CBD Oil Drug Interactions – The CYP Pathway If you are taking a medication affected by cannabidiol, you should consult your doctor to make sure that it is. May 23, Have you ever been told not to take your medication with grapefruit? Some good places to research drug interactions with CBD would be this. Learn more about Cannabidiol uses, effectiveness, possible side effects, interactions, dosage, user ratings and products that contain Cannabidiol.
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This is called the entourage effect and takes place in the ECS endocannabinoid system , promoting a healthy lifestyle. In some instances, hemp-derived oils have even helped people reduce the number of pharmaceutical pills they take. Others have learned that CBD is a useful addition to their daily medicines, even working in combination with other prescribed solutions.
These enzymes are involved in metabolizing over 60 percent of all pharmaceuticals. Cannabinoids can inhibit or induce a CYP enzyme, effectively altering the way your body processes drugs metabolized by those enzymes. If the cannabinoid induces a CYP enzyme, it will shorten the lifespan of the second drug due to more of that enzyme being made. Information on the ways medications are metabolized, and which CYP enzymes break down those medications, is available for any drug approved in the US.
This info allows patients and doctors to research whether the drug and cannabinoid in question are metabolized by the same enzymes. Cannabidiol, like other natural foods, can aid in achieving a balance and a higher quality of life. However, compounds that affect CYP enzymes are also present in some produce and dietary supplements at your local grocery store. There are compounds in grapefruit that interact with the metabolism of several medications by affecting this same CYP family of enzymes.
Compared to grapefruit, cannabinoids—especially CBD—are more potent inhibitors of these enzymes. If a doctor or pharmacist cautions against eating grapefruit while taking a specific medication, chances are cannabinoids can cause a drug interaction as well.
Your chosen method of cannabinoid administration can affect which CYP enzymes metabolize them. There are a variety of ways to use CBD oil, and your usage will vary depending on your lifestyle and health goals. The various modes of administration will also impact how long it takes for CBD to work.
When cannabinoids are inhaled, they enter into the bloodstream through the lungs. Vaporized CBD bypasses the digestive system and has a rapid onset effect. A pilot study with 24 subjects was conducted in a randomized, double-blind, placebo-controlled design to evaluate the impact of the ad hoc use of CBD in smokers, who wished to stop smoking.
Pre- and post-testing for mood and craving of the participants was executed. Craving was assessed using the Tiffany Craving Questionnaire On day 1 and 7, exhaled CO was measured to test smoking status.
Sedation, depression, and anxiety were evaluated with the MRS. At day 7, the anxiety levels for placebo and CBD group did not differ. CBD did not increase depression in contrast to the selective CB1 antagonist rimonabant. CBD might weaken the attentional bias to smoking cues or could have disrupted reconsolidation, thereby destabilizing drug-related memories.
To the best of our knowledge, no acute studies were performed that solely concentrated on CBD glycemic effects. Moreover, the only acute study that also measured CBD effect on appetite was the study we described above, comparing different cannabis strains.
Growth hormone and prolactin levels were unchanged. Compared to the healthy individuals, the cortisol levels increased less after TSST in the 32 at-risk individuals. The CBD group showed less reduced cortisol levels but differences were not significant. Truly chronic studies with CBD are still scarce. Nonetheless, we also included these studies with repeated CBD treatment, because we think that compared to a one-time dose of CBD, repeated CBD regimens add value and knowledge to the field and therefore should be mentioned here.
These results are supported by another study described in the review by Grotenhermen et al. CBD was administered on average with three other drugs, including clobazam The coadministration led to an alteration of blood levels of several antiepileptic drugs. In the case of clobazam this led to sedation, and its levels were subsequently lowered in the course of the study.
A first pilot study in healthy volunteers in by Mincis et al. Clinical chronic lasting longer than a couple of weeks studies in humans are crucial here but were mostly still lacking at the time of writing this review. They hopefully will shed light on the inconsistencies observerd in animal studies. Chronic studies in humans may, for instance, help to test whether, for example, an anxiolytic effect always prevails after chronic CBD treatment or whether this was an artifact of using different animal models of anxiety or depression.
In a 4-week open trial, CBD was tested on Parkinson's patients with psychotic symptoms. This led to a reduction of their psychotic symptoms. Moreover, no serious side effects or cognitive and motor symptoms were reported. No adverse effects were observed and her symptoms improved. The same positive outcome was registered in another study described by Bergamaschi et al.
The respective treatment was maintained for three additional weeks. This was the case for three patients in the CBD group and five patients in the amisulpride group. CBD treatment was accompanied by a substantial increase in serum anandamide levels, which was significantly associated with clinical improvement, suggesting inhibition of anandamide deactivation via reduced FAAH activity. In addition, the FAAH substrates palmitoylethanolamide and linoleoyl-ethanolamide both lipid mediators were also elevated in the CBD group.
CBD showed less serum prolactin increase predictor of galactorrhoea and sexual dysfunction , fewer extrapyramidal symptoms measured with the Extrapyramidal Symptom Scale, and less weight gain.
Moreover, electrocardiograms as well as routine blood parameters were other parameters whose effects were measured but not reported in the study. CBD better safety profile might improve acute compliance and long-term treatment adherence. A press release by GW Pharmaceuticals of September 15th, , described 88 patients with treatment-resistant schizophrenic psychosis, treated either with CBD in addition to their regular medication or placebo.
Important clinical parameters improved in the CBD group and the number of mild side effects was comparable to the placebo group. Moreover, neurological and physiological examinations were performed, which neither showed signs of CBD toxicity nor severe side effects. The study also illustrated that CBD was well tolerated. CBD in addition to their regular epilepsy medication. Another clinical study lasting at least 3 months with children and young adults with various forms of epilepsy, who were treated with the CBD drug Epidiolex, was presented at the American Academy for Neurology in In a few cases, severe side effects occurred, but it is not clear, if these were caused by Epidiolex.
The largest CBD study conducted thus far was an open-label study with Epidiolex in patients mainly children, the average age of the participants was 11 suffering from severe epilepsy, who could not be treated sufficiently with standard medication. Ten percent of the patients reported side effects tiredness, diarrhea, and exhaustion.
After extensive literature study of the available trials performed until September , CBD side effects were generally mild and infrequent. The only exception seems to be a multicenter open-label study with a total of patients aged 1—30 years, with treatment-resistant epilepsy. This led to a reduction in seizure frequency. It is therefore difficult to put the side effect frequency into perspective. Attributing the side effects to CBD is also not straightforward in severely sick patients.
Thus, it is not possible to draw reliable conclusions on the causation of the observed side effects in this study. This rating instrument comprised the following factors: This assessment instrument analyzes adverse medication effects, including psychic, neurologic, autonomic, and other manifestations. Using various safety outcome variables, clinical tests, and the cannabis side effect inventory, it was shown that there were no differences between the placebo group and the CBD group in the observed side effects.
The occurrence of various degrees of GVHD was compared with historical data from patients, who had only received the standard treatment. This resulted in lower resistin levels compared to baseline. The hormone resistin is associated with obesity and insulin resistance. Compared to baseline, glucose-dependent insulinotropic peptide levels were elevated after CBD treatment.
This incretin hormone is produced in the proximal duodenum by K cells and has insulinotropic and pancreatic b cell preserving effects. CBD was well tolerated in the patients. However, with the comparatively low CBD concentrations used in this phasetrial, no overall improvement of glycemic control was observed.
When weight and appetite were measured as part of a measurement battery for side effects, results were inconclusive. For instance, the study mentioned above, where 23 children with Dravet syndrome were treated, increases as well as decreases in appetite and weight were observed as side effects.
However, in the safety analysis group, consisting of subjects, 10 showed decreased weight and 12 had gained weight. Both these factors were not controlled for in the reviewed studies.
This review could substantiate and expand the findings of Bergamaschi et al. First, more studies researching CBD side effects after real chronic administration need to be conducted. Many so-called chronic administration studies, cited here were only a couple of weeks long.
Second, many trials were conducted with a small number of individuals only. To perform a throrough general safety evaluation, more individuals have to be recruited into future clinical trials. Third, several aspects of a toxicological evaluation of a compound such as genotoxicity studies and research evaluating CBD effect on hormones are still scarce. Especially, chronic studies on CBD effect on, for example, genotoxicity and the immune system are still missing.
Last, studies that evaluate whether CBD-drug interactions occur in clinical trials have to be performed.
In conclusion, CBD safety profile is already established in a plethora of ways. However, some knowledge gaps detailed above should be closed by additional clinical trials to have a completely well-tested pharmaceutical compound.
The study was commissioned by the European Industrial Hemp Association. EIHA paid nova-Institute for the review. Iffland K, Grotenhermen F An update on safety and side effects of cannabidiol: National Center for Biotechnology Information , U.
Journal List Cannabis Cannabinoid Res v. Published online Jun 1. Find articles by Kerstin Iffland. Find articles by Franjo Grotenhermen. Author information Copyright and License information Disclaimer. This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This article has been cited by other articles in PMC.
Relevant Preclinical Studies Before we discuss relevant animal research on CBD possible effects on various parameters, several important differences between route of administration and pharmacokinetics between human and animal studies have to be mentioned. Open in a separate window. The reality is more complex, because CBD is lipophilic and, for example, will consequently accumulate in fat tissue. These calculations were made with the intention to give the reader an impression and an approximation of the supraphysiological levels used in in vitro studies.
CBD-drug interactions Cytochrome Pcomplex enzymes This paragraph describes CBD interaction with general drug -metabolizing enzymes, such as those belonging to the cytochrome P family. Neurological and neurospychiatric effects Anxiety and depression Some studies indicate that under certain circumstances, CBD acute anxiolytic effects in rats were reversed after repeated day administration of CBD.
Psychosis and bipolar disorder Various studies on CBD and psychosis have been conducted. Addiction CBD, which is nonhedonic, can reduce heroin-seeking behavior after, for example, cue-induced reinstatement. Neuroprotection and neurogenesis There are various mechanisms underlying neuroprotection, for example, energy metabolism whose alteration has been implied in several psychiatric disorders and proper mitochondrial functioning.
Immune system Numerous studies show the CBD immunomodulatory role in various diseases such as multiple sclerosis, arthritis, and diabetes. Cell migration Embryogenesis CBD was shown to be able to influence migratory behavior in cancer, which is also an important aspect of embryogenesis.
Cancer Various studies have been performed to study CBD anticancer effects. Food intake and glycemic effects Animal studies summarized by Bergamaschi et al. Genotoxicity and mutagenicity Jones et al. Acute Clinical Data Bergamaschi et al. Physiological effects In a double-blind, placebo-controlled crossover study, CBD was coadministered with intravenous fentanyl to a total of 17 subjects.
Psychosis The review by Bergamaschi et al. Addiction A case study describes a patient treated for cannabis withdrawal according to the following CBD regimen: Endocrine effects and glycemic including appetite effects To the best of our knowledge, no acute studies were performed that solely concentrated on CBD glycemic effects.
Physiological effects A first pilot study in healthy volunteers in by Mincis et al. Neurological and neuropsychiatric effects Anxiety Clinical chronic lasting longer than a couple of weeks studies in humans are crucial here but were mostly still lacking at the time of writing this review.
Psychosis and bipolar disorder In a 4-week open trial, CBD was tested on Parkinson's patients with psychotic symptoms. Conclusion This review could substantiate and expand the findings of Bergamaschi et al. Safety and side effects of cannabidiol, a Cannabis sativa constituent.
Cannabis und Cannabinoide in der Medizin: Cannabidiol exerts sebostatic and antiinflammatory effects on human sebocytes. Controlled clinical trial of cannabidiol in Huntington's disease.
Molecular targets of cannabidiol in neurological disorders. Exogenous cannabinoids as substrates, inhibitors, and inducers of human drug metabolizing enzymes: Distinct effects of D9-tetrahydro-cannabinoland cannabidiol on neural activation during emotional processing. Safety and pharmacokinetics of oral cannabidiol when administered concomitantly with intravenous fentanyl in humans. Inhibition and induction of human cytochrome P CYP enzymes. How physicochemical properties of drugs affect their metabolism and clearance.
Valproic acid Valproic acid can cause liver injury. Taking cannabidiol with valproic acid might increase the chance of liver injury. Moderate Be cautious with this combination. Eslicarbazepine Eslicarbazepine is changed and broken down by the body.
Cannabidiol might decrease how quickly the body breaks down eslicarbazepine. This might increase levels of eslicarbazepine in the body by a small amount.
Cannabidiol might decrease how quickly the liver breaks down some medications. In theory, using cannabidiol along with some medications that are broken down by the liver might increase the effects and side effects of some medications.
Before using cannabidiol, talk to your healthcare provider if you take any medications that are changed by the liver. Some medications changed by the liver include chlorzoxazone Lorzone and theophylline Theo-Dur, others.
Some medications changed by the liver include amitriptyline Elavil , haloperidol Haldol , ondansetron Zofran , propranolol Inderal , theophylline Theo-Dur, others , verapamil Calan, Isoptin, others , and others. Some medications changed by the liver include theophylline Theo-Dur, others , omeprazole Prilosec, Omesec , clozapine Clozaril, FazaClo , progesterone Prometrium, others , lansoprazole Prevacid , flutamide Eulexin , oxaliplatin Eloxatin , erlotinib Tarceva , and caffeine.
Some medications changed by the liver include nicotine, chlormethiazole Heminevrin , coumarin, methoxyflurane Penthrox , halothane Fluothane , valproic acid Depacon , disulfiram Antabuse , and others.
Some medications changed by the liver include ketamine Ketalar , phenobarbital, orphenadrine Norflex , secobarbital Seconal , and dexamethasone Decadron. Some medications changed by the liver include proton pump inhibitors including omeprazole Prilosec , lansoprazole Prevacid , and pantoprazole Protonix ; diazepam Valium ; carisoprodol Soma ; nelfinavir Viracept ; and others. Some medications changed by the liver include nonsteroidal anti-inflammatory drugs NSAIDs such as diclofenac Cataflam, Voltaren , ibuprofen Motrin , meloxicam Mobic , and piroxicam Feldene ; celecoxib Celebrex ; amitriptyline Elavil ; warfarin Coumadin ; glipizide Glucotrol ; losartan Cozaar ; and others.
Some medications changed by the liver include amitriptyline Elavil , codeine, desipramine Norpramin , flecainide Tambocor , haloperidol Haldol , imipramine Tofranil , metoprolol Lopressor, Toprol XL , ondansetron Zofran , paroxetine Paxil , risperidone Risperdal , tramadol Ultram , venlafaxine Effexor , and others.
Some medications changed by the liver include alprazolam Xanax , amlodipine Norvasc , clarithromycin Biaxin , cyclosporine Sandimmune , erythromycin, lovastatin Mevacor , ketoconazole Nizoral , itraconazole Sporanox , fexofenadine Allegra , triazolam Halcion , verapamil Calan, Isoptin and many others. Some medications changed by the liver include testosterone, progesterone Endometrin, Prometrium , nifedipine Adalat CC, Procardia XL , cyclosporine Sandimmune , and others. Rufinamide Rufinamide is changed and broken down by the body.
Cannabidiol might decrease how quickly the body breaks down rufinamide. This might increase levels of rufinamide in the body by a small amount.
Sedative medications CNS depressants Cannabidiol might cause sleepiness and drowsiness. Medications that cause sleepiness are called sedatives. Taking cannabidiol along with sedative medications might cause too much sleepiness. Some sedative medications include benzodiazepines, pentobarbital Nembutal , phenobarbital Luminal , secobarbital Seconal , thiopental Pentothal , fentanyl Duragesic, Sublimaze , morphine, propofol Diprivan , and others.
Topiramate Topiramate is changed and broken down by the body. Cannabidiol might decrease how quickly the body breaks down topiramate. This might increase levels of topiramate in the body by a small amount. Zonisamide Zonisamide is changed and broken down by the body. Cannabidiol might decrease how quickly the body breaks down zonisamide.
This might increase levels of zonisamide in the body by a small amount. Herbs and supplements with sedative properties Cannabidiol can cause sleepiness or drowsiness. Using it along with other herbs and supplements that have the same effect might cause too much sleepiness.
Some of these herbs and supplements include calamus, California poppy, catnip, hops, Jamaican dogwood, kava, L-tryptophan, melatonin, sage, SAMe, St. John's wort, sassafras, skullcap, and others. There are no known interactions with foods. The following doses have been studied in scientific research: A prescription cannabidiol product Epidiolex has been used.
The recommended starting dose is usually 2. There is no strong scientific evidence that nonprescription cannabidiol products are beneficial for epilepsy. N Engl J Med. Quality Traits of "Cannabidiol Oils": Low-dose cannabidiol is safe but not effective in the treatment of Crohn's Disease, a randomized controlled trial. Cannabidiol treatment for refractory seizures in Sturge-Weber Syndrome.
Cannabidiol for the prevention of graft-versus-host-disease after allogeneic hematopoietic cell transplantation: Biol Blood Marrow Transplant. Drug-drug interaction between clobazam and cannabidiol in children with refractory epilepsy.
Cannabidiol in patients with treatment-resistant epilepsy: Efficacy and safety of cannabidiol and tetrahydrocannabivarin on glycemic and lipid parameters in patients with type 2 diabetes: Cannabidiol as a potential treatment for febrile infection-related epilepsy syndrome FIRES in the acute and chronic phases. Cannabidiol as a new treatment for drug-resistant epilepsy in tuberous sclerosis complex. Interactions between cannabidiol and commonly used antiepileptic drugs.
Trial of cannabidiol for drug-resistant seizures in the Dravet Syndrome. Labeling accuracy of cannabidiol extracts sold online. The non-psychoactive cannabis-constituent cannabidiol is an oral anti-arthritic therapeutic in murine collagen-induced arthritis. Analgesic and anti-inflammatory activity of constituents of Cannabis sativa L. Effects of cannabidiol on amphetamine-induced oxidative stress generation in an animal model of mania.
Cannabidiol in vivo blunts beta-amyloid induced neuroinflammation by suppressing IL-1beta and iNOS expression. Br J Pharmacol ; Cannabidiol inhibits inducible nitric oxide synthase protein expression and nitric oxide production in beta-amyloid stimulated PC12 neurons through p38 MAP kinase and NF-kappaB involvement.
Neurosci Lett ; CNS Neurosci Ther ; Bisogno T, Di Marzo Y. The role of the endocannabinoid system in Alzheimer's disease: Curr Pharm Des ; Rev Bras Psiquiatr ; Trends Pharmacol Sci ; Cannabidiol as an emergent therapeutic strategy for lessening the impact of inflammation on oxidative stress. Free Radic Biol Med ; Sedative activity of cannabis in relation to its delta'-trans-tetrahydrocannabinol and cannabidiol content.
Hypnoticlike effects of cannabidiol in the rat. Karler R, Turkanis SA. The anticonvulsant activity of cannabidiol and cannabinol. Anticonvulsant interaction of cannabidiol and ethosuximide in rats. J Pharm Pharmacol ; Consroe P, Wolkin A. Cannabidiol-antiepilpetic drug comparisons and interactions in experimentally induced seizures in rats.
J Pharmacol Exp Ther ; Cannabidiol and Cannabis sativa extract protect mice and rats against convulsive agents. Assessing antidepressant activity in rodents: Antidepressant-like effect of delta9-tetrahydrocannabinol and other cannabinoids isolated from Cannabis sativa L.
Pharmacol Biochem Behav ; Effects of intracisternal administration of cannabidiol on the cardiovascular and behavioral responses to acute restraint stress. Cannabidiol, a constituent of Cannabis sativa, modulates sleep in rats. Cannabidiol reduces intestinal inflammation through the control of neuroimmune axis.
Modulation of mediotemporal and ventrostriatal function in humans by Delta9-tetrahydrocannabinol: Arch Gen Psychiatry ;
The DA Guide to CBD Drug Interactions
Learning Objectives. 4. Identify common adverse effects of medical cannabis use. Describe medical cannabis drug interactions. Describe (prescription. Cannabidiol: learn about effectiveness, usual dosage, and drug interactions on MedlinePlus. By inhibiting cytochrome P, CBD can either reduce or increase the effects advice patients not to eat grapefruit shortly before or after taking a medication. See CBD-Drug Interactions: The Role of Cytochrome P for more information.