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Some medications changed by the liver include nicotine, chlormethiazole (Heminevrin), coumarin, methoxyflurane (Penthrox), halothane (Fluothane), valproic acid (Depacon), disulfiram (Antabuse), and others. Medications changed by the liver (Cytochrome P450 2B6 (CYP2B6) substrates) Some medications are changed and broken down by the liver. Cannabidiol might decrease how quickly the liver breaks down some medications. In theory, using cannabidiol along with some medications that are broken down by the liver might increase the effects and side effects of some medications. Before using cannabidiol, talk to your healthcare provider if you take any medications that are changed by the liver.

Some medications changed by the liver include amitriptyline (Elavil), haloperidol (Haldol), ondansetron (Zofran), propranolol (Inderal), theophylline (Theo-Dur, others), verapamil (Calan, Isoptin, others), and others. Medications changed by the liver (Cytochrome P450 1B1 (CYP1B1) substrates) Some medications are changed and broken down by the liver. Cannabidiol might decrease how quickly the liver breaks down some medications. In theory, using cannabidiol along with some medications that are broken down by the liver might increase the effects and side effects of some medications. Before using cannabidiol, talk to your healthcare provider if you take any medications that are changed by the liver.

Some medications changed by the liver include testosterone, progesterone (Endometrin, Prometrium), nifedipine (Adalat CC, Procardia XL), cyclosporine (Sandimmune), and others. Medications changed by the liver (Glucuronidated drugs) Some medications are changed and broken down by the liver. Cannabidiol might decrease how quickly the liver breaks down some medications. Taking cannabidiol along with some medications that are broken down by the liver might increase the effects and side effects of these medications.
Some of these medications changed by the liver include acetaminophen (Tylenol, others) and oxazepam (Serax), haloperidol (Haldol), lamotrigine (Lamictal), morphine (MS Contin, Roxanol), zidovudine (AZT, Retrovir), and others. Medications that decrease the breakdown of other medications by the liver (Cytochrome P450 2C19 (CYP2C19) inhibitors) Cannabidiol is broken down by the liver. Some medications might decrease how quickly the liver breaks down cannabidiol. Taking cannabidiol along with these medications might increase the effects and side effects of cannabidiol.
Some medications that might decrease the breakdown cannabidiol in the liver include cimetidine (Tagamet), fluvoxamine (Luvox), omeprazole (Prilosec); ticlopidine (Ticlid), topiramate (Topamax), and others. Medications that decrease the breakdown of other medications in the liver (Cytochrome P450 3A4 (CYP3A4) inhibitors) Cannabidiol is broken down by the liver. Some medications might decrease how quickly the liver breaks down cannabidiol. Taking cannabidiol along with these medications might increase the effects and side effects of cannabidiol.
Some medications that might decrease how quickly the liver breaks down cannabidiol include amiodarone (Cordarone), clarithromycin (Biaxin), diltiazem (Cardizem), erythromycin (E-mycin, Erythrocin), indinavir (Crixivan), ritonavir (Norvir), saquinavir (Fortovase, Invirase), and many others. Medications that increase breakdown of other medications by the liver (Cytochrome P450 3A4 (CYP3A4) inducers) Cannabidiol is broken down by the liver. Some medications might increase how quickly the liver breaks down cannabidiol. Taking cannabidiol along with these medications might decrease the effects of cannabidiol.
Some of these medicines include carbamazepine (Tegretol), phenobarbital, phenytoin (Dilantin), rifampin, rifabutin (Mycobutin), and others. Medications that increase the breakdown of other medications by the liver (Cytochrome P450 2C19 (CYP2C19) inducers) Cannabidiol is broken down by the liver. Some medications might increase how quickly the liver breaks down cannabidiol. Taking cannabidiol along with these medications might decrease the effects of cannabidiol.
Some medications that might increase the breakdown of cannabidiol in the liver include carbamazepine (Tegretol), prednisone (Deltasone), and rifampin (Rifadin, Rimactane). Methadone (Dolophine) Methadone is broken down by the liver. Cannabidiol might decrease how quickly the liver breaks down methadone. Taking cannabidiol along with methadone might increase the effects and side effects of methadone. Rufinamide (Banzel) Rufinamide is changed and broken down by the body. Cannabidiol might decrease how quickly the body breaks down rufinamide. This might increase levels of rufinamide in the body by a small amount. Sedative medications (CNS depressants) Cannabidiol might cause sleepiness and drowsiness. Medications that cause sleepiness are called sedatives. Taking cannabidiol along with sedative medications might cause too much sleepiness.

Are there safety concerns?

Cannabidiol has effects on the brain. The exact cause for these effects is not clear. However, cannabidiol seems to prevent the breakdown of a chemical in the brain that affects pain, mood, and mental function. Preventing the breakdown of this chemical and increasing its levels in the blood seems to reduce psychotic symptoms associated with conditions such as schizophrenia. Cannabidiol might also block some of the psychoactive effects of delta-9-tetrahydrocannabinol (THC). Also, cannabidiol seems to reduce pain and anxiety.

Some medications changed by the liver include chlorzoxazone (Lorzone) and theophylline (Theo-Dur, others). Medications changed by the liver (Cytochrome P450 1A2 (CYP1A2) substrates) Some medications are changed and broken down by the liver. Cannabidiol might decrease how quickly the liver breaks down some medications. In theory, using cannabidiol along with some medications that are broken down by the liver might increase the effects and side effects of some medications. Before using cannabidiol, talk to your healthcare provider if you take any medications that are changed by the liver.

Some medications changed by the liver include ketamine (Ketalar), phenobarbital, orphenadrine (Norflex), secobarbital (Seconal), and dexamethasone (Decadron). Medications changed by the liver (Cytochrome P450 2C19 (CYP2C19) substrates) Some medications are changed and broken down by the liver. Cannabidiol might decrease how quickly the liver breaks down some medications. In theory, using cannabidiol along with some medications that are broken down by the liver might increase the effects and side effects of some medications. Before using cannabidiol, talk to your healthcare provider if you take any medications that are changed by the liver.

Pregnancy and breast-feeding: Cannabidiol is POSSIBLY UNSAFE to use if you are pregnant or breast feeding. Cannabidiol products can be contaminated with other ingredients that may be harmful to the fetus or infant. Stay on the safe side and avoid use.

Similar to other European countries (e.g. Germany, Switzerland) each authority In Finland controls products that have been placed on the market in accordance with their respective competence. Fimea engages in collaboration with the Customs to control the import of products. Where necessary, the Customs will request Fimea to issue a statement if the Customs encounters a preparation that could be a medicine.

The Finnish Medicines Agency (Fimea) recently stated that Cannabidiol (CBD) is controlled as a medicine in Finland. A (medicinal) preparation that contains CBD needs a prescription and each preparation is assessed separately by Fimea. Furthermore, purchasing products containing CBD from abroad may be illegal. It is forbidden to import a preparation containing CBD into Finland that is classified as a medicine without a prescription. “Anyone who orders products from the net, for example, or brings products with them from abroad must first ensure that importing them is legal.” According to the agency, the restrictions depend on the composition of the product and how it would be classified in Finland. Furthermore, the restrictions also vary according to whether the medicine is imported from within or outside of the European Economic Area (EEA).

According to the Finnish Food Authority (FFA) the use of Hemp (and its ingredients like CBD) as food is currently being discussed in working groups of the EU Commission. The aim is to clarify its status as novel food in the Novel Food Catalogue of the Commission. This work has not been finished yet and the interpretation on the FFA webpage will be updated if necessary. Foodstuffs which are considered as novel foods in the EU may not be used as foodstuffs without a novel food authorization. Neither may they be marketed containing medical claims.

For more information please read the statement “Cannabidiol (CBD) is controlled as a medicine in Finland” on the Fimea website.

Review by the physician

Pharmacotherapeutic Group: Other Analgesics and Antipyretics

The spray container should be shaken before use and the spray should be directed at different sites on the oromucosal surface changing the application site each time the product is used.

Patients with significant hepatic or renal impairment

In an in vitro study Sativex was found to inhibit the UGT enzymes UGT1A9 and UGT2B7 at concentrations that could be achieved in the clinic. Care should be taken when prescribing Sativex with concomitant medications which are solely metabolised by both or either of these UGTs (e.g. Propofol and certain antivirals). Patients with genetic glucuronidation disorders (e.g. Gilbert’s disease) may exhibit increased serum concentrations of bilirubin and must be treated with caution when Sativex is co-administered.