Can I take CBD oil with Prednisone?

by Apoorva Shivankar, M.D

can i take cbd oil with prednisone

Cannabidiol (CBD) is the latest revolution of the medical world managing almost everything including inflammation and resultant pain whereas prednisolone is a well-established magic drug for inflammation. 

They efficiently provide relief to people suffering from strong inflammatory conditions like arthritis, respiratory tract infections, gastric ulcers or allergic reactions individually, but then how strong are they when taken together? Or do they nullify each-others actions? Let us see.

 

Inflammation

This inflammation is a physiological response of the human body wherein the immune system fights against injury or incoming infections, destroys or repairs damaged tissues and even eliminate foreign pathogens.

As an offshoot of this struggle, we develop redness, warmth, and swelling, pain over the affected area and this is called inflammation. The most common manifestation of this inflammation process is fever and pain. Inflammation can take place anywhere inside or outside the body and if left untreated can become chronic giving rise to serious health problems like:

  • Rheumatoid arthritis
  • Heart disease
  • Ulcerative colitis
  • Crohn’s disease
  • Type 2 diabetes
  • Asthma
  • Other autoimmune diseases.
  • Neurodegeneration, including Alzheimer’s disease

Here comes the role of strong anti-inflammatory agents like

 

Prednisone

Prednisone is a type of steroid belonging to the drug class called corticosteroids. It is a potent anti-inflammatory agent which tames inflammatory conditions by suppressing the immune response directly irrespective of the phase of inflamed tissue.

Prednisone is the current drug of choice of most doctors to treat chronic inflammatory conditions like rheumatoid arthritis, asthma, Alzheimer’s disease and even as an immunosuppressant. It can effectively counter the body’s tendency to erroneously attack itself as seen in autoimmune diseases like lupus, inflammatory bowel disease, type 2 diabetes mellitus, and sarcoidosis and can effectively ward off unwanted immune response against transplants or grafts.

But this magical effect of prednisone comes with a cost. It brings along with it a host of unpleasant side-effects including:

  • Restlessness, Insomnia, Dizziness, Sweating
  • Headaches and body aches
  • Nausea, heartburn
  • Mood changes
  • High blood pressure
  • Increased risk of infection due to decreased immunity

and many more.

Prolonged use of corticosteroids can precipitate severe effects restricting prednisone use mostly to short term affairs (flare-ups) only. Long-term use can cause:

  • Vision problems like glaucoma, cataracts
  • Muscle pain and cramping
  • Skin conditions such as thinning and easy bruising
  • Weight gain
  • Puffy face
  • Increased risk of osteoporosis
  • Slower wound healing.
  • Stunted growth in some children.

This is not all, getting off the corticosteroids can be a new struggle in itself. It comes with ‘steroid withdrawal syndrome which occurs especially if prednisone is consumed in higher doses or for longer durations.

Sudden withdrawal can land you up in weakness, fatigue, decreased appetite, weight loss, muscle tenderness, joint pains, abdominal pain and headaches. So, instead of sudden stoppage, a gradual tapering down method is preferred.

Mentioning all this doesn’t mean that we are against prednisone. It is still the best drug available for rheumatoid arthritis, organ transplantations, asthma, post-surgery people, etc. In fact, it is an important part of the management strategy of the current Covid pandemic wherein it reduces the inflammatory damage caused to the lungs.

Only concern is the untoward effects of prednisone which led for a search of newer, safer alternatives to these steroids. CBD proved itself to be a strong natural candidate here.

CBD oil

CBD oil is a Cannabis sativa plant extract with a multitude of medicinal properties and free from the characteristic HIGH EFFECT of cannabis. This absence of high effect is due to the fact that CBD oil restricts its THC concentration to almost nil levels.

CBD oil as an anti-inflammatory agent

Cannabidiol acts by modulating the Endocannabinoid system of the human body. This system comprises of a widespread network of cannabinoid receptors (2 types: CB1 and CB2) and endogenous cannabinoids to maintain a homeostatic balance within the body.

CB1 are mostly situated in the nervous system and are important in resolving mood disorders, depression, stress, sleep, neurodegenerative issues, etc. Whereas CB2 cell receptors are present throughout the body especially in the immune system and thus keep the immune responses in order. To maintain the immune responses to an optimum level, the endogenous cannabinoids Anandamide and 2-AG bind to the CB2 receptors and generate signals to restrict immune responses, thereby lowering inflammation.

In severe cases, these endocannabinoids get used up and then the inflammatory response begins to rise. This may lead to arthritic pain, IBD, peptic ulcers, lung involvement in asthma or covid and even auto-immune disease. At this point, CBD helps in the restoration of endocannabinoids by preventing the breakdown of anandamide. These increased levels of anandamide then reset the ECS back on track and turns off inflammation.

The best part of CBD is unlike prednisone, CBD is devoid of serious side effects. It may rarely lead to minor untoward effects like dry mouth, drowsiness, light-headedness, nausea, diarrhoea, etc when taken in large doses.

 

Is it safe to take CBD oil with prescription drugs?

Why not!!

Both are potent anti-inflammatory agents and taking both together can get the best results out.

CBD can mask the side-effects of prednisone.

Great, isn’t it? Many people get charmed by this.

 

If you also think the same way, we have something to tell you.

Consuming CBD and prednisone together may not probably be a very good idea.

Why so?

Coz of their metabolic drug interaction.

 

Yes, though CBD is not known to cause any strong side effect on its own, it can enhance the benefits as well as adverse effects of other medications by interacting with their metabolisms.  CBD undergoes degradation by CYP450 family of liver enzymes (CYP3A4, CYP2C9, CYP2D6, CYP2C19 and CYP1A2) which is also involved in the metabolism of more than 60 other medications including prednisone.

Prednisone on entering the body is converted to its active form prednisolone in the liver. This prednisolone is later broken down by liver enzymes of the CYP450 family especially CYP3A4. So, when given along with CBD, both prednisolone and CBD compete for CYP 450 for their clearance and CBD being a more potent competitive inhibitor can actually reduce the availability of CYP450 to degrade prednisolone.

The resulting slower metabolism increases the blood levels of prednisolone which remain elevated for a longer duration. These increased amounts may exaggerate effects as well as side-effects and even cause overdose toxicity which may be deleterious.

The beneficial part of the combo is CYP inhibition phenomenon affects only the clearance of prednisolone and not its activation. So, the positive effects of prednisolone are maintained along with its routine side-effects like anxiety, mood changes, depression, dizziness, sleeping difficulty and nervousness which can be easily handled by the added CBD.

Another possibility is that prednisone itself being a weak inducer of CYP3A4 can accelerate CBD clearance and thus, decrease its effectiveness.

Can CBD reduce or replace Prednisone requirement?

Despite of being equally effective, CBD cannot be used as the main-stream medication to treat inflammatory disorders because:

  • Not enough research work on CBD as an anti-inflammatory medication is done till now in the human body.
  • Lack of strict regulations on production, extraction, formulation and labelling of CBD oil cause inconsistency in the quality of CBD products and provide a wide scope for malpractices.

But then there are significant number of patients who do not respond to prescription steroid drugs. Such refractory cases then can resort to CBD oil as a suitable alternative. Also, CBD can be a good option for people who wish to avoid the risks involved in prolonged prednisone use.

 

How to switch from Prednisone to CBD?

As we know, going off prednisone or any other steroids can cause withdrawal symptoms. So, to avoid those risks, in case of switching, it is important to initially taper down the dosage of prednisone very slowly under the guidance of a healthcare provider and with the back-up of diet and exercise to minimize the symptoms in the meanwhile. Following this, CBD can take over at right time.

Final thought:

CBD oil does have the potential to take over prednisone but more research in humans and higher stability in CBD products is needed before it enters the mainstream of drugs.

As far as taking CBD and prednisone together is concerned, with concomitant use, the health benefits and side-effects of prednisone are both retained and amplified. Though CBD can take care of the side effects, the clearance of prednisone is also hampered in presence of CBD, increasing the risk of overdose toxicity.

So, the combination is usually avoided and if needed can be taken with caution under doctors guidance with dose adjustments and a sufficient time gap between the two medications.

FAQs

Q. What drugs should not be taken with CBD?

Drugs that undergo metabolism in the same way as CBD does, that is with the help of CYP450, should be avoided with CBD. They include

  • Blood thinners like warfarin, clopidogrel.
  • Heart rhythm medication, amiodarone.
  • Thyroid medication, levothyroxine.
  • Anti-seizure drugs including clobazam, lamotrigine, and valproate.

 

Q. Are there any other anti-inflammatory medications (apart from corticosteroids and CBD)?

Yes, the nonsteroidal anti-inflammatory drugs (NSAIDs) like Aspirin, Diclofenac, Ibuprofen, Naproxen, etc. can aid mild inflammation and pain. They reduce inflammation by inhibiting the enzymes called cyclo-oxygenase and thereby blocking the release of prostaglandins, the chief mediators of inflammation.

 

References:

  1. Oláh A, Tóth BI, Borbíró I, Sugawara K, Szöllõsi AG, Czifra G, Pál B, Ambrus L, Kloepper J, Camera E, Ludovici M, Picardo M, Voets T, Zouboulis CC, Paus R, Bíró T. Cannabidiol exerts sebostatic and antiinflammatory effects on human sebocytes. J Clin Invest. 2014 Sep;124(9):3713-24. doi: 10.1172/JCI64628. Epub 2014 Jul 25. PMID: 25061872; PMCID: PMC4151231.

  2. Margolin L, Cope DK, Bakst-Sisser R, Greenspan J. The steroid withdrawal syndrome: a review of the implications, etiology, and treatments. J Pain Symptom Manage. 2007 Feb;33(2):224-8. doi: 10.1016/j.jpainsymman.2006.08.013. PMID: 17280928.

  3. Ribeiro A, Ferraz-de-Paula V, Pinheiro ML, Vitoretti LB, Mariano-Souza DP, Quinteiro-Filho WM, Akamine AT, Almeida VI, Quevedo J, Dal-Pizzol F, Hallak JE, Zuardi AW, Crippa JA, Palermo-Neto J. Cannabidiol, a non-psychotropic plant-derived cannabinoid, decreases inflammation in a murine model of acute lung injury: role for the adenosine A(2A) receptor. Eur J Pharmacol. 2012 Mar 5;678(1-3):78-85. doi: 10.1016/j.ejphar.2011.12.043. Epub 2012 Jan 12. PMID: 22265864.

  4. Booz GW. Cannabidiol as an emergent therapeutic strategy for lessening the impact of inflammation on oxidative stress. Free Radic Biol Med. 2011 Sep 1;51(5):1054-61. doi: 10.1016/j.freeradbiomed.2011.01.007. Epub 2011 Jan 14. PMID: 21238581; PMCID: PMC3085542.

  5. Takeda S, Misawa K, Yamamoto I, Watanabe K. Cannabidiolic acid as a selective cyclooxygenase-2 inhibitory component in cannabis. Drug Metab Dispos. 2008 Sep;36(9):1917-21. doi: 10.1124/dmd.108.020909. Epub 2008 Jun 12. PMID: 18556441.

  6. Hammell DC, Zhang LP, Ma F, Abshire SM, McIlwrath SL, Stinchcomb AL, Westlund KN. Transdermal cannabidiol reduces inflammation and pain-related behaviours in a rat model of arthritis. Eur J Pain. 2016 Jul;20(6):936-48. doi: 10.1002/ejp.818. Epub 2015 Oct 30. PMID: 26517407; PMCID: PMC4851925.

  7. Nichols JM, Kaplan BLF. Immune Responses Regulated by Cannabidiol. Cannabis Cannabinoid Res. 2020 Feb 27;5(1):12-31. doi: 10.1089/can.2018.0073. PMID: 32322673; PMCID: PMC7173676.

  8. Russo EB. Cannabinoids in the management of difficult to treat pain. Ther Clin Risk Manag. 2008 Feb;4(1):245-59. doi: 10.2147/tcrm.s1928. PMID: 18728714; PMCID: PMC2503660.

  9. McDonnell AM, Dang CH. Basic review of the cytochrome p450 system. J Adv Pract . 2013 Jul;4(4):263-8. doi: 10.6004/jadpro.2013.4.4.7. PMID: 25032007; PMCID: PMC4093435.

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