Why Mixing Sedatives and Cannabis Can Be Harmful to Your Health

Medical cannabis is helping Americans live better lives and providing another way to manage chronic pain and other debilitating symptoms. While more research is needed, doctor-supervised cannabis is generally considered safe compared to other drugs, which can have detrimental side effects.

If you are managing one or more chronic health conditions, there are some important things to know about marijuana use and how drugs interact. With guidance from a cannabis healthcare provider, long-term medical marijuana use may be safer for pain management and central nervous system disorders, including neuropathy, muscle spasms, and other conditions.

Patients living with chronic health conditions may also be using other substances, such as prescription antidepressants, anti-inflammatories, autoimmune prescription medications, chemotherapy-induced nausea, and more. Mixing marijuana with prescription medication can cause drug interactions that can cause injury or adverse reactions.

Drug Interactions: Antidepressant Medications and Cannabis

During the COVID-19 pandemic, there was a substantial increase in the number of patients reporting symptoms of severe anxiety and depression. For many Americans, that meant turning to prescription medications or antidepressants to help them through the difficult period.

Prior to the 2020 pandemic, 1 in 8 American adults were already taking antidepressants. Some studies estimate that the number of adults prescribed antidepressants increased by almost 19% from 2020 to 2022.

Antidepressant drugs, including the first developed MAOIs, have a long history in treating depression. Antidepressants affect the brain by impacting neurotransmitters such as serotonin and norepinephrine, which are crucial for mood regulation. They improve mood, cognitive functions, and overall emotional well-being. These drugs are effective but come with management challenges, such as potential risks and interactions with substances like marijuana. Individuals with depressive symptoms may self-medicate with marijuana, but this practice carries risks, especially when combined with antidepressants.

Source: The New York Times

What some people may not know is that cannabis is contraindicated (conflicts) with all common antidepressants. The combination of marijuana use and antidepressant medications can cause heavy sedation, which can lead to health risks, injury, and life-threatening adverse effects.

Common Depression or Anxiety Medications That Conflict With Cannabis

When you speak with a cannabis healthcare provider, you are asked about the prescription medications you are currently taking. That is an important safety check with a medical professional to make sure you are not mixing marijuana with other drugs that could harm you.

Here are some of the most commonly prescribed antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac) and sertraline (Zoloft), and an explanation of how they can interact with cannabis.

Selective Serotonin Reuptake Inhibitors

Also called SSRIs, this type of medication includes Prozac, Zoloft (the most commonly prescribed medication in the United States), and Lexapro. These drugs stimulate increased levels of serotonin in the brain.

Serotonin is a chemical that helps regulate learning, memory, body temperature, sex drive, sleep, hunger, and mood or feelings of happiness. When combined with cannabis, SSRIs can become highly sedative, leading to impairment and potential injury. Additionally, increased levels of these medications due to cannabis consumption can lead to potentially fatal conditions like serotonin syndrome, emphasizing the importance of understanding the risks associated with this drug interaction.

Serotonin-norepinephrine reuptake inhibitors (SNRIs) also increase levels of norepinephrine and serotonin in the brain and can interact with cannabis, potentially leading to similar cardiovascular risks.

Benzodiazepines

Drugs in this pharmaceutical category include Xanax, Ativan, and Valium. Benzodiazepines interact with gamma-aminobutyric acid (GABA), which helps produce a calming effect when you are feeling stressed or anxious.

Since cannabis and benzodiazepines both have sedative properties, combining them can lead to excessive drowsiness and sedation. Physicians warn that cannabis taken with these medications can lead to respiratory depression (slowed breathing) and trip and fall injuries.

Similarly, tricyclic antidepressants (TCAs) can also interact with cannabis, potentially leading to adverse effects such as increased heart rate and blood pressure. TCAs, like amitriptyline and nortriptyline, are prescribed less frequently due to their side effects compared to other antidepressants.

Monoamine Oxidase Inhibitors

The prescription medications Nardil and Parnate are two examples of MAOIs. This class of medication increases serotonin, dopamine, and norepinephrine neurotransmitters in the brain. When combined with cannabis, MAOIs can increase blood pressure (hypertension) and heart rate, which can pose a substantial risk for patients living with cardiovascular problems.

Other Medications That Can Conflict With Medical Cannabis

Antidepressants are not the only class of medications that are contraindicated with cannabis for safety reasons. There are three other types of medications that can also present safety risks. Clinical and pharmacologic considerations are crucial when combining cannabis with other medications.

Opioids

Drugs that are prescribed for pain management include Oxycodone, Hydrocodone, and Morphine. These powerful pain medications work by binding to receptors in the brain and other areas of the body. The combination of opioids and cannabis can increase the risk of an overdose incident and also cause life-threatening respiratory depression.

Nonsteroidal Anti-Inflammatory Drugs

Common over-the-counter (OTC) medications like Ibuprofen and Naproxen can also cause harm when taken with cannabis. Nonsteroidal anti-inflammatory drugs suppress the production of some chemicals in the body, reducing pain perception (and thereby providing relief).

The contraindications with cannabis and these drugs are not as serious as other types of medications. However, physicians warn that NSAIDs and cannabis can reduce alertness and muscle coordination, which can cause trip and fall injuries. Consult with your pain physician to discuss best practices for combining two drugs or more.

Antihistamines

If you have seasonal or indoor allergies, you are probably very familiar with drugs like Benadryl, Claritin, and Zyrtec. Antihistamines can cause drowsiness, and using cannabis in conjunction with OTC allergy medications can amplify the sedative effects.

Mixing cannabis with any drug that can cause sedation presents safety risks. One of the most serious concerns is that combining cannabis with sedatives can cause respiratory depression, where breathing is slowed or may even stop.

Drug contraindications are just one of many considerations that patients need to think about before they begin using medical cannabis. At MedWell Health and Wellness Centers in Massachusetts, our cannabis healthcare providers provide expert guidance, helping to educate and inform patients and improve safety.

What Side Effects Should You Watch Out For?

When you consume cannabis, you will experience psychoactive effects. How strong those effects are depends on your tolerance for cannabis, the quantity of cannabis products consumed, whether you have an empty or full stomach, and other considerations.

Physicians do not recommend combining cannabis with prescription medication. However, patients with complex medical conditions may do so without consulting with a physician. It is important to understand the side effects that can warn you of possible interactions so that you can take immediate steps to get medical care. Additionally, consuming cannabis in high doses can potentially worsen depression symptoms, indicating a complex interplay between cannabis and mood disorders.

Some of the symptoms to watch out for include:

• Excessive or dangerous levels of drowsiness or sedation.
• Impaired cognitive functioning, such as memory loss or inability to focus, think, or speak well.
• Breathing difficulties.
• Feeling lightheaded or dizzy.
• Rapid, sustained heart rate.
• Gastrointestinal problems (upset stomach or nausea).
• Impaired motor skills (walking, standing, moving, and muscle coordination).

Cannabis-induced psychosis is another series of symptoms to watch out for. That can include hallucinations, delusions, disorganized thinking, difficulty concentrating, or distinguishing between imagination and reality. Higher potency cannabis products (particularly Sativa dominant strains) have a higher probability of causing marijuana use-related psychosis.

Should You Stop Taking Certain Medications While Using Cannabis?

Cessation of prescription medications can also cause side effects and potential health risks. You should never stop taking any prescribed medication without first consulting with a healthcare provider, including a doctor or pharmacist. It is especially important to consult with a healthcare provider when considering the combination of cannabis and antidepressant treatment to navigate potential interactions and side effects.

Suppose your provider agrees to add cannabis to your treatment plan (alongside prescription medications). In that case, it is advised that you titrate slowly by starting with very low doses and potency cannabis products. Over time, the amount can be increased while monitoring tolerance, response, and potential side effects. Report any symptoms to your healthcare provider for guidance and recommendations.

What Should You Do If You Accidentally Take Cannabis With Sedative Medication?

If you have taken cannabis and an antihistamine, antidepressant, or pain medication, monitor your symptoms carefully. Drugs that can impact the central nervous system and brain may have a delayed response; it may take up to ninety minutes to feel the full effects.

Should you experience extreme drowsiness, where you feel your safety is at risk, immediately call for emergency medical attention. Difficulty breathing, a sense of confusion, or intermittent loss of consciousness are all signs of a potentially life-threatening health situation.

Until help arrives, remain in an upright and seated condition. Do not lay down or consume food, as sedation can cause potential choking hazards. Stay hydrated by sipping water. If you are unable to seek immediate medical assistance, call a family member or friend to help. You may also contact your local poison control center to ask for advice on safely managing symptoms.

Even small doses of cannabis can place you at a higher risk of experiencing increased heart rate, higher blood pressure, and other possible interactions. If you plan to combine any substance or active ingredient with cannabis products, please consult with a healthcare provider to protect your health. Additionally, cannabis use, especially when mixed with other substances, can have broader implications on health and recovery, including risks of addiction and mental health impacts.