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can i take cbd oil and lorazepam

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:

  • CYP2C9
  • CYP2C19
  • CYP3A4
  • CYP2D6

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:

  • CYP3A4
  • CYP2D6

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.

In our latest question and answer, the pharmacist discusses whether or not CBD oil interacts with oxycodone or Atifan (lorazepam).

CBD (Cannabidiol) With Ativan (Lorazepam) Interaction

No known interactions but watch out for potential sedation.

Baba asked

I have been taking 0.5mg of Ativan (lorazepam) mid-day and at night for about 6 years to help me with anxiety due to shortness of breath. Can I try CBD oil twice a day with this? I would like to wean off lorazepam if hemp oil helps with this and insomnia.

At a glance

  • There is no known drug interaction between CBD (cannabidiol) and Ativan (lorazepam).
  • However, both can cause sedation, drowsiness and dizziness so caution must be taken when combining them.

Answer

There are no known interactions between Ativan (lorazepam) and CBD (cannabidiol). However, both can increase sedation and somnolence (feeling of sleepiness).

Therefore, caution is advised when using both together and you should not operate heavy machinery or take part in activities that require mental alertness until you know how both medications affect you.

Below, I discuss CBD, Ativan and potential interactions in more detail.

What Is CBD (Cannabidiol)?

Cannabidiol, often referred to simply as ‘CBD’, is one of the many constituents of marijuana and is known to be an active component in regard to activity with our endocannabinoid system.

Unlike THC (delta-9-tetrahydrocannabinol), CBD is thought to be ‘non-psychoactive’ in that it doesn’t cause a ‘high’ or euphoria. Nevertheless, it certainly does affect the central nervous system as studies show it can be beneficial for symptoms of anxiety and can cause sedation.

CBD has been investigated for a wide variety of therapeutic effects, including:

  • Chronic Pain
  • PTSD
  • Multiple sclerosis
  • Parkinson’s Disease
  • Epilepsy
  • Huntington’s Disease

In addition, CBD may make high THC preparations more tolerable for individuals as it can ‘attenuate’ or reduce the ‘high’ experienced without reducing potential medicinal effects.

CBD Side Effects

CBD is very well tolerated in most individuals and is not associated with dependence or withdrawal symptoms, even after extended use.

Although CBD can cause sedation and a general feeling of tiredness, it is not associated with respiratory depression and has been used safely with CNS depressants such as opioids and benzodiazepines. Nevertheless, CBD can cause additive drowsiness when used with other medications with similar side effects (e.g. lorazepam).

The overall side effect profile of CBD is minimal, especially at doses that are used in over the counter products (

3-15 mg) per dose.

Even high doses of CBD are considered well-tolerated. The prescription product Epidiolex, which comes in a concentration of 100 mg/ml and is used for rare seizure disorders, provides a high amount of CBD and lists the following side effects in the prescribing information for the drug:

  • Decreased appetite (16-22% incidence)
  • Diarrhea (9-20% incidence)
  • Sedation (3-6% incidence)
  • Lethargy (4-8% incidence)
  • Somnolence (23-25% incidence)
  • Sleep disturbances (5-11% incidence)

CBD Drug Interactions

There is a lack of information regarding interactions with CBD products and it appears that some may be dose-related (meaning higher doses increase the risk of interaction) (14). Potential interactions stem from the fact that CBD may inhibit certain CYP metabolizing enzymes in the liver, including:

  • CYP 3A4
  • CYP 2C19
  • CYP 1A1
  • CYP 2B6
  • CYP 2C9

When a metabolizing enzyme is inhibited, it cannot break down a drug as effectively or as quickly, leading to increased concentrations. This can increase the risk of side effects.

A good example of this is the interaction between Lipitor, a cholesterol-lowering medication, and clarithromycin, an antibiotic. Clarithromycin can inhibit CYP 3A4, which is responsible for metabolizing Lipitor. This increases concentrations of the drug, putting individuals at risk for serious side effects, such as rhabdomyolysis.

It should be noted that most interaction studies with CBD have been only done in animals and the extent of potential interactions in humans isn’t well known.

Ativan (lorazepam), the drug in question regarding CBD interactions, is not metabolized by CYP enzymes, but rather by liver glucuronidation. As far as we know, CBD has no effect of Ativan concentrations in the body.

Lastly, the concern with combining CNS depressants together is the risk of respiratory depression. Opioids and benzodiazepines are well associated with it. CBD products, however, are not and are generally considered safe in that regard.

Ativan Information

Ativan (lorazepam) is a rapid-acting benzodiazepine medication and is used primarily for the treatment of anxiety disorders.

It has several advantages over other benzodiazepines, including:

  • It is not metabolized by CYP liver enzymes and has fewer potential drug interactions when compared to medications that are.
  • It does not have active metabolites and therefore doesn’t accumulate in the body. This can be beneficial in certain populations, such as the elderly.

The most common side effects of benzodiazepines, like Ativan, are as follows:

  • Sedation
  • Fatigue
  • Memory impairment
  • Dizziness
  • Impaired motor coordination
  • Shallow breathing (high doses)

Taking CBD With Ativan

As discussed, there are no known interactions between CBD and Ativan. However, it is important to know that both can cause sedation and a general feeling of fatigue, which could be additive if taken together.

It is important to let your doctor know all the medications/over the counter products you are taking so you can be appropriately monitored.

References

  1. An Update on Safety and Side Effects of Cannabidiol: A Review of Clinical Data and Relevant Animal Studies. PubMed
  2. Risks, Management, and Monitoring of Combination Opioid, Benzodiazepines, and/or Alcohol Use. PubMed
  3. Ativan Prescribing Information. AccessFDA
  4. Statin-induced rhabdomyolysis: a complication of a commonly overlooked drug interaction. PubMed
  5. Characterization of major phytocannabinoids, cannabidiol and cannabinol, as isoform-selective and potent inhibitors of human CYP1 enzymes. PubMed
  6. Characterization of cannabidiol-mediated cytochrome P450 inactivation. PubMed
  7. Potent inhibition of human cytochrome P450 3A isoforms by cannabidiol: role of phenolic hydroxyl groups in the resorcinol moiety. PubMed
  8. Multicenter, Double-Blind, Randomized, Placebo-Controlled, Parallel-Group Study of the Efficacy, Safety, and Tolerability of THC:CBD Extract and THC Extract in Patients with Intractable Cancer-Related Pain. ScienceDirect
  9. Controlled clinical trial of cannabidiol in Huntington’s disease. FDA
  10. Epidiolex Prescribing Information. AccessFDA
  11. Cannabidiol for the treatment of psychosis in Parkinson’s disease. PubMed
  12. Oromucosal Δ9-tetrahydrocannabinol/cannabidiol for neuropathic pain associated with multiple sclerosis: An uncontrolled, open-label, 2-year extension trial. ScienceDirect
  13. Multiple mechanisms involved in the large-spectrum therapeutic potential of cannabidiol in psychiatric disorders. FDA
  14. Medical Marijuana for Treatment of Chronic Pain and Other Medical and Psychiatric Problems A Clinical Review. JAMA Network
  15. Effects of ipsapirone and cannabidiol on human experimental anxiety. PubMed
  16. The diverse CB1 and CB2 receptor pharmacology of three plant cannabinoids: delta9-tetrahydrocannabinol, cannabidiol and delta9-tetrahydrocannabivarin. PubMed

There is no known drug interaction between CBD (cannabidiol) and Ativan (lorazepam). However, both can cause sedation and drowsiness.