JTH asked
I take Crestor (Rosuvastatin) 5 mg. Is there an interaction if I use CBD (cannabidiol). Is there with other statins?
At a glance
- A significant interaction between Crestor and CBD is unlikely as Crestor is minimally metabolized via CYP liver enzymes (which CBD can affect).
- Nevertheless, there is a lack of data available regarding the interaction and caution is recommended since adverse effects with Crestor can be serious.
Answer
There are no known drug interactions between Crestor (rosuvastatin) and CBD (cannabidiol). However, studies evaluating the use of both together are lacking and we just may not be fully aware of any potential drug interactions or adverse effects.
Nevertheless, based on what we do know about Crestor and CBD metabolism, clinically significant drug interactions appear to be unlikely. This is because Crestor does not extensively undergo hepatic metabolism via CYP metabolizing enzymes, suggesting a limited risk of significant drug interactions according to most studies.
Below, I discuss CBD, Crestor and potential interactions in more detail.
What Is CBD?
Cannabidiol is one of the many medicinally active constituents of marijuana (i.e. cannabis). It is considered 'non-euphoric' as it does not cause a 'high', unlike the more well-known THC (tetrahydrocannabinol).
Cannabidiol can make up nearly around 40% of cannabis extracts, although this can vary depending on the stain being evaluated.
CBD has been investigated for a wide variety of therapeutic effects, and has been used for the treatment of:
- Epilepsy
- Crohn's Disease
- Multiple sclerosis
- Parkinson's Disease
- Chronic pain
The first FDA prescription CBD product (Epidiolex) was recently approved in 2018 for the treatment of seizures associated with Lennox-Gastaut syndrome and Dravet syndrome. Clinical trials for Epidiolex show that it can significantly reduce seizure frequency when added to other antiepileptic therapies for the listed syndromes.
What Is Crestor?
Crestor (rosuvastatin) is an HMG-CoA reductase inhibitor, which are used to:
- Lower total cholesterol, low density lipoprotein (LDL), and triglycerides.
- Increase high density lipoprotein (HDL).
- Primary and secondary prevention of coronary heart disease.
Drug interactions and serious adverse reactions are a concern with statin drugs like Crestor. Adverse effects can include:
- Liver toxicity (i.e. hepatotoxicity)
- Myopathy (muscle dysfunction)
Drug interactions can increase the risk of myopathy particularly and it is prudent to be aware of any potentially conflicting medications you may be taking.
How CBD Interacts With Medication
The majority of drug interactions occur when one or more affect CYP metabolizing enzymes in the liver.
Inhibition or induction of CYP metabolizing enzymes can cause significant changes in drug elimination, causing either an increase or decrease in drug levels.
Many recent studies do indicate that CBD potentially affects many different metabolizing enzymes in the body. In fact, studies have shown that CBD may inhibit a variety of liver metabolizing enzymes, including:
- CYP 2C9
- CYP 1A2
- CYP 3A4
- CYP 2C19
Inhibition of a particular enzyme may potentially cause increases in drug concentrations that are substrates for that enzyme. This has the risk to increase the risk of adverse effects.
The prescribing information for Epidiolex (the prescription CBD product) details many potential interactions. Below is an excerpt in reference to CYP 2C19 interactions:
"In vivo data show that coadministration of EPIDIOLEX increases plasma concentrations of drugs that are metabolized by (i.e., are substrates of) CYP2C19 (e.g., diazepam) and may increase the risk of adverse reactions with these substrates. Consider a reduction in dosage of sensitive CYP2C19 substrates, as clinically appropriate, when coadministered with EPIDIOLEX"
CBD With Crestor Details
Potential drug interactions are of particular concern with drugs like Crestor, due to the risk of serious adverse effects, such as myopathy.
Many 'statin' drugs are metabolized via CYP enzymes, and therefore, caution needs to be taken prior to starting therapy with CBD.
Fortunately, Crestor is thought to be minimally metabolized in the liver via CYP enzymes. Data suggests that there is some metabolism by CYP2C9 and CYP2C19 but little or no metabolism by CYP3A4.
Most studies discussing potential drug interactions with the 'statin' class of medications make note that liver metabolism is a minor pathway for Crestor elimination, suggesting significant drug interactions are unlikely to occur, especially when compared to other statins like Lipitor and Zocor.
Nevertheless, since there is some CYP metabolism of Crestor, and because data may be lacking, it is important to use caution if adding on CBD. Be sure to let your doctor know so you can be appropriately monitored.
References
- Long-term use of rosuvastatin: a critical risk benefit appraisal and comparison with other antihyperlipidemics. PubMed
- Interactions between cannabidiol and commonly used antiepileptic drugs. PubMed
- Potent inhibition of human cytochrome P450 3A isoforms by cannabidiol: role of phenolic hydroxyl groups in the resorcinol moiety. PubMed
- Epidiolex Prescribing Information. AccessFDA
- The Effect of Cytochrome P450 Metabolism on Drug Response, Interactions, and Adverse Effects. American Family Physician
- Cannabinoids in the management of difficult to treat pain. PubMed
- A preliminary controlled study to determine whether whole-plant cannabis extracts can improve intractable neurogenic symptoms. PubMed
- Low-Dose Cannabidiol Is Safe but Not Effective in the Treatment for Crohn's Disease, a Randomized Controlled Trial. PubMed
- Trial of Cannabidiol for Drug-Resistant Seizures in the Dravet Syndrome. PubMed
- Cannabidiol, a Cannabis sativa constituent, as an antipsychotic drug. PubMed
- A review of the pharmacologic and pharmacokinetic aspects of rosuvastatin. PubMed
