Weed May Mess With Your Medicines, Causing Harm

By Dennis Thompson
HealthDay Reporter

THURSDAY, Dec. 16, 2021 (HealthDay News) — Many individuals flip to marijuana or cannabidiol to ease their achy joints and assist them sleep, however a brand new examine suggests that might wreak havoc with some other drugs they’re taking.

Why? Because the physique makes use of the identical set of enzymes to course of all of them, scientists report.

The chemical compounds in marijuana — THC, cannabidiol (CBD), cannabinol (CBN) — are metabolized within the physique by a minimum of two households of enzymes that additionally assist course of and eradicate greater than 70% of essentially the most generally used prescribed drugs from the physique, the researchers stated.

That means there is a danger that pot would possibly dangerously amp up the results of some prescribed drugs, or trigger different drugs to flush via your system so shortly that they do you no good, stated lead researcher Philip Lazarus. He’s a professor of pharmaceutical sciences at Washington State University, in Spokane.

“We noticed some vital inhibitions,” Lazarus stated. “The concentrations we see within the lab are most likely an indicator there may be a minimum of some inhibition of those enzymes in real-time.”

Some medication that may very well be affected by pot use embody the blood thinner warfarin, the breast most cancers drug tamoxifen, and painkillers like acetaminophen (Tylenol) or ibuprofen (Motrin), stated Lazarus and Ed Bednarczyk, a medical affiliate professor of pharmacy observe on the University at Buffalo, in New York.

In two lab experiences printed within the December concern of the journal Drug Metabolism and Disposition, Lazarus served as senior creator. One examine checked out a household of enzymes referred to as cytochrome P450s (CYPs), and the opposite analyzed the enzyme group UDP-glucuronosyltransferases (UGTs).

The CYPs are concerned within the early levels of metabolizing THC and CBD, whereas the UGTs are concerned within the later levels.

THC and CBD keep in your physique for under about half-hour earlier than the enzymes break them down, however the chemical compounds that consequence from the method can linger in your physique for as much as two weeks, the examine authors stated in background notes.

In the lab, the researchers examined how the pot chemical compounds would possibly intrude with these enzymes’ potential to interrupt down different medication, utilizing cultured human kidney cells to check a single enzyme at a time.

The investigators discovered that the most important THC metabolites inhibited key CYP enzymes, together with a number of that serve key roles within the liver.

And all three hashish chemical compounds, however particularly CBD, inhibited two of the first UGT enzymes within the liver.

CBD was additionally discovered to dam three enzymes that account for about 95% of UGT metabolism within the kidney, which helps clear toxins and a few medication from the physique.

CBD, THC block enzymes that break down different meds

“It’s a really, excellent reminder that these interactions are actual,” Bednarczyk stated. “It’s essential for physicians and pharmacists who’re working with sufferers to discover this.”

This is the primary analysis effort to display the potential results of pot on UGT enzymes, the researchers stated. The examine additionally sheds extra mild on marijuana’s impact on CYP enzymes.

It’s been recognized for a while that pot may work together with different medication, stated Paul Armentano, deputy director of NORML, a bunch that advocates for the reform of marijuana legal guidelines.

The U.S. Food and Drug Administration’s labeling of a type of artificial THC referred to as dronabinol, which has been accessible as a prescription drug for greater than 30 years, signifies that it’d affect CYP ranges, Armentano famous. And the company’s warning for Epidiolex, a plant-based prescription CBD drug, additionally addresses how the substance may have an effect on the liver, he added.

But Armentano questioned how highly effective these interactions may very well be, given how lengthy marijuana has been used each recreationally and medicinally.

“Adults — and sufferers specifically — have been consuming cannabinoids medicinally for hundreds of years, and this observe has change into fairly commonplace over the previous few a long time,” Armentano stated. “Many of those sufferers are older and plenty of of them may be prescribed different drugs. Were cannabinoids to be considerably contraindicated amongst this inhabitants, one would presume that there can be ample empirical proof already accessible substantiating this concern.”

Pot’s impact on metabolism would not seemingly have an effect on somebody who takes a leisure toke or three on the weekend, Lazarus stated.

“Even although it most likely inhibits these enzymes, it would not inhibit them sufficient to intrude along with your on a regular basis metabolism,” Lazarus acknowledged.

The drawback comes if you combine common pot use with different medication, or in the event you’re taking a marijuana-derived product alongside your prescription.

“Generally,” Bednarczyk stated, “CBD is believed to inhibit metabolic pathways, and THC is believed to induce metabolic pathways. THC could make your blood ranges of different medication fall, and CBD could make your blood ranges rise.”

Warfarin, CBD a harmful combo

One well-known instance is warfarin, “a really, very potent blood thinner,” Bednarczyk stated.

A case examine printed a few years in the past famous one warfarin affected person who “had the results of this drug go approach up into the hazard zone shortly after beginning CBD,” Bednarczyk stated. “That one, you do not mess with. The results of getting too excessive a stage even transiently for a number of days could be deadly,” he warned.

“That’s the king of the hill for danger, as a result of it is all around the map when it comes to patient-to-patient variability,” Bednarczyk stated of warfarin and pot. “One affected person can want a bucket of these things to have the identical impact as one other affected person who’s on the bottom dose manufactured.”

The reverse happens if you combine pot with tamoxifen, a hormone remedy drug used to deal with breast most cancers by blocking the results of estrogen, Lazarus stated.

For tamoxifen to work, he famous, it should be damaged down by the physique into one other chemical referred to as endoxifen, which is 100 instances extra energetic than tamoxifen.

If pot interferes with the processing of tamoxifen, it may trigger the breast most cancers affected person to obtain little to no profit from the drug, Lazarus defined.

Lazarus stated he is additionally involved concerning the interplay pot may need with over-the-counter ache drugs.

Ibuprofen “is poisonous to your liver and your kidney anyway, however you begin taking marijuana on prime of that, then you are going to see some vital results,” Lazarus stated. “It would most likely trigger toxicity since you’re slowing down its metabolism, so which means you are not excreting the stuff and you’ve got extra of it sitting in your physique.”

However, all these considerations are based mostly on lab research. What’s wanted now are medical trials to ascertain the true results of pot on different medication, Lazarus famous.

“We should do some medical research to point out in folks that in the event you’re taking a particular drug and you then additionally smoke a marijuana cigarette that morning, you see larger or decrease ranges of that drug in your physique,” Lazarus stated.

In the meantime, individuals ought to talk about their use of pot merchandise with their physician and their pharmacist to ensure they don’t seem to be placing their well being in danger, Lazarus and Bednarczyk stated.

“This shouldn’t be a roll-your-own course of,” Bednarczyk stated.

More info

The Mayo Clinic has extra on doable drug interactions with marijuana.

SOURCES: Philip Lazarus, PhD, professor, pharmaceutical sciences, Washington State University, Spokane, Wash.; Ed Bednarczyk, PharmD, medical affiliate professor, pharmacy observe, University at Buffalo, New York; Paul Armentano, deputy director, NORML, Washington, D.C.; Drug Metabolism and Disposition, Dec. 13, 2021