Does CBD interact with metformin?

Metformin is an antidiabetic drug. It is the most common medication used in lowering blood sugar levels in type II diabetes and polycystic ovary disease.

Unfortunately, metformin also brings with it a number of negative side effects. Many people wonder whether CBD is a suitable alternative to this common prescription drug or whether taking them together is safe.

We will explore possible interactions to watch out for between CBD (and other cannabinoids) and metformin.

Does CBD interact with metformin?

Yes, CBD and metformin can cause a dramatic drop in blood sugar levels when taken together - leading to side effects such as dizziness, fainting, and injury.

It is best to take CBD and metformin approximately 2 hours apart to avoid these potential side effects.

CBD can interact with metformin in two ways:

1. Increased potency (agonist interaction)

CBD may have an agonist reaction when taken with metformin. Both drugs affect the blood sugar levels in the body. Both metformin and CBD can cause a reduction in blood glucose levels, although the mechanisms by which they achieve this are very different from each other.

Metformin makes cells more responsive to insulin and increases lipid metabolism. CBD acts on the body's endocannabinoid system (ECS) and may be responsible for the increased amount of insulin in the body. These interactions between the two may help lower blood sugar levels in patients with diabetes. However, it largely depends on the physiology of the individual's body as in some patients it can lead to a rapid drop in blood sugar levels, which can cause dizziness, fainting, etc.

2. Slow elimination (metabolic inhibition)

The second interaction that these two drugs can have is metabolic. Both can compete for the same liver enzymes, primarily CYP3A4. This can cause the concentrations of both drugs to rise for a longer period of time and may take longer to be removed from the body. This interaction could lead to several side effects. 

So far, no cases of adverse reactions have been reported when the two medicines are used together. There is no research available to determine how these two drugs interact and what complications they may have. Therefore, the risk of interaction is minor, but not entirely nonexistent.

Other names for metformin

Metformin is sold under many different names. They all have the same risks and potential interactions.

Other names of metformin include:

• Kazano
• Invokamet
• Xigduo XR
• Synjardy
• Glucovance
• Jentadueto
• Actoplus
• PrandiMet
• Avandamet
• Kombiglyze XR
• Janumet

Is it safe to take CBD and metformin together?

It is possible to take both CBD and metformin as they have very little chance of interacting. However, it is always better to take extra caution as both drugs have their side effects and when taken together can cause your blood sugar levels to drop more than they need to. Consult your doctor first and seek his/her professional opinion. Never take these two medicines alone without medical supervision.

If you decide to take both medicines, it may be possible to reduce side effects by taking only small doses of both medicines at first. The dosage of both medicines depends on your condition and your body's needs. Avoid taking them together and try to space the doses of both medicines.

Depending on your body's response to the two medications, the dose of CBD and metformin may be decreased or increased. If you experience any unusual side effects, contact your doctor immediately.

Is CBD a suitable alternative to metformin?

CBD contains no psychoactive elements and has many benefits. It works by acting on the body's endocannabinoid system by acting on its receptors. This ability can play a vital role in energy regulation by influencing how cells respond to insulin. CBD can therefore help cells respond better to insulin and reduce lipid levels in the body.

CBD combined with the cannabis compound tetrahydrocannabivarin (THCV) can increase insulin production and lower blood sugar levels in patients with diabetes.

A study has shown that CBD can cause a "browning of fat" process that can help with lipid metabolism and prevent obesity.

CBD also has anti-inflammatory and antioxidant properties and may help reduce inflammation in the pancreas and aid insulin production. 

Given CBD's many benefits, it is possible that it will become an alternative for anti-diabetic treatment. However, sufficient research and studies on it are still lacking. There is not much information about its positive and negative effects on diabetic patients, so CBD is not a perfect substitute for metformin.

If you decide to take CBD and take metformin at the same time, you must first consult your doctor and get tested. Take the medication as directed, at the right time, and don't take more than you need.

What is metformin?

Metformin is a type of biguanide antihyperglycaemic drug. It is used as a first choice drug in the treatment of type II diabetes and in the treatment of polycystic ovary disease.

It can control blood sugar levels in the body by reducing glucose production in the liver, increasing the sensitivity of cells to insulin, and increasing GDF (growth differentiation factor 15), which reduces appetite and calorie intake.

Metformin Specifications:

What does metformin do?

Metformin lowers blood glucose levels in diabetic patients without causing hypoglycemia.

Diabetes is a chronic disease in which high blood sugar levels occur. Normally, when the body takes in sugar from the diet, the pancreas releases the hormone insulin. Insulin controls blood sugar levels and allows cells to absorb glucose, which they use as an energy source.

Several factors, such as genetics, excess body fat and others, can make blood cells insensitive to insulin. This causes the cells to absorb less sugar, which causes high amounts of sugar to flow in the bloodstream instead, making insulin ineffective. This leads to increased blood glucose levels, insulin resistance and also insulin deficiency. Over time, it can cause many consequences such as kidney damage, high blood pressure, etc.

Metformin reduces the liver's ability to produce glucose (gluconeogenesis) and counteracts the effect of glucagon. It also activates 5′-AMP-activated kinase (AMPK), which increases glucose uptake by cells. It also decreases lipid synthesis and increases fatty acid oxidation. It also increases insulin sensitivity and increases peripheral glucose uptake and utilization. 

Metformin is prescribed along with the design of an appropriate diet and exercise program. Combining them can normalize blood sugar levels and maintain weight. 

Metformin has been shown to be effective in treating high blood sugar, restoring ovulation and weight loss in polycystic ovary disease (PCOD). Studies of its potential anti-cancer abilities are also underway.

The liver does not metabolise metformin, instead it is excreted unchanged in the urine. However, it affects the activity of a liver enzyme called CYP3A4.

Metformin is not recommended for use in several conditions. These include hypersensitivity to metformin, congestive, heart failure, diabetic ketoacidosis with or without coma, severe kidney disease, and abnormal creatinine clearance.

Side effects of metformin:

• Abdominal bloating
• Chest discomfort
• Chills
• Constipation
• Diarrhea
• Dizziness
• Dyspepsia
• Flatulence
• Gastrointestinal disorders
• Heartburn
• Hypoglycaemia
• Lactic acidosis
• Myalgia
• Nausea
• Vomiting
• Nausea

Types of drug interactions with CBD

CBD has proven to be safe and useful in treating many conditions. However, like most other drugs, CBD can interact with other medications. Therefore, any combination of medications with CBD must be supervised. If you are taking any medications in addition to CBD, always remain vigilant and keep an eye out for unusual side effects.

There are three ways CBD can interact with other medications:

1. Agonist interaction

This occurs when two drugs act on the same receptors in the body, resulting in increased effects.

Examples of drugs that can cause an agonistic interaction with CBD are:

Antihypertensives - these include beta blockers, calcium channel blockers, central agonists, diuretics, ACE inhibitors, alpha blockers and angiotensin II receptor blockers. CBD can interact with these and cause a drop in blood pressure.

Antidiabetic drugs - These include GLP-1 receptor agonists, meglitinides, SGLT-2 inhibitors, sulfonylureas and insulin, alpha-glucosidase inhibitors, and DPP-4 inhibitors.

Anti-anxiety medications - These include drugs such as benzodiazepines and barbiturates. CBD could prolong their effect.

2. Antagonistic interactions

These are the opposite of agonistic interactions. It occurs when two drugs have opposite effects on each other. If taken together, one drug would cancel out the effects of the other, causing a reduction in the effectiveness of the other drug.

Drugs that have antagonistic interactions with CBD include:

Immunosuppressants - these include azathioprine, mycophenolate cyclosporine, methotrexate, etc. The immunostimulant properties of CBD may reduce the effects of these drugs.

Stimulants - These include amphetamine and modafinil. CBD may cause a reduction in their effects.

Immunomodulators - These include antihistamines such as carbinoxamine, desloratadine, levocetirizine. CBD may enhance their sedative effect.

Asthma medications - These include drugs like albuterol, fluticasone, montelukast, ipratropium bromide and theophylline. CBD can counteract their abilities, especially theophylline.

3. Inhibition of metabolism

Some drugs need similar enzymes to break down drug molecules. This leads to the two drugs competing with each other, causing their metabolism to slow down.

These include drugs such as:

Blood thinners - CBD can cause an increase in the effect of warfarin, enoxaparin, heparin and others, which can be very dangerous.

NSAIDs - These include ibuprofen, naproxen and high-dose aspirin. CBD could cause them to last longer in the body.

Opiate analgesics - These include morphine, codeine and hydrocodone. CBD can cause them to stay in the bloodstream longer, which can cause complications. 

Antidepressants - CBD can cause these drugs to last longer in the body because it slows down their metabolism. Antidepressants include trazodone, mirtazapine, vortioxetine, vilazodone and others.

Key takeaways: is it safe to take metformin with CBD?

CBD has the potential to become an alternative treatment for diabetes in the future.

CBD and metformin may have a mild interaction, with both drugs lasting longer in the body and lowering blood sugar levels below normal.

Although they have a very low likelihood of interacting, caution should be taken when taking both. Use them only under the guidance of a certified physician and seek medical attention immediately if any unusual side effects occur.

Sources:

• Jadoon, K. A., Ratcliffe, S. H., Barrett, D. A., Thomas, E. L., Stott, C., Bell, J. D., … & Tan, G. D. (2016). Efficacy and safety of cannabidiol and tetrahydrocannabivarin on glycemic and lipid parameters in patients with type 2 diabetes: a randomized, double-blind, placebo-controlled, parallel-group pilot study. Diabetes Care, 39(10), 1777-1786.
• Parray, H. A., & Yun, J. W. (2016). Cannabidiol promotes browning in 3T3-L1 adipocytes. Molecular and cellular biochemistry, 416(1), 131-139.
• Li, K., Feng, J. Y., Li, Y. Y., Yuece, B., Lin, X. H., Yu, L. Y., … & Storr, M. (2013). Anti-inflammatory role of cannabidiol and O-1602 in cerulein-induced acute pancreatitis in mice. Pancreas, 42(1), 123-129.