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cbd oil and kidney transplant

Dr. McIntrye, who co-authored a 2018 study that concluded that healthcare providers need more information about drug-drug interactions with CBD and psychotropic medication, says much of the information out there is confusing and contradictory. Therefore, he echoes Dr. Alloway’s statement that it is absolutely prudent that patients clear the use of CBD with their doctor before giving it a go.

CBD is thought to act on certain receptors in your brain and other parts of the body, in ways that could relieve pain, or help certain health conditions, like childhood seizure disorders. However, as with any “natural” product, the fact that it comes from plants doesn’t automatically render it innocuous. For some people, particularly those taking certain prescription medications, using CBD is risky. It has anticoagulant effects that can thin blood; it can also modestly lower blood pressure. These effects could be dangerous for people with certain medical conditions.

Case in point: tacrolimus , an immunosuppressive medication used to prevent organ rejection in patients who have had heart, liver, or kidney transplants. CBD interferes with the metabolism of tacrolimus, according to research conducted by Dr. Alloway , who specializes in post-transplant immunosuppression. And because tacrolimus is a narrow therapeutic index drug (meaning the window between efficacy and toxicity is very small), this interference can lead to clinically significant negative outcomes (such as kidney problems or organ rejection), she says.

Does CBD interact with medications?

But claims that CBD aids in the treatment of certain mental health and psychiatric conditions, don’t pass muster, says Roger McIntyre, MD , professor of psychiatry and pharmacology at the University of Toronto.

Furthermore, most prescription medications used to manage these conditions are metabolized by cytochrome P450, making it entirely possible that CBD could interfere with—rather than enhance—treatment.

“Herbal products are drugs,” says Rita Alloway, Pharm.D. , research professor of nephrology at the University of Cincinnati College of Medicine. “Just because [something] is herbal … doesn’t mean it can’t interact with any of the pharmaceutically manufactured drugs that you may be taking.”

And shoppers are buying it, so to speak—one recent report indicated that CBD sales are expected to hit $16 billion by 2026, up from just over $1 billion in 2018. But what exactly is CBD, and is it safe for people who are using prescription medications? Before using it, it’s important to learn about the potential CBD drug interactions.

Tacrolimus is a mainstay medication for organ transplant, so this possible interaction could be important for patients who need an organ transplant. Moreover, there has been some research on the potential to use CBD in transplant patients. Both THC and CBD tend to tone down immune activity and they have recently been suggested for treating graft-versus host disease, a potentially deadly reaction to organ transplants.

With CBD becoming more mainstream, doctors are on the lookout for how this powerful chemical affects human health. But a typical adult in the U.S. takes at least one pharmaceutical, and CBD ’s interaction with other medications can be significant, especially given how easily one can overdose on common drugs. A new potential interaction has been highlighted by scientists at the University of Cincinnati, in Ohio. They report a woman using an extremely high dose of pure CBD for epilepsy — between 2-3 grams per day. She was also taking tacrolimus, a common immunosuppresive drug, to treat a kidney disorder. When combining these two treatments, tacrolimus levels in the blood rose by three-fold — a dangerous result. Because the addition of CBD helped control the seizures, her doctors helped her adjust the dose of these two drugs. This is commonly what happens with drug-drug interactions — there is an important need to monitor drug levels, but the interaction can be managed without ill effect for many patients.

The interaction between CBD and tacrolimus – a drug used in kidney disease and organ transplants – can be managed via dosage adjustment and careful monitoring by a doctor.

How relevant is a cannabinoid-drug interaction like this to the average person? It depends greatly on the dose of CBD . In this case, there are probably two proteins that CBD interferes with to increase drug exposure — it inhibits CYP3A4 , an enzyme that breaks down more than half of all pharmaceuticals, and it can inhibit P-gp, a protein which pumps chemicals out of certain cells. But this woman was using multiple grams of CBD per day. If she got this from good quality cannabis flower (say, a flower that’s 20% CBD by weight), she would have to eat half an ounce each day. That’s not the normal dose that people take, even those using cannabis for epilepsy. When unpurified cannabis extracts are used, the common doses are 10-100 times lower. THC and other plant compounds appear responsible for this greater potency, and the consequent lesser risk of drug-drug interactions. In other words, THC seems to make CBD a safer more effective medicine.

First, the distinction needs to be made between recreational cannabis and medical cannabis. Recreational cannabis is most commonly smoked and contains high levels of Δ-9 tetrahydrocannabinol (THC), responsible for the euphoric intoxicating “high” but which can cause anxiety and panic attacks at high doses. Medical cannabis, which generally contains higher concentrations of cannabidiol (CBD), a nonintoxicating cannabinoid, is taken by mouth, avoiding the cardiovascular and pulmonary harms of smoke inhalation. Medical cannabis may achieve symptom relief with subpsychoactive doses of THC, avoiding the acute neuropsychiatric side effects that are of significant concern for transplant adherence.

– Guest Post written by Joshua Rein @ThepHunClub

Official Blog of the American Journal of Kidney Diseases

Cannabis may be efficacious for several symptoms frequently experienced by people with advanced CKD and ESKD, including pain. Last year’s NephMadness featured the Pain Region , with Team Opioids making it to the final four but losing to the eventual champion, US HTN Guidelines. The opioid epidemic has been devastating. It seems like opioids are the only effective treatment option for pain but as described in last year’s post , opioids have their own issues and short-term and chronic use are associated with increased mortality in people with CKD , ESKD , and kidney transplant recipients .

Many patients are already using cannabis, sometimes without our knowledge. More than ever before, we need to be aware of the risks and benefits of cannabis use in our patients . Physicians remain poorly educated with respect to cannabis and the endocannabinoid system . The federal prohibition on cannabis as a Schedule I drug in the US has strongly limited research and has prevented teaching about the drug in medical education.

Joshua Rein @ThepHunClub Joshua Rein is an Instructor of Medicine at the Icahn School of Medicine at Mount Sinai in New York City. His clinical and research interests include the kidney endocannabinoid system and the effects of cannabis and cannabinoids on kidney function.