Contents
- 1 Which bioMD+ product is BEST for YOU?
- 1.1 Which bioMD+ product is BEST for YOU?
- 1.2 What Drugs Should Not be Taken With CBD?
- 1.3 What Prescription Drugs Should Not Be Taken With CBD Oil?
- 1.4 Can I Take CBD Oil With Prednisone?
- 1.5 CBD Oil And Thyroid Medications
- 1.6 Can I Take Ibuprofen With CBD Oil
- 1.7 Does Topical CBD Interact With Medications?
- 1.8 CBD Oil And Beta-Blockers
- 1.9 CBD Oil And Statins
Medicinal Cannabis And CBD Potential Drug Interactions
The Cannabis sativa L. (cannabis) has long been used in traditional medicines around the world for treating various conditions [source]. Cannabis is used for either medicinal or recreational purposes, which are utterly based on the content of a group of compounds in the plant, designated as cannabinoids. Recently, there has been increasing interest in cannabis, as shown in the inclined publications, reviews, and clinical trials throughout the years, largely due to a change of attitudes towards the use of cannabis in many countries. For example, the FDA recently approved the first cannabis-derived drug (Epidiolex®) for the treatment of severe seizure disorders, and the projected sales of cannabidiol (CBD) products are estimated as high as $1.9 billion by 2020 [source].
It has been widely accepted that delta 9-tetrahydrocannabinol (Δ9-THC) alongside with less abundant Δ8-THC are the most potent psychoactive cannabinoids in cannabis. In contrast, cannabinol (CBN) and CBD lack the psychoactive properties.
| Cannabis Based Treatment | Study Type/Location/n | Dosage/Administration | Efficacy, Tolerability and Notes | References |
|---|---|---|---|---|
| Chemotherapy Induced Nausea and Vomiting (CINV) | ||||
| -Dronabinol [Marinol®; (-) trans Δ9-THC) alone or in combination with ondansetron (8–15 mg IV] | -Interventional (Placebo controlled). -n = 64. -USA. | -Capsule (2.5–20 mg). -Oral. | -Both were effective in CINV and well tolerated while dronabinol was more effective. -Combination is not more effective. | [23] |
| -Dronabinol [Marinol®; (-) trans Δ9-THC] | -Interventional (retrospective). -Children with malignancy. | -Solution administered orally (2.5–5 mg/m2 body surface every 6 h as needed). | -Positive response were reported for 60% of patients. -Prospective trial would be needed to confirm the dronabinol effect in CINV therapy. | [24] |
| -Nabilone with 5HT3 antagonist | -Interventional (retrospective) -n = 110 with median age 14 years with malignancy. | -Oral. | -Adverse effect was reported with minor clinical significance. -Poor nausea control in nabilone treated group. | [25] |
| Pain“}”>Chronic Pain | ||||
| -Sativex® (Δ9-THC: CBD at a ratio of 27:25 mg/mL) -THC (27 mg/mL) | -Interventional (Double Blind, Randomized, Parallel Group, Placebo Controlled), n = 177. -Phase 3. -UK. | -Oromucodal spray with maximum Δ9-THC: CBD (130:120 mg/day) or 130 mg/day Δ9-THC alone Each actuation is 100 μL. | -Compared with the placebo, the Sativex treated group showed significant pain relief unlike the Δ9-THC which was non-significant. -Reported adverse effects including dizziness, gastrointestinal disorders and confusion. | [26] |
| -Sativex® (Δ9-THC: CBD at a ratio of 27:25 mg/mL) | -Interventional (single group assignment) -Phase 3. -UK. | -Oromucodal spray with maximum 130:120 mg/day of Δ9-THC: CBD. | -The long-term use is well tolerated without losing pain-relieving effects in terminal chronic-related pain refectory to opioids. -Adverse effects and tolerability assessed at the RCT withdrawal visit, 7–10 days later, then monthly, and at the withdrawal or completion of the study. | [27] |
| – Sativex® (Δ9-THC: CBD at a ratio of 27:25 mg/mL) | -Interventional (Double Blind, Randomized, Parallel Group, Placebo Controlled). -Phase 3. -Multicentric. -n = 399. | -Oromucodal spray (100 μL per actuation twice daily in the morning and evening with a maximum of 10 sprays for 5 weeks). | -No significant difference was reported in advanced chronic patients with chronic pain (unalleviated with opioids). -Nabiximol still beneficial to secondary endpoints. -No evidence of abuse or misuse was reported. | [28] |
| -No significant difference was reported in advanced chronic patients with chronic uncontrolled pain. | [29] | |||
| -Nabiximols (Sativex®; Δ9-THC: CBD at a ratio of 27:25 mg/mL) | -Interventional (Double Blind, Randomized, Parallel Group, Placebo Controlled). -Phase 2. -USA. -n = 360. | -Oromucodal spray in low (1–4 sprays/day), medium (6–10 sprays/day) and high (11–16 sprays/day) doses. | -Efficacy and safety were reported at low and medium doses against advanced chronic pain. -The adverse effects at high doses. | [30] |
| -Nabiximols (Sativex®, Δ9-THC: CBD at a ratio of 27:25 mg/mL) | -Interventional (Double-Blind, Placebo controlled, Crossover Pilot trial). -n = 16. | Sublingual spray (7.5–30 mg/day).”}”>-Sublingual spray (7.5–30 mg/day). | -No significant difference was reported against chemotherapy-induced neuropathy. -Two-fold reduction of the pain in the responder group with adverse effects. | [31] |
| Cannabis cigarettes (3.56% Δ9-THC) in combination with opiates | -Interventional (open label). | -Pulmonary administration for chronic pain, including chronic patients. | -Declined chronic pain around 27% in patients receiving oxycodone or morphine analgesics. -No serious adverse effects were reported. | [32] |
| 5HT3; 5-hydroxytryptamine 3 receptors, Δ9-THC; Delta -9 tetrahydrocannabinol, CBD; Cannabidiol, CINV; Chemotherapy induced Nausea and Vomiting, IV; Intravenous, n; number of participants, RCT; Randomised controlled trial. | ||||
Great product used for pain relief and sleep improvement.
Emmarie I. Great product! Really works for aches and pains, and I sleep better with it!
Madelyn G. My wife suffered from severe pain during her periods. This oil helped to reduce that unbearable pain. This oil is now her regular staple.
Peter J. Potential Drug Interactions With CBD
Drug interactions can occur when two or more drugs/substances with similar or different actions (including herbal substances) are co-administered, such as warfarin with aspirin, and cyclosporine A with St John’s Wort. Drug interactions may result from chemical reactions between different components or modifications by certain components of certain biochemical pathways involved in the action or metabolism of related drugs.
Effects Of Cannabis On Drug Metabolizing Enzymes And Related Drug Interactions
| Cannabinoid Based Treatment and Interactions | Affected Transporters and/or Metabolic Enzymes | Experimental Results, Notes and Outcomes | References |
|---|---|---|---|
| Cannabis, THC, CBD, CBN with either chemotherapies, abuse drugs or medications | -Membrane transporters ABC super family (glycoprotein P; P-gp, Breast chronic-resistance protein; BCRP, and multidrug resistance protein; MRP1, 2, 3 and 4) -Cytochrome P450 (3A, 2D6, 2C9, 1A1, 1A2, 1B1, 2B6 and 2C8) -UDP-glucuronosyltransferases (UGTs) | -P-gp, BCRP, and MRP1-4 transporters expression were dysregulated by cannabinoids, but in higher concentrations than that usually measured in cannabis smokers. -CYP3A was competitively inhibited by THC, CBD and CBN, with CBD being the most potent in a concentration compatible with that in usual cannabis inhalation. -CYP2D6 was inhibited by THC, CBD and CBN, with CBD being the most potent in a higher concentration than that in usual cannabis consumption. -CYP2C9 was inhibited by THC, CBD and CBN, with CBD inhibitory effect being dependent on the used substrates. -CYP1A1, 1A2, 1B1, 2B6, 2C19, 3A4 and 2C8 were strongly inhibited by CBD. -UGT1A9, and 2B7 were inhibited by CBD. -UGT1A7, 1A8, and 1A9 were inhibited by CBN. -UGT2B7 was activated by CBN.Cannabinoids and drugs with inhibitory or stimulatory effects on UGT2B7 will interact.Clinical studies are warranted to explore the potential interactions with chemotherapy, alcohol, abuse drugs, and prescription medications. | [17,50,51] |
| Δ9-THC, CBD and marijuana inhalation with psychotropic agents | -Cytochrome P450 | -CYP2C9 and CYP3A4 were inhibited by Δ9-THC. -CYP2C19 and CYP3A4 were inhibited by CBD. -CYP1A1 and CYP1A2 were induced by marijuana inhalation.Cannabinoids consumption via pyrolysis induced CYP due to aromatic hydrocarbons.The effect of cannabinoids on the CYP activity influenced by the formulation, administration route, and derivation (Plant based or synthetic).Clinical studies are warranted to explore the potential drug–drug interactions with cannabinoids. | [52] |
| Cannabinoids on other drugs | Cytochrome P450 | -CYP3A4 inhibitors and stimulators affect the elimination of Δ9-THC and CBD.Reviewed the pharmacokinetic interactions between cannabinoids on other drugs. Limited data on the drug’s effects on the accumulation of cannabinoids and marijuana. More clinical studies are warranted. | [53] |
| CBD with antiepileptic drugs | Cytochrome P450 or unknown | Clinical studies of DDI: -Non-significant increase of the clobazam plasma level administered with CBD (n = 13 children) due to potent inhibition of CYP2C19. -Significant change of plasma level of N-desmethylclobazam by CBD co-administration while no significant change in the level of valproate, stiripentol and levetiracetam (n = 24 open label trial). -All patients showed significant changes of the plasma levels of clobazam, N-desmethylclobazam, rufinamide, and topiramate by increasing CBD doses. The mean therapeutic range was exceeded for clobazam and N-desmethylclobazam; the plasma levels of eslicarbazepine and zonisamide were increased in adults only (n = 39 adults and 42 children).The purified CBD formula is FDA approved with antiepileptic drugs as a result of the published randomized clinical trials.CBD is well tolerated with potential DDI and adverse effects.The compulsory monitoring drug levels and patients’ liver functions are advised. | [47,54] |
| Synthetic and Phyto-cannabinoids | -Cytochrome P450 -UGTs | -CYP1A catalysed MROD activity was weakly inhibited by MAM-2201, JWH-019, STS-135, and UR-144. -CYP2C8 catalysed amodiaquine N-deethylase was strongly inhibited by AM-2201, MAM-2201, and EAM-2201. -CYP2C9 catalysed diclofenac hydroxylation and CYP3A-catalyzed midazolam 1′-hydroxylation were inhibited by AM-2201 and MAM-2201. -CYP2C9 catalysed diclofenac 4′-hydroxylation, CYP2C19-catalyzed [S] -mephenytoin 4′-hydroxylation, and CYP3A-catalyzed midazolam 1′ hydroxylation were strongly inhibited by EAM-2201 (time-dependent inhibition). -CYP2B6 and CYP2C9 were strongly inhibited by THC, CBN and CBD. -CYP2A6 was inhibited by THC and CBN (mechanism-based inhibition). -CYP2D6 was competitively inhibited by CBD. -CYP1A1 mRNA expression was increased by THC in Hepa-1 cells, but EROD activity in CYP1A1 supersomes was inhibited by THC. -CYP1A1, CYP1A2, and CYP1B1 were strongly inhibited by CBD (mechanism-based inhibition). -CYP3A was inhibited by CBD in human liver microsomes. -CYP2C19-catalyzed [S] -mephenytoin hydroxylation was inhibited by (CBD and THC (Mixed-type inhibition). -UGT1A9- and UGT2B7 catalysed ethanol glucuronidation were non-competitively inhibited by CBD, and unlike the inclined ethanol glucuronidation in human liver microsome by CBN (dose dependent). -UGT1A3 catalysed chenodeoxycholic acid 24-acylglucuronidation was strongly competitively inhibited by AM-2201, MAM-2201, and EAM-2201. -UGT2B7-mediated naloxone 3β-D-glucuronidation was competitively inhibited by AM-2201.Clinical studies of pharmacokinetics mediated drug interactions of synthetic and phyto-cannabinoids with the CYP and UTGs substrates are warranted. | [55,56] |
| ABC; ATP-binding cassette, AM-2201, EAM-2201, MAM-2201, JWH-019, STS-135, and UR-144; Synthetic cannabinoids, BCRP; Breast chronic resistance proteins, CBD; Cannabidiol, CBN; cannabinol, CYP; Cytochrome P450, DDI; drug–drug interactions, MROD; 7-methoxyresorufin O-demethylation, MRP; Multidrug resistance proteins, P-gp; Glycoprotein P, THC; tetrahydrocannabinol, UGTs; UDP-glucuronosyltransferases. | |||
Which bioMD+ product is BEST for YOU?
Which bioMD+ product is BEST for YOU?
Metabolic Drug-Drug Interactions Between Cannabidiol And Enzyme Substrates, Inhibitors, Or Inducers.
CBD and its primary active metabolite 7-hydroxy CBD (7-OH-CBD) have similar reported effects on a number of CYP450 enzymes. CYP450 enzymes are implicated in the primary metabolism and biotransformation of the majority of therapeutic agents and xenobiotics [source].
How To Increase CBD Bioavailability
Bioavailability is the degree and rate at which a substance or drug absorbs into the bloodstream. Bioavailability determines how much of the drug or substance is present in the body to supply a level of effect. For example, when a doctor prescribes medication, part of the calculation already has bioavailability included when establishing the standard dosage.
With CBD, it varies based on the consumption method and the concentration that the product contains. To get the most bioavailability out of CBD, the excellent route would be to inject the CBD directly into the bloodstream through the vein by a needle. It would deliver 100% of the CBD into the bloodstream, but that is not the most preferred method.
Another way would be oral consumption; such as CBD Capsules, CBD edibles, and beverages—through oral use, it offers certain benefits but also reduces the bioavailability drastically.
Due to the fact it will pass through the metabolic and digestive systems which filter out a sizable amount of CBD before reaching the bloodstream. Vaporized consumption involves inhaling CBD directly into the lungs through a vape pen or a vaporizer device.
By directly entering into the lungs, the CBD can directly enter into the bloodstream providing higher bioavailability and decreased breakdown rates. It is essential to keep in mind that your state of health will influence the delivery form that may or may not work when obtaining the best utilization of the bioavailability.
Medication or any type of supplements can create a lot of trouble in your body. That is why smart people consult their doctors before deciding to take any sort of medication for their health. Every time you visit your healthcare provider, the first question you are asked is about your recent medication history. This is because side-effects from the wrong medication can wreak havoc on your body.
Taking CBD is legal, and it has a long history of being used in traditional medicine. CBD is one of the hundreds of chemicals known as cannabinoids that are found in the cannabis plant. When people use marijuana, they take in CBD and THC. That is why smoking marijuana produces a psychoactive effect. This comes not from CBD but THC. The marijuana plant contains both of them, but CBD is different: this compound is a schedule 1 narcotic. It doesn’t have any psychoactive effects, so it won’t get you high.
The limited research on CBD has gotten plenty of people talking about CBD and its effects on their symptoms. We don’t have enough research available to come to any conclusions, though. Still, everything so far points to the positive aspects of CBD and how much help it has been in the world of pharmaceuticals. CBD’s popularity has influenced and attracted many to learn more about the drug. One of the most common questions is about the interaction of CBD and other drugs.
Any bad interaction may produce side-effects and will sometimes make matters worse. But if a drug will work with CBD, this combination may have a greater effect on your condition’s symptoms. Knowing this information would be highly valuable.
The legalization of CBD has given many people access to the drug. Its rise in popularity is due to its anti-inflammatory properties, which can have tremendous healing effects for our bodies without taking a toll on them. CBD doesn’t have any major side-effects that will slow down our body in any way. When you take CBD, it interacts with the endocannabinoid system and starts to regulate the production of natural cannabinoids in our body. In this article, we are going to take a closer look at the drugs that aren’t compatible with CBD.
What Drugs Should Not be Taken With CBD?
Since more than half of all medications depend on CYP450 enzymes to be metabolized, check carefully which of your prescribed and over-the-counter medications fit this criterion and look for delayed or suppressed effectiveness, as well as extended side effects and possible signs of drug toxicity. Examples of drugs with CYP450 effects that represent cause for concern include:
- Antiarrhythmics
- Antibiotics
- Anesthetics
- Angiotensin II blockers
- Antihistamines
- Antipsychotics
- Antidepressants
- Anti-epileptics
- Benzodiazepines
- Beta-blockers
- Calcium channel blockers
- HIV antivirals
- HMG CoA reductase inhibitors
- NSAIDs
- Oral hypoglycemic agents
- PPIs
- Prokinetics
- Steroids
- Sulfonylureas
One class of drugs to be particularly wary of are called prodrugs. These drugs must be metabolized to become active, therapeutic compounds. The version of the drug you ingest is actually inert and depends on the biochemical reaction with CYP3A4 to become active at all. If CBD suppresses your CYP3A4 levels, a prodrug might not even work at all. Examples of prodrugs include codeine, which gets synthesized into morphine in the liver. ADHD drugs Concerta and Vyvanse are two others.
What Prescription Drugs Should Not Be Taken With CBD Oil?
Currently, sparse research suggests that CBD can illicit problematic interactions with certain other prescription drugs. The findings are far from conclusive — further research is still needed on CBD’s interaction with different medications. Many doctors and researchers urge individuals using CBD medically or recreationally to be cautious about mixing it with other prescriptions and to consult healthcare providers about possible interactions.
Can I Take CBD Oil With Prednisone?
CBD will interact with other drugs despite its general safety. Taking CBD will send the drug through your digestive system, then to the liver via the hepatic portal vein. In the liver, the CBD will be metabolized. The enzyme CYP3A4 is involved in the metabolization of 25% of all drugs, including CBD. When you take CBD, it inhibits CYP3A4’s effects. As such, CBD will increase the concentration of other drugs in the body. This will also increase the risk of side-effects.
Many doctors will not recommend mixing CBD and prednisone. The reason why so many people find CBD and prednisone together appealing is that they want to increase the effects of the medicine. What they don’t see is the risk, which can quickly escalate to dangerous levels. If you want to take CBD for an inflammatory condition, then you have to stop taking prednisone. You must give up one drug to try out the other – you can’t take them both at the same time. That is why talking to your doctor before making any decisions is a must.
CBD Oil And Thyroid Medications
People who have taken CBD oil with thyroid medication have experienced mild nausea and anxiety. This is because the substance competes for metabolism along the cytochrome p450 pathway. If someone takes thyroid medication after CBD oil, then they are going to experience such side-effects. That’s why many doctors suggest leaving time between taking these two drugs. There are plenty of things about this mixture that you should pay the most attention to; otherwise, they will have side-effects.
There isn’t much research on taking CBD oil and thyroid drugs together. CBD can be very helpful in suppressing the effects of inflammation, and many consider CBD to be a natural immunosuppressant. CBD oil is an all-natural product that doesn’t contain any harmful chemicals. If you are thinking about taking thyroid medication and CBD to strengthen the effectiveness of relief, you need to consult your doctor first. Any ingredient can cause multiple side-effects if taken by someone who cannot handle the product. The same applies if your body can’t handle CBD well. In that case, you should stop taking it immediately or ask your doctor for advice on the proper dosage for you.
Can I Take Ibuprofen With CBD Oil
Certain drugs available on the market are not compatible with CBD, but ibuprofen is not one of them. If your body can handle ibuprofen, then you can take CBD along with this painkiller. Multiple studies have been done on this, and the results have shown no interaction between ibuprofen and CBD. The only side-effect you may feel is if you are allergic to any of these substances or if your body can’t handle ibuprofen or CBD well.
Taking CBD will reduce aches and pains related to your conditions. If you are feeling any sort of pain in your body, it will relax the muscle tissue. If your body tolerates the effect of CBD, then you can add ibuprofen to increase its overall effect. Again, you must consult your doctor for proper guidance. Yes, studies that have been done say that CBD mixes well with ibuprofen without any future side-effects. But you can never be too sure what kind of reaction these drugs will have on your body. If you are allergic to any of the drugs, you will experience the associated side-effects.
It is recommended to take CBD daily, as it will balance the hormones in your body and reduce the appearance of many symptoms.
Does Topical CBD Interact With Medications?
If you are planning to stick with CBD lotion for more topical CBD treatment, then you don’t have to worry about any sort of interaction with other medications. This is because CBD topicals never get absorbed directly into the bloodstream. That’s why they don’t come in contact with other medications taken in that period. Medication has to hit the bloodstream to have any sort of effect on your body, but topical CBD doesn’t do that. When you reach for the CBD oil, though, you will see drugs mixing with CBD oil in the bloodstream.
But any topical CBD cream or lotion will be fine. They won’t interact or interfere with any other drugs in your system, either. Research on this subject is lacking, but many researchers are working hard to determine any specific interactions that take place between CBD and other medications. The effects of such mixtures are still unclear, so you need to consult your doctor to determine your best course of action in this regard. If they give you the green light to try out CBD with medication, then you can go ahead and do so without being worried.
Some CBD products have shown positive effects with other drugs. However, there are many cases where it didn’t. Not all human beings have the same bodily tolerance. Whereas one person can take large quantities of CBD without feeling nauseated, another may experience anxiety just from consuming a small dose. That’s why a doctor’s prescription is key. Before trying the product, make sure to ask your doctor for their guidance on the right approach to this issue.
What Drugs Should Not be Taken With CBD Hemp Oil?
How drugs interact. Drugs are metabolized and eliminated by enzymes in the liver—specifically, the cytochrome P450 (CYP) family of enzymes.
- Warfarin. Use of cannabinoids increases the risk of bleeding in patients taking warfarin.
- Theophylline.
- Clobazam.
- Valproate.
- Alcohol.
CBD Oil And Beta-Blockers
People consume beta-blockers to reduce their blood pressure. Taking CBD will help keep your blood pressure under control. If you are thinking about taking them together to boost their effectiveness, you have to be prepared to face some potential side-effects. It can be very tempting to take both of them, which will create many other issues that can quickly reach dangerous levels. Beta-blockers are made to reduce your heart rate by stopping the release of adrenaline. If you are thinking about using both of them, your blood pressure will drop quickly. Unhealthy blood pressure levels will produce more side-effects.
The list of side-effects you may experience is feeling faint, weak, nauseous, and dizzy, along with an increased chance of going into shock. While multiple studies show CBD interacts positively with other drugs, the evidence supporting its use with beta-blockers is limited. Since CBD blocks the enzymes needed to interact with drugs in the body, sometimes the effectiveness of a drug will decline instead of increasing. For these reasons, if you are planning to take any other drug with CBD, you need to ask your doctor first to determine which drugs will suit your body. Drugs usually don’t work well for everyone, with all the varying body types and physiques. If you take a higher dosage of one drug and lower dosage of another, this may create a toxic effect in your body.
Something many aren’t aware of or pay much attention to is dosage. This is actually crucial to your body, more than you might think. Only a doctor or healthcare provider will know the right type of medication for your system that won’t cause any damage.
CBD Oil And Statins
CBD will increase the serum concentration of statins, but the impact will be limited to only some. CBD oil won’t affect pravastatin or rosuvastatin, but it will interact with atorvastatin and simvastatin. Many doctors suggest cutting your mediation in half to consume the CBD. If you are planning to add CBD oil into your life, make sure to do it with a licensed physician. They will monitor your blood cholesterol levels and prescribe you a suitable dosage that won’t damage your internal system.
Some doctors will refuse to treat a patient if they are taking CBD. If you find yourself in this situation, it is better to switch to another doctor for further examination. CBD oil is commonly well-tolerated, and it is rare for someone to have serious side-effects from taking too much CBD. Mixing drugs will create an imbalance in your internal system.
CBD And Wellbutrin: What Drugs Should Not Be Taken With CBD And Wellbutrin?
Always discuss with your physician first as everyone’s biochemistry is a little bit different. What I will tell you is that the biggest concern with CBD and prescription medication is when that medication is sensitive to grapefruit or high amounts of citric acid. If you are taking a prescription that is sensitive to grapefruit, it is recommended that you wait two hours after taking the medication or take the CBD two hours before medication to avoid this interaction. What essentially happens in these scenarios, is that the CBD and said prescription may fight for attention of the same receptors, causing neither to work to their full potential.
CBD And Pet Meds: What Drugs Should Not Be Taken With CBD And Pet Meds?
Some medications susceptible to this are blood pressure medications, cholesterol medications, anxiety drugs, antihistamines, corticosteroids, and antibiotics. On the bright side, other medications can have an enhanced effect when combined with CBD. Anti-seizure medications may be more effective, for one.
Conclusion
Normally, CBD has all the right ingredients your body needs to overcome pain. While most drugs will be very helpful when they come in contact with CBD, others will start to unleash a barrage of symptoms. That’s why you need to do the right research beforehand and ask your doctor about proper indications for CBD and other medications you’ve been taking. They will give you advice on what you need to do and how much of the drug to take for the right effect.
