klonopin with weed

Your Favorite Relaxation Habit Might Be Secretly Screwing With Your Meds

Yep, even OTC cold meds.

Considering that Martha Stewart now co-hosts a stoner-friendly TV show with Snoop Dogg (thank you, Potluck Dinner Party), it’s pretty safe to say that smoking weed is no longer a habit you need to hide from your mom. (Or your doctor, for that matter.)

But as medical marijuana (and, let’s be real, casual marijuana) use continues to rise, have you ever considered the fact that your weed pen might actually be screwing with some of the other medications you take? Yep, kind of scary.

“There are literally hundreds of of chemicals in the cannabis plant, including the psychoactive chemicals that give us a traditional marijuana high and chemicals that just happen to be in the plant,” says Timothy Brennan, M.D., director of the Addiction Institute at Mount Sinai West and Mount Sinai St. Luke’s Hospitals. “All of those, of course, are free to interact with prescription, over-the-counter, or any other medications one might be using.”

In fact, some of the compounds in cannabis can trigger certain enzymes that impact the way your body processes medications, Brennan explains. (This isn’t limited to cannabis; if you’ve ever seen a note to avoid grapefruit on your pill bottles, that’s because grapefruit can have the same effect.)

Related: 5 Women Who Use Pot In Their Everyday Lives Share How They Do It

“The problem is that cannabis is still listed as a Schedule I drug through the Drug Enforcement Agency,” he says, which effectively means that researchers aren’t supposed to study it. “That makes it’s very challenging for physicians and medical scientists to do any research on cannabis.”

So, where does that leave you? If you’re going to use marijuana (prescribed or otherwise) while you’re taking other drugs, “being truthful and open with your physician about your medication use is the most important thing, because you could be setting yourself up for potential marijuana drug interactions,” says Brennan. “It could at least plant the seed in a doctor’s mind that if you are suffering from certain side effects related to your other drugs the doctor can investigate if cannabis might be causing that.”

That said, there are a few types of drugs to watch out for if you’re planning on smoking pot.

Antidepressant Medications, or SSRIs and SNRIs

“The key point here is that cannabis is fundamentally a psychoactive compound,” says Brennan. “People use it because it exerts its action on the brain, on the central nervous system receptors.” But antidepressant medications—the most common of which are selective serotonin reuptake inhibitors (SSRIs), like Zoloft (or sertraline) or Celexa (or ditalopram), and serotonin norepinephrine reuptake inhibitors (SNRIs), like Cymbalta (or duloxetine)—also exert psychoactive effects on some of the same receptors.

“The challenge for people who have mood disorder or depression is that every time they’re using cannabis, they’re taking another psychoactive drug,” says Brennan. “And that can make it very challenging for a patient or physician to figure out what drug is actually having an effect on what.” Plus, he adds, the cannabis could actually negate the positive effects of prescription medication.

This is what it’s like to suffer from depression:

Anti-Anxiety Medications, or Benzodiazepines

Anti-anxiety medications like Ativan (Lorazepam), Klonopin (Clonazepam), or Xanax (Alprazolam) are all part of a class of medications called benzodiazepines, says Brennan. “Again, you have two psychoactive compounds interacting with each other in the brain,” he says. “If somebody’s really struggling with anxiety, I’d like to know what products are going in their brain so I can better understand how I’m medicating them. But if they’re smoking cannabis at the same time as using Ativan or Klonopin, it’s really hard to figure out what’s going on.”

A lot of people will smoke marijuana and say, “This is the only thing that helps my anxiety!” Other people will say they’re never more paranoid than when they smoke pot. That’s true for prescription drugs, too—people have different reactions to different products. “The challenge with cannabis is there’s no scientific data out there to say it tested against Ativan or Klonopin—the data doesn’t exist,” says Brennan.

Related: ‘How I Told My Partner That I’m HIV-Positive’

Sleeping Pills

You’re already aware that mixing alcohol with sleeping pills is a bad idea. Same goes for pot. “This depends on how much cannabis someone is using and what effect cannabis has on them, but mixing any product that with the opportunity to sedate someone or alter their consciousness is potentially dangerous,” says Brennan. “When you combine cannabis with a sedative hypnotic like Zolpidem or Ambien, I think people could perhaps find themselves in a very usual psychological state.”

If you’ve been prescribed sleeping medication, whether you use it regularly or just to get through those tough red-eye flights, you’re better off sticking to just the prescription medication for the duration of the dose, versus mixing it with cannabis or any other drugs.

Related: 5 Signs Your Exhaustion Is A Symptom Of A Much Bigger Problem

Allergy and Cold Meds

You might think that allergy and cold medicines like Benadryl (diphenhydramine) or Mucinex (guaifenesin) are NBD because you can grab them straight off the drugstore shelves—but if you take them with marijuana, they could have unanticipated effects.

“Benadryl, or allergy and cold meds, are sedative products,” says Brennan. “Some people can take them and go about their day, others take one dose and they’re on the couch for the rest of the day. I think it’s really important for people to remember that cannabis is not a harmless product, and we don’t know how it might interact with even over-the-counter drugs.”

So if you’re sick, stick to just one drug (the cold meds, please) if you want it to work its magic as fast as possible.

Smoking pot can mess with cold medicines, anti-depressants, and more. Experts share potential marijuana drug interactions and how to avoid them.

Klonopin with weed

Karen Berger, PharmD, Medical Writer

Anna is a NJMMP medical cannabis patient. She has been using cannabis for several years. Recently, she saw her doctor for anxiety and he put her on Klonopin (clonazepam). She was happy with the decision, because she had tried Klonopin several years ago and had great results and few side effects. However, this time, she noticed that she was feeling extremely tired and disoriented. What happened?

When you take any medication (whether it is prescription or over-the-counter) or have certain medical conditions, you always have to be aware of potential drug interactions. For example, if you have high blood pressure, it is not safe to take medications that contain decongestants, because decongestants can raise your blood pressure.

So, what about medical cannabis? While we all think of medical cannabis as a plant, we still have to think about potential drug interactions.

The good news in general with medical cannabis is that serious adverse effects are rare, and deaths from overdose do not occur.

A quick pharmacology lesson: drug interactions are often caused by certain enzymes which process medications in your body.

Certain enzymes are known as:

  • Inhibitors: An enzyme inhibitor slows down the metabolism of another drug – for example, if drug A is an enzyme inhibitor, it may inhibit the metabolism of drug B. What does this mean? Your body is not processing drug B as efficiently as it normally would, and this can result in higher drug levels and effects (potentially toxic) of drug B, as well as increased intensity of side effects.
  • Inducers: This is basically the opposite scenario. An enzyme inducer speeds up the metabolism of another drug. So, if drug A is an enzyme inducer, it can potentially induce the metabolism of drug B. This means drug B may be removed from your body faster, and may not be as effective. With certain drugs, it can even cause withdrawal symptoms.

Some of the most common enzymes involved with drug interactions are known as cytochrome P450 3A4 (CYP450 3A4), cytochrome P450 1A2 (CYP450 1A2), and cytochrome P450 2C9 (CYP450 2C9).

Because both THC and CBD are metabolized by CYP3A4 and CYP2C9, cannabis is involved in many drug interactions.

Also, THC induces CYP1A2. That means THC can potentially interact with any of these drugs, lowering the levels of the drug in your body, and making it less effective:

  • Clozaril (clozapine)
  • Cymbalta (duloxetine)
  • Naprosyn, Anaprox (naproxen)
  • Flexeril (cyclobenzaprine)
  • Zyprexa (olanzapine)
  • Haldol (haloperidol)
  • Thorazine (chlorpromazine)

CBD is a strong inhibitor of both CYP3A4 and CYP2D6. Because CYP3A4 is involved with metabolism of about 25% of all drugs, CBD may increase levels of:

  • Macrolide antibiotics
    • Zithromax (azithromycin)
    • Biaxin (clarithromycin)
    • Erythromycin
  • Calcium channel blockers
    • Calan (verapamil)
    • Cardizem (diltiazem)
  • Benzodiazepines
    • Valium (diazepam)
    • Xanax (alprazolam)
    • Klonopin (clonazepam)*
    • Ativan (lorazepam)
  • Cyclosporine
  • Certain erectile dysfunction medications
    • Viagra (sildenafil)
    • Cialis (tadalafil)
    • Levitra (vardenafil)
    • Stendra (avanafil)
  • Antihistamines
  • Haldol (haloperidol)
  • Antiretrovirals used in HIV or AIDS treatment
  • Certain statins
    • Lipitor (atorvastatin)
    • Zocor (simvastatin)

*This is what happened to Anna- the cannabis interfered with her Klonopin, making the Klonopin build up in her body and making her experience more side effects.

CYP2D6 metabolizes many antidepressants, so CBD may increase levels of these drugs in your body:

  • SSRI antidepressants
    • Prozac (fluoxetine)
    • Paxil (paroxetine)
    • Zoloft (sertraline)
    • Celexa (citalopram)
    • Lexapro (escitalopram)
  • Tricyclic antidepressants
    • Elavil (amitriptyline)
    • Pamelor (nortriptyline)
  • Antipsychotics
  • Beta blockers
    • Tenormin (atenolol)
    • Lopressor, Toprol XL (metoprolol)
    • Inderal (propranolol)
    • Zebeta (bisoprolol)
  • Opioids
    • Forms of oxycodone
    • Forms of codeine
    • Forms of morphine
    • Ultram (tramadol)

Other drug interactions:

  • Medical cannabis may interact with Coumadin (warfarin), a blood thinner that has many drug interactions. THC and CBD increase warfarin levels, making the patient prone to bleeding.
  • Alcohol may increase levels of THC.
  • Combining cannabis with tobacco can cause increased respiratory symptoms.
  • Many drugs are known as CNS depressants , because they slow down brain activity in the central nervous system (CNS), and are used to treat anxiety, panic, acute stress reactions, and sleep disorders. CNS depressants tend to have an additive effect with other CNS depressants. Cannabis has been shown to have additive CNS depressant effects with alcohol, barbiturates (such as phenobarbital), and benzodiazepines (see list above).

This is not a complete list; other drug interactions may occur.

The folks over at Leafly remind us that other factors may come into play with cannabis/drug interactions, such as the CBD:THC ratio, and different strain profiles. The article, linked above, provides some more information about cannabis and drug interactions and how cannabis may even be used in conjunction with a certain medication to increase its effect. Due to the versatility of cannabis, Leafly states that “one of the most compelling arguments for cannabis is that it can actually reduce the need to combine multiple medications that have a high risk potential of producing adverse interactions.” Dr. Donald Abrams, chief of hematology-oncology at San Francisco General Hospital and professor of clinical medicine at the University of California, San Francisco, sums it up well: “Why would I write six different prescriptions, all of which may interact with each other, when I could just recommend one medicine [cannabis]?”

Because data on drug interactions with medical cannabis is still being researched , we do not yet have a full picture of all possible drug interactions. There may be many more that we do not know about yet. Always ask your healthcare professional for advice.

The pharmacists and doctors at MyCureAll are working on identifying drug interactions for cannabis, as well as working to get cannabis covered and have the best medical protocols for each condition.

Information in this post is intended to be general information. For personalized advice, always check with your healthcare provider.

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