If you are already using some medications, even if they are OTC ones, CBD drug interactions are still possible, so study our list with care. Zanaflex is used for, Aug 04, · Zanaflex is a prescription medicine used to treat the symptoms of muscle stiffness (spasticity) associated with conditions… Accurate Education: Cannabidiol (CBD) – Side Effects and Drug Interactions Cannabidiol (CBD) has promise for many medical applications although they are not yet well defined nor are the
Most Common CBD Drug Interactions and Side Effects
It’s perfectly natural to be concerned about possible CBD drug interactions a nd their side effects.
Seeing how 66% of adult Americans take one or more prescription drugs and that 25% consumed cannabis in one year, there’s bound to be some overlap between the two.
That’s why reading up on all the essential information regarding how CBD and other medications interact in the human body should be a number one priority when consuming weed.
Before we present the extensive CBD drug interaction list , let’s talk a little about CBD itself.
What Is CBD?
CBD (cannaabidiol) is a phytocannabinoid found in cannabis along with 113 other cannabinoids.
When people say that CBD is everywhere, they mean it. You can find CBD in consumer products like cosmetics , drinks, even food. Other uses for CBD oil include relief for countless medical conditions , like migraines, autism, mental disorders, and MS, to name but a few.
Another factor that contributes to the popularity of CBD is the fact that, unlike THC, CBD is non-psychoactive. Meaning there is no such thing as a CBD high (even though it does feel different ) .
How Can CBD Oil Interact with Medications?
CBD can inhibit the activity of cytochrome P450 — a family of liver enzymes that metabolize toxins and certain medications (CBD included) that enter the human body.
CBD can temporarily block the regular function of these enzymes, causing some drugs in the system to break down more slowly.
Thus, it can increase the amount (and potency) of these medications in the system, as well as the risks of possible side effects and medication interactions .
Moreover, some serious complications can occur in some cases of drug interactions with cannabis , like bleeding and hemorrhages, and even respiratory system issues.
In other instances, CBD can also speed up the performance of some of the enzymes in this group, which in turn speeds up the metabolism of certain drugs. What does this mean? The levels of these drugs in the system are lower and, thus, less effective.
Cannabidiol is not the only one blocking CYP450. Grapefruit and grapefruit juice also show the same effects as drug interactions with CBD oil do. In fact, CBD is just as powerful as bergapten — the most potent inhibitor of liver enzymes found in grapefruit.
The main difference between the two is that you can find grapefruit warnings listed on most medications, unlike CBD. In short, if you see that you shouldn’t use a particular drug with grapefruit , it’s a safe bet that you shouldn’t use it with CBD either.
Other substances like watercress and St. John’s Wort might produce a similar effect when combined with certain drugs.
What Drugs Should Not Be Taken with CBD?
The list can get quite extensive as almost 60% of the drugs on the market are broken down in the body through the liver, i.e., through CYP450.
Nevertheless, the most common medications that you shouldn’t use in unison with CBD (isolate, broad, or full-spectrum) include:
- Anti-epileptic and anti-seizure drugs
- Blood thinners
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Muscle relaxants
- Sedatives (benzodiazepines)
- Beta and calcium channel blockers
- Chemotherapy medication
Consulting a professional on what medications interact with CBD oil is crucial before mixing these drugs with cannabidiol.
This list does not include all the drugs that interact with cannabidiol, nor does it mean that combining any of these types of medication will cause issues when taken with CBD.
The severity of the reaction will depend on the amount of time the drugs have been in your system, as well as some pre-existing medical conditions or allergies.
Anti-Epileptic or Anti-Seizure Drugs and CBD
We start CBD oil drug interactions talk with drugs used to treat epilepsy and seizures . Mixed with cannabidiol, they can lead to severe consequences due to these medications interacting with marijuana.
CBD and Clobazam
This is particularly true of clobazam , which can have serious interactions with CBD. Clobazam (Onfi) is used in combination with other medicines to control seizures, particularly the ones caused by Lennox-Gastaut syndrome , a rare form of epilepsy among children.
This drug is metabolized by the liver enzymes that CBD blocks, resulting in major CBD drug interactions.
Simply put, when used together, the effects and side effects of clobazam increase. This could lead to many adverse effects , such as dizziness, constipation, drowsiness, breathing problems, and even depression and suicidal thoughts.
CBD and Valproate
Valproate is the other of the two drugs that are known to cause major interactions with CBD. In addition to epilepsy, you can use valproic acid to treat some mental conditions and migraines.
Valproic acid could cause severe, even life-threatening liver damage, usually within the first six months of therapy. This medication also has some intense CBD hemp oil drug interactions . The combined use of valproate and cannabinoid oil could increase the risk of liver damage.
CBD and Eslicarbazepine
Another anti-seizure drug known to interact with CBD is eslicarbazepine (Aptiom), although it’s less severe than the previous two.
It can be used alone or with other drugs to treat focal seizures (seizures that affect only one hemisphere of the brain) in adults and children by reducing the number of attacks.
Eslicarbazepine can lead to moderate drug interactions with CBD . Cannabidiol use could slow down the metabolism of eslicarbazepine in the body and thus increase the drug potency in the system, but only by a small degree.
CBD, Topiramate, and Zonisamide
CBD also has a similar effect on topiramate (Topamax) and zonisamide , which are used to treat epilepsy. Likewise, the former is also said to increase some CBD oil effects , l ike stress reduction. It could also enhance some C BD oil side effec ts , such as drowsiness and sleepiness.
CBD and Statins
Statins are drugs that reduce cholesterol levels in the body and, in that way, help reduce the risk of heart attacks and strokes .
Atorvastatin and simvastatin are some of the most commonly prescribed cholesterol-lowering medications. Used in combination with a proper diet, atorvastatin lowers bad cholesterol and fats in the body and “improves” HDL, or good cholesterol in the blood.
Statins are known to interact with CBD. So, if you want to avoid serious CBD drug interactions , don’t use them both frequently.
In atorvastatin interactions with CBD, CBD oil use can increase the serum concentration of atorvastatin and simvastatin, which results in them staying in the system for longer and causing dangerous accumulation.
Unlike these two drugs, there is no proof that other statins, like for example, pravastatin and rosuvastatin, can be affected by cannabidiol.
Blood Thinners and CBD
What prescription drugs should not be taken with CBD oil ? Definitely, warfarin, rivaroxaban, and apixaban.
Warfarin treats existing blood clots and prevents new ones from forming. It also interacts with cannabidiol . How?
Warfarin is metabolized by the CYP2C9 enzyme, the same one that CBD is said to block. The combination of these two drugs is particularly harmful as it can lead to severe bleeding and thrombosis.
Other blood thinners such as rivaroxaban and apixaban increase the likelihood of side effects. At the same time, some medications like heparin and edoxaban have not shown any significant interaction with CBD.
Does CBD Oil Interact With Blood Pressure Medications?
CBD oil can reduce the efficacy of blood pressure medications regarding hypertension. In a similar manner, blood pressure medications can potentially reduce CBD’s effectiveness.
Cannabidiol is an inhibitor of the cytochrome P-450 enzyme system, so you should be careful when mixing CBD oil with medications for high blood pressure like metoprolol and amlodipine .
Although negative interactions between blood pressure medications and CBD oil are rare, stay cautious and consult with your doctor.
The most common interactions of mixing blood pressure medication and CBD oil are:
- CBD and Amlodipinebesylate — CBD could metabolize slower when combined with Amlodipine besylate.
- CBD and Valsartan (Diovan) — CBD will metabolize slower when mixed with Valsartan.
- CBD and Lisinopril — Lisinopril’s antihypertensive function may decrease if you combine it with CBD oil.
- CBD and Metoprolol — its antihypertensive function can decrease if mixed with CBD oil.
- CBD and Hydrochlorothiazide — Hydrochlorothiazide’s antihypertensive function can decrease if mixed with CBD oil.
So, does CBD interfere with blood pressure medicine ? Yes, CBD can interact with blood pressure medications. It can also be risky for some people because CBD has anticoagulant effects. In other words, it can thin the blood.
Furthermore, since CBD can lower blood pressure, mixing it with other drugs can be dangerous for individuals who suffer from certain medical conditions.
For example, a 2020 study shows that CBD can improve blood flow because it widens blood vessels. Another study from 2017 shows that CBD can reduce blood pressure in individuals under stress.
CBD Oil and Thyroid Medication Interactions
CBD oil can help with various thyroid dysfunctions, like thyroid storm, hypothyroidism, goiter, hyperthyroidism, and thyroiditis.
However, since both substances compete in the cytochrome P450 pathways to get metabolized , mixing them can lead to various side effects, from hyperthyroidism to mild nausea and anxiety.
Moreover, if you mix CBD with thyroid medication, their interaction can potentially result in subtherapeutic effects. This means that the medicine will stop being effective. The mentioned interaction can also cause toxic levels of the drugs in the bloodstream.
Can You Take CBD Oil With Antidepressants?
Doctors prescribe antidepressants for various psychiatric and psychological disorders, from OCD and attention deficit hyperactivity disorder to stress and anxiety.
Their primary function is to correct neurotransmitters’ chemical imbalances in the brain responsible for mood and behavior swings.
There are five main types of antidepressants:
- SSRIs (selective serotonin reuptake inhibitors)
- SNRIs (serotonin-noradrenaline reuptake inhibitors)
- NASSAs (noradrenaline and specific serotonergic antidepressants)
- TCAs (tricyclic antidepressants)
- MAOIs (monoamine oxidase inhibitors)
CBD oil drug interactions can reduce t he effectiveness of some antidepressants, like SSRIs (Prozac and Zoloft) and SNRIs (Effexor and Pristiq).
Others like MAOIs (Nardil and Marplan) and TCAs (Amitriptyline and Anafranil) could result in more serious damage. They should not be taken together with CBD. In addition to increasing the sedative effect of cannabidiol, they could also cause hypertension and tachycardia and enhance the side effects of CBD oil .
Buspirone is an anti-anxiety medication, commonly prescribed with antidepressants, used to treat generalized anxiety disorder. This drug also comes with warnings of severe CBD drug interactions .
On a positive note, CBD and antidepressants have many of the same beneficial effects. In fact, CBD oil benefits patients suffering from sleep issues and anxiety. It could one day replace antidepressants altogether as cannabidiol has fewer side effects than these medications.
NSAIDs and CBD Drug Interactions
The use of nonsteroidal anti-inflammatory drugs (NSAIDs) can also be affected by CBD consumption. The liver processes these drugs, so there can be possible drug interactions with CBD hemp oil.
CBD and Diclofenac
We use diclofenac to treat pain and inflammation. Since it reduces the substances in the body that cause inflammation, you can also use it for spondylitis, acute migraines, headaches, and menstrual cramps.
Keep in mind that diclofenac interactions with cannabidiol can lead to liver issues and bleeding complications, especially after frequent use.
CBD and Naproxen
Naproxen is a prescription drug that treats headaches, tendonitis, toothaches, and joint stiffness caused by arthritis and gout.
It is also used as medicine for colds, which calls for caution due to existing weed drug interactions when combining CBD and flu drugs that contain naproxen.
Unlike diclofenac, naproxen is more commonly used to treat chronic conditions as it does not work fast enough for acute pain.
On top of that, CBD and naproxen interactions can result in prolonged effects of the medication. In this case, some of the side effects include nausea, heartburn, and reduced blood pressure.
CBD and Ibuprofen Interaction
Ibuprofen ( Advil ) is one of the most commonly used nonprescription medicines for pain relief. It is an NSAID (non-steroidal anti-inflammatory drug) that reduces inflammation and pain levels in the body.
When it comes to CBD and ibuprofen interaction , things get a little tricky. The kidneys mostly metabolize ibuprofen, so it shouldn’t pose a risk when taken with CBD.
Plus, it is not one of the medications known to have adverse effects when combined with grapefruit, so it’s safe to assume that the same goes for CBD.
Is ibuprofen a blood thinner ? Yes, it may not be as potent as aspirin, but it can still affect blood clotting time, especially if it has been in your system for a while.
Now, you may be thinking: can I take ibuprofen with CBD oil without experiencing any side effects? The answer is “yes,” as long as the doses are right and spaced out correctly, as indicated on the medicine bottle.
In that case, there shouldn’t be any major interactions between CBD and Advil either. Bear in mind, though, that Advil is a medication people usually take more than once a day. So, you might want to avoid possible side effects from the frequent use of ibuprofen and cannabidiol and consult your physician about everything.
Muscle Relaxants and CBD
Muscle relaxants, such as cyclobenzaprine and tizanidine , can also cause CBD oil and drug interactions.
Cyclobenzaprine (Flexeril) is a short-term treatment for muscle spasms, whereas tizanidine (Zanaflex) treats muscle spasms caused by multiple sclerosis or spinal cord injuries. Both block nerve impulses, or pain sensations, sent to the brain.
According to the drug interaction checker , cyclobenzaprine interactions with CBD are classified as moderate. Long story short, Flexeril and weed combo could increase the side effects of the medication, such as dizziness, confusion, and a lack of concentration.
Additionally, older people could undergo impairment in judgment, thinking, and motor coordination. The same is true of cannabidiol and tizanidine interactions.
Sedatives and CBD
Moderate interactions are possible when mixing sedatives and quality CBD oil .
Sedatives include benzodiazepines, such as alprazolam (Xanax), lorazepam (Ativan), diazepam (Valium), morphine , and others, as well as sleep aids like zolpidem (Ambien).
Doctors usually prescribe them for anxiety and sleep disorders.
T HC and CB D also have a sedative effect on the body. The exact relationship between cannabinoids and sedatives, as well as potential CBD and drug interactions , is not known.
However, higher doses of CBD and benzodiazepines could cause an additive effect, i.e., cannabinoids might increase the effects of the sedatives.
Beta Blockers and Calcium Channel Blockers and CBD
Beta-blockers ( Inderal, Sectral) and calcium channel blockers ( Norvasc, Cardizem) treat angina, blood pressure, tachycardia, and migraines.
Interactions between CBD oil and beta and calcium channel blockers could result in lower blood pressure that might cause the user to feel weak, lethargic, and dizzy. In rare cases, drug interactions with cannabis could lead to users fainting or even going into shock.
CBD and Chemotherapy Medication
One of the benefits of cannabidiol is its use in cancer therapy , particularly in combating the side effects of cancer treatment, such as nausea, vomiting, and weight loss.
CBD can prolong the time it takes to process certain chemotherapy drugs, such as etoposide and methotrexate, and cannabis drug interactions could lead to toxic accumulation in the bod y.
Opioids and CBD
Opioids are narcotics used to relieve pain. Some of the most commonly used painkillers include fentanyl , oxycodone , morphine, and codeine .
While it was believed that opioids and CBD increased feelings of drowsiness when combined, new research shows that CBD and opioids use can actually enhance the effects of CBD oil.
Additionally, you could use cannabidiol instead of opioids because it can lower opioids side effects, cravings, and withdrawal severity.
Drugs That Decrease the Benefits of CBD Oil
Although there are little or no drug interactions between CBD oil and antibiotics , rifampin (Rifadin, Rimactane) is known to decrease the effect of CBD on the body.
Carbamazepine (Tegretol), an anticonvulsant, and prednisone , a corticosteroid, have the same effect on cannabidiol.
CBD and Other Herbs and Supplements
When using certain sleep-inducing herbs, like calamus , poppy , sage , or supplements (such as L-tryptophan and melatonin ) with CBD, a person could feel even more sedated or sleepy.
This is not necessarily an adverse effect if you are going for it (there are plenty CBD products for sleep with added melatonin). However, it can impair day-to-day activities and cause discomfort and inconvenience.
How to Minimize CBD Oil and Drug Interactions?
The severity of drug interactions with cannabidiol can vary. First and foremost, it depends on the manner in which you take CBD. It goes without saying that when used orally, CBD is most likely to interact with other medications.
If applied topically, as a CBD cream or body lotion , the chances of interactions are lower.
Secondly, another essential factor is the correct CBD oil dosage . Always use the dosage indicated on the medicine bottle and the recommended amount of CBD to avoid any possible interactions.
And lastly, remember, when in doubt, consult a professional.
Final Words About CBD and Medications
Like everything else in life, you have to take the bad with the good. The same goes for CBD. Although it can be beneficial, it doesn’t come without risks.
The best thing to do is exercise caution and carefully read up on all the CBD drug interactions and possible side effects to avoid any potential complications. And again, always consult with your doctor before mixing your meds with CBD.
Does CBD interact with prescription drugs?
Like all other medications, CBD can also interact with certain drugs. Sadly, there isn’t one rule that fits all cases. In other words, not every drug produces the same effects or reacts the same way when in contact with other medications.
It’s best if you consult your physician before combining these.
What medications does CBD interfere with?
In short, quite a lot. CBD is known to block the work of cytochrome P450, a group of liver enzymes that are responsible for metabolizing nearly 60% of all medications, both prescribed and OTC.
This is particularly true of drugs that have similar health effects as CBD, such as antiepileptic drugs (like Clobazam, Valproate, and Eslicarbazepine), NSAIDs (like Diclofenac and Naproxen), and sedatives (like Xanax, Ativan, and Valium).
What medications should not be taken with CBD?
The most common medications that you should not mix with CBD are:
- Anti-epileptic and anti-seizure drugs
- Blood thinners
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Muscle relaxants
- Sedatives (benzodiazepines)
- Beta and calcium channel blockers
- Chemotherapy medication
These are but a few drugs that interact with cannabidiol. How strong will your body’s reaction be? It depends on how long the drug has been in your system and if you have any pre-existing medical conditions.
What drugs should not be taken with CBD in the UK?
Although they might have different brand names, the active components of e.g. Ibuprofen or Diclofenac, are the same anywhere in the world, and the way CBD interacts with them is identical regardless of the location.
It is best to consult your physician before taking any kind of medication, especially if you are thinking of using several drugs simultaneously. Another good idea is to ensure that you buy your CBD from reputable UK sources that offer certified quality and third-party testing.
Is marijuana a depressant?
Even though it is known to produce similar effects, marijuana is not classified as a depressant. Depressants affect GABA receptors in the brain, while marijuana impacts dopamine levels in the body.
Does CBD Oil interact with antidepressants?
Yes, CBD oil can reduce SSRIs (Prozac and Zoloft) and SNRIs (Effexor and Pristiq) effectiveness, for example. On top of that, it can cause even more severe side effects if you take MAOIs (Nardil and Marplan) and TCAs (Amitriptyline and Anafranil).
Not to mention that mixing CBD oil with antidepressants can cause tachycardia and hypertension.
On the other hand, CBD oil can be used as a replacement for antidepressants when it comes to dealing with anxiety, stress, and insomnia.
Does CBD oil interact with co-codamol?
So far, there haven’t been any indications of interactions between CBD and co-codamol. However, this doesn’t mean that they cannot interact. If you are experiencing any issues, you should consult a medical professional.
What is co-codamol? Co-codamol is a combination of paracetamol and codeine. It is commonly prescribed to relieve pain caused by headaches, muscle aches, migraines, and toothaches.
Codeine, on the other hand, is an opioid, which also might have some minor interactions with cannabidiol.
Can you take CBD oil with high blood pressure medication?
You can since CBD can lower blood pressure. Nevertheless, CBD oil can also reduce the effectiveness of blood pressure medications, just like blood pressure medications can reduce CBD’s effectiveness. It’s best to be cautious and consult with your doctor before thinking of experimenting with drugs and CBD.
Given that CBD has anticoagulant effects, it can thin the blood, which can be dangerous for some people.
Does CBD have any drug interactions with pet medications?
CBD pet products , such as oils and treats, are well-tolerated by pets and are not known to cause any serious issues. However, just like with humans, sometimes cannabidiol can interact with certain medications. Sadly, the research is scarce when discussing CBD oil for dogs drug interactions .
How long does CBD stay in your system?
The period of how long CBD remains in your body varies. Usually, it is two to five days . However, it depends on how you consume it and what kind of CBD oil you are using.
In terms of combining CBD with other drugs, some users recommend a two-hour waiting period as the safest way to avoid adverse reactions. Still, these CBD drug interactions have not been tested or proven yet, and in no way can they be taken as a general rule.
About the Author
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Zanaflex: Uses, Dosage & Side Effects – www.medic8.com
What should I avoid while taking Zanaflex? After making any changes in how you take Zanaflex, contact your doctor if you notice any change in how well the comparable works or if it causes increased side effects. Tell your doctor if you are pregnant or plan to become pregnant. Be careful when going from sitting or lying down position to standing as tizanidine may increase your risk of falls. Follow all directions on your prescription label.
An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it zanaflex.
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Alcohol increases the peak concentration of tizanidine and also the likelihood of side effects. Liver enzymes specifically aminotransferase should be monitored when starting treatment and for at least one month after the maximum dosage is achieved. Notes: In general, seniors or children, people with certain medical conditions such as liver or kidney problems, heart disease, diabetes, seizures or people who take other medications are more at risk of developing a wider range of side effects.
For a complete list of all side effects, click here. Bottom Line Tizanidine is an effective muscle relaxant; however, it causes sedation and has a high risk of liver toxicity, so monitoring of liver enzymes is required.
Tips Capsules may be opened and the contents sprinkled on food. Can be taken with or without food, but should be dosed consistently either with or without food. Take tizanidine exactly as directed. Do not increase the dosage without your doctor’s advice. Tizanidine tablets and capsules are not directly interchangeable; a dosage adjustment may be necessary talk with your doctor.
Be careful when going from sitting or lying down position to standing as tizanidine may increase your risk of falls. Remove any fall hazards such as loose rugs from your home. Seek immediate medical advice if you experience any worrying side effects including hallucinations or allergic-type reactions.
Do not stop taking tizanidine suddenly without your doctor’s advice as high blood pressure and a fast heartbeat may result. Effects are dose-related the bigger the dose, the stronger the effect, but the more noticeable any side effects are.
Do not drink any alcohol while taking tizanidine. Do not take any other medication, including medicines brought over-the-counter, in addition to tizanidine, without first checking with your doctor or pharmacist first to make sure they are compatible. Response and Effectiveness The effects of tizanidine peak within hours and start to wear off within 3 to 6 hours. Because of this short duration of effect, tizanidine may be dosed on an “as needed” basis during times when muscle spasms are at their most severe.
Interactions Medicines that interact with tizanidine may either decrease its effect, affect how long it works for, increase side effects, or have less of an effect when taken with tizanidine. It can increase some of the side effects of tizanidine. Before taking this medicine You should not use Zanaflex if you are allergic to tizanidine, or if: you also take the antidepressant fluvoxamine Luvox ; or you also take the antibiotic ciprofloxacin Cipro.
To make sure Zanaflex is safe for you, tell your doctor if you have: liver disease; low blood pressure; or high blood pressure. It is not known whether Zanaflex will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant. It is not known whether tizanidine passes into breast milk or if it could harm a nursing baby.
Tell your doctor if you are breast-feeding a baby. How should I take Zanaflex? Take Zanaflex exactly as it was prescribed for you. Follow all directions on your prescription label.
Your doctor may occasionally change your dose to make sure you get the best results. Do not use this medicine in larger or smaller amounts or for longer than recommended. In most cases you may take Zanaflex up to 3 times in one day if needed.
Allow 6 to 8 hours to pass between doses. You may take Zanaflex with or without food, but take it the same way each time.
Switching between taking tizanidine with food and taking it without food can make the medicine less effective or cause increased side effects. Switching between Zanaflex tablets and capsules can also cause changes in side effects or how well the medicine works. After making any changes in how you take Zanaflex, contact your doctor if you notice any change in side effects or in how well the medicine works.
Zanaflex is a short-acting medication, and its effects will be most noticeable between 1 and 3 hours after you take it. You should take this medicine only for daily activities that require relief from muscle spasms.
Do not take more than three doses 36 mg in a hour period. Too much of this medicine can damage your liver. You will need frequent blood tests to check your liver function. If you stop using Zanaflex suddenly after long-term use, you may have withdrawal symptoms such as dizziness, fast heartbeats, tremors, and anxiety. Ask your doctor how to safely stop using this medicine. Store at room temperature away from moisture and heat.
See also: Zanaflex dosage information in more detail What happens if I miss a dose? Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.
Iodine is not available outside of the United States
Not every drug produces https://www.medic8.com/nutrition/heart-health/health/page78.html same effects or reacts the same way when in contact with other drugs.
You might want to avoid possible side effects from frequent use comparable ibuprofen and cannabidiol. Eslicarbazepine zanaflex lead to moderate drug interactions with CBD. Some of the used commonly used pain-killers include fentanyl, oxycodone, morphine, and codeine. The exact relationship between cannabinoids and sedatives, as well as potential CBD drug interactions are not known, however, higher doses of CBD and benzodiazepines could cause an additive effect, i.
Hope Without Commitment Find the best treatment options. These drugs are zanaflex by the liver, so there are possible drug interactions with CBD hemp oil.
First for foremost, it depends on the manner in which CBD is taken. Buspirone is an anti-anxiety medication, commonly prescribed with antidepressants, used to treat generalized anxiety disorder.
Statins are known to interact with CBD.
Another important factor is the for CBD oil dosage. The most common alternatives for muscle relaxant effects would be tizanidine and baclofen. Nor does it mean that a combination of used of these types of medication will cause zanaflex when taken with CBD.
Tizanidine CNS depressants such as benzodiazepines, opioids, and tricyclic antidepressants CNS depressants such as benzodiazepines, opioids, and tricyclic zanaflex high blood pressure drugs such as clonidine, guanfacine, and methyldopa high blood pressure drugs such as clonidine, guanfacine, and check this out heart rhythm drugs such as comparable, mexiletine, propafenone, and verapamil monoamine oxidase inhibitors MAOIs such as phenelzine, tranylcypromine, and isocarboxazid antibiotics such as levofloxacin, moxifloxacin, and zanaflex certain antidepressant and antianxiety medications oral contraceptives birth control pills pain drugs such as tramadol or meperidine ciprofloxacin.
Another option would be used reduce for sertraline. However, it can impair day-to-day activities and cause discomfort and inconvenience.
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Depending on the reason for choosing a different option, any of the choices can be a good alternative. It is always important to seek professional advice when getting treatment.
For example when looking at Zanaflex vs. Flexeril for fibromyalgia, a medical professional will discuss all the side effects, costs, and effectiveness so that a patient can choose the best alternative. When it comes to CBD and ibuprofen interaction, things get a little tricky. Is ibuprofen a blood thinner? Yes, it may not be as potent as aspirin, but it can still affect blood clotting time, especially if it has been in your system for a while. Now, you may be thinking: can I take ibuprofen with CBD oil without experiencing any side effects?
Bear in mind, though, that Advil is a medication people usually take more than once a day. You might want to avoid possible side effects from frequent use of ibuprofen and cannabidiol. Muscle Relaxants and CBD Muscle relaxants, such as cyclobenzaprine and tizanidine, can also cause medical marijuana drug interactions. Cyclobenzaprine Flexeril is used as a short-term treatment for muscle spasms, whereas tizanidine Zanaflex is used to treat muscle spasms caused by multiple sclerosis or spinal cord injuries.
Both block nerve impulses, or pain sensations, sent to the brain. According to the drug interaction checker, cyclobenzaprine interactions with CBD are classified as moderate. A Flexeril-CBD oil combo could increase the side effects of the medication, such as dizziness, confusion, and a lack of concentration.
The same is true of cannabidiol and tizanidine interactions. Sedatives can include benzodiazepines, such as alprazolam Xanax , lorazepam Ativan , diazepam Valium , morphine, and others, as well as sleep aids like zolpidem Ambien. Sedatives are drugs that slow down brain activity and help a person relax. They are usually prescribed for anxiety and sleep disorders. The exact relationship between cannabinoids and sedatives, as well as potential CBD drug interactions are not known, however, higher doses of CBD and benzodiazepines could cause an additive effect, i.
Interactions between CBD oil and beta and calcium channel blockers could result in lower blood pressure that might cause the user to feel weak, lethargic, and dizzy. In rare cases, marijuana and drug interactions could lead to users fainting or even going into shock. CBD and Chemotherapy Medication One of the benefits of cannabidiol is the use of CBD oil for cancer, particularly in combating the side effects of cancer treatment, such as nausea, vomiting, and weight loss.
CBD can prolong the time it takes to process certain chemotherapy drugs, such as etoposide and methotrexate and could lead to toxic accumulation in the body as a result of cannabis drug interactions. Opioids and CBD Opioids are narcotics used to relieve pain. Some of the most commonly used pain-killers include fentanyl, oxycodone, morphine, and codeine.
While it was believed that opioids and CBD increased feelings of drowsiness when combined, new research shows that CBD and opioids use can actually enhance the effects of CBD oil. Also, cannabidiol could be used instead of opioids because of lower-risk CBD oil side effects.
Carbamazepine Tegretol , an anticonvulsant, and prednisone, a corticosteroid, have the same effect on cannabidiol. This is not necessarily an adverse effect if you are going for it. However, it can impair day-to-day activities and cause discomfort and inconvenience. The severity of drug interactions with cannabidiol can vary. First and foremost, it depends on the manner in which CBD is taken. It goes without saying that when used orally, CBD is most likely to interact with other medications.
If it is applied topically, for instance, a CBD cream or body lotion, chances of interactions are lower. Another important factor is the right CBD oil dosage. And remember, when in doubt, consult a professional. Bottom Line Like everything else in life, you have to take the bad with the good. The same goes for CBD. Depending upon how beneficial the sertraline has been, this is an idea to think about.
Use cyclobenzaprine as needed for as short a duration as possible. When we feel we need to use medications that may be slightly riskier than other options, we need to alert our patients as to what to look for.
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Zanaflex Alternatives: Tizanidine Vs Flexeril, And Baclofen
Though for drugs were capable of causing all of these symptoms, baclofen may also last longer in your used. Muscle spasticity refers to muscle twitches, spasms, and tightening that can be uncomfortable or painful. Tizanidine was found to cause drowsiness and dry mouth. Hope Without Commitment Find the best treatment options. Learn more about zanaflex and baclofen and how they compare.
Here example when looking at Zanaflex vs. Tizanidine and baclofen have similar strengths, but zanaflex is slightly stronger. Call Now What Is Baclofen? How Strong Are They? One found that baclofen was more comparable to cause muscle weakness. No medication meets all the requirements that a patient needs even if it is a medication that belongs to the same tizanidine drug class.
Here are examples of other drugs that may interact with tizanidine and cyclobenzaprine. Tizanidine and baclofen are similar in many respects.
Call our free and confidential helpline Most private insurances accepted. Studies have looked at zanaflex side effects profiles. Tizanidine versus baclofen in the treatment of spasticity in patients with multiple sclerosis. It has been sold under the comparable name Lioresal since it was approved in
Dec 28, · It works by blocking nerve impulses (pain sensations) that are sent to your brain. Tizanidine is used to treat spasticity by temporarily relaxing muscle tone. Tizanidine may also be used for purposes not listed in this medication guide.
Call Now What Is Baclofen? It has been sold under the brand name Lioresal since it was approved in How Strong Are They? Tizanidine and baclofen have similar strengths, but tizanidine is slightly stronger. Considering the doses in which they are commonly taken, baclofen is slightly weaker and requires a few more milligrams in an appropriate dose.
Both medications involve treatment that starts with a smaller dose that increases throughout treatment. How Are They Different? Tizanidine and baclofen are similar in many respects. Studies have looked at their side effects profiles. One found that baclofen was more likely to cause muscle weakness. Tizanidine was found to cause drowsiness and dry mouth.
Though both drugs were capable of causing all of these symptoms, baclofen may also last longer in your system. It has a half-life of 6. Sources Bass, B. Hallucinations Problems with motor coordination As an alternative, valium is more expensive. The lower potential of dependency makes the tizanidine street value low. Valium is an effective alternative because it kicks in faster and lasts longer in the body, exerting its relaxant effect.
No medication meets all the requirements that a patient needs even if it is a medication that belongs to the same tizanidine drug class. Therefore, medical personnel can provide an alternative to tizanidine other drugs in the same class due to various reasons.
Depending on the reason for choosing a different option, any of the choices can be a good alternative.
Accurate Education: Cannabidiol (CBD) – Side Effects and Drug Interactions
Cannabidiol (CBD) has promise for many medical applications although they are not yet well defined nor are the mechanisms by which it works well understood. When taking CBD one must be aware of potential side effects and drug interactions CBD may have with other medications.
Links to other Pertinent Educational Pages:
- CBD – Introduction
- CBD – Clinical Use Overview
- CBD – Dosing, Products and Formulations
- CBD – Treatment of Addiction
- CBD- Treatment of Anxiety
- CBD – Treatment of Dental Disease
- CBD – Synergy between CBD and PEA
- CBD – Side Effects and Drug Interactions
- CBD – Mechanisms of Action
The medical information on this site is provided as a resource for information only, and is not to be used or relied upon for any diagnostic or treatment purposes and is not intended to create any patient-physician relationship. Readers are advised to seek professional guidance regarding the diagnosis and treatment of their medical concerns.
Key to Links:
- Grey text – handout
- Red text – another page on this website
- Blue text – Journal publication
- CBD: Side Effects
- CBD: Safety
- CBD: Drug Interactions
- CBD: Metabolism of CBD
- CBD: Resources and References
CBD: Side Effects
CBD has been determined to be safe, with no fatal overdoses on record. It is generally well tolerated with minimal or mild side effects only. CBD does not affect motor function or memory and does not appear to have the potential for physical dependence (e.g. withdrawal and tolerance), nor is it associated with abuse or addiction.
The side effects of CBD are mild and include:
- Low blood pressure
- Dry mouth
CBD offers great therapeutic potential but remains poorly studied. Human CBD short-term studies illustrate low toxicity and only mild adverse effects. However, it is unknown what side effects may be caused by prolonged use. It is important to note that there are few to no long term studies on CBD administration in healthy people even though short term trials show CBD to be safe and well tolerated. Studies also do not assess prolonged use in chronically ill people who often take medications continuously for many years. Even animal studies only evaluate chronic CBD treatment for up to several months, which may mimic prolonged use in people, but differences cannot be excluded.
There is no evidence for CBD to have abuse or dependence potential, and there is no evidence of public health related problems associated with the use of pure CBD.
CBD: Drug Interactions
Cannabinoids and Opioids
There appears to be a synergistic analgesic (pain-relieving) benefit when cannabinoids are added to opioid treatment for pain in which there is a greater-than-additive benefical effect with the addition of cannabinoids. Studies indicate a trend towards reduced use of opioids when patients taking opioids add cannabinoids to their regimen. It is not uncommon for patients started on cannabinoids to be able to taper down or off opioids.
Interestingly, animal studies suggest that cannabinoids may reduce the development of tolerance to the analgesic benefits of opioids, resulting in less need for opioid dose escalation.
There is no enhancement of cardiorespiratory suppression from opioids with the addition of cannabinoids due to the very low density of cannabinoid (CB) receptors in brainstem cardiorespiratory centers. There does not appear to be any significant interactions with opioids regarding a cannabinoid effect on the metabolism of most opioids.
However, there is research showing that CBD may inhibit CYP2D6, one of the liver enzymes responsible for metabolizing tramadol and codeine. Because the analgesic benefits from tramadol and codeine come from their active metabolites resulting from CYP2D6 metabolism, these two opioids may be less effective if taken with CBD.
P-glycoprotein (P-gp) Transporters
Another way in which medications may interact with one another is through their effect on drug transport systems, especially the P-glycoprotein (P-gp) system. The P-gp transporters transport medications and metabolites out of the central nervous system and brain through the blood-brain barrier into the blood. The activity of P-gp transporters can significantly impact the effect of drugs such as morphine, oxycodone and methadone on the brain by reducing their levels in the brain. Early findings indicate that CBD significantly inhibits P-gp-mediated drug transport, suggesting CBD could potentially increase brain levels of morphine and other opioids that are P-gp substrates thus enhancing their impact. CBD may also influence the absorption and disposition of other coadministered compounds that are P-gp substrates.
UDP-glucuronosyltransferase (UGT) family of enzymes
The UDP-glucuronosyltransferase (UGT) family of enzymes found in the liver and kidneys play an important role in the metabolism of medications. These enzymes attach glucoronide to medications to facilitate their elimination. The interaction between UGTs and cannabinoids have not yet been thoroughly examined but a recent 2021 study evaluated the potential of Δ9-THC, CBD, and cannabinol (CBN), and their major metabolites, to inhibit the activity of UGT enzymes.
The highest inhibition was seen by CBD against the glucuronidation activity of UGTs 1A9, 2B4, 1A6, and 2B7 but strong inhibition of UGT1A9 and UGT2B7 was also found with THC and CBN. Regarding the metabolites of these cannabinoids, there was weak or no inhibition was found.
This inhibition of UGT activity by CBD, THC and CBN may play an important role in drug-drug interactions. Major cannabinoids found in the plasma of cannabis users inhibit several UDP-glucuronosyltransferase (UGT) enzymes, including UGT1A6, UGT1A9, UGT2B4, and UGT2B7. This study identified the potential of cannabinoids to inhibit all the major kidney UGTs as well as the two most abundant UGTs present in liver. This study suggests that as all three major kidney UGTs are inhibited by cannabinoids, greater drug- drug interaction effects might be observed from co-use of cannabinods and therapeutics that are cleared renally.
Smoking – Tobacco and Marijuana
Smoking marijuana and tobacco both induce CYP1A2 through activation of the aromatic hydrocarbon receptors, and this effect between the two products is additive. Of note: this effect is based on the smoke associated with the smoking of marijuana or tobacco, not the drugs in the smoke. As a result of this CYP1A2 enzyme being induced, in other words more CYP1A2 enzyme is manufactured, medications that are metabolized by CYP1A2 will be broken down faster, blood levels will be decreased and the therapeutic effects of the drug will be reduced. CYP1A2 is the enzyme responsible for metabolizing such drugs as caffeine, tizanidine (Zanaflex), duloxetine (Cymbalta), methadone, olanzapine (Zyprexa) and melatonin.
When one suddenly stops smoking either tobacco, marijuana or both, the induction effect is quickly reversed and the levels of CYP 1A2 enzyme rapidly return to previous levels (downregulation) over a few days. When this occurs in an individual chronically taking one of the medications metabolized by CYP 1A2, the blood levels of this medication may quickly rise leading to the potential for increased side effects and toxicity from the medication.
This is especially significant in medications that have a narrow therapeutic index such as tizanidine (Zanaflex), in which even small increases in blood levels may be associated with increased side effects. It is therefore important to reduce doses of these medications in the first few days after suddenly stopping smoking either tobacco, marijuana or both to avoid possible toxicity from the medication. Due to body size and gender-related variables, this reduction is especially warranted in small females.
While the CYP 1A2 enzyme is not a major enzyme in the metabolism of methadone, it has been reported that methadone levels can dangerously increase with smoking cessation. As a rule of thumb, it has been recommended that a stepwise daily methadone dose reduction of approximately 10% be engaged until the fourth day after smoking cessation.
Alcohol and Benzodiazepines
The combination of cannabinoids with alcohol and benzodiazepines may increase sedation and cognitive impairment.
NSAIDS (Non-Steroid Anti-inflammatory Drugs)
It has been reported that NSAIDs such as ibuprofen and naproxen, particularly indomethacin, can partially antagonize the effects of THC, although the mechanism responsible is not fully understood.
Anticholinergic drugs (tricyclic antidepressants (TCAs) and some muscle relaxers)
Medications with anticholinergic activity such as amitriptyline (Elavil) and doxepin, and muscle relaxers such as cyclobenzaprine (Flexeril) may increase the psychoactive side effccts of cannabinoids.
CBD and Piperine
Blood levels and duration of action of CBD may be increased if CBD is accompanied by ingestion of piperine, an alkaloid found in black pepper (Piper nigrum) . Piperine has been found to reduce metabolic breakdown of CBD in the intestines and the liver. Furthermore, piperine may suppress the elimination of CBD (and THC) from the brain by inhibiting the P-gp transporter mechanism involved, leading to prolonged effects of CBD and THC.
Metabolism of CBD
The way in which many drug interactions occur is through their impact on how a drug is metabolized. Understanding how CBD is metabolized provides insight as to how other drugs may interact with CBD.
CBD is extensively metabolised in the liver, primarily to 7-OH-CBD which is then metabolised further into as many as 100 metabolites that are excreted in feces and urine. Seven CYP enzymes have been identified as metabolising CBD: CYP1A1, CYP1A2, CYP2C9, CYP2C19, CYP2D6, CYP3A4, and CYP3A5, but the two main ones are CYP3A4 and CYP2C19.
Although research is lacking, the metabolites formed from CBD are believed to be present in the body at pharmacologically significant concentrations. Pharmacological studies of CBD metabolites are scarce but suggest biological activities not directly related to CB receptors. The pharmacological effects observed with CBD may be attributed at least in part to its metabolites.
CBD: Drug-Metabolic Interactions
The major cannabanoids, THC and CBD are both metabolized in the liver by the CYP450 enzymes 2C9, 2C19 and 3A4. Drugs that inhibit these enzymes may enhance or prolong the effects of THC and CBD. Whether people with genetic variants of these enzymes may experience altered effects from cannabinoids is not known. In one study, potential drug–drug interactions of THC/CBD oro-mucosal spray (Sativex, nabiximols) in combination with CYP450 inducers and inhibitors were assessed using various dose regimens. The antibiotic rifampicin, an inducer of CYP3A4, significantly reduced the peak plasma concentration of CBD, while the antifungal ketoconazole, a CYP3A4 inhibitor, nearly doubled the peak plasma concentration of CBD. However, the moderate CYP2C19 inhibitor omeprazole (Prilosec), a proton-pump inhibitor used to treat gastroesophageal reflux disease (GERD), did not significantly alter the pharmacokinetics of CBD.
CBD has been identified as a potent inhibitor of CYP2D6 which may have significant impact on the metabolism of medications that are broken down by CYP2D6, including hydrocodone (Norco, Vicodin, Zohydro, Hysingla). As such, use of CBD especially at high doses with tramadol, codeine or hydrocodone may significantly reduce the analgesic effectiveness of these opioids.
Limited evidence also suggests that CBD may significantly inhibit CYP2C19, the enzyme responsible for metabolizing many medications including:
- Anticoagulants such as clopidogrel (Plavix),
- Tricyclic antidepressants such as amitriptyline (Elavil)
- SSRI antidepressants including citalopram Celexa) and e scitalopram (Lexapro)
- Proton pump inhibitors such as omeprazole (Prilosec) and pantoprazole (Protonix)
- Other drugs including indomethacin (Indocin), diazepam (Valium) and propranolol (Inderal).
As a result this may lead to elevated blood levels of these medications and their associated side effects.