Hey everyone
Stumbled upon this thread from a Google search. First off, a little background and apologies in advance for the long post but think it's important to provide context here...
I've been taking low dose PPI (15mg lansoprazole) for about 15 years. For the first 5 years I smoke cannabis pretty regularly with no issues, mostly flower given that's all that was readily available back then. I gave it a rest for a while but more recently picked it back up about 2 years ago dabbling into flower, vape, and edibles and super impressed at how commercialized everything became (ha). For the last 18 months, no real issues with the exception of an occasional "I'm kind of freaking out, need to control my breathing...it's just the weed, all in your head!". Flower, vape, edibles all seemed to be the culprit here so no real link to one or another. Lots of stress with COVID and everything else "2020" so didn't really think much of it. However, one other observation I made when smoking with others is that my tolerance was significantly lower...one hit and I was done...this was true even after smoking practically every day for a year straight. Awesome, right?! Not exactly...
Fast forward to a couple months ago, pretty standard Sunday popped an edible early afternoon (same dose, same bottle, nothing different) and had the standard good experience. Later that night, took one hit of some flower (same strain, batch) as per usual and watched some TV. An hour later, my heart started racing and I started the same "It's all in your head" routine except this time I couldn't stop it. Upper back/shoulder pain, shortness of breath, lightheaded, right side arm/shoulder/face started tingling so figured it was a panic attack. Well, whatever it was lasted for 2 hours curled up in the fetal position thinking I was going to die. So, red flags went up and I stopped for a few days. 3 days later, I took one very small hit of flower and was fine for 15 minutes until I started having a similar reaction albeit significantly less intense so I was able to get over it after an hour but still not fun.
I went to the doctor the next day and had an EKG and all sorts of blood tests and everything was normal. I was shocked. Over the next month, I stayed away. I definitely had some pretty severe withdrawal symptoms (daily user for a year plus) but eventually got over it. A month later, I hurt my back so went to a 10mg:5mg CBD/THC edible for some relief thinking the CBD would help keep me calm. Well, I was wrong and spent another 2-3 hours in the middle of the night thinking I was going to die with similar symptoms. That was about a 3 weeks ago and I haven't touched cannabis since. My mind is continuously trying to figure out why that happened.
Now I have known for some time now that PPI can have some pretty nasty effects from long term usage. However, I take for severe heartburn and have been to a gastroenterologist several times to discuss how to treat my heartburn. He basically told me that I was taking a low dose and any side effects of long term use were likely to be less severe than any damage I would do to my esophagus/GI tract from repeat heartburn. He also advised against any potential surgery option given my age (mid 30's) and potential complications. So not entirely sure what I'm going to do. However, this thread helped me search for more info on PPI / cannabis interactions and I found something interesting...
This article basically speaks to PPI's limiting oxidation of THC or increasing bioavailability of THC in the bloodstream. In other words, there is a link to an increased amount of THC absorbed in the bloodstream for those who take PPI. I would imagine that this effect is greater the longer you are on PPI but that is simply me speculating.
Xenobiotic-mediated inhibition or potentiation of cannabinoid metabolism
Δ9-THC is oxidized by the xenobiotic-metabolizing CYP mixed-function oxidases 2C9, 2C19, and 3A4 into approximately 80 metabolites
Reference78Reference468,. Therefore substances that inhibit these CYP isoenzymes such as certain anti-depressants (e.g. fluoxetine, fluvoxamine, moclobemide, and nefazodone), proton pump inhibitors (e.g. cimetidine and omeprazole), macrolides (e.g.arithromycin, erythromycin, telithromycin, troleandomycin), anti-mycotics (e.g. itraconazole, fluconazole, ketoconazole, miconazole, voriconazole, posaconazole), calcium antagonists (e.g. diltiazem, verapamil), HIV protease inhibitors (e.g. ritonavir, indinavir, nelfinavir, saquinavir, telaprevir, atazanavir, boceprevir, lopinavir), amiodarone, conivaptan, sulfaphenazole, azamulin, ticlopidine, nootkatone, grapefruit juice, mibefradil, and isoniazid can potentially increase the bioavailability of Δ9-THC (and metabolites such as 11-hydroxy-THC) as well as the risk of experiencing THC- and 11-hydroxy-THC-related side effects
Reference422Reference468Reference470Reference1389. Additive tachycardia, hypertension, and drowsiness have been reported with THC and concomitant consumption of tricyclic antidepressants such as amytryptiline, amoxapine, and desipramine
Reference227. Additive hypertension, tachycardia, and possible cardiotoxicity have been reported with THC and concomitant consumption of sympathomimetic agents such as amphetamines and cocaine
Reference227. Additive or supra-additive tachycardia and drowsiness have been reported with THC and concomitant consumption of atropine, scopolamine, antihistamines, or other anti-cholinergics
Reference227. Reversible hypomanic reaction has been reported with concomitant consumption of THC with disulfiram
Reference227.
