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cbd gel capsules interact with medications

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. Medications changed by the liver (Cytochrome P450 1B1 (CYP1B1) substrates) Some medications are changed and broken down by the liver. 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.

Cannabidiol has effects on the brain. The exact cause for these effects is not clear. However, cannabidiol seems to prevent the breakdown of a chemical in the brain that affects pain, mood, and mental function. Preventing the breakdown of this chemical and increasing its levels in the blood seems to reduce psychotic symptoms associated with conditions such as schizophrenia. Cannabidiol might also block some of the psychoactive effects of delta-9-tetrahydrocannabinol (THC). Also, cannabidiol seems to reduce pain and anxiety.

Some medications changed by the liver include nonsteroidal anti-inflammatory drugs (NSAIDs) such as diclofenac (Cataflam, Voltaren), ibuprofen (Motrin), meloxicam (Mobic), piroxicam (Feldene), and celecoxib (Celebrex); amitriptyline (Elavil); warfarin (Coumadin); glipizide (Glucotrol); losartan (Cozaar); and others. Medications changed by the liver (Cytochrome P450 2D6 (CYP2D6) substrates) Some medications are changed and broken down by the liver. 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.

How does it work?

Some reported side effects of cannabidiol include dry mouth, low blood pressure, light headedness, and drowsiness. Signs of liver injury have also been reported in some patients using higher doses of Epidiolex.

Some medications changed by the liver include nicotine, chlormethiazole (Heminevrin), coumarin, methoxyflurane (Penthrox), halothane (Fluothane), valproic acid (Depacon), disulfiram (Antabuse), and others. Medications changed by the liver (Cytochrome P450 2B6 (CYP2B6) substrates) Some medications are changed and broken down by the liver. 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.

Moderate Be cautious with this combination. Brivaracetam (Briviact) Brivaracetam is changed and broken down by the body. Cannabidiol might decrease how quickly the body breaks down brivaracetam. This might increase levels of brivaracetam in the body. Carbamazepine (Tegretol) Carbamazepine is changed and broken down by the body. Cannabidiol might decrease how quickly the body breaks down carbamazepine. This might increase levels of carbamazepine in the body and increase its side effects. Clobazam (Onfi) Clobazam is changed and broken down by the liver. Cannabidiol might decrease how quickly the liver breaks down clobazam. This might increase the effects and side effects of clobazam. Eslicarbazepine (Aptiom) 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. Everolimus (Zostress) Everolimus is changed and broken down by the body. Cannabidiol might decrease how quickly the body breaks down everolimus. This might increase levels of everolimus in the body. Lithium Taking higher doses of cannabidiol might increase levels of lithium. This can increase the risk of lithium toxicity. Medications changed by the liver (Cytochrome P450 1A1 (CYP1A1) substrates) Some medications are changed and broken down by the liver. 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.

Parkinson disease: Some early research suggests that taking high doses of cannabidiol might make muscle movement and tremors worse in some people with Parkinson disease.

One small study suggests that this interaction could help relieve pain and reduce opioid use when used together. 4 However, more research should be done on this topic.

Opioids, such as hydrocodone/acetaminophen (Vicodin, Norco), oxycodone, (Oxycontin, Percocet) and fentanyl (Duragesic) are a powerful class of drugs used to treat pain that can be addictive. Research suggests that there is a relationship between the body’s opioids—endogenous, or naturally occurring opioids—and endocannabinoid system, although the exact mechanisms remain unknown.

Derived from the hemp plant, Cannabidiol (CBD) has become a popular treatment for back pain and other conditions. CBD has few side effects and is generally considered low risk. However, if you take prescription or over-the-counter medications you should be aware of potential interactions, particularly if the CBD is taken orally. Topical CBD products do not go through the bloodstream so there is less chance of them interacting with medications.

CBD and sedatives

CBD likely blocks the metabolism of these drugs in the liver—because of cytochrome P450—and causes the medication to exist in a higher level in the body and prolong its effects, 3 which can be toxic or cause other problems, such as excess bleeding or hemorrhage.

Sedatives are medications that suppress the central nervous system and are often prescribed to treat anxiety and sleeping disorders. Medications include benzodiazepines, such as alprazolam (Xanax) and lorazepam (Ativan), or sleep aids, like zolpidem (Ambien).

According to one study, people who take anti-epileptic medication for refractory epilepsy, such as clobazam (Onfi, Sympazan), may benefit from taking CBD. 2 This is because both drugs are metabolized in cytochrome P450 and may enhance the medication’s effects. Dose adjustments of clobazam may be necessary and this combination should be strictly monitored by a health care professional.

Drugs used to thin blood, such as warfarin (Coumadin), and drugs that carry an increased risk of bleeding, such as ibuprofen (Advil) or naproxen (Aleve), have been shown to interact with CBD.

Hussain SA, Dlugos DJ, Cilio MR, Parikh N, Oh A, Sankar R. Synthetic pharmaceutical grade cannabidiol for treatment of refractory infantile spasms: A multicenter phase-2 study. Epilepsy Behav. 2020 Jan;102:106826. View abstract.

Yadav V, Bever C Jr, Bowen J, et al. Summary of evidence-based guideline: complementary and alternative medicine in multiple sclerosis: report of the guideline development subcommittee of the American Academy of Neurology. Neurology. 2014;82(12):1083-92. View abstract.

Formukong EA, Evans AT, Evans FJ. Analgesic and anti-inflammatory activity of constituents of Cannabis sativa L. Inflammation 1988;12(4):361-71. View abstract.

Side Effects

Naftali T, Mechulam R, Marii A, et al. Low-dose cannabidiol is safe but not effective in the treatment of Crohn’s Disease, a randomized controlled trial. Dig Dis Sci. 2017 Jun;62(6):1615-20. View abstract.

Gaston TE, Bebin EM, Cutter GR, Liu Y, Szaflarski JP; UAB CBD Program. Interactions between cannabidiol and commonly used antiepileptic drugs. Epilepsia. 2017 Sep;58(9):1586-92. View abstract.

Parihar V, Rogers A, Blain AM, Zacharias SRK, Patterson LL, Siyam MA. Reduction in Tamoxifen Metabolites Endoxifen and N-desmethyltamoxifen With Chronic Administration of Low Dose Cannabidiol: A CYP3A4 and CYP2D6 Drug Interaction. J Pharm Pract. 2020:897190020972208. View abstract.

Szaflarski JP, Bebin EM, Cutter G, DeWolfe J, et al. Cannabidiol improves frequency and severity of seizures and reduces adverse events in an open-label add-on prospective study. Epilepsy Behav. 2018 Oct;87:131-136. Epub 2018 Aug 9. View abstract.