Baba asked
I have been taking 0.5mg of Ativan (lorazepam) mid-day and at night for about 6 years to help me with anxiety due to shortness of breath. Can I try CBD oil twice a day with this? I would like to wean off lorazepam if hemp oil helps with this and insomnia.
At a glance
- There is no known drug interaction between CBD (cannabidiol) and Ativan (lorazepam).
- However, both can cause sedation, drowsiness and dizziness so caution must be taken when combining them.
Answer
There are no known interactions between Ativan (lorazepam) and CBD (cannabidiol). However, both can increase sedation and somnolence (feeling of sleepiness).
Therefore, caution is advised when using both together and you should not operate heavy machinery or take part in activities that require mental alertness until you know how both medications affect you.
Below, I discuss CBD, Ativan and potential interactions in more detail.
What Is CBD (Cannabidiol)?
Cannabidiol, often referred to simply as 'CBD', is one of the many constituents of marijuana and is known to be an active component in regard to activity with our endocannabinoid system.
Unlike THC (delta-9-tetrahydrocannabinol), CBD is thought to be 'non-psychoactive' in that it doesn't cause a 'high' or euphoria. Nevertheless, it certainly does affect the central nervous system as studies show it can be beneficial for symptoms of anxiety and can cause sedation.
CBD has been investigated for a wide variety of therapeutic effects, including:
- Chronic Pain
- PTSD
- Multiple sclerosis
- Parkinson's Disease
- Epilepsy
- Huntington's Disease
In addition, CBD may make high THC preparations more tolerable for individuals as it can 'attenuate' or reduce the 'high' experienced without reducing potential medicinal effects.
CBD Side Effects
CBD is very well tolerated in most individuals and is not associated with dependence or withdrawal symptoms, even after extended use.
Although CBD can cause sedation and a general feeling of tiredness, it is not associated with respiratory depression and has been used safely with CNS depressants such as opioids and benzodiazepines. Nevertheless, CBD can cause additive drowsiness when used with other medications with similar side effects (e.g. lorazepam).
The overall side effect profile of CBD is minimal, especially at doses that are used in over the counter products (~3-15 mg) per dose.
Even high doses of CBD are considered well-tolerated. The prescription product Epidiolex, which comes in a concentration of 100 mg/ml and is used for rare seizure disorders, provides a high amount of CBD and lists the following side effects in the prescribing information for the drug:
- Decreased appetite (16-22% incidence)
- Diarrhea (9-20% incidence)
- Sedation (3-6% incidence)
- Lethargy (4-8% incidence)
- Somnolence (23-25% incidence)
- Sleep disturbances (5-11% incidence)
CBD Drug Interactions
There is a lack of information regarding interactions with CBD products and it appears that some may be dose-related (meaning higher doses increase the risk of interaction) (14). Potential interactions stem from the fact that CBD may inhibit certain CYP metabolizing enzymes in the liver, including:
- CYP 3A4
- CYP 2C19
- CYP 1A1
- CYP 2B6
- CYP 2C9
When a metabolizing enzyme is inhibited, it cannot break down a drug as effectively or as quickly, leading to increased concentrations. This can increase the risk of side effects.
A good example of this is the interaction between Lipitor, a cholesterol-lowering medication, and clarithromycin, an antibiotic. Clarithromycin can inhibit CYP 3A4, which is responsible for metabolizing Lipitor. This increases concentrations of the drug, putting individuals at risk for serious side effects, such as rhabdomyolysis.
It should be noted that most interaction studies with CBD have been only done in animals and the extent of potential interactions in humans isn't well known.
Ativan (lorazepam), the drug in question regarding CBD interactions, is not metabolized by CYP enzymes, but rather by liver glucuronidation. As far as we know, CBD has no effect of Ativan concentrations in the body.
Lastly, the concern with combining CNS depressants together is the risk of respiratory depression. Opioids and benzodiazepines are well associated with it. CBD products, however, are not and are generally considered safe in that regard.
Ativan Information
Ativan (lorazepam) is a rapid-acting benzodiazepine medication and is used primarily for the treatment of anxiety disorders.
It has several advantages over other benzodiazepines, including:
- It is not metabolized by CYP liver enzymes and has fewer potential drug interactions when compared to medications that are.
- It does not have active metabolites and therefore doesn't accumulate in the body. This can be beneficial in certain populations, such as the elderly.
The most common side effects of benzodiazepines, like Ativan, are as follows:
- Sedation
- Fatigue
- Memory impairment
- Dizziness
- Impaired motor coordination
- Shallow breathing (high doses)
Taking CBD With Ativan
As discussed, there are no known interactions between CBD and Ativan. However, it is important to know that both can cause sedation and a general feeling of fatigue, which could be additive if taken together.
It is important to let your doctor know all the medications/over the counter products you are taking so you can be appropriately monitored.
References
- An Update on Safety and Side Effects of Cannabidiol: A Review of Clinical Data and Relevant Animal Studies. PubMed
- Risks, Management, and Monitoring of Combination Opioid, Benzodiazepines, and/or Alcohol Use. PubMed
- Ativan Prescribing Information. AccessFDA
- Statin-induced rhabdomyolysis: a complication of a commonly overlooked drug interaction. PubMed
- Characterization of major phytocannabinoids, cannabidiol and cannabinol, as isoform-selective and potent inhibitors of human CYP1 enzymes. PubMed
- Characterization of cannabidiol-mediated cytochrome P450 inactivation. PubMed
- Potent inhibition of human cytochrome P450 3A isoforms by cannabidiol: role of phenolic hydroxyl groups in the resorcinol moiety. PubMed
- Multicenter, Double-Blind, Randomized, Placebo-Controlled, Parallel-Group Study of the Efficacy, Safety, and Tolerability of THC:CBD Extract and THC Extract in Patients with Intractable Cancer-Related Pain. ScienceDirect
- Controlled clinical trial of cannabidiol in Huntington's disease. FDA
- Epidiolex Prescribing Information. AccessFDA
- Cannabidiol for the treatment of psychosis in Parkinson's disease. PubMed
- Oromucosal Δ9-tetrahydrocannabinol/cannabidiol for neuropathic pain associated with multiple sclerosis: An uncontrolled, open-label, 2-year extension trial. ScienceDirect
- Multiple mechanisms involved in the large-spectrum therapeutic potential of cannabidiol in psychiatric disorders. FDA
- Medical Marijuana for Treatment of Chronic Pain and Other Medical and Psychiatric Problems A Clinical Review. JAMA Network
- Effects of ipsapirone and cannabidiol on human experimental anxiety. PubMed
- The diverse CB1 and CB2 receptor pharmacology of three plant cannabinoids: delta9-tetrahydrocannabinol, cannabidiol and delta9-tetrahydrocannabivarin. PubMed
