Linda asked
Trazodone with CBD interaction. I take 100 mg of trazodone for sleep. I have had intense back pain for 25 yrs. have tried everything out there to no avail. Is CBD an option?
At a glance
- There is a lack of information available regarding whether or not CBD (cannabidiol) interacts with trazodone.
- Current information suggests that there is no significant interaction between the two.
- However, both can cause sedation, so using both together can enhance this effect.
Answer
We have written quite a few articles regarding potential drug interactions with CBD. Feel free to browse the following articles that will provide some more background on CBD, potential uses and interaction information:
The following are some highlights from the above articles:
- Cannabidiol (CBD) is one of the many active constituents of cannabis. It is non-euphoric, meaning it does not cause a "high". It does, however, possess some psychoactive effects as studies have shown it can help with conditions like anxiety and PTSD.
- CBD has been used to treat a variety of indications, including pain, inflammation, anxiety and epilepsy. In fact, the FDA recently approved a CBD prescription product (Epidiolex) for the treatment of rare forms of epilepsy.
- There is a lack of data available regarding whether CBD interacts with prescription medication, such as trazodone. However, CBD has been shown to inhibit a variety of liver metabolizing enzymes, which can therefore theoretically affect trazodone levels in the body.
CBD Drug Interactions
Recent studies indicate that CBD can potentially affect the metabolism of a variety of drugs via inhibition of CYP metabolizing enzymes. Data indicates that CBD may inhibit the following liver metabolizing enzymes:
- CYP1A2
- CYP2B6
- CYP2C8
- CYP2C9
- CYP2C19
- CYP3A4
Metabolizing enzyme inhibition often leads to increased drug concentrations (due to decreased enzyme activity).
Trazodone Information And Metabolism
Trazodone is an oral antidepressant but is chemically unrelated to other antidepressant classes (e.g. SSRIs, tricyclic and tetracyclic antidepressants). It does, however, have a similar mechanism of action in that it affects a variety of neurotransmitters in the brain. It is also thought to act as an anxiolytic.
Trazodone is extensively metabolized in the liver by CYP3A4. Therefore, any substance or drug that affects CYP3A4 (like CBD potentially), could affect trazodone concentrations.
The prescribing information for trazodone offers the following information regarding potential interactions:
"Consider reducing DESYREL [trazodone] dose based on tolerability when DESYREL [trazodone] is coadministered with a strong CYP3A4 inhibitor"
Combining CYP3A4 inhibitors with trazodone can increase the risk of adverse effects.
The full extent of potential adverse effects isn't well known but studies have indicated the combination may increase the risk of cardiac arrhythmias and serotonin syndrome.
CBD With Trazodone
We, unfortunately, don't have any studies that have looked specifically at a potential interaction between CBD and trazodone.
However, most of the available evidence points to the lack of interaction. Only lab and animal studies have indicated that CBD can inhibit CYP3A4. Human studies have either not demonstrated this or have been inconclusive.
In fact, the prescribing information for Epidiolex, the FDA-approved CBD product (which must evaluate potential drug interactions), does not state that it affects drugs metabolized by CYP3A4 (conversely, Epidiolex is itself metabolized by CYP3A4, and must be used cautiously with drugs that either inhibit or induce that enzyme).
Having said all of the above, it is important to be aware of the theoretical interaction and be under the supervision of your doctor if you plan on using CBD with trazodone.
Lastly, both CBD and trazodone can cause sedation, so it is important to be aware of that and not drive or partake in tasks that require mental alertness until you know how they affect you.
Final Words
As with all medication, it is important to make your doctor aware of everything you are taking so you can be appropriately monitored.
Although the risk of a significant interaction between CBD and trazodone doesn't appear to be high, there may simply be a lack of data available.
References
- Epidiolex Prescribing Information. AccessFDA
- Characterization of cannabidiol-mediated cytochrome P450 inactivation. PubMed
- Oleptro Prescribing Information. PubMed
- Potent inhibition of human cytochrome P450 3A isoforms by cannabidiol: role of phenolic hydroxyl groups in the resorcinol moiety. PubMed
- Neuroprotective effect of cannabidiol, a non-psychoactive component from Cannabis sativa, on beta-amyloid-induced toxicity in PC12 cells. PubMed
- Neural basis of anxiolytic effects of cannabidiol (CBD) in generalized social anxiety disorder: a preliminary report. Sage Journals
- Cannabidiol, a Cannabis sativa constituent, as an antipsychotic drug. PubMed
