CBD is biphasic , meaning that it has different effects on the system depending on the concentration in the bloodstream. Up to a certain point, CBD can provide beneficial health properties, but those have been shown to plateau once that threshold has been reached. In short, you can have too much of a good thing.
Current research on using cannabis to treat nausea and vomiting suggests CBD oil may also help prevent these unwanted lithium side effects. Though, it’s important to note that while the results have been positive, they’re also based on treatment plans that include both CBD and THC. As the stigma around CBD and cannabis in general continues to dissipate, more research on cannabidiol’s therapeutic benefits will be conducted and the general public will have a clearer idea of how CBD oil specifically can help with certain conditions.
Always consult with your physician before embarking on any new course of treatment, together you can decide if using CBD oil with lithium is the right option for you.
How to Safely Use CBD Oil and Lithium Together
In most instances, mood disorders like bipolar disorder are treated with lithium in conjunction with other antipsychotic, mood stabilizing, anti-depressant, and/or anti-anxiety medications; it’s not uncommon for a mood-regulating medication regimen to include more than one prescription. This means there’s a greater possibility for side effects.
These results are promising, and point to CBD oil as a potential and well-tolerated supplement to lithium treatment plans when it comes to schizophrenia.
It’s also important to educate yourself on the research that’s already been done on combining CBD oil and lithium so you can make your decision with full confidence.
Your ideal dosage of CBD oil will vary depending on metabolism, weight, age, and numerous other internal factors, so there is no standard “ideal dosage”. To use CBD oil and lithium together safely, it is recommended that you follow the dosing information found on your CBD oil product, or use this dosage guide as a starting point.
The researchers further warned that while the list may be used as a starting point to identify potential drug interactions with marijuana or CBD oil, plant-derived cannabinoid products may deliver highly variable cannabinoid concentrations (unlike the FDA-regulated prescription cannabinoid medications previously mentioned), and may contain many other compounds that can increase the risk of unintended drug interactions.
Many drugs are broken down by enzymes in the liver, and CBD may compete for or interfere with these enzymes, leading to too much or not enough of the drug in the body, called altered concentration. The altered concentration, in turn, may lead to the medication not working, or an increased risk of side effects. Such drug interactions are usually hard to predict but can cause unpleasant and sometimes serious problems.
Absolutely. Inhaled CBD gets into the blood the fastest, reaching high concentration within 30 minutes and increasing the risk of acute side effects. Edibles require longer time to absorb and are less likely to produce a high concentration peak, although they may eventually reach high enough levels to cause an issue or interact with other medications. Topical formulations, such as creams and lotions, may not absorb and get into the blood in sufficient amount to interact with other medications, although there is very little information on how much of CBD gets into the blood eventually. All of this is further complicated by the fact that none of these products are regulated or checked for purity, concentration, or safety.
CBD can alter the effects of other drugs
While generally considered safe, CBD may cause drowsiness, lightheadedness, nausea, diarrhea, dry mouth, and, in rare instances, damage to the liver. Taking CBD with other medications that have similar side effects may increase the risk of unwanted symptoms or toxicity. In other words, taking CBD at the same time with OTC or prescription medications and substances that cause sleepiness, such as opioids, benzodiazepines (such as Xanax or Ativan), antipsychotics, antidepressants, antihistamines (such as Benadryl), or alcohol may lead to increased sleepiness, fatigue, and possibly accidental falls and accidents when driving. Increased sedation and tiredness may also happen when using certain herbal supplements, such as kava, melatonin, and St. John’s wort. Taking CBD with stimulants (such as Adderall) may lead to decreased appetite, while taking it with the diabetes drug metformin or certain heartburn drugs (such as Prilosec) may increase the risk of diarrhea.
Researchers from Penn State College of Medicine evaluated existing information on five prescription CBD and delta-9-tetrahydrocannabinol (THC) cannabinoid medications: antinausea medications used during cancer treatment (Marinol, Syndros, Cesamet); a medication used primarily for muscle spasms in multiple sclerosis (Sativex, which is not currently available in the US, but available in other countries); and an antiseizure medication (Epidiolex). Overall, the researchers identified 139 medications that may be affected by cannabinoids. This list was further narrowed to 57 medications, for which altered concentration can be dangerous. The list contains a variety of drugs from heart medications to antibiotics, although not all the drugs on the list may be affected by CBD-only products (some are only affected by THC). Potentially serious drug interactions with CBD included
CBD has the potential to interact with many other products, including over-the-counter medications, herbal products, and prescription medications. Some medications should never be taken with CBD; the use of other medications may need to be modified or reduced to prevent serious issues. The consequences of drug interactions also depend on many other factors, including the dose of CBD, the dose of another medication, and a person’s underlying health condition. Older adults are more susceptible to drug interactions because they often take multiple medications, and because of age-related physiological changes that affect how our bodies process medications.
Products containing cannabidiol (CBD) seem to be all the rage these days, promising relief from a wide range of maladies, from insomnia and hot flashes to chronic pain and seizures. Some of these claims have merit to them, while some of them are just hype. But it won’t hurt to try, right? Well, not so fast. CBD is a biologically active compound, and as such, it may also have unintended consequences. These include known side effects of CBD, but also unintended interactions with supplements, herbal products, and over-the-counter (OTC) and prescription medications.
He met criteria for Autism Spectrum Disorder, co-morbid with severe intellectual disability and associated aggressive and self-harmful behaviors and sleep difficulties. At baseline, he was non-verbal with incontinence, though with full strength and ambulation.
In an open-label study of CBD involving children and adults with refractory epilepsy, the use of concomitant ASMs was evaluated for 8 of the most commonly used agents (clobazam, lamotrigine, topiramate, rufinamide, valproic acid, levetiracetam, stiripentol, and felbamate). Most ASMs did not demonstrate significantly different serum levels in the presence of increasing CBD doses. Those that did demonstrate changes were topiramate, zonisamide, eslicarbazepine, rufinamide, and clobazam (with its active metabolite N-desmethylclobazam), all of which demonstrated higher serum levels with concomitant CBD use, either in adults or in both adults and children. Abnormal liver enzyme levels were noted in participants taking concomitant valproate. 7,16
Cannabidiol has a high volume of distribution and is very lipophilic and highly protein bound. 8 After absorption from the GI tract, CBD is metabolized in the liver, where the primary enzymes involved in its hydroxylation are those of the CYP family. 9 In addition, CBD inhibits the function of certain CYP enzymes, which likely contributes to its pharmacologic interactions with other medications. 10 -12
In 2018, the United States Food and Drug Administration (FDA) approved an oil-based highly purified liquid formulation of Cannabidiol (CBD) (Epidiolex ® – Greenwich Biosciences, Inc.) for the treatment of seizures associated with Dravet syndrome (DS) and Lennox-Gastaut syndrome (LGS) in patients over 2 years of age. Unlike other approved antiseizure medications (ASMs), CBD has a unique structure and potentially novel multimodal mechanism of action and does not activate or bind directly to cannabinoid receptors CB1 or CB2 at physiologically relevant concentrations. 1,2
Upon evaluation in the ED, he was afebrile though somnolent. When arousable and more awake he was ataxic compared to baseline. Blood pressure, blood counts, electrolytes, liver enzyme levels, renal function tests, and clobazam levels were all unremarkable. In contrast, the lithium level was notably elevated at 2.4 mmol/L (compared to his historic baseline of 1 -1.3 mmol/L). Psychiatry and neurology were consulted. Lithium was stopped, and midday doses of clonidine and felbamate were held. He was placed NPO and on twice maintenance intravenous fluids with serial checks of lithium levels and monitoring of urine output, with a targeted goal of 1-2 ml/kg/hr. Lithium levels declined over the subsequent 48 hours, and his mental status improved. He was monitored for 3 days during which time he gradually returned to baseline and remained seizure-free. His parents reported improved behavior and requested that he remain off lithium. On the day of discharge, his lithium level was 0.6 mmol/L, and he remained on perphenazine, quetiapine, and trazodone.