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does cbd oil interact with prednisone

CBD Oil and Prednisone – April 2021

Does CBD interact with prednisone, and if so, are there risks that should cause concern?

Prednisone is a prescription drug used to provide relief for inflamed areas of the body. It is also indicated to treat conditions, such as inflammation (swelling), severe allergies, arthritis , asthma, eye or vision problems, blood or bone marrow problems, and stomach or bowel problems (1 ) .

Moreover, doctors prescribe prednisone to help patients with lupus, skin conditions, endocrine problems, kidney problems, ulcerative colitis, adrenal problems, and flare-ups of multiple sclerosis.

Prednisone is a corticosteroid, or a cortisone-like medicine or steroid. This drug works on the immune system to help relieve swelling, redness, itching, and allergic reactions.

However, this medicine may cause changes in mood or behavior for some patients. Symptoms to watch for include depression, trouble with sleeping , a false or unusual sense of well-being, mood swings, and personality changes while taking this medicine (2 ) .

Can CBD Be Taken With Prednisone?

Taking CBD along with prednisone could either decrease the effects of cannabidiol or increase the amount of prednisone entering the bloodstream.

Whenever one takes CBD or any medicine, it passes through the digestive system to the liver, where an enzymatic pathway, called the cytochrome P450 (CYP450) family of enzymes, metabolizes or breaks down the substance ingested.

Liver enzymes CYP450 process about 60% of all medications. One of these, CYP3A4, metabolizes prednisone to make it available to the body (3 ) .

Studies have demonstrated that CBD strongly inhibits the activity of CYP3A4 liver enzymes (4 ) .

Meanwhile, prednisone is a weak inducer of CYP3A4 (5 ) . Still, prednisone may increase how quickly the liver breaks down CBD when they are taken in combination.

In particular, the effects of taking CBD along with prednisone could either decrease the effects of cannabidiol or increase the amount of prednisone entering the bloodstream.

The increased prednisone concentration can amplify the drug’s many side effects and raise the risk of severe symptoms, such as dizziness or fainting, blurred vision, irregular or pounding heartbeat, increased thirst or urination, irritability, and unusual tiredness or weakness (6 ) .

Thus, medical experts advise those taking CBD and prednisone to be cautious with this combination (7 ) .

Can CBD Replace Prednisone?

N o study explicitly says CBD can be used in place of prednisone. However, studies have shown that CBD possesses many potential therapeutic benefits that may help with some symptoms or conditions for which prednisone is indicated.

Prednisone is sometimes prescribed for bone marrow problems , which is important for the health of blood cells . Meanwhile, studies have shown that CBD promotes the structural health of bones .

The effect of CBD on bones was also demonstrated by a 2015 study that investigated the properties of cannabidiol concerning bone-related conditions. Data showed that CBD led to an improvement in fracture healing (8 ) .

Like prednisone, CBD can help with skin conditions. A study published in the journal Trends in Pharmacological Sciences has suggested the existence of a functiona l endocannabinoid system (ECS) in the skin and implicated it in various biological processes (9 ) .

CBD impacts the TRPV-1 and GPR55 receptors (10 ) . Both receptors are found in the skin and play a role in pain signaling and inflammation.

CBD has also been shown to help with mood swings, depression, dizziness, and sleeping difficulty, which may be the side effects from taking prednisone.

A study published in the Journal of Psychopharmacology found that CBD may decrease anxiety levels in individuals with a social anxiety disorder (SAD).

Results indicated that, relative to placebo, CBD was associated with significantly decreased subjective anxiety (11 ) .

In another study, results showed that CBD could theoretically induce rapid-acting antidepressant-like effects and enhance neurotransmission (12 ) . Neurotransmission is the process of communication between nerve cells.

In a 2019 study published in The Permanente Journal , sleep and anxiety scores were measured in human subjects, and the findings showed that CBD could hold benefits for anxiety-related disorders (13 ) .

Meanwhile, CBD’s antiemetic properties, which prevent nausea and vomiting, are incredibly helpful.

A 2014 review from the European Journal of Pharmacology established the potential of cannabis to limit or prevent nausea and vomiting from a wide range of causes (14 ) .

More importantly, the powerful anti-inflammatory properties of CBD could help with some of the same disorders that prednisone treats.

CBD’s anti-inflammatory characteristics have been shown in several human and animal studies, like that of a 2014 study published in the Journal of Clinical Investigation and a 2012 research conducted by authors from the Department of Pathology, School of Veterinary Medicine in the University of São Paulo, Brazil (15 ) .

Other studies have demonstrated that the anti-inflammatory and immunosuppressive actions of CBD may be of use in treating rheumatoid arthritis and the associated pain (16 ) .

Meanwhile, research published in the Free Radical Biology & Medicine Journal by George Booz of the University of Mississippi Medical Center showed that CBD, which may interact with the endocannabinoid system, is a promising prototype for anti-inflammatory drug development (17 ) .

Conclusion

CBD “is generally well tolerated with a good safety profile,” the World Health Organization (WHO) states in a critical review (18 ) .

Still, it is not clear how much to take or how often a person should use it for any particular problem.

High doses of CBD may also interact with other medications, such as blood thinners, antidepressants, and immune suppressors (19 ) .

Thus, individuals should be cautious when supplementing their existing medications with CBD.

Do not take other pharmaceuticals unless they have been discussed with a medical professional.

More importantly, before using CBD as a remedy for specific symptoms or conditions, consult with a doctor experienced in cannabis use for advice.

Medically reviewed DR. WIEGMANN on 06-22-2020

Does CBD interact with prednisone, and if so, are there risks that should cause concern? Prednisone is a prescription drug used to provide relief for inflamed areas of the body. It is also indicated to treat conditions, such as inflammation (swelling), severe allergies, arthritis, asthma, eye or vision problems, blood or bone marrow problems, and stomach or bowel problems.

Does CBD Interact or Interfere with Medication? What Arthritis Patients Must Know Now

If you use CBD products, you need to understand how they could interact with the other medications you take.

CBD Drug Interactions

CBD (cannabidiol) is seemingly everywhere, with oils, tinctures, pills, chocolates, gummy bears, and creams available all over the internet, at national drugstore chains, and perhaps at your local farmer’s market — even if you don’t live in a state where medical or recreational marijuana is legal.

CBD, a type of chemical known as a cannabinoid, is a mainingredient in hemp, one type of cannabis plant. Marijuana, another type of cannabis plant, also has some CBD but an abundance of THC (tetrahydrocannabinol), an intoxicating cannabinoid known for making users feel “stoned” or “high.” While CBD won’t get you high, it interacts with cannabinoid receptors in your body and may have effects that are sought by people with arthritis, such as pain relief, reduced inflammation, and improvements in sleep and anxiety.

According to CreakyJoints research presented at the 2019 Annual European Congress of Rheumatology meeting earlier this year, 52 percent of respondents reported having tried CBD for a medical reason. Of those who did, 93 percent said it helped. More than half said they wanted more information on CBD from their doctor, but 58 percent of those who told their doctors about their CBD use did not get the information on safety, effectiveness, and dosing they were looking for.

One common concern among people with chronic illness who use CBD is whether CBD can interfere with prescription drugs you may take for arthritis or other conditions.

We put commonly asked questions to Nina M. Bemben, PharmD, BCPS, a specialist in drug interactions who is trying to educate other pharmacists about possible drug-drug interactions with CBD, as well as Rachna Patel, DO, a physician who does consultations about medical marijuana and CBD and sells her own line of CBD products.

What kind of drug interactions can happen with CBD?

A huge number of medications, including CBD, are broken down by the same large family of liver enzymes, called CYP450.

CBD inhibits some enzymes in this family. This makes them break down certain drugs more slowly, which could potentially increase side effects unless your doctor adjusts the dose. On the other hand, CBD induces other enzymes in this family, which speeds the breakdown of certain drugs so they may potentially be less effective unless the dose is increased.

As examples, you may experience increased side effects if CBD is used along with these drugs:

  • Antidepressants (such as fluoxetine, or Prozac)
  • Medications that can cause drowsiness (antipsychotics, benzodiazepines)
  • Macrolide antibiotics (erythromycin, clarithromycin)
  • Heart medications (some calcium channel blockers)

“There is still a lot of uncertainty about how CBD interacts with drug-metabolizing enzymes in the body. We know that there are some drug-metabolizing enzymes that are affected by CBD, some that are not, and many others where we just don’t have any information yet,” says Dr. Bemben.

What do we know for sure about CBD’s interactions with other drugs?

The most direct information comes from studies on the only FDA-approved CBD product, Epidiolex, which is used to treat rare forms of epilepsy. Epidiolex has been found to increase blood levels of the blood thinner warfarin about 30 percent, which raises the risk of bleeding. It also interacts with other medications used for epilepsy.

“The manufacturer of Epidiolex was asked by the FDA to conduct more drug-drug interaction studies, so we will learn more about CBD’s interactions with other drugs in the future,” says Dr. Bemben.

Can CBD interact with medications I take specifically for arthritis?

“Based on what we know now about the way CBD is metabolized, I would not expect significant drug-drug interactions with drugs commonly used in arthritis treatment, such as methotrexate, and most nonsteroidal anti-inflammatory drugs (NSAIDs). I would advise caution on one NSAID, diclofenac, because there isn’t information on how CBD affects — if at all — the enzyme that metabolizes it,” says Dr. Bemben.

Rheumatologists are always on the alert for liver problems that may result from arthritis medications, and that includes CBD as well as NSAIDs and methotrexate.

Are older people more at risk of CBD drug interactions?

Yes, for several reasons. “As we age, our livers and kidneys may be slower to eliminate drugs from the body. In addition, older patients and those with chronic health problems are more likely to be using multiple medications, so the risk for drug interactions increases,” says Dr. Bemben.

Dr. Patel worries in particular about any side effects or interactions that result in dizziness and may increase the risk of falls in the elderly. For example, using the antidepressant fluoxetine together with cannabis products can increase dizziness and drowsiness.

Are there some people who should stay away from CBD?

Hold off if you have known liver damage, says Dr. Patel. In a study done on mice published earlier this year, the dose of CBD used to protect against seizures was found to induce liver damage. According to other animal research, CBD may increase levels of liver enzymes, raising concerns about liver toxicity in patients taking methotrexate.

“We use other therapies that cause liver injury, like nonsteroidal anti-inflammatories (NSAIDs). If liver enzymes go up in someone on methotrexate, we would generally hold the drug other than methotrexate [for example, CBD or an NSAID] to see if the enzyme levels normalize,” says Michael Weinblatt, MD, professor of medicine at Harvard Medical School in Boston.

People who take Epidiolex for epilepsy are more likely to develop abnormal liver enzymes, as well as sleepiness and other symptoms, if they are also using valproic acid to control seizures.

“This is important for people with arthritis to know because valproic acid is sometimes used for pain that isn’t controlled by other medications,” says Dr. Patel.

If I stick with a CBD cream, does that reduce the risk of drug interactions?

Probably, since little if any of a topical product is likely to be absorbed into your system. “Unfortunately, we just don’t have good information about how much of a topical CBD product gets absorbed. This can be influenced by the inactive ingredients in the product, where on the body it’s applied, and whether you apply a bandage over the area after applying it,” says Dr. Bemben.

While topical CBD products may not be absorbed deeply enough to raise concerns about drug interactions, that also means they may not be as effective for arthritis pain. “If you just have one joint hurting and it’s close to the surface, using a topical would be appropriate. It’s not as likely to help a hip or other deep joint,” says Dr. Patel.

Which health professionals need to know I’m trying CBD?

Tell your rheumatologist and anyone else who prescribes medication for you. If you need surgery, an anesthesiologist may choose a different dose or type of anesthesia if you’re using CBD.

“If you fill all of your medications at the same pharmacy, your pharmacist will be able to assess for drug interactions for all of them, regardless of who prescribed them. You should still let the pharmacist know about over-the-counter medications, herbs, and supplements — including CBD — that you don’t get through the pharmacy. It is important to bring the CBD product to your doctor and pharmacist so they can check the amount of CBD and other ingredients it contains,” says Dr. Bemben.

“While patients may be wary of stigma surrounding CBD products, I believe most health care providers understand this is a growing area and one strategy patients are trying in hopes of getting relief,” she says.

Is there an online source I can use to figure out which of my medications might interact with CBD?

Online databases are available to help health professionals evaluate potential drug-drug interactions, at a price. “Freely available resources tend to be less reliable, and this highlights the importance of discussing all your medications, including CBD, with your doctor and pharmacist,” says Dr. Bemben.

One source available to patients is drugs.com, where you can plug in either cannabidiol (which will give you the FDA-approved oral product Epidiolex) or cannabis (which will give you both THC and CBD) and check for possible interactions with other medications you take.

Has anyone had a life-threatening drug interaction with CBD?

“There haven’t been reports of serious drug-drug interactions with over-the-counter CBD products. However, these products are relatively new and it typically takes time for reports to be published. We have very little information about over-the-counter CBD products and how they may interact with other drugs,” says Dr. Bemben.

Learn more about CBD interactions with drugs and how to stay safe when you use CBD for pain or other symptoms.