Cbd interactions

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CBD Interactions: A Comprehensive Overview

Introduction to CBD and Its Uses

Cannabidiol (CBD) is a non-intoxicating compound found in cannabis, widely used for its potential therapeutic benefits. It has gained popularity for treating conditions such as epilepsy, chronic pain, anxiety, and inflammation. However, CBD's interactions with other drugs and its adverse effects are critical considerations for both medical and recreational users.

Adverse Drug Events (ADEs) and Common Side Effects

CBD is not without risks. Nearly half of CBD users experience adverse drug events (ADEs), which often correlate with dosage. Common side effects include elevated liver enzymes, sedation, sleep disturbances, infections, and anemia . In clinical settings, CBD has been associated with hepatic abnormalities, diarrhea, fatigue, vomiting, and somnolence . These effects necessitate careful monitoring, especially in patients with complex medical conditions.

Pharmacokinetic and Pharmacodynamic Drug-Drug Interactions (DDIs)

CBD interacts with various medications through pharmacokinetic and pharmacodynamic mechanisms. It affects enzymes like CYP3A4 and CYP2C19, which are crucial for drug metabolism, and P-glycoprotein, involved in drug excretion. This interaction can alter the effectiveness and toxicity of other drugs . For instance, CBD can interact with anti-epileptic drugs, antidepressants, opioid analgesics, and even common medications like acetaminophen .

Specific Interactions with Antiepileptic Drugs

CBD's interaction with antiepileptic drugs (AEDs) is particularly noteworthy. Studies have shown that CBD can cause elevated transaminases when used with valproate and increased sedation and lethargy with clobazam . These interactions highlight the need for monitoring and potential dose adjustments when CBD is used alongside AEDs .

Interaction with THC and Other Substances

CBD also interacts with delta-9-tetrahydrocannabinol (THC), another major cannabinoid. The interaction between CBD and THC can vary based on the timing and dosage of administration. CBD can potentiate or inhibit THC's effects, influencing anxiety, memory, and body temperature regulation 56. Additionally, CBD's interaction with substances like alcohol and tobacco further complicates its safety profile .

Serious Adverse Effects and Long-Term Safety

While most adverse effects of CBD are mild to moderate, serious adverse effects (SAEs) can occur. These include elevated liver enzymes, convulsions, and upper respiratory tract infections, particularly when CBD is used with other medications . Long-term safety data is still limited, and more research is needed to fully understand the chronic effects of CBD use .

Conclusion

CBD offers promising therapeutic benefits but is not without risks. Its interactions with other drugs, particularly antiepileptic medications, and its potential for serious adverse effects necessitate careful consideration and monitoring. As CBD use continues to grow, both consumers and healthcare providers must stay informed about its safety profile and potential drug interactions to ensure its benefits outweigh the risks.

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Most relevant research papers on this topic

Potential Adverse Drug Events and Drug–Drug Interactions with Medical and Consumer Cannabidiol (CBD) Use

CBD use may cause adverse drug events and drug-drug interactions, requiring careful monitoring and alternative therapies for medically complex patients.

Rigorous JournalHighly Cited

2019·

213citations

·Joshua D. Brown et al.

Cannabidiol Adverse Effects and Toxicity

CBD has proven therapeutic efficacy for serious conditions like Dravet and Lennox-Gastaut syndromes, but its use should be based on a careful consideration of adverse effects and potential drug-drug interactions.

Systematic ReviewRigorous JournalHighly Cited

2019·

271citations

·M. Huestis et al.

Serious adverse effects of cannabidiol (CBD): a review of randomized controlled trials

CBD has rare serious adverse effects, mainly elevated transaminases, convulsions, sedation, lethargy, and upper respiratory tract infections, which may be related to drug-drug interactions.

Systematic Review

2020·

50citations

·R. G. dos Santos et al.

Cannabidiol Interactions with Medications, Illicit Substances, and Alcohol: a Comprehensive Review

CBD interacts with various medications, including anti-epileptic drugs, antidepressants, opioid analgesics, and THC, and also with alcohol and tobacco.

Literature Review

2021·

64citations

·P. Balachandran et al.

Interaction between cannabidiol (CBD) and ∆9-tetrahydrocannabinol (THC): influence of administration interval and dose ratio between the cannabinoids

CBD pretreatment can potentiate THC's effects in adolescent rats, but the effects depend on the time between administration and the dose ratio between the two cannabinoids.

Rigorous JournalHighly Cited

2011·

78citations

·A. Zuardi et al.

Interactions between cannabidiol and Δ9-THC following acute and repeated dosing: Rebound hyperactivity, sensorimotor gating and epigenetic and neuroadaptive changes in the mesolimbic pathway

Repeated co-administration of CBD and THC may have complex and supradditive effects on the brain, with CBD slightly inhibiting rebound locomotor hyperactivity and slightly reducing sensorimotor gating effects.

Non-RCT

2017·

40citations

·S. M. Todd et al.

Adverse effects of cannabidiol: a systematic review and meta-analysis of randomized clinical trials

CBD is well-tolerated and has few serious adverse effects, but interactions with other medications should be monitored.

Meta-AnalysisVery Rigorous JournalHighly Cited

2020·

195citations

·E. Chesney et al.

How does cannabidiol (CBD) influence the acute effects of delta-9-tetrahydrocannabinol (THC) in humans? A systematic review

CBD may reduce some acute effects of THC, such as anxiety and psychosis-like effects, but its effects vary across studies and outcomes.

Systematic ReviewHighly Cited

2019·

151citations

·A. Freeman et al.

Molecular targets for cannabidiol and its synthetic analogues: effect on vanilloid VR1 receptors and on the cellular uptake and enzymatic hydrolysis of anandamide

CBD and its analogues may mediate some of their anti-inflammatory effects through interaction with vanilloid VR1 receptors or increased levels of endogenous anandamide.

In Vitro StudyHighly Cited

2001·

1075citations

·T. Bisogno et al.

Interactions between cannabidiol and commonly used antiepileptic drugs

Cannabidiol (CBD) may interact with commonly used antiepileptic drugs, causing potential pharmacokinetic interactions.

Non-RCTHighly Cited

2017·

294citations

·T. Gaston et al.

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