In general, cannabis may not present a conflict with most prescription medications. However, it is important to consult with a medical professional and disclose cannabis use when you are taking prescriptions. Physicians and pharmacists may not ask you if you have a medical card. And if you haven’t told them, they can’t give you potentially lifesaving information about drug interactions.
There hasn’t been one single report of an overdose where marijuana was the sole cause of death. You can consume too much cannabis and experience symptoms caused by toxicity. However, those symptoms typically dissipate without medical intervention. And they can be so unpleasant that the average cannabis user knows their limit (and stays within it).
But the biggest concern for patients is whether cannabis will make prescription drugs less effective. If you have diabetes, cancer, or a cardiovascular condition, it could pose a significant risk. If you are taking psychotropic medications to treat moderate to severe anxiety or depression, cannabis could worsen your symptoms.
Patients May Not Be Aware of Contraindicated Medications
Some medications conflict with cannabis. Just as cannabinoids can have many wellness benefits, cannabis can be strong enough to change the way medications work in your body. That includes everything from daily prescription medications to post-surgical or procedural care.
In some cases, cannabis can reduce the efficacy of the prescription drug. For example, cannabis can inhibit enzymes produced in the liver. When that happens, medications may not be absorbed well. Cannabis can mildly impair the biosynthesis of drugs like antibiotics. And if you are fighting an infection and using medications like erythromycin, or miocamycin, it could reduce the antibiotic’s strength. And also produce side effects like nausea and gastrointestinal upset.
Be safe and give your practitioner a full disclosure. And if you feel uncomfortable talking about medical cannabis with your family doctor? Find a board-certified physician that specializes in medical cannabis recommendations. That practitioner can provide expert advice about medical marijuana and communicate on your behalf with your family doctor.
Also remember, that use of medical cannabis is legally protected by the Health Insurance Portability and Accountability Act (HIPAA). It cannot be disclosed outside of the doctor/patient relationship and without your consent. But you need the ongoing advice and recommendations of a physician to make sure medical cannabis doesn’t conflict with your prescription medications. Safety first!
7 Medications Known to Conflict with Medical Marijuana
There are not many prescription drugs that conflict with medical cannabis. However, many patients use the following seven medications to treat conditions like respiratory illness, seizures, and more. And these medications are known to interact negatively with cannabis.
Warfarin is prescribed when patients are at a higher-than-normal risk of developing blood clots. Deep vein thrombosis is developing one or more blood clots that commonly occur in the leg, thigh, or pelvis area.
Both THC and CBD suppress the metabolic activity of CYP2C9, which is an enzyme that can increase warfarin levels. That means increased risks of bleeding from an INR ratio to unsafe levels where the patient can experience life-threatening bleeding.
Valproate is a drug that is prescribed for epileptic seizures. Some patients also receive this prescription to help manage bipolar disorders or to help with migraine symptoms. Some clinical studies showed that patients using prescription Epidiolex (CBD) with Valproate multiplied the drug’s effect three times. That increases the risk of injury to the liver.
Theophylline is often prescribed for patients who suffer from chronic respiratory issues like bronchitis, asthma, or emphysema. Smokable marijuana can make the drug dissipate or metabolize quickly so that it works less efficiently. However, other types of cannabis (such as edibles or tincture drops) may not have the same negative interaction.
Clobazam is a benzodiazepine prescribed to treat seizure disorders like Lennox-Gastaut syndrome in both children and adults. While the FDA approved the first-ever cannabis-derived epilepsy medication (Epidolex), CBD can inhibit CYP2C219. This reduces the effectiveness of Clobazam and can increase the concentration of the drug in blood plasma. That can result in an increased level of sedation or drowsiness.
Both cannabidiol (CBD) and cannabis may be used for patient treatment, but physicians will generally reduce the dosage of Clobazam prescriptions to counteract the sedative effects.
5. Suboxone and Subutex
For patients recovering from opioid addiction to drugs like heroin, Oxycodone or Fentanyl, Suboxone, and Subutex (as well as Buprenorphine) may be prescribed. The medications are used to make withdrawal symptoms more manageable as part of a step-down addiction therapy plan.
There are some significant safety risks associated with using cannabis with Suboxone, Subutex, or drugs that contain Buprenorphine. Cannabis, when mixed with this class of medications, can produce severe depressive symptoms. That can lead to respiratory depression (problems breathing), which can be life-threatening.
Consequently, the Buprenorphine class of medications is contraindicated with cannabis for another reason. Cannabis and clinical-grade CBD can cause Suboxone and Subutex to be less effective. That means patients may not get the relief they need from withdrawal symptoms and relapse into opioid drug use.
6. Antidepressants and Anti-Anxiety Medication Prescriptions
One class of prescriptions commonly prescribed for insomnia, anxiety, and depression, are Benzodiazepines. However, Benzodiazepines typically cause memory problems and even blackout memory events. Cannabis can exacerbate memory loss, which is used simultaneously and creates a ‘mental fog’ and short-term memory loss.
Common medication prescriptions in this category include:
· Fluoxetine (Prozac, Sarafem, Selfemra)
· Sertraline (Zoloft)
· Vortioxetine (Trintellix)
· Citalopram (Celexa)
· Escitalopram (Lexapro)
Impacting brain chemistry, most antidepressants do not mix with any other kind of drug. That includes medical cannabis. People who have conditions like Generalized Anxiety Disorder (GAD), Post-Traumatic Stress Disorder (PTSD), or moderate to severe Attention Deficit Hyperactivity Disorder (ADHD) can experience heightened anxiety. Using cannabis (depending on the strain) can exacerbate feelings of paranoia and duress.
Because antidepressants and anti-anxiety medications do not mix with cannabis, most physicians will not prescribe them if they know a patient has a medical card.
Seroquel is used to treat symptoms of bipolar disorder. The drug (Quetiapine) can increase side effects, including confusion, concentration problems, drowsiness, and dizziness. Movement and coordination can also be impaired when Seroquel is consumed with cannabis.
Remember, if you are taking any prescriptions, do not stop taking them until you get medical professionals’ advice. Reducing or halting a daily dose of medication can present health and safety risks for patients.
What If Your Primary Care Physician Doesn’t Know You Are Using Medical Marijuana?
Some physicians are in support of alternative medicine and therapies that provide results for their patients. Other practitioners may be strongly against cannabis for personal reasons. It may not be something they wish to recommend to their patients under any circumstance. Doctors can feel apprehensive about legal liability as well.
As long as cannabis remains a Schedule 1 drug on the Controlled Substances Act, some practitioners will have misgivings. If your physician is strongly opposed to medical marijuana, you may not have discussed it with them. You may not feel like you want to defend your right as a patient to try alternative therapies like CBD or medical marijuana. And you may not have told your physician that you have a medical card.
Understandably, some people want to keep their use of medical cannabis private. But when you don’t disclose that you are a registered patient who used medical marijuana, you could be putting your health at risk. Because cannabis interacts with some prescription drugs, your physician has to be aware of everything you are taking. That includes CBD supplements, medical marijuana, and even vitamins and nutritional products you use daily.
The best approach is, to be honest with your doctor. They may not personally agree with it, but the information will help them make better decisions about your prescriptions. And if they make you feel uncomfortable about the use of medical cannabis, you can always find a doctor who supports alternative health practices.