There’s reason to believe that, as safe as CBD has been shown when used alone, it may have the potential to negatively react with other medications to create some unintended side effects. The Portland Clinic pharmacy team offers important cautions for those thinking about trying cannabidiol, more commonly known as CBD. CBD is broken down by the same enzyme as 75% of medications and drugs. Here is a list of the medications that interact with CBD and if it's safe to mix.
What Kind of Drug Interactions Can Happen with CBD?
Many consumers are increasingly turning to CBD products as a natural alternative to everything from chronic pain relief to the treatment of ADHD, anxiety, and more. While CBD, one of the many compounds inherent to the cannabis sativa plant, may offer a nice alternative to current treatments, including prescription drugs, it’s important to be smart about how CBD could potentially interact with any other medications you’re taking.
7 Common CBD Oil Drug Interactions
- Antidepressants, such as Fluoxetine or Prozac
- Any drug that causes drowsiness, including antipsychotics and benzodiazepines
- Macrolide antibiotics like Erythromycin and Clarithromycin
- Seizure Medications Like Clobazam, Lamotrigine and Vaproate
CBD has many exciting possibilities when it comes to therapeutic treatment, but it’s important to remember that the research around is in the very early stages. Because researchers haven’t fully explored CBD’s mechanism of action (yet), it can be sometimes be hard to predict whether it will have interactions with other medications, both over-the-counter and prescriptions. What behaves as a safe and natural remedy for one patient could have unintended negative interactions with another patient, depending on the other compounds in the patient’s system.
While we’ll outline some of the most common CBD oil drug interactions, it’s always important to visit with your doctor or consult with a pharmacist if you have any concerns about potential negative side effects.
Does CBD Interact with Medications?
There’s reason to believe that, as safe as CBD has been shown when used alone, it may have the potential to negatively react with other medications to create some unintended side effects.
CBD may at times react with over-the-counter medications, herbal products, and some prescription medications, which underscores the necessity of talking with a doctor or pharmacist before trying CBD products if you’re regularly taking a drug for a heart condition, pain or another medical condition. Some medications should never be taken with CBD, while others can be modified or reduced in order to decrease the chance of a negative CBD drug interaction. And while CBD information for medical professionals is in early phases, your doctor is still the best equipped to provide sound advice about how to safely use CBD for your particular medical condition.
According to Nina M. Bemben, PharmD, BCPS —a specialist in drug interactions—CBD, along with many other medications and compounds, are broken down for the body’s use by the liver enzyme family known as Cytochrome p450. Because CBD acts as an inhibitor to certain CYP enzymes, it could cause other medications in the body to be broken down more slowly—which, unless your doctor lowers your dosage, could lead to increased side effects. On the other hand, CBD can induce other CYP enzymes, which may lead to a faster drug metabolism, resulting in reduced efficacy unless the dosage is increased.
While much research is needed on exactly how CBD behaves within our bodies and how it interacts with various other medications, here’s a good general rule to remember: if you take a drug with a label that features a grapefruit juice warning, it’s a good idea to steer clear of any CBD product while you take that drug. Why? According to the U.S. Food and Drug Administration , a medication with this warning, taken together with grapefruit or grapefruit juice, can manifest at a higher than intended concentration within the blood, potentially causing adverse events.
What does this have to do with CBD? A class of chemicals present in grapefruit juice, known as furanocoumarins, inhibit the enzyme CYP3A4—in much the same way CBD does, resulting in a slower metabolization of medications. So, if you’re taking a medication that features a grapefruit warning, there’s a good chance CBD may cause a few issues with that drug as well. More than 85 different drugs react negatively with grapefruit, including many of the following—you’ll notice a distinct overlap between this list and the list of drugs that commonly have a CBD drug interaction:
- Antibiotics and antimicrobials
- Anticancer medications
- Antiepileptic drugs
- Blood pressure medications
- Blood thinners
- Cholesterol medications
- Erectile dysfunction medications
- GI medications, such as those used to treat nausea and GERD
- Heart rhythm medications
- Mental health medications, such as to treat anxiety, depression, or mood disorders
- Pain management medications
- Prostate medications
The good news? Based on what we know about how CBD is metabolized, there doesn’t seem to be much concern over potential reactions to nonsteroidal anti-inflammatory drugs and/or other prescription medications used to treat the symptoms of arthritis. More good news: there are no reports of any life-threatening interactions that over-the-counter CBD products have had with any herbal, OTC, or prescription drug. Commonly reported side effects have included drowsiness, nausea, diarrhea, dry mouth, a decrease in medication efficacy and changes in appetite or weight.
With the help of your doctor, it’s possible to add CBD to your therapeutic regimen, even if you’re taking another prescription medication that could interact negatively with CBD. It may just be a question of adjusting dosage, monitoring liver function and/or carefully watching for side effects.
We also want to stress that you should never forego your current medication to try CBD without talking with your doctor first. Some medications will need the dosage slowly tapered down in order to safely discontinue use, while others may require careful monitoring.
7 Common CBD Oil Drug Interactions
Let’s take a closer look at common medications CBD oil may negatively interact with:
1. Antidepressants, such as Fluoxetine or Prozac
Some common medications prescribed for depression, such as Fluoxetine and Prozac, when combined with CBD, may increase drowsiness or dizziness. This can be dangerous for patients who are older or who otherwise experience mobility issues, as it may increase the chances for a dangerous or even life-threatening fall.
2. Any drug that causes drowsiness, including antipsychotics and benzodiazepines
Any drug that causes drowsiness, which is a surprisingly large collection, has the potential to combine with CBD for an intensified effect. Anyone who is taking these types of medications combined with CBD is at an increased risk for impaired judgment, falls, and other dangerous situations that result from excessive drowsiness.
3. Warfarin and Clopidogrel
Warfarin is a fairly common drug prescribed as a blood thinner. The most reliable information we have about CBD’s potential interaction with Warfarin comes from studies of the only FDA-approved CBD product, Epidiolex, which is a prescription treatment for rare forms of epilepsy. Epidiolex has been shown to increase blood levels of Warfarin by approximately 30 percent. With this increase comes a higher risk of excessive bleeding. Clopidogrel also interacts with CBD.
4. Macrolide antibiotics like Erythromycin and Clarithromycin
These types of antibiotics are widely prescribed for the treatment of bacterial infections. Because CBD has the ability to slow down or speed up the metabolism of antibiotics by our CPY450 enzymes, taking antibiotics in conjunction with CBD may mean you end up with a higher dose of drugs in your system than is either safe or effective.
Amiodarone is often prescribed to address irregular heart rhythm. CBD metabolism often is slowed down when taken in combination with Amiodarone, resulting in elevated levels of both medications in your system if they’re used together. In addition, both CBD and amiodarone can cause an elevation in liver enzymes, and the effect is exacerbated when the two are taken together.
Levothyroxine is a commonly prescribed thyroid medication. In fact, it is likely the most popular drug prescribed for thyroid issues. When CBD and levothyroxine are taken together, they are forced to compete within the CPY450 enzyme pathways for effective drug metabolism. This kind of drug interaction could cause thyroxine to accumulate, which could result in hyperthyroidism. In addition, when thyroid medications and CBD products are taken too closely together, some patients may experience short-term anxiety and mild nausea.
Seizure medications, like Clobazam, Lamotrigine and Vaproate
Clobazam, Lamotrigine, and Vaproate often are prescribed for patients experiencing seizures, either due to epilepsy or other health conditions. In some cases, CBD has increased the Clobazam levels of children treated with both Clobazam and CBD for epilepsy.
Does CBD Consumption Method Matter?
The manner in which you consume CBD absolutely has an effect on its potential to negatively react with other medications you take. Inhaling CBD, for example, deposits the compound almost immediately into your bloodstream, which allows it to reach peak concentration within 30 minutes. This delivery method avoids the liver’s metabolism, but may still increase the chances that CBD will negatively react with other medications already in your system.
Edible CBD vehicles, like soft chews, CBD gummies, etc., take longer to absorb and reach peak concentration, but they also have the potential to reach a highly concentrated enough level that negative interactions are possible. The same is true for a CBD oil or emulsion tincture .
CBD topicals, such as balms, creams, CBD lotion, etc., are the least likely to react negatively with other medications in your bloodstream because absorption through the skin decreases the amount of CBD that may eventually make its way into your bloodstream.
Other factors that influence both the occurrence and severity of a CBD interaction with other pharmaceutical drugs may include the age of the patient, the dosage amount of both CBD, and the interacting drug, plus any existing underlying medical conditions. Older patients may be at higher risk of potential negative drug interaction for a couple of reasons: first, as we age, the time our bodies take to process compounds like CBD and other medications increases, and second, older patients are more likely to take multiple medications on a regular basis.
Your doctor can help you figure out what type of CBD and dosage may be right for you, considering your medical profile and any medications you already take on a regular basis.
Create a CBD Treatment Plan with Your Medical Team Today!
CBD shows great promise in being able to offer patients relief from a wide variety of medical conditions, but it’s still in the early stages of research. If you want to try CBD, but are already taking a medication to treat your condition, make sure to confer with your doctor before adding CBD to your treatment plan or before using CBD to replace any of your current medications.
Your doctor can help you develop a plan that will let you enjoy the highest therapeutic effect of CBD with the fewest possible side effects. And when you’re ready to purchase high quality, responsible CBD products, our team at Farmer & Chemist is here to help—we have a broad variety of CBD oils, creams, gummies, and more. Our team of pharmacists and pharmacy technicians are also available to answer any questions you may have about the appropriate use of CBD, as well as any potential drug interaction you need to speak to your doctor about.
Does CBD Gummies Interact With Medications
If you’ve been thinking about trying cannabidiol — more commonly known as CBD — welcome to the rapidly growing club. Interest in CBD as a treatment for pain, insomnia, anxiety and other complaints has been rising steadily ever since Oregon and other states legalized cannabis (marijuana).
CBD is one of many natural chemical compounds found in cannabis, but unlike the plant’s other well-known chemical, THC, it has no psychoactive or mind-altering effects. Instead, CBD owes its popularity to its therapeutic effects. Before you try it, however, be aware that it carries potential risks, as well — especially if you take other medications or have liver problems.
To date, the only FDA-approved use of CBD is a prescription medication called Epidiolex, which treats seizure disorders. Other over-the-counter uses, while widely promoted, need further study to support their claims. These include the following:
With its naturally sedating effects, CBD is used by many people as a sleep aid.
Anxiety and depression
CBD has shown promising results for many people with these issues.
Pain and inflammation
Some patients with arthritis and cancer find CBD helpful in reducing these symptoms.
Much remains unknown about how CBD works, its therapeutic benefits and its safety. For your own safety, it’s important to be aware of the known risks. They include the following:
CBD liver harm
CBD can be harmful to the liver. People with liver impairment should be cautious or avoid it.
CBD medication interactions
Because of its effect on the liver and liver enzymes, CBD can interfere with many medications, either increasing their levels in the blood to potentially toxic levels, or decreasing levels and reducing their effectiveness. Certain seizure medications, antidepressants, muscle relaxers, and drugs that can suppress the central nervous system (such as benzodiazepines, sleeping pills and opioids), among many other medications, may have strong interactions.
It’s important to talk to your doctor or pharmacist before using CBD to make sure you’re not taking a medication that will interact badly with it.
CBD drowsiness and other side effects
Because CBD causes drowsiness on its own, it also increases the drowsiness caused by other medications, including antihistamines (such as Benadryl), benzodiazepines (Xanax, Ativan, Valium), antipsychotics, antidepressants and opioids, as well as alcohol and supplements such as kava, melatonin and St. John’s Wort.
CBD’s sedating effects are similar to alcohol, so it’s not a good idea to use it if you need to drive or to do anything that requires mental alertness. Other common side effects of CBD include diarrhea and changes in appetite and mood.
CBD safety and regulation
Over-the-counter CBD products are not regulated by the FDA. Although most are extensively tested, there is still a possibility of error (such as the mix-up reported last September in The Oregonian), so be wary that products might not be 100% CBD as labeled.
Considering CBD? Talk to your doctor or pharmacist first
If you have questions about how your medications will interact with CBD, reach out to your doctor or local pharmacist for help. Pharmacists are great resources and can help come up with alternative therapies if CBD is not a good option for you.
CBD Drug Interaction List: Is it Safe to take CBD with your Medications?
CBD is phenomenally popular right now. It’s being used to treat pain, anxiety, epilepsy, psychosis, and even neurodegenerative diseases like Alzheimer’s and Parkinson’s. It’s been called a “wonder drug,” without irony, and it has essentially no known downsides. It is readily available and easy to take.
At the same time, it’s important to be aware that CBD can interact with some medications. Taking it at the same time as other drugs can affect CBD’s dosage and effects, and can even change how your body breaks it down.
This article is your guide to safely taking CBD alongside your other medications and supplements. First, it has a quick overview of how CBD interacts with other drugs in your body, and then it lists the most common drugs that interact with CBD, and which you should be careful about taking at the same time. If you want to skip ahead, you can find the list here.
The CYP450 Pathway
Once a drug enters your system, its molecules are circulated through your blood and interact with your cells and tissues, doing whatever it is they’re supposed to do. Painkillers reduce pain signals and can stop swelling, antidepressants interact with brain cells to change your brain chemistry, and so on.
Once they’ve done their work, your body needs to get rid of the drug molecules. Too much of any drug in your bloodstream is toxic, and can start to harm your body.
Your body uses all kinds of systems to get rid of drugs, and the most important of these are enzymes–chemicals that break down other chemicals. The largest set of enzymes are the cytochrome p-450 group (or CYP450), which are responsible for breaking down about 75% of the medications and recreational drugs that we take.
CBD and the CYP450 Pathway
CBD interacts with the CYP450 system in three ways. First, some of the enzymes in the system are responsible for breaking down CBD molecules, as they are for molecules of other drugs. That’s normal–nothing to worry about there.
Second, CBD can affect how CYP450 enzymes are produced by your liver, making it produce not enough of some enzymes or too much of others. This can stop your liver from processing some drugs, like the epilepsy medications clobazam and valproic acid.
Third, and most importantly, CBD can actually stop many of the CYP system’s enzymes from working properly. This is called “inhibition,” and it can cause problems if it prevents the enzymes from breaking down other drugs. Sometimes, the enzymes are responsible for activating other drugs instead, but the same problem comes up–if CBD stops the enzyme from working, then it doesn’t do its normal job, and the other drug won’t behave normally, which can have negative consequences.
For instance, there’s a group of antidepressants called selective-serotonin reuptake inhibitors, which include drugs like citalopram, norfluoxetine, and sertraline. Normally, an enzyme called CYP3A4 breaks down molecules of those drugs, making sure they don’t build up to unsafe levels that can damage cells or tissues. CBD inhibits CYP3A4, though, which means that taking CBD and sertraline at the same time could be dangerous. CYP3A4 wouldn’t break the sertraline down, and it would accumulate for far too long.
It’s worth noting that CBD isn’t the only thing that does this. The herbs St. John’s Wort and goldenseal can also stop CYP450 enzymes from working properly, as can grapefruit and starfruit juice, and even tobacco.
Drugs that Interact with CBD List
That brings us to our list. Remember, the general rule is that you need to be careful taking CBD at the same time as any drug or medication that gets processed by CYP450 enzymes. If you’re thinking about doing so, be sure to check with your doctor first.
Here are the most common of those drugs and medications. They include many painkillers, anti-inflammatories, antipsychotics, antidepressants, anticonvulsants, statins, opioids, and other groups.