breastfeeding mother with newborn baby

Ask The Pharmacist Vol. 1

I'm Curious about CBD When Breastfeeding

This is probably the number one question we get asked! And it certainly comes as no surprise. New parenthood comes with a long list of challenges. Many people experience post-partum depression, anxiety, exhaustion, and (ironically) insomnia, as well as the purely
physical challenges that arise after carrying a growing baby for 40ish weeks and being
run over by a freight train…errr… I mean experiencing beautiful childbirth! For all these reasons, it is easy to see why we get dozens of questions about the safety of using our products while breastfeeding.

Most of the information that we have regarding cannabis focuses on THC, rather than CBD. The type of gold-standard data that the medical community needs to make decisions on safety (which comes from randomized-controlled trials) aren’t available yet for CBD. Based on what we know so far about THC, we can expect that some amount of CBD will be found in mother’s breastmilk.
Additionally, “pumping and dumping” doesn’t work with cannabis compounds either, as it may take days or weeks before appearing in breastmilk. We just don’t know what the short and long-term risks might be for baby.

The FDA and others in the medical community are in an ongoing effort to determine the effects of CBD while breastfeeding. Their focus at this time is to determine if there are negative effects on the breastfed baby or what effect it has on mother’s milk production.

At this time, your fellow mamas at Betoken cannot recommend using CBD while
breastfeeding. Hang in there mama, you got this. And when you’re ready for us, we’ll be here for you.

Can I Take CBD With Zoloft?

With all of the challenges balancing work, home and family life, trying to maintaining some glimpse of a
social life, all while navigating a global pandemic, it comes as no surprise that mental health disorders
and psychiatric medication use are on the rise in the US. Zoloft (sertraline) has been a widely used
medication for many years – it is used to treat depression, panic attacks, obsessive-compulsive disorder
(OCD), post-traumatic stress disorder (PTSD), social anxiety disorder (SAD), and a severe form of PMS
called premenstrual dysphoric disorder (PMDD). Zoloft works to increase your brain’s natural supply of
serotonin, one of many chemicals naturally produced by your brain to make you feel good and balanced.
While it is an effective treatment for many, patients taking Zoloft may have breakthrough symptoms of
anxiety or severe PMS symptoms, and many have asked whether or not our products can be safely used
at the same time.

We’ll start with a little background: Your liver has a system of enzymes that are used to break down
medications and other chemicals that enter the body. Some medications (and even grapefruit juice and
pineapple juice!) can increase or decrease the amount of these enzymes produced by the liver.
Cannabidiol (CBD) is known to decrease the production of several enzymes that break down Zoloft and
other psychiatric medications, which could theoretically raise the concentrations of the drugs in the
body.

Zoloft and CBD, as well as Zoloft and valerian root (which is in the Nighty Night formulation), when taken together, can cause increased drowsiness, dizziness, confusion, and difficulty concentrating.

Generally speaking, it is especially dangerous for older patients (over the age of 65) to combine sedating
medications, and in addition to the previous side effects, they may experience an impairment in
thinking, judgement, and motor coordination. Avoid driving or operating heavy machinery until you
know how these types of medications affect you. Additionally, it is important to avoid alcohol while
taking these.

Generally speaking, topical formulations tend to have little systemic absorption if used in a small area
(their effects are more localized), so CBD creams or ointments such as Not this Month or Pain, Pain Go
Away should theoretically pose less of a risk.

This is not to say that using Zoloft and oral formulations of CBD together is completely off-limits, but it is a delicate balance that differs in everyone. It is extremely important, especially dealing with our unique levels of neurotransmitters (chemicals that make us happy) and liver enzymes, that you work closely with a healthcare professional and be sure to use a reputable CBD brand who shows quality standards (like Betoken, see the certificate of analysis here).

CBD may have interactions with other antidepressants and psychiatric meds. Feel free to ask us
questions about your particular regimen, and most importantly, always check with your doctor,
pharmacist, or mental health professional before starting a new medication or stopping an existing
medication.

Can CBD actually have a paradoxical effect?
It is possible, but evidence would lead to the contrary. There are paradoxical reactions everywhere in medicine – everyone has heard a horror story from a friend who tried to give their kid a dose of Benadryl on a red eye flight and ended up having a jittery, hyperactive kid instead. Another well known example are stimulants – they are FDA approved to treat ADHD and for weight-loss. The mechanism in ADHD is inherently paradoxical and still somewhat a mystery, but the mechanism for weight loss is well understood. 
We’ve seen evidence of CBDs effectiveness as an anxiolytic – a review of 11 studies has shown that CBD reduces anxiety when taken before an anxiety-inducing event, while another review showed that up to 80% of patients showed reduction in anxiety after taking CBD for one month. 
 
CBD and THC are both cannabinoids and some of what we know about CBD comes from assumptions based on knowledge of THC. Interestingly, THC been shown to decrease anxiety in some, while provoking severe anxiety in others. This can likely be attributed to all of us having differing levels of GABA, CB1 and CB2 (cannabinoid), and glutamate receptors in our anxiety centers of the brain – whether or not someone becomes relaxed or anxious after taking THC likely depends on their balance of these. However, CBD is a non-psychotomimetic component of marijuana, and its effects differ substantially from those of THC. CBD has even been used to help control anxiety provoked by THC. 
Another potential explanation for any paradoxical-like effect may be that irritability and nausea, a couple of documented side effects of CBD, are some of the same symptoms people experience when having anxiety. This could possibly explain a feeling of anxiety after taking CBD. 
Can I take CBD with Enbrel?

Although these drugs have not been studied together, I see no major reason that they couldn’t be used together. We don’t yet know the long term effects of CBD, but there is some promising data from out there that CBD may help reduce inflammation and symptoms of arthritis. However, just a general warning, since none of our products should be taken this way, I wouldn’t recommend inhaling any CBD product while taking Enbrel. I would definitely let your doc know before using CBD (as with any medication or herbal supplement).

Can I take CBD with Levothyroxine?

I would recommend discussing this with your doctor before beginning any new medication or herbal supplement while taking levothyroxine. If you do get the OK from your doc, I would suggest taking the medications far apart (e.g. levothyroxine first thing in the morning and CBD at night), and I would be on the lookout for symptoms of hyperthyroidism (mild nausea, increased heart rate, sweating, shaking hands, etc). As you may know, consistency is key while taking levothyroxine, so it would be a good idea to get your thyroid levels checked if you start taking this on a regular basis

DISCLAIMER

Regulations and data surrounding marijuana, CBD, and other related products are still developing. As such, the information contained in this post should not be construed as medical or legal advice. Always consult with your doctor before trying any substance or supplement.

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