CBD Oil And Ativan

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In our latest question and answer, the pharmacist discusses whether or not CBD oil interacts with oxycodone or Atifan (lorazepam). When you take CBD alongside certain medications, it can trigger negative drug interactions. Here we explain what drugs shouldn’t be taken with CBD — and when to consult your doctor if you’re not sure about the potential interactions. Cannabidiol (CBD), a cannabinoid, can interact with the anxiolytic and sedative benzodiazepine lorazepam (Ativan) and aggravate its effects.

Does CBD Oil Interact With Oxycodone Or Ativan?

CBD (cannabidiol) is becoming one of the most popular over the counter supplements. As such, we have been receiving many questions regarding potential drug interactions. In our following question and answer, the pharmacist discusses whether or not CBD oil interacts with oxycodone or Ativan (lorazepam).

Brad asked

I started recently taking CW HEMP OIL 28mg per dose. I take 5mg/325mg oxycodone twice a day and lorazepam 0.5 mg for anxiety if needed. Are any of these interactions with the CBD Oil?

Answer

Cannabidiol, also known as CBD, is one of the major constituents of the cannabis plant. Depending on the cannabis species and chemovar (i.e. chemical variation), CBD can make up nearly 40% of the active constituents in extracts.

What Is CBD?

CBD, unlike THC, is considered to be non-euphoric and therapeutically beneficial for the treatment of pain, inflammation anxiety etc.

The mechanism of action of CBD is complex, but is thought to bind to receptors that can cause desensitization of pain and can inhibit the inactivation of the endogenous cannabinoids (naturally occurring the the body) such as anandamide, and therefore increase its concentration.

CBD Drug Interactions

Most of what we know in regard to drug interactions come from clinical trials of commercially available prescription products that contain CBD or synthetic versions of it. One such drug is Sativex. The trials for these drugs don’t list any specific drugs that may interact but do mention how cannabinoids, such as CBD, can affect metabolizing enzymes.

Both THC and CBD have been shown in studies to metabolized by the cytochrome P450 system of metabolizing enzymes and could potentially inhibit them. In fact, studies have shown CBD inhibition of the following metabolizing enzymes:

If any of these metabolizing enzymes are inhibited, drugs that are substrates for them may potentially have their concentrations increased (due to a decrease in metabolism).

CBD Interactions With Oxycodone And Ativan

CBD With Oxycodone

Oxycodone is known to be metabolized by a variety of enzymes, including:

There is therefore a risk of increased oxycodone concentrations in the body when taken with CBD, due to inhibition of metabolism. This could potentially increase sedation with the drug and as well as increase the risk of respiratory depression. However, this risk appears to be low.

Most studies which show that CBD can affect metabolizing enzymes use extremely large doses, much more than most individuals would be taking. One such study used over 250mg CBD per dose! Most individuals would be using closer to 3 to 30 mg per dose and lower doses aren’t associated with significant metabolizing enzyme inhibition.

CBD With Ativan

Ativan (lorazepam) is not thought to be metabolized by any CYP enzymes, but is instead metabolized by liver glucuronidation. Therefore, there doesn’t appear to be any potential interactions between Ativan and CBD. However, as CBD can cause mild sedation, caution is advised when combining with other sedating drugs, such as Ativan.

Conclusion

There is a theoretical interaction between CBD and oxycodone, where oxycodone concentrations could be increased, but the risk appears to be low and has never been documented. Nevertheless, you should be sure to speak with your doctor before adding CBD to your medication list if you take oxycodone.

CBD is not thought to interact with Ativan as Ativan is not metabolized by CYP enzymes. It is a sedating drug however and use with CBD might lead to additive sedation.

CBD Drug Interactions – Mixing Cannabidiol and Medications

Are you worried about potential CBD-drug interactions? In this article, we explain the mechanism behind drug metabolism and how CBD may interfere with it.

The range of therapeutic properties offered by CBD (cannabidiol) has spurred its popularity in recent years. This natural compound is known to relieve a host of symptoms, allowing for safer and more effective management of different health conditions.

And unlike THC (tetrahydrocannabinol), CBD is non-intoxicating, so it won’t get you high.

CBD can assist in the treatment of anxiety disorders and depression, inflammation and pain, neurodegeneration, seizure disorders, sleep deprivation, metabolic conditions, neuropathy, migraines, inflammatory bowel disease, and more.

Considering CBD has so many potential health benefits, you may start wondering if it can interact with certain medications used to address the same symptoms — and whether you should or shouldn’t take these drugs with CBD.

Below you’ll find the dos and don’ts of using CBD along with medications.

Let’s start with the don’ts.

What Drugs Should Not Be Taken with CBD

Studies from the Indiana University Department of Medicine have provided a list of pharmaceutical drugs and medications which shouldn’t be taken with CBD.

The list below covers all groups of drugs that can negatively interact with CBD oil.

  • Angiotension II Blockers
  • Antiarrhythmics
  • Antibiotics
  • Antidepressants
  • Anticonvulsants / Anti-Seizure Medications
  • Antihistamines
  • Antipsychotics
  • Anesthetics
  • Beta-Blockers
  • Benzodiazepines
  • Calcium Channel Blockers
  • HIV Antivirals
  • HMG CoA Reductase Inhibitors (Statins)
  • Immune Modulators
  • Non-Steroidal Anti-Inflammatory Drugs
  • Oral Hypoglycemic Agents
  • Proton-Pump Inhibitors (PPIs)
  • Prokinetics
  • Steroids and Corticosteroids
  • Sulfonylureas

There’s also a group of drugs called “prodrugs” that first need to be processed into their therapeutic compounds instead of being therapeutic compounds on their own. In plain English, the inactive compound is consumed, and once in the body, it turns into the active compound.

If this mechanism is dependant on the CYP450 system (more on that later), a drug interaction can lead to insufficient concentrations of the therapeutic agent in the bloodstream — reducing its potency.

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CBD Interaction with Drugs & Medications

This section covers the most common interactions between CBD and medications. If you take any of the substances listed below, make sure to consult your doctor before buying CBD oil.

CBD and Ibuprofen Interaction

Ibuprofen is one of the Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), meaning it can produce similar benefits to CBD in terms of inflammation and pain relief. Previously we’ve mentioned that NSAIDs interact with CBD, which may raise concerns about potential negative interactions between CBD oil and Ibuprofen.

According to a study from the Journal of Neurology Research, there have been no reported interactions between CBD and ibuprofen, although it doesn’t mean they do not exist. Health experts suggest that potential interactions may be dosage-dependent. If a certain dosage threshold is breached, CBD and NSAIDs like Ibuprofen can lead to unforeseen and potentially severe nervous system pathology.

CBD and Adderall Interaction

A 2020 study found that higher doses of medical cannabis led to a decreased use of ADHD medication in adults. Products containing a higher concentration of CBD were linked to lower ADHD scores. This means that CBD can interact with ADHD meds, decreasing their efficacy while providing more pronounced benefits. The potential side effects of interactions between CBD and Adderall may lead to decreased appetite.

CBD and Lamictal Interaction

Using medical cannabis and Lamictal may increase side effects such as dizziness, confusion, drowsiness, and difficulty concentrating. Elderly consumers may also experience impairment in judgment. That being said, none of these side effects were proven to result from CBD use per se. When it comes to interactions between CBD and Lamictal, it can make the medication more or less effective, depending on the dosage.

CBD Oil and Antibiotics

There is no known interaction between CBD and antibiotics, although these interactions may occur if an antibiotic is metabolized through the cytochrome P450 enzyme system. Some studies indicate that taking CBD and antibiotics together may amplify the effects of one another without any negative side effects. However, more research is needed to confirm these findings on a larger scale.

CBD Oil and Omeprazole

CBD can inhibit the enzymes that are targeted by omeprazole and other Proton Pump Inhibitors (PPIs). Taking CBD with certain heartburn medications can increase the risk of diarrhea.

CBD and Thyroid Medications

Some people report mild nausea when taking CBD oil together with their thyroid medications. Since both substances are processed by the CYP450 enzyme system, taking CBD with a thyroid medication may cause hyperthyroidism because more thyroxine would be secreted than the body could metabolize.

CBD and Lisinopril

CBD can temporarily lower blood pressure, so taking it alongside medications like Lisinopril might reduce it even more, making you feel lethargic and weak. Always consult your doctor before adding CBD to your routine if you use anti-hypertension meds.

CBD and Prednisone

Since both CBD and corticosteroids are potent inhibitors of the CYP450 enzyme system, concomitant use may increase the risk of systemic side effects from corticosteroid use due to decreased glucocorticoid clearance. Corticosteroids like prednisolone and hydrocortisone should never be taken with CBD.

How Drugs Interact: Understanding Drug Metabolism

Metabolism can refer to how your body uses energy for weight management, or the way drugs are metabolized in your body.

The former is known as the basal metabolic rate, or in simple terms, the number of calories a person needs to maintain healthy body functions while at rest.

The latter is very different from the basal metabolic rate. Drug metabolism refers to how a substance is processed and used by the body — with the majority of this processing happening in the liver.

Scientists call it the ‘first-pass effect’ or ‘first-pass metabolism.’

Using straightforward terms, when you take a medication, it is broken down in the liver into its active compounds so that the body can use them. Just like carbohydrates are broken down into sugars, fats into triglycerides, and proteins into amino acids — drugs break down into their individual ingredients.

From there, they are controlled by specific enzymes, which transform these compounds into metabolites. These metabolites then influence different processes in your body and are flushed with urine once used up.

How Is CBD Metabolized?

Drug metabolism determines the rate at which the body processes medications and other therapeutic compounds into their individual metabolites and how long they can stay in your system.

When you take CBD in the form of an oil, capsule, or gummy, it has to pass through your gut, where it is released into the bloodstream. From then, they travel through the bloodstream to the liver, where it absorbs through the hepatic portal. The liver breaks CBD down into its metabolites using enzymes, after which it can circulate throughout the body in the bloodstream again.

What Is the Cytochrome P450 System?

Aside from breaking compounds down into metabolites, the liver also detoxifies and excretes foreign substances and other types of toxic compounds. This can happen through a system of enzymes referred to as the Cytochrome P450 (CYP450). These enzymes contain heme as a cofactor to convert cannabinoids into more water-soluble molecules, increasing their absorption and efficacy.

Researchers estimate that the CYP450 system is responsible for metabolizing 60% of any drugs out there. And interestingly, doctors and pharmacists use this system to understand, evaluate, and predict the benefits of the drug and potential side effects based on their dosages.

However, certain compounds have the ability to compromise the CYP system’s functioning, negatively affecting the metabolism of certain medications. Once these interactions occur, the drugs can be metabolized faster or slower than normal.

CBD And the Cytochrome P450 System

As mentioned earlier, CBD can interact directly with the CYP450 system in the liver. According to preclinical studies, CBD binds to the site where the enzyme activity occurs, competing with other compounds and thus preventing this system from breaking down other substances.

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This inhibitory effect on the CYP450 enzymes mainly depends on how much CBD a person takes, their unique physiology, and the type of CBD used (e.g., full-spectrum CBD vs. CBD isolate). The dosage determines the strength used by the CBD to bind to the active site of the metabolic enzymes. The tighter the bond, the more competitive inhibition.

Contraindications for Taking CBD with Medications

The mechanism behind CBD’s health benefits proves that it’s not a biologically inert compound. Instead, the pharmacokinetics and pharmacodynamics of CBD are complex and similar to any other medication. Therefore, it has the potential to compromise the metabolism of certain medications.

Any therapeutic substance that relies on the CYP450 system can be potentially affected by CBD. A common indicator for such interaction is when your medication has a grapefruit warning on the bottle. However, this is by no means a solid point of reference, and you should always check with your doctor and pharmacist before taking the two compounds together.

Why You Should Always Consult Your Doctor First

The list of drugs that we’ve mentioned above is by no means definite and doesn’t include all the pharmaceutical substances that may interact with CBD. Similarly, not all the medication from these categories will necessarily cause an interaction — as is the case for antibiotics and Ibuprofen.

A consultation with a doctor experienced in CBD and cannabis use can help you establish the right routine for your medications and supplements to avoid potentially negative interactions. Some compounds work synergistically with CBD, so asking your doctor can help you maximize the effect of your treatment.

Not to mention that the doctor can guide you on finding the optimal dosage for yourself.

Key Takeaways on CBD Drug Interactions

The safety profile of CBD has been acknowledged by major health agencies, such as the World Health Organization (WHO), showing that it’s well-tolerated by animals and humans and rarely produces any dangerous side effects.

CBD also has a profound impact on an array of systems, which explains its therapeutic versatility. That being said, this versatility is also the reason why CBD interacts with so many prescription meds and over-the-counter (OTC) PRODUCTS.

Again, if you’re not sure if CBD will interact with the medication that you might be taking, a consultation with a health professional will not harm — unlike trying to figure out these interactions on your own.

Livvy Ashton

Livvy is a registered nurse (RN) and board-certified nurse midwife (CNM) in the state of New Jersey. After giving birth to her newborn daughter, Livvy stepped down from her full-time position at the Children’s Hospital of New Jersey. This gave her the opportunity to spend more time writing articles on all topics related to pregnancy and prenatal care.

Does CBD Interact With Lorazepam (Ativan)?

Cannabidiol (CBD), a cannabinoid, can interact with the anxiolytic and sedative benzodiazepine lorazepam (Ativan) and aggravate its effects.

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Lorazepam (Ativan) is a medication used to treat anxiety, sleeping disorder, seizures, and panic disorder. It belongs to the benzodiazepine family. It is a short-acting benzodiazepine.

Cannabidiol or CBD, a cannabinoid extracted from the cannabis family, can interact with lorazepam and enhance its actions.

CBD acts as an agonist for lorazepam. It can increase its amount in the body and cause more side effects.

Table of Contents

Does CBD Interact With Lorazepam (Ativan)?

Yes. CBD can interact with lorazepam (Ativan). This combination is considered high-risk and should be avoided unless otherwise specified by a healthcare professional.

CBD may potentiate the effects of Ativan by reducing the body’s ability to metabolize the drug and increasing the risk of side effects such as sedation, dizziness, & short-term memory loss, and more.

Its interaction with lorazepam can take place in two ways:

A) Slowed Elimination (Metabolic Inhibition)

Drug metabolism is the process by which the drugs break down in the body to make it easy for them to perform their actions and to eliminate them from the body.

This task largely comes down to the cytochrome P450 enzymes found in the liver.

When two drugs require the same enzymes for metabolism, it results in a type of interaction called “metabolic inhibition” or “metabolic competition.” This action could slow down the metabolism of one or both drugs.

Lorazepam (Ativan) is primarily metabolized by CYP3A4. This same enzyme group is involved with metabolizing CBD as well. Hence, on consuming them together, they end up competing with each other for the breakdown in the liver. This action may enhance the plasma levels of lorazepam.

This effect is most dangerous in patients taking either CBD, Ativan, or both substances on a recurring basis. If Ativan isn’t cleared from the body by the time you take a second dose (because of delayed elimination from CBD), it could eventually lead to a buildup of toxic levels in the bloodstream — resulting in side effects.

B) Increased Effect (Agonistic Interaction)

An agonistic interaction occurs when two or more substances exhibit the same effect on the body. These substances might act on the same or different receptors, but they produce effects in the same direction when consumed together.

Because CBD and lorazepam are both central nervous system suppressants, their effects may compound. This interaction carries the greatest risk of producing adverse effects.

Taking both CBD and lorazepam could result in a higher risk of side effects associated with central nervous system suppression, including dizziness, lightheadedness, fainting, short-term memory loss, and more.

Similar Medications: CBD & Benzodiazepines

Lorazepam is classified as a benzodiazepine anxiolytic. CBD and benzodiazepines all share similar risks for interaction and side effects. All drugs in this class are considered to have a moderate to high-risk interaction with CBD and other cannabinoids.

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Here’s a list of similar medications that share a similar level of risk when combined with CBD:

Is It Safe to Take CBD & Lorazepam (Ativan) Together?

No. It is not considered safe to take CBD alongside benzodiazepines such as Ativan (lorazepam). The risk of serious side effects is high with this class of medications.

CBD may potentiate (increase) the effects of lorazepam in the body. It can also lead to excessive accumulation of the drug by slowing its metabolism and elimination from the body.

CBD is considered to carry a high risk of interaction with lorazepam.

If both the drugs are taken in minimum dosage, it is less likely to cause many side effects.

It’s recommended to consume these two medicines together only under medical guidance. One must exercise caution when taking them together.

Is CBD A Viable Alternative to Lorazepam (Ativan)?

CBD may be a viable alternative to lorazepam (Ativan) for managing mild to moderate bouts of anxiety, insomnia, or muscle tension. However, CBD is much milder than Ativan and may not be strong enough for certain situations.

A study has shown that CBD may be effective in the treatment of generalized anxiety disorder, panic disorder, social anxiety disorder, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD) [1].

CBD has also been shown to be effective as an adjunctive treatment for seizures [2]. It’s even gained approval for use in seizures caused by two rare forms of epilepsy, Lennox-Gastaut syndrome and Dravet syndrome.

CBD has enough potential to become a proper anxiolytic sedative and may even replace benzodiazepines like lorazepam someday.

However, with the current available research and study, it’s not completely sufficient as a replacement for lorazepam for anything more than mild to moderate symptoms.

What is Lorazepam (Ativan)?

Lorazepam is an anxiolytic, sedative, and anti-seizure drug belonging to the benzodiazepine family. It’s used to treat panic disorders, severe anxiety, and seizures, including ones such as status epilepticus and a short-acting benzodiazepine, and gets and rapidly cleared in the body.

Ativan is the most common brand name for lorazepam, but there are many generic forms as well. It’s a prescription medicine approved by the FDA for the treatment of anxiety disorders and seizures.

Lorazepam (Ativan) Specs:

Drug Name Lorazepam
Trade Names Ativan, Tavor, Temesta, Khamos, Larpose, Lopam, Lopez, Lorazine, Loree, Lorel, Lorus, Orazep, Trapex, Zora
Classification Benzodiazepines
CYP Metabolism Cytochrome P450 enzymes
Interaction With CBD Agonistic, Metabolic inhibitor
Risk of Interaction High

Other Names For Lorazepam (Ativan)

Lorazepam is sold under many different names. All share the same risk and potential interactions.

Other names for Lorazepam (Ativan) include:

What Does Lorazepam (Ativan) Do?

Lorazepam is classified as a benzodiazepine drug. It’s used to treat various neurological disorders, including seizure disorders (such as status epilepticus and alcohol withdrawal), anxiety, panic disorders, muscle tension, and insomnia.

Lorazepam works by binding to the benzodiazepine (GABA) receptors, which are responsible for suppressing or relaxing electrical activity in the brain. When this happens, we feel more calm and relaxed, anxiety levels subside, and we’re much more primed for falling asleep.

GABA causes chloride ions to pass across neuronal cell membranes via an ion channel in the receptors. When enough chloride ions are conducted, the local neuron membrane potentials increase. This effect makes it difficult for action potentials to fire and thus ultimately results in less excitation of the neurons.

Benzodiazepines do not replace GABA and do not affect GABA concentrations in the brain. However, they enhance the effect of GABA at the γ-aminobutyric acid type A (GABAA) receptor. Benzodiazepines can intensify the inhibitory activity of GABA in the central nervous system.

Side Effects of Lorazepam (Ativan)

There are many negative side effects associated with Ativan. Everybody is different, so it’s important to listen to your body and follow the dosage recommendations given to you by your doctor.

One of the main issues associated with this drug is dependency and addiction following long-term use. Because of its dependency-forming ability, lorazepam, like other benzodiazepines, is used as a first-line treatment for seizures but not for long-term treatment.

Lorazepam has also been associated with drug abuse and misuse.

Simultaneous use of benzodiazepines may result in heavy sedation, respiratory depression, coma, and death. These drugs are not suggested for use in patients for whom alternative treatment options are available.

Lorazepam can also cause withdrawal symptoms if stopped abruptly. The withdrawal symptoms consist of increased anxiety, irritability, insomnia, tremors, headaches, stomach pain, nausea, hallucinations, fatigue, depression, and more.

Lorazepam must be used with caution in patients with depression or psychosis as it can lead to an increased risk of suicidal ideation.

Side Effects of Lorazepam Include:

  • Asthenia
  • Blood dyscrasias
  • Change in appetite
  • Change in libido
  • Confusion
  • Constipation
  • Convulsions
  • Depression
  • Disorientation
  • Dizziness
  • Drowsiness & fatigue
  • Dysarthria
  • Extrapyramidal symptoms
  • Hypersensitivity reactions
  • Hypotension
  • Increase in alkaline phosphatase (ALP)
  • Increased bilirubin
  • Increased liver transaminases
  • Irritability
  • Jaundice
  • Lack of motivation
  • Loss of memory
  • Movement disorder
  • Nausea
  • Respiratory depression
  • Sleep apnea
  • Suicidal ideation
  • Tremor
  • Unsteadiness & vertigo
  • Visual disturbances

Key Takeaways: Is it Safe to Take Lorazepam (Ativan) With CBD?

CBD may reduce the body’s ability to metabolize lorazepam, leading to a longer duration of effects and a potential increase in serum levels over the course of several days or weeks.

Don’t attempt to combine CBD with Ativan without first speaking to your prescribing physician.

To further reduce the risk of side effects, it’s best to take only the minimum dosage of both medications with proper spacing in timing between them both (at least 2 hours apart).

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