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Cbd oil vs amitriptyline for pain

CBD and other medications: Proceed with caution

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.

Doubling up on side effects

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.

CBD can alter the effects of other drugs

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.

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

  • a common blood thinner, warfarin
  • a heart rhythm medication, amiodarone
  • a thyroid medication, levothyroxine
  • several medications for seizure, including clobazam, lamotrigine, and valproate.
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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.

Does the form of CBD matter?

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.

The bottom line: Talk to your doctor or pharmacist if using or considering CBD

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.

People considering or taking CBD products should always mention their use to their doctor, particularly if they are taking other medications or have underlying medical conditions, such as liver disease, kidney disease, epilepsy, heart issues, a weakened immune system, or are on medications that can weaken the immune system (such as cancer medications). A pharmacist is a great resource to help you learn about a potential interaction with a supplement, an herbal product (many of which have their own drug interactions), or an over-the-counter or prescription medication. Don’t assume that just because something is natural, it is safe and trying it won’t hurt. It very well might.

Amitriptyline with Cannabidiol (CBD)?

Does anyone have experience of using CBD at the same time as amitriptyline? I’m currently on 20mg per day of ami but want to try CBD as an alternative. Do I need to taper off the ami first? Thanks.

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0 likes, 11 replies

11 Replies

elizabeth85938 epfletcher

Posted 4 years ago

I use CBD Oil alongside Pregabalin with no problems – I am tapering off Pregab and CBD is helping with the withdrawals. I know of one friend who is on Amitrip and using CBD with no problems. Just bear in mind that it takes a while of taking the Oil for it to build up and needs patience. If you then want to taper off Amitriptyline do it slowly – even though you are not on a high dose you will still perhaps have some withdrawal symptoms, certainly if you have been on this drug for a long time. Hope this helps

epfletcher elizabeth85938

Posted 4 years ago

Hi there and thanks for your reply. This is good to know! I read recently about the oil taking a while to build up – it can take as long as 6 weeks, apparently – have I got that right? Do you mind me asking how you use the oil (when in the day/how much do you use)? I have received a couple of CBD samples but am at a bit of a loss to know how to get started. I know that everyone is different, but it would be good to hear from someone who is actually trying the CBD. Regarding the amitriptyline, I’ve been on it for around 4 months – originally on a 10 mg dose, increasing to 20 mg a couple of months ago. My plan is to reduce from 20 to 17.5 mg per night, see how things go for a couple of weeks, say, then reduce by a further 2.5 mg daily, which I hope will turn out OK.

elizabeth85938 epfletcher

Posted 4 years ago

Yes, it can take up to 6 weeks or so to build up in the body. I am not allowed to say where I buy mine on this forum unfortunately but there is a lot to choose from and finding what will work best for you is trial and error. I tried 3 levels of the oil before I settled on one, I use 3 drops under the tongue 3 times a day Hold it there for a couple of minutes and then swallow). Some taste nicer than others!! There are various strengths to choose from and the lower strengths did not work for me. I will see if I can private message you and then maybe I can give you more info. As for the Amitriptyline, you are wise to taper off as you say with a couple of weeks in between to see if you have any withdrawals. If you are fine on 2.5mgs after 5-7 days just carry on down but not 2.5mg daily – that may well be too much for your body to cope with so leave gaps between. Even on the dose you are taking it will not take long before you get to the finish line so try not to hurry it. Good luck

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epfletcher elizabeth85938

Posted 4 years ago

Hi there. This is very helpful and I think I will start the CBD today, at the level you’ve suggested, and see how I get on.

Re the Amitriptyline, I’ve reread my earlier post and realise that I worded it very badly and can understand how you read it as you did! I’ve now reduced from 20 mg to 17.5 mg and intend to continue to reduce by 2.5 mg per day (not daily), allowing two weeks at each reduced level before reducing further.

Thanks again for your help.

louella2005 elizabeth85938

Posted 4 years ago

Hi Elizabeth. I’m on pregabalin 75mg once a day. I’ve just got a cbd oil organic one 1000mg. I suffer with terrible anxiety. Do u think I’m ok tking one drop a day of the cbd oil a day When I’m on pregabalin . I get so frightened of mixing things . I tried asking my doc but they can’t tell me as they don’t prescribe it . So I’ve been up and down whether to tk it or not . I don’t see any halm in one drop a day . Kind regards Louise x

elizabeth85938 louella2005

Posted 4 years ago

I take CBD Oil (more than 1 drop a day) alongside Pregabalin which I am tapering off from. I have never had a problem. CBD Oil takes a while to know which strain to buy and how many drops will help you. Where did you buy your oil if you don’t mind me asking? There are a couple of outlets in the UK that I have used and can verify are good to deal with but I am not allowed to give you links on here I am afraid. If you look back on previous posts here you will read more I have said to others. If you ever wish to come off Pregabalin because you have side effects there is an excellent support group, Lyrica Survivors (Official) Closed you could join where you can find a wealth of information about this drug and what it does to your brain chemistry and central nervous system, also how to safely and slowly taper off it. That is your choice Louise but you may find it helpful. I do hope you are able to sort this out to your best advantage. Best regards, Liz