Published: Nov 7, 2021

Can I Smoke Weed While Taking Spironolactone?

In our latest question and answer, the medical cannabis pharmacist discusses if it is ok to smoke weed while taking spironolactone.

Answered by: Dr. Geoffrey Brown, PharmD

Capsules

Elize Asked

I just started taking spironolactone to lower certain hormone levels. I tend to smoke weed often. Are there any interactions I should be concerned with? I have smoked on this medicine before and was fine, I’m more worried about it making the drug ineffective or having too high of levels of the spironolactone in my system.

Summary

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There are no known major drug interactions between cannabis and spironolactone.

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Both drugs can cause low blood pressure, so be sure to drink plenty of water as spironolactone is a diuretic.

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Cannabis may affect certain hormone levels which could impact your spironolactone therapy, but more research is needed.

Answer

Hi Elize and thank you for your question. Based on what you stated in your question I wouldn’t be too concerned about anything from a safety standpoint. Both drugs can cause changes in blood pressure, so that’s something to be cognizant of. There is a theoretical way that cannabis could decrease the effectiveness of spironolactone in your particular use case, but there’s not enough data available to say for sure.

Spironolactone is a potassium-sparing diuretic that’s typically used to manage high blood pressure, but in your case, it’s being used for its hormonal effects. Spironolactone blocks certain hormones in the body called androgens and is commonly used off-label for this purpose. Androgens, such as testosterone, play a role in the development of certain male traits, so blocking them can be beneficial in certain circumstances (such as severe acne).

Spironolactone doesn’t actually lower the levels of androgens in the body (like you alluded to in your question) it just prevents them from reaching their intended target (androgen receptors) and causing their normal effects.

Now back to your question. Are there any interactions you should be concerned with? From a safety standpoint, there are no known major drug interactions that I’d be concerned with. Depending on the dose of spironolactone you’re using there’s a chance that smoking weed could interact and cause low blood pressure (hypotension). Both drugs are known to cause changes in blood pressure, so these effects might be additive. Spironolactone works to lower blood pressure through diuresis, so be sure to drink plenty of water to keep your blood pressure up!

Smoking weed has been associated with postural hypotension. This is where your blood pressure drops too low upon standing or sitting up after you’ve been sitting or lying down for a while. If you ever experience dizziness or feel lightheaded after smoking weed that could be a sign that your blood pressure is too low.


Are there any interactions that could cause excessive levels of spironolactone?

No, there aren’t any known interactions that we’d expect to cause this effect. Cannabis (and the chemicals inside it) are metabolized by enzymes in the liver, so smoking weed can alter the way your liver metabolizes other drugs. Smoking cannabis, in particular, may cause additional drug interactions because the chemicals present in marijuana smoke also interfere with drug-metabolizing enzymes. But spironolactone isn’t metabolized by the enzymes that cannabis and its smoke impact, so there’s no interference with metabolism. While there’s no apparent interaction in this case be sure to always check with your doctor or pharmacist before starting any new prescription medication, OTC drugs, vitamins, or herbal supplements to make sure it’s safe to take while using cannabis and with any other drugs you might be taking.

Cannabis is relatively safe and well-tolerated when used responsibly, but it can alter the metabolism of other drugs. This can result in changes in a drug’s concentration in your blood. If levels of certain drugs get too high they can cause toxicity. If the levels get too low, the drug could become ineffective. But again, that doesn’t appear to be the case in this scenario.


Are there any interactions that could make spironolactone ineffective?

There is a theoretical way that smoking cannabis could cause spironolactone to become ineffective, but it’s completely hypothetical as there’s conflicting research on the topic. Cannabis is known to affect certain hormone levels including androgens. Androgens are the same hormones you’re trying to block by taking spironolactone.

If frequent cannabis smoking increases your androgen levels (some studies say this is the case) that could alter the effectiveness of spironolactone. However, there’s conflicting research about cannabis’ effects on androgen levels. Some studies say that smoking cannabis causes androgen levels to rise and other studies say that it causes levels to go down. So, there’s no way for me to give you a definite yes or no answer here because more research is needed on this topic. To be completely clear, there is no research investigating the combined effects of these two drugs for this intended purpose. This is purely theoretical and for that reason, I wouldn’t worry about cannabis decreasing the effectiveness of your spironolactone for now.

Overall, smoking weed while taking spironolactone should be safe in most instances, but please be cautious as both drugs may cause low blood pressure. Until we get more research about cannabis’ effects on androgen levels we really can’t say for sure how this might impact your spironolactone therapy. I hope this helps answer your question.

Thanks and please reach back out with any additional questions you may have!

References

Health Canada. (2018). Information for Healthcare Professionals: cannabis and the cannabinoids. Dried or fresh plant and oil administration by ingestion or other means. Government of Canada, Health Canada

Aldactone [package insert]. New York, NY: Pfizer, Inc. 2008.

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Dr. Geoffrey Brown, PharmD

Dr. Geoffrey Brown is a registered medical cannabis pharmacist in New York State and the founder of CannaBuff. He graduated from the University at Buffalo with a Doctor of Pharmacy degree in 2018. His cannabis research has been featured by the national advocacy group NORML and local news organizations. Please feel free to reach out to him if you want to connect!

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