How does CBD interact with a Steroid like Prednisone?

Uwe’s answer:

Thanks for your kind words, and sorry about the late reply.

First, I’m not a physician and cannot dispense medical advice. However, I can share some evidence-based information that may help you make more informed and discerning decisions.

As you may already know that the use of corticosteroids such as prednisone is a common and powerful pharmacological treatment approach to reduce or tame the ill effects of an over-reactive immune system. The trade-offs are common adverse effects such as weight gain, anxiety, insomnia, rapid changes in mood, weakness, and an increased risk for osteoporosis and infections. Given the evidence that cannabis-based therapeutics may provide therapeutic support to mitigate Obesity (Metabolic Syndrome), Mood Disorders (Anxiety), Osteoporosis, and of course, it may help to address a key symptom of autoimmune disorders, i.e., immune over-reactivity (e.g., Rheumatoid Arthritis) it may turn out that cannabis-based therapeutics may induce complementary or even synergistic results.

However, this hope is tempered by what we know about how both prednisone and some cannabis constituents, primarily CBD, are metabolized. The liver metabolizes prednisone into prednisolone, mostly broken down by an enzyme belonging to the cytochrome P450 family. More specifically, the enzyme CYP3A4.1 CBD inhibits CYP3A4. As such, the effects of CBD may be diminished, or the effects of prednisone may be enhanced, including both prednisone’s therapeutic or adverse effects potential.2 And while CBD may become a steroid-sparing agent, i.e., an agent that allows for the induction of the optimal therapeutic effect with lower steroid dosages, the co-administration of CBD-based products and prednisone ought to be ideally guided by a cannabis-educated physician. To my knowledge, no data currently exists examining replacing prednisone with CBD. Still, clinical trials are looking at CBD as a steroid-sparing agent for auto-immune patients with Crohn’s Disease.3

Anecdotally, CBDA has also been employed to induce potentially beneficial anti-inflammatory effects that may be helpful for patients with chronic inflammation of auto-immune origins. However, raw cannabis and respective cannabinoid acid forms have not been extensively studied, and their prednisone interaction potential has not been examined.

Endnotes:
1. Pharma KB. Prednisone, Pharmacokinetics.  https://www.pharmgkb.org/chemical/PA451100

2. Yamaori S, Ebisawa J, Okushima Y, Yamamoto I, Watanabe K. (2011 Apr) Potent inhibition of human cytochrome P450 3A isoforms by cannabidiol: role of phenolic hydroxyl groups in the resorcinol moiety. Life Sci. 88(15-16):730-736.

3. ClinicalTrials.gov Identifier: NCT04056442. A Phase 2a Study to Evaluate the Safety, Tolerability and Efficacy of Cannabidiol as a Steroid-sparing Therapy in Steroid-dependent Crohn’s Disease Patients.  Study Link