Does CBD interact with prednisone, and if so, are there risks that should cause concern?

Prednisone is a prescription drug used to provide relief for inflamed areas of the body. It is also indicated to treat conditions, such as inflammation (swelling), severe allergies, arthritis, asthma, eye or vision problems, blood or bone marrow problems, and stomach or bowel problems (1). 

Moreover, doctors prescribe prednisone to help patients with lupus, skin conditions, endocrine problems, kidney problems, ulcerative colitis, adrenal problems, and flare-ups of multiple sclerosis. 

Prednisone is a corticosteroid, or a cortisone-like medicine or steroid. This drug works on the immune system to help relieve swelling, redness, itching, and allergic reactions.

However, this medicine may cause changes in mood or behavior for some patients. Symptoms to watch for include depression, trouble with sleeping, a false or unusual sense of well-being, mood swings, and personality changes while taking this medicine (2).

Can CBD Be Taken With Prednisone?

Taking CBD along with prednisone could either decrease the effects of cannabidiol or increase the amount of prednisone entering the bloodstream.

Whenever one takes CBD or any medicine, it passes through the digestive system to the liver, where an enzymatic pathway, called the cytochrome P450 (CYP450) family of enzymes, metabolizes or breaks down the substance ingested. 

Liver enzymes CYP450 process about 60% of all medications. One of these, CYP3A4, metabolizes prednisone to make it available to the body (3).

Studies have demonstrated that CBD strongly inhibits the activity of CYP3A4 liver enzymes (4).

Meanwhile, prednisone is a weak inducer of CYP3A4 (5). Still, prednisone may increase how quickly the liver breaks down CBD when they are taken in combination. 

In particular, the effects of taking CBD along with prednisone could either decrease the effects of cannabidiol or increase the amount of prednisone entering the bloodstream.

The increased prednisone concentration can amplify the drug’s many side effects and raise the risk of severe symptoms, such as dizziness or fainting, blurred vision, irregular or pounding heartbeat, increased thirst or urination, irritability, and unusual tiredness or weakness (6).

Thus, medical experts advise those taking CBD and prednisone to be cautious with this combination (7).

Can CBD Replace Prednisone?

No study explicitly says CBD can be used in place of prednisone. However, studies have shown that CBD possesses many potential therapeutic benefits that may help with some symptoms or conditions for which prednisone is indicated. 

Prednisone is sometimes prescribed for bone marrow problems, which is important for the health of blood cells. Meanwhile, studies have shown that CBD promotes the structural health of bones

The effect of CBD on bones was also demonstrated by a 2015 study that investigated the properties of cannabidiol concerning bone-related conditions. Data showed that CBD led to an improvement in fracture healing (8).

Like prednisone, CBD can help with skin conditions. A study published in the journal Trends in Pharmacological Sciences has suggested the existence of a functional endocannabinoid system (ECS) in the skin and implicated it in various biological processes (9). 

CBD impacts the TRPV-1 and GPR55 receptors (10). Both receptors are found in the skin and play a role in pain signaling and inflammation.

CBD has also been shown to help with mood swings, depression, dizziness, and sleeping difficulty, which may be the side effects from taking prednisone. 

A study published in the Journal of Psychopharmacology found that CBD may decrease anxiety levels in individuals with a social anxiety disorder (SAD). 

Results indicated that, relative to placebo, CBD was associated with significantly decreased subjective anxiety (11). 

In another study, results showed that CBD could theoretically induce rapid-acting antidepressant-like effects and enhance neurotransmission (12). Neurotransmission is the process of communication between nerve cells.

In a 2019 study published in The Permanente Journal, sleep and anxiety scores were measured in human subjects, and the findings showed that CBD could hold benefits for anxiety-related disorders (13).

Meanwhile, CBD’s antiemetic properties, which prevent nausea and vomiting, are incredibly helpful. 

A 2014 review from the European Journal of Pharmacology established the potential of cannabis to limit or prevent nausea and vomiting from a wide range of causes (14). 

More importantly, the powerful anti-inflammatory properties of CBD could help with some of the same disorders  that prednisone treats. 

CBD’s anti-inflammatory characteristics have been shown in several human and animal studies, like that of a 2014 study published in the Journal of Clinical Investigation and a 2012 research conducted by authors from the Department of Pathology, School of Veterinary Medicine in the University of São Paulo, Brazil (15).

Other studies have demonstrated that the anti-inflammatory and immunosuppressive actions of CBD may be of use in treating rheumatoid arthritis and the associated pain (16).

Meanwhile, research published in the Free Radical Biology & Medicine Journal by George Booz of the University of Mississippi Medical Center showed that CBD, which may interact with the endocannabinoid system, is a promising prototype for anti-inflammatory drug development (17).  

Conclusion

CBD “is generally well tolerated with a good safety profile,” the World Health Organization (WHO) states in a critical review (18).

Still, it is not clear how much to take or how often a person should use it for any particular problem. 

High doses of CBD may also interact with other medications, such as blood thinners, antidepressants, and immune suppressors (19).

Thus, individuals should be cautious when supplementing their existing medications with CBD. 

Do not take other pharmaceuticals unless they have been discussed with a medical professional. 

More importantly, before using CBD as a remedy for specific symptoms or conditions, consult with a doctor experienced in cannabis use for advice.

Medically reviewed DR. WIEGMANN on 06-22-2020


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  2. Mayo Clinic. (2020, Feb 1). Prednisone. Retrieved from https://www.mayoclinic.org/drugs-supplements/prednisone-oral-route/side-effects/drg-20075269?p=1.
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  10. Sharir H, Abood ME. Pharmacological characterization of GPR55, a putative cannabinoid receptor. Pharmacol Ther. 2010;126(3):301–313. DOI:10.1016/j.pharmthera.2010.02.004; Costa B, Giagnoni G, Franke C, Trovato AE, Colleoni M. Vanilloid TRPV1 receptor mediates the antihyperalgesic effect of the nonpsychoactive cannabinoid, cannabidiol, in a rat model of acute inflammation. Br J Pharmacol. 2004;143(2):247–250. DOI:10.1038/sj.bjp.0705920.
  11. Crippa JA et al.Neural basis of anxiolytic effects of cannabidiol (CBD) in generalized social anxiety disorder: a preliminary report.J Psychopharmacol. 2011 Jan;25(1):121-30. DOIi: 10.1177/0269881110379283. Epub 2010 Sep 9. DOI: 10.1177/0269881110379283.
  12. Linge R et al. Cannabidiol induces rapid-acting antidepressant-like effects and enhances cortical 5-HT/glutamate neurotransmission: role of 5-HT1A receptors. Neuropharmacology. 2016 Apr;103:16-26. doi: 10.1016/j.neuropharm.2015.12.017. Epub 2015 Dec 19.DOI: 10.1016/j.neuropharm.2015.12.017.
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  15. Oláh A, Tóth BI, Borbíró I, et al. Cannabidiol exerts sebostatic and antiinflammatory effects on human sebocytes. J Clin Invest. 2014;124(9):3713–3724. DOI:10.1172/JCI64628; Ribeiro A et al. Cannabidiol, a non-psychotropic plant-derived cannabinoid, decreases inflammation in a murine model of acute lung injury: role for the adenosine A(2A) receptor. Eur J Pharmacol. 2012 Mar 5;678(1-3):78-85. DOI: 10.1016/j.ejphar.2011.12.043. Epub 2012 Jan 12.
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  18. Expert Committee on Drug Dependence Fortieth Meeting. Cannabidiol (CBD) Critical Review Report. June 2018. Retrieved from https://www.who.int/medicines/access/controlled-substances/CannabidiolCriticalReview.pdf.
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