Cannabinoids, such as CBD and THC, have even been investigated to aid in opioid withdrawal symptoms.
In our latest question and answer, the pharmacist discusses whether or not CBD (cannabidiol) products interact with hydrocodone.
The doses of CBD used in studies that have shown potential interactions ranges widely. While most over the counter CBD products range from 1mg to 10mg per serving, studies have used anywhere from 100mg to 600mg! There is a good chance the more commonly used lower doses of CBD don’t have significant interactions at all, but more studies are needed.
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.
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.
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.
In regard to drug interactions with CBD, there is a distinct lack of studies to make definitive statements. This is true with hydrocodone and CBD interactions as well.
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.
There are a variable of published studies that suggest that while CBD does inhibit metabolizing enzymes, it is not significant and the amount of CBD needed to affect these metabolizing enzymes in humans far exceeds what is possible with common dosing and consumption.
This is especially significant in medications that have a narrow therapeutic index such as tizanidine (Zanaflex), in which even small increases in blood levels may be associated with increased side effects. It is therefore important to reduce doses of these medications in the first few days after suddenly stopping smoking either tobacco, marijuana or both to avoid possible toxicity from the medication. Due to body size and gender-related variables, this reduction is especially warranted in small females.
Inflammatory Bowel Disease
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NSAIDS (Non-Steroid Anti-inflammatory Drugs)
The major cannabanoids, THC and CBD are both metabolized in the liver by the CYP450 enzymes 2C9, 2C19 and 3A4. Drugs that inhibit these enzymes may enhance or prolong the effects of THC and CBD. Whether people with genetic variants of these enzymes may experience altered effects from cannabinoids is not known. In one study, potential drug–drug interactions of THC/CBD oro-mucosal spray (Sativex, nabiximols) in combination with CYP450 inducers and inhibitors were assessed using various dose regimens. The antibiotic rifampicin, an inducer of CYP3A4, significantly reduced the peak plasma concentration of CBD, while the antifungal ketoconazole, a CYP3A4 inhibitor, nearly doubled the peak plasma concentration of CBD. However, the moderate CYP2C19 inhibitor omeprazole (Prilosec), a proton-pump inhibitor used to treat gastroesophageal reflux disease (GERD), did not significantly alter the pharmacokinetics of CBD.
CBD: Drug Interactions
Nicotine Addiction – Preliminary findings indicate that CBD reduces cigarette smoking in smokers trying to quit. Although the mechanism for this effect has not been definitely identified, CBD may modulate nicotine reward through its ability to increase endocannabinoid levels by inhibiting FAAH, the enzyme that breaks down the endogenous endoccannabinoids (see belpw). It has been demonstrated that inhibiting FAAH blocks nicotine seeking and nicotine-induced dopamine release in the NAc reward center. It also reduces anxiety during nicotine withdrawal in animals.