Kava and CBD - liver enzymes

[Zaphod]

The general recommendation by most is to be cautious and avoid other medications that are metabolized by the same liver enzymes. From a previous thread (http://kavaforums.com/forum/threads/is-drinking-kava-every-night-unhealthy.8036/#post-95703)
@verticity is quoted as saying
"Also you should avoid combining it with things like Tylenol/Paracetamol or Ibuprofen that stress the liver. Although kava does not cause liver damage it, like many drugs is metabolized by the liver, so you need to be careful combining it with other drugs that are also metabolized by the liver (in particular those that are metabolized by the following liver enzymes in the Cytochrome P450 family: 1A2, 2C9, 2C19, 2D6, 3A4, 4A9/11; and possibly 2E1) , especially ones like Tylenol that are actually toxic to the liver in overdose. In other words, be careful combining it with most other drugs. You can use aspirin instead, which is metabolized by a different pathway in the liver. Even though it does not cause liver damage, kava could potentially alter the metabolism of your other medicines, that is make them stay in your system longer and thus be more potent than they are supposed to be, because they are competing with kava to be metabolized.
Note: Tylenol is metabolized by CYP450 1A2, 2E1, 2A6, and 2D6 (at high doses), and possibly 3A4.
Ibuprofen is metabolized by CYP450 2C9, 2C8 and at high doses, 3A4, 2C19, 2D6, 2E6, and 2B6"

CBD is becoming a very popular option for many attempting for anxiety relief and multiple other issues. While it doesn't have a lot of supporting solid clinical trials I see many people who drink kava also being drawn to CBD and some drinking it at the same time.
From this study "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5789126/" CBD uses pretty extensivly:
"The metabolism of CBD is also by way of the hepatic P450 enzyme system. To date there are seven major isoforms identified that contribute to this process: CYP1A1, CYP1A2, CYP2C9, CYP2C19, CYP2D6, CYP3A4, and CYP3A5, with CYP3A4 and CYP2C19 being the dominant contributors [9]."
The paper is specifically looking at the interaction of CBD and warafarin.

So long story short - I am looking for those of you smarter than I in these types of things to comment on if we should be cautious about combining CBD and kava in the same way we are cautious about acetaminophen and kava?

 

[The Kap'n]

The general recommendation by most is to be cautious and avoid other medications that are metabolized by the same liver enzymes. From a previous thread (http://kavaforums.com/forum/threads/is-drinking-kava-every-night-unhealthy.8036/#post-95703)
@verticity is quoted as saying
"Also you should avoid combining it with things like Tylenol/Paracetamol or Ibuprofen that stress the liver. Although kava does not cause liver damage it, like many drugs is metabolized by the liver, so you need to be careful combining it with other drugs that are also metabolized by the liver (in particular those that are metabolized by the following liver enzymes in the Cytochrome P450 family: 1A2, 2C9, 2C19, 2D6, 3A4, 4A9/11; and possibly 2E1) , especially ones like Tylenol that are actually toxic to the liver in overdose. In other words, be careful combining it with most other drugs. You can use aspirin instead, which is metabolized by a different pathway in the liver. Even though it does not cause liver damage, kava could potentially alter the metabolism of your other medicines, that is make them stay in your system longer and thus be more potent than they are supposed to be, because they are competing with kava to be metabolized.
Note: Tylenol is metabolized by CYP450 1A2, 2E1, 2A6, and 2D6 (at high doses), and possibly 3A4.
Ibuprofen is metabolized by CYP450 2C9, 2C8 and at high doses, 3A4, 2C19, 2D6, 2E6, and 2B6"

CBD is becoming a very popular option for many attempting for anxiety relief and multiple other issues. While it doesn't have a lot of supporting solid clinical trials I see many people who drink kava also being drawn to CBD and some drinking it at the same time.
From this study "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5789126/" CBD uses pretty extensivly:
"The metabolism of CBD is also by way of the hepatic P450 enzyme system. To date there are seven major isoforms identified that contribute to this process: CYP1A1, CYP1A2, CYP2C9, CYP2C19, CYP2D6, CYP3A4, and CYP3A5, with CYP3A4 and CYP2C19 being the dominant contributors [9]."
The paper is specifically looking at the interaction of CBD and warafarin.

So long story short - I am looking for those of you smarter than I in these types of things to comment on if we should be cautious about combining CBD and kava in the same way we are cautious about acetaminophen and kava?

I would say mixing kava and CBD may actually have a beneficial effect by causing the delay of metabolism of the CBD allowing it to do its thing longer in your system. The difference between CBD and tylenol is that tylenol's metabolites are actually toxic, and you don't want them sticking around.

 

[Zaphod]

I would say mixing kava and CBD may actually have a beneficial effect by causing the delay of metabolism of the CBD allowing it to do its thing longer in your system. The difference between CBD and tylenol is that tylenol's metabolites are actually toxic, and you don't want them sticking around.

Good point - although I have seen CBD half-life quoted as 18-32 hours so it already hangs on a long time.

 

[The Kap'n]

Good point - although I have seen CBD half-life quoted as 18-32 hours so it already hangs on a long time.

Oh wow, that's a long half-life. Ehhh, being that it's that long, I'm not sure kava would have that much of an impact, as the kava might be gone before the CBD is (9-18 hours for kava)


Edit: I guess that would fully depend on how long the enzyme inhibition actually lasts after kava consumption.

 

[Krunkie McKrunkface]

Just got my liver panels drawn this morning. I'll know in a day or two if this should be cause for concern. I have been consuming both large amounts daily of kava (8 TBS med grind avg) and high doses of CBD. 30mg three times a day, cannabutter in tea or hot chocolate. I also vapourize or smoke a fair bit of really bodacious CBD hemp flower that is very high in CDB, > 20% and I confess to being very fond of the effects of a strong heavy kava with a high dose of CBD, like say 50 - 75 mg. Then again, I'm not doing this strictly recreationally, I use it to help with side effects of cancer treatments. btw of which, cystoscopy this morning shows no signs of bladder cancer returning. I'll get blood results on everything else very soon. Will post my liver panels, good or bad, as usual. Never had any problems so far.

 

[Zaphod]

Just got my liver panels drawn this morning. I'll know in a day or two if this should be cause for concern. I have been consuming both large amounts daily of kava (8 TBS med grind avg) and high doses of CBD. 30mg three times a day, cannabutter in tea or hot chocolate. I also vapourize or smoke a fair bit of really bodacious CBD hemp flower that is very high in CDB, > 20% and I confess to being very fond of the effects of a strong heavy kava with a high dose of CBD, like say 50 - 75 mg. Then again, I'm not doing this strictly recreationally, I use it to help with side effects of cancer treatments. btw of which, cystoscopy this morning shows no signs of bladder cancer returning. I'll get blood results on everything else very soon. Will post my liver panels, good or bad, as usual. Never had any problems so far.

Yes, definitely share when you get your results. I will admit to dipping my toe in the CBD oil myself, and I think kava and CBD make a nice combination so far. I think as both pick up in popularity there will be a lot of people doing both - hence it would be nice to have some sort of at least initial assessment of the risk profile.