I Am 30 Days Into Withdrawal From The Opioid Oxycodone And Are Pretty Much Through The Physical Symptoms That Are Plain Such As Diarrhea And Flu-like Symptoms Are Because Of Side Effect?

Posted on Mon, 20 Mar 2023

Question: You answered a question concerning CBD and risperidone, other psych meds on July 22 for me. I made a serious error and didn't specify you for my follow-up question. This is another follow-up question, mostly questions about side-effects, CBD, withdrawal symptoms, and pharmacology of which you have shown learning. I am 30 days into withdrawal from the opioid Oxycodone and are pretty much through the physical symptoms that are plain such as diarrhea and flu-like symptoms. The emotional withdrawals such as false emotion from long-term opioid abuse even though it was prescribed medication, it was 1 every 6 hours for level 8 degree pain. The pain is and was real, and taken care of now by Lyrica, CBD drops 1500mg 8 drops morning and evening, an anti-inflammatory from my Primary that is not addictive. My question is concerning the CBD tendency to cause reduction of substance from the liver, thus a build-up in medication like that caused by grapefruit except more pronounced. I have Bipolar 1 and take psych meds. During the twenty-eight years I have been on psych meds I have learned their effects and side-effects on me to a small degree. The withdrawals emotional symptoms are confusing me with the side-effects I am coping with. Both are giving me a quick temper, constant anger, repetitive thoughts, and the physical repetitive mouth, lip and tongue movements constantly. Can you help me discern between the two? I will give a more full med list in the next box. Thank you!

Answered by Dr. Malik (9 hours later)

Brief Answer:
The symptoms are more likely side effects.

Detailed Answer:
Hello,
Liver metabolism of drugs is a complex process. Majority of drugs undergo liver metabolism by the enzyme family called cytochrome P-450. During the process, most drugs are converted into an inactive form with no or less pharmacologic effects, but certain drugs are converted into active form as well. Cytochrome P-450 enzyme family consists of many enzymes. Each enzyme is responsible for the metabolism of certain drugs.

Risperidone is metabolized by an enzyme which is inhibited by CBD oil. This inhibition may cause an increase of Risperidone concentration in the blood. Yes, the mechanism is similar to Grapefruit’s inhibition of a different cytochrome P-450 enzyme which causes an increase in the concentration of medicines metabolized by that enzyme.

In fact, CBD oil’s interaction with cytochrome P-450 enzymes is a complex process and still not fully understood.

Regarding your current symptoms: a repetitive mouth, lip, tongue movements, repetitive thoughts and constant anger are more likely side effects rather than withdrawal symptoms. Besides CBD oil, Lyrica (Pregabalin) may interact with risperidone (if you are still on it) or other antipsychotic medicines (e.g. bipolar I medicines) as well.

Please, send me your full medication list with dosages for a better understanding of the possible drug interaction or overdose so that I can guide you better.

I hope the above information will be helpful to you.
Please, also feel free to ask me if there is anything else you need to know.

Thank you

Note: For further follow up on related General & Family Physician Click here.

Above answer was peer-reviewed by : Dr. Arnab Banerjee