CBD, although in reality a medicine which has been used by civilization for centuries, is just reaching the mainstream in its modern form. It can be ingested, topically applied, or taken as an oil. Whichever method you use, Safety first! CBD should be taken safely, and that means knowing how it interacts with other medicines you may be taking.
Modern medicine is just starting to explore how CBD can be applied to better health. Your doctor can recommend CBD as a medicine, but products containing CBD are mostly available over the counter as dietary or other forms of supplements and are NOT FDA approved.
What’s the difference between medication and a supplement? Good question. Let’s start with that.
Medications And Supplements
Supplements are most commonly known as “dietary supplements.” They are defined legally by the FDA as “products taken by mouth that contain dietary ingredients.” Ingredients are substances used to enhance daily health, such as vitamins, minerals, or amino acids.
Medications, as per FDA, are substances that are taken in or applied on to the body to treat a medical condition, infection, or disease.
Medications and supplements by nature interact inside the body. CBD can have some especially sensitive interactions with medications and supplements.
What Is CBD?
The medical community is still studying the benefits of CBD, but it has actually been around for a long time.
CBD stands for cannabidiol, and it is extracted from the cannabis sativa plant. But it is not to be confused with “reefer.” CBD is derived mostly from the sister plant Hemp, and it is the second most prevalent active ingredient in the plant after Tetra Hydro Cannabinol (THC), the psychoactive compound found in marijuana. The one that gets you “high.”
Cannabidiol is a different phytocannabinoid first discovered in 1940. Cannabinoids are the chemicals found in the cannabis plant. Here’s a fun fact: There are cannabinoid receptors already present and active inside your body! They are part of the Endocannabinoid System, which could be involved in regulating a wide variety of physiological and cognitive processes, according to preliminary studies.
CBD can be used as a topical treatment and thus will not enter the bloodstream, but these creams often are not as effective. CBD can also be ingested in food, or as an extract tincture or as an oil, among other methods. Although CBD is an integral part of medicinal marijuana treatments, they are not mutually exclusive.
So no need to worry that you are going to get high or catch a buzz from CBD. However, what is important to understand is how it will interact with your body. Let’s explore that in our next segment.
To understand how CBD interacts with other medications or supplements inside your system, it is important to understand two underlying concepts: Drug interaction and Drug metabolism.
- Drug metabolism is the metabolic breakdown of drugs within the system. This is usually carried out through the liver, although not only there. The liver breaks down the enzymes and converts them into either waste or active chemical substances.
- Drug interaction is a change in the effects of a drug due to co-mingling with supplements, food, beverages, or, of course, other drugs. Drug interaction is measured by a labeling system ranging from minor to moderate to major.
Thus, the interaction between two or more drugs or with supplements can interrupt the conversion and affect the effects of one or the other of the substances or medications, amplifying or conversely, muting them. You may end up with some effects dominating while others become insufficient—kind of like “crossing the streams” in the Ghostbusters movie.
This can be especially dangerous, depending on the medical condition of the patient. For example, taking a nasal decongestant may irritate patients with high blood pressure, potentially causing complications. CBD is a substance the liver breaks down, so naturally, it can interfere or alter the effects of any other substance processed by the liver.
Now let’s look more specifically at CBD’s effects and what drugs should not be taken with CBD.
CBD And Its Effects
Cannabidiol’s benefits have begun to be recognized in the medical community, and CBD is believed to be effective in lowering blood pressure and as an anticoagulant. Great strides have also been made in applying CBD to the treatment of epilepsy. CBD oil, in particular, seems to be highly effective in diminishing seizures, excuse the pun.
But if the CBD is competing with medication or another supplement, it can slow down metabolizing. This results in higher amounts of medication in the system than may be intended with the dosage measurement.
For example, CBD in tandem with sleepy supplements or herbs may cause extreme drowsiness. This is a good example of how CBD can become less “benign” in combination with other substances, in what is known as “drug-drug” interactions.
The opposite can also occur. If the medication or supplement is occupying the liver, the CBD might not work as effectively either.
So what are the drugs you should not take in tandem with CBD? The next section will highlight them.
What Not To Take And Why
At the center of the reasoning for moderating CBD intake if taking certain medications is cannabidiols presence as an inhibitor. Specifically, it’s interaction with a group of enzymes known as the cytochrome 450 family.
CBD inhibits an important enzyme within the 450 family called CYP3A4, which is responsible for metabolization of around 60 percent of prescribed medications.
So, for example, although some physicians are claiming success in treating mental disorders like anxiety with cannabidiol, others caution that CBD interferes with the standard prescription medications commonly used to treat such disorders.
Another example is Tacrilomus, which is sold under the brand names Protopic and Prograf, among others. This is a medication prescribed to patients who have received an organ transplant, designed to prevent rejection of the new organs. It specifically interacts with cytochrome 450, and disruption can lead to dangerous levels that can prevent the medicine from working.
That is an extreme case, but CBD can interfere with a long list of treatments, and in some cases, like chemo, the measurements are so precise and lacking margin of error that any interference could cause worse damage.
The Grapefruit Effect
A little trick exists for determining if CBD treatment may interfere with medications. It’s called the Grapefruit Rule.
Grapefruit also interacts with the same enzymes as cannabidiol, like cytochrome 450. Not just grapefruit, but citrus in general. Most labels on prescriptions will highlight if the medication is affected by the consumption of grapefruit.
Therefore, if the medication is not intended to work in tandem with grapefruit, it is affected when used in tandem with CBD. Check your labels!
There exists another class of drugs that interact negatively with Cannabidiol. This class is called “Pro-Drugs.”
Pro-Drugs are medications that need to be metabolized to produce the therapeutic compound. One example is the pain medication Codeine, which must be metabolized to become morphine and act as the pain reliever it is intended to be.
If the process is dependent on the enzyme mentioned above CYP3A4, inhibiting its breakdown will result in too little of the active compound required to produce therapeutic effects. Some ADHD medications also fall into this category.
There are measures you can take to ensure that you do not inadvertently sabotage your own treatment and recovery.
These measures, first and foremost, include talking to your doctor, of course – anyone who prescribes you medication, even if it is psychiatric.
Moderating and balancing dosage is the most important component of protecting yourself, and your dosages can be determined with the advice of your doctor.
Finally, monitoring. Consult with your doctor regularly and make sure he is monitoring your progress and measuring things like plasma levels in your bloodstream. Your pharmacist can also be helpful in many of these same respects, like monitoring, dosage, and interactive risks.
Also, be aware that over the counter drugs can have an effect. Not just supplements or medicine, but anything that is absorbed into the bloodstream, such as food or caffeine, when used in tandem with CBD, can have their effects altered.
But this article is meant to be fair, balanced, and informative, not just meant to scare you off. CBD could be revolutionary in health care. Most over the counter CBD-based treatments do not have high enough levels of CBD to have an adverse effect.
However, as stated at the beginning of this article and it can’t be said enough: Safety First!