Importance of checking drug interactions with CBD

January 2, 2019

When prescribing or purchasing CBD, in any form, it is very important that a medication profile be reviewed and checked for potential drug interactions.  There are 2 major cyp450 enzymes that metabolize CBD; cyp3a4 (metabolizes most drugs) and cyp2d6.  I recently had a client that came to me with a number of issues (after extensive interviews including a med profile which, at the time, only include something for sleep the primary ones being a compromised immune system which presented as a chronic EBV viral infection, spleen issues, chronic sore throat, swollen lymph nodes etc. and, more importantly, chronic gut issues which included ongoing stomach ulcers, SIBO (syndrome of inappropriate bacterial overgrowth-out of balance gut bacteria, gut inflammation, potential parasite and a 20 pound weight loss over a 3 month period.  These issues were supported by a stool test and a nutritional test.   I proceeded to treat the immune issues with LDN, colostrum, vitamin d and high dose vitamin C.  I started to treat the gut issues with high dose probiotics, digestive enzymes and GI microbix and oregano for the potential parasites.  I started CBD oil for both the gut and immune issues.  Shortly afterwards I got a call from the client telling me that she was presenting with, initially, severe sweating of her hands (palmar hyperhydrosis) along with extreme fatigue which only got progressively worse over the next week.  At this point I thought she may have been experiencing a "herx" reaction to parasite/bacteria die off (even thought about testing her flor Lyme as this is the kind of Herx reaction one might see).  I started her on acetyl-glutathione and zeolyte powder for the assumed toxins. She then called me to tell me that she remembered that just recently her psychiatrist put her on fluoxetine, an SSRI antidepressant, that when I looked at the side effects severe sweating, extreme fatigue etc.  She then told me that shortly after starting this drug she had minor symptoms of sweating etc.  When I looked for a potential drug interaction with the CBD it turned out she did in fact have an interaction with cyp2dr which was preventing the metabolism of the fluoxetine thus steadily increasing her blood levels.  Fluoxetine when used routinely has a half life of up to 6 days.  A few days before I told her about the drug interaction she went ahead and stopped the drug anyway after she read the side effects.  I also suggested she stop the CBD for at least a week before starting again (waiting for the serum levels of the drug to go down.  Since then her symptoms have steadily declined.

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