Drug interactions are a significant consideration in modern medicine. More than half of U.S. adults regularly take prescription meds and at least 75 percent of Americans take at least one over the counter drug. Lots of people, including most seniors (the fastest growing demographic of cannabis users), take multiple drugs, and these compounds can interact and impact the metabolism of each other.
Cannabis is one of the most widely consumed substances in the usa and around the world, and a large number of cannabis users also consume pharmaceutical products. Because of the increasing acceptance and prevalence of cannabis being a therapeutic option, it’s important for physicians and patients to comprehend how various cannabis components, including cannabidiol (CBD) and tetrahydrocannabinol (THC), the key phytocannabinoids, may connect with commonly consumed pharmaceuticals.
But pertinent information regarding cannabinoid-drug interactions is difficult to acquire because of marijuana prohibition and consequent restrictions on clinically relevant research. Hence the necessity for Project CBD’s primer, which was written not just in help health care professionals and patients anticipate and avoid problematic outcomes but additionally to take advantage of situations where cannabis and pharmaceuticals can act synergistically in a positive way.
“It’s a complicated issue,” says research chemist Adrian Devitt-Lee, the article author from the Project CBD primer. “Although drug interactions are rarely so dangerous as to entirely preclude the use of a medication, they can have serious impacts on a patient’s treatment and wellbeing.”
The Project CBD primer features a discussion of various “substrates” or drugs which can be metabolized by cytochrome P450, a sizable family of non-specific enzymes that take part in wearing down approximately 60 to 80 percent of all pharmaceuticals. Cytochrome P450 enzymes may be inhibited or amplified by CBD, THC as well as other plant cannabinoids, thereby reducing or prolonging the action of another drug.
By suppressing or inducing specific cytochrome P450 enzymes, CBD and THC can alter how one metabolizes an array of substances. Much depends on the particular substrate involved in the drug interaction. Some pharmaceuticals, referred to as “prodrugs,” don’t become functional until these are metabolized into a dynamic component. If CBD or THC inhibits the breakdown of the prodrug, the latter will remain inactive – whereas inhibiting your metabolism of any regular drug will result in higher blood amounts of the active substance.
Several variables make precise predictions about drug interactions difficult, for practiced physicians. “It is easier to gauge whether drug interactions are most likely rather than predict their exact effect,” the Project CBD primer asserts.
Thus far, based upon observations regarding the widespread use of raw cannabis flower and full-spectrum cannabis oil, it does not appear that there were many problems due to cannabinoid-drug interactions. The clinical utilization of Sativex (a 1:1 CBD:THC sublingual tincture) and Marinol (a pure, synthetic THC pill) has ended in few, if any, reported adverse events attributable specifically to interactions with pharmaceuticals.
Towards the extent that there have been problematic drug interactions with cannabinoids, these have involved high doses of nearly pure CBD isolates, not cannabis generally. Despite the fact that THC is an intoxicant and CBD is not really, the truth that people often use higher doses of pure CBD makes it a much riskier player in metabolic drug interactions.
Consider the numbers: Ten milligrams of THC in a cannabis product is a hefty dose to get a naive patient and sufficiently psychoactive for the occasional recreational user. Ten mgs of THC coupled with an identical quantity of CBD in a Sativex tincture hit the analgesic sweet spot in clinical trials. They are moderate doses compared to the quantity of single-molecule CBD administered to epileptic children in clinical studies – approximately 50 mg per kilogram – with CBD doses as much as 2000 mg not unusual among patients who obtain CBD isolates from internet storefronts and other unregulated sources.
THC features its own built-in guard rails – consume too much and you’ll know you’ve hit your limit. With CBD, you can find no guard rails, no dysphoric feedback loop which says you’ve had enough. CBD is intrinsically safe, but when extracted from the plant and concentrated being an isolate, high doses are necessary for therapeutic efficacy – unlike whole plant CBD-rich extracts, which have a broader therapeutic window and they are good at lower doses than single-molecule CBD.
Drug interactions are more inclined with high dose CBD therapy than other forms of cannabis consumption. Physicians and patients needs to be concerned about this, given that the existing regulatory regime privileges CBD isolates over artisanal, plant-derived, multicomponent formulations.
Just how cannabinoids are administered (smoking, eating, etc.) even offers a significant influence on whether or not drug interactions occur. Interactions are a lot more likely when both prescription medication is taken orally and processed through the liver prior to being distributed with the body. Cannabinoids are absorbed more if ingested on the full stomach. Ingested cannabinoids could have higher peak liver concentrations than inhaled cannabinoids, so ingested cannabinoids should have more potent drug interactions.
The Project CBD primer notes the sequence and also the route of administering cannabidiol may influence how another drug is metabolized. One study disclosed that CBD features a stronger inhibitory impact on a particular cytochrome P450 enzyme if it’s administered twenty or so minutes before the second drug.
CBD also interacts with THC. By taking CBD and THC together, individuals could find that the outcomes of THC are tempered but prolonged slightly. It is actually known that 11-OH-THC, a THC breakdown component, is much more potent than THC on the CB1 cannabinoid receptor, which mediates psychoactivity. 11-COOH-THC, another THC metabolite, has anti-inflammatory effects without causing a high.
Some individuals can hardly tolerate any THC. The wide variety of reactions to THC-rich cannabis could be affected by genetic tkqkzu factors. A common polymorphism (or variant) of any gene that encodes a specific cytochrome P450 enzyme alters how one metabolizes THC so that it stops working more slowly and stays active longer, leading to hypersensitivity to THC’s psychoactive effects.
That could be one reason why some people find THC-rich cannabis to be unpleasant, while countless millions smoke it to relax. This genetic variant exists among 20% in European & Middle Eastern populations, meaning one in five Caucasians are THC-averse. Lower than 10% of Africans have this genetic variant and among Asians it’s less than 5%.