CBD Oil And Astrazeneca

Cannabis/Cannabinoids for Treating COVID-19 Associated Neuropsychiatric Complications 3 Department of Microbiology, Immunology and Tropical Medicine, The George Washington University School of America has vaxxed millions of weed lovers, but holdouts still have questions, or are hesitant. THC clinicians offer sage advice. Cannabidiol is a chemical in the Cannabis sativa plant, also known as marijuana or hemp. One specific form of CBD is approved as a drug in the U.S. for seizure.

Cannabis/Cannabinoids for Treating COVID-19 Associated Neuropsychiatric Complications

3 Department of Microbiology, Immunology and Tropical Medicine, The George Washington University School of Medicine and Health Sciences, 2300 I Street, NW, Ross Hall Room 502A, Washington, DC 20037 USA

Sanjay B. Maggirwar

3 Department of Microbiology, Immunology and Tropical Medicine, The George Washington University School of Medicine and Health Sciences, 2300 I Street, NW, Ross Hall Room 502A, Washington, DC 20037 USA

Greg Bunt

4 American Board of Psychiatry and Neurology, NYU Medical School, 550 First Ave, New York, NY 10016 USA

1 Medical Consequences of Drug Abuse and Infections Branch, National Institute on Drug Abuse, NIH, Bethesda, MD USA

3 Department of Microbiology, Immunology and Tropical Medicine, The George Washington University School of Medicine and Health Sciences, 2300 I Street, NW, Ross Hall Room 502A, Washington, DC 20037 USA

4 American Board of Psychiatry and Neurology, NYU Medical School, 550 First Ave, New York, NY 10016 USA

Copyright © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2021

This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

Abstract

COVID-19 epidemic has resulted in devastating mortality and morbidity consisting of socioeconomic and health effects that have included respiratory/pulmonary, cardiovascular, mental health and neurological consequences such as anxiety, depression, and substance use. Several effective vaccines have been developed and extensive efforts are underway to develop therapeutics to treat COVID-19. Cannabis and/or its product-cannabidiol (CBD) are being advertised for the treatment of COVID-19 associated mental/neurological complications and substance use disorders. However, research reviewed shows that there is insufficient data from clinical studies to support the use of cannabis or CBD for the treatment of COVID-19 associated mental health and neurological complications. Additional basic and clinical research is suggested to develop cannabis or cannabidiol for the treatment of mental health problems associated with coronavirus infection and or substance use disorders. In the meantime, it is important that the addiction physician/psychiatrist must caution while prescribing or recommending cannabis or CBD for treating such clinical indications.

Graphical abstract

Research shows that currently there is no clinical evidence to support the use of cannabis or any of its compounds including CBD for treating any of the neuropsychiatric complications of COVID-19. Thus, it is important that the addiction physicians/psychiatrists caution their patients from using cannabis or cannabis products for treating any such complications.

In 1918, the Spanish flu killed millions of people worldwide. Once again, the world is facing a devastating viral pandemic where almost 189 million people have been infected with a novel corona virus, known as severe acute respiratory syndrome cornonavirus-2 (SARS-Cov2), that binds to a host cell through its target angiotensin-converting enzyme 2 (ACE 2) receptor (Cevik et al. 2020), leading to corona virus induced disease, known as COVID-19, that has resulted in more than 4 million deaths worldwide (Coronavirus Resource Center, 2021). The facts and not the ‘alternate facts’, are clear, that the COVID-19 pandemic has resulted in a wide range of unprecedented economic, social, and short-and long-term medical/health consequences including severe acute respiratory syndrome (SARS) (DeFelice et al. 2020), hypertension, myocardial injury (Clerkin et al. 2020), anxiety, depression, tremors, seizures, and impaired consciousness (Whittaker et al. 2020; Acharya et al. 2020; Varatharaj et al. 2020). It is estimated that about 45% of adults in the US suffered from impaired mental health because of worry and stress over the virus (Krizinger et al. 2020). According to CDC, people with pre-existing health conditions including asthma, coronary heart disease, hypertension, diabetes, immunocompromised state, and dementia also might be at increased risk from COVID-19 (CDC 2020). Furthermore, the conditions such as imposed shelter-in-place, physical distancing, low esteem, social isolation, and potential financial distress from job loss might further lead to mental health problems, increased substance use, and possibly suicides. Finally, limited access to mental health care and addiction treatment for treating substance use disorders (SUDs) may also in part exacerbate COVID-19 related complications, making it necessary to use telemedicine to treat people with SUDs.

Several vaccines are being successively used to prevent further Covid-19-related morbidity and mortality. Besides using currently available therapeutics like remdesivir, dexamethasone, and convalescent plasma, extensive efforts worldwide are underway to develop new therapeutics to combat the coronavirus induced symptomatic disease (COVID-19) and associated complications. Some of the newer therapeutics under development also include SNG001, an inhalable beta interferon delivered by nebulizer, (Synairgen); AZD7442, a long-acting monoclonal antibody combination as both an infusion and an intramuscular injection (AstraZeneca); and Camostat mesilate, an orally administered serine protease inhibitor that may block SARS-CoV-2 virus from entering cells (Uno 2020; Sagent Pharmaceuticals), under the NIH’s program of Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV). [(COVID-19 Therapeutics Prioritized for Testing in Clinical Trials | National Institutes of Health (NIH)), accessed 03282021]. In addition, the second set of facts are that the internet is filled with suggestions that cannabis or one of its many cannabinoids including cannabidiol (CBD) could be used for the treatment of not only coronavirus infection induced inflammation via cytokine storm (Hu et al. 2021), but also anxiety, depression, post-traumatic disorder (PTSD), and cognitive decline seen in patients with COVID-19. Because of the recent changes in legalization of cannabis or CBD in most US states, cannabis and/or CBD products have become easily accessible as over the counter products for treating a wide variety of clinical conditions. Therefore, in this short review, we will show that the currently available research from published clinical studies and trials is insufficient to support the use of cannabis or cannabinoids including CBD for the treatment of mental health problems in people with or without coronavirus infection or SUDs and more basic and clinical research is needed to support such claims.

The use of cannabis as medicine is not new. In year 2737 BC, the Chinese Emperor Shen-Nung was the first to describe the medicinal value of cannabis (Li 1974) and since then many preparations of cannabis have been used for recreational and medicinal purposes (Gaoni and Mechoulam 1971; Mechoulam and Gaoni 1967; Breivogel et al. 1998). Cannabis sativa, Linn. is a complex plant that has 560 identified and characterized chemicals (ElSohly et al. 2017), of which 104 are classified as cannabinoids, while the rest are terpenes and flavinoids. Cannabinoids like cannabichromene (CBC), cannabidolic acid (CBDA), cannabidiol (CBD), delta-9-tetrahydrocannabivarin (Δ 9 -THCV), cannabinol (CBN), delta-9-tetrahyrocannabinol (Δ-THC), cannabinol (CBL), delta-9-tetrahydrocannabivaric acid (Δ 9 -THCAA), are the major components of C. sativa, while cannabigerolic acid (CBGA), cannabigerol (CBG) and delta-8-tetrahydrocannabinol (Δ8-HC) are minor constituents (Gul et al. 2018) and have been postulated to have some medicinal value (Smith 1998). Curre 9 ntly, data on safety, pharmacology, and clinical efficacy on any of these cannabinoids is insufficient to support their use as medicine (Khalsa et al. 2019). Only two cannabinoids—the psychoactive delta-9-tetrahydrocannabinol (THC) and non-psychoactive cannabidiol (CBD)—have been extensively studied for their potential therapeutic applications. Although CBD has potential to treat a wide range of clinical conditions like disorders of generalized anxiety, social anxiety, panic, and PTSD (Blessing et al. 2015), and depressive disorders via serotonergic pathways (de Mello et al. 2014) and endocannabinoid system (Ashton and Moore 2011), more clinical research from well-designed clinical trials is needed to support its use in treating anxiety and depressive disorders and bipolar disorders (Ashton et al. 2005). CBD also may be effective in promoting wakefulness, via triggering increased dopamine levels in either lateral hypothalamus or dorsal raphe nuclei, the areas of brain responsible for wakefulness, suggesting that CBD could treat sleeping disorders such as narcolepsy (Murillo-Rodriguez et al. 2008). In fact, CBD did improve the quality and quantity of sleep of a 10-year-old young patient with PTSD, likely due to its anxiety-relieving benefits (Shannon and Opila-Lehman 2016). But this is in one case report. There is a clear paucity of data from well-designed clinical trials to support the use of cannabis, CBD, or any other cannabinoid for treating sleep disorders, either anxiety, depression, other neurological complications associated with COVID-19 or patients with SUDs. However, there is a silver lining-the fact that CBD inhibits SARS-Cov-2 replication and promotes the host innate response in humans (Nguyen et al. 2021), a clear positive aspect of CBD, and as evidenced by data from the NIH’s database (http://clinicaltrials.gov; accessed July 13, 2021), several investigators are studying either the dose tolerability or the efficacy of CBD in treating anxiety or depression. However, it remains to be seen when clinical data would be available from these clinical studies that would support the use of CBD for treating any of the mental or neuropsychiatric complications. In the meantime, it must be pointed out that currently, there are no data from any clinical studies or trials that have been considered adequate by a regulatory body like the US FDA to support the use of CBD for the treatment of various mental or neuropsychiatric conditions as being promoted.

In the case of cannabis, cannabinoids including CBD for treating substance use disorders, limited research does suggest that CBD could potentially treat patients with opiate, cannabis, and tobacco use disorders (OUD, CUD, TUD) (Chye et al. 2019). Earlier studies showed that legalization of medical marijuana reduced the number of over-dose deaths from opioid pain relievers (Finney et al. 2015), and that medical marijuana laws significantly reduced prescribing of opioids for pain (Bradford and Bradford 2016). But more recently, Hurd et al. (2019) reported that acute administration of CBD to heroin abstinent patients with OUD significantly reduced craving, anxiety, heart rate and salivary cortisol without causing adverse effects. In the case of cannabis use disorder (CUD), CBD reduced euphoria, fewer depressive and psychotic-like symptoms and improvements in attentional improvements, verbal learning, and memory without impairing cognition when smoking cannabis, suggesting that prolonged therapy with CBD may be a useful adjunct therapy for treating cannabis dependence (Slowij et al. 2018; Weise and Wilson-Poe 2018). Trigo et al. (2018) also reported that nabiximols (CBD + THC in 1:1 ratio [Sativex®]) combined with Motivational Enhancement Therapy and Cognitive Behavioral Therapy (MET/CBT), reduced the cannabis use and craving but not withdrawal symptoms in chronic cannabis users. Incidentally, CBD is approved for treating a rare form of epilepsy-Lennox-Gastaut and Dravet syndromes in young children, another positive effect of CBD as medicine. Regarding tobacco use disorder, in a study of 24 tobacco smokers, CBD inhaler reduced the number of tobacco cigarettes by 40% when compared to placebo (Morgan et al. 2013); and a single dose of 800 mg oral dose of CBD reduced the salience and pleasantness of cigarette cues but did not influence tobacco craving or withdrawal or any subjectively rated side effects (Hindocha et al. 2018). These studies in a small number of patients provide us a positive signal that CBD has a great potential to treat a wide range of clinical conditions, but not without conducting additional well-designed clinical trials to support its use as therapy for mental conditions including SUDs. It is also important to keep in mind that cannabinoids may result in adverse pharmacokinetic/pharmacodynamic drug-drug interactions with other pharmacologic agents used in the treatment of patients with COVID-19 (Land et al. 2020) or patients with substance use disorders.

In clinical practice, CBD is available as: (a) pharmaceutical grade CBD that may be prescribed off-label; (b) as over the counter CBD products in pharmacies; (c) as CBD products obtained through internet sources; and (d) CBD preparations from cannabis dispensaries. Efficacy, safety, and tolerability data at widely varying doses however are needed for the physician to make informed clinical recommendations and decisions. Recent survey data of addiction physicians’ views from an ASAM symposium indicated that most addiction physicians have a considerable interest in the utilization of CBD, both pharmaceutical grade and non-pharmaceutical grade, in clinical practice particularly for its potential for the treatment of pain; however, substantially more research is needed for physicians to recommend or prescribe CBD as a medication for a range of clinical disorders. Therefore, it is imperative that the clinicians treating patients with any of the above COVID-19 associated mental or neurological conditions and substance use disorders inform their patients about the lack of sufficient clinical evidence for the use of CBD or cannabis and discourage them from using non-FDA approved cannabis, cannabinoids including CBD or THC for self-treating themselves for COVID-19 related health problems including SUDs.

In summary, research reviewed clearly suggests that, although CBD, that is approved for treating epilepsy in young children, and in combination with THC as Sativex, for treating symptoms of multiple sclerosis, and has potential to treat a wide range of clinical indications, there is insufficient clinical evidence to support the use of cannabis or its highly advertised product-CBD in the treatment of COVID-19-asociated mental health or neuropsychiatric complications at this time. More systematic evaluation of cannabis or CBD in large clinical trials is essential prior to endorsing wider use of CBD or other cannabis products for alleviation of mental health symptomatology. Therefore, we suggest that as per the FDA’s GLPs (good laboratory practice and good clinical practice guidelines), well-designed basic, clinical studies, and randomized double-blind, placebo-controlled clinical trials, including studies of drug-drug interactions, where appropriate, be conducted to access whether cannabis, or individual cannabinoids such as THC, CBD, alone or in combination are safe and effective in treating mental disorders including cognitive decline, anxiety, depression, and/or PTSD seen in patients with COVID-19 or people with SUDs. Furthermore, and more importantly, because of variability of chemical constituents in cannabis from different sources, cannabis used in research must be of research grade and well characterized in terms of its chemical composition as per the FDA’s good manufacturing guidelines (GMPs).

Acknowledgements

Dr. Jag H. Khalsa is grateful to the US National Institute on Drug Abuse, a component of the National Institutes of Health, Department of Health and Human Services, for an opportunity to serve as a Special Volunteer following his retirement on October 31, 2017, after 30+ years as the Chief, Medical Consequences of Drug Abuse and Infections Branch.

Does cannabis interact with a COVID shot?

After more than a year of isolation, the COVID-19 vaccines are ushering in normal life, and a reason to celebrate.

And while many are wondering if it’s OK to have a celebratory drink after the vaccine, what about those of us that commemorate major milestones with cannabis?

  • The vaccine trials didn’t exclude or track cannabinoid use status, but multiple experts say that there is no evidence the vaccine interacts badly with either alcohol or marijuana.
  • Anecdotal evidence also points towards cannabis use pre or post-vaccination being OK. Almost 301 million Americans have received a dose and the number of new COVID cases continues to decline, demonstrating the vaccines are safe and effective. Millions of Americans who regularly enjoy marijuana have vaccine immunity to this deadly new pathogen.
  • Vaccines’ rare side effects stand in contrast to a global pandemic killing about 600 Americans per day ; with variants on the rise.

It’s crucial folks protect themselves and their communities, yet anti-vax sentiment lurks in the cannabis community, just like broader society. Weed lover Joe Rogan back-peddled on comments that younger people should forgo the vaccine. In reality, heavy lifetime cannabis consumers report being less likely to get vaccinated, 2021 survey research indicates.

Sticking to the routine

Health experts say they aren’t seeing evidence showing a detriment to using cannabis pre- or post-vaccination.

Dr. Frank Lucido, a medical cannabis specialist based in Berkeley, California, worries about lung illness from severe COVID, not vaccine/weed interactions, he told Leafly.

If people are sticking to their regular cannabis consumption habits, Lucido said he does not see a reason to be ultra-cautious around using cannabis as the body generates protective levels of antibodies against the novel coronavirus.

Certified California Nurse Practitioner Eloise Theisen, president of the American Cannabis Nurses Association and chief nursing officer for Leaf 411, said the Leaf 411 hotline has had an uptick in questions surrounding the COVID vaccine and safety uses associated with CBD and cannabis use.

“If you are using cannabis daily and it is necessary, please continue using it…”

Eloise Theisen, Nurse Practitioner, via Leaf 411

“As far as cannabis goes, we know that cannabinoids can stay in the system for 5-13 days depending on the frequency of use,” the organization said through a written response. “If you are using cannabis daily and it is necessary, please continue using it… If you are new to cannabis and have just received your vaccine, please wait 24 hours before starting a new cannabinoid treatment plan and be sure to talk with your healthcare professional to review your treatment plan.”

I was pretty nervous about the experience of getting my first vaccine at the Moscone Center in San Francisco, so I took a CBD tincture beforehand to relax.

Megan Dooley Fisher, who works as a brand ambassador for the Garden Society, also didn’t go into getting her COVID vaccines with a conscious plan to change her cannabis consumption habits. She smoked and vaped cannabis after her vaccine doses.

“That would have just been my normal,” she says.

Leafly Senior Editor David Downs reported typical THC use amid vaccination in April-May. Side effects? Mild soreness for a day at the injection site.

Tolerance breaks also welcome

Medical writer, author, and speaker Uwe Blesching also said he has not seen studies associated with cannabis use making the body’s immune response less effective after a vaccine. But if you want to, slow it down a bit.

Mara Gordon, who has created therapeutic cannabis dosing regimens for thousands of patients worldwide through her company Aunt Zelda’s, said high-dose patients might want to reduce use during vaccination.

“There is an immune response, obviously, with cannabinoid-based medicine, but I think using it at normal doses should be just fine,” she says. “People that are on extremely high doses, like over 100 milligrams of CBD and stuff like that, I think they should probably wait a while if they can, but none of our doctors have told us that we need to cut back on any of the medicine we’re recommending or that we’re giving patients.”

The Centers for Disease Control and Prevention (CDC) has released guidelines for people who’ve been newly vaccinated that recommend talking to your doctor about using over-the-counter pain medication like ibuprofen for vaccine side effects. This is because these medications, which are non-steroidal anti-inflammatory drugs (NSAIDs), may dampen the production of protective antibodies.

But Gordon says while cannabis, like NSAIDs, does have anti-inflammatory properties, the impact of cannabis isn’t something to worry about compared to that of over-the-counter drugs. She dabbed high doses of THC in the evening after receiving her shot and applied a topical to deal with the pain in her arm.

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“You want to have the body have a bit of an immune response that’s how the vaccines work by having some sort of inflammatory event, so you don’t want to use too much anti-inflammatory,” Gordon says.

A short partying pause

Leland Radovanovic, who heads the cannabis and psychedelic PR firm Conscious Communications Collective, says he didn’t put a lot of thought into his cannabis consumption around the time of his vaccine. The Berkshires, MA daily cannabis user also regularly vapes nicotine, and said his cannabis consumption went down after his first dose of the COVID-19 vaccine.

“The first vaccine I got hit me really, really hard,” he says. “I was super lethargic for a week, really foggy-brained. I was having a really hard time putting a string of thoughts together and I could only work for maybe 15, 20 minutes at a time. My [cannabis] consumption was pretty low that week just because I didn’t even have the energy to consume.”

This all checks out as vaccine side effects include symptoms like tiredness, headache, muscle pain, chills, fever, and nausea.

“You are not going to feel like going out and partying anyway.”

Mara Gordon, founder, Aunt Zelda’s

“You are not going to feel like going out and partying anyway,” Gordon says of the experience of getting the vaccine.

After getting his second dose, Radovanovic said he felt pretty good and planned to return to his normal cannabis consumption routine that includes vaping and edibles.

While there are still many unknowns ahead in terms of defeating COVID-19, with no reports of adverse health effects from the millions of vaccinated Americans who also use cannabis, those who love the leaf can feel safe in staying high and hydrated after getting the jab.

Cannabidiol (CBD)

Cannabidiol (CBD) is a chemical in the Cannabis sativa plant, also known as cannabis or hemp. One specific form of CBD is approved as a drug in the U.S. for seizures.

Over 80 chemicals, known as cannabinoids, have been found in the Cannabis sativa plant. Delta-9-tetrahydrocannabinol (THC) is the most famous ingredient in cannabis. But CBD is obtained from hemp, a form of the Cannabis sativa plant that only contains small amounts of THC. CBD seems to have effects on some chemicals in the brain, but these are different than the effects of THC.

A prescription form of CBD is used for seizure disorder (epilepsy). CBD is also used for anxiety, pain, a muscle disorder called dystonia, Parkinson disease, Crohn disease, and many other conditions, but there is no good scientific evidence to support these uses.

Laws passed in 2018 made it legal to sell hemp and hemp products in the US. But that doesn’t mean that all CBD products made from hemp are legal. Since CBD is an approved prescription drug, it can’t be legally included in foods or dietary supplements. CBD can only be included in “cosmetic” products. But there are still CBD products on the market that are labeled as dietary supplements. The amount of CBD contained in these products is not always the same as what is stated on the label.

How effective is it?

Natural Medicines Comprehensive Database rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, Ineffective, and Insufficient Evidence to Rate.

The effectiveness ratings for CANNABIDIOL (CBD) are as follows:

Likely effective for.

  • Seizure disorder (epilepsy). A specific prescription product (Epidiolex, GW Pharmaceuticals) is approved by the US FDA to treat seizures caused by Dravet syndrome, Lennox-Gastaut syndrome, or tuberous sclerosis complex. It is unclear if other forms of CBD are helpful for seizure. For now, stick with the prescription product.

Is it safe?

When taken by mouth: CBD is possibly safe to take in appropriate doses. Doses of up to 200 mg daily have been used safely for up to 13 weeks. With the guidance of a healthcare provider, a specific prescription CBD product (Epidiolex) has been used at higher doses and for longer durations.

CBD can cause some side effects, such as dry mouth, low blood pressure, light headedness, and drowsiness. Signs of liver injury have also been reported with high doses of the prescription form of CBD, called Epidiolex.

When applied to the skin: There isn’t enough reliable information to know if CBD is safe or what the side effects might be.

Special precautions & warnings:

Pregnancy and breast-feeding: It may be unsafe to take CBD if you are pregnant or breast feeding. CBD products can be contaminated with other ingredients that may be harmful to the fetus or infant. Stay on the safe side and avoid use.

Children: It is possibly safe for children to take a specific prescription CBD product (Epidiolex) by mouth in doses up to 25 mg/kg daily. This product is approved for use in children with certain conditions who are at least 1 year old. It isn’t clear if other CBD products are safe in children.

Liver disease: People with liver disease may need to use lower doses of CBD.

Parkinson disease: Some early research suggests that taking high doses of CBD might make muscle movement and tremors worse in some people with Parkinson disease.

Are there interactions with medications?

Moderate Be cautious with this combination. Brivaracetam (Briviact) Brivaracetam is changed and broken down by the body. CBD might decrease how quickly the body breaks down brivaracetam. This might increase levels of brivaracetam in the body. Caffeine Caffeine is changed and broken down by the body. CBD might decrease how quickly the body breaks down caffeine. This might increase levels of caffeine in the body. Carbamazepine (Tegretol) Carbamazepine is changed and broken down by the body. CBD might decrease how quickly the body breaks down carbamazepine. This might increase levels of carbamazepine in the body and increase its side effects. Citalopram (Celexa) Citalopram is changed and broken down by the body. CBD might decrease how quickly the body breaks down citalopram. This might increase levels of citalopram in the body and increase its side effects. Clobazam (Onfi) Clobazam is changed and broken down by the liver. CBD might decrease how quickly the liver breaks down clobazam. This might increase the effects and side effects of clobazam. Eslicarbazepine (Aptiom) Eslicarbazepine is changed and broken down by the body. CBD might decrease how quickly the body breaks down eslicarbazepine. This might increase levels of eslicarbazepine in the body by a small amount. Everolimus (Zostress) Everolimus is changed and broken down by the body. CBD might decrease how quickly the body breaks down everolimus. This might increase levels of everolimus in the body. Lithium Taking higher doses of CBD might increase levels of lithium. This can increase the risk of lithium toxicity. Medications changed by the liver (Cytochrome P450 1A1 (CYP1A1) substrates) Some medications are changed and broken down by the liver. CBD might change how quickly the liver breaks down these medications. This could change the effects and side effects of these medications. Medications changed by the liver (Cytochrome P450 1A2 (CYP1A2) substrates) Some medications are changed and broken down by the liver. CBD might change how quickly the liver breaks down these medications. This could change the effects and side effects of these medications. Medications changed by the liver (Cytochrome P450 1B1 (CYP1B1) substrates) Some medications are changed and broken down by the liver. CBD might change how quickly the liver breaks down these medications. This could change the effects and side effects of these medications. Medications changed by the liver (Cytochrome P450 2A6 (CYP2A6) substrates) Some medications are changed and broken down by the liver. CBD might change how quickly the liver breaks down these medications. This could change the effects and side effects of these medications. Medications changed by the liver (Cytochrome P450 2B6 (CYP2B6) substrates) Some medications are changed and broken down by the liver. CBD might change how quickly the liver breaks down these medications. This could change the effects and side effects of these medications. Medications changed by the liver (Cytochrome P450 2C19 (CYP2C19) substrates) Some medications are changed and broken down by the liver. CBD might change how quickly the liver breaks down these medications. This could change the effects and side effects of these medications. Medications changed by the liver (Cytochrome P450 2C8 (CYP2C8) substrates) Some medications are changed and broken down by the liver. CBD might change how quickly the liver breaks down these medications. This could change the effects and side effects of these medications. Medications changed by the liver (Cytochrome P450 2C9 (CYP2C9) substrates) Some medications are changed and broken down by the liver. CBD might change how quickly the liver breaks down these medications. This could change the effects and side effects of these medications. Medications changed by the liver (Cytochrome P450 2D6 (CYP2D6) substrates) Some medications are changed and broken down by the liver. CBD might change how quickly the liver breaks down these medications. This could change the effects and side effects of these medications. Medications changed by the liver (Cytochrome P450 2E1 (CYP2E1) substrates) Some medications are changed and broken down by the liver. CBD might change how quickly the liver breaks down these medications. This could change the effects and side effects of these medications. Medications changed by the liver (Cytochrome P450 3A4 (CYP3A4) substrates) Some medications are changed and broken down by the liver. CBD might change how quickly the liver breaks down these medications. This could change the effects and side effects of these medications. Medications changed by the liver (Glucuronidated drugs) Some medications are changed and broken down by the liver. CBD might change how quickly the liver breaks down these medications. This could change the effects and side effects of these medications. Medications that decrease the breakdown of other medications by the liver (Cytochrome P450 2C19 (CYP2C19) inhibitors) CBD is changed and broken down by the liver. Some drugs decrease how quickly the liver changes and breaks down CBD. This could change the effects and side effects of CBD. Medications that decrease the breakdown of other medications in the liver (Cytochrome P450 3A4 (CYP3A4) inhibitors) CBD is changed and broken down by the liver. Some drugs decrease how quickly the liver changes and breaks down CBD. This could change the effects and side effects of CBD. Medications that increase breakdown of other medications by the liver (Cytochrome P450 3A4 (CYP3A4) inducers) CBD is changed and broken down by the liver. Some drugs increase how quickly the liver changes and breaks down CBD. This could change the effects and side effects of CBD. Medications that increase the breakdown of other medications by the liver (Cytochrome P450 2C19 (CYP2C19) inducers) CBD is changed and broken down by the liver. Some drugs increase how quickly the liver changes and breaks down CBD. This could change the effects and side effects of CBD. Methadone (Dolophine) Methadone is broken down by the liver. CBD might decrease how quickly the liver breaks down methadone. Taking cannabidiol along with methadone might increase the effects and side effects of methadone. Rufinamide (Banzel) Rufinamide is changed and broken down by the body. CBD might decrease how quickly the body breaks down rufinamide. This might increase levels of rufinamide in the body by a small amount. Sedative medications (CNS depressants) CBD might cause sleepiness and slowed breathing. Some medications, called sedatives, can also cause sleepiness and slowed breathing. Taking CBD with sedative medications might cause breathing problems and/or too much sleepiness. Sirolimus (Rapamune) Sirolimus is changed and broken down by the body. CBD might decrease how quickly the body breaks down sirolimus. This might increase levels of sirolimus in the body. Stiripentol (Diacomit) Stiripentol is changed and broken down by the body. CBD might decrease how quickly the body breaks down stiripentol. This might increase levels of stiripentol in the body and increase its side effects. Tacrolimus (Prograf) Tacrolimus is changed and broken down by the body. CBD might decrease how quickly the body breaks down tacrolimus. This might increase levels of tacrolimus in the body. Tamoxifen (Soltamox) Tamoxifen is changed and broken down by the body. CBD might affect how quickly the body breaks down tamoxifen. This might affect levels of tamoxifen in the body. Topiramate (Topamax) Topiramate is changed and broken down by the body. CBD might decrease how quickly the body breaks down topiramate. This might increase levels of topiramate in the body by a small amount. Valproate Valproic acid can cause liver injury. Taking cannabidiol with valproic acid might increase the chance of liver injury. CBD and/or valproic acid might need to be stopped, or the dose might need to be reduced. Warfarin CBD might increase levels of warfarin, which can increase the risk for bleeding. CBD and/or warfarin might need to be stopped, or the dose might need to be reduced. Zonisamide Zonisamide is changed and broken down by the body. CBD might decrease how quickly the body breaks down zonisamide. This might increase levels of zonisamide in the body by a small amount.

Are there interactions with herbs and supplements?

Herbs and supplements with sedative properties CBD might cause sleepiness and slowed breathing. Taking it along with other supplements with similar effects might cause too much sleepiness and/or slowed breathing in some people. Examples of supplements with this effect include hops, kava, L-tryptophan, melatonin, and valerian.

Are there interactions with foods?

CBD can be taken with food or without food. But taking it with food can cause the body to absorb more CBD than when it is taken without food. This might increase the effects of CBD.

Fatty foods or drinks, such as whole milk, and alcohol can also make the body absorb more CBD.

How is it typically used?

CBD has most often been used by adults in doses of 200 mg or less per day. Speak with a healthcare provider to find out what dose might be best for a specific condition.

For information on using prescription CBD, a product called Epidiolex, speak with a healthcare provider.

Other names

Methodology

To learn more about how this article was written, please see the Natural Medicines Comprehensive Database methodology.

References

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