CBD and other plant cannabinoids can potentially interact with many pharmaceuticals by inhibiting the activity of cytochrome P, a family of liver enzymes. This paragraph describes CBD interaction with general (drug)-metabolizing enzymes, such as those belonging to the cytochrome P family. Curr Drug Metab. ;17(3) Cannabinoids and Cytochrome P Interactions. Zendulka O(1), Dovrtělová G, Nosková K, Turjap M, Šulcová A, Hanuš L.
P450 CBD and Cytochrome
Stay calm, and let us remind you the following: Although there is some logic in to this madness the large amounts of bergapten contained in these fruits would interact with cytochrome P in a similar way as CBD does , this is not a wise idea: In order to determine the appropriate dosages of medications, doctors make calculations using the average amount of time it takes for various drugs and medications to be processed through the cytochrome P system.
If only one drug is being processed, and the system is generally healthy, these averages provide accurate dosage information. However, certain substances have the ability to affect processing times within this system, making drugs metabolize faster or slower than they would on their own. Similarly, if the cytochrome P system is unhealthy due to problems with the liver or other pre-existing conditions, drugs may not metabolize as they should.
Interestingly, CBD is not alone in its effect on drug metabolism. Grapefruit , watercress , St. When the CYP system is impacted in this way, it leads to higher levels of certain drugs in your system at one time. This can cause unwanted side effects, and sometimes, an overdose.
If you are taking a medication affected by cannabidiol, you should consult your doctor to make sure that it is safe for you to supplement your personal care routine with CBD.
From there, the two of you may consider adjusting the dosage on your medications so that you can use both products safely. Any drug metabolized by CYP enzymes could potentially interact with cannabidiol. This list does not include all of the potential medications impacted by cannabidiol. Nor will every medication in the categories contained on this list will cause an interaction.
For these reasons, you should consult with a medical professional before supplementing with CBD. In other words, you ingest an inactive compound and once in the body, it is processed into the active drug. If this processing is dependent on CYP3A4 part of the larger CYP system , then inhibitors can result in too little active drug in the body for the desired therapeutic effect.
Codeine , for example, is a prodrug that is metabolized into morphine which provides the effect. Vyvanse and Concerta are two other popular pharmaceutical medications for ADHD that fall into this category. If you are worried that your CYP pathway may not be functioning properly, physicians can test the system to ensure that the medications you take are metabolizing as expected.
Alcohol and cannabis are both widely consumed in our society and the effects of combining the two are well known. What is less understood by the general public, is the effects of combining alcohol and the cannabinoid compound CBD. Alcohol depends on a few different metabolic pathways in the human body, with the primary enzymes involved being: Although the pharmacokinetics of alcohol and CBD are not yet well-understood, what we do know is CBD inhibits the CYP enzyme system, and this system plays a significant role in alcohol metabolism.
CBD is rapidly gaining ground on coffee in terms of popularity and so it only makes sense that people would start combining the two. Caffeine is molecularly very similar to adenosine , a compound produced in our bodies that activates the A2a receptor.
Caffeine binds to the A2a receptors, inhibiting the reuptake of adenosine. Consequently, blocking adenosine from binding results in vasodilation , which increases clarity and alertness. It is worth noting that these effects depend on the serving size of the CBD. High amounts of CBD are more likely to cause drowsiness and sedation.
After extensive literature study of the available trials performed until September , CBD side effects were generally mild and infrequent. The only exception seems to be a multicenter open-label study with a total of patients aged 1—30 years, with treatment-resistant epilepsy.
This led to a reduction in seizure frequency. It is therefore difficult to put the side effect frequency into perspective. Attributing the side effects to CBD is also not straightforward in severely sick patients. Thus, it is not possible to draw reliable conclusions on the causation of the observed side effects in this study.
This rating instrument comprised the following factors: This assessment instrument analyzes adverse medication effects, including psychic, neurologic, autonomic, and other manifestations. Using various safety outcome variables, clinical tests, and the cannabis side effect inventory, it was shown that there were no differences between the placebo group and the CBD group in the observed side effects. The occurrence of various degrees of GVHD was compared with historical data from patients, who had only received the standard treatment.
This resulted in lower resistin levels compared to baseline. The hormone resistin is associated with obesity and insulin resistance. Compared to baseline, glucose-dependent insulinotropic peptide levels were elevated after CBD treatment. This incretin hormone is produced in the proximal duodenum by K cells and has insulinotropic and pancreatic b cell preserving effects. CBD was well tolerated in the patients.
However, with the comparatively low CBD concentrations used in this phasetrial, no overall improvement of glycemic control was observed.
When weight and appetite were measured as part of a measurement battery for side effects, results were inconclusive. For instance, the study mentioned above, where 23 children with Dravet syndrome were treated, increases as well as decreases in appetite and weight were observed as side effects. However, in the safety analysis group, consisting of subjects, 10 showed decreased weight and 12 had gained weight. Both these factors were not controlled for in the reviewed studies.
This review could substantiate and expand the findings of Bergamaschi et al. First, more studies researching CBD side effects after real chronic administration need to be conducted. Many so-called chronic administration studies, cited here were only a couple of weeks long. Second, many trials were conducted with a small number of individuals only. To perform a throrough general safety evaluation, more individuals have to be recruited into future clinical trials.
Third, several aspects of a toxicological evaluation of a compound such as genotoxicity studies and research evaluating CBD effect on hormones are still scarce. Especially, chronic studies on CBD effect on, for example, genotoxicity and the immune system are still missing.
Last, studies that evaluate whether CBD-drug interactions occur in clinical trials have to be performed. In conclusion, CBD safety profile is already established in a plethora of ways. However, some knowledge gaps detailed above should be closed by additional clinical trials to have a completely well-tested pharmaceutical compound. The study was commissioned by the European Industrial Hemp Association. EIHA paid nova-Institute for the review.
Iffland K, Grotenhermen F An update on safety and side effects of cannabidiol: National Center for Biotechnology Information , U. Journal List Cannabis Cannabinoid Res v. Published online Jun 1. Find articles by Kerstin Iffland. Find articles by Franjo Grotenhermen. Author information Copyright and License information Disclaimer.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This article has been cited by other articles in PMC. Relevant Preclinical Studies Before we discuss relevant animal research on CBD possible effects on various parameters, several important differences between route of administration and pharmacokinetics between human and animal studies have to be mentioned.
Open in a separate window. The reality is more complex, because CBD is lipophilic and, for example, will consequently accumulate in fat tissue. These calculations were made with the intention to give the reader an impression and an approximation of the supraphysiological levels used in in vitro studies. CBD-drug interactions Cytochrome Pcomplex enzymes This paragraph describes CBD interaction with general drug -metabolizing enzymes, such as those belonging to the cytochrome P family.
Neurological and neurospychiatric effects Anxiety and depression Some studies indicate that under certain circumstances, CBD acute anxiolytic effects in rats were reversed after repeated day administration of CBD.
Psychosis and bipolar disorder Various studies on CBD and psychosis have been conducted. Addiction CBD, which is nonhedonic, can reduce heroin-seeking behavior after, for example, cue-induced reinstatement.
Neuroprotection and neurogenesis There are various mechanisms underlying neuroprotection, for example, energy metabolism whose alteration has been implied in several psychiatric disorders and proper mitochondrial functioning. Immune system Numerous studies show the CBD immunomodulatory role in various diseases such as multiple sclerosis, arthritis, and diabetes.
Cell migration Embryogenesis CBD was shown to be able to influence migratory behavior in cancer, which is also an important aspect of embryogenesis. Cancer Various studies have been performed to study CBD anticancer effects.
Food intake and glycemic effects Animal studies summarized by Bergamaschi et al. Genotoxicity and mutagenicity Jones et al. Acute Clinical Data Bergamaschi et al. Physiological effects In a double-blind, placebo-controlled crossover study, CBD was coadministered with intravenous fentanyl to a total of 17 subjects. Psychosis The review by Bergamaschi et al.
Addiction A case study describes a patient treated for cannabis withdrawal according to the following CBD regimen: Endocrine effects and glycemic including appetite effects To the best of our knowledge, no acute studies were performed that solely concentrated on CBD glycemic effects. Physiological effects A first pilot study in healthy volunteers in by Mincis et al.
Neurological and neuropsychiatric effects Anxiety Clinical chronic lasting longer than a couple of weeks studies in humans are crucial here but were mostly still lacking at the time of writing this review. Psychosis and bipolar disorder In a 4-week open trial, CBD was tested on Parkinson's patients with psychotic symptoms.
Conclusion This review could substantiate and expand the findings of Bergamaschi et al. Safety and side effects of cannabidiol, a Cannabis sativa constituent. Cannabis und Cannabinoide in der Medizin: Cannabidiol exerts sebostatic and antiinflammatory effects on human sebocytes. Controlled clinical trial of cannabidiol in Huntington's disease. Molecular targets of cannabidiol in neurological disorders.
Exogenous cannabinoids as substrates, inhibitors, and inducers of human drug metabolizing enzymes: Distinct effects of D9-tetrahydro-cannabinoland cannabidiol on neural activation during emotional processing.
Safety and pharmacokinetics of oral cannabidiol when administered concomitantly with intravenous fentanyl in humans. Inhibition and induction of human cytochrome P CYP enzymes. How physicochemical properties of drugs affect their metabolism and clearance. New horizons in predictive drug metabolism and pharmacokinetics. Royal Society of Chemistry: Human metabolites of cannabidiol: Induction and genetic regulation of mouse hepatic cytochrome P by cannabidiol.
ABC transporters P-gp and Bcrp do not limit the brain uptake of the novel antipsychotic and anticonvulsant drug cannabidiol in mice. Cannabidiol enhances xenobiotic permeability through the human placental barrier by direct inhibition of breast cancer resistance protein: Am J Obstet Gynecol.
Influence of single and repeated cannabidiol administration on emotional behavior and markers of cell proliferation and neurogenesis in non-stressed mice. Cannabidiol, among other cannabinoid drugs, modulates prepulse inhibition of startle in the SHR animal model: Cannabidiol attenuates sensorimotor gating disruption and molecular changes induced by chronic antagonism of NMDA receptors in mice.
Effects of cannabidiol on amphetamine-induced oxidative stress generation in an animal model of mania. Cannabidiol, a nonpsychotropic component of cannabis, inhibits cue-induced heroin seeking and normalizes discrete mesolimbic neuronal disturbances. Schurr A, Livne A. Differential inhibition of mitochondrial monoamine oxidase from brain by hashish components.
Neuroprotective effects of the nonpsychoactive cannabinoid cannabidiol in hypoxicischemic newborn piglets. Acute and chronic administration of cannabidiol increases mitochondrial complex and creatine kinase activity in the rat brain. Inhibiting heat shock proteins can potentiate the cytotoxic effect of cannabidiol in human glioma cells.
Cannabidiol CBD and its analogs: The antitumor activity of plant-derived non-psychoactive cannabinoids. Long-term cannabidiol treatment prevents the development of social recognition memory deficits in Alzheimer's disease transgenic mice.
Cannabidiol arrests onset of autoimmune diabetes in NOD mice. Transdermal cannabidiol reduces inflammation and pain-related behaviours in a rat model of arthritis. Id-1 gene and protein as novel therapeutic targets for metastatic cancer. The preimplantation mouse embryo is a target for cannabinoid ligand-receptor signaling. Pharmacological targeting of ion channels for cancer therapy: Cannabidiol inhibits cancer cell invasion via upregulation of tissue inhibitor of matrix metalloproteinases Cannabidiol inhibits lung cancer cell invasion and metastasis via intercellular adhesion molecule Gene and protein as novel therapeutic targets for metastatic cancer.
Cannabidiol as a novel inhibitor of Id-1 gene expression in aggressive breast cancer cells. Delta9-tetrahydrocannabinol and cannabidiol as potential curative agents for cancer: Chemopreventive effect of the non-psychotropic phytocannabinoid cannabidiol on experimental colon cancer. Efficacy and safety of cannabidiol and tetrahydrocannabivarin on glycemic and lipid parameters in patients with type 2 diabetes: Marijuana extracts possess the effects like the endocrine disrupting chemicals.
Inhibition of hepatic microsomal cytochrome P by cannabidiol in adult male rats. Cannabidiol displays antiepileptiform and antiseizure properties in vitro and in vivo. J Pharm Ex Ther. Cannabidiol exerts anti-convulsant effects in animal models of temporal lobe and partial seizures.
Current status and prospects for cannabidiol preparations as new therapeutic agents. Persson A, Ingelman-Sundberg M. Pharmacogenomics of cytochrome P dependent metabolism of endogenous compounds: J Pharmacogenomics Pharmacoproteomics ; 5: Pathophysiological implications of neurovascular P in brain disorders. Therapeutic satisfaction and subjective effects of different strains of pharmaceutical-grade cannabis. Cannabidiol enhances consolidation of explicit fear extinction in humans.
Although environment foods, herbs, and other drugs and disease status can affect CYP3A4 activity, the primary source of variability may be your DNA.
This may be because there are many variants influencing CYP3A4 function, but each one is relatively rare. In fact, a few dozen clinical trials have already shown altered pharmacokinetics, side effects, or efficacy of various drugs due to this polymorphism. How does it affect CYP3A4 activity if it is spliced out? A study showed that it can affect the splicing itself.
Keep in mind that these are only estimates and that a clinical study is needed to further refine them. Ketoconazole is also sold as tablets for fungal infections. So … would you recommend using Ketoconazole for edibles? Is there a plant based alternative that would work as well?
Piperine supposedly suppresses the CYP enzymes as well. And inhibiting CYP3A4 is not for everyone since this could cause interactions with other drugs as well.
But yes, ketoconazole will boost the bioavailability and effects of THC. Piperine probably has similar effects as well. I summarize them and send them straight to your inbox.
No spam or other nonsense, just science! Over 3, scientific articles related to cannabis were published last year!
CBD Drug interactions
Cannabidiol can inhibit the cytochrome P system's ability to metabolize certain drugs, leading. Though completely safe to use, CBD can potentially interact with many pharmaceuticals by inhibiting the activity cytochrome P, a family of. CBD affects the body in many different ways. One not often talked about is how it interacts with the cytochrome P system in the liver.