Products containing cannabidiol (CBD) seem to be all the rage these days, promising relief from a wide range of maladies, from insomnia and hot flashes to chronic pain and seizures. Some of these claims have merit to them, while some of them are just hype. But it won’t hurt to try, right? Well, not so fast. CBD is a biologically active compound, and as such, it may also have unintended consequences. These include known side effects of CBD, but also unintended interactions with supplements, herbal products, and over-the-counter (OTC) and prescription medications.
People considering or taking CBD products should always mention their use to their doctor, particularly if they are taking other medications or have underlying medical conditions, such as liver disease, kidney disease, epilepsy, heart issues, a weakened immune system, or are on medications that can weaken the immune system (such as cancer medications). A pharmacist is a great resource to help you learn about a potential interaction with a supplement, an herbal product (many of which have their own drug interactions), or an over-the-counter or prescription medication. Don’t assume that just because something is natural, it is safe and trying it won’t hurt. It very well might.
Doubling up on side effects
The researchers further warned that while the list may be used as a starting point to identify potential drug interactions with marijuana or CBD oil, plant-derived cannabinoid products may deliver highly variable cannabinoid concentrations (unlike the FDA-regulated prescription cannabinoid medications previously mentioned), and may contain many other compounds that can increase the risk of unintended drug interactions.
CBD has the potential to interact with many other products, including over-the-counter medications, herbal products, and prescription medications. Some medications should never be taken with CBD; the use of other medications may need to be modified or reduced to prevent serious issues. The consequences of drug interactions also depend on many other factors, including the dose of CBD, the dose of another medication, and a person’s underlying health condition. Older adults are more susceptible to drug interactions because they often take multiple medications, and because of age-related physiological changes that affect how our bodies process medications.
Absolutely. Inhaled CBD gets into the blood the fastest, reaching high concentration within 30 minutes and increasing the risk of acute side effects. Edibles require longer time to absorb and are less likely to produce a high concentration peak, although they may eventually reach high enough levels to cause an issue or interact with other medications. Topical formulations, such as creams and lotions, may not absorb and get into the blood in sufficient amount to interact with other medications, although there is very little information on how much of CBD gets into the blood eventually. All of this is further complicated by the fact that none of these products are regulated or checked for purity, concentration, or safety.
There is currently no known “correct” dose of CBD oil. Depending on individual needs and what is being treated, the daily dose may range between 5 and 25 mg.
CBD oil can interact with certain medications, including some drugs used to treat epilepsy. CBD inhibits an enzyme called cytochrome P450 (CYP450), which metabolizes certain drugs. By interfering with CYP450, CBD may either increase the toxicity or decrease the effectiveness of these drugs.
CBD oil comes as full-spectrum oils or in forms that contain CBD isolates. Unlike isolates, which contain CBD only, full-spectrum oils contain a variety of compounds found naturally in the cannabis plant, including proteins, flavonoids, terpenes, and chlorophyll. Alternative practitioners believe these compounds offer more substantial health benefits, although there is no clear evidence of this.
How to Calculate CBD Dose
CBD shows promise in the treatment of anxiety disorders, suggests a 2015 review of studies in the journal Neurotherapeutics. According to the investigators, CBD demonstrated potent anxiolytic (anxiety-relieving) effects in animal research, albeit with counterintuitive results.
Many of these interactions are mild and require no adjustment to treatment. Others may require a drug substitution or the separation of doses by several hours.
CBD’s exact mechanism of action is unclear. Unlike THC, CBD has a relatively low affinity for cannabinoid receptors in the brain. These are the molecules to which THC binds to elicit its psychoactive effects.
Potential drug-drug interactions with CBD include: