WHAT WE KNOW, DON’T KNOW & THINGS IN THE MIDDLE
WHAT IS IN THE BOTTLE?
BEWARE: HEMP OIL & HEMP SEED OIL CONTAIN NO CBD
ABSORPTION
DOSE WILL DEPEND ON FORMULATION TYPE, INTENDED USE AND BODY WEIGHT
POSSIBLE INTERACTIONS WITH PRESCRIPTION DRUGS
CBD and the minor cannabinoids are metabolized (broken down) by the liver and they can affect the activity of various enzyme systems in the liver that also are responsible for the metabolism and inactivation of many drugs and supplements. The most studied liver enzyme system is the P450 cytochrome family, and in vitro (in an artificial environment) and animal studies confirm that cannabinoids generally inhibit the activity of these enzymes. As such, if a medication is inactivated by this family of enzymes, the concurrent use of CBD can cause the blood stream levels of the other medications to increase (i.e., inhibiting the inhibitor), enhancing its clinical effects and/or the chance of side effects. This interaction is potentially most significant for blood thinners (e.g., Coumadin®, Eliquis®). While it is not necessarily contraindicated to use CBD while on blood thinners, it is essential that their use be monitored by a physician for the possible need to, at minimal, change the dose of the medication Similarly, there are many medications that are inactivated by the P450 family of enzymes, including but not limited to: SSRI anti-depressants (e.g., Zoloft®, Celexa®), sedatives or benzodiazepams (e.g. Valium®), anti-arrhythmics (e.g. Amiodarone) and calcium channel blockers (e.g. Diltiazem).
In general, avoid the use of CBD if any of your prescribed medications have a GRAPEFRUIT WARNING on the label, or at minimum, consult with your physician before initiating use. Grapefruit juice is a known inhibitor of the P450 enzyme system, similar to CBD.
To further complicate matters, there is some evidence that CBD can also stimulate other enzymes in the P450 family, potentially causing a previous satisfactory dose of medication (anti-platelet agent Plavix®) to now be inadequate (stimulating the inhibitor).
Concomitant use of Central Nervous System depressants and/or alcohol could create a potential enhanced sedative effect, and perhaps require lowering your CBD or CBN dose.
Avoid the use of CBD if you have glaucoma. There is evidence that CBD can increase intra-ocular pressure.
While this section in particular, and the website generally has been researched and written by Michael J. Cohen MD, none of the statements should be considered nor interpreted as medical advice. Throughout, great care has been taken to point out the widespread lack of scientific research that exists and precludes any definitive statements. It is likely, however that scientific research for CBD etc. will greatly increase over the next several years. The final arbiter of potential benefit versus safety is YOUR physician.
Cannabidiol (CBD)- what we know and what we don’t. Peter Grinspoon MD, Harvard Health Publishing, Harvard Med School. 6/2019
www.medicalnewstoday.com/articles/327518. 1/17/2020
A systematic review of cannabidiol dosing in clinical populations, S. A. Millar et. al., Br J Clin Pharm. 2019;85:1888-1900.
Dosage, Efficacy and Safety of Cannabidiol Administration in Adults: A Systematic Review of Human Trials; Christian Larsen,
Jorida Shahinas; J Clin Med Res. 2020;12(3):129-141