CBD Oil And Gabapentin

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Clinical studies have shown that the major psychoactive ingredient of Cannabis sativa Δ9-tetrahydrocannabinol (THC) has some analgesic efficacy in neuropathic pain states. However, THC has a significant side effect profile. We examined whether the profile of THC could be improved by co-administering … There is no interaction between CBD oil and gabapentin. However, both may cause sedative effects, which can be additive if used together.

THC and gabapentin interactions in a mouse neuropathic pain model

Clinical studies have shown that the major psychoactive ingredient of Cannabis sativa Δ9-tetrahydrocannabinol (THC) has some analgesic efficacy in neuropathic pain states. However, THC has a significant side effect profile. We examined whether the profile of THC could be improved by co-administering it with the first-line neuropathic pain medication gabapentin. This was done using the chronic constriction injury (CCI) model of neuropathic pain in C57BL6 mice. At 8 days post-CCI nerve injury, acute systemic administration of gabapentin produced a dose-dependent decrease in CCI-induced mechanical and cold allodynia, and increased motor incoordination. Coadministration of THC and gabapentin in a fixed-ratio dose-dependently reduced mechanical and cold allodynia, and produced all the side-effects observed for THC, including motor incoordination, catalepsy and sedation. Isobolographic analysis indicated that the ED50 for the THC:gabapentin induced reduction in allodynia was 1.7 times less than that predicted for an additive interaction. The therapeutic window of combination THC:gabapentin was greater than that for THC alone. These findings indicate that gabapentin synergistically enhances the anti-allodynic actions of THC and improves its therapeutic window. Thus, THC may represent a potential adjuvant for neuropathic pain medications such as gabapentin.

Keywords: Cannabinoid; Gabapentin; Isobolograph; Neuropathic pain; Synergy; Tetrahydrocannabinol.

Copyright © 2018 Elsevier Ltd. All rights reserved.

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Neurontin (Gabapentin) With CBD Oil Interaction

In our latest question and answer, the pharmacist discusses the potential interaction between CBD oil and gabapentin.

Sue asked

I have pretty bad neuropathy and have been prescribed gabapentin. Is it safe to also use CBD oil?

Answer

Neurontin (gabapentin) is not known to interact with CBD (cannabidiol) oil. However, there is a lack of data available overall when it comes to potential drug interactions with CBD as it is not well studied (currently at least) in that regard.

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Nevertheless, based on what we know about CBD and gabapentin metabolism, an interaction appears to be unlikely, as will be discussed below.

What Is CBD?

Cannabidiol (CBD) is one of the many constituents of the cannabis (i.e. marijuana) plant. In fact, depending on the specific strain of cannabis, CBD can make up over 40% of the total constituents (1).

An interesting characteristic of CBD is that it is ‘non-psychoactive’, meaning it doesn’t cause a “high” or euphoria (2). This is distinct from THC (tetrahydrocannabinol), which is largely responsible for the high that is associated with marijuana.

Multiple studies have shown CBD to be safe for most individuals and has an extremely wide dosage range. Doses ranging from a few milligrams all the way up to 1,500 mg have been taken with few adverse effects for up to four weeks (3).

CBD has numerous effects on the body, many of which aren’t fully understood. Nevertheless, CBD has been used for several indications, including:

  • Bipolar disorder (4)
  • Dystonia (5)
  • Epilepsy (6)
  • Huntington’s Disease (7)
  • Multiple Sclerosis (8)
  • Parkinson’s Disease (9)
  • Schizophrenia (10)
  • Anxiety (11)
  • Neuropathy (19)
  • Inflammation (20)

CBD certainly looks promising from a medical standpoint, but more studies are needed to determine its effects and overall efficacy.

As CBD may help with various types of pain (e.g. neuropathy), it makes sense to look into its use for those indications and whether or not it is safe with other medications for those indications (like gabapentin).

CBD Drug Interactions

When it comes to drug interactions, many aren’t definitively known but there are some theoretical ones that are proposed based on how CBD is metabolized.

CBD is metabolized by the cytochrome P450 system, the major enzymes involved in drug metabolism. Most drug interactions involve this system of enzymes. When a drug metabolizing enzyme is inhibited, concentrations of a drug may be increased due to decreased metabolism. For example:

  • Drug A is metabolized by CYP 3A4.
  • Drug B inhibits CYP 3A4.
  • Taking Drug B with Drug A may result in increased concentrations of Drug A (due to decreased metabolism). This can potentially increase the risk of side effects.
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Studies have shown that CBD can affect numerous enzymes, which could potentially affect how other drugs are metabolized.

Studies have shown that CBD can potentially inhibit:

We say potentially inhibit since lab studies have shown that CBD can inhibit the above enzymes, but several human studies don’t show consistent results.

There is a prescription CBD product known as Epidiolex that offers a little insight unfortunately into potential interactions. It has very few details on specific interactions, and the prescribing information for the drug only theorizes potential interactions based on the potential for CYP metabolizing enzyme inhibition (16). The only drugs it mentions that have confirmed drug interactions are:

  • Diazepam (increases concentrations)
  • Onfi (Clobazam) (increases concentrations)

How Is Gabapentin Metabolized?

The vast majority of drugs are metabolized via the CYP enzyme system. Gabapentin, however, is not. Interestingly, it is not metabolized to any appreciable degree in humans and is excreted intact in the urine (17).

Due to the lack of gabapentin metabolism, CBD isn’t thought to interact with it and should not affect levels of gabapentin in the body if taken at the same time.

The only thing to be aware of is that high doses of CBD can have sedative and slight hypnotic effects (18). Due to this, it is a general warning that CBD be used cautiously with CNS (central nervous system) depressants, like gabapentin, due to the risk of additive sedation.

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