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. Adverse Effects & Drug Interactions Describe medical cannabis drug interactions. Describe respiratory . Cannabis does not appear to affect immune cells. Any drug that is metabolised by the liver will be affected by CBD. These will be CBD Oil May Help Kids With Severe Form Of Epilepsy.
affected by cbd oil drugs
There are various mechanisms underlying neuroprotection, for example, energy metabolism whose alteration has been implied in several psychiatric disorders and proper mitochondrial functioning. A study comparing acute and chronic CBD administration in rats suggests an additional mechanism of CBD neuroprotection: Mitochondrial activity was measured in the striatum, hippocampus, and the prefrontal cortex.
Since the mitochondrial complexes I and II have been implied in various neurodegenerative diseases and also altered ROS reactive oxygen species levels, which have also been shown to be altered by CBD, this might be an additional mechanism of CBD-mediated neuroprotection. In healthy cells, this can be interpreted as a way to protect against the higher ROS levels resulting from more mitochondrial activity. Another publication studied the difference of acute and chronic administration of two doses of CBD in nonstressed mice on anxiety.
Already an acute i. Fifteen days of repeated i. However, the higher dose caused a decrease in neurogenesis and cell proliferation, indicating dissociation of behavioral and proliferative effects of chronic CBD treatment. The study does not mention adverse effects. Numerous studies show the CBD immunomodulatory role in various diseases such as multiple sclerosis, arthritis, and diabetes. These animal and human ex vivo studies have been reviewed extensively elsewhere, but studies with pure CBD are still lacking.
It would be especially interesting to study when CBD is proinflammatory and under which circumstances it is anti-inflammatory and whether this leads to side effects Burstein, Table 1 shows a summary of its anti-inflammatory actions; McAllister et al.
In case of Alzheimer's disease AD , studies in mice and rats showed reduced amyloid beta neuroinflammation linked to reduced interleukin [IL]-6 and microglial activation after CBD treatment. This led to amelioration of learning effects in a pharmacological model of AD.
The chronic study we want to describe in more detail here used a transgenic mouse model of AD, where 2. CBD was able to prevent the development of a social recognition deficit in the AD transgenic mice. Using statistical analysis by analysis of variance, this was shown to be only a trend. This might have been caused by the high variation in the transgenic mouse group, though.
This was probably due to already elevated cholesterol in the transgenic mice. The study observed no side effects. After CBD treatment was stopped, observation continued until the mice were 24 weeks old. CBD increased IL levels, which is thought to act as an anti-inflammatory cytokine in this context.
After inducing arthritis in rats using Freund's adjuvant, various CBD doses 0. CBD reduced joint swelling, immune cell infiltration. CBD was shown to be able to influence migratory behavior in cancer, which is also an important aspect of embryogenesis. Helix-loop-helix Id proteins play a role in embryogenesis and normal development via regulation of cell differentiation. High Id1-levels were also found in breast, prostate, brain, and head and neck tumor cells, which were highly aggressive.
In contrast, Id1 expression was low in noninvasive tumor cells. Id1 seems to influence the tumor cell phenotype by regulation of invasion, epithelial to mesenchymal transition, angiogenesis, and cell proliferation.
There only seems to exist one study that could not show an adverse CBD effect on embryogenesis. An in vitro study could show that the development of two-cell embryos was not arrested at CBD concentrations of 6. Various studies have been performed to study CBD anticancer effects.
CBD every 3 days for a total of 28 weeks, almost completely reduced the development of metastatic nodules caused by injection of human lung carcinoma cells A in nude mice. The typical side effects of traditional anticancer medication, emesis, and collateral toxicity were not described in these studies. Consequently, CBD could be an alternative to other MMP1 inhibitors such as marimastat and prinomastat, which have shown disappointing clinical results due to these drugs' adverse muscoskeletal effects.
Two studies showed in various cell lines and in tumor-bearing mice that CBD was able to reduce tumor metastasis. CBD downregulated Id1 at promoter level and reduced tumor aggressiveness. Moreover, to carry out these experiments, animals are often immunologically compromised, to avoid immunogenic reactions as a result to implantation of human cells into the animals, which in turn can also affect the results.
Another approach was chosen by Aviello et al. After 3 months, the number of aberrant crypt foci, polyps, and tumors was analyzed. The high CBD concentration led to a significant decrease in polyps and a return to near-normal levels of phosphorylated Akt elevation caused by the carcinogen.
Animal studies summarized by Bergamaschi et al. Chronic administration 14 days, 2. This effect could be inhibited by coadministration of a CB2R antagonist. The positive effects of CBD on hyperglycemia seem to be mainly mediated via CBD anti-inflammatory and antioxidant effects. In addition, treatment increased adiponectin and liver glycogen concentrations.
CBD showed inhibition of testosterone oxidation in the liver. Motor function was also tested on a rotarod, which was also not affected by CBD administration. Static beam performance, as an indicator of sensorimotor coordination, showed more footslips in the CBD group, but CBD treatment did not interfere with the animals' speed and ability to complete the test. Compared to other anticonvulsant drugs, this effect was minimal.
CBD did not lead to adverse effects. In addition, psychomotor function and psychological functions were not disturbed. Interestingly, the CYP2C19 inhibitor omeprazole, used to treat gastroesophageal reflux, could not significantly affect the pharmacokinetics of CBD. Unfortunately, it was not mentioned whether this effect was mediated via the cytochrome P complex. Another aspect, which has not been thoroughly looked at, to our knowledge, is that several cytochrome isozymes are not only expressed in the liver but also in the brain.
It might be interesting to research organ-specific differences in the level of CBD inhibition of various isozymes. Apart from altering the bioavailability in the overall plasma of the patient, this interaction might alter therapeutic outcomes on another level. Generally, more human studies, which monitor CBD-drug interactions, are needed.
In a double-blind, placebo-controlled crossover study, CBD was coadministered with intravenous fentanyl to a total of 17 subjects. This was followed by a single 0. This extensive tool tests, for example, 78 adverse effects divided into 23 categories corresponding to organ systems or body parts. No respiratory depression or cardiovascular complications were recorded during any test session.
The results of the evaluation of pharmacokinetics, to see if interaction between the drugs occurred, were as follows. No effect was evident for urinary CBD and metabolite excretion except at the higher fentanyl dose, in which CBD clearance was reduced.
Importantly, fentanyl coadministration did not produce respiratory depression or cardiovascular complications during the test sessions and CBD did not potentiate fentanyl's effects. No correlation was found between CBD dose and plasma cortisol levels. CBD did not worsen the adverse effects e.
Coadministration was safe and well tolerated, paving the way to use CBD as a potential treatment for opioid addiction. A Dutch study compared subjective adverse effects of three different strains of medicinal cannabis, distributed via pharmacies, using VAS. The 12 adjectives used for this study were as follows: This strain showed significantly lower levels of anxiety and dejection. Moreover, appetite increased less in the high CBD strain.
The review by Bergamaschi et al. This holds especially true for the extrapyramidal motor side effects elicited by classical antipsychotic medication. Order of drug administration was pseudorandomized across subjects, so that an equal number of subjects received any of the drugs during the first, second, or third session in a double-blind, repeated-measures, within-subject design. This effect was caused by opposite neural activation of relevant brain areas.
In addition, no effects on peripheral cardiovascular measures such as heart rate and blood pressure were measured. A randomized, double-blind, crossover, placebo-controlled trial was conducted in 16 healthy nonanxious subjects using a within-subject design.
The doses were selected to only evoke neurocognitive effects without causing severe toxic, physical, or psychiatric reactions. The physiological parameters, heart rate and blood pressure, were also monitored and no significant difference between the placebo and the CBD group was observed. A case study describes a patient treated for cannabis withdrawal according to the following CBD regimen: Hepatic enzymes were also measured daily, but no effect was reported. Naturalistic studies with smokers inhaling cannabis with varying amounts of CBD showed that the CBD levels were not altering psychomimetic symptoms.
CBD might work to alleviate disorders of addiction, by altering the attentive salience of drug cues. The study did not further measure side effects. CBD can also reduce heroin-seeking behaviors e. This was shown in the preclinical data mentioned earlier and was also replicated in a small double-blind pilot study with individuals addicted to opioids, who have been abstinent for 7 days. One hour after the video session, subjective craving was already reduced after a single CBD administration.
The effect persisted for 7 days after the last CBD treatment. Interestingly, anxiety measures were also reduced after treatment, whereas no adverse effects were described. A pilot study with 24 subjects was conducted in a randomized, double-blind, placebo-controlled design to evaluate the impact of the ad hoc use of CBD in smokers, who wished to stop smoking.
Pre- and post-testing for mood and craving of the participants was executed. Craving was assessed using the Tiffany Craving Questionnaire On day 1 and 7, exhaled CO was measured to test smoking status. Sedation, depression, and anxiety were evaluated with the MRS. At day 7, the anxiety levels for placebo and CBD group did not differ.
CBD did not increase depression in contrast to the selective CB1 antagonist rimonabant. CBD might weaken the attentional bias to smoking cues or could have disrupted reconsolidation, thereby destabilizing drug-related memories. To the best of our knowledge, no acute studies were performed that solely concentrated on CBD glycemic effects. Moreover, the only acute study that also measured CBD effect on appetite was the study we described above, comparing different cannabis strains.
Growth hormone and prolactin levels were unchanged. Compared to the healthy individuals, the cortisol levels increased less after TSST in the 32 at-risk individuals. The CBD group showed less reduced cortisol levels but differences were not significant. Truly chronic studies with CBD are still scarce.
Nonetheless, we also included these studies with repeated CBD treatment, because we think that compared to a one-time dose of CBD, repeated CBD regimens add value and knowledge to the field and therefore should be mentioned here.
These results are supported by another study described in the review by Grotenhermen et al. CBD was administered on average with three other drugs, including clobazam The coadministration led to an alteration of blood levels of several antiepileptic drugs. In the case of clobazam this led to sedation, and its levels were subsequently lowered in the course of the study.
A first pilot study in healthy volunteers in by Mincis et al. 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.
They hopefully will shed light on the inconsistencies observerd in animal studies. Chronic studies in humans may, for instance, help to test whether, for example, an anxiolytic effect always prevails after chronic CBD treatment or whether this was an artifact of using different animal models of anxiety or depression. In a 4-week open trial, CBD was tested on Parkinson's patients with psychotic symptoms.
This led to a reduction of their psychotic symptoms. Moreover, no serious side effects or cognitive and motor symptoms were reported. No adverse effects were observed and her symptoms improved.
The same positive outcome was registered in another study described by Bergamaschi et al. The respective treatment was maintained for three additional weeks. This was the case for three patients in the CBD group and five patients in the amisulpride group.
CBD treatment was accompanied by a substantial increase in serum anandamide levels, which was significantly associated with clinical improvement, suggesting inhibition of anandamide deactivation via reduced FAAH activity. In addition, the FAAH substrates palmitoylethanolamide and linoleoyl-ethanolamide both lipid mediators were also elevated in the CBD group.
CBD showed less serum prolactin increase predictor of galactorrhoea and sexual dysfunction , fewer extrapyramidal symptoms measured with the Extrapyramidal Symptom Scale, and less weight gain.
Moreover, electrocardiograms as well as routine blood parameters were other parameters whose effects were measured but not reported in the study. CBD better safety profile might improve acute compliance and long-term treatment adherence.
A press release by GW Pharmaceuticals of September 15th, , described 88 patients with treatment-resistant schizophrenic psychosis, treated either with CBD in addition to their regular medication or placebo.
Important clinical parameters improved in the CBD group and the number of mild side effects was comparable to the placebo group. Moreover, neurological and physiological examinations were performed, which neither showed signs of CBD toxicity nor severe side effects. The study also illustrated that CBD was well tolerated. CBD in addition to their regular epilepsy medication. Another clinical study lasting at least 3 months with children and young adults with various forms of epilepsy, who were treated with the CBD drug Epidiolex, was presented at the American Academy for Neurology in In a few cases, severe side effects occurred, but it is not clear, if these were caused by Epidiolex.
The largest CBD study conducted thus far was an open-label study with Epidiolex in patients mainly children, the average age of the participants was 11 suffering from severe epilepsy, who could not be treated sufficiently with standard medication. Ten percent of the patients reported side effects tiredness, diarrhea, and exhaustion. 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.
CBD oil products do not contain this cannabinoid and do not have psychoactive properties. Products high in CBD have actually been found to potentially reduce symptoms of psychosis.
That being said, CBD oil does have the potential to interact with antipsychotic medications. It has been found to reduce the clearance of some antipsychotic medications from the body. Before using CBD oil with antipsychotics, you should discuss the risks and benefits with your healthcare provider.
There are a variety of mood stabilizers used to treat bipolar disorder and supplement treatment for other mental health disorders. Lithium has been used as a mood stabilizer for decades. There are also many medications that are used as mood stabilizers that are also used in seizure disorders, such as lamotrigine or valproic acid. CBD has been studied in these patients as well, and it has been found to improve mood in bipolar disorder. Some studies have found that CBD may have effects similar to lithium for these patients.
Patients who suffer from bipolar disorder may be at higher risk for mood swings if using products containing THC, which can be anxiety-inducing. CBD also has the potential to interact with these medications through the CYP system in a similar way that it interacts with antidepressants and antipsychotic medications. CBD and cannabinoids have been used to reduce anxiety for many years.
They produce a calming effect and can help users relax. Benzodiazepines are also used by those who suffer from anxiety to calm their symptoms. When used in combination with benzodiazepines, CBD products have the potential to increase sedation. These side effects should be monitored closely to ensure the safe use of these drugs together. If cannabis products are used that contain THC, there is also a risk that this product could cause worse anxiety.
The use of CBD with caffeine, the most commonly used stimulant, has been found to be a good combination. These drugs work well together to improve alertness while reducing symptoms of anxiety when used in the right amounts. However, if too much CBD is used it may cause more symptoms of sedation which could offset the desired stimulation from caffeine. The Cytochrome P system describes the elaborate group of enzymes in the liver that are responsible for the metabolism of many drugs.
Each enzyme has its own name; for example, the enzyme responsible for the metabolism of the most drugs is the CYP3A4 enzyme. The CYP enzyme plays a huge role in the actions and metabolism of many substances that enter our body.
Breaking down drugs for elimination from the body is not the only role of the CYP enzymes. There are some medications that need to be broken down by the CYP enzymes before they become active in the body.
These medications are called prodrugs, and if they are unable to be metabolized by the CYP enzymes, they remain inactive and do not work.
Any time medications block these enzymes or increase the production of these enzymes, it can make a huge impact on the metabolism of many other substances. That makes it very important to monitor this system and how it is impacted by drugs. These are both major metabolizing enzymes for our body, which means CBD has the potential to interact with many substances. More research is also needed to understand the relationship between the dose of CBD and its potential to impact these enzymes, as well as the differences in drug interactions between CBD oil and other preparations that include CBD.
Cannabis Drug Interactions
Learn more about Cannabidiol uses, effectiveness, possible side effects, interactions, dosage, user ratings and products that contain Cannabidiol. The use of CBD oil in patients on antipsychotic medications is somewhat That makes it very important to monitor this system and how it is impacted by drugs. medications are known to interact with cannabis. Fish Oil (omega-3 polyunsaturated fatty acids) · Flexeril (cyclobenzaprine) · ibuprofen (Advil, Motrin, IBU.