While generally considered safe, CBD may cause drowsiness, lightheadedness, nausea, diarrhea, dry mouth, and, in rare instances, damage to the liver. Taking CBD with other medications that have similar side effects may increase the risk of unwanted symptoms or toxicity. In other words, taking CBD at the same time with OTC or prescription medications and substances that cause sleepiness, such as opioids, benzodiazepines (such as Xanax or Ativan), antipsychotics, antidepressants, antihistamines (such as Benadryl), or alcohol may lead to increased sleepiness, fatigue, and possibly accidental falls and accidents when driving. Increased sedation and tiredness may also happen when using certain herbal supplements, such as kava, melatonin, and St. John’s wort. Taking CBD with stimulants (such as Adderall) may lead to decreased appetite, while taking it with the diabetes drug metformin or certain heartburn drugs (such as Prilosec) may increase the risk of diarrhea.
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.
Doubling up on side effects
Researchers from Penn State College of Medicine evaluated existing information on five prescription CBD and delta-9-tetrahydrocannabinol (THC) cannabinoid medications: antinausea medications used during cancer treatment (Marinol, Syndros, Cesamet); a medication used primarily for muscle spasms in multiple sclerosis (Sativex, which is not currently available in the US, but available in other countries); and an antiseizure medication (Epidiolex). Overall, the researchers identified 139 medications that may be affected by cannabinoids. This list was further narrowed to 57 medications, for which altered concentration can be dangerous. The list contains a variety of drugs from heart medications to antibiotics, although not all the drugs on the list may be affected by CBD-only products (some are only affected by THC). Potentially serious drug interactions with CBD included
Many drugs are broken down by enzymes in the liver, and CBD may compete for or interfere with these enzymes, leading to too much or not enough of the drug in the body, called altered concentration. The altered concentration, in turn, may lead to the medication not working, or an increased risk of side effects. Such drug interactions are usually hard to predict but can cause unpleasant and sometimes serious problems.
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.
One study evaluated the use of CBD and fentanyl, one of the most potent opioids available. Per the study:
While studies looking at specific drug interactions with CBD are uncommon, it is known that CBD affects the cytochrome P450 system, which is extremely important for the metabolism of countless drugs.
Cannabidiol (CBD) is a major constituent of the cannabis plant and is considered “non-psychoactive”, unlike delta-9-tetrahydrocannabinol (THC). In fact, depending on the variety of cannabis, CBD can make up close to 40% of cannabis extracts according to studies.
Safety Of CBD And Opioids Like Hydrocodone
In fact, toxicity studies in animals show extremely large amounts of CBD are needed to produce dangerous effects.
Below, we discuss the current evidence available regarding CBD and potential interactions with hydrocodone, including a potential decrease in efficacy of the pain relieving drug.
This interaction is more theoretical than evidence based as there are a lack of studies that have reported this interaction. In addition, there is some controversy in regard to just how much, if at all, CBD can inhibit metabolizing enzymes.
I take hydrocodone and have been for the past few years. I am wondering if it is safe to take CBD (cannabidiol) oil with it for additional pain relief.
Anticholinergic drugs (Tricyclic antidepressants (TCAs) and some muslce relatxers)
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CBD is extensively metabolised in the liver, primarily to 7-OH-CBD which is then metabolised further into as many as 100 metabolites that are excreted in feces and urine. Seven CYP enzymes have been identified as metabolising CBD: CYP1A1, CYP1A2, CYP2C9, CYP2C19, CYP2D6, CYP3A4, and CYP3A5, but the two main ones are CYP3A4 and CYP2C19.
Bioavailability and Tissue Distribution of CBD
Cannabis – Inflammatory Bowel Disease (coming soon)
The time it takes for blood levels to go down to half of a maximum level (half-life) depends on dose and route of administration. The half-life is shorter for smoked/vaped administration and longer for oral and buccal use. The half-life of CBD is reported between 1.4 and 10.9 hours after oromucosal spray, 2–5 days after chronic oral administration, 24 hours after intravenous use, and 31 hours after smoking. Overall, however, there is considerable variation of these parameters in different individuals. Like THC, CBD is rapidly distributed into tissues with a high volume of distribution CBD and preferentially accumulates in adipose (fat) tissues due to its high lipophilicity.
Cannabinoids and Opioids
Cannabis – Sleep (coming soon)