CBD + Contraindications

CBD (or cannabis/industrial hemp in general) is not for everyone — despite few potential adverse side effects used on its own — and for some on pharmaceuticals or with certain conditions, it needs to be used with caution. A “contraindication” here simply means, not recommended. While we at EQ have seen success with CBD/cannabinoids used with a whole host of pathologies and symptoms, with or without adjunct medication, the “contraindication” status of CBD and your medications is between yourself and your doctor!

For the record, between the two EQ co-founders, Marcy and Coco have successfully used CBD with Paxil, Wellbutrin, Klonopin, Xanax, Propranolol, and Enbrel, and while they chose to stop or decrease use of those medications, it was not because of CBD in a negative sense. They worked quite well together, but ultimately they were happier and healthier with an altered/lowered pharmaceutical routine and more CBD. So everyone’s mileage may vary, and doctors are experts for a reason.

Cytochrome P450 (CYP450)

One simple fact to keep in mind is that cannabinoids (such as CBD) can regulate our Endocannabinoid System (“ECS”) so well with their “homeostatic” tendencies that our medications work differently (if they use the CYP450 liver enzymes — keep reading!) What does this mean? Examples include folks on epilepsy, blood pressure, or narcotic medications experiencing these prescriptions working too well, meaning an uptick in side effects, upon which their doctors recommend lowering the dose of said medication. We advise looping your doctor in when it comes to your CBD journey! Especially since the opposite can happen, though fewer medications are on such a list.

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Outside of clinical environments, complaints of CBD interacting with medications is not often intrusive in a treatment plan, especially since the aforementioned risks are associated with fairly high doses of daily CBD. While everyone’s “high dose” is very personal, many reported interactions are at over 100mg per day doses, and most EQ customers are at 50mg or below. We however recommend you ALWAYS consult with your doctor about your medications before starting CBD, and journal every day about any uptick in medication side effects or decrease in medication efficacy!

Medications themselves can also inhibit CBD’s ability to be metabolized properly. Phenobarbital, for instance, makes CBD less effective.

You may have been told to avoid grapefruits before taking a medication despite no allergy, and this also has to do with Cytochrome P450 (“CYP450”) family of liver enzymes. CBD can change how this enzyme processes medication (as mentioned, usually faster but sometimes slower). A quick tip to get knowledge on your medications and CYP450 is to ask your doctor or pharmacist if you should avoid grapefruit with your medication; if YES, you know that you should use CBD carefully.

“According to the Indiana University Department of Medicine, drugs known to use the CYP450 system include:

  • Steroids
  • HMG CoA reductase inhibitors
  • Calcium channel blockers
  • Antihistamines
  • Prokinetics
  • HIV antivirals
  • Immune modulators
  • Benzodiazepines
  • Antiarrythmics
  • Antibiotics
  • Anesthetics
  • Antipsychotics
  • Antidepressants
  • Anti-epileptics
  • Beta blockers
  • PPIs
  • NSAIDs
  • Angiotension II blockers
  • Oral hypoglycemic agents
  • Sulfonylureas

This list does not include all of the potential medications impacted by CBD. Nor will every medication in the categories contained on this list cause an interaction. For these reasons, you should consult with a medical professional before supplementing with CBD.

There are certain medications, known as “prodrugs,” that need to be metabolized to produce the therapeutic compound. In other words, you ingest an inactive compound and once in the body, it is processed into the active drug. If this processing is dependent on CYP3A4 (part of the larger CYP450 system), then inhibitors can result in too little active drug in the body for the desired therapeutic effect.

Codeine, for example, is a prodrug that is metabolized into morphine which provides the effect.

Vyvanse and Concerta are two other popular pharmaceutical medications for ADHD that fall into this category.

If you are worried that your CYP450 pathway may not be functioning properly, physicians can test the system to ensure that the medications you take are metabolizing as expected.” (source)

Glaucoma/Eye Pressure

There’s been research that shows that for those with glaucoma, or predisposition to it, CBD can increase intraocular eye pressure the opposite way THC can decrease it…meaning high doses of CBD are not advisable without THC to balance. Your eye doctor can very quickly check eye pressure for you at a routine visit, and drops can easily remedy as the effect is temporary.