Supplementing with CBD while on prescription meds? You may need to lower your dose.
Thinking about adding supplemental CBD to your daily routine? Some early research suggests that the cannabinoid may enhance the effects of certain pharmaceutical drugs. While more investigation is needed, this could mean that those taking supplemental CBD may be able to lower their doses of medications. This preclinical research also suggests that CBD might increase the blood concentrations of certain drugs. Here’s what you need to know about how CBD interacts with pharmaceuticals.
Substances that you take into your system are metabolized by the liver, including cannabis. In this case, metabolism refers to the breakdown of substances in the liver. The liver is the body’s primary detoxifying organ. Interestingly, liver metabolism is one of the reasons some people may struggle to feel the effects of edibles.
Edible cannabis goes through “first pass metabolism” in the liver. Sometimes, the liver is extremely efficient in removing unwanted compounds, like THC from the body. This means that you may not feel the effects of the edible at all.
However, if you consume a high enough dosage of cannabidiol (CBD) along with your substance of choice, the liver may not be able to effectively break down the compound.
Thus, CBD may enhance some of the effects of your preferred medicine or drug. CBD is considered a safe and non-toxic phytochemical unique to the cannabis plant. Unlike its psychoactive relative, THC, CBD does not produce a euphoric cannabis “high”. Instead, it tends to calm anxiety and lift the mood.
As it turns out, a group of enzyme proteins called Cytochrome P450 (CYPS) is responsible for breaking down 70 to 80 percent of current pharmaceutical drugs. Members of this same enzyme family breakdown CBD in the body. However, early research has shown that, when the dose is right, CBD may actually block this enzyme from doing its job.
As a result, the body may have a more difficult time clearing out and metabolizing substances like pharmaceutical drugs. In some cases, it is possible that this can cause unsafe levels of pharmaceuticals to build up in the blood and cause toxicity. This also means that patients who want to continue with supplemental CBD may need to lower their doses of conventional medicines.
Worst case scenario, pharmaceutical drugs build up to toxic levels in the blood.
In low doses, CBD acts as a substrate for the enzymes. A substrate is a compound that can connect with and be altered by an enzyme. A 1993 study, however, found that high doses of CBD (120 milligrams) inhibited up to 80 percent of the activity for two enzymes in the CYPS family. Notably, the P450s 2C and 3A enzymes. The 2C enzyme was much more sensitive to the inhibitory properties of CBD at lower doses.
CBD seems to hijack a primary metabolic site on the enzyme. This means that it shuts out other chemical compounds that would otherwise be broken down by the protein. A small 2015 trial of CBD in epileptic children found that the cannabinoid increased blood levels of the anti-epileptic drug, clobazam.
As a result, doctors lowered the overall dose of clobazam in 10 of the 13 participants.
Concerned about whether or not CBD is interacting with your medications? Talk with your doctor. Those taking supplemental CBD, especially in high doses, may want to regularly get their blood levels checked when also taking pharmaceuticals. Here are some potential questions to ask a medical professional:
Searching for more information on how cannabis interacts with some prescription drugs? Take a look at this article.