Drug interactions with hemp cbd oil
Cannabidiol CBD is ubiquitous in state-based medical cannabis programs and consumer products for complementary health or recreational use. CBD has intrinsic pharmacologic effects and associated adverse drug events ADEs along with the potential for pharmacokinetic and pharmacodynamic drug—drug interactions DDIs. Given CBD use among patients with complex conditions and treatment regimens, as well as its expanded consumer use, awareness of potential safety issues with CBD is needed. Prescribing information for federally approved products containing CBD were reviewed. Common ADEs include transaminase elevations, sedation, sleep disturbances, infection, and anemia.
Does CBD interact with other medications?
Cannabidiol CBD is ubiquitous in state-based medical cannabis programs and consumer products for complementary health or recreational use.
CBD has intrinsic pharmacologic effects and associated adverse drug events ADEs along with the potential for pharmacokinetic and pharmacodynamic drug—drug interactions DDIs.
Given CBD use among patients with complex conditions and treatment regimens, as well as its expanded consumer use, awareness of potential safety issues with CBD is needed. Prescribing information for federally approved products containing CBD were reviewed. Common ADEs include transaminase elevations, sedation, sleep disturbances, infection, and anemia. Given CBD effects on common biological targets implicated in drug metabolism e.
General clinical recommendations of reducing substrate doses, monitoring for ADEs, and finding alternative therapy should be considered, especially in medically complex patients. These effects should be considered in the risk-benefit assessment of CBD therapy and patients and consumers made aware of potential safety issues with CBD use.
Cannabis Cannabis sativa L. The vast majority of cannabis use is recreational but there is increasing use of cannabis and cannabis-derived substances for medical and complementary health purposes.
This increased access includes expansion of medical marijuana programs in roughly two-thirds of U. These two sources of access can be thought to represent two distinct populations of users: 1 Those who are medically complicated and medically supervised with high comorbidity and pharmaceutical burden; and 2 the heterogeneous lay public using cannabis or derivatives for recreational or complementary health purposes without medical supervision, with or without other chronic health concerns and medications.
Both user populations, as well as much of the healthcare community, seemingly extrapolate the safety of cannabis and cannabis-derived substances like CBD from its long history of recreational use.
However, recognition that this general benignancy of CBD is perhaps only applicable to younger, healthier individuals using cannabis recreationally creates a tremendous patient safety concern in this new era. Whole cannabis and hemp a strain grown to have low THC composition contain over one hundred other cannabinoids and hundreds more botanical compounds that may have their own biological effects [ 5 , 6 ].
CBD may be delivered as a purified product, be one component in a botanical extract from cannabis or hemp, or be consumed as part of the whole cannabis or hemp plant. Regardless, CBD and other components in cannabis have known Cytochrome P CYP and other enzyme system activity making these compounds susceptible to, or complicit as, inhibitors or inducers of these enzymes—i. Further, cannabis may have significant biological effects, e. We further introduce and discuss the regulatory environment for cannabis, hemp, and CBD as it pertains to the scope and magnitude of use.
For this review, full prescribing information or monographs and new drug applications NDA were extracted from federal agency websites e. FDA, Health Canada.
Other approved prescription products containing only derivatives of THC, dronabinol and nabilone, were out of scope. Prescribing information was reviewed and information on adverse events, clinical pharmacology, DDI studies, and contraindications were extracted and summarized. The review focused specifically on adverse reactions that could be attributable to DDIs or potentiated by concomitant use as well as ADEs that may be most relevant in medically complicated persons.
Where necessary, human clinical trial publications were also reviewed. CBD is increasingly used in state-approved medical cannabis programs. Currently, 11 states also have adult use cannabis programs i. State-based medical cannabis programs were estimated to include over 2.
Many of these conditions are highly prevalent in older adults, specific to children and adolescents with severe illness, or otherwise clustered among persons with serious underlying indications for medical cannabis use. Such users are likely to have complex medical profiles and pharmacotherapeutic regimens [ 13 , 14 , 15 , 16 ].
CBD is expected to have potential for broad therapeutic use. Potential uses of CBD alone or in combination with THC include epilepsy, pain, cancer, inflammation, anxiety, neurodegeneration, multiple sclerosis, psychotic disorders, and depression [ 17 , 18 , 19 , 20 , 21 , 22 , 23 ].
Currently, only epilepsy, cancer-related pain, and multiple sclerosis are recognized indications for CBD by international federal agencies. CBD-based consumer products have entered the U. CBD-infused products including lip balms, beverages, vapors, edibles, topicals, essential oils, and so on are highly prevalent in myriad consumer settings including gas stations, health spas, retail pharmacies, bakeries, and coffee shops.
FDA has clearly stated that products that are specifically marketed with claims of a therapeutic benefit remain under the purview of the FDA and require approval — including cannabis- or hemp-derived CBD [ 25 ].
FDA further stated that no food products can enter inter-state commerce, CBD is not a safe food additive, and that CBD or other cannabis-derived compounds cannot be considered dietary supplements as they are or contain pharmacologically active ingredients [ 26 ]. Nevertheless, without clear enforcement, the products have proliferated primarily with CBD extracted from industrial hemp in concentrations ranging from very low e. Two CBD containing pharmaceutical products are currently marketed.
Sativex is approved in the United Kingdom, Europe, Canada, and other countries but has not been approved for use in the U.
It is available as a buccal spray and is administered up to 12 sprays per day with 2. It is approved by the U. Cannabinoid CB receptors make up part of the endocannabinoid system, which leads to many of the therapeutic uses of cannabis product with roles in appetite, sleep, and pain sensations, as well as roles in the immune system, thermoregulation, and so on [ 29 , 30 ].
CB 1 is the primary target for most desired therapeutic effects of THC but is also dose limiting given effects on mood, memory, and anxiety. CBD actually has low affinity for CB receptors and is considered a negative allosteric modulator of the endogenous cannabinoid, anandamide [ 4 , 31 ].
CBD may be an inverse agonist of CB 2 , which is strongly implicated in the immune system, and may contribute broad and varied anti-inflammatory effects [ 32 , 33 , 34 ]. A comprehensive review of these targets and potential effects can be found elsewhere [ 4 ]. Other molecular targets within the endocannabinoid system or independent pathways and their physiological actions are of continued interest [ 35 , 36 ].
Nevertheless, given these varied targets, CBD should be expected to have a variety of biological effects with documented large variation in dose requirements and response between individuals for both effectiveness and safety [ 35 ]. CYP enzymes are implicated in the primary metabolism and biotransformation of the majority of therapeutic agents and xenobiotics [ 37 ]. Metabolic drug—drug interactions between cannabidiol and enzyme substrates, inhibitors, or inducers.
When co-administered with 3A4 inhibitors CBD and its active metabolite have increased systemic exposures and decreased exposures when co-administered with a 3A4 inducer. Administration with omeprazole 40 mg; six days , a CYP2C19 inhibitor led to no changes [ 38 ]. These findings were confirmed in additional in vivo studies with additional observed increases in topiramate, rufinamide, zonisamide, and eslicarbazepine [ 40 ].
It is worth noting that these studies were prudent given the indication of Epidiolex for refractory and serious seizure disorders with concomitant antiepileptic therapies [ 11 ]. For the confirmed CYP isoforms 3A4 and 2C19 that are important to CBD metabolism, these enzymes are associated with some of the most common drugs implicated as inhibitors and inducers. Thus, caution should be taken when using even medically supervised CBD in patients stabilized or newly initiating these medications in particular given the potential effects on both CBD and the medication in question.
These interactions can potentiate a wide array of ADEs and negative clinical outcomes specific to the substrate and indicated treatment. Thus, caution should be taken with any concomitant use between CBD and many common medications used by otherwise healthy persons. The clinical relevance of this activity has not been assessed. Even basic, everyday over-the-counter medications are implicated, such as over-the-counter naproxen and ibuprofen could lead to significant side effects e.
Drug—drug interactions between cannabidiol and secondary metabolism or transport proteins. However, the inactive, hydroxylated, 7-COOH-CBD metabolite [ 10 , 51 ], which is also the most abundant metabolite, is a substrate for P-glycoprotein and an inhibitor of the breast cancer resistance protein BCRP and the bile salt export pump BSEP at clinically relevant concentrations.
As the metabolite is inactive, no clinically relevant effects and actions are expected nor require CBD dose adjustments. However, both enzymes play roles in efflux of xenobiotics from tissues and transport into excretion pathways. For BCRP substrates, which include glyburide, imatinib, methotrexate, mitoxantrone, nitrofurantoin, prazosin, statins, dipyridamole, and others, increased side effects from these substrates are possible with increased distribution into tissues and decreased efflux into excretory organs.
Similarly, BSEP substrates, such as paclitaxel, digoxin, statins, telmisartan, glyburide, ketoconazole, rosiglitazone, celecoxib, and others, can experience increased side effects.
The general recommendations to avoid co-administration, monitoring for adverse effects and toxicity, and reducing the substrate dose when possible apply. CBD is administered in patients with serious medical conditions that are treated with medications that have their own side effect profiles. Co-administration increases the potential of experiencing overlapping profiles even with direct DDIs via metabolic or transport pathways.
CBD, compared to THC, does have noteworthy benefits in some complex patient profiles such as no addiction potential and fewer psychomimetic effects overall. However, these benefits and effects of THC are beyond the scope of this review.
While clinical trials of approved products provide insight to pharmacodynamic DDIs, caution should be taken in interpretation as the study cohorts include children and adults with serious epilepsy, multiple sclerosis, or other conditions and are not fully generalizable to all users. While we have reviewed both Sativex and Epidiolex prescribing information, this section includes a review mostly of Epidiolex prescribing information and other literature only as that product contains only CBD and many side effects associated with Sativex are indicative of THC rather than CBD such as psychoactive effects and cardiovascular warnings.
There is wide variation in consumer products with nearly half of CBD products reported to be underlabeled regarding CBD concentration and nearly one-third overlabeled as well as batch-to-batch and manufacturer variability [ 52 ], which may affect predictability of therapeutic response and ADEs. Prediction of risk-benefit should consider ADEs in light of expected dose variability, user weight, as well as other presented factors.
Highest 3. Edibles have less predictable absorption profiles, which depends largely on the components of what is ingested e. Liquids, especially when administered without food and at known concentrations, will have predictable bioavailability similar to Epidiolex and Sativex products with measurable drug levels between 1—3 h and max concentrations after 3—5 h after ingestion [ 54 , 55 ]. Vaping CBD, which is available via consumer products and some state-based CBD programs, will heat the mixture to approximately — Celsius and will lead to rapid bioavailability within the first inhalation with maximum concentrations reached within 15 to 30 min [ 56 , 57 ].
Vaping also risks transformation of CBD and any excipients to oxidized forms, though this is likely to a lesser extent compared to traditional smoking, as well as inter-user variability due to inhalation behaviors [ 58 ].
Considering variation in cumulative ADE risk, consumer use versus medical or complementary health use may vary. Many users may sporadically be exposed to CBD while others may consume it daily or multiple times per day. Inhibitory actions on metabolism or drug transport and pharmacodynamic interactions can be immediate in most cases whereas inductive effects require prolonged exposures e.
Many ADEs such as somnolence, insomnia, and sleep disturbances are likely to occur even with sporadic and acute exposure while infections, transaminase elevations, and weight loss will require prolonged exposure. Adverse effects associated with CBD appear to be dose dependent though not proportional in all cases. In phase III clinical trials, 2. Caution should be taken when CBD is used with medications with potential to cause hepatic injury or in people with pre-existing hepatic impairment, such as alcoholics or those with hepatitis.
Such medications implicated with hepatic injury reports may include antiepileptics, antipsychotics, acetaminophen, certain antibiotics e. CBD as prescribed in Epidiolex carries a recommendation for a lowering by half for the starting, maintenance, and maximum doses 2.
Common to cannabis-derived therapeutics are the general side effects of somnolence, sedation, lethargy, fatigue, and asthenia. In clinical trials, these occurred frequently in treatment groups and exhibited a modest dose-response relationship.
Such side effects are also attributable to commonly prescribed medications such as benzodiazepines, opioids, antidepressants, antiepileptics, and antihistamines, which are used by medically complex and healthy persons alike.
Co-administration will likely potentiate lethargic and sedative effects and may lead to excessive sedation, interruption in daily activities or work, and create a public health hazard via sedated drivers. Where possible, co-administration should be avoided, and patients and consumers counseled or informed of the potential for excessive sedation and steps to mitigate risk to themselves and others such as not operating vehicles or reserving CBD use for nighttime use.
Clinical trials suggest that this side effect may also diminish with prolonged therapy so, when needed, a lower starting dose and slower titration may allow for continued CBD use until tolerance is achieved [ 11 ]. For recreational consumer use of CBD, such tolerance may never be achieved without sustained use. It is unclear if this dose-response relationship is related to target pathways and associated affinities for receptors or simply spurious.
While a direct pathway for this adverse effect with CBD is uncertain, insomnia and sleep disruption are also side effects of other medications including antidepressants, dopamine agonists, stimulants, antiepileptics, steroids, diuretics, and beta-blockers.
medications are known to interact with cannabis. Includes amlodipine, lisinopril, tramadol. The cannabis-derived cannabinoids of most therapeutic interest are. THC and cannabidiol (CBD). ▫ Minor cannabinoids include cannabigerol.
Susan Ince. CBD, a type of chemical known as a cannabinoid, is a mainingredient in hemp, one type of cannabis plant. According to CreakyJoints research presented at the Annual European Congress of Rheumatology meeting earlier this year, 52 percent of respondents reported having tried CBD for a medical reason. Of those who did, 93 percent said it helped.
CBD inhibits the cytochrome P enzyme, which is involved in metabolizing many drugs.
It has made its way into our shampoos and lotions. There are CBD-infused smoothies, bath bombs and beer. There are even holiday treats looking at you, CBD jelly beans.
Medicinal Cannabis—Potential Drug Interactions
Show all medications in the database that may interact with cannabis. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. Available for Android and iOS devices. Subscribe to Drugs. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment.
Side effects and drug Interactions.
Join Now! Share ConsumerLab. Simply provide an email address below. You must provide a valid email address. Your message has been sent. Thanks for sharing! CBD Drug Interactions. Not with something that has only 25mg of CBD?
A review paper on the safety and side effects of cannabiniods suggests that controlled cannabinoid administration is safe and non-toxic in humans and animals.
The endocannabinoids system ECS has garnered considerable interest as a potential therapeutic target in various carcinomas and cancer-related conditions alongside neurodegenerative diseases. Cannabinoids are implemented in several physiological processes such as appetite stimulation, energy balance, pain modulation and the control of chemotherapy-induced nausea and vomiting CINV. However, pharmacokinetics and pharmacodynamics interactions could be perceived in drug combinations, so in this short review we tried to shed light on the potential drug interactions of medicinal cannabis. Hitherto, few data have been provided to the healthcare practitioners about the drug—drug interactions of cannabinoids with other prescription medications.
Cannabis Drug Interactions
CBD is a cannabinoid that is being researched for its various potential health benefits. It is now being heavily researched because of numerous anecdotal reports regarding CBD's magical therapeutic effects. CBD oil has the potential to effectively help people with certain health issues. The majority of scientific research shows that it is safe to use and consume. However, it can have some unintended side-effects and pose risk when used incorrectly. In this article we will be answering a few questions on drug interactions with CBD oil and common drugs to avoid with CBD. CBD hemp oil drug interactions are often overlooked and it's important to shed more light on this topic as the CBD industry takes another step forward. Cannabinoids are a group of compounds that are found in the cannabis sativa plant. There are over cannabinoids found in the hemp plant that are being studied for their potential health benefits. Cannabidiol CBD is one of the many cannabinoids that is now being widely studied for the potential health benefits they can provide. When these cannabinoids work together, there is an amplified effect in the endocannabinoid system known as the entourage effect. It is not uncommon for over-the-counter drugs and prescription drugs to interact with other compounds.
What Drugs Should Not Be Taken With CBD?
Some of these conditions are physical, such as one study published in Therapeutics and Clinical Risk Management which indicates that this hemp oil extract can offer pain relief for those struggling with major medical conditions such as cancer, rheumatoid arthritis, and peripheral neuropathic pain, and it does it with minimal side effects. Other users find that the cannabinoids within CBD products help ease mental health conditions. For instance, a case series in the Journal of Alternative and Complementary Medicine shares that CBD has been found helpful in reducing the severity of symptoms commonly associated with post-traumatic stress disorder PTSD , one of which is frequent nightmares. The reason for this is because it could create potential interactions. When talking about CBD drug interactions, MedlinePlus says that these can be broken down into two basic categories. The two drugs that should never be taken with CBD oils or other CBD dietary supplements are clobazam and valproic acid. Taking CBD with clobazam could intensify the way this drug works, increasing its side effects too. Further, combining valproic acid with CBD could cause injury to your liver.
