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Can Marijuana Cause Deadly Drug Interactions?

Chelsea Clinton recently suggested that marijuana might be deadly when taken with other drugs. But is this really true?

Although marijuana can interact with other drugs, there do not appear to be any reports of deaths that directly resulted from taking marijuana in combination with other drugs.

While speaking in Ohio on Sept. 24, Clinton was asked whether her mother, Hillary Clinton, supports changing the way marijuana is categorized by the Drug Enforcement Administration so that it would be easier for researchers to conduct studies on the drug. Chelsea Clinton replied that her mother does support research on marijuana. Then, she added, “But we also have anecdotal evidence now from Colorado, where some of the people who were taking marijuana for those purposes, the coroner believes, after they died, there was drug interactions with other things they were taking.”

A spokesperson for Clinton later said Clinton “misspoke about marijuana’s interaction with other drugs contributing to specific deaths,” according to The Huffington Post.

By itself, marijuana is not known to have direct lethal effects. According to the U.S. Drug Enforcement Administration, no overdose deaths from marijuana have been reported in the United States.

In addition, the evidence that marijuana may interact with other drugs is limited, according to a 2007 review paper in the American Journal of Health-System Pharmacy.

Still, marijuana does appear to interact with a number of drugs, the review said. If marijuana is taken with alcohol, benzodiazepines (drugs that treat anxiety) or muscle relaxants, the combination can result in “central nervous system depression,” the review said, which means that people can experience decreased breathing and heart rate, and loss of consciousness. [How 8 Common Medications Interact with Alcohol]

There also have been reports of people experiencing a rapid heart rate and delirium after using marijuana while taking older forms of antidepressants (known as tricyclic antidepressants), the review said.

Marijuana may also interact with drugs that are broken down by enzymes in the liver known as cytochrome P450 enzymes, according to the Mayo Clinic. That’s because a compound in marijuana called cannabidiol can inhibit these enzymes. Therefore, marijuana may prevent other drugs from being broken down properly, and as a result, levels of these other drugs may be increased in the blood, which “may cause increased effects or potentially serious adverse reactions,” the Mayo Clinic says.

One example is the drug sildenafil, commonly known by the brand name Viagra, which is broken down by cytochrome P450 enzymes. In 2002, researchers in the United Kingdom reported that a 41-year-old man had a heart attack after taking marijuana and Viagra together. This report could not prove that the marijuana-Viagra combination was definitely the cause of the man’s heart attack. However, the researchers said that doctors “should be aware” of the effects of inhibiting cytochrome P450 enzymes when prescribing Viagra.

Still, Live Science could not find any scientific or news reports of people who have died as a result of marijuana interacting with another drug.

But that doesn’t mean marijuana is harmless — the drug can impair coordination and slow down reaction time, and it has been linked with fatal car crashes, according to the National Institute on Drug Abuse (NIDA). A 2011 study found that people who reported driving within 3 hours of using marijuana, or drivers who tested positive for the drug, were more than twice as likely to be involved in a car crash compared with other drivers.

The Mayo Clinic says marijuana can increase the drowsiness caused by some drugs, including diazepam (Valium), codeine, antidepressants and alcohol, and so people need to be cautious if they drive or operate machinery after using these drugs with marijuana.

People who take high doses of marijuana may experience anxiety attacks or hallucinations, according to the NIDA. In some rare cases, intoxication with marijuana has been linked with suicide. In 2014, researchers from Germany reported that two men died from heart problems that were brought on by smoking cannabis.

But marijuana may have a benefit in terms of reducing deaths from opioid painkillers. A 2014 study found that rates of overdose death from opioids were lower in states where medical marijuana is legal. Another study, published earlier this month, found that rates of opioid use decreased among younger adults in states that had legalized medical marijuana. It’s possible that people are substituting medical marijuana for opioids to treat chronic pain, the researchers said.

Chelsea Clinton recently suggested that marijuana might be deadly when taken with other drugs. But is this really true?

Drug Interactions between cannabis and Valium

This report displays the potential drug interactions for the following 2 drugs:

  • cannabis
  • Valium (diazepam)

Interactions between your drugs

diazePAM cannabis (Schedule I substance)

Applies to: Valium (diazepam) and cannabis

MONITOR: Central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these effects, especially in elderly or debilitated patients. Sedation and impairment of attention, judgment, thinking, and psychomotor skills may increase.

MANAGEMENT: During concomitant use of these drugs, patients should be monitored for potentially excessive or prolonged CNS and respiratory depression. Cautious dosage titration may be required, particularly at treatment initiation. Ambulatory patients should be counseled to avoid hazardous activities requiring mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

References
  1. “Product Information. Belsomra (suvorexant).” Merck & Company Inc, Whitehouse Station, NJ.
  2. Divoll M, Greenblatt DJ, Lacasse Y, Shader RI “Benzodiazepine overdosage: plasma concentrations and clinical outcome.” Psychopharmacology (Berl) 73 (1981): 381-3
  3. Plushner SL “Valerian: valeriana officinalis.” Am J Health Syst Pharm 57 (2000): 328-35
  4. Lemberger L, Rowe H, Bosomworth JC, Tenbarge JB, Bergstrom RF “The effect of fluoxetine on the pharmacokinetics and psychomotor responses of diazepam.” Clin Pharmacol Ther 43 (1988): 412-9
  5. Feldman SA, Crawley BE “Interaction of diazepam with the muscle-relaxant drugs.” Br Med J 1 (1970): 336-8
  6. Stovner J, Endresen R “Intravenous anaesthesia with diazepam.” Acta Anaesthesiol Scand 24 (1965): 223-7
  7. “Product Information. Trileptal (oxcarbazepine)” Novartis Pharmaceuticals, East Hanover, NJ.
  8. Ochs HR, Greenblatt DJ, Verburg-Ochs B “Propranolol interactions with diazepam, lorazepam and alprazolam.” Clin Pharmacol Ther 36 (1984): 451-5
  9. “Product Information. Precedex (dexmedetomidine)” Abbott Pharmaceutical, Abbott Park, IL.
  10. Cerner Multum, Inc. “UK Summary of Product Characteristics.” O 0
  11. Sotaniemi EA, Anttila M, Rautio A, et al “Propranolol and sotalol metabolism after a drinking party.” Clin Pharmacol Ther 29 (1981): 705-10
  12. “Product Information. Tasmar (tolcapone).” Valeant Pharmaceuticals, Costa Mesa, CA.
  13. “Product Information. Lexapro (escitalopram).” Forest Pharmaceuticals, St. Louis, MO.
  14. Greb WH, Buscher G, Dierdorf HD, Koster FE, Wolf D, Mellows G “The effect of liver enzyme inhibition by cimetidine and enzyme induction by phenobarbitone on the pharmacokinetics of paroxetine.” Acta Psychiatr Scand 80 Suppl (1989): 95-8
  15. “Product Information. Ultiva (remifentanil).” Mylan Institutional (formally Bioniche Pharma USA Inc), Canonsburg, PA.
  16. “Product Information. Xatral (alfuzosin).” Sanofi-Synthelabo Canada Inc, Markham, ON.
  17. Stambaugh JE, Lane C “Analgesic efficacy and pharmacokinetic evaluation of meperidine and hydroxyzine, alone and in combination.” Cancer Invest 1 (1983): 111-7
  18. “Product Information. Rexulti (brexpiprazole).” Otsuka American Pharmaceuticals Inc, Rockville, MD.
  19. “Product Information. Fycompa (perampanel).” Eisai Inc, Teaneck, NJ.
  20. Greiff JMC, Rowbotham D “Pharmacokinetic drug interactions with gastrointestinal motility modifying agents.” Clin Pharmacokinet 27 (1994): 447-61
  21. Desager JP, Hulhoven R, Harvengt C, Hermann P, Guillet P, Thiercelin JF “Possible interactions between zolpidem, a new sleep inducer and chlorpromazine, a phenothiazine neuroleptic.” Psychopharmacology (Berl) 96 (1988): 63-6
  22. Grabowski BS, Cady WJ, Young WW, Emery JF “Effects of acute alcohol administration on propranolol absorption.” Int J Clin Pharmacol Ther Toxicol 18 (1980): 317-9
  23. “Product Information. Artane (trihexyphenidyl).” Lederle Laboratories, Wayne, NJ.
  24. Driessen JJ, Vree TB, Booij LH, van der Pol FM, Crul JF “Effect of some benzodiazepines on peripheral neuromuscular function in the rat in-vitro hemidiaphragm preparation.” J Pharm Pharmacol 36 (1984): 244-7
  25. “Product Information. Ultram (tramadol).” McNeil Pharmaceutical, Raritan, NJ.
  26. Miller LG “Herbal medicinals: selected clinical considerations focusing on known or potential drug-herb interactions.” Arch Intern Med 158 (1998): 2200-11
  27. MacLeod SM, Giles HG, Patzalek G, Thiessen JJ, Sellers EM “Diazepam actions and plasma concentrations following ethanol ingestion.” Eur J Clin Pharmacol 11 (1977): 345-9
  28. Hamilton MJ, Bush M, Smith P, Peck AW “The effects of bupropion, a new antidepressant drug, and diazepam, and their interaction in man.” Br J Clin Pharmacol 14 (1982): 791-7
  29. “Product Information. Meridia (sibutramine).” Knoll Pharmaceutical Company, Whippany, NJ.
  30. Markowitz JS, Wells BG, Carson WH “Interactions between antipsychotic and antihypertensive drugs.” Ann Pharmacother 29 (1995): 603-9
  31. Ferslew KE, Hagardorn AN, McCormick WF “A fatal interaction of methocarbamol and ethanol in an accidental poisoning.” J Forensic Sci 35 (1990): 477-82
  32. “Product Information. Seroquel (quetiapine).” Zeneca Pharmaceuticals, Wilmington, DE.
  33. Cerner Multum, Inc. “Australian Product Information.” O 0
  34. “Product Information. Iopidine (apraclonidine).” Alcon Laboratories Inc, Fort Worth, TX.
  35. Naylor GJ, McHarg A “Profound hypothermia on combined lithium carbonate and diazepam treatment.” Br Med J 2 (1977): 22
  36. Tverskoy M, Fleyshman G, Ezry J, Bradley EL, Jr Kissin I “Midazolam-morphine sedative interaction in patients.” Anesth Analg 68 (1989): 282-5

View all 36 references

Drug and food interactions

diazePAM food

Applies to: Valium (diazepam)

GENERALLY AVOID: Acute alcohol ingestion may potentiate the CNS depression and other CNS effects of many benzodiazepines. Tolerance may develop with chronic ethanol use. The mechanism may be decreased clearance of the benzodiazepines because of CYP450 hepatic enzyme inhibition. Also, it has been suggested that the cognitive deficits induced by benzodiazepines may be increased in patients who chronically consume large amounts of alcohol.

MONITOR: Grapefruit juice may increase the plasma concentrations of orally administered drugs that are substrates of the CYP450 3A4 isoenzyme. However, the interaction seems to affect primarily those drugs that undergo significant presystemic metabolism by CYP450 3A4 (i.e., drugs with low oral bioavailability), presumably due to the fact that grapefruit juice inhibits intestinal rather than hepatic CYP450 3A4. Because pharmacokinetic interactions involving grapefruit juice are often subject to a high degree of interpatient variability, the extent to which a given patient may be affected is difficult to predict.

MANAGEMENT: Patients should be advised to avoid alcohol during benzodiazepine therapy. Patients who regularly consume grapefruit or grapefruit juice should be monitored for adverse effects and altered plasma concentrations of drugs that undergo significant presystemic metabolism by CYP450 3A4. Grapefruit and grapefruit juice should be avoided if an interaction is suspected. Orange juice is not expected to interact with these drugs.

References
  1. Yamreudeewong W, Henann NE, Fazio A, Lower DL, Cassidy TG “Drug-food interactions in clinical practice.” J Fam Pract 40 (1995): 376-84
  2. Josefsson M, Zackrisson AL, Ahlner J “Effect of grapefruit juice on the pharmacokinetics of amlodipine in healthy volunteers.” Eur J Clin Pharmacol 51 (1996): 189-93
  3. Zaidenstein R, Soback S, Gips M, Avni B, Dishi V, Weissgarten Y, Golik A, Scapa E “Effect of grapefruit juice on the pharmacokinetics of losartan and its active metabolite E3174 in healthy volunteers.” Ther Drug Monit 23 (2001): 369-73
  4. Lee AJ, Chan WK, Harralson AF, Buffum J, Bui BCC “The effects of grapefruit juice on sertraline metabolism: An in vitro and in vivo study.” Clin Ther 21 (1999): 1890-9
  5. Kantola T, Kivisto KT, Neuvonen PJ “Grapefruit juice greatly increases serum concentrations of lovastatin and lovastatin acid.” Clin Pharmacol Ther 63 (1998): 397-402
  6. Lilja JJ, Kivisto KT, Neuvonen PJ “Grapefruit juice-simvastatin interaction: Effect on serum concentrations of simvastatin, simvastatin acid, and HMG-CoA reductase inhibitors.” Clin Pharmacol Ther 64 (1998): 477-83
  7. Flanagan D “Understanding the grapefruit-drug interaction.” Gen Dent 53 (2005): 282-5; quiz 286
  8. Majeed A, Kareem A “Effect of grapefruit juice on cyclosporine pharmacokinetics.” Pediatr Nephrol 10 (1996): 395
  9. Edgar B, Bailey D, Bergstrand R, et al “Acute effects of drinking grapefruit juice on the pharmacokinetics and dynamics on felodipine and its potential clinical relevance.” Eur J Clin Pharmacol 42 (1992): 313-7
  10. Hukkinen SK, Varhe A, Olkkola KT, Neuvonen PJ “Plasma concentrations of triazolam are increased by concomitant ingestion of grapefruit juice.” Clin Pharmacol Ther 58 (1995): 127-31
  11. Garg SK, Kumar N, Bhargava VK, Prabhakar SK “Effect of grapefruit juice on carbamazepine bioavailability in patients with epilepsy.” Clin Pharmacol Ther 64 (1998): 286-8
  12. Gunston GD, Mehta U “Potentially serious drug interactions with grapefruit juice.” S Afr Med J 90 (2000): 41
  13. Bailey DG, Malcolm J, Arnold O, Spence JD “Grapefruit juice-drug interactions.” Br J Clin Pharmacol 46 (1998): 101-10
  14. Dresser GK, Spence JD, Bailey DG “Pharmacokinetic-pharmacodynamic consequences and clinical relevance of cytochrome P450 3A4 inhibition.” Clin Pharmacokinet 38 (2000): 41-57
  15. Bailey DG, Kreeft JH, Munoz C, Freeman DJ, Bend JR “Grapefruit juice felodipine interaction: Effect of naringin and 6′,7′-dihydroxybergamottin in humans.” Clin Pharmacol Ther 64 (1998): 248-56
  16. Bailey DG, Dresser GR, Kreeft JH, Munoz C, Freeman DJ, Bend JR “Grapefruit-felodipine interaction: Effect of unprocessed fruit and probable active ingredients.” Clin Pharmacol Ther 68 (2000): 468-77
  17. “Product Information. Valium (diazepam).” Roche Laboratories, Nutley, NJ.
  18. Fuhr U, Maier-Bruggemann A, Blume H, et al. “Grapefruit juice increases oral nimodipine bioavailability.” Int J Clin Pharmacol Ther 36 (1998): 126-32
  19. Ozdemir M, Aktan Y, Boydag BS, Cingi MI, Musmul A “Interaction between grapefruit juice and diazepam in humans.” Eur J Drug Metab Pharmacokinet 23 (1998): 55-9
  20. Clifford CP, Adams DA, Murray S, Taylor GW, Wilkins MR, Boobis AR, Davies DS “Pharmacokinetic and cardiac effects of terfenadine after inhibition of its metabolism by grapefruit juice.” Br J Clin Pharmacol 42 (1996): p662
  21. Lilja JJ, Kivisto KT, Neuvonen PJ “Grapefruit juice increases serum concentrations of atorvastatin and has no effect on pravastatin.” Clin Pharmacol Ther 66 (1999): 118-27
  22. Sigusch H, Hippius M, Henschel L, Kaufmann K, Hoffmann A “Influence of grapefruit juice on the pharmacokinetics of a slow release nifedipine formulation.” Pharmazie 49 (1994): 522-4
  23. “Grapefruit juice interactions with drugs.” Med Lett Drugs Ther 37 (1995): 73-4
  24. Bailey DG, Arnold JM, Munoz C, Spence JD “Grapefruit juice–felodipine interaction: mechanism, predictability, and effect of naringin.” Clin Pharmacol Ther 53 (1993): 637-42
  25. Takanaga H, Ohnishi A, Maatsuo H, et al. “Pharmacokinetic analysis of felodipine-grapefruit juice interaction based on an irreversible enzyme inhibition model.” Br J Clin Pharmacol 49 (2000): 49-58
  26. Sato J, Nakata H, Owada E, Kikuta T, Umetsu M, Ito K “Influence of usual intake of dietary caffeine on single-dose kinetics of theophylline in healthy human subjects.” Eur J Clin Pharmacol 44 (1993): 295-8
  27. Bailey DG, Arnold JM, Strong HA, Munoz C, Spence JD “Effect of grapefruit juice and naringin on nisoldipine pharmacokinetics.” Clin Pharmacol Ther 54 (1993): 589-94
  28. Bailey DG, Arnold JMO, Spence JD “Grapefruit juice and drugs – how significant is the interaction.” Clin Pharmacokinet 26 (1994): 91-8
  29. Libersa CC, Brique SA, Motte KB, et al. “Dramatic inhibition of amiodarone metabolism induced by grapefruit juice.” Br J Clin Pharmacol 49 (2000): 373-8
  30. “Product Information. Doral (quazepam).” Wallace Laboratories, Cranbury, NJ.
  31. Jonkman JH, Sollie FA, Sauter R, Steinijans VW “The influence of caffeine on the steady-state pharmacokinetics of theophylline.” Clin Pharmacol Ther 49 (1991): 248-55
  32. Damkier P, Hansen LL, Brosen K “Effect of diclofenac, disulfiram, itraconazole, grapefruit juice and erythromycin on the pharmacokinetics of quinidine.” Br J Clin Pharmacol 48 (1999): 829-38
  33. Eagling VA, Profit L, Back DJ “Inhibition of the CYP3A4-mediated metabolism and P-glycoprotein-mediated transport of the HIV-I protease inhibitor saquinavir by grapefruit juice components.” Br J Clin Pharmacol 48 (1999): 543-52
  34. Min DI, Ku YM, Geraets DR, Lee HC “Effect of grapefruit juice on the pharmacokinetics and pharmacodynamics of quinidine in healthy volunteers.” J Clin Pharmacol 36 (1996): 469-76

View all 34 references

cannabis (Schedule I substance) food

Applies to: cannabis

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

MANAGEMENT: Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

References
  1. Gilman AG, Rall TW, Nies AS, Taylor P, eds. “Goodman and Gilman’s the Pharmacological Basis of Therapeutics. 8th ed.” New York, NY: Pergamon Press Inc. (1990):
  2. “Product Information. Fycompa (perampanel).” Eisai Inc, Teaneck, NJ.
  3. Warrington SJ, Ankier SI, Turner P “Evaluation of possible interactions between ethanol and trazodone or amitriptyline.” Neuropsychobiology 15 (1986): 31-7
  4. “Product Information. Rexulti (brexpiprazole).” Otsuka American Pharmaceuticals Inc, Rockville, MD.

View all 4 references

Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

See Also

  • Cannabis Drug Interactions
  • Valium Drug Interactions
  • Valium General Consumer Information
  • Drug Interactions Checker
Drug Interaction Classification
These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.

Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Some mixtures of medications can lead to serious and even fatal consequences.

A Moderate Drug Interaction exists between cannabis and Valium. View detailed information regarding this drug interaction.