Cannabis interaction with steroids, fluticasoe and montelukast

[Sweet Seeds]

Hi everyone,

New to this forum but a long time grower and user of cannabis, also working in the cannabis industry for the past 10 years (I work in a major European seed bank).

So, I've been having respiratory problems for the past few years, ran some tests and I have asthma with mild obstruction. The lung specialist advised me a treatment with Singulair (montelukast) and a fluticasone+formoterol inhaler. The fluticasone in the inhaler is a corticosteriod.

I've been investigating a bit in the internet before I start with the treatment to find that these medicines (montelukast and fluticasone) are catalyzed by cytochrome P450 and cannabis (or some cannabinoids) inhibits the cytochrome P450. This leads to a poor "catalyzation" of the medicines in the liver and side effects can be more intense because the medicines will be present in the blood stream in higher amounts and for a longer time.

I've been reading this in many articles and asthma forums, but I closed the websites and I don't have them anymore in my favourites, but here is one example:

"Marijuana may also interact with drugs that are broken down by enzymes in the liver known as cytochrome P450 enzymes" -> Here

If you google for terms like "cannabis p450", "singulair p450", "steroids and cannabis", etc, you'll find a lot of websites where this interaction is mentioned has potentially harmful.

At this moment and for the past 2 years I've been consuming my cannabis through edibles (cannabis chocolate chip cookies baked by me) and I also smoke 1 or 2 small joints per day (about 0,5gr per day). But I can easily refrain from smoking while I take the medications. What I really would like to keep with is the edibles, because I use them medically for some gastric and intestinal problems, and to sleep better, etc, while feeling more comfortable and happy, of course

What should I do?

Am I worrying to much? Maybe the quantity of cannabis I'm taking is not much and is not an issue. Maybe the dangerous interaction between steroids and cannabis is for those who take steroids in the form of pills (or other ingested form) and not so much for topical uses like with an inhaler that only reaches the lungs... Or maybe it is dangerous only for long term treatments while mine will probably only last 1 to 2 months.

For what I've been reading it also seems that the cannabinoid that really inhibits cytochrome P450 is cannabidiol (CBD), so I assume that using cannabis with less than 1% CBD and 12-20% THC wouldn't be a problem. Am I right? If so, then the problem is that I have no ways to test my cannabis cookies for CBD content. I can only guess.

On the other hand, if CBD and asthma medication like corticosteroid inhalers and montelukast have dangerous interactions, I wonder if this is known within the medical community in states and countries where medical cannabis is legal and already working as an "industry". I myself live in a country where medical cannabis has been "legalized" just a few months ago, but the medical community is not yet instructed in regards to these issues.

To my lung specialist (before someone asks), I did not mention my cannabis use because I thought it wouldn't be a problem and because I was not asked about it. I was only asked if I smoke tobacco, which I don't.

One last question: "my" seed bank as recently released a lot of CBD-rich strains and, as usual, I test every strain that we release, so lately my stash has been about 80% CBD-rich strains, so I've been having a lot more CBD lately than before. How long does it take for CBD to leave the bloodstream? Is it the same as THC? (just so that I know how long should I wait until I start the "treatment").

Any opinion or information would be more than welcome. Thanks,

tommy

 

[AngryBird]

Let me hook you up with a member.
She is a bit busy these days, in the meantime, read her threads see in my signature SweetSue's Threads.
CBD and THC are 2 different ingredients needed in medical Cannabis.
Maybe you should try to vape it instead of smoking it, since your problem is in your lungs.
We have found that the usage of Cannabis increases the affect on some conventional medicine. I am not familiar with yours, that is why I called for help.

 

[AngryBird]

Hi everyone,

New to this forum but a long time grower and user of cannabis, also working in the cannabis industry for the past 10 years (I work in a major European seed bank).

So, I've been having respiratory problems for the past few years, ran some tests and I have asthma with mild obstruction. The lung specialist advised me a treatment with Singulair (montelukast) and a fluticasone+formoterol inhaler. The fluticasone in the inhaler is a corticosteriod.

I've been investigating a bit in the internet before I start with the treatment to find that these medicines (montelukast and fluticasone) are catalyzed by cytochrome P450 and cannabis (or some cannabinoids) inhibits the cytochrome P450. This leads to a poor "catalyzation" of the medicines in the liver and side effects can be more intense because the medicines will be present in the blood stream in higher amounts and for a longer time.

I've been reading this in many articles and asthma forums, but I closed the websites and I don't have them anymore in my favourites, but here is one example:

"Marijuana may also interact with drugs that are broken down by enzymes in the liver known as cytochrome P450 enzymes" -> Here

If you google for terms like "cannabis p450", "singulair p450", "steroids and cannabis", etc, you'll find a lot of websites where this interaction is mentioned has potentially harmful.

At this moment and for the past 2 years I've been consuming my cannabis through edibles (cannabis chocolate chip cookies baked by me) and I also smoke 1 or 2 small joints per day (about 0,5gr per day). But I can easily refrain from smoking while I take the medications. What I really would like to keep with is the edibles, because I use them medically for some gastric and intestinal problems, and to sleep better, etc, while feeling more comfortable and happy, of course

What should I do?

Am I worrying to much? Maybe the quantity of cannabis I'm taking is not much and is not an issue. Maybe the dangerous interaction between steroids and cannabis is for those who take steroids in the form of pills (or other ingested form) and not so much for topical uses like with an inhaler that only reaches the lungs... Or maybe it is dangerous only for long term treatments while mine will probably only last 1 to 2 months.

For what I've been reading it also seems that the cannabinoid that really inhibits cytochrome P450 is cannabidiol (CBD), so I assume that using cannabis with less than 1% CBD and 12-20% THC wouldn't be a problem. Am I right? If so, then the problem is that I have no ways to test my cannabis cookies for CBD content. I can only guess.

On the other hand, if CBD and asthma medication like corticosteroid inhalers and montelukast have dangerous interactions, I wonder if this is known within the medical community in states and countries where medical cannabis is legal and already working as an "industry". I myself live in a country where medical cannabis has been "legalized" just a few months ago, but the medical community is not yet instructed in regards to these issues.

To my lung specialist (before someone asks), I did not mention my cannabis use because I thought it wouldn't be a problem and because I was not asked about it. I was only asked if I smoke tobacco, which I don't.

One last question: "my" seed bank as recently released a lot of CBD-rich strains and, as usual, I test every strain that we release, so lately my stash has been about 80% CBD-rich strains, so I've been having a lot more CBD lately than before. How long does it take for CBD to leave the bloodstream? Is it the same as THC? (just so that I know how long should I wait until I start the "treatment").

Any opinion or information would be more than welcome. Thanks,

tommy

I sent her a message, as soon as she can, she will be here.

 

[Sweet Seeds]

Hi AngryBird,

Thank you very much for your reply.

I actually happen to know SweetSue and even emailed her the other day when I posted this thread here. But thanks for your help. Sue loves some of our strains and we sent her a few a couple of years ago, when we exchanged some emails. I even think that her nick "SweetSue" has something to do with our seed bank, hehehe, or else it's just a coincidence

So when I saw that she was still active in the forum I decided to send her an email.

But it's all good, I'm not in a hurry so I can wait, as she might be busy these days, as you say.

I'm trying to get better so that next week (in about 8 days) I can go to CannaFest in Prague, Czech Republic. So I decided that before CannaFest I will not start any treatment, to avoid any negative surprises while I'm in the expo.

About vaporizing, you are very right and that is a great advice for maybe 95% of cannabis users, by unfortunately I'm on the other 5%. I used to vaporize a lot, just to give you an idea from 2010 until 2016 I only vaporized and never smoked. I had (and still have) two Volcano's, a Plenty, one Herborizer and a few other less known vaporizers.

But the vapor irritates my throat and lungs... I knew it did but I kept vaporizing, until in early 2016 I had a sponthaneous pneumothorax with total colapse of my left lung. Luckily I recovered with no major issues, beside the pain of the chest tube and 6 days in the hospital.

After that I was much more cautious, used the Herborizer more, instead of Volcano, because the Herborizer develops a softer vapor that goes through water filtration and there was a difference, but after 6 months with the Herborizer I then decided to try smoking small pure joints, with double filter (cardboard filter + "sponge" filter), to which I'm very careful and take off all the little stems (even the smaller ones) and all the leaves, so that the smoke is as softer as possible.

And I know that smoking like this, only 1 or 2 small joints per day (0.5gr) is much better for my lungs than vaporizing. I know it sounds strange, as if I was not aware that vaporizing is much more healthier than smoking, but even though I know that and I'm still a fan of vaporizers and recommend them, this is my situation.

We have found that the usage of Cannabis increases the affect on some conventional medicine. I am not familiar with yours, that is why I called for help.

Well, this one is very interesting: repost marijuana drug interaction article - My MSAA Community | HealthUnlocked

Says things like this:

"CYP450 Enzymes
Cytochrome P450 (CYP450) enzymes are responsible for the metabolism of most chemicals and medications that enter the human body. Humans have roughly 60 CYP genes. CYP450 enzymes occur primarily in liver cells where drug metabolism occurs.
Chemicals or drugs may be substrates, inhibitors, or inducers of CYP450 enzymes. Substrates are substances that are metabolized by the enzyme. Inhibitors reduce the activity of the enzyme, preventing the metabolism of its substrates and thus increasing the substrate concentration and effect. Inducers, on the other hand, increase the activity of the enzyme, enhancing the metabolism of its substrates and thus decreasing the substrate concentration and effect.[6]
The CYP1A2, CYP3A4, CYP2C9, and CYP2C19 enzymes are known to be affected by marijuana use.[7,8]
CYP1A2
Smoking marijuana regularly is believed to cause induction of the CYP1A2 enzyme, which may decrease serum concentrations of 1A2 substrates.[9] One study reported that theophylline clearance was 48% greater in individuals who smoked more than 2 joints weekly.[10] Marijuana would be expected to have a similar effect on other 1A2 substrates."

So, it is not a direct interaction and that is what makes it more tricky and that is probably the reason why most people have no idea of this type of interaction. Maybe not even doctors.

What happens is that cannabinoids, mainly CBD for what I understand, inhibit these CYP450 enzymes. And with this inhibition, all the traces of the medicines (like steroids) present in fluticasone and montelucaste, can not be catalyzed in the liver and so they remain in the bloodstream, with all the undesirable side effects that such medicines have to our body if they are not catalyzed (eliminated) correctly.

There's not much information about this in the internet, but the information that is available points in this direction.

What I don't know (and would need help to figure out) is how relevant or irrelevant it may be in regards to a topical (localized) corticosteroid use for 1 or 2 months in a person who uses about 3 grams of smoked cannabis per week and another 3 grams of cannabis in edibles per week, taking in consideration that I can do well without smoking if it has to be, only with the edibles.

Is it that the worst side effects referred to in the internet are more to people who use steroids for bodybuilding reasons? That is another question, hehehe, which I suppose that probably no one in this forum has a clue about

Thanks again and happy smokes/vapors!

tommy

 

[AngryBird]

The beautiful part of Cannabis, is that it heals, it doesn't "just" put a lid on symptoms.
The bad part is that there are more "user experienced" researches on dosage and reactions.
The steroids you take are the same as a bodybuilder's? If I am not mistaken, they have more than one type.
I only have one live experience with a bodybuilder, using steroids and smoke an occasional joint.
I haven't heard him say anything about reactions etc.
But, he isn't really interested in the scientific part of the above combo.

 

[Sweet Seeds]

Hi again AngryBird,

Well, I'm not taking anything yet, hehehe, but the prescription I have is for fluticasone, which is a corticosteroid that is inhaled and absorbed in the lungs.

Kind regards,

tommy

 

[SweetSue]

Hello Tommy. Just a quick note as I pack to move cross country. I’ll get deeper into this later today when I’m already in the road.

Yes indeed, CBD will interfere with the catalyzation of drugs that use the P450 pathway, but that shouldn’t preclude you using cannabis.

For one thing, this is only a concern with doses of CBD in the 100s of milligrams. If it is a concern it simply means that your medical team needs to be more alert to your serum levels of those drugs. If CBD is causing backup of these meds the solution is to control the pharmaceutical, not to eliminate the cannabis.

It’s all a matter of balance and monitoring.

Watch for cannabis medicines in inhaler form, which I believe would benefit your asthma expression. IMO, as the mother of an asthmatic daughter, there appears to be a strong connection between anxiety and asthma. CBD is incredibly valuable as a treatment to anxiety, and thusly may help control at least some of the asthma. Just a thought that popped into my head.

I’ll be back later. Have a trailer to pack.

 

[Sweet Seeds]

Hi Sue,

Very happy to read from you Hope all is well in your world

That's a very nice and informative answer, thank you very much. I know no one is going to tell me that it is absolutely safe to use cannabis while doing this sort of medication, but I needed to know if it is a big risk or small risk. So any answer like yours is a big plus.

Let me know about your other thoughts, but no hurries, enjoy your trip and when you have time and you feel like it let me know what else you have to say about it.

Nice to know that the interaction is only relevant with high doses of CBD. I don't know how many CBD is in my cookies but I assume that if I get high (THC high) with one cookie, then that cookie might have something like 8mg to 16mg of THC... and if there is more THC than CBD in my cookies, then probably CBD will stand somewhere between 1mg and 6mg per cookie and that's what I would be using per day.

I might try to find a way to test my cookies. We at the seed bank work with a lab in Madrid for the cannabinoid and terpenoid tests of our strains, so maybe they can test the cannabinoid content of my cookies. I think they will be in CannaFest next weekend so I'll try to speak with them.

I will also try to speak with a doctor in CannaFest about this subject or else one week later I will be at a Medical Cannabis conference in Lisbon and I will have a chance to debate this with a few doctors. I'm having an exposition in that conference with a collection of my bud photos and trichome macrophotography

But the best help I can get is from you, so when you have time, get back to me

These cannabis inhalers sound very well and I sure would like to give it a try. I have to figure out how to get one.

One last question... as you have an asthmatic daughter maybe you have an opinion... Singulair (montelukast) and inhaled corticosteroids are the only way to treat/control/deal with asthma? I mean, isn't there any other alternative that could do a similar work but that is less harmless to our body?

I really don't like to use pharmacy medicines, but the lung specialist said that I have a mild obstruction in the lower part of my lungs and if I use singulair and the inhaled corticosteroids for 1 or 2 months I may eventually be able to reverse that obstruction. The asthma is not "reversible" but the obstruction is probably reversible, that's why I'm in a dilemma on if I should try the treatment or not.

And that's it for now, hehe... Thanks again and have a nice and comfortable trip

tommy

 

[Bud]

Asked and answered, a month or two
is a drop in the bucket, get it done and move on.
RSO is the way to go. Imo!

 

[SweetSue]

Asked and answered, a month or two
is a drop in the bucket, get it done and move on.
RSO is the way to go. Imo!

Hahaha! Thanks Bud. Oh, that it were as simple as that answer.

@Tommy Gomez, are you still out there? I ended up moving to a completely different place and just now feel settled enough. To be honest, I forgot to get back to this.

 

[Sweet Seeds]

Hi Sue and Bud!

Thanks

Sure, I'm still here, hehehe. Never did the "treatment", so it's all good, hehehe.

My asthma "comes and goes". I go about 3 months or even more without any sign of it, but then there's times like last week when I have to use Salbutamol (Ventolin) every day to be able to sleep.

One day when I was have difficulties to breathe I tried to smoke a joint instead of the Ventolin and it worked even better, it seemed great to me. So I'm sure that cannabis meds in inhaler for could have a great value for me. Unfortunatelly although my country legalized medical cannabis a couple of years ago, product availability is very poor and there is no way I can get anything like that for now.

I keep having 1 cannabis cookie in the afternoon and 1 or 2 small joints (about 0,5gr in total) by night.

My asthma is for allergic reasons, as I'm a stage 6 (the greatest level) allergic to cat dander and I have to live with one at least 16 hours per day. I work from home, so 8 hours sleep and 8 hours work, that's the least I have to deal with it and I've been getting a lot of health problems in the last few years because of it. Cat's already 14 year old, so probably the problem will be solved soon (or not, hehe). Anyway the asthma is chronic, so I'll always have to live with it, just hoping it doesn't get worst.

Thanks again my friends. Kind regards,

tommy

 

[Bakingbaduk]

Hi Sue,

Very happy to read from you Hope all is well in your world

That's a very nice and informative answer, thank you very much. I know no one is going to tell me that it is absolutely safe to use cannabis while doing this sort of medication, but I needed to know if it is a big risk or small risk. So any answer like yours is a big plus.

Let me know about your other thoughts, but no hurries, enjoy your trip and when you have time and you feel like it let me know what else you have to say about it.

Nice to know that the interaction is only relevant with high doses of CBD. I don't know how many CBD is in my cookies but I assume that if I get high (THC high) with one cookie, then that cookie might have something like 8mg to 16mg of THC... and if there is more THC than CBD in my cookies, then probably CBD will stand somewhere between 1mg and 6mg per cookie and that's what I would be using per day.

I might try to find a way to test my cookies. We at the seed bank work with a lab in Madrid for the cannabinoid and terpenoid tests of our strains, so maybe they can test the cannabinoid content of my cookies. I think they will be in CannaFest next weekend so I'll try to speak with them.

I will also try to speak with a doctor in CannaFest about this subject or else one week later I will be at a Medical Cannabis conference in Lisbon and I will have a chance to debate this with a few doctors. I'm having an exposition in that conference with a collection of my bud photos and trichome macrophotography

But the best help I can get is from you, so when you have time, get back to me

These cannabis inhalers sound very well and I sure would like to give it a try. I have to figure out how to get one.

One last question... as you have an asthmatic daughter maybe you have an opinion... Singulair (montelukast) and inhaled corticosteroids are the only way to treat/control/deal with asthma? I mean, isn't there any other alternative that could do a similar work but that is less harmless to our body?

I really don't like to use pharmacy medicines, but the lung specialist said that I have a mild obstruction in the lower part of my lungs and if I use singulair and the inhaled corticosteroids for 1 or 2 months I may eventually be able to reverse that obstruction. The asthma is not "reversible" but the obstruction is probably reversible, that's why I'm in a dilemma on if I should try the treatment or not.

And that's it for now, hehe... Thanks again and have a nice and comfortable trip

tommy

Hi,

I've just come across this thread after looking for whether it'll be OK to consume cannabis with montelukast(which thanks to all you guys, I have some answers). My partner and I make edibles for a living and after seeing you have not been able to test your edibles. We use a T-Check machine.

We believe testing is vital, especially from our point of view, because our customers should have the knowledge of what they're putting into their bodies.

Thanks,
Baking Bad UK

 

[iceglobe]

Hahaha! Thanks Bud. Oh, that it were as simple as that answer.

@Tommy Gomez, are you still out there? I ended up moving to a completely different place and just now feel settled enough. To be honest, I forgot to get back to this.

Hi SweetSue,

I have been on montelukast for years and am an active smoker (2 or so joints a day). I just recently felt the need to do more research on drug interactions and came across this thread. I have been reading about P450s and feel some worry that I have potentially caused a build up of montelukast in my blood since I am a daily smoker. If you are still around and willing to give some more insight into P450s, marijuana consumption and montelukast I would be forever grateful.

Thank you!

Iceglobe