Here at Nature Med we are proud to be partnered with Elevate Holistics and have access to such great information about the medicinal benefits of the cannabis plant. Recently Elevate sat down with BHealth Consulting’s Doctor of Pharmacy Kelsey Schwander to discuss cannabis and possible interactions it may have with other drugs. This blog is a transcript of that interview, but first lets learn a little about Dr. Schwander!
BHealth Consulting’s mission is to empower patients, providers and businesses to create healthcare solutions. Dr. Kelsey Schwander is a clinical pharmacist who provides medication education, pharmacy services, and much more. She has her Clinical Cannabinoid Certification. She has spoken to many patients and healthcare providers about cannabis. Dr. Schwander has been invited to speak at healthcare conferences, webinars and podcasts. BHealth Consulting’s main focus is providing specialized medication consultation services. BHealth Consulting wants you to take control of your health and medications!
Dr. Kelsey Schwander (BHealth Consulting): So let’s start with the medication. Yes, cannabis can interact with supplements with prescription medications. I have a lot of patients who say, “Oh well, cannabis is completely natural. It can’t interact with my prescription medication.” I’m like, “No, no it can.” So we have to be careful.
Dr. Kelsey Schwander (BHealth Consulting): There’s four main interactions I like to talk to people about. So I’ll briefly go over those, and hopefully that will give people an idea. I won’t go over all the medications because there’s a lot on how they work and it depends what other medications you’re on, but I’ll go over generally how these interactions work.
Because I think it’s really important for you to understand. Because a lot of healthcare providers will be like, “Oh, it interacts. You can’t use it,” and that’s not necessarily true.
You really just need to talk to someone who’s aware of the interaction.
Dr. Kelsey Schwander (BHealth Consulting): When you have a prescription medication and cannabis, what happens is when you consume both of them, they have to be metabolized. And a lot of times they’re metabolized in the liver by the same enzyme. When they’re both in there they’re fighting to be metabolized—and one wins out. Whichever loses, so let’s say we have a prescription medication and then we have THC. We’ve metabolized them and the prescription medication wins and holds on to the enzyme. And so THC increases in your body. So there are some prescription medications that will actually increase the amount of THC or cannabis or CBD in your body. So you want to be aware of that because you may need to consume less than another person would.
Dr. Kelsey Schwander (BHealth Consulting): Another example, which as a pharmacist, this is scarier for me is when it’s the opposite. This is when we have a prescription medication and THC, and the prescription medication levels change. The prescription medication goes really high or really low. So for example, let’s say it’s a blood thinner and there’s an interaction and it increases. You’re at an increased risk of bleeding, which can be really dangerous. So we need to be aware of that.
Dr. Kelsey Schwander (BHealth Consulting): Some other interactions that happen are additive effects. THC, alcohol, benzodiazepines, like Xanax—things like that. They have additive effects like sedation for example. We know that THC can have sedating side effects, but you add alcohol and you add some medications that can increase that, it can be dangerous as well.
Dr. Kelsey Schwander (BHealth Consulting): The last one is, some prescription medication we call them prodrugs, so this is really nerdy but I think it’s important to know. One example is a breast cancer drug, is called Tamoxifen. I don’t know if anyone’s heard of it, but it’s a prodrug. So what that means is when I consume it, it’s not in its active form. It has to be metabolized to get into its active form. And what happens is, if there’s an interaction, so let’s say I take that medication and I take cannabis and there’s an interaction, that drug can’t be converted into its active form and therefore it’s not working. And in this case it’s a cancer drug. So, that can have really bad side effects. Sometimes we can monitor it.
So it’s really important to let people know what you’re on. A physician know or someone like myself know so we can help monitor that. Not to go too far, into the medications, but the big ones I like to let people know is the blood thinners, you want to be careful, talk to someone about it. Any HIV or transplant, if you have a transplant medication, we have to be careful and then any antipsychotics. So if someone has some mental health issues and they’re stable on their antipsychotics, we want to be careful because if they interact, we can disrupt that balance. So those are the four, generally speaking we really should be careful of.
Dr. Kelsey Schwander (BHealth Consulting): I left one thing out. So someone mentioned opioids, so there is a drug interaction there, but it’s actually a good drug interaction. So that actually a patient who use both of them together, we find that patients can use less opioids. So that’s something that you have to be careful because of the state of effects, but some drug interactions can have good responses. So keep that in mind too. So sorry. So you, your question was, are there dangerous side effects?
I always tell patients if you’re on opioids or chronic pain, you always, always, always, no matter what you’re on, you should always tell your healthcare provider that you’re starting to use cannabis because they’re going to have to monitor you. They’re changing the dose with opioids—we know that it can increase sedation with cannabis. So, that’s a bad side effect we need to be careful of. Always talk to your provider before you start cannabis, if you’re on opioids. But again, the downside to the side effects of cannabis are minimal compared to some of the prescription medications out there.
To find out more and to book a consultation with BHealth Consulting check out their website: https://www.bhealthconsulting.com/contact
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