Cannabidiol, or CBD, is a derivative of marijuana that has recently become available as a prescription drug, Epidiolex.
It is FDA-approved for two rare forms of childhood epilepsy, Lennox-Gastaut and Dravet syndromes, and was fast-tracked for that indication because of the dire need for treatment in children with these intractable seizures.
Meanwhile, the same drug has been available as a supplement for the past decade, called CBD oil. Many patients take this oil for its rumored mental health benefits, and you’ll need to know the basics when they request prescriptions for it.
CBD vs THC
Marijuana (cannabis) is a blend of over 100 cannabinoids, only one of which is tetrahydrocannabinol (THC), the cannabinoid that is most responsible for the high people get from consuming pot. CBD, on the other hand, does not cause a “high,” although many people consider it to be somewhat tranquilizing. CBD also does not cause some of the problems seen with THC, such as cognitive impairment, anxiety, and (more rarely) psychosis. Those dangers are particularly relevant to adolescents, where the latest data show that marijuana triples the risk of psychotic disorders (Jones HJ et al, JAMA Psych 2018;75(3):240–246). CBD has neuroprotective properties, and it may actually lower the risk of psychosis and anxiety with THC. For more information, see the table “Cannabinoids From CBD to THC” above.
CBD in psychiatric disorders
In one of the most paradoxical clinical findings in recent memory, it turns out that CBD, far from causing psychosis, may actually be an effective treatment for psychosis. So far, 5 out of 7 controlled trials of CBD’s antipsychotic effects have been positive, and the latest of these is reviewed in this issue (Epidemiol Psychiatr Sci 2018;27(4):327–335). Another prescription CBD product, Arvisol, is undergoing phase I clinical trials in schizophrenia.
In addition to psychosis, there are a couple of small, placebo-controlled trials of CBD in social anxiety disorder. These looked at the drug’s acute effects when taken before a stressful social situation in 34 subjects. Compared to placebo, CBD had a significant effect, bringing anxiety down to the same levels reported by healthy controls (Blessing EM et al, Neurotherapeutics 2015;12(4):825–836).
Somnolence is the main side effect with CBD, but studies in sleep are mixed. Tolerance can develop to its sedative effects, and low doses (below 160 mg) can be stimulating (Babson KA, Curr Psychiatry Rep 2017;19(4):23). CBD does not appear to help bipolar mania or the cognitive impairments of schizophrenia.
CBD oil or Epidiolex?
Are CBD oil and Epidiolex really the same drug? They are both CBD, short for cannabidiol, but where they differ is in their purity and regulatory status. Epidiolex is a Schedule V prescription drug, the lowest level of regulation for a controlled substance. CBD oil is an over-the-counter supplement. It is legal in all states as long as it’s extracted from the hemp plant, a variety of cannabis that contains little THC and produces no high.
In terms of purity, CBD oil is a gamble. In a study of 84 online products, only 30% contained the amount of CBD on the label, and 21% contained THC (Bonn-Miller MO et al, JAMA 2017;318(17):1708–1709).
The FDA keeps a running tally of unacceptable products at www.fda.gov/NewsEvents/PublicHealthFocus/ucm484109.htm. Another good source is Consumer Labs, which tests products for purity and integrity. Among their recommended options, the best-priced oils are available at elixinol.com and bluebirdbotanicals.com.
The dosages used in psychiatric research range from 300 mg/day for anxiety to 800–1,200 mg/day for schizophrenia. The epilepsy dosage, 10–20 mg/kg/day, adds up to around the same amount used in schizophrenia for most adults. Cost is an issue with CBD, prescribed or not. A 300 mg dose is $20–50/day in the over-the-counter form and around $35/day for the prescription when paying out of pocket.
CBD, Marinol, and medical marijuana
CBD is in a very different category than dronabinol (Marinol) and nabilone (Cesamet), the other prescription cannabinoids. These are synthetic isomers of THC (Δ-9-THC) and are under tighter regulation than CBD (Schedule III vs Schedule V). They are only approved for nausea during chemotherapy and, in the case of dronabinol, anorexia in AIDS. As pure THC compounds without the protective effects of CBD, they may have even more psychedelic effects than marijuana (Bhattacharyya S et al, Neuropsychopharm 2010;35(3):764–774). “Medical marijuana” can refer to any marijuana component, such as CBD, or to the plant itself. It usually refers to the plant, which is legal with a prescription in 33 states and Washington DC. Each state has its own list of conditions that medical marijuana is approved for.
Side effects and drug interactions
The World Health Organization concluded that CBD has “a good safety profile” (WHO, 2018). Somnolence is its main side effect, and the PDR warns of elevated liver enzymes. On drug screens, CBD can cause a false positive for THC.
CBD may raise the levels of psychiatric medications through inhibition at UGT2B7 (lamotrigine, lorazepam) and CYP2C19 (diazepam and several SSRIs and antipsychotics). CBD itself is metabolized by CYP3A4 and CYP2C19.
Risks vs benefits
The FDA fast-tracked the approval of Epidiolex (CBD) because its risk-benefit profile is favorable for rare forms of epilepsy that are difficult to control with current anticonvulsants. The bar is higher for disorders with existing treatments, like psychosis and anxiety, and the data in these conditions are scarcer.
While we sort out these dilemmas, patients will no doubt experiment with the readily available CBD oil, so what should we do in the interim? We recommend the following commonsense approach.
TCPR Verdict: We don’t have much evidence to endorse or warn against CBD. Though it’s premature to prescribe CBD, we should guide patients to safer products if they are getting it on their own. That’s harm reduction, like suggesting to casual drinkers that red wine is safer than vodka
What is Gabapentin and What is the side effects of Gabapentin ?
Applies to gabapentin: oral capsule, oral solution, oral suspension, oral tablet
Gabapentin is used to help control partial seizures (convulsions) in the treatment of epilepsy. This medicine cannot cure epilepsy and will only work to control seizures for as long as you continue to take it.
Gabapentin is also used to manage a condition called postherpetic neuralgia, which is pain that occurs after shingles.
Gabapentin works in the brain to prevent seizures and relieve pain for certain conditions in the nervous system. It is not used for routine pain caused by minor injuries or arthritis. Gabapentin is an anticonvulsant.
This medicine is available only with your doctor’s prescription.
This product is available in the following dosage forms:
The only conditions for which gabapentinoid drugs are FDA-approved to manage pain are postherpetic neuralgia (both gabapentin and pregabalin [Lyrica]) and diabetic neuropathy, spinal cord injury, and fibromyalgia (pregabalin only). Nevertheless, use of these drugs has tripled during the past 15 years. This increase likely reflects gabapentinoid use for managing non–FDA-approved pain conditions, in part to avoid opioid use. In this review, researchers identified 34 placebo-controlled randomized trials (with ≈4200 patients) of gabapentinoids for noncancer, non–FDA-approved pain conditions. Most trials’ durations were 4 to 12 weeks.
Results of the Gabapentin review were as follows:
- Only weak evidence supports use of gabapentin for diabetic neuropathy (only pregabalin is approved for this indication).
- Minimal evidence supports use of gabapentin for nondiabetic painful neuropathies.
- Studies of gabapentinoids for managing low back pain or sciatica have been largely negative.
- Only minimal evidence supports a clinically meaningful benefit of off-label gabapentin use for fibromyalgia (for which pregabalin is approved).
- Both gabapentin and pregabalin are approved for managing postherpetic neuralgia, but both are used often for acute zoster pain, for which studies have shown no benefit.
- A small number of studies of gabapentinoid use for other pain syndromes (e.g., traumatic nerve injury, complex regional pain syndrome, burn injury, sickle cell pain) showed no clinically important benefits.
Along with its needed effects, gabapentin may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
What is the side effects of Gabapentin ?
Check with your doctor immediately if any of the following side effects occur while taking gabapentin:
- Clumsiness or unsteadiness
- continuous, uncontrolled, back-and-forth, or rolling eye movements
More common in children
- Aggressive behavior or other behavior problems
- concentration problems and change in school performance
- false sense of well-being
- hyperactivity or increase in body movements
- rapidly changing moods
- reacting too quickly, too emotional, or overreacting
- suspiciousness or distrust
- Black, tarry stools
- chest pain
- depression, irritability, or other mood or mental changes
- loss of memory
- pain or swelling in the arms or legs
- painful or difficult urination
- shortness of breath
- sore throat
- sores, ulcers, or white spots on the lips or in the mouth
- swollen glands
- unusual bleeding or bruising
- unusual tiredness or weakness
Incidence not known
- Abdominal or stomach pain
- blistering, peeling, or loosening of the skin
- clay-colored stools
- dark urine
- decreased urine output
- fast or irregular heartbeat
- increased thirst
- itching or skin rash
- joint pain
- large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
- loss of appetite
- muscle ache or pain
- red skin lesions, often with a purple center
- red, irritated eyes
- unpleasant breath odor
- vomiting of blood
- yellow eyes or skin
Some side effects of gabapentin may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
- Blurred vision
- cold or flu-like symptoms
- lack or loss of strength
- lower back or side pain
- swelling of the hands, feet, or lower legs
- trembling or shaking
Less common or rare
- Accidental injury
- appetite increased
- back pain
- bloated or full feeling
- body aches or pain
- burning, dry, or itching eyes
- change in vision
- change in walking and balance
- clumsiness or unsteadiness
- cough producing mucus
- decrease in sexual desire or ability
- difficulty with breathing
- dryness of the mouth or throat
- excess air or gas in the stomach or intestines
- excessive tearing
- eye discharge
- feeling faint, dizzy, or lightheadedness
- feeling of warmth or heat
- flushed, dry skin
- flushing or redness of the skin, especially on the face and neck
- frequent urination
- fruit-like breath odor
- impaired vision
- increased hunger
- increased sensitivity to pain
- increased sensitivity to touch
- increased thirst
- noise in the ears
- pain, redness, rash, swelling, or bleeding where the skin is rubbed off
- passing gas
- redness or swelling in the ear
- redness, pain, swelling of the eye, eyelid, or inner lining of the eyelid
- runny nose
- tender, swollen glands in the neck
- tightness in the chest
- tingling in the hands and feet
- trouble sleeping
- trouble swallowing
- trouble thinking
- unexplained weight loss
- voice changes
- weakness or loss of strength
- weight gain
You can not take Prescription for a long time, you need find a way to treat your pain without prescription. Exercising is the best way to relieve your pain. because exercising can enhance your immune system and increase your muscle strength and make your nerve strong.
You can also take some natural nutritions to increase your immune system too. Some anti-aging products can also increase your immune ability. You can try USANA Products ro make you strong. I take USANA Essentials every day and I find my health get better and better. You can also try to become a usana distributor or associate and eat health organic food to get rid of your headache or nerve pain.