Cannabis has become very popular both recreationally and medically because it has a lot of fantastic effects. However, using cannabis with medications can have adverse effects.
Drug interactions are most often seen with cannabis because the cannabis compounds primarily cannabinoids (CBD and THC) affect receptors and enzymes involved with drug metabolism.
Cannabis and Sedatives and Sleep Medications
One of the most common interactions is between cannabis and medications that are sedatives, which can include benzodiazepines (Xanax, Valium, Ativan), barbiturates, and sleep medications (Ambien, Zaleplon, Lunesta). When these medications and cannabis are ingested simultaneously, drowsiness, impaired coordination, dizziness and respiratory depression may occur. When someone is using both of these agents, it is a good idea to stay out of the pool and not drive or operate machinery while being on this dual medication.
Antidepressant and Anti-Anxiety Medications
If one uses a CBD-rich cannabis product, there is a possibility that they are inhibiting the metabolism of their antidepressant, which causes the antidepressant to have increased levels in the bloodstream. While severe interactions are uncommon, there is a potential for enhanced drug side effects, such as dizziness, drowsiness and even serotonin syndrome.
Cannabis and Anti-Coagulants
Another class of medicine where cannabis has been shown to have significant drug interactions, and possibly dangerous side effects, is anti-coagulants. Anticoagulants are medications like a blood thinner (warfarin, Coumadin) which cannabis has been reported to exacerbate an enzymatic inhibition by THC and CBD, which have been shown to potentially cause dangerous bleeding.
Interactions with Pain Medications and Opioids
Cannabis use will amplify the sedation experienced with opiates (e.g., oxycodone, morphine), creating greater impairment like breathing depression, effects on cognitive status, and dizziness. Some research suggests that cannabis may help reduce the amount of opiates required to achieve effective pain relief. Cannabis affects the metabolism of the pain-relieving non-steroidal anti-inflammatory drugs (NSAIDS), like ibuprofen, and may affect the effectiveness or side effect profile of these drugs.
Cannabis and Heart Medications
THC can produce short term increases in heart rate and blood pressure, thus affecting medications prescribed for hypertension (e.g., beta-blockers, ACE inhibitors) or arrhythmia medications.
Interactions with Diabetes Medications
Some studies point toward cannabis being helpful in managing symptoms related to diabetes. However, finding a precise interaction between strong cannabis (especially THC-rich cannabis) and insulin or oral diabetes medications has the potential to lead to drastic changes in blood sugar levels. Individuals taking diabetes medications must closely monitor their blood sugar and note their cannabis use to their physician.
Interactions with Seizures Medications (Antiepileptic) and Cannabis
CBD is widely touted for its anticonvulsant effects and is used to treat epilepsy. However, CBD-rich cannabis interacts with seizure medications, such as clobazam, valproate, or lamotrigine. CBD may inhibit metabolism, causing blood concentrations of clobazam, valproate, or lamotrigine to rise to dosages that may elevate side effects such as dizziness, sedation, or liver stress.
Chemotherapy and Cancer Drugs
Many cancer patients are using cannabis to assist with the side effects of chemotherapy. There are examples of potential interactions between cannabis and chemotherapy agents, including paclitaxel, irinotecan, or immunotherapy. THC and CBD affect the liver’s ability to metabolize these cancer medications resulting in potential effects on the effectiveness of chemotherapy or increased side effects.
Recommendations for Safe Cannabis Drug Interactions
- Consult with a physician or other health care provider
- Start with low doses, and go slow.
- Monitor closely.
- When ready, titrate doses properly.
With understanding the potential risks, and working in close collaboration with their health care providers, individuals can have positive results and safely include cannabis as part of their treatment.