How Does CBD Interact with Other Medications [Explained] Is it safe?

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Just about all chemical compounds, ranging from over-the-counter drugs and prescription medications to illicit substances, interact with other compounds. With the use of cannabis for medicinal purposes being legalized in various states throughout the United States, many patients are now taking advantage of the phenomenal medical benefits of CBD. However, this raises the question of the effects that CBD might have when used in conjunction with other medications.

While CBD is safe to use, there is the possibility that it interferes with other drugs that you are taking. In this article, we will take a closer look at how CBD interacts with 10 of the top medications that are used for different conditions.

How does CBD interact with other drugs?

In essence, the way that CBD is metabolized can interfere with how your body normally metabolizes other medications you take. If these medications aren’t metabolized properly, they may hang around and stay in your system more than you would want them to. This could cause various side effects and complications.

As most of us are aware, research has shown that CBD has the potential to treat various medical conditions by manipulating the endocannabinoid system (ECS), with very few unintended effects. The problem is that some of the CBD side-effects could be dangerous if they are not properly understood. One of these effects is the is the inhibition of the cytochrome P-450 enzyme system.

This is the system in the body that is responsible for metabolizing about 90% of the drugs that we consume. It works by breaking down the substances that we put into our body and turning them into simpler substances that our body actually knows how to use. The problem is that if you take a large dose of CBD, the body’s P450 enzymes will become temporarily inactive. When those enzymes are inactive, it becomes much harder for the body to process certain drugs out there.

In fact, basically any drug that is metabolized by cytochrome P-450 enzymes has the potential to interact with CBD. Let’s take a closer look at some of these drugs.

1. Prozac: Antidepressant

Cannabidiol (CBD) can be used to make people feel more relaxed, happier, and less stressed. As a result, people who suffer from anxiety or depression are more likely to use CBD (and more of it), when compared to people who don’t suffer from this condition. Of course, there are many people who suffer from these conditions who also take prescription anti-depressants. This is why it’s important that medical professionals and patients are aware of the potential interaction that could arise from combining the two.

As most of us know, Prozac is a very well-known medication that’s used primarily to treat depression and panic attacks. It’s used to improve sleep, mood, energy levels, appetite, and may also help to restore interest in day-to-day living.

One of the major challenges that physicians face when it comes to prescribing antidepressants to patients who use CBD, is determining the correct dosage to prescribe. This combination leads to difficulties in measuring the degree each substance produces side effects, and how they affect behavior and mood.

Adverse interactions between CBD and selective serotonin reuptake inhibitors (SSRIs) are rare. However, there are speculations based on isolated reports that combining SSRIs (such as Prozac) with CBD could increase the risk of hypomania, which is a mild form of mania.

2. Warfarin: Blood thinner

While the majority of patients who use blood thinners along with CBD suffer from no ill side effects, there is the possibility that it could cause problems. Common blood thinners like Warfarin are subjected to prolonged activity and increased effect when taken together with CBD, and this could result in elevated INR, which is a test used to monitor the effects of warfarin).

A 2007 study published in “Phytomedicine,” for example, showed that CBD has some mild anti-coagulating effects. This means that CBD can increase warfarin levels, which means that people on warfarin should exercise caution when adding CBD to the mix.

Essentially, adding CBD to the mix can cause blood to thin temporarily. This could have the same dangerous effects as taking a double dose of warfarin, as it increases the risks but shouldn’t cause any long-term issues. As CBD is excreted from the body, the clotting factors and platelets should return to their previous levels.

3. Risperidone: Antipsychotic

Risperidone is an antipsychotic medication that is commonly prescribed to treat mild cases of schizophrenia, bipolar disorder, and ASD. While there is no reason to worry that the combination of risperidone and CBD will lead to life-threatening side effects, some users have reported severe anxiety attacks due to the combination.

Also, high doses of CBD could potentially lead to its prolonged activation. This is also the case for drugs like haloperidol, which is a similar antipsychotic medication of the same class. Ultimately, CBD has the potential to intensify the side effects associated with risperidone.

Moreover, antipsychotic medications are used as tranquilizers and are most effective in treating people who have hallucinations, psychotic episodes, and delusions associated with schizophrenia and other psychotic disorders. The way that CBD interacts with the enzyme cytochrome P450 is vital, as they can essentially deactivate each other.

4. Clobazam: Epilepsy and seizures

Although CBD has proven to be an effective and safe treatment option for epilepsy and seizures, a 2015 publication in “Epilepsia” has shown that frequent use of CBD could increase the levels of Clobazam in both adults and children. In this same study, adults who were taking clobazam reported sedation more frequently.

Furthermore, a study conducted by Dr. Gaston and her team at the University of Alabama at Birmingham found that CBD could potentially alter the blood levels of commonly used antiepileptic drugs such as Clobazam. While it’s not fully understood why this happens, it is thought to be because CBD is a strong inhibitor of various enzymes in the human cytochrome P450 system.

Another interesting finding from one of the studies done on how CBD interacts with other medications revealed that when Clobazam is broken down, it may interact with CBD in some people resulting in fatigue and tiredness. Again, findings aren’t conclusive, but there does seem to be the possibility of negative effects when these two substances are used in conjunction with one another.

5. Nyquil: Cold and Flu relief

The problem here is actually with a substance called doxylamine, which is an antihistamine that can be found in Nyquil and other over the counter allergy medicines. The combination of CBD and any of these types of medicines can lead to increased confusion, drowsiness, cognitive impairments, and decreased motor function.

CBD is responsible for blocking the action of the enzymes in the liver that break down most of the medicines you find on pharmacy shelves, and since the liver is the primary detoxifying organ in the body, the action of blocking its enzymes can result in the possibility that over the counter drugs might not be effectively cleared from the system. This can significantly increase the chance of negative side effects.

6. HIV Antiretrovirals

All medications that enter the body are eventually metabolized, either to be activated so that they can work in the body or broken down for elimination from the body. Usually, this task is accomplished by enzymes – more specifically, cytochrome p450 enzymes. There are three ways in which medications can act on these enzymes; induce them to make more of them, break them down, or inhibit them from their functional roles.

The problem occurs when the same enzyme works on two different medications, as is the case with CBD and antiretrovirals. The outcome will depend on the interaction of the medicines with the enzyme.

To put it simply, if one medicine induces the enzyme to increase production, but the other is broken down by it, the effect of the second medicine would be reduced because its breakdown is sped up by the existence of the other medicine. If both medications inhibit the actions of the enzyme, the effect of both medications will be increased. However, if both medications induce the enzyme, the effects of both medications could be decreased.

Confusing, I know.

Moreover, when certain antivirals such as atazanavir, ritonavir, and saquinavir are taken with CBD, they could increase the duration and effects of the CBD, but may also lead to an increase in their own side effects. For this reason, patients who start using CBD after using these medications are cautioned to start with a low dosage.

7. Xanax: Anti anxiety

While mixing Xanax with CBD isn’t as dangerous as mixing it with certain other substances (like alcohol or opioids), you should still exercise caution. Mixing Xanax and CBD may heighten the side effects of either or both substances, meaning you could experience severe drowsiness, concentration problems, or even confusion.

Also, keep in mind that the combination of CBD and Xanax could result in poor decision making. For example, you may be more likely to add alcohol to the mix, and consuming alcohol with Xanax can be very dangerous.

8. Buprenorphine: Pain Medication

Buprenorphine is an opioid pain medication that is thought to have a high potential for addiction. In high doses, this is a drug that could cause coma, respiratory distress, or even death. And when combined with CBD, the risk of these things is believed to increase as both substances are known to depress the central nervous system.

Cannabis and buprenorphine are both sedatives, which means that there is a high chance of becoming hypersedated when you combine the two. A list of drugs that contain buprenorphine includes: Bunavail, Probuphine, Butrans, Suboxone, and Belbuca among others. Symptoms to look out for are slowed speech, slowed or irregular heartbeat, difficulty controlling motor functions, or excessive sedation.

9. Beta blockers: Blood pressure

Generally speaking, those with heart conditions need to be cautious when it comes to cannabis, as CBD can cause blood pressure and heart rate levels to fluctuate. In other words, it could make you more sensitive to a heart attack. This is especially true for individuals who have just started taking CBD and have not yet developed a tolerance. Even for regular consumers, CBD may slow down the heart rate.

In reality, beta blockers or other blood pressure medications can have opposite effects on the heart rate. For example Beta Blockers will reduce blood pressure but slow down the heart rate, and for regular consumers, there’s a chance that CBD will amplify the effects of the beta blockers by having an additive effect of slowing down the heart. Well-known beta blockers include Tenormin, Toprol-XL, Sectral, Bystolic, and Zebeta.

10. Sodium oxybate: anti-sleep medication

Sodium oxybate is an anti-sleep medication often used to treat narcolepsy. When combined with CBD, there is the risk of depressing the central nervous system to dangerous levels. In very severe cases, this could contribute to a coma. Other symptoms to look out for are depression, dizziness, low blood pressure, shallow breathing, and impaired motor function.

Final thoughts on Interaction between CBD and Other Medications

Always exercise caution when taking CBD along with other medications. While CBD is largely considered to be an incredibly safe and therapeutic medication, there is still the possibility that it will have a negative impact when combined with other drugs. If in doubt, do your research and make sure you are in the know about any potential side effects, however small they might be.

And lastly, it is important to understand that we are not medical professionals, and thus none of the aforementioned information should be taken as fact or medical advice. Everyone has different reactions and a different internal response to CBD, so your individual experience may be very different from those presented above.

Sources:

https://www.ncbi.nlm.nih.gov/pubmed/16644197

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Cannabidiol significantly reduces seizures in patients with severe form of epilepsy.

Cannabidiol (CBD), a compound derived from the cannabis plant that does not produce a “high” and has been an increasing focus of medical research, was shown in a new large-scale, randomized, controlled trial to significantly reduce the number of dangerous seizures in patients with a severe form of epilepsy called Lennox-Gastaut syndrome.

In the new study comparing two doses of CBD to a placebo, the researchers reported a 41.9 percent reduction in “drop seizures” – a type of seizure that results in severe loss of muscle control and balance – in patients taking a 20 mg/kg/d CBD regimen, a 37.2 percent reduction in those on a 10 mg/kg/d CBD regimen, and a 17.2 percent reduction in a group given a placebo.

The phase III trial was led by principal investigator and study first co-author Orrin Devinsky, MD, a professor of neurology, neurosurgery, and psychiatry at NYU School of Medicine and director of NYU Langone’s Comprehensive Epilepsy Center, and was published online May 17 in The New England Journal of Medicine.

“This new study adds rigorous evidence of cannabidiol’s effectiveness in reducing seizure burden in a severe form of epilepsy and, importantly, is the first study of its kind to offer more information on proper dosing,” says Dr. Devinsky. “These are real medications with real side effects, and as providers we need to know all we can about a potential treatment in order to provide safe and effective care to our patients.”

The study included an investigational liquid, oral formulation of CBD called Epidiolex. The product is manufactured by GW Pharmaceuticals, which operates in the U.S. as Greenwich Biosciences; GW Pharmaceuticals funded the clinical trial.

Safety of Two CBD Doses Studied

Lennox-Gastaut syndrome is a rare and severe form of epilepsy characterized by frequent drop seizures and severe cognitive impairment. Six medications are approved to treat seizures in patients with the syndrome, but disabling seizures occur in most patients despite these treatments.

Researchers enrolled 225 patients (age 2 to 55) with Lennox-Gastaut syndrome across 30 international sites in a randomized, double-blind, placebo-controlled trial to assess the efficacy and safety of two doses of CBD: Seventy-six patients received 20 mg/kg/d CBD, 73 received 10 mg/kg/d CBD, and 76 were given a placebo. All medications were divided into two doses per day for 14 weeks. The number of seizures were monitored beginning four weeks prior to the study for baseline assessment, then tracked throughout the 14-week study period and afterwards for a four-week safety check.

Side effects occurred in 94 per of patients in the 20 mg CBD group, 84 percent in the 10 mg CBD group, and 72 percent of those taking placebo. Side effects were generally reported as mild or moderate in severity and those that occurred in more than 10 percent of patients included: sleepiness, decreased appetite, diarrhea, upper respiratory infection, fever, vomiting, nasopharyngitis, and status epilepticus. Fourteen patients taking CBD experienced dose-related, elevated liver enzymes that were reversible. Seven participants from the CBD group withdrew from the trial due to side effects compared to one participant in the placebo group.

“This landmark study provides data and evidence that Epidiolex can be an effective and safe treatment for seizures seen in patients with Lennox Gastaut Syndrome, a very difficult to control epilepsy syndrome,” adds study co-first author, Anup Patel, MD, chief of Neurology at Nationwide Children’s Hospital.

A study led by Dr. Devinsky published in last May’s New England Journal of Medicine showed a 39 percent drop in seizure frequency in patients with a different rare form of epilepsy, Dravet syndrome. Those findings represented the first large-scale, randomized clinical trial for the compound. Open label CBD studies led by Dr. Devinsky also have shown positive results for treatment-resistant epilepsies.

In April, a U.S. Food and Drug Administration advisory panel unanimously voted to recommend approval of a new drug application for Epidiolex cannabidiol oral solution, following a meeting where researchers, including Dr. Devinsky, presented their findings. The FDA will decide whether to approve the medication in late June.

“While the news gives hope for a new treatment option to the epilepsy community, more research remains imperative to better determine the effects of CBD and other similar cannabis-derived compounds on other forms of the disease and in more dosing regimens,” says Dr. Devinsky.

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JAZZY CBD HEMP FLOWER 7 Gram Jar – cbdhemp.direct (Review)

Jazzy CBD Flower from cbdhemp.direct

Cert TEST RESULTS HERE

  • Smell – 5/10

  • Look – 7/10

  • Smoke – 4/10

  • Effects – 9/10

 

 

Came super quick, wrapped in a foil wrapper?!? I guess to protect from the smell? It wasn’t really a oxygen bag like you get at your local dispensary in Cali. It was more like the mylar reflector for a grow room. Opened the usps flat rate envelope and it was smack you in the face loud. Smell was like the mids sacks you would get as a teen but stronger. Came with free pink rolling papers.

First impressions of it were great until I lit up a bowl of it. Dry and nasty, brings me back to the reggy dirt weed teen days almost. After that I packed a bong with some ice and it was 10x better and tolerable to smoke.

Great calming effect almost like a warm blanket on a cold night, immediately felt content with life and everything around me. Super rad feeling and long lasting. About 2 – 2 1/2 good hours of peak with this. After effects are very mellow, sleepy and relaxed. Great for a night time dosing IMO.

 

The buds are pretty uniform, a mix of small/med and large ones. No shake, all bud. Packaging was more pretty then useful, I can’t see it lasting long (Maybe why mine was stale and dry?)

All and all I would recommend this product, maybe mine was just a stale old batch? Still was great overall and worth the $$.

Overall Id give it a 6.5/10

(Only due to the harsh dry smoke they deff need to fix this if they are going to market it as enjoyable smoke).

cbdhemp.direct as a company was 8/10 with the shipping and speed. (Reasoning was the Smell and how it could get caught in the mail pretty easy.)

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Does CBD Really Work For Anxiety?

More people are turning to CBD as a way to manage mental health issues.

Anxiety affects almost all of us in small ways. Before giving a speech or doing something new, we might feel unsure, unprepared or nervous. Some of those feelings may well manifest in physical symptoms like shortness of breath, clammy hands or headaches.

However, to people who have been diagnosed with an anxiety disorder or who experience panic attacks, anxiety is so much more than simply feeling overwhelmed. It can be totally debilitating.

Typical treatments for anxiety usually center around either therapy, medication or both. This includes talk therapy or cognitive behavioral therapy, and medications like benzodiazepines, antidepressants, beta blockers and SNRIs (serotonin and norepinephrine reuptake inhibitors). But non-pharmaceutical solutions are also becoming more popular, especially as new research on them emerges. Case in point: CBD products.

RJ SANGOSTI VIA GETTY IMAGES

First things first: What actually is CBD?

CBD, or cannabidiol, comes from the cannabis plant (aka the natural plant where hemp and marijuana come from). This plant produces over 400 different chemicals, one of which is CBD. CBD products on their own contain little to no THC, the psychoactive component found in the plant that makes users feel high or stoned. This, however, doesn’t make the product totally free to use without legal repercussions anywhere you want: CBD may still be classified as an illegal substance in some states, although the law is often murky and up for interpretation.

CBD is available in oils, or it can be added to creams, ointments and beauty products. It can also be used in a vape pen or even consumed through food like CBD gummies. Joel Greengrass, CEO of Theramu, a company that creates non-THC CBD oil, said he has observed a huge increase in interest and popularity of CBD for skin and wellness complaints, as well as for the treatment of a range of anxiety conditions.

“Overall awareness of CBD and the variety of ailments and symptoms that it can relieve is increasing daily as is the desire to move away from harsh prescription pharmaceuticals,” Greengrass said.

CBD may help with anxiety or mental health issues.

Virginia Thornley, a board-certified neurologist in Sarasota, Florida, reviews scientific articles on cannabidiol. She explained that CBD’s effects are similar to anti-anxiety medication or antidepressants. CBD has “no psychoactive properties compared to high-dose THC and also helps with post-traumatic stress disorder,” she said.

Researchers at São Paulo University in Brazil found similar benefits in the treatment of social anxiety and fear, with results showing that “cannabinoid was shown to decrease anxiety in patients with social phobia,” according their 2017 study.

Blake Pearson, founder of GreenlyMed and a practicing doctor in Ontario, Canada, specializes in cannabinoid medicine and said he has personally seen patients who have lowered their intake of prescription medications or reduced the negative side effects of taking other medications. However, Pearson would like to see more robust research, including random controlled trials.

“Unfortunately, American scientists continue to have a hard time securing research funding because marijuana remains a Schedule 1 substance in the U.S. ― a controversial view that places it on a par with heroin, LSD and ecstasy,” Pearson said. Schedule 1 drugs are identified as having “no currently accepted medical use and a high potential for abuse,” according to the Drug Enforcement Administration. This designation can make research challenging, Pearson added.

Initial data also suggests that CBD has other far-reaching medical applications. A 2013 study published in the British Journal of Clinical Pharmacology found that “CBD was shown to offer benefits including acting in some experimental models as an anti-inflammatory, anticonvulsant, antioxidant, antiemetic, anxiolytic and antipsychotic agent.” This means CBD could be used as “potential medicine for the treatment of neuroinflammation, epilepsy, oxidative injury, vomiting and nausea, anxiety and schizophrenia.”

SPENCER PLATT VIA GETTY IMAGES

More research needs to be done.

All of this certainly isn’t to say you should purchase CBD and toss your prescription medication in the toilet. Some experts continue to have concerns about CBD as a mental health treatment and advise patients to proceed with caution.

“Strong data is lacking with CBD. There have been only small research trials some showing benefit, others showing no benefit with CBD,” said Pritham Raj, an internist-psychiatrist in Portland, Oregon. “So, in short, the jury is still out. This doesn’t mean CBD doesn’t work for anxiety, it just means that we don’t have enough information to make a strong argument for CBD in the treatment of anxiety.”

However, CBD use is better than patients self-medicating with marijuana in a bid to treat anxiety, Raj added.

Among most cannabis components, “CBD is the best of all options in reducing anxiety,” Raj said. “THC has been shown more definitively to increase anxiety, which is why self-medicating with traditional marijuana products often leads to increased overall anxiety.”

Pearson agreed that more research is needed, but believes that CBD is worth trying.

“For those patients who have tried and failed with prescription anti-anxiety medications or want another option for other reasons, CBD is a potential alternative with a good safety profile that offers fewer negative side effects and fewer contraindications with other substances,” Pearson said. “While it won’t work for everyone, it offers a gentler alternative that I have seen work for many people.”

The World Health Organization takes a similar stance, saying there is no evidence of abuse potential or harm associated with the use of pure CBD. However, WHO cautions against its use as a medicine until further research and evidence have been amassed. And, of course, it’s always best to talk with your doctor before making any changes to your health routine.

This story has been updated to include additional details about federal law surrounding CBD.

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