October 05, 2020 6 min read

People are taking CBD in hopes of managing all sorts of conditions, like pain, insomnia, anxiety, and even chronic disorders. For many people who are otherwise healthy, this hemp-based natural solution is a no-brainer.

For others, especially those who take one or more daily medications, it is crucial to consider CBD drug interactions before starting a new CBD routine.

Luckily, many people have found a way to integrate CBD into their daily lives without implications, and others have even reported being able to replace their normal medications with CBD (with a doctor's guidance, of course).

Sure, this won’t be the reality for everyone because CBD affects each person differently. Still, understanding the way that CBD interacts with your daily medications is the first step to making CBD work for you.

So, what medications may interact with CBD? And can you take CBD with other medications?

We’ll break down what we know about CBD drug interactions (and give you some tips for talking to your doctor about CBD down below.)

Table of Contents
How is Cannabis Used
Medicinal Cannabis Use
Recreational Cannabis Use
How Does Cannabis Work?
Cannabis Effects
Resources

Key Takeaways

  • CBD has the potential to interact with many over-the-counter and prescription drugs. These interactions may happen in multiple ways, usually by either increasing the amount of the drug available in your system or by decreasing its effectiveness.
  • CBD drug interactions can range from mild to potentially harmful, so it's important to talk to your doctor before taking CBD.
  • In many cases, people have been able to space out their CBD and medication doses in order to avoid interactions.
  • Your doctor can also help monitor your medication levels and dosing routine to help make necessary adjustments and decide if CBD is safe for you.
  • Always proceed with caution, under the care of your doctor, and watch out for adverse reactions or signs that your regular medication is no longer working.

CBD Safety and Implications

A close up of a man measuring a CBD oil dose

Generally speaking, CBD is widely regarded as safe, and even leading organizations have found CBD to have no public safety risks. That’s because it has very few known side effects , is non-habit forming, and will not cause psychoactive effects. That means that while CBD may not be the right solution for everyone, it may be a safe option to try.

Of course, while CBD’s safety profile is generally sound, we still have a lot to learn. Researchers are still learning how CBD interacts inside the human body, especially in the case of various chronic conditions.

What we do know is that CBD may interact with certain medications that are metabolized by the same pathways. CBD is not known to have any fatal chemical reactions or toxicity on it’s own, but it may cause certain medications to be less effective. In some cases, it may even increase active levels of certain medications in the body.

If the affected medication is taken to control life-threatening conditions, CBD drug interactions could be serious. For this reason, it is crucial to understand how CBD is metabolized and what medications may interact with it.

How is CBD Metabolized?

Before a drug or substance enters the bloodstream, it must be metabolized by one or more pathways in the body. CBD is no exception, and research shows that a very important part of CBD's metabolic process is carried out in the liver.

The cytochrome P450 (CYP450) liver enzymes group is responsible for converting certain substances so that they can be utilized and then eliminated from the body.

One of the enzymes from this group, CYP3A4 is specifically responsible for converting CBD during digestion. However, the CYP3A4 enzyme is also responsible for metabolizing over half of the prescription drugs on the market today. This duality is what causes complications.

CBD drug interactions can happen multiple ways. Because CBD inhibits CYP3A4 enzymes, it may decrease the body's ability to process other substances that rely on these same enzyme pathways.

This slows down the metabolic process, which can potentially be a problem. When a drug is metabolized too slowly, there may be too much of the substance in your system at one time. This results in exaggerated effects that can lead to unwanted side effects.

Alternatively, the opposite can be true. Certain medications that inhibit the CYP3A4 enzymes may decrease the body's ability to process CBD correctly. Either way, it’s clear that interactions between common medications and CBD is something that can’t be ignored.

What Medications Interact with CBD?

A bottle of medications that may interact with CBD

While it is impossible to list all of the medications that may have interactions with CBD, there is a simple indicator—check for a grapefruit warning.

Many medications come with a “grapefruit warning” on the label that advises against taking the medication with grapefruit juice. That’s because grapefruit also interacts with the same liver enzyme pathways and can cause certain medications to metabolize too slowly.

Many different types of medications have a grapefruit warning, and therefore will interact with CBD when taken simultaneously. Medications with this warning include:

  • Antibiotics
  • Anti-nausea medications
  • Antimicrobials
  • Anticancer treatments
  • Antidepressants
  • Antihistamines
  • Anxiety medications
  • Antiepileptic drugs (AEDs)
  • Blood pressure medications
  • Blood thinning medications
  • Cholesterol medications
  • Corticosteroid
  • Erectile dysfunction medications
  • GI medications
  • Heart medications
  • Immunosuppressants
  • Pain medications

Keep in mind that not every drug that falls into one of these categories has a grapefruit warning—this is only a generalized list. Your doctor will have more accurate information regarding your medications and CBD interactions.

If your medications do have a grapefruit warning, not all hope is lost! There may be some things you can do (with the guidance of your doctor) to create balance between your medications and CBD dose.

Can You Avoid CBD Drug Interactions?

Although the initial instinct may be to just avoid CBD altogether if you take certain medications, total avoidance may not be necessary.

Multiple studies have shown that while CBD interacts with many medications, it still may be safe to take it concurrently. One clinical trial evaluated interactions between a popular seizure medication, clobazam, and CBD. The study found that the two may be safely combined, but that medication levels should be monitored.

Another example is Epidiolex, an FDA-approved drug consisting of CBD isolate and trace terpenes, which may be safe to take alongside certain medications. In general, many medications with a grapefruit warning may be taken simultaneously without serious implication.

The ability to combine CBD and other medications that utilize the same enzyme pathways boils down to a few factors, like dosage and dosing schedule. In other words, a low-dose of a medication may not interact with enough liver enzymes to affect the metabolization of a low-dose of CBD.

Alternatively, spacing medications out can help allow time for the liver pathways to “normalize” so that there are no interactions. This is one reason why your physician may recommend taking certain medications in the morning and others at night.

Discussing CBD Drug Interactions with Your Doctor

Taking CBD should always start with a conversation with your doctor. When discussing CBD, be sure to disclose all the over-the-counter and prescription medications, vitamins, and supplements you’re taking.

A woman talking to her doctor about CBD

Tell your doctor why you think CBD could help. Be sure to identify whether you want to add CBD to your wellness routine, or plan to use it to replace a medication you’re already taking. Never stop taking any prescribed medication without seeking your doctor’s advice.

You may also want to discuss the type of CBD you intend to take with your doctor. Not all CBD is absorbed the same way, and different products may have different benefits. For help choosing a CBD formula, check out our CBD Buyer’s Guide.

If your doctor approves of your decision to take CBD, ask whether your current medications will interact with CBD. Then, talk to your doctor about working out a dosage plan and dosing schedule that avoids drug-drug interactions.

Depending on your current medications, your doctor may not recommend taking CBD. If there is room in your wellness plan for CBD, he or she may also recommend monitoring the plasma serum levels of your medications.

When combining CBD with your regular medications, your doctor will be able to tell you what type of side effects to look out for to identify an adverse reaction. It will vary by medication, but some general signs may include drowsiness, dizziness, nausea, or signs that your medication is no longer working as well as it was before.

In addition, you may want to look for common CBD side effects.

Resources

  1. “Potent inhibition of human cytochrome P450 3A isoforms by cannabidiol: Role of phenolic hydroxyl groups in the resorcinol moiety” https://www.medicinalgenomics.com/wp-content/uploads/2013/11/Potent-inhibition-of-CYP3A-with-CBD.pdf
  2. “Drug-drug interaction between clobazam and cannabidiol in children with refractory epilepsy” https://pubmed.ncbi.nlm.nih.gov/26114620/
  3. “FDA Approves First Drug Comprised of an Active Ingredient Derived from Marijuana to Treat Rare, Severe Forms of Epilepsy” https://www.fda.gov/news-events/press-announcements/fda-approves-first-drug-comprised-active-ingredient-derived-marijuana-treat-rare-severe-forms

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