Is CBD Safe With Lialda?

Nicole asked

Are there any known interactions between CBD oil and Lialda?

Answer

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.