Drug interactions with hemp cbd oil
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.
Does CBD interact with other medications?
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.
In general, cannabinoids are usually well tolerated, but bidirectional effects may be expected with concomitant administered agents via affected membrane transporters Glycoprotein p, breast cancer resistance proteins, and multidrug resistance proteins and metabolizing enzymes Cytochrome P and UDP-glucuronosyltransferases.
Caution should be undertaken to closely monitor the responses of cannabis users with certain drugs to guard their safety, especially for the elderly and people with chronic diseases or kidney and liver conditions. The Cannabis sativa L. Cannabis is used for either medicinal or recreational purposes, which are utterly based on the content of a group of compounds in the plant, designated as cannabinoids. Recently, there has been increasing interest in cannabis, as shown in the inclined publications, reviews, and clinical trials throughout the years Figure 1 , largely due to a change of attitudes towards the use of cannabis in many countries.
These receptors have been postulated as endocannabinoid receptors with debatable contributions in the endocannabinoid signalling [ 5 ]. The phytocannabinoids have been shown to have a range of biological activities by mimicking the endocannabinoids, for example, anandamide and 2-arachidonoylglycerol act as the endogenous ligand of cannabinoid receptors CB 1 and CB 2 [ 5 , 6 , 7 ].
The endocannabinoid system ECS as a potential therapeutic target for various pathological conditions has attracted a substantial interest, particularly in cancer treatment and neurological disorders [ 8 ]. In fact, inclined endocannabinoid level by either externally administered cannabinoids or by curtailing the degradation pathways might represent a useful strategy for developing new treatments for neurodegenerative diseases, nausea and vomiting, chronic pain, and several carcinomas.
A recent review scrutinised the preclinical and clinical studies for the medical use of cannabis [ 8 ].
Hitherto, scattered bidirectional data on the effect of cannabinoids on mental health could be retrieved upon peri-pubertal exposure. For instance, the peri-pubertal administration of CBD prevented the behavioural abnormalities in schizophrenia animal models [ 9 ]. There is also preclinical evidence for the impaired extinction fear in adulthood for mice exposed to THC and stress concurrently in peri-adolescence; however, no effect was observed in animals exposed to either THC or stress alone [ 10 ].
Further clinical studies are warranted to confirm the long-term anxiety disorders and pathological fear in adulthood upon concomitant exposure to cannabis and stress by teenagers [ 10 ]. Furthermore, neurocognitive deficits with poorer psychomotor speed and working memory were reported in adolescents with high rates of cannabis use, but these effects were ameliorated effectively and affordably by aerobic fitness [ 11 ].
There are several reviews that have outlined the potentiality of cannabinoids as anticancer agents, alleviators of chemotherapy-induced nausea and vomiting CINV , and cancer-related pain [ 8 , 12 , 13 , 14 , 15 , 16 ]. Studies of oral or oromucosal cannabinoid spray or pulmonary administration of cannabis smoke in oncology patients showed its tolerability with dose-dependent adverse effects Table 1.
Generally, cannabinoids containing products are used socially in cancer patients for its orexigenic, analgesic, antitumor, anxiolytic, and antiemetic effects [ 17 ]. The resiliency and complexity of cancer cells could rationalise the intervention with synergistic drug combinations, where smaller doses and curtailed side effects could be achieved. A cocktail of medications is usually given to cancer patients to overcome resilient cancer complexity, in most cases with combinatorial chemotherapeutic agents alongside alleviating medications such as antiemetics, appetite stimulant and pain killers.
In this regard, there is potential to reduce or minimize the adverse effects of chemotherapeutic agents by using natural products such as cannabinoids Table 1 , which have been shown to have certain alleviating polypharmacological activities [ 18 , 19 , 20 , 21 , 22 ]. However, it is necessary to study the potential drug interactions, since there is still a lack of sufficient data out for clinical studies on possible interactions between cannabis and other prescription medications such as chemotherapeutic agents.
Drug interactions may result from chemical reactions between different components or modifications by certain components of certain biochemical pathways involved in the action or metabolism of related drugs [ 33 ]. Drug interactions can be affected by various factors including disease and patient conditions, as well as the nature of the compounds involved.
Therefore, a drug interaction may lead to an enhanced drug response or modified or unexpected adverse reactions. For example, a recent review advised patients receiving warfarin against concomitant cannabis use due to the probable risk of bleeding [ 34 ]. On one hand, pharmacodynamic interactions comprise synergistic or antagonistic interactions on the same drug targets, e.
Most reported drug interactions are pharmacokinetic ones, e. CYP may be changed by interacting components through induction and inhibition. A longer period of time, for instance, several days is usually required for the induction of CYP, which may lead to reduced drug plasma levels via increased metabolism, and consequently decreased drug effects. In contrast, the CYP inhibition is usually instantaneous and may lead to inclined drug plasma levels via enhanced metabolism, thus exaggerating the drug effects, which may result in substantial adverse reactions or toxicities [ 33 ].
Furthermore, cannabinoids bind to many members of membrane transporters e. Interactions of cannabinoids with BCRP [ 35 , 36 ] and P-gp [ 37 , 38 , 39 ] have been reported in preclinical studies. The duration of cannabinoids exposure affects the expression of P-gp [ 40 , 41 ] with downregulation in chronic exposure and upregulation in short exposure. Another family of transporters is multidrug resistance protein MRP which is coded by the ABCC gene and is involved in the transportation of various anticancer drugs [ 42 ].
Notably, the concentrations of cannabinoids used in these studies of the cannabinoid effects on membrane transporters are higher than that commonly measured in cannabis smokers [ 17 ]. There are numerous in-vitro and in-vivo studies indicating that cannabinoids may act on P isoenzymes to affect the metabolism of various drugs. The inhibition or induction of CYP by cannabinoids, e. However, in many cases, the relevance of experimental findings in cells or animals to humans has yet to be established.
Specific clinical studies are often needed to verify these interactions before a conclusion can be drawn. For example, studies showed that medicinal cannabis did not affect the clinical pharmacokinetics of irinotecan and docetaxel [ 45 ], while co-administration of cannabidiol CBD and clobazam CLB increased the blood CLB level in children with epilepsy [ 46 ]. A similar recent study showed that concomitant administration of CBD significantly changed serum levels of topiramate, rufinamide, clobazam, eslicarbazepine, and zonisamide in patients with treatment-resistant epilepsy [ 47 ].
Abnormal liver function test results were also noted in participants taking concomitant valproate, indicating the importance of monitoring serum levels of commonly used antiepileptic drugs and liver functions during treatment with CBD [ 47 ]. On the other hand, a study in healthy adults found that concomitant administration of fentanyl did not affect the plasma level of CBD, and the co-administration did not produce cardiovascular complications or respiratory depression during the test sessions and CBD did not potentiate fentanyl effects [ 48 ]; however, keloconazole CYP3A4 inhibitor was found to increase and rifampin a CYP3A4 inducer to reduce THC and CBD concentrations [ 49 ].
A comprehensive overview of the pharmacokinetic interactions of synthetic and phytocannabinoids is summarised in Table 2. Overview of the recent reviews of the drug—drug interactions with cannabinoids. Cannabinoids and drugs with inhibitory or stimulatory effects on UGT2B7 will interact. Clinical studies are warranted to explore the potential interactions with chemotherapy, alcohol, abuse drugs, and prescription medications.
The effect of cannabinoids on the CYP activity influenced by the formulation, administration route, and derivation Plant based or synthetic. Clinical studies are warranted to explore the potential drug—drug interactions with cannabinoids.
More clinical studies are warranted. The purified CBD formula is FDA approved with antiepileptic drugs as a result of the published randomized clinical trials. Clinical studies of pharmacokinetics mediated drug interactions of synthetic and phyto-cannabinoids with the CYP and UTGs substrates are warranted. A study with 21 individuals showed that vaporized cannabis increased the analgesic effects of opioids without altering plasma opioid levels [ 32 ].
A non-controlled, prospective open-label study in participants found that medicinal cannabis reduced the consumption of opioids [ 57 ]. The current research generally supports the use of medical cannabis as an adjunct or opioid substitute. On the other hand, it should be noted that a recent survey in the US indicates that cannabis may increase the risk of developing nonmedical prescription opioid use [ 58 ].
A study in 32 adult cannabis smokers found that low-dose alcohol approximately 0. Thus, it is important to develop a program at the state or national level to monitor the use of different forms of cannabis and their associations to different medical conditions.
A study in a mouse neuropathic pain model found a synergistic interaction between gabapentin and THC, where gabapentin not only improved the THC therapeutic window, but also effectively enhanced its anti-allodynic activity [ 61 ]. In addition, there are early studies or case reports indicating potential drug interactions with warfarin, oxymorphone, pentobarbital, cocaine, sympathomimetic amines, disulfiram, disulfiram etc.
Interestingly, Russo mentioned that in extensive clinical application including complex drug regimens with opioids, tricyclic antidepressants, anticonvulsants etc, no drug interactions have been observed that would contraindicate or preclude the use of nabiximols with any specific pharmaceutical, although additive sedative effects are always possible [ 62 ].
There is still limited data on significant drug interactions caused by medicinal cannabis. Thus, the evidence-based clinical guidelines on interactions of drugs with medicinal cannabis are still lacking. Nevertheless, caution should be undertaken to closely monitor the responses of cannabis users with certain drugs to guard their safety, especially for the elderly and people with chronic diseases or kidney and liver conditions.
National Center for Biotechnology Information , U. Journal List Medicines Basel v. Medicines Basel. Published online Dec Muhammad A. Author information Article notes Copyright and License information Disclaimer. Received Nov 30; Accepted Dec This article has been cited by other articles in PMC. Abstract The endocannabinoids system ECS has garnered considerable interest as a potential therapeutic target in various carcinomas and cancer-related conditions alongside neurodegenerative diseases.
Introduction The Cannabis sativa L. Open in a separate window. Figure 1. Table 1 Recent clinical studies of cannabinoids in oncology patients. Effects of Cannabis on Drug Metabolizing Enzymes and Related Drug Interactions There are numerous in-vitro and in-vivo studies indicating that cannabinoids may act on P isoenzymes to affect the metabolism of various drugs.
Table 2 Overview of the recent reviews of the drug—drug interactions with cannabinoids. Cannabinoids consumption via pyrolysis induced CYP due to aromatic hydrocarbons. Reviewed the pharmacokinetic interactions between cannabinoids on other drugs. Other Potential Drug Interactions A study with 21 individuals showed that vaporized cannabis increased the analgesic effects of opioids without altering plasma opioid levels [ 32 ]. Conclusions There is still limited data on significant drug interactions caused by medicinal cannabis.
Funding This work was partially supported by the Maxwell Family Foundation. Conflicts of Interest The authors declare no conflict of interest. References 1. Bonini S. Cannabis sativa: A comprehensive ethnopharmacological review of a medicinal plant with a long history.
Corroon J. Cannabis Cannabinoid Res. Brown A. Novel cannabinoid receptors. De Petrocellis L. Non-CB 1, non-CB 2 receptors for endocannabinoids, plant cannabinoids, and synthetic cannabimimetics: Focus on G-protein-coupled receptors and transient receptor potential channels.
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.
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. But while CBD has been advertised as an effective way to treat a wide mix of maladies, the compound is still largely unregulated and unstudied.
Susan Ince.
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.
CBD Drug Interactions
CBD inhibits the cytochrome P enzyme, which is involved in metabolizing many drugs. Compounds in grapefruit inhibit the same enzyme group, which is why physicians advice patients not to eat grapefruit shortly before or after taking a medication. By inhibiting cytochrome P , CBD can either reduce or increase the effects of other drugs. In compiling a list of conditions that CBD may help, we examined hundreds of peer-reviewed articles in scientific journals. Skip to main content.
What Drugs Should Not Be Taken with CBD?
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.
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.
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.
What Drugs Should Not Be Taken With 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. It also does not induce changes in food intake; nor does it affect physiological parameters like heart rate, body temperature or blood pressure. There are very few known side effects of cannabinoids. The above review paper mentions the following as potential side effects. To put this in perspective, eating a portion of grapefruit would have a similar effect on the P liver enzymes. Drug interactions should be viewed as a minor side effect of certain cannabinoids. In states that have legalized medical marijuana and hemp for many years, this potential interaction with the P enzyme has not proven to be clinically significant. The only documented serious concern has been noted in epilepsy patients taking Clobazam, an anticonvulsant. A majority of these patients needed to have their dose of Clobazam reduced due to side effects. A report concluded that CBD is safe and effective for treatment of refractory epilepsy in patients receiving Clobazam, but emphasized the importance of monitoring blood levels of Clobazam in those patients using CBD. Side effects and drug Interactions. Inhibition of Hepatic Liver Drug Metabolism. Certain cannabinoids can potentially inhibit the activity of the liver enzyme called cytochrome P
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? Share your thoughts and comments about this topic in the space below. Please abide by the following rules: If you make a statement of fact, such as whether a type of treatment does or does not work, state your basis -- such as personal experience or a published study.
