With the use of cannabis medicine becoming more and more common around the world, one frequently asked question among patients is, can I use cannabis medicine while taking antibiotics?
Cannabis and antibiotics are currently not considered to be contraindicated. While still ongoing, the current research regarding interactions between cannabis medicine and antibiotics is somewhat limited.
Among the data that does exist, studies have suggested the following:
- An increased potential for experiencing side effects related to the use of antibiotics, such as vomiting, nausea, and/or diarrhea.
- Antibiotics may cause a reduction in CBD levels.
- Clindamycin can be found on at least one doctor compiled list of potential drug interactions related to cannabis.
Based on the evidence available, the consensus appears to be that the potential for interaction is low, and patients should be made aware of the increased potential for vomiting, nausea, and/or diarrhea.
The increased risk of antibiotic related side effects I likely due to the potential for cannabis to inhibit certain enzymes (cytochrome p450 enzymes) within the liver. These enzymes are involved in the biosynthesis of some antibiotics such as erythromycin, miocamycin and troleandomycin.
Should a patient begin to experience any of these negative side effects, it is recommended that they consider reducing their cannabis medicine dosage, or discontinuing their cannabis medicine treatment until the course of antibiotics is complete. When reducing or ceasing dosage, patients should also be advised that they may experience a temporary worsening of the symptoms for which they are taking cannabis, such as pain or sleep disturbance. This is necessary to prioritize the antibiotics treatment.
Beyond the research in the area of drug interaction potentials, there has also been some study regarding the possible antibiotic and antimicrobial properties of cannabis.
Research is still ongoing, however thus far cannabinoids have been shown to have the following potentials:
- CBG has been shown to be able to kill antibiotic-resistant bacteria, including Methicillin-Resistant Staphylococcus Aureus (MRSA).
- CBD can kill some forms of Gram-negative bacteria, including Neisseria gonorrhoeae.
- CBD has the potential to enhance the effectiveness of certain antibiotics.
- Major cannabinoids such as THC, CBD, CBG, CBC, and CBN have all been shown to have some level of effectiveness in killings different strains of MRSA bacteria.
- CBD shows a low tendency to produce resistance in bacteria.
This research does look promising, however it’s important to remember that further study and formulation work is needed before we can determine the efficacy and viability of any new treatment options.
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Research regarding cannabis and antibiotics:
- A Systematic Review on the Pharmacokinetics of Cannabidiol in Humans https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6275223/
- An Update on Safety and Side Effects of Cannabidiol: A Review of Clinical Data and Relevant Animal Studies https://doi.org/10.1089/can.2016.0034
- Exogenous cannabinoids as substrates, inhibitors, and inducers of human drug metabolizing enzymes: a systematic review https://doi.org/10.3109/03602532.2013.849268
- A Phase I, open-label, randomized, crossover study in three parallel groups to evaluate the effect of Rifampicin, Ketoconazole, and Omeprazole on the pharmacokinetics of THC/CBD oromucosal spray in healthy volunteers https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3671111/
- NTI Meds to be Closely Monitored when Co-Administered with Cannabinoids https://sites.psu.edu/cannabinoid/files/2020/06/NTI-Meds-to-be-Closely-Monitored-when-Co-Administered-with-Cannabinoids_2020_04_25.pdf
- Cannabis Interactions https://www.drugs.com/drug-interactions/cannabis.html
- The Antimicrobial Activity of Cannabinoids https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7400265/
- The antimicrobial potential of cannabidiol https://pubmed.ncbi.nlm.nih.gov/33469147/
- The antimicrobial effect behind Cannabis sativa https://bpspubs.onlinelibrary.wiley.com/doi/full/10.1002/prp2.761
- Cannabinoids-Promising Antimicrobial Drugs or Intoxicants with Benefits? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7345649/
- Antibacterial cannabinoids from Cannabis sativa: a structure-activity study https://pubmed.ncbi.nlm.nih.gov/18681481/
- Uncovering the Hidden Antibiotic Potential of Cannabis https://pubmed.ncbi.nlm.nih.gov/32017534/
- Cannabidiol is an effective helper compound in combination with bacitracin to kill Gram-positive bacteria https://www.nature.com/articles/s41598-020-60952-0
- Antibacterial activity of delta9-tetrahydrocannabinol and cannabidiol https://pubmed.ncbi.nlm.nih.gov/1085130/
- Immunoregulatory Role of Cannabinoids during Infectious Disease https://doi.org/10.1159/000481824
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