Is CBD Safe With Lialda?

In our latest question and answer, the pharmacist discusses the use of CBD (cannabidiol) with Lialda.

Question

Are there any known interactions between CBD oil and Lialda?

Asked by Nicole On Apr 09, 2019

Answered by
Medical Content Reviewed By PharmacistAnswers Staff

On Apr 12, 2019
Bottle Of CBD Oil With Hemp Plant With Text For Lialda

Overview

There is no known drug interaction between CBD (cannabidiol) and Lialda (mesalamine).

Even though there are no studies available that specifically discuss a potential interaction between CBD and Lialda, one appears to be unlikely since Lialda is not metabolized by CYP enzymes and the anti-inflammatory actions of the drug are mostly due to its local effects (i.e. effect doesn't rely on the drug being absorbed systemically).[1]


CBD Interactions

There is much we don't know about how CBD (cannabidiol) could potentially interact with other drugs.

For some time, many studies on the matter suggested that CBD has a very low likelihood of causing drug interactions unless extremely high doses were taken.[2]

However, more recent studies have definitively shown that CBD does in fact pose some risk for drug interactions (especially anti-epileptic drugs) via a variety of mechanisms.[3]

In fact, one study reported that CBD increased concentrations of N-desmethylclobazam (an active metabolite of the anti-epileptic drug clobazam) more than three-fold, which could increase the risk of dose-related side effects.[4]

Other studies report that CBD has been linked to an increase in liver enzymes when used with certain anti-epileptics (like valproate).[5]

There are a variety of mechanisms by which CBD could affect concentrations of other drugs.

The prescribing information for Epidioloex, a prescription CBD for rare forms of seizure, states that CBD could either inhibit or induce (i.e. increase the activity of) several metabolizing enzymes.[6]

Therefore, CBD has the potential to interact with drugs that are metabolized by those enzymes. These enzymes include:

  • UGT1A9
  • UGT2B7
  • CYP1A2
  • CYP2B6
  • CYP2C8
  • CYP2C9
  • CYP2C19
  • UGT2B7

It is always a good idea to check with your pharmacist or doctor regarding potential drug interactions if you are considering taking CBD. They can let you know if anything has been reported or make an educated guess based on the known metabolism of the drugs you are taking.


Lialda With CBD

As it concerns Lialda, as mentioned earlier, CBD is not known to interact with it for a few reasons:

  • It is not metabolized by an enzyme known to be affected by CBD
  • The medicinal effects of the drug are mostly due to a local effect (i.e. the effects of the drug aren't dependent on it being absorbed)

Lialda contains mesalamine, which is a derivative of salicylic acid.

It works to reduce inflammation in the intestines via several mechanisms including:[7]

  • Decreasing prostaglandin formation
  • Inhibiting leukotriene synthesis
  • Inhibiting accumulation of thromboxane A
  • Inhibiting the activation of NFκB, which regulates proteins that may cause inflammation.[8]

Since Lialda works locally in the large intestine, the active ingredient in the drug (mesalamine) is also available in rectally administered products, such as Canasa.

Lialda does get metabolized to some extent, such as in the intestines and in the liver by N-acetyltransferase, but CBD is not known to have any effect on this.

The majority of interactions with Lialda are with drugs that affect gastric pH, since the tablets have a 'gastro-resistant' film.

This film delays the initial release of the drug until the tablet is exposed to a higher pH (which is found in the intestines).[9] CBD is not known to affect the acidity of the stomach or intestines.


Summary

There is no known drug interaction between Lialda and CBD (cannabidiol).

References
  1. ^ Lialda Prescribing Information. AccessFDA
  2. ^ Cannabinoids in the management of difficult to treat pain. PubMed
  3. ^ An Update on Safety and Side Effects of Cannabidiol: A Review of Clinical Data and Relevant Animal Studies. PubMed
  4. ^ Drug-drug interaction between clobazam and cannabidiol in children with refractory epilepsy. PubMed
  5. ^ Interactions between cannabidiol and commonly used antiepileptic drugs. PubMed
  6. ^ Epidiolex Prescribing Information. AccessFDA
  7. ^ Elsevier ClinicalKey: Lialda Monograph. ClinicalKey (Subscription Required)
  8. ^ Mesalamine in the treatment and maintenance of remission of ulcerative colitis. PubMed
  9. ^ The Multimatrix Mesalamine Formulation. PubMed

About the Pharmacist

Dr. Brian Staiger Pharm.D

Dr. Brian Staiger is a licensed pharmacist in New York State and the founder of PharmacistAnswers.com. He graduated from the University At Buffalo with a Doctor of Pharmacy degree in 2010. He has been featured in numerous publications including the Huffington Post as well as a variety of health and pharmacy-related blogs. Please feel free to reach out to him directly if you have any inquiries or want to connect! He's answered thousands of medication and pharmacy-related questions and he's ready to answer yours! Brian.Staiger@PharmacistAnswers.com Office: 716-389-3076

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