CBD is just one of the compounds, known as cannabinoids, that are found in the cannabis plant. For this reason, many have dismissed the idea of using CBD, because it has been closely associated with the more common compound, delta-9 tetrahydrocannabinol, or THC. It is this THC compound that causes the mind-altering ‘high’.
It is important to note here that CBD is derived from the hemp plant, a close cousin of the marijuana plant that is known for its high THC levels. Unlike the marijuana plant, hemp contains very little THC (less than 0.3%), and according to the World Health Organisation, “CBD exhibits no effects indicative of any abuse or dependence potential…. To date, there is no evidence of public health-related problems associated with the use of pure CBD.”
Though CBD does not produce the ‘high’ that THC does, it does appear to produce significant changes within the brain and body, which is what has prompted the research into its medicinal benefits.
How does it work?
CBD works by attaching to specific receptors. Interestingly, the human body actually produces certain cannabinoids itself. The body has two primary receptors for cannabinoids, which are the CB1 and CB2 receptors.
CB1 receptors are responsible for movement, coordination, pain, mood, emotions, appetite, memories, among other things. These receptors are mainly found in the brain and THC attaches to them.
CB2 is the other type of receptor in the body, and this deals with the immune system, affecting inflammation and pain. Previously, it was believed that CBD attached to these receptors in the body. Now it is understood that instead CBD encourages the body to use more of its own cannabinoids.
When is it contraindicated?
CBD interacts with the body by being metabolized by the cytochrome P450 enzymes; CYP3A4 and CYP2C19. Even though that might read like a random combination of letters and numbers, it is actually important information because it indicates that CBD should not be taken with certain other medications.
Due to the fact that some other medications are also metabolized by the same enzymes as CBD, combining them can put them in competition with each other. This can result in the reduced metabolization of the other drug. If these other drugs are not metabolized at the expected rate, it can raise their blood levels and cause complications. For this reason, some combinations should be completely avoided, whilst others would require altered doses.
What medicines are contraindicated to be used in conjunction with CBD and why?
Blood Thinners (Warfarin/Coumadin) - CBD could block the metabolism of these drugs, causing them to remain in higher concentrations and be more active, which could become toxic or cause other complications.
Benzodiazepines (Xanax/Ativan) - The metabolism of these types of drugs could be affected in a similar way, potentially increasing the side effects. This could result in those taking the medication to feel more sedated or drowsy and in some cases could even become toxic or interfere with the respiratory system.
Other medications to be aware of include:
- Calcium channel blockers,
- Antiretrovirals and
These are among a group of drugs that researchers believe could also be affected by CBD. In these cases, the concern is that CBD could increase the serum concentration of these drugs.
The mechanism for how this can occur with CBD and these medications is the same mechanism that causes citrus fruit to inhibit liver enzymes. So in the same way as citrus juice, CBD can increase the concentration of medications in your blood. With many of these drugs the dosage is very important, so when taking them alongside CBD, it is crucial to be aware of this effect and moderate dosage of both accordingly.
The degree to which this effect is seen in the body depends largely on the dosage of the medication and the concentration of CBD. High concentrations of CBD have a greater potential to disrupt the metabolism and concentration of medications. On the other hand, low concentrations of CBD have been shown to have little to no effect on other medications.
There is still not enough research to tell us what the exact dose of CBD is that it would have noticeable effects for any given drug. A lot more research and trials are needed in this area, and it is likely to be years before we have the full picture on this.
So for now, finding this balance is a case of starting small and testing what works for you and your body. This should be done with the supervision of a health professional.
Are there other foods or substances that should be avoided?
Alcohol: CBD and alcohol both have similar effects to each other on the body in that they both relax you and lower your inhibitions. Because of this, when CBD and alcohol are taken together, the effects can be multiplied and have a greater than intended overall impact.
If alcohol alone makes you feel tired and relaxed, then alcohol combined with CBD could well magnify this and give a greater sense of relaxation and tiredness than intended. It is also thought that CBD combined with alcohol, could affect your mood. For example, someone who normally becomes consuming alcohol alone might find that they become calmer when consuming CBD along with alcohol.
Interestingly, alcohol and CBD don’t have to be taken at the same time for their effects to be combined. They can be consumed within 4 to 8 hours of each other, and they will still both be in your system and will interact with each other. It is important to be aware of this because the consequences of taking both at different times could be unintended. For example, if you have some alcohol in the early evening and some CBD oil before bed at night, you may not think they are related. However, the overall effects you are expecting from each substance individually, could be magnified as the CBD and alcohol will still both be in your system at the same time. This could result in a combined effect.
Edibles: CBD is infused with many common foods and drinks from soft drinks to coffee and chocolate to lollies. Consuming CBD that has been mixed with food or drinks is generally considered as safe as any other way of consuming CBD but there are some concerns to be aware of. Dosage guidelines are still in their very early stages, so knowing exactly how much of a concentration of CBD you are consuming. So when consuming CBD in an edible form along with any other medication, it is important to start with a small dose and slowly increase to find your tolerance level.
Tips for getting started:
- If you are taking any current medication, the safest option is to consult with your medical professional about what you are currently taking and why you want to add CBD into the mix.
- Start off with small doses, gradually adding in the CBD over a period of weeks. This way you can monitor the combined effect, and ensure the CBD is not causing a build-up in the concentration of any of your existing medications.
- Be aware that CBD and other medications can have combined effects even if they are taken 4 - 8 hours apart.
- Take specific notes of what doses of medication and what amount of CBD you are taking at what times. This way, you can be sure you have a full and accurate picture of what combined effects you could be experiencing and when.
The bottom line:
The best current research suggests that to take CBD alongside other common medications safely, you need to be very aware of the combined effects. CBD can affect the rate at which other drugs are metabolized, and this can lead to different concentrations of other medications in the blood than intended.
It is advisable to consult with your medical professional if you are currently taking any form of medication. This will help you decide if CBD is likely to have the desired effect that you are looking for. It will also help you work out how to safely start taking CBD alongside your existing medication so that you can enjoy the benefits, while minimising the risks. Your medical professional will be able to monitor the concentrations of any existing medications in your blood and track those levels as you introduce CBD to make sure they continue to have the desired effect.
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