The therapeutic potential of cannabis has called the scientific community’s attention, who in the last decades have intensified their researches to reveal the secrets of this plant.  Especially everything related to cannabidiol (CBD).

This non-psychoactive cannabinoid from cannabis is considered one of the most interesting components by many scientists.  It has many properties which can become a real alternative to traditional treatments.

In recent years, treatments based on CBD have been very successful for people who suffer from pathologies in which traditional treatment is no longer effective.  Therefore, various questions arise: Can we take CBD with other medication? Can we substitute traditional synthetic medicine with CBD?

Cannabinoids and its interaction with medications

Many people who wish to use cannabinoids for therapeutic purposes are already taking various medication.  However, the additional use of cannabinoids with other medication can cause interactions that can reduce or increase its therapeutic effects.

To understand the origin of these said interaction, we need to observe the enzymes from Cytochrome P450 (CYP450), a big family of haemoproteins (molecules present in the blood stream) that are highly involved in the metabolism of many medications, a necessary step so that the body can remove the medications.

The metabolism of these medications depend on the level of these enzymes in the blood. Certain substances can affect the metabolism of drugs or medicine.  As the metabolic capacity increases, the effects of the medications disappear much more rapidly.  On the contrary, when it decreases, the effects increase.

Cannabinoids like CBD inhibit the enzymatic system CYP450. Therefore, when it is combined with other medication, the duration hereof increases in the blood, and at the same time, it increases the risk of the secondary effects in cases where the dosage is very elevated. [1]

Cannabinoids have the advantage of being able to gradually reduce the dosage of synthetic drugs maintained in the same dosage of cannabinoids.

Although there is no real medical literature example of major cases in the interaction between cannabinoids and medications, as well as studies about this topic only being in the first stages, it is strongly recommended that you consult with a specialist before incorporating treatment with cannabinoids.

How does CBD substitute drugs?

We have seen that the combination of cannabinoids and drugs can in some cases have therapeutic benefits such as reducing the dosage of certain drugs. On the other hand, the few existing studies on the subject prevent us from stating that cannabinoids such as CBD can permanently replace traditional medicine in the long term. Studies are currently underway to understand their mechanisms.

However, existing studies have demonstrated that CBD can have considerable therapeutic potential in treating diverse pathologies such as anxiety, epilepsy or inflammation.

In fact, the first results from several studies have shown that CBD, with its potential anxiolytic role, could become an interesting alternative to traditional synthetic drugs in the treatment of various anxiety disorders such as generalised anxiety disorder, panic disorder, social anxiety disorder, obsessive-compulsive disorder and post-traumatic stress disorder (PTSD). However, further studies are needed to study the effects of chronic CBD administration in more relevant clinical populations. [2]

Although not all mechanisms of cannabidiol are currently known, existing studies have shown that it can be an interesting alternative for the treatment of several epileptic syndromes due to its anticonvulsant, neuroprotective and non-toxic properties, compared to traditional treatments that present long-term overdose risks[3] ; controlling seizures, reducing excessive neural activity and brain damage present in neural diseases [4]  In addition, antiepileptic drug-resistant epilepsy (refractory epilepsy), which affects almost 30% of epileptic patients, would also benefit from the properties of CBD.[5]  A study in paediatric patients with epilepsy showed an improvement in their condition after oral intake of cannabis extracts [6].

Research has shown that cannabidiol has many other properties, including anti-inflammatory, antioxidant, analgesic, antipsychotic and others…  [7] But as the conclusions of most of these studies indicate, further studies in larger, long-term populations are needed before definitive conclusions can be drawn about the properties of this cannabinoid. Although the results are more than encouraging, it is too early to know if CBD can become a viable alternative to synthetic drugs.

CBD: a solution to combat antibiotic resistance?

Antibiotic resistance is one of the most worrying issues for the World Health Organization, which in its first global report on antimicrobial resistance in 2014 reported that, if nothing is done, we could move into a post-antibiotic era, where previously common infections could become life-threatening again.

Results from a study published in 2019 showed that CBD could be a serious solution to fighting antibiotic resistance. In fact, the use of cannabidiol inhibited the release of membrane vesicles, which plays a major role in antibiotic resistance, in Gram-negative bacteria. On the other hand, its effect on Gram-positive bacteria would not be as significant.

Therefore, together with certain antibiotics, the bactericidal effects of cannabidiol on Gram-negative bacteria would be significantly increased. As for Gram-positive bacteria, CBD would only increase the antibiotic effect of Kanamycin.

Overall the results of this study showed that when CBD is used with specific antibiotics and in certain bacteria, it can increase antibiotic activity by inhibiting the membrane vesicles that are partially responsible for antibiotic resistance. However, more studies are needed to confirm whether CBD is a viable solution to this problem. [8]

[1] Yamaori, S., et alt. (2011). Potent inhibition of human cytochrome P450 3A isoforms by cannabidiol: Role of phenolic hydroxyl groups in the resorcinol moiety. Life Sciences, 88(15-16), 730–736. doi:10.1016/j.lfs.2011.02.017

[2] Blessing, E. M., et alt. (2015). Cannabidiol as a Potential Treatment for Anxiety Disorders. Neurotherapeutics, 12(4), 825–836. doi:10.1007/s13311-015-0387-1

[3] Machado Bergamaschi, et alt. (2011). Safety and Side Effects of Cannabidiol, a Cannabis sativa Constituent. Current Drug Safety, 6(4), 237–249. doi:10.2174/157488611798280924

[4] Campos, A. C., et alt. (2016). Cannabidiol, neuroprotection and neuropsychiatric disorders. Pharmacological Research, 112, 119–127. doi:10.1016/j.phrs.2016.01.033

[5] Devinsky, O., et alt. (2014). Cannabidiol: Pharmacology and potential therapeutic role in epilepsy and other neuropsychiatric disorders. Epilepsia, 55(6), 791–802. doi:10.1111/epi.12631

[6] Press, C. A., et alt. (2015). Parental reporting of response to oral cannabis extracts for treatment of refractory epilepsy. Epilepsy & Behavior, 45, 49–52. doi:10.1016/j.yebeh.2015.02.043

[7] Di Marzo, V., & Piscitelli, F. (2015). The Endocannabinoid System and its Modulation by Phytocannabinoids. Neurotherapeutics, 12(4), 692–698. doi:10.1007/s13311-015-0374-6

[8] Kosgodage, U. S., et alt. (2019). Cannabidiol Is a Novel Modulator of Bacterial Membrane Vesicles. Frontiers in Cellular and Infection Microbiology, 9, 324. doi:10.3389/fcimb.2019.00324