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Medical cannabis is becoming increasingly more popular around the world. But, while the herb is proving to be a useful medical tool, researchers still know fairly little about how cannabis may interact with various pharmaceutical medications. In the upcoming years, this will certainly be a major area of study. In the meantime, here are nine prescription medications that you generally avoid mixing with weed (or at least talk to a professional about).

A note about drug interactions

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The best advice? If you’re trying a new medication and decide to consume cannabis, listen to your body and talk to a doctor. 

Drug interactions are quite complicated. Not only might two substances interact with each other, but they may also interact with whatever anomalies you may have going on with your personal biochemistry.

For example, while one person may feel overly sedated after mixing cannabis with Ativan, another person may find that cannabis helps them lower their dose of the benzodiazepine or deal with difficult to manage side effects.

If you’ve been consuming cannabis regularly, suddenly stopping once you start a new medication may result in some withdrawal symptoms.  This could affect how you respond to a new medication.

To avoid a bad time, it may be best to talk to a medical professional about gradually increasing your dose of a new medication and staying small with cannabis to see how the new drug cocktail makes you feel.

The more drugs you add in, the more challenging things become. It’s important to note that the information presented in this article is far from complete and intended for educational purposes only. Always work with a medical professional when testing out new drug interactions.

Having a terrible reaction? Call for emergency assistance.

1. Drugs containing propoxyphene

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Back in 2010, the opioid painkiller propoxyphene was withdrawn from the U.S. market. The compound is known to be toxic to the heart, even in doses formerly considered therapeutic.

However, if you happen to have any leftover propoxyphene medications, it is best to not use them. It’s also unwise to mix them with cannabis.

Drugs that contain propoxyphene include:

  • Balacet
  • Darvon (Compound 32, Compound 65, N)
  • Darvoset (N 100, A500, N 50)
  • PC-Cap
  • PP-Cap
  • Propacet 100
  • Propoxyphene Compound 65
  • Trycet
  • Wygesic

Symptoms to watch for:

  • Oversedation
  • Dizziness
  • Confusion
  • Difficulty concentrating
  • Impaired judgement
  • Impaired motor skills
  • Impaired thinking

These symptoms may be worse in the elderly.

2. Drugs that contain buprenorphine

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Ironically, buprenorphine is an opioid pain medication that is also used to treat opioid addiction. As an opioid, this drug is also thought to have a high potential for addiction.

In high doses, this drug can also cause respiratory distress, coma, and death. When combined with cannabis, the risk of these things increases, since both substances depress the central nervous system.

Both buprenorphine and cannabis are sedatives which means the chance of being overly sedated with this combination is high.

Common drugs that contain buprenorphine include:

  • Butrans
  • Belbuca
  • Bunavail
  • Buprenex
  • Probuphine
  • Suboxone
  • Subutex
  • Zubslov

Some symptoms to watch for include:

  • Excessive sedation
  • Respiratory problems
  • Inability to stay awake
  • Difficulty controlling motor function
  • Slowed speech
  • Inability to perform cognitive tasks
  • Slowed or irregular heartbeat

If you have mixed buprenorphine and cannabis and are experiencing these symptoms, call for emergency help.

3. Drugs that contain levomethadyl acetate

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Levomethadyl acetate is synthetic opioid painkiller similar to methadone. This drug is sold under the brand name Orlaam. Like other painkillers, this drug can cause some sedation. Mixing Orlaam with cannabis can be so sedative that it is uncomfortable and may even be physically dangerous.
Symptoms to watch for include:
  • Drowsiness or oversedation
  • Dizziness or lightheadedness
  • Confusion
  • Depression
  • Slow, shallow breathing
  • Poor motor coordination
  • Impaired thinking
  • Impaired judgement

4. Beta blockers

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It’s generally thought that those with heart conditions should be extremely cautious with cannabis. Cannabis can cause blood pressure levels to fluctuate and heart rate, meaning that it might make some more sensitive to a heart attack. This is especially true for novice consumers. In regulars, cannabis may slow heart rate.

Those taking beta blockers or other blood pressure medications should be particularly cautious, as both substances can have opposite effects on heart rate. Beta blockers reduce blood pressure but slow heart rate. In regular consumers, there’s a chance that cannabis may amplify the effects of beta blockers by having an additive effect on slowing heartbeat. Either way, it’s a tricky mix.

Common beta blockers include:

  • Sectral
  • Tenormin
  • Zebeta
  • Lopressor
  • Toprol-XL
  • Corgard
  • Bystolic
  • Inderal LA
  • InnoPran XL

Some symptoms to watch for include:

  • Feeling faint, fainting
  • Dizziness
  • Nausea
  • Irregular heartbeat
  • Shallow breathing
  • Fatigue
  • Confusion

5. Benzodiazepines

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Benzodiazepines are powerful sedatives in their own right. While there are certainly a lot of people out there who mix benzos with cannabis, this can make for a powerful and uncomfortable experience. Common benzodiazepines include:

  • Ativan
  • Klonopin
  • Xanax

Both cannabis and benzodiazepine medications can have strong sedative effects on the brain, putting patients at risk of oversedation. Both compounds can have an effect on GABA, a calming neurotransmitter that dampens excitability in the brain. In general, mixing cannabis and benzodiazepines should be closely monitored. Similarly, patients may want to avoid mixing cannabis with other sedative medications like sleeping pills.

Symptoms to watch for include:

  • Oversedation
  • Slowed or slurred speech
  • Slowed motor skills
  • Driving impairment
  • Cognitive impairment
  • Constipation

6. SSRIs

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Thus far, only minor interactions are noted for mixing cannabis with some of the most common SSRIs. Some evidence suggests that cannabis compounds may increase the effect of some SSRIs, like Prozac. Those with manic depression (bipolar disorder) or at risk for manic depression have reason to be more mindful of potential mood alterations when mixing these two types of medications.

Both cannabis and SSRIs also increase serotonin. There is a potential risk developing sudden serotonin syndrome when combining these two drugs, but firm research on the subject is needed. Some common SSRIs include,

  • Lexapro
  • Prozac
  • Zoloft
  • Paxil

Symptoms to watch for:

  • Difficulty sleeping
  • Symptoms of mania
  • Agitation
  • Anxiety
  • Excessive paranoia
  • Rapid heart rate
  • Headache
  • Gastrointestinal distress
  • Mood variability and mood swings

7. SNRIs

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Those taking another class of antidepressant drugs, SNRIs, may need to be mindful of cannabis consumption. Both SNRIs and cannabis can cause serotonin fluctuations, which may make you more likely to develop sudden serotonin syndrome or have other unwanted mood side effects. Further, some cannabis compounds may increase blood concentrations of antidepressant drugs. Though, there is little research on this topic. SNRI’s are also used to treat nerve pain.

Some common SNRIs include:

  • Effexor
  • Cymbalta
  • Pristiq

Symptoms to watch for include:

  • Memory impairment
  • Confusion
  • Agitation
  • Paranoia
  • Rapid heart rate
  • Changes in blood pressure
  • Headache
  • Muscle twitching
  • Gastrointestinal distress

8. Antipsychotic medications

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Antipsychotic medications are tranquilizers. High-THC cannabis can also be sedating, meaning that there are some possible interactions between these two substances. When consumed together, symptoms should be closely monitored.

There is some evidence to suggest that cannabis may heighten the effect of certain antipsychotic drugs, like Seroquel and Abilify. Though, the significance of this is unknown. Some common antipsychotic medications include:

  • Seroquel
  • Abilify
  • Clozaril
  • Geodon
  • Zyprexa

Symptoms to watch for:

  • Excessive sedation
  • Slow motor skills
  • Decreased cognitive function
  • Confusion
  • Impaired driving

9. Sodium oxybate

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Sodium oxybate is an anti-sleep medication that is often used to treat narcolepsy. When combined with cannabis, patients may risk depressing the central nervous system a little too much.

In the most severe cases, this may contribute to coma. Some symptoms to watch for include:

  • Dizziness or lightheadedness
  • Depression
  • Low blood pressure
  • Shallow breathing
  • Difficulty thinking
  • Impaired judgement
  • Impaired motor function

Want to know if cannabis might interact with a medication you are taking? There are a few resources at your disposal. Take a look at MedScape’s Drug Interaction Checker here. A doctor or a pharmacist may also be able to help.

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Delilah Butterfield

Delilah Butterfield is a Pacific Northwest native with a passion for cannabis and natural health. Contact her on Twitter @delilahbfield.
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