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Toxins, pharmaceutical drugs, over the counter drugs, supplements, caffeine, alcohol, and CBD are all broken down by enzymes in the liver.

Guide On How Much CBD You Should Take

By A&T Organic's posted February 19 2020

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What is in CBD?
CBD has been shown to inhibit CYP P450 activity. The job of CYP P450 is to break down toxins and medications.

Generally speaking, if you take one drug that is metabolized by CYP P450, it is easy for the enzyme to do its job.

CYP 450 breaks down the medication in a reasonable amount of time, and everyone is happy.  

It is reasonably safe to say we are primarily concerned with those taking larger servings. A simple solution to this is start slow, monitor your body’s response, and if something doesn’t feel right seek medical attention.


We don't know all of the interactions, especially with specific drugs. To further complicate things, most of the research has been done on CBD isolate. It is up to you, the consumer, to monitor your own body’s response.


Toxins, pharmaceutical drugs, over the counter drugs, supplements, caffeine, alcohol, and CBD are all broken down by enzymes in the liver. More specifically, about 60% of pharmaceutical drugs are metabolized by a liver enzyme called CYP P450. CBD is also metabolized by the CYP P450 enzyme.


Don’t overdo it. In cannabis therapy, we often find that “less is more”. If you are not getting the desired effects, even though you’ve tried raising your dose, try lowering your dose instead. This has helped many people find the “sweet spot”, the best dose range for the particular condition at that period of time. Remember, the sweet spot can move over time. You have to continue to monitor yourself and adjust as necessary.   

Is CBD really safe?

CBD is generally considered safe to consume (as long as it’s clean and has no toxins); however, we use the “precautionary principle” in making recommendations. This principle serves as a guide to making wiser decisions in the face of uncertainty. It guides us to act cautiously in the face of the unknown- “do no harm” and prevent harm- while observing outcomes and making small adjustments over time.


“Drug interactions are especially important to consider when using life-saving, sense saving drugs, drugs with narrow therapeutic windows, or medications with major adverse side effects," Devitt-Lee reports. "In particular, those patients who utilize high doses of CBD concentrates and isolates should keep these factors in mind when mixing remedies."


Standard doses have been shown to be effective for pain, inflammation, autoimmune disorders, Lyme disease, anxiety, depression, arthritis, some mental disorders, fibromyalgia, multiple sclerosis, inflammatory bowel syndrome, autism, and weight loss.

How does CBD metabolize?


The issue is that CBD is metabolized by cytochrome P450 enzymes, occupying the site of enzymatic activity and preventing it from metabolizing other compounds or pharmaceuticals. Interestingly, components of grapefruit can have the same effect.


"The extent to which CBD behaves as a competitive inhibitor of cytochrome CYP450 depends on how tightly CBD binds to the active site of the metabolic enzyme before and after oxidation," writes Adrian Devitt-Lee, a researcher at Project CBD who has studied the topic of drug interactions extensively.


"This can change greatly, depending on how, and how much CBD is administered, the unique attributes of the individual taking this medication, and whether isolated CBD or whole plant remedy is used.”


This means that patients ingesting CBD products should pay close attention to changes in blood levels of important drugs in their protocol and adjust dosage accordingly under a doctor’s supervision.

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If your medication uses the CYP 450 2C19 enzyme use caution (google this information or speak with a pharmacist). Some of these drugs include proton pump inhibitors including omeprazole (Prilosec), lansoprazole (Prevacid), and pantoprazole (Protonix); diazepam (Valium); carisoprodol (Soma); nelfinavir (Viracept); and others.


Conclusion

If you are taking, for example, a benzodiazepine medication and CBD or a chemotherapy drug and CBD you may be at risk. CBD blocks the P450 enzyme, in turn, it takes longer for your body to break down other medications, increasing (or decreasing) the amount of medication present in the person's blood. This could result in unwanted side-effects or overdose.  


A systematic review in 2014 concluded that CBD generally has a low risk of clinically significant drug-interactions (Stout and Cimino, 2014). A few studies in the current review included an examination of drug-drug interactions with CBD. GW Pharmaceuticals performed a clinical trial investigating the pharmacokinetic interaction between CBD/THC spray (sativex) and rifampicin (cytochrome P450 inducer), ketoconazole, and omeprazole (cytochrome P450 inhibitors) (Stott et al., 2013c).


Let's use caffeine, for example. Caffeine is a drug most can relate to. Both CBD and caffeine rely on CYP 450 enzyme for break down. CBD will inhibit the CYP 450 enzyme, which results in a slower excretion rate of caffeine = prolonged effects of caffeine.


"Titration is a term borrowed from chemistry that means taking small steps over time in order to allow for adjustments slowly. This process lowers the risk of problems such as overdose, overwhelm, or overreaction.


We always recommend titration as the best way to introduce CBD to the body. It means starting on the low side (NO MATTER THE CONDITION) of a dosage range and adjusting upward slowly over time until the desired effect is reached. This cautious approach has served our patients well, and many experts now recommend it as a dosing protocol for medical cannabis.


Since there is a wide range of dosing possibilities, we have identified three dose ranges that are useful for different conditions. Microdose, standard dose, and a macro (therapeutic) dose. These three ranges, combined with the patient's body weight, determine the recommended starter dose.


The statements made regarding these products have not been evaluated by the Food and Drug Administration. The efficacy of these products has not been confirmed by FDA-approved research. These products are not intended to diagnose, treat, cure or prevent any disease. All information presented here is not meant as a substitute for or alternative to information from health care practitioners.


Please consult your health care professional about potential interactions or other possible complications before using any product. The Federal Food, Drug and Cosmetic Act requires this notice.


You may reach a dose level at which you experience a reduction in the benefit, unpleasant, or an adverse reaction. If this happens, step back to the previous dose and continue at that level for at least four days. Then cautiously move up a step again. If your body responds positively to that level, continue at that dose. This is your target dose

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