CBD Oil And Ativan

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In our latest question and answer, the pharmacist discusses whether or not CBD oil interacts with oxycodone or Atifan (lorazepam). Cannabidiol (CBD), a cannabinoid, can interact with the anxiolytic and sedative benzodiazepine lorazepam (Ativan) and aggravate its effects. There is no known drug interaction between CBD (cannabidiol) and Ativan (lorazepam). However, both can cause sedation and drowsiness.

Does CBD Oil Interact With Oxycodone Or Ativan?

CBD (cannabidiol) is becoming one of the most popular over the counter supplements. As such, we have been receiving many questions regarding potential drug interactions. In our following question and answer, the pharmacist discusses whether or not CBD oil interacts with oxycodone or Ativan (lorazepam).

Brad asked

I started recently taking CW HEMP OIL 28mg per dose. I take 5mg/325mg oxycodone twice a day and lorazepam 0.5 mg for anxiety if needed. Are any of these interactions with the CBD Oil?

Answer

Cannabidiol, also known as CBD, is one of the major constituents of the cannabis plant. Depending on the cannabis species and chemovar (i.e. chemical variation), CBD can make up nearly 40% of the active constituents in extracts.

What Is CBD?

CBD, unlike THC, is considered to be non-euphoric and therapeutically beneficial for the treatment of pain, inflammation anxiety etc.

The mechanism of action of CBD is complex, but is thought to bind to receptors that can cause desensitization of pain and can inhibit the inactivation of the endogenous cannabinoids (naturally occurring the the body) such as anandamide, and therefore increase its concentration.

CBD Drug Interactions

Most of what we know in regard to drug interactions come from clinical trials of commercially available prescription products that contain CBD or synthetic versions of it. One such drug is Sativex. The trials for these drugs don’t list any specific drugs that may interact but do mention how cannabinoids, such as CBD, can affect metabolizing enzymes.

Both THC and CBD have been shown in studies to metabolized by the cytochrome P450 system of metabolizing enzymes and could potentially inhibit them. In fact, studies have shown CBD inhibition of the following metabolizing enzymes:

If any of these metabolizing enzymes are inhibited, drugs that are substrates for them may potentially have their concentrations increased (due to a decrease in metabolism).

CBD Interactions With Oxycodone And Ativan

CBD With Oxycodone

Oxycodone is known to be metabolized by a variety of enzymes, including:

There is therefore a risk of increased oxycodone concentrations in the body when taken with CBD, due to inhibition of metabolism. This could potentially increase sedation with the drug and as well as increase the risk of respiratory depression. However, this risk appears to be low.

Most studies which show that CBD can affect metabolizing enzymes use extremely large doses, much more than most individuals would be taking. One such study used over 250mg CBD per dose! Most individuals would be using closer to 3 to 30 mg per dose and lower doses aren’t associated with significant metabolizing enzyme inhibition.

CBD With Ativan

Ativan (lorazepam) is not thought to be metabolized by any CYP enzymes, but is instead metabolized by liver glucuronidation. Therefore, there doesn’t appear to be any potential interactions between Ativan and CBD. However, as CBD can cause mild sedation, caution is advised when combining with other sedating drugs, such as Ativan.

Conclusion

There is a theoretical interaction between CBD and oxycodone, where oxycodone concentrations could be increased, but the risk appears to be low and has never been documented. Nevertheless, you should be sure to speak with your doctor before adding CBD to your medication list if you take oxycodone.

CBD is not thought to interact with Ativan as Ativan is not metabolized by CYP enzymes. It is a sedating drug however and use with CBD might lead to additive sedation.

Does CBD Interact With Lorazepam (Ativan)?

Cannabidiol (CBD), a cannabinoid, can interact with the anxiolytic and sedative benzodiazepine lorazepam (Ativan) and aggravate its effects.

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Lorazepam (Ativan) is a medication used to treat anxiety, sleeping disorder, seizures, and panic disorder. It belongs to the benzodiazepine family. It is a short-acting benzodiazepine.

Cannabidiol or CBD, a cannabinoid extracted from the cannabis family, can interact with lorazepam and enhance its actions.

CBD acts as an agonist for lorazepam. It can increase its amount in the body and cause more side effects.

Table of Contents

Does CBD Interact With Lorazepam (Ativan)?

Yes. CBD can interact with lorazepam (Ativan). This combination is considered high-risk and should be avoided unless otherwise specified by a healthcare professional.

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CBD may potentiate the effects of Ativan by reducing the body’s ability to metabolize the drug and increasing the risk of side effects such as sedation, dizziness, & short-term memory loss, and more.

Its interaction with lorazepam can take place in two ways:

A) Slowed Elimination (Metabolic Inhibition)

Drug metabolism is the process by which the drugs break down in the body to make it easy for them to perform their actions and to eliminate them from the body.

This task largely comes down to the cytochrome P450 enzymes found in the liver.

When two drugs require the same enzymes for metabolism, it results in a type of interaction called “metabolic inhibition” or “metabolic competition.” This action could slow down the metabolism of one or both drugs.

Lorazepam (Ativan) is primarily metabolized by CYP3A4. This same enzyme group is involved with metabolizing CBD as well. Hence, on consuming them together, they end up competing with each other for the breakdown in the liver. This action may enhance the plasma levels of lorazepam.

This effect is most dangerous in patients taking either CBD, Ativan, or both substances on a recurring basis. If Ativan isn’t cleared from the body by the time you take a second dose (because of delayed elimination from CBD), it could eventually lead to a buildup of toxic levels in the bloodstream — resulting in side effects.

B) Increased Effect (Agonistic Interaction)

An agonistic interaction occurs when two or more substances exhibit the same effect on the body. These substances might act on the same or different receptors, but they produce effects in the same direction when consumed together.

Because CBD and lorazepam are both central nervous system suppressants, their effects may compound. This interaction carries the greatest risk of producing adverse effects.

Taking both CBD and lorazepam could result in a higher risk of side effects associated with central nervous system suppression, including dizziness, lightheadedness, fainting, short-term memory loss, and more.

Similar Medications: CBD & Benzodiazepines

Lorazepam is classified as a benzodiazepine anxiolytic. CBD and benzodiazepines all share similar risks for interaction and side effects. All drugs in this class are considered to have a moderate to high-risk interaction with CBD and other cannabinoids.

Here’s a list of similar medications that share a similar level of risk when combined with CBD:

Is It Safe to Take CBD & Lorazepam (Ativan) Together?

No. It is not considered safe to take CBD alongside benzodiazepines such as Ativan (lorazepam). The risk of serious side effects is high with this class of medications.

CBD may potentiate (increase) the effects of lorazepam in the body. It can also lead to excessive accumulation of the drug by slowing its metabolism and elimination from the body.

CBD is considered to carry a high risk of interaction with lorazepam.

If both the drugs are taken in minimum dosage, it is less likely to cause many side effects.

It’s recommended to consume these two medicines together only under medical guidance. One must exercise caution when taking them together.

Is CBD A Viable Alternative to Lorazepam (Ativan)?

CBD may be a viable alternative to lorazepam (Ativan) for managing mild to moderate bouts of anxiety, insomnia, or muscle tension. However, CBD is much milder than Ativan and may not be strong enough for certain situations.

A study has shown that CBD may be effective in the treatment of generalized anxiety disorder, panic disorder, social anxiety disorder, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD) [1].

CBD has also been shown to be effective as an adjunctive treatment for seizures [2]. It’s even gained approval for use in seizures caused by two rare forms of epilepsy, Lennox-Gastaut syndrome and Dravet syndrome.

CBD has enough potential to become a proper anxiolytic sedative and may even replace benzodiazepines like lorazepam someday.

However, with the current available research and study, it’s not completely sufficient as a replacement for lorazepam for anything more than mild to moderate symptoms.

What is Lorazepam (Ativan)?

Lorazepam is an anxiolytic, sedative, and anti-seizure drug belonging to the benzodiazepine family. It’s used to treat panic disorders, severe anxiety, and seizures, including ones such as status epilepticus and a short-acting benzodiazepine, and gets and rapidly cleared in the body.

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Ativan is the most common brand name for lorazepam, but there are many generic forms as well. It’s a prescription medicine approved by the FDA for the treatment of anxiety disorders and seizures.

Lorazepam (Ativan) Specs:

Drug Name Lorazepam
Trade Names Ativan, Tavor, Temesta, Khamos, Larpose, Lopam, Lopez, Lorazine, Loree, Lorel, Lorus, Orazep, Trapex, Zora
Classification Benzodiazepines
CYP Metabolism Cytochrome P450 enzymes
Interaction With CBD Agonistic, Metabolic inhibitor
Risk of Interaction High

Other Names For Lorazepam (Ativan)

Lorazepam is sold under many different names. All share the same risk and potential interactions.

Other names for Lorazepam (Ativan) include:

What Does Lorazepam (Ativan) Do?

Lorazepam is classified as a benzodiazepine drug. It’s used to treat various neurological disorders, including seizure disorders (such as status epilepticus and alcohol withdrawal), anxiety, panic disorders, muscle tension, and insomnia.

Lorazepam works by binding to the benzodiazepine (GABA) receptors, which are responsible for suppressing or relaxing electrical activity in the brain. When this happens, we feel more calm and relaxed, anxiety levels subside, and we’re much more primed for falling asleep.

GABA causes chloride ions to pass across neuronal cell membranes via an ion channel in the receptors. When enough chloride ions are conducted, the local neuron membrane potentials increase. This effect makes it difficult for action potentials to fire and thus ultimately results in less excitation of the neurons.

Benzodiazepines do not replace GABA and do not affect GABA concentrations in the brain. However, they enhance the effect of GABA at the γ-aminobutyric acid type A (GABAA) receptor. Benzodiazepines can intensify the inhibitory activity of GABA in the central nervous system.

Side Effects of Lorazepam (Ativan)

There are many negative side effects associated with Ativan. Everybody is different, so it’s important to listen to your body and follow the dosage recommendations given to you by your doctor.

One of the main issues associated with this drug is dependency and addiction following long-term use. Because of its dependency-forming ability, lorazepam, like other benzodiazepines, is used as a first-line treatment for seizures but not for long-term treatment.

Lorazepam has also been associated with drug abuse and misuse.

Simultaneous use of benzodiazepines may result in heavy sedation, respiratory depression, coma, and death. These drugs are not suggested for use in patients for whom alternative treatment options are available.

Lorazepam can also cause withdrawal symptoms if stopped abruptly. The withdrawal symptoms consist of increased anxiety, irritability, insomnia, tremors, headaches, stomach pain, nausea, hallucinations, fatigue, depression, and more.

Lorazepam must be used with caution in patients with depression or psychosis as it can lead to an increased risk of suicidal ideation.

Side Effects of Lorazepam Include:

  • Asthenia
  • Blood dyscrasias
  • Change in appetite
  • Change in libido
  • Confusion
  • Constipation
  • Convulsions
  • Depression
  • Disorientation
  • Dizziness
  • Drowsiness & fatigue
  • Dysarthria
  • Extrapyramidal symptoms
  • Hypersensitivity reactions
  • Hypotension
  • Increase in alkaline phosphatase (ALP)
  • Increased bilirubin
  • Increased liver transaminases
  • Irritability
  • Jaundice
  • Lack of motivation
  • Loss of memory
  • Movement disorder
  • Nausea
  • Respiratory depression
  • Sleep apnea
  • Suicidal ideation
  • Tremor
  • Unsteadiness & vertigo
  • Visual disturbances

Key Takeaways: Is it Safe to Take Lorazepam (Ativan) With CBD?

CBD may reduce the body’s ability to metabolize lorazepam, leading to a longer duration of effects and a potential increase in serum levels over the course of several days or weeks.

Don’t attempt to combine CBD with Ativan without first speaking to your prescribing physician.

To further reduce the risk of side effects, it’s best to take only the minimum dosage of both medications with proper spacing in timing between them both (at least 2 hours apart).

CBD (Cannabidiol) With Ativan (Lorazepam) Interaction

No known interactions but watch out for potential sedation.

Baba asked

I have been taking 0.5mg of Ativan (lorazepam) mid-day and at night for about 6 years to help me with anxiety due to shortness of breath. Can I try CBD oil twice a day with this? I would like to wean off lorazepam if hemp oil helps with this and insomnia.

At a glance

  • There is no known drug interaction between CBD (cannabidiol) and Ativan (lorazepam).
  • However, both can cause sedation, drowsiness and dizziness so caution must be taken when combining them.

Answer

There are no known interactions between Ativan (lorazepam) and CBD (cannabidiol). However, both can increase sedation and somnolence (feeling of sleepiness).

Therefore, caution is advised when using both together and you should not operate heavy machinery or take part in activities that require mental alertness until you know how both medications affect you.

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Below, I discuss CBD, Ativan and potential interactions in more detail.

What Is CBD (Cannabidiol)?

Cannabidiol, often referred to simply as ‘CBD’, is one of the many constituents of marijuana and is known to be an active component in regard to activity with our endocannabinoid system.

Unlike THC (delta-9-tetrahydrocannabinol), CBD is thought to be ‘non-psychoactive’ in that it doesn’t cause a ‘high’ or euphoria. Nevertheless, it certainly does affect the central nervous system as studies show it can be beneficial for symptoms of anxiety and can cause sedation.

CBD has been investigated for a wide variety of therapeutic effects, including:

  • Chronic Pain
  • PTSD
  • Multiple sclerosis
  • Parkinson’s Disease
  • Epilepsy
  • Huntington’s Disease

In addition, CBD may make high THC preparations more tolerable for individuals as it can ‘attenuate’ or reduce the ‘high’ experienced without reducing potential medicinal effects.

CBD Side Effects

CBD is very well tolerated in most individuals and is not associated with dependence or withdrawal symptoms, even after extended use.

Although CBD can cause sedation and a general feeling of tiredness, it is not associated with respiratory depression and has been used safely with CNS depressants such as opioids and benzodiazepines. Nevertheless, CBD can cause additive drowsiness when used with other medications with similar side effects (e.g. lorazepam).

The overall side effect profile of CBD is minimal, especially at doses that are used in over the counter products (~3-15 mg) per dose.

Even high doses of CBD are considered well-tolerated. The prescription product Epidiolex, which comes in a concentration of 100 mg/ml and is used for rare seizure disorders, provides a high amount of CBD and lists the following side effects in the prescribing information for the drug:

  • Decreased appetite (16-22% incidence)
  • Diarrhea (9-20% incidence)
  • Sedation (3-6% incidence)
  • Lethargy (4-8% incidence)
  • Somnolence (23-25% incidence)
  • Sleep disturbances (5-11% incidence)

CBD Drug Interactions

There is a lack of information regarding interactions with CBD products and it appears that some may be dose-related (meaning higher doses increase the risk of interaction) (14). Potential interactions stem from the fact that CBD may inhibit certain CYP metabolizing enzymes in the liver, including:

When a metabolizing enzyme is inhibited, it cannot break down a drug as effectively or as quickly, leading to increased concentrations. This can increase the risk of side effects.

A good example of this is the interaction between Lipitor, a cholesterol-lowering medication, and clarithromycin, an antibiotic. Clarithromycin can inhibit CYP 3A4, which is responsible for metabolizing Lipitor. This increases concentrations of the drug, putting individuals at risk for serious side effects, such as rhabdomyolysis.

It should be noted that most interaction studies with CBD have been only done in animals and the extent of potential interactions in humans isn’t well known.

Ativan (lorazepam), the drug in question regarding CBD interactions, is not metabolized by CYP enzymes, but rather by liver glucuronidation. As far as we know, CBD has no effect of Ativan concentrations in the body.

Lastly, the concern with combining CNS depressants together is the risk of respiratory depression. Opioids and benzodiazepines are well associated with it. CBD products, however, are not and are generally considered safe in that regard.

Ativan Information

Ativan (lorazepam) is a rapid-acting benzodiazepine medication and is used primarily for the treatment of anxiety disorders.

It has several advantages over other benzodiazepines, including:

  • It is not metabolized by CYP liver enzymes and has fewer potential drug interactions when compared to medications that are.
  • It does not have active metabolites and therefore doesn’t accumulate in the body. This can be beneficial in certain populations, such as the elderly.

The most common side effects of benzodiazepines, like Ativan, are as follows:

  • Sedation
  • Fatigue
  • Memory impairment
  • Dizziness
  • Impaired motor coordination
  • Shallow breathing (high doses)

Taking CBD With Ativan

As discussed, there are no known interactions between CBD and Ativan. However, it is important to know that both can cause sedation and a general feeling of fatigue, which could be additive if taken together.

It is important to let your doctor know all the medications/over the counter products you are taking so you can be appropriately monitored.

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