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cbd and hydrocodone

Cbd and hydrocodone

The doses of CBD used in studies that have shown potential interactions ranges widely. While most over the counter CBD products range from 1mg to 10mg per serving, studies have used anywhere from 100mg to 600mg! There is a good chance the more commonly used lower doses of CBD don’t have significant interactions at all, but more studies are needed.

This interaction is more theoretical than evidence based as there are a lack of studies that have reported this interaction. In addition, there is some controversy in regard to just how much, if at all, CBD can inhibit metabolizing enzymes.

When a metabolizing enzyme is inhibited, this often leads to increased concentrations for most drugs, due to decreased metabolism.

Taking Hydrocodone With CBD (Cannabidiol)

I take hydrocodone and have been for the past few years. I am wondering if it is safe to take CBD (cannabidiol) oil with it for additional pain relief.

One study evaluated the use of CBD and fentanyl, one of the most potent opioids available. Per the study:

Answer

However, hydrocodone is metabolized in the body by CYP 2D6 to hydromorphone, which is significantly more potent than hydrocodone and mainly responsible for the analgesic effects of the drug. Therefore, potential metabolism inhibition by CBD could theoretically decrease the effectiveness of hydrocodone (due to less conversion to hydromorphone).

Cannabidiol (CBD) is a major constituent of the cannabis plant and is considered “non-psychoactive”, unlike delta-9-tetrahydrocannabinol (THC). In fact, depending on the variety of cannabis, CBD can make up close to 40% of cannabis extracts according to studies.

Cbd and hydrocodone

The reduction of intestinal inflammation through the control of neuroimmune axis exerted by CBD suggests this CBD may be a promising drug for the therapy of inflammatory bowel disease, especially Crohn’s disease. CBD modulates inflammatory agents IL-12 and IL-10 and reduces activity of TNF-α, another inflammatory agent. CBD inhibits recruitment of inflammation-inducing mast cells and macrophages in the intestine, reducing intestinal damage principally mediated by peroxisome proliferator activated receptor-γ (PPAR-γ) receptor pathway. These findings may explain the significant reduction in disease activity for Crohn’s disease noted in a retrospective observational study of 30 patients treated with Δ9-THC and CBD. Lymphocytes are another key target of the immunomodulatory action of CBD. Specifically, CBD exhibits a generalized suppressive effect on T- cell functional activities in the gut.

Scientific evidence shows that CBD has analgesic benefits for inflammatory and neuropathic pain but the explanation of how is not yet clear, although it may in part be attributed to the anxiolytic properties of CBD which may influence the impact of pain. CBD is an allosteric modulator of the mu- and delta-opioid receptors and has been noted to potentially enhance the analgesic effects of both endogenous and exogenous opioids. An allosteric modulator is an agent that modulates, or changes, the shape of a receptor. A “negative” modulator changes the shape in such a way as to weaken or reduce the ability of the receptor to interact with another molecule, whereas a “positive” modulator changes the shape in such a way as to enhance the ability of the receptor to interact with another molecule.

Peak CBD blood concentrations and total amounts of CBD entering the blood (area under the curve or AUC) are dose-dependent. Maximum blood levels (Cmax) are increased and reached faster with smoking or vaping CBD compared with oral or sublingual/buccal administrtion. Additionally, Cmax is increased and reached faster after oral administration when taken on a full stomach or with eating, especially fatty foods. The time it takes to reach maximal blood levels (Tmax) does not appear to be dose-dependent and is between 1 and 4 hours.

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.

CBD: Drug Interactions

Inflammatory Bowel Disease

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.

Nicotine Addiction – Preliminary findings indicate that CBD reduces cigarette smoking in smokers trying to quit. Although the mechanism for this effect has not been definitely identified, CBD may modulate nicotine reward through its ability to increase endocannabinoid levels by inhibiting FAAH, the enzyme that breaks down the endogenous endoccannabinoids (see belpw). It has been demonstrated that inhibiting FAAH blocks nicotine seeking and nicotine-induced dopamine release in the NAc reward center. It also reduces anxiety during nicotine withdrawal in animals.

Metabolism of CBD

As a result this may lead to elevated blood levels of these medications and their associated side effects.

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 engaging the use of CBD for therapeutic benefits, one must be aware of potential drug interactions CBD may have with other medications.