Bea asked
Does CBD oil interact with amiodarone?
At a glance
- CBD (cannabidiol) and amiodarone can interact via a variety of mechanisms. Taking them together can increase concentrations of both, increasing the risk of side effects. Additionally, they can both cause elevated liver enzymes. Therefore, they should not be used together unless directed by your doctor.
Answer
Yes, there is a potential interaction between CBD (cannabidiol) and amiodarone. However, it hasn't been well-documented or studied and the potential severity isn't known.
Having said that, there is a good amount of published data on both CBD and amiodarone that gives us a good idea of how they could interact with each other.
Amiodarone is notorious for having several major drug interactions, simply based on how it is affects metabolizing enzymes and the liver.
Being an anti-arrhythmic medication, it is extremely important that amiodarone is dosed correctly. Taking it with other medications that could alter concentrations of it in the body can be dangerous (i.e. by increasing the risk of side effects or decreasing effectiveness).
I discuss the potential interaction in more detail in the next sections but it important to make the overall point that you shouldn't use CBD (cannabidiol) with amiodarone without speaking to your doctor first.
Amiodarone Metabolism
Amiodarone is class III antiarrhythmic drug, has a complex pharmacokinetic profile, and is metabolized via a variety of pathways in the body.
Several studies have been published on the pharmacokinetic profile of amiodarone, which is important when it comes to potential drug interactions.
It is extensively metabolized in the liver, mostly by two enzymes:
- CYP3A4
- CYP2C8
CBD (Cannabidiol) Interacting With Amiodarone
Any drug that affects those enzymes (either by inhibiting or inducing them), can alter concentrations of amiodarone in the body. This has the potential to increase the risk of severe side effects/toxicity or decrease the effectiveness of the drug, both serious consequences.
The prescribing information warns about taking amiodarone with CYP3A4 or CYP2C8 inhibitors:
"Since amiodarone is a substrate for CYP3A4 and CYP2C8, drugs/substances that inhibit CYP3A4 may decrease the metabolism and increase serum concentrations of amiodarone."
Numerous studies have reported that CBD (cannabidiol) can inhibit CYP2C8. In fact, the prescribing information for Epidiolex, a prescription CBD product used for treating a rare form of seizures (Lennox-Gastaut syndrome or Dravet syndrome) states the following:
References
- Elsevier ClinicalKey: Amiodarone Monograph
- Elsevier ClinicalKey: Cannabidiol Monograph
- Epidiolex Prescribing Information
- Pharmacokinetic drug interactions with amiodarone. PubMed
- The role of CYP 3A4 and 1A1 in amiodarone-induced hepatocellular toxicity. PubMed
- Cordarone Prescribing Information
