I just finished my CannyNurse program last week and LOVED it--so now I've met a person in my town who has Polymyalgia Rheumatica--is on prednisone--and wants to use cannabis. Can you help me with info on using CBD with Prednisone? I'm going to treat his Polymyalgia rheumatica as a type of RA and let the research you offer be a great spring-board for us to start experimenting....I'm just not sure about the steroid interfering....Your thoughts deeply appreciated!
Hi B_____,
Thanks for your kind words and sorry about the late reply.
First, I’m not a physician and as such cannot dispense medical advice. However, I can share with you some evidence-based information that may help you in making 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-off are common adverse effects such as weight gain, anxiety, insomnia, rapid changes in mood, weakness, and an increased risk for osteoporosis and infections for example. Given the evidence that cannabis-based therapeutics may provide therapeutic support to mitigate Obesity (Metabolic Syndrome), Mood Disorders (Anxiety), Osteoporosis, and of course 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. Prednisone is metabolized by the liver into prednisolone, which is primarily broken down by an enzyme belonging to the cytochrome P450 family. More specifically by the enzyme CYP3A4.1 CBD inhibits CYP3A4 and 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 turn out to be 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, but clinical trials are under way looking at CBD as a steroid sparing agent for auto-immune patients with Crohn’s Disease for example.3
Anecdotally, CBDA has also been employed to induce potentially helpful anti-inflammatory effects that may be helpful for patients with chronic inflammation of auto-immune origins. Raw cannabis and respective cannabinoid acid forms have not been extensively studied and their prednisone interaction potential have not been examined.
I hope this info help a little.
Be well and until soon,
Uwe
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. https://clinicaltrials.gov/ct2/show/NCT04056442?term=cannabidiol&cond=Crohn+Disease&draw=2&rank=1
