By Dr. Minchul An, Co-Founder & CEO at Buzzn
CBD has been all the buzz lately in the health and wellness space; with evidence suggesting CBD oil may benefit those who suffer from anxiety or depression. However, many are wondering if supplementing CBD in addition to their antidepressant therapy is a safe and effective option. Here is what we know so far.
SSRIs are the first-line medications used for the treatment of depression. They are well researched and provide relief to millions of people. Several have also reported that the use of CBD oil in combination with their SSRIs resulted in improved symptoms of depression without additional side effects. That being said, this combination may not be for everyone. CBD has the potential to interact with SSRIs, and other antidepressants, resulting in increased amounts of antidepressant in the body and a higher risk of side effects.
Our liver enzymes, or cytochrome P450, are what allows us to metabolize drugs to be excreted from our system. CBD and drug interactions can mimic the interactions between grapefruit and drugs. CBD works the same way in the liver as grapefruit. Check your prescription bottle. If there is a grapefruit warning label that says “avoid this medication with grapefruit,” then this would essentially apply to CBD also. Cannabidiol (CBD), the most well researched cannabinoid, is a strong liver enzyme blocker, specifically a strong inhibitor of CYP3A4. What that means is CBD blocks this specific liver enzyme (CYP3A4) that’s used to metabolize other drugs in our body. As a result, CBD may increase serum concentrations of certain drugs that are specifically metabolized by these enzymes. Drugs include certain antibiotics, blood pressure medications, cholesterol medications, antidepressants, antipsychotics, and even treatment for HIV.
Our liver enzyme CYP3A4 metabolizes about a quarter of all drugs, so CBD may increase serum concentrations of many prescription drugs.
Drugs metabolized by (liver enzyme) CYP3A4:
- HMG CoA reductase inhibitors.
- Calcium channel blockers.
- HIV antivirals.
- Immune modulators.
Drugs that are potent inhibitors of (liver enzyme) cytochrome P450 and therefore decrease the metabolism of cannabinoids:
- Drugs that are potent inhibitors of CYP3A4 isoenzymes may increase the bioavailability of CBD:
- Potent inhibitors of CYP3A4 include Clarithromycin, Diltiazem, Erythromycin, Grapefruit juice, Itraconazole, Ketoconazole, Nefazodone, Ritonavir, Telithromycin, and Verapamil.
Drugs that are inducers of (liver enzyme) cytochrome P450 and therefore accelerate the metabolism of cannabinoids:
- Drugs that are inducers of CYP3A4 isoenzymes may accelerate the bioavailability of CBD:
- Potent inducers of CYP3A4 include Carbamazepine, Hypericum Perforatum (St. John’s Wort), Phenobarbital, Phenytoin, and Rifampin.
CBD drug interactions are not always bad. CBD can make other drugs more effective, so much so that you can reduce the dosage of those other drugs and thus have less negative side effects to deal with. Keep in mind other cannabinoids like THC and CBN can interact with our cytochrome P450 system as well. CBD (along with THC and CBN) can interact with not only CYP3A4 (previously mentioned), but also other liver enzymes such as CYP2D6, CYP2C9 and CYP2C19.
There is still so much we don’t know about the pharmacokinetics (PK) and pharmacodynamics (PD) of cannabinoids. Most of the clinical and anecdotal research out there is around THC and seizures.
Ultimately, CBD is considered an active drug. The current prescription drug out on the market is called Epidiolex, a concentrated dose of pure CBD isolate derived from marijuana. It’s classified by the DEA as a Schedule 5 drug used for the treatment and prevention of seizure disorders. If you have an extensive medication history, it’s extremely important to have a healthcare professional perform a med reconciliation — to be able to know if there is a possible drug-drug interaction.
Before buying any CBD product, speak to a healthcare professional to see what interactions it may cause with your current medication regimen. From there, it’s important to tailor treatment options with your prescribing doctor and see if CBD is really a good fit for you. We’re here to help, feel free to contact me directly at firstname.lastname@example.org for a med reconciliation and consultation.