enzymes are vital in breaking down toxins and drugs entering the body or systems. The action of CBD on CYP450 temporarily inhibits the activity of these enzymes. In addition, it also alters the metabolism of other compounds in the body.
Remember, the enzymes and liver metabolize numerous drugs you take to alleviate various health concerns. During metabolism, the enzymes will break down or process the different substances entering the body before transforming them into valuable substances the body can use.
Studies show that higher CBD doses will hinder the proper functioning of the CYP450, making it hard for the body and system to process certain medications. When the body doesn't metabolize the medicine properly, they become overdue. The longer the medicine or substance remains in the system results in unintended side effects.
The most interesting or exciting fact is that grapefruit similarly interacts with drugs such as CBD in the body. These substances work by inhibiting the metabolism of drugs and toxins in the body in the same way. Thus, it'll be good to keep off some medications when using grapefruit or CBD-infused products. Notably, some medicines will provide warnings or guidelines on avoiding the fruit or taking grapefruit juice. Below are some of the drugs you have to avoid when taking these substances:
● Alprazolam
● Colchicine
● Dronedarone
● Amiodarone
● Felodipine
This article provides a comprehensive overview of the common drugs and checks the possibility of interacting with CBD.
Antidepressants
The CDC reports that more than 12% of Americans above 12 years have taken an antidepressant in the past month, with fluoxetine (Sarafem and Prozac) being the common one. CBD also has properties that make them a better option for combating depression, but it's not common for patients to combine Prozac and CBD to alleviate this condition.
Fluoxetine is one of the most effective selective serotonin reuptake inhibitors (SSRI), which can help to alleviate anxiety, OCD, and bulimia. The common side effects of using this medication include abnormal dreams, skin rashes, sweating, and diarrhea. Experts reveal that most SSRIs function by boosting the dopamine and serotonin levels in the brain.
Researchers have invested more resources and time in researching SSRIs. Despite the extensive research on the effectiveness of this medication, many individuals can’t find relief when using SSRIs like Prozac alone. Studies show that the impact of CBD on the body's ECS improves the symptoms of anxiety and depression, as the system affects emotions, anxiety, and mood.
With the numerous restrictions on cannabis, there have been limited results to confirm the negative drug interaction when you combine CBD and SSRIs. Many patients have reported improvements when combining these drugs to treat depression. Nevertheless, CBD's effects on CYP450 enzymes may result in the body retaining more antidepressant medications in the system. The retention may result in a rare side effect called hypomania (mild mania).
Blood Thinners
Like other plant cannabinoids, CBD can interrupt the functioning and effects of different blood-thinning medications, such as warfarin or ibuprofen. In a study that Grayson and the other researchers carried out in 2017 and published in the Behaviour & Epilepsy Case Reports, the finding shows that there was an interaction between CBD and warfarin.
The researchers pointed out that studying or understanding the possible drug interactions between any medication that the CYP450 enzyme metabolizes and cannabis products is essential.
The main issue is when the metabolism of cannabidiol and the drug is in a similar pathway. The metabolization of these drugs in the same ways leads to a spike in warfarin levels. Increased warfarin levels in the body might result in increased effects of blood thinning. Thus, it'll be good to keep monitoring your INR level. The INR is a special test that you can use to check the warfarin effects on the body. After the test, you realize that you require a lower dose than the medical professionals prescribe.
Experts reveal that trial and error or testing out is the best way to select the most effective CBD products and doses, as you have to try as many products as possible.
Drugs for Seizures and Epilepsy
Marijuana proponents reveal that CBD edges the other cannabinoids due to the lack of psychoactive or causing an intoxicating high. Thus, many patients are switching to CBD to treat epilepsy and seizures, especially in children. The story of young girl Charlotte Figi brought a massive boost for CBD in the medical community to treat epilepsy and seizures.
The young girl had Dravets Syndrome, resulting in frequent seizures and causing the condition to be debilitating. Charlotte reported hundreds of epilepsy-related seizures per month resulting from the condition. However, after using Charlotte's Web, one of the high CBD marijuana strains, the number of seizures reduced from the hundreds to two or three seizures monthly.
Despite most studies suggesting that high CBD doses could help alleviate epilepsy symptoms, Lester Bornheim found some interesting and contradicting facts in 1992. The researchers found that taking low CBD doses doesn't cause antiepileptic effects but continues to inhibit the functioning of CYP450 enzymes. The inhibition of the enzyme functions and processes leads to increased antiepileptic drugs, including clobazam and nor clobazam, to stay in the body for a long time resulting in more aggressive seizures.
During the 70th Annual American Epilepsy Society meeting in January 2017, Professor Szafalrski discussed the outcome of a certain study on the relationship between antiepileptic drugs and CBD use. He revealed that CBD greatly interacts with various antiepileptics drugs, including topiramate, zonisamide, and rufinamide.
In January 2018, Chang published reviews on the research findings of Szaflarski in the Epilepsy Currents. Chang revealed that the researchers included 42 children among the 81 volunteers. The researchers administered 5 mg of marijuana CBD/kilogram of the total body weight each day. After every two weeks, the manufacturers increased the dose by 5 mg/kg daily to up to 50 mg/kg per day.
One of the practices during the study was to check the serum antiepileptic drug (AED) levels in the patients to identify the possibility of any interaction between CBD and the drugs. Although AED levels were increasing in some drugs, the team realized a drop in clobazam levels in the system. Thus, the body may require fewer or lower amounts of AEDs when taking cannabidiol, but you'll need more clobazam.
Cold and Flu Drugs
Studies show even drug interactions between over-the-counter flu & cold medication and CBD. However, experts reveal that some substances or components in these drugs might trigger side effects or interaction with CBD. Below are some of the substances present in different flu and cold drugs that might trigger adverse effects when using CBD while on the drugs;
● Doxylamine - this component is present in drugs like Nyquil. It's an antihistamine that may cause an increase in the drowsy and calming effects of CBD.
● Naproxen - present in anti-inflammatory medications like naproxen and aleve. The substance could alter the CBDs' effectiveness in the body.
● Chlorpheniramine - common in chlorpheniramine or antihistamines and increases the levels of drowsiness.
● Pseudoephedrine - present in decongestants, including Sudafed Congestion. The compound can increase the levels and risk of serotonin syndrome (in the brain) when combined with CBD.
● Pheniramine - present in most cold and flu prescription products. Studies link the compound to increased drowsiness and adverse effects when you combine it with CBD.
Besides the above effects of the possible interaction between cold & flu medicine and CBD, the interaction can also result in decreased motor function, cognitive impairment, and confusion.
Antiretroviral Drugs
Reports show that approximately 40 million individuals globally live with HIV/AIDS. This condition affects the body by weakening the immune system, leaving the patient vulnerable or at risk of infections. Currently, the medical community administers antiretroviral drugs, like Ritonavir and Saquinavir, to help alleviate the condition and its symptoms.
Some studies show that using CBD when taking these drugs can cause an increased efficacy and timeline of cannabidiol in the body. In addition, the combination can also lead to enhanced serum concentration or levels and other adverse side effects. However, up-to-date scientists and researchers are yet to conduct a study on the possible interaction between antiretroviral drugs and CBD.
Nevertheless, in January 2019, Costiniuk and other researchers published a report or review in the British Medical Journal. The main aim of the study or report was to research the tolerability, safety, and CBD effects on the immune activation of orally-consumed cannabinoids in individuals living with HIV. With the increased studies and research, you'll soon learn or understand more about how marijuana consumption affects the health of people living with HIV/AIDS.
Nevertheless, until scientists and medical professionals discover the effects, it'll be good to start with low CBD doses when you're on any antiretroviral drug.
Anti-anxiety Drugs
Various studies and evidence clearly outline the dangerous or debilitating effects of combining alcohol and opioids with anti-anxiety medications like Xanax. With limited studies, research and studies, you can't have a comprehensive or clear outline of the effects of mixing CBD with different antidepressants.
However, as CBD affects the CYP450 system, you're likely to experience an increased level of the antidepressant in the body. The increased drug levels in the blood may result in various adverse effects, including drowsiness, loss of focus, confusion, etc.
Medications to Control Blood Pressure
Medical professionals commonly prescribe beta blockers as a treatment alternative to control or reduce blood pressure. Some studies show that CBD has properties that can help to control high blood pressure. With the ability of CBD to also control high blood pressure, you may be tempted to combine CBD products with beta-blockers to get optimal results. Despite helping to manage your high blood pressure, the combination might result in adverse side effects.
Remember, beta blocker works by reducing or stopping the secretion of adrenaline (a stress hormone) to help reduce the heart rate. Thus, combining beta blockers and CBD might be dangerous, as it can lead to a sudden or quick drop in your blood pressure. Sometimes the levels may drop to unhealthily low rates. The common side effects of low unhealthy blood pressure rates include general weakness, dizziness & feeling faint, and it can result in shock.
What are the Common Medications You Should Avoid Combining with CBD?
Taking CBD with some drugs may result in adverse reactions. Some studies show that combining CBD with some medications, especially those that CYP450 enzymes break down, may be harmful to the body. The interaction results in an increased amount of the drugs remaining in the bloodstream or system.
Thus, it'll be good to understand the different types of drugs that you should never take with CBD. This section outlines the drugs that the CYP450 enzymes metabolize once they get into the body. Experts advise that you consult your physician when you're using these drugs and consider combining them with CBD. These drugs include
● Immunosuppressants - these drugs help to treat autoimmune disorders, including rheumatoid arthritis, psoriasis, etc.
● Chemotherapeutics - these drugs help in cancer treatments and alleviate the related symptoms.
● Antidepressants - these drugs help to alleviate major depressive disorders(MOD). In addition, you can also use drugs to treat other mood disorders, such as post-traumatic stress disorder (PTSD).
● Opioids - common to alleviate post-surgery discomfort and provide pain relief
● Antipsychotics - helps to treat a wide range of psychotic disorders, including schizophrenia.
● Benzodiazepines - helps to alleviate insomnia and other anxiety-related disorders.
● Calcium channel blockers - vital for treating a wide range of heart complications and stabilizing high blood pressure
● Antiepileptics - helps to reduce seizures and treat epilepsy.
● Proton pump inhibitors - these drugs help in the treatment of stomach ulcers and acid reflux.
● Propranolol - helps in treating or controlling high blood pressure. You also use it in alleviating physical symptoms that come with anxiety disorders.
● Warfarin - helps in treating blood clots.
With the extensive nature of CBD, you may be confused about the whole story. Therefore, if you feel concerned about CBD interacting with the other drugs or medication you're taking, it'll be wise to seek professional help. You can talk to your physician to ensure that you use the medications safely and without risks of having adverse effects from the combination.
Do the Different CBD Drug Forms Affect the Interaction with Other Drugs
You apply some CBD products, like topical (balms, creams, and lotions), by rubbing them on the skin of the affected area. Rubbing on the skin surface stimulates rapid and direct absorption to enhance localized pain relief.
Remember, the body doesn't absorb topicals into the bloodstream at similar or significant levels. The absorption technique makes the drug in the body have different sedative effects than CBD edibles or oils. In addition, the absorption mechanism helps to reduce the risk of causing any interaction with other prescription medications or drugs.
Ultimately, while using topicals, CBD does not enter the body systems, especially in the liver. Thus, it can't have major interactions with other medications or drugs that use the CPY450 enzyme. With this evidence and combination of effects make topicals a safe option to take CBD, as it does not result in enhanced drug side effects or CBD drug interactions.
Final Thoughts: CBD Interactions with other Drugs or Medications
Despite the limited studies on the potential reaction between prescribed medication and CBD, evidence shows we're still at risk. Some experts, like Yasmin Hurd, believe that CBD can result in adverse reactions. She suspects marijuana cannabidiol can react or interact with most oral drugs or medication.
Other experts reveal that the suggestion makes sense. More than 60% of prescription medications or drugs interact with the liver's CYP450 enzymes. Thus, combining these medications with CBD makes high drug levels and concentrations get or remain in the system. The retention results from the ability of CBD to block the functionality of the CYP450 enzymes.
The news comes as a shock and disappointment to patients using some drugs like warfarin. When CBD blocks or inhibits the blood thinner metabolism, it increases the level of this medication, which may escalate to toxic levels. Medical experts reveal that using CBD and warfarin may result in adverse side effects like traumatic bleeding or dangerous hemorrhage.
Most users combining anti-anxiety drugs like Ativan or Xanax with CBD may lead to increased levels or degrees of sedation. In addition, despite being rare instances, the combination can result in respiratory complications. The combination can also increase the concentration of serum or the amount of drug in the blood, especially when you use CBD with antiretrovirals, beta-blockers, and antihistamines.
While low CBD does are less likely to result in drug interaction, there is no line or appropriate measure for the safe amount. Thus, if you intend to use CBD to treat or alleviate a particular health concern, it's appropriate to consult your healthcare provider before using it. The consultation becomes important when you want to combine CBD with other prescription or over-the-counter drugs.
With the possible adverse effects of combining CBD and other medication, it’ll be vital to consult a qualified marijuana physician before opting for the marijuana cannabinoid. HappyMD has a wide network of marijuana-friendly and experienced doctors to help you choose the right dose and help prevent adverse reactions. You can also join thousands of patients who apply for and get medical marijuana cards online on this platform.
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