ADHD med in morning and CBD oil in af. – CHADD’s ADHD Pare.
CHADD’s ADHD Parents Together
ADHD med in morning and CBD oil in afternoon?
Hey everyone! I have a 9 year old son with ADHD, and he takes 20 mg of Vyvanse each morning. It is working very well for him, but he is metabolizing through it very quickly, and it is out of his system by 3:30. I was interested in possibly giving him some CBD oil in the afternoon to help with his symptoms in the afternoon/evening, but I’ve read here that some are saying that CBD oil should not be given with stimulant meds. Now, is that still the case if it isn’t given until after the meds have left the system? Is it okay to give it to him after the meds have worn off to help with the remainder of the day?
I appreciate your kind responses.
I have been given my son a low dose of CBD Oil in the morning and afternoon. Our doctor still has not prescribed us medication (that’s another discussion). We have seen a lot improvement with his anxiety but not much with the symptoms of ADHD. If you don’t mine me asking, approximately how many milligrams of CBD Oil do you give your son?
How do you know which is CBD oil to give?
HELLO! I JUST JOINED! I’M NOT SURE IF YOU’VE FINALLY PUT YOUR CHILD ON CBD OIL, BUT WE ARE STARTING THE ISOLATE SINCE THE BROAD FULL SPECTRUM CBD OIL HAS TRACE AMOUNTS OF THC, WHICH CAN AGGRAVATE ANXIETY MORE SINCE IT SPEEDS UP HEART RATE PLUS AT A YOUNG AGE IT IS BETTER TO AVOID THE THC BUT EVENTUALLY AS THEY GET OLDER IT SHOULDN’T BE MUCH OF AN ISSUE! THESE ARE THE DAYS WE ARE GUINEA PIGS SINCE WE DO NOT FULLY KNOW THE LONGTERM AFFECTS OF CBD OIL! THEY SEEM TO THING IT CAN SLOW DOWN RESPONSE BUT EVERYONE IS DIFFERENT PLUS THE BODY GOES THROUGH WITHDRAWALS WHICH IS SCARY! IT JUST DEPENDS ON YOUR SITUATION HOW SEVERE IT IS! MINE IS PRETTY SEVERE SO I HAVE EXHAUSTED OPTIONS! MY SON IS ON PROTANDIM WHICH IS A HOLISTIC OPTION! HE HAS DEFINITELY GOTTEN BETTER & COULD CONTINUE TO BUT HIS ADHD IS THROUGH THE ROOF & PROTANDIM AT THIS MOMENT IN TIME ISN’T AS AFFECTIVE! IT MAY BE DOWN THE ROAD BUT IN THE MEANTIME WE ARE STRUGGLING! I HOPE YOUR CHILD HAS IMPROVED! WISHING YOU THE BEST
Bring your concerns about the Vyvanse to your son’s doctor and talk about changes in dose or a different medication or supportive intervention. That is a better choice and a more effective one for your son than including CBD oil. It may be a relatively easy fix and one that the doctor can better assist you with.
There is not any evidence that CBD oil will treat ADHD symptoms, which are related to executive function. There is limited research into CBD oil for anxiety, which has been done in small groups with adults, only. There is no indication that it would be effective in treating ADHD symptoms in children.
Also, there hasn’t been research into possible interactions between CBD and other medications. So you run a chance of a medication interactions, especially since CBD oil is not regulated and you can’t be sure of what you actually have.
Furthermore, using CBD oil could make it difficult for you to get good treatment for your son in the future, as many professionals will decline to work with people or families that us cannabis products, including CBD oil.
You might find our Q&A “Will ADHD Symptoms Improve with Marijuana?” at bit.ly/nrcmarijuanaQA to be helpful.
The National Resource Center on ADHD
Our son is also on 20 mg vyvanse and some days it’s gone before 3. We’ve chosen to give a “booster” in the afternoon. It’s just 5 mg of Ritalin and it’s so much better. It took a couple of weeks to establish but makes such a huge difference in keeping evenings happier.
We are also doing a booster of our medication so he can get through homework, sports and the evening.
Vyvanse (like many stimulants) do have a short lifespan, which isn’t always bad for the long term health of our kiddos, but can be problematic for our kids “surviving” their last class of the day, completing any/all homework effectively/efficiently (without you and/or them wanting to rip your hair out), or participation in afterschool activities/sports. My son has ADHD (diagnosed at 5) and Autism Spectrum Disorder (diagnosed at 9) and has been on Vyvanse since he was 6 (was on Adderol at 5, but the weight loss and lack of sleep was too destructive). When my son began gymnastics, we quickly realized it wasn’t just a matter of being able to complete homework and focus during sports, it was also a SAFETY issue for him and his teammates since gymnastics can be dangerous if you’re not focused and impulsive. We opted to give him a fast-acting 5ml dose of Adderol (or was it Ritalin? It was a tiny oval blue tablet) afterschool (between ages 10-12) on the afternoons he had gymnastics practice (3+ days a week). It made a HUGE difference! I cannot impress upon you enough the benefits of discussing these concerns with his pediatrician/neurologist and if they don’t take you seriously, seek a second opinion elsewhere. As much as our family discourages the use of prescription medications, there are times and needs for them. I’ve seen so many kids who not only failed to succeed but also suffered social, emotional, and relationship detriments because it can take such a toll on them to “keep it together” to behave/act/appear like all the other neurotypical kids. I’d love one day for my son to not be on meds, as he’s getting older, we’re finding him taking more weekends off of meds (his choice) and we’re slowly seeing an increase in his ability to manage (he’s nearly 15 now) the symptoms of his ADHD/ASD, but it has taken a LOT of work at home, school, therapies, ADHD/ASD-specific summer camps (Talisman Programs) and kind/constructive conversations for him to become more self-aware so as to better negate, prevent, or diminish the challenges he faces from ADHD/ASD. At the end of the day, I believe our ADHD/ASD kids are quite brilliant, unfortunately they are on the outside looking in and sometimes feel trapped in their own mind/bodies. It takes so much effort to fit in with neurotypicals, it’s taken me years to personally wrap my own head around it. But I believe their unique qualities can help them succeed in ways that are not as effortless for neurotypicals. Companies like Microsoft are seeking individuals like our kids, because they can hyperfocus and see/do things that blow the rest of us out of the water Best of luck to you and your son. It does get easier, and some behaviors/challenges diminish, go away, or are replaced by different ones, but with your support, it does improve!
Hey everyone! I have a 9 year old son with ADHD, and he takes 20 mg of Vyvanse each morning. It is working very well for him, but he is metabolizing through it very quickly, and it is out of his…
CBD Drug Interactions Explained: What Drugs Should Not Be Taken With CBD
Cannabidiol, or CBD, is one of over a 100 different types of a specific kind of compound called phytocannabinoids found in the Cannabis sativa plant.
CBD is has become increasingly popular in recent years due to its wide range of therapeutic effects as well as its ability to relieve a host of symptoms effectively , but also to do so safely and with few side effects. And unlike tetrahydrocannabinol (THC), the other most abundant phytocannabinoid found in the cannabis plant, CBD is non-intoxicating and non-psychoactive – something that for many people is an undesirable yet unavoidable part of taking a high-THC containing cannabis extract.
CBD is most widely known and has been popularized as being used for seizure disorders such as epilepsy but has also proven to be effective in helping to relieve the symptoms of other conditions. These include anxiety, depression, schizophrenia, inflammatory and neuropathic pain, Parkinson’s disease, Crohn’s and other forms of inflammatory bowel disease, as well as certain types of cancer.
However, despite the fact that the vast majority of the science indicates CBD oil is safe to use on its own, CBD is a powerful compound that interacts with a variety of systems within the body. And as such, CBD not only shows potential as a powerful therapeutic agent, but can become less benign when taken together with other substances such as pharmaceutical drugs.
Let’s find out why.
Before we take a look at how CBD interacts with medications, first we need to understand how the body’s metabolism works in general, the systems involved in CBD metabolism, how CBD is metabolized and how CBD affects something called the Cytochrome P-450 system.
What Is Metabolism?
A lot of people think of metabolism in terms of how easily or slowly they gain and lose weight, often claiming to have a “fast” or “slow” metabolism. In scientific terms, this is what is known as the basal metabolic rate, or the amount of calories an individual requires in order to sustain normal body functions while at rest.
However, this basal metabolic rate is very different to metabolism – the way in which substances such as different types of food are broken down and used by the body – with much of this process happening in the gut and the liver in what is known as the ‘first-pass effect,’ or ‘first-pass metabolism’.
Explained very simplistically, when food is eaten, it is broken down by the liver into its individual compounds in order for it to be used by the body. So for example, carbohydrates are broken down into sugars, fats into triglycerides, and proteins into amino acids. From there, the metabolism, under the control of chemicals called enzymes, transforms these compounds into metabolites that can then be used by the body, for instance as fuel for cellular processes or as building blocks for various systems and tissues.
Just like food has to go through this process, so too does a therapeutic compound such as CBD, but in what is more specifically called drug metabolism. Drug metabolism refers to the rate at which medications and other therapeutic compounds are broken down by the body into its individual metabolites and how long these metabolites stay in the body.
So, when CBD is ingested by mouth, either as an oil, tincture, capsule or edible, it has to pass through the digestive system where the it is absorbed into the bloodstream by the intestines. From there, the CBD is transported by the blood to the liver where it enters the liver via the hepatic portal. Once the CBD is in the liver, it is broken down into its metabolites by enzymes after which it can be circulated throughout the body in the bloodstream.
The Cytochrome P450 System
However, in addition to breaking compounds down into metabolites, is also has one other very specific and important role it plays during this metabolic process – the detoxification and excretion of foreign drugs (called xenobiotics) and other types of toxic substances.
It does through a system called the cytochrome P450 system (CYP) which consists of a special group of enzymes containing heme as a cofactor to convert fat-soluble compounds into more water-soluble compounds and aiding in their absorption and use.
It is estimated that the CYP system is responsible for metabolizing over 60% percent of any drug that has been consumed. And interestingly, pharmaceutical researchers and doctors also use cytochrome P450 system to understand, calculate and predict drug dosages, effects as well as its potential side effects.
For instance, if only one therapeutic compound is being processed by the liver, and the system in general is healthy, scientist can use the average amount of time it takes for the drug or medication to be processed through the CYP to calculate accurate dosage information.
However, there are certain substances that have the ability to affect the way in which the CYP system processes compounds such as CBD that causes certain drugs to metabolize faster or slower than what they would normally have done.
CBD And The Cytochrome P450 System
As mentioned, CBD also has the ability to interact directly with the CYP system in the liver. Preclinical research is showing that the way in which CBD does is by binding to the site where the enzyme activity occurs acting as a “competitive inhibitor”, displacing its chemical competitors, and thus preventing the CYP system from metabolizing other compounds.
The extent to which CBD acts as a competitive inhibitor of the cytochrome P450 binding proteins is mainly dependent on how much CBD is ingested, the unique physiology of the individual as well as the type of CBD product used (e.g. CBD isolate v.s full-spectrum CBD extracts). This is due to these factors determining how tightly the CBD molecules bind to the active site of the metabolic enzyme, with increased and tighter bonds resulting in more competitive inhibition.
What this means in plain English is that CBD sort of “out competes” other medications when it comes to reaching first place in for getting metabolized by the CYP enzymes. This, in essence means that CBD deactivates the effects of all the other therapeutic compounds that pass through the CYP system.
How successful it is in its competition with other medicines depends on a few factors but mostly the amount of CBD that enters into the bloodstream. If it’s not very much, it will have very little to no noticeable effect on the CYP activity and the majority of the medicine will be metabolized. On the other hand, if a large dose of CBD is taken, it will bind to a lot more of the site of enzyme activity and leave a lot more of the other medicine to not be metabolized.
Why CBD’s Competitive Inhibitory Effect On The Cytochrome P450 System Is Important
When the CYP system is affected in this way by CBD, it both changes and the way in which certain other drugs are metabolized as well as prevent a lot of the drug to be metabolized. When this happens, it leads to higher levels of other drug compounds to remain in the body at a single time.
At the very least these elevated concentrations can cause unwanted side effects like an increased risk of bleeding or a suppressed immune system, but more worryingly, it can quite easily result in an overdose.
CBD and Drug Interactions: Contraindications
Any therapeutic compound that is metabolized by the CYP system has the potential of being affected by CBD. One indication that your medicine might be metabolized by the CYP system is if your pharmacist told you not to eat grapefruit or watercress or use St. John’s Wort or goldenseal supplements. However this is by no means a solid test and you should always check with your pharmacist of doctor first (more on that later).
According to the Indiana University Department of Medicine, pharmaceutical drugs and medications which could be contraindicated for use with CBD include:
- Steroids and corticosteroids for example hydrocortisone, cortisone, prednisone, triamcinolone and dexamethasone
- HMG CoA reductase inhibitors (statins) for example atorvastatin, fluvastatin, lovastatin, pravastatin, pitavastatin, simvastatin and rosuvastatin
- Calcium channel blockers for example amlodipine, diltiazem, felodipine, isradipine, nicardipine, nifedipine, nisoldipine and verapamil
- Antihistamines for example brompheniramine. cetirizine, chlorpheniramine, clemastine, diphenhydramine, fexofenadine and loratadine
- Prokinetics (motility drugs) for example domperidone, metoclopromide, levosulpiride, renzapride and pruclopride
- HIV antivirals for example abacavir, didanosine, emtricitabine, lamivudine, stavudine, tenofovir alafenamide and disoproxil fumarate as well as zidovudine
- Immune modulators for example immune globulins, immunosuppressive agents and immunostimulants for example bacterial and viral vaccines
- Benzodiazepines for example alprazolam, clobazam, clonazepam, clorazepate, chlordiazepoxide, diazepam, estazolam and lorazepam
- Antiarrythmics for example amiodarone, flecainide, procainamide, propafenone, quinidine and tocainide
- Antibiotics for example amoxicillin, doxycycline, cephalexin, ciprofloxacin, clindamycin, metronidazole, azithromycin, sulfamethoxazole-trimethoprim, amoxicillin-clavulanate and levofloxacin
- Anesthetics for example barbiturates, amobarbital, methohexital, thiamylal, etomidate., ketamine and propofol
- Antipsychotics for example aripiprazole, asenapine, cariprazine, clozapine, lurasidone, olanzapine, quetiapine, risperidone and ziprasidone
- Antidepressants for example citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, vortioxetine and vilazodone
- Anticonvulsants / Anti-Seizure Medications for example acetazolamide, carbamazepine, clobazam, clonazepam, ethosuximide, fosphenytoin, gabapentin, lacosamide, lamotrigine, levetiracetam, methsuximide, nitrazepam, oxcarbazepine, paraldehyde, phenobarbital, phenytoin, primidone, topiramate, valproic acid, vigabatrin, felbamate, tiagabine hydrochloride and zonisamide
- Beta blockers for example acebutolol, atenolol, betaxolol, betaxolol, bisoprolol fumarate, carvedilol, esmolol, labetalol, metoprolol, nadolol, nebivolol, penbutolol, propranolol, sotalol and timolol
- Proton-Pump Inhibitors (PPIs) for example omeprazole, lansoprazole, pantoprazole, rabeprazole, esomeprazole and dexlansoprazole
- Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) for example aspirin, celecoxib, diclofenac, diflunisal, etodolac, ibuprofen, indomethacin, ketoprofen, ketorolac, nabumetone, naproxen, oxaprozin, piroxicam, salsalate, sulindac, tolmetin
- Angiotension II Blockers for example azilsartan, candesartan, eprosartan, irbesartan, losartan, olmesartan, telmisartan and valsartan
- Oral Hypoglycemic Agents for example sulfonylureas, meglitinides, biguanides, thiazolidinediones, α-Glucosidase inhibitors, DPP-4 inhibitors, SGLT2 inhibitors and cycloset
- Sulfonylureas for example glynase, micronase, amaryl, diabinese, glucotrol, tolinase and tolbutamide
There are also other medications known as “prodrugs” that first need to be metabolized into its therapeutic compounds as opposed to being a therapeutic compound in and of itself (like most medications). In other words, the inactive compound is ingested, and once in the body, it is processed into its active compound.
If this processing is dependent on the CYP system, then inhibitors can cause an insufficient amount of the active drug compound to be available in the body which can result in the desired therapeutic effect not being reached.
One such prodrug for example is codeine which is metabolized into morphine. Similarly, lisdexamfetamine under the brand names Vyvanse and Concerta are two other popular ADHD medications which also fall into this category.
Why You Should Always Speak To Your Doctor First
The above mentioned list of drugs that could interact with CBD is by no means exhaustive and does not include all of the medications on which CBD may have an interaction with. Similarly, not all of the medication categories listed above will necessarily cause and interaction (although if you are taking one of these medications it is recommended to rather err on the side of caution). For this reason it is vital that you should consult your doctor or treating physician before using any CBD oil or product. Your doctor is not only able to advise you with regard to a possible CBD-drug interaction, but can also monitor the therapeutic as well as side effects of both the CBD and the medications you are on. Similarly, your doctor can also help you adjust the dosages of both the medication and CBD so you can take both simultaneously but also do so safely.
The safety profile of CBD is well established with study after study showing that it is well tolerated and safe to use, while at the same time rarely producing any serious side effects. Similarly, CBD is a compound that has a profound impact on a wide variety of systems within the body which is what makes it such an effective therapeutic agent for so many conditions. But at the same time it is good to remember that it is also this, that is the reason why it has the potential to interact with other drugs and why CBD should be consumed with care and respect.
CBD shows potential as a powerful therapeutic agent, but can become less benign when taken together with other substances such as pharmaceutical drugs.