July 29, 2022 7 min read

THC-O is the ultra-potent THC analog that everyone’s talking about, but there’s more to this legal cannabinoid than it’s borderline-psychedelic effects. For instance, it may carry many of the same benefits as traditional THC, and possibly even similar risks. One ever important question for THC-O consumers who take prescription medications is–What THC-O drug interactions should I be concerned about?

THC-O research is still pretty limited, so we mostly need to rely on what we know about traditional THC to understand THC-O'S potential to interact with other medications. Luckily, the way that two cannabinoids interact with the body aren't all that different, and they are thought to be metabolized in a similar manner, so we have a pretty good idea what drug interactions you should be concerned with.

Before you pair THC-O with any medications, here's what you need to know.

Table of Contents
THC-O vs Delta-9 and Metabolic Absorption
TH-O Metabolic Pathways
THC Drug Interactions
What Happens During THC Drug Interactions?
Can You Combine THC-O with Delta-9?
Can You Take THC-O with Alcohol?
Tips for THC-O Dosing While on Medications

Key Takeaways

  • We need more research to fully understand THC-O drug reactions, but experts believe it reacts similarly to THC.
  • Many cannabinoids, including THC, use the same metabolic pathways as many common classes of prescription drugs.
  • It still may be safe to take high-quality THC products if you take a prescription medication, but check with your doctor first.
A model of the THC-O molecule to demonstrate its similarities to Delta-9-THC

THC-O vs Delta-9-THC and Metabolic Absorption

In order to understand possible THC-O drug interactions, we need to first understand what causes drug interactions to begin with.

There are many different ways that substances can interact, both positively and negatively, inside the body. Primarily, the number one cause for concern is when substances share the same metabolic pathways.

In other words, when the metabolic enzymes needed to break down two substances are the same, there could be an issue with supply. That means that there may not be enough space or resources within the body's metabolism adequately break down both substances. This may cause multiple issues, like poor absorption or even a buildup of certain chemicals in the body, which in some cases could be dangerous.

THC-O Metabolic Pathways

Many prescription medications use the CYP3A4 metabolic pathway. This is the metabolic pathway used by THC and many other cannabinoids, like THCO-O, as well as most prescription and over-the-counter drugs. This is the reason that you may need to take certain medications a few hours apart or at different times during the day.

Some medications may even come with a “grapefruit warning” which further demonstrates the idea of conflicting metabolic pathways. Grapefruit is known to inhibit the CYP3A4 enzyme, which means that it can delay or prevent the absorption of drugs that rely on that enzyme. The grapefruit warning simply means that you shouldn't take that medication with grapefruit juice.

Research has found that both CBD and THC heavily rely on the CYP3A4 metabolic pathway for absorption and are known to inhibit the CYP3A4 enzyme. That means that they have the potential to react with any drug that uses that same metabolic pathway, which unfortunately is most prescription medications.

How Serious is the Risk?

It's always important to be wary of the risks of drug interactions, whether you're taking THC-O or any other substance. Still, some evidence suggests that the interaction may not be very significant. One study found that "Studies of THC, CBD, and CBN inhibition and induction of major human CYP-450 isoforms generally reflect a low risk of clinically significant drug interactions with most use," but also noted that human trials are lacking and more information is needed.

It's important to note, of course, that all of the data available is about either CBD or Delta-9-THC. THC-O is much more potent and therefore may pose a greater risk. Keep that in mind when reviewing the following possible drug interactions, which are mostly based on data concerning traditional THC.

THC Drug Interactions

THC, and therefore THC-O, is known to negatively interact with some prescription medications, including:

  • Benzodiazepines
  • Opioids
  • Antidepressants
  • Immunosuppressants
  • Blood Pressure Medications
  • Blood Sugar Medications

What Happens During THC-O Drug Interactions?

A bottle of prescription medications that may have adverse interactions with THC-O

As we mentioned previously, all of these medications rely on the CYP3A4 enzyme that THC may suppress. This means that the drug may break down more slowly due to a lack of available enzymes.

There are two primary scenarios to consider:

Drugs May Be Ineffective

First, lack of metabolic enzymes may inhibit absorption, making the medication less effective. It could even prevent absorption entirely, rendering the medication entirely ineffective. This is obviously a severe risk when you're taking a life saving medication.

Drugs May Build Up in the Body

The second scenario involves what happens when those medications aren't adequately absorbed and processed. If a medication cannot be metabolized, it may build up in the system over time. For many medications, this runs the risk of toxicity in the form of overdose. Obviously, in many cases, this also can be dangerous or even life-threatening.

Other Complications

Other scenarios are less common, but still possible. For instance THC is known to increase the effect of some medications, like benzodiazepines. It's well documented that THC can increase the potential of benzodiazepines to cause sedative like effects, which can be both a benefit and a drawback depending on how the combination is used.

This could be the case, in varying circumstances, with many medications. Sometimes making a medication more effective is not necessarily a benefit. For instance, increasing the effects of a medication designed to lower high blood pressure could result in the blood pressure dropping too low.

That means that while THC may be a useful addition to your medicinal routine in some cases, you should definitely talk to your doctor before including THC-O alongside your current medications. You and your doctor will be able to determine whether or not THC poses any benefits or if the risks are too significant. In some cases, simply putting some space between your medication and THC-O dosage will allow time for your body to regenerate the needed enzymes to properly metabolize both substances.

Now, let's discuss some other comment thco combinations that he may be concerned about:

Can You Combine THC-O and Delta-9?

Because many people are more accustomed to Delta-9, they often wonder if they can use THC-O and Delta-9 at the same time. The answer is yes, there's no reason you can't combine THC-O with Delta-9. In fact, it may help to mediate some of THC-O’s potency and create a slightly milder psychoactive effect, potentially with with increased therapeutic effects.

Some people also like to combine THC-O with Delta-8, which is even milder than Delta-9 and can help provide effects that are more consistent and easier to navigate for new cannabis consumers. Our THC-O + Delta-8 Vape is a perfect example of this mildly potent cannabinoid synergy.

Of course, the actual effects you’ll experience depend on how much of each cannabinoid you take and your personal THC tolerance. Delta-8, Delta-9, and THC-O all result in cross-tolerance, meaning if you have a tolerance to one, you have at least some tolerance to all three. To learn how to navigate this tolerance and dose THC-O responsibility, you may want to read “How Much THC-O Should I Take?

Can You Take THC-O With Alcohol?

It's not uncommon to hear that someone has mixed THC with alcohol, but this may not be the best idea, especially when using THC-O. This method, commonly called “crossfading,” is not generally recommended because the two substances have very different impacts on the body and cognition.

THC-O is even more potent than traditional THC, so it may be especially dangerous and unpredictable to combine it with alcohol. Generally speaking, alcohol can increase THC absorption, which could lead to extremely potent effects when using something as strong as THC-O.

One study even found that THC may slow down the rate at which alcohol is absorbed, which might temporarily prevent feelings of drunkenness, leading to an alcohol overdose in the long run. Otherwise, there's not much research concerning the combination of THC and alcohol, but it may be a combination you want to steer clear of.

Research doesn't have much to say about THC-O specifically, especially in terms of combining it with alcohol, but it's better to play it safe and choose only one recreational substance at a time.


A person holding their daily medication that they are able to take with THC-O under doctor's guidance

Tips for THC-O Dosing When You Take Prescription Medications

If you are already taking daily medications, your opportunity to try THC-O may not be squandered. Using the following tips, you may be able to safely experience THC-O without disruption your usually therapeutic regimen.

Discuss THC-O with Your Doctor

First and foremost, you should always talk to your doctor when changing your medication routine, even when adding a natural supplement like hemp-derived cannabinoids. Be sure to ask your doctor about the potential of THC drug interactions, and make sure that he or she is up to date on current THC research.

Dose Slowly

If you've gotten your doctor's approval, then you should start with using THC-O in very small doses. This is especially important if you don't have much experience with THC and aren't sure how you'll react because THC-O is incredibly potent. Some people enjoy the effects from doses between 1-5 milligrams, and microdosing THC-O is a popular concept.

Space Out Your Doses

You should definitely follow your doctor's recommendations first and foremost, but if he or she doesn't give you any specifics about when to take THC-O, we recommend spacing it out from other medication doses. Usually, a few hours is enough time for the necessary enzymes to regenerate so you’re less likely to experience any interactions.

Listen to Your Body

Even when you take small doses, you may find that THC-O is stronger than you expected. Pay attention to how you feel, how long it takes for THC-O effects to kick in, and whether or not you notice anything different that could be attributed to a drug interaction. Read more about THC-O side effects to ensure you understand the THC-related risks.

Avoid Other Substances

It may go without saying, but you'll probably want to avoid layering on other substances when you combine THC-O with your medications. Only combine THC with other substances when you have your doctor’s go ahead, and avoid combining it with other recreational substances or alcohol.

Vida Optima Elev8 THC-O vape

Looking for THC-O to Buy Online?

THC-O is federally legal when made from legal hemp material, which makes it much more accessible than Delta-9-THC products. Its one of the primary benefits of THC-O for most consumers–you can buy it online and have it shipped right to your door.

Check out our Elev8 Collection to find a selection of THC-O + Delta-8 vaporizers in a variety of formulas designed to meet any need. Our unique cannabinoid and terpene synergy is designed to elevate you to your perfect level of lift (with no risk of contaminants or shady vape ingredients).All Vida Optima products are 100% Farm Bill compliant and made according to the industry’s highest quality standards.


  1. “Get to Know an Enzyme: CYP3A4”https://www.pharmacytimes.com/view/2008-09-8687
  2. “Medicinal Cannabis—Potential Drug Interactions”https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6473892/
  3. “Exogenous cannabinoids as substrates, inhibitors, and inducers of human drug metabolizing enzymes: a systematic review”https://pubmed.ncbi.nlm.nih.gov/24160757/
  4. “Marihuana attenuates the rise in plasma ethanol levels in human subjects” https://pubmed.ncbi.nlm.nih.gov/1326277/

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