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CBD drug interactions Drug interactions may take place if CBD is taken at the same time as another course or dose of medication. CBD can affect how our bodies process other drugs, which may When you take CBD alongside certain medications, it can trigger negative drug interactions. Here we explain what drugs shouldn’t be taken with CBD — and when to consult your doctor if you’re not sure about the potential interactions. Did you know that CBD can be dangerous when combined with some psychiatric medications? Read this on HealthyPlace.

CBD drug interactions

Drug interactions may take place if CBD is taken at the same time as another course or dose of medication. CBD can affect how our bodies process other drugs, which may impact how much of the medication ends up in our system as well as alter its reaction in the body, potentially causing negative side effects.

This article explores possible CBD drug interactions based on the effect that CBD has on the cytochrome P-450, a system in the body that is responsible for processing many different drugs and medications.

Before taking a new medication or food supplement it’s highly important to consult your doctor or healthcare professional. This article does not substitute for medical advice.

CBD and beta blockers ( β-blockers)

CBD has been linked with lowering blood pressure, however can have negative interactions with beta blockers and other blood pressure medication if taken together. CBD can affect how our bodies process beta blockers and can cause undesired effects – consult your prescribing doctor.

CBD and statins

Cholesterol reducing medications like statins can be impacted by CBD. CBD can pre-occupy the body’s system for processing certain drugs, this can cause medicines to remain in one’s system for longer, resulting in a potentially dangerous accumulation – consult your prescribing doctor.

CBD is safe:

CBD is a naturally occurring extract of the cannabis plant and many people use it as a daily supplement. It is non-addictive and non-psychoactive, meaning it won’t get you high like the other cannabis extract, THC.

In November 2017 the World Health Organisation (WHO) released its assessment of CBD, where it described the substance as having a “good safety profile” and noted that there were “no public health related problems associated with the use of pure CBD”. Despite this good safety profile, CBD does impact how your body processes other drugs and medications, which, if unaccounted for, can cause your body harm.

How CBD is processed in the body

Within the body, CBD is broken down by CYP enzymes and then processed by the body’s cytochrome P-450 system, which is also responsible for processing and metabolising a number of other drugs. A side effect of CBD is that it preoccupies the cytochrome P-450 system, slowing down the processing of particular drugs.

If your body’s cytochrome P-450 system is busy metabolising CBD rather than your medication, it can cause the medicine to remain in your system for longer than it is meant to. In some cases this may result in the medication accumulating or building up in the body to potentially toxic levels.

CBD and grapefruit

Naturally occurring compounds in grapefruit also impact CYP enzymes, just as CBD does. That’s why it’s recommended to avoid grapefruits and their juice while taking certain medicines. If a warning like this exists on your current medications, it is an indication that they may also be impacted by CBD.

The myth of the “two-hour rule” for taking CBD while on other medications

A worrying trend among online CBD communities and forums is risky and careless advice being given around taking CBD with other medications. Known as the “two-hour rule”, many community members looking to help newcomers advise a two-hour gap between taking other medications and CBD, in order to “give the liver a break” and avoid drug interaction.

While given in good nature, and far better than not leaving any gap, this kind of advice is risky given the vastly different medications, conditions and situations people are in. The advice should be that anyone taking other medication should consult their doctor before supplementing CBD products. A two-hour window is not enough time to guarantee that CBD and other medicines will not interact in a negative or dangerous way in your body.

CBD and alcohol

Despite no negative interactions having been reported between CBD and alcohol, it’s still advisable to exercise caution and be wary of excessive alcohol consumption in combination with CBD use, as both substances are processed by the liver.

It’s noteworthy that CBD can actually reduce blood alcohol levels if taken with alcohol. The study ‘Interaction of cannabidiol and alcohol in humans’ found:

“The combination of alcohol plus CBD resulted in significantly lower blood alcohol levels compared to alcohol given alone”.

CBD can also be a useful tool for recovering alcoholics, as it can help alleviate some of the symptoms of alcohol withdrawals and alcohol addiction.

CBD and recreational cannabis

No negative interactions having been reported between CBD and recreational cannabis use. In fact, CBD has shown to counteract some of the negative side effects of recreational cannabis, particularly anxiety. Many use CBD bud or flowers as an alternative to cannabis when trying to quit or cut down usage.

How to use hemp buds / CBD bud

CBD-rich strains of cannabis are an exciting product of the CBD and medicinal cannabis movement. Hemp buds offer an alternative to CBD oil as a source of CBD that can be smoked, vaped or used to make edibles and ingested.

CBD drug interaction warnings

The medications and substances highlighted in the following section have the potential to have an interaction with CBD, as many are processed by the cytochrome P-450 system. This list is not exhaustive and there are many other medications that may interact with CBD.

The result of the CBD/drug interaction is different for each, potentially increasing or decreasing the effectiveness of the medication, resulting in possibly dangerous side effects if not taken into account by your medical professional. This doesn’t mean the medications cannot be taken alongside CBD, but it’s of utmost importance you notify your doctor.

CBD and epilepsy treatments:

In clinical studies CBD has reduced the severity of seizures caused by epilepsy. However, some study participants experienced negative side effects from CBD interacting with their other epilepsy medications, such as Carbamazepine (Tegretol). Possible side effects include diarrhea, vomiting, fatigue and pyrexia (increased body temperature).

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Consulting your doctor before treating epilepsy with CBD is crucial, as CBD interactions with epileptic medicines have been proven.

CBD and chemotherapy

CBD interacts with many chemotherapy drugs. CBD can increase the amount of time it takes for the body to process the chemotherapy drugs, resulting in a toxic buildup.

These are some common chemotherapy drugs which are processed by the cytochrome P-450 system and could strongly interact with CBD:

  • Etoposide (VePesid, Eposin, Etopophos)
  • Methotrexate
  • Paclitaxel (Taxol)

CBD with heart and cardiovascular medications

CBD has the potential to interact with many different heart medications, such as statins, a class of lipid-lowering medication and beta blockers ( β-blockers), which are medications that treat abnormal heart rhythms and are employed following heart attacks. Examples of heart medications that have interaction warnings include:

  • Ticagrelor (Brilinta)
  • Quinidine
  • Pitavastatin (Pravachol)
  • Talinoloa
  • Atorvastatin (Lipitor)
  • Celiprolol (Celicard)
  • Amiodarone (Cordarone)
  • Clopidogrel (Plavix)
  • Carvedilol (Coreg)
  • Nifedipine (Adalat, Procardia)
  • Valsartan (Diovan)

CBD and antidepressants

While most antidepressants do not interact with CBD, it’s still advisable to let your healthcare provider know you plan to start supplementing CBD. As always, reducing or tapering off antidepressant medication without medical supervision is not advised.

The anti-anxiety medication Buspirone, sold as BuSpar, is used to treat generalised anxiety disorder and is also often prescribed in addition to antidepressants. Buspirone is processed in the liver by cytochrome P-450 and may have a strong drug interaction with CBD, just as its warning not to consume it with grapefruit suggests.

Another antidepressant that comes with a strong interaction warning is Clomipramine (Anafranil).

CBD and blood pressure medications (calcium channel blockers)

Calcium channel blockers, blood thinners, and medications treating blood pressure and abnormal heart rhythms have a strong interaction warning with CBD. For example, CBD reduces the body’s ability to break down the prescription blood thinner warfarin, thereby amplifying its intended effect. Other examples of medications that may interact with CBD include:

  • Valsartan (Diovan)
  • Verapamil (Calan, Isoptin, Verelan)
  • Nifedipine (Adalat, Procardia)
  • Diltiazem (Cardizem)
  • Isradipine (DynaCirc)
  • Torsemide (Demadex)
  • Felodipine (Plendil)
  • Amlodipine (Norvasc)

CBD and sedative medications (benzodiazepine)

Benzodiazepines (sometimes called ‘benzos’) are used for treating: anxiety, insomnia, nausea, depression and panic attacks. CBD can slow down the body’s ability to process some benzodiazepines, namely the widely used alprazolam (Xanax) and diazepam (Valium). This may result in higher blood concentrations of the drug, causing side effects. Other common benzodiazepines which may have an interaction with CBD include:

  • Alprazolam (Xanax)
  • Triazolam (Halcion)
  • Diazepam (Valium)
  • Midazolam (Versed)
  • Pitavastatin (Pravachol
  • Quazepam (Doral)
  • Triazolam (Halcion)

CBD and antibiotics

Fluoroquinolone antibiotics in particular can interact with CBD. They are commonly used to treat a variety of illnesses, such as respiratory and urinary tract infections. Examples include:

  • Ciprofloxacin (Cipro)
  • Gemifloxacin(Factive)
  • Levofloxacin (Levaquin)
  • Moxifloxacin(Avelox)
  • Norfloxacin (Noroxin)
  • Ofloxacin (Floxin)

Other medications that have CBD interaction warnings:

  • Cholesterol treatment: Lovastatin (Mevacor)
  • Anti-fungal medications: Ketoconazole (Nizoral) & Itraconazole (Sporanox)
  • Anti-inflammatory drug: Troglitazone and Methylprednisolone
  • Anti-histamines: fexofenadine (Allegra) & Terfenadine (Seldane)
  • Viagra (Sildenafil)
  • Cholesterol and lipid-lowering medication:Simvastatin (Zocor)
  • Malaria medications: Artemether (Artenam, Paluther) & Halofantrine
CBD cream for pain

Regularly using a topical cannabidiol (CBD) cream is an effective source of targeted pain relief for many, especially for people suffering from multiple sclerosis, arthritis, or those who often have sore or inflamed muscles.

CBD Drug Interactions – Mixing Cannabidiol and Medications

Are you worried about potential CBD-drug interactions? In this article, we explain the mechanism behind drug metabolism and how CBD may interfere with it.

The range of therapeutic properties offered by CBD (cannabidiol) has spurred its popularity in recent years. This natural compound is known to relieve a host of symptoms, allowing for safer and more effective management of different health conditions.

And unlike THC (tetrahydrocannabinol), CBD is non-intoxicating, so it won’t get you high.

CBD can assist in the treatment of anxiety disorders and depression, inflammation and pain, neurodegeneration, seizure disorders, sleep deprivation, metabolic conditions, neuropathy, migraines, inflammatory bowel disease, and more.

Considering CBD has so many potential health benefits, you may start wondering if it can interact with certain medications used to address the same symptoms — and whether you should or shouldn’t take these drugs with CBD.

Below you’ll find the dos and don’ts of using CBD along with medications.

Let’s start with the don’ts.

What Drugs Should Not Be Taken with CBD

Studies from the Indiana University Department of Medicine have provided a list of pharmaceutical drugs and medications which shouldn’t be taken with CBD.

The list below covers all groups of drugs that can negatively interact with CBD oil.

  • Angiotension II Blockers
  • Antiarrhythmics
  • Antibiotics
  • Antidepressants
  • Anticonvulsants / Anti-Seizure Medications
  • Antihistamines
  • Antipsychotics
  • Anesthetics
  • Beta-Blockers
  • Benzodiazepines
  • Calcium Channel Blockers
  • HIV Antivirals
  • HMG CoA Reductase Inhibitors (Statins)
  • Immune Modulators
  • Non-Steroidal Anti-Inflammatory Drugs
  • Oral Hypoglycemic Agents
  • Proton-Pump Inhibitors (PPIs)
  • Prokinetics
  • Steroids and Corticosteroids
  • Sulfonylureas

There’s also a group of drugs called “prodrugs” that first need to be processed into their therapeutic compounds instead of being therapeutic compounds on their own. In plain English, the inactive compound is consumed, and once in the body, it turns into the active compound.

If this mechanism is dependant on the CYP450 system (more on that later), a drug interaction can lead to insufficient concentrations of the therapeutic agent in the bloodstream — reducing its potency.

CBD Interaction with Drugs & Medications

This section covers the most common interactions between CBD and medications. If you take any of the substances listed below, make sure to consult your doctor before buying CBD oil.

CBD and Ibuprofen Interaction

Ibuprofen is one of the Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), meaning it can produce similar benefits to CBD in terms of inflammation and pain relief. Previously we’ve mentioned that NSAIDs interact with CBD, which may raise concerns about potential negative interactions between CBD oil and Ibuprofen.

According to a study from the Journal of Neurology Research, there have been no reported interactions between CBD and ibuprofen, although it doesn’t mean they do not exist. Health experts suggest that potential interactions may be dosage-dependent. If a certain dosage threshold is breached, CBD and NSAIDs like Ibuprofen can lead to unforeseen and potentially severe nervous system pathology.

CBD and Adderall Interaction

A 2020 study found that higher doses of medical cannabis led to a decreased use of ADHD medication in adults. Products containing a higher concentration of CBD were linked to lower ADHD scores. This means that CBD can interact with ADHD meds, decreasing their efficacy while providing more pronounced benefits. The potential side effects of interactions between CBD and Adderall may lead to decreased appetite.

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CBD and Lamictal Interaction

Using medical cannabis and Lamictal may increase side effects such as dizziness, confusion, drowsiness, and difficulty concentrating. Elderly consumers may also experience impairment in judgment. That being said, none of these side effects were proven to result from CBD use per se. When it comes to interactions between CBD and Lamictal, it can make the medication more or less effective, depending on the dosage.

CBD Oil and Antibiotics

There is no known interaction between CBD and antibiotics, although these interactions may occur if an antibiotic is metabolized through the cytochrome P450 enzyme system. Some studies indicate that taking CBD and antibiotics together may amplify the effects of one another without any negative side effects. However, more research is needed to confirm these findings on a larger scale.

CBD Oil and Omeprazole

CBD can inhibit the enzymes that are targeted by omeprazole and other Proton Pump Inhibitors (PPIs). Taking CBD with certain heartburn medications can increase the risk of diarrhea.

CBD and Thyroid Medications

Some people report mild nausea when taking CBD oil together with their thyroid medications. Since both substances are processed by the CYP450 enzyme system, taking CBD with a thyroid medication may cause hyperthyroidism because more thyroxine would be secreted than the body could metabolize.

CBD and Lisinopril

CBD can temporarily lower blood pressure, so taking it alongside medications like Lisinopril might reduce it even more, making you feel lethargic and weak. Always consult your doctor before adding CBD to your routine if you use anti-hypertension meds.

CBD and Prednisone

Since both CBD and corticosteroids are potent inhibitors of the CYP450 enzyme system, concomitant use may increase the risk of systemic side effects from corticosteroid use due to decreased glucocorticoid clearance. Corticosteroids like prednisolone and hydrocortisone should never be taken with CBD.

How Drugs Interact: Understanding Drug Metabolism

Metabolism can refer to how your body uses energy for weight management, or the way drugs are metabolized in your body.

The former is known as the basal metabolic rate, or in simple terms, the number of calories a person needs to maintain healthy body functions while at rest.

The latter is very different from the basal metabolic rate. Drug metabolism refers to how a substance is processed and used by the body — with the majority of this processing happening in the liver.

Scientists call it the ‘first-pass effect’ or ‘first-pass metabolism.’

Using straightforward terms, when you take a medication, it is broken down in the liver into its active compounds so that the body can use them. Just like carbohydrates are broken down into sugars, fats into triglycerides, and proteins into amino acids — drugs break down into their individual ingredients.

From there, they are controlled by specific enzymes, which transform these compounds into metabolites. These metabolites then influence different processes in your body and are flushed with urine once used up.

How Is CBD Metabolized?

Drug metabolism determines the rate at which the body processes medications and other therapeutic compounds into their individual metabolites and how long they can stay in your system.

When you take CBD in the form of an oil, capsule, or gummy, it has to pass through your gut, where it is released into the bloodstream. From then, they travel through the bloodstream to the liver, where it absorbs through the hepatic portal. The liver breaks CBD down into its metabolites using enzymes, after which it can circulate throughout the body in the bloodstream again.

What Is the Cytochrome P450 System?

Aside from breaking compounds down into metabolites, the liver also detoxifies and excretes foreign substances and other types of toxic compounds. This can happen through a system of enzymes referred to as the Cytochrome P450 (CYP450). These enzymes contain heme as a cofactor to convert cannabinoids into more water-soluble molecules, increasing their absorption and efficacy.

Researchers estimate that the CYP450 system is responsible for metabolizing 60% of any drugs out there. And interestingly, doctors and pharmacists use this system to understand, evaluate, and predict the benefits of the drug and potential side effects based on their dosages.

However, certain compounds have the ability to compromise the CYP system’s functioning, negatively affecting the metabolism of certain medications. Once these interactions occur, the drugs can be metabolized faster or slower than normal.

CBD And the Cytochrome P450 System

As mentioned earlier, CBD can interact directly with the CYP450 system in the liver. According to preclinical studies, CBD binds to the site where the enzyme activity occurs, competing with other compounds and thus preventing this system from breaking down other substances.

This inhibitory effect on the CYP450 enzymes mainly depends on how much CBD a person takes, their unique physiology, and the type of CBD used (e.g., full-spectrum CBD vs. CBD isolate). The dosage determines the strength used by the CBD to bind to the active site of the metabolic enzymes. The tighter the bond, the more competitive inhibition.

Contraindications for Taking CBD with Medications

The mechanism behind CBD’s health benefits proves that it’s not a biologically inert compound. Instead, the pharmacokinetics and pharmacodynamics of CBD are complex and similar to any other medication. Therefore, it has the potential to compromise the metabolism of certain medications.

Any therapeutic substance that relies on the CYP450 system can be potentially affected by CBD. A common indicator for such interaction is when your medication has a grapefruit warning on the bottle. However, this is by no means a solid point of reference, and you should always check with your doctor and pharmacist before taking the two compounds together.

Why You Should Always Consult Your Doctor First

The list of drugs that we’ve mentioned above is by no means definite and doesn’t include all the pharmaceutical substances that may interact with CBD. Similarly, not all the medication from these categories will necessarily cause an interaction — as is the case for antibiotics and Ibuprofen.

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A consultation with a doctor experienced in CBD and cannabis use can help you establish the right routine for your medications and supplements to avoid potentially negative interactions. Some compounds work synergistically with CBD, so asking your doctor can help you maximize the effect of your treatment.

Not to mention that the doctor can guide you on finding the optimal dosage for yourself.

Key Takeaways on CBD Drug Interactions

The safety profile of CBD has been acknowledged by major health agencies, such as the World Health Organization (WHO), showing that it’s well-tolerated by animals and humans and rarely produces any dangerous side effects.

CBD also has a profound impact on an array of systems, which explains its therapeutic versatility. That being said, this versatility is also the reason why CBD interacts with so many prescription meds and over-the-counter (OTC) PRODUCTS.

Again, if you’re not sure if CBD will interact with the medication that you might be taking, a consultation with a health professional will not harm — unlike trying to figure out these interactions on your own.

Livvy Ashton

Livvy is a registered nurse (RN) and board-certified nurse midwife (CNM) in the state of New Jersey. After giving birth to her newborn daughter, Livvy stepped down from her full-time position at the Children’s Hospital of New Jersey. This gave her the opportunity to spend more time writing articles on all topics related to pregnancy and prenatal care.

CBD and Some (Psychiatric) Medications: Dangerous Together

CBD and Some (Psychiatric) Medications: Dangerous Together

Did you know that CBD can be dangerous when combined with some psychiatric medications?

Cannabidiol, or CBD, is skyrocketing in popularity. According to a poll conducted by SingleCare in 2020, 33 percent of the 2,000 respondents had tried CBD 1 . It’s touted as wellness-enhancing, and people use it for many reasons, among them reducing symptoms of anxiety, depression symptoms, and insomnia. It’s generally considered safe and effective for mental health concerns, with even a 2019 Psychology Today article encouraging people to use it for a variety of mental health challenges 2 . What many sources don’t tell you, and what the Psychology Today article only glosses over, is that CBD can be dangerous when combined with certain prescription medications, including many psychiatric medications.

How to Tell If CBD Shouldn’t Be Combined with Your Mental Health Medication

If you are taking a medication that carries the “grapefruit warning,” a statement on the bottle notifying you to avoid eating grapefruit or drinking grapefruit juice while taking the prescription, CBD is dangerous 3,4 . Both grapefruit and CBD block a group of enzymes made by the body called cytochrome P450. These enzymes are largely responsible for the body’s metabolization of medication. When grapefruit and CBD block those enzymes, medication isn’t processed correctly in the body. Depending on the drug, either too much remains in the system, leading to toxicity and increased side effects, or the medication doesn’t absorb properly, and you don’t benefit from it the way you need to. Either way, your physical and mental health can suffer. 5

This is particularly worrisome given that more people are taking prescription medications for anxiety and depression than ever before 6 . According to Harvard Medical School, a partial list of common psychiatric medications that carry the grapefruit warning and are unsuitable to take with CBD includes 7 :

  • Diazepam (Valium)
  • Triazolam (Halcion)
  • Midazolam (Versed)
  • Buspirone (BuSpar)
  • Sertraline (Zoloft)
  • Carbamazepine (Tegretol)

This is an incomplete list of psychiatric medications disrupted in the body by CBD. If you are taking any prescription medication and are also taking (or are considering taking) CBD, check your label to see if it carries the grapefruit warning. Also, check with your doctor or pharmacist for more information.

  1. SingleCare Team. (2020, April). The 2020 CBD survey. SingleCare. Retrieved from https://www.singlecare.com/blog/cbd-survey/
  2. Bongiorno, P. (2019, January). CBD oil for mental health—should you take it, too? Psychology Today. Retrieved from https://www.psychologytoday.com/us/blog/inner-source/201901/cbd-oil-mental-health-should-you-take-it-too
  3. DiSalvo, D. (2019, June). What CBD and grapefruit have in common when it comes to drug interactions: Risks you should know. Forbes. Retrieved from https://www.forbes.com/sites/daviddisalvo/2019/06/30/what-cbd-and-grapefruit-have-in-common-when-it-comes-to-drug-interactions-risks-you-should-know/?sh=40f3b71d719d
  4. Chesak, J. (2019, November). CBD and drug interactions: What you need to know. Retrieved from https://www.healthline.com/health/cbd-and-drug-interactions-what-you-need-to-know#the-basics
  5. U.S. Food and Drug Administration (FDA). (2017, July). Grapefruit juice and some drugs don’t mix. Retrieved from https://www.fda.gov/consumers/consumer-updates/grapefruit-juice-and-some-drugs-dont-mix
  6. Marsh, T. (2019, May). Depression and anxiety prescriptions are climbing nationwide. GoodRx. Retrieved from https://www.goodrx.com/blog/depression-and-anxiety-prescriptions-are-climbing-nationwide/
  7. Harvard Health Publishing. (2020, October). Grapefruit and medication: A cautionary note. Harvard Medical School. Retrieved from https://www.health.harvard.edu/staying-healthy/grapefruit-and-medication-a-cautionary-note

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