Patients taking metoprolol or other beta-blockers should consult their doctor as to whether to consume CBD.
Cannabis is a complex plant, with hundreds of chemicals and over 100 distinct cannabinoids. The little research that examines cannabidiol or CBD, the second most common cannabinoid found in cannabis, shows evidence of potential health benefits for a wide range of conditions. As CBD becomes more mainstream, however, a key question comes to mind, “How will CBD interact with my current medication?”
Patients taking statins should speak to their healthcare provider before using CBD.
Should I take CBD with metformin?
CBD’s documented effects on liver function and enzymes that metabolize several medications are relevant when considering whether or not to consume CBD with certain drugs. CBD acts on the same metabolites as grapefruit — therefore, many of the prescription drugs that carry grapefruit warning labels may have similar risks when taken with CBD.
Patients taking generic warfarin or Coumadin should consult their healthcare provider for individualized information and get blood tests before beginning a CBD regimen.
In 2017, researchers at the University of Alabama, Birmingham, conducted a study published in Epilepsy & Behavior Case Reports which showed that CBD increases the effects of drugs used for blood-thinning by slowing down how the body metabolizes warfarin and prolonging its presence in the system. By increasing the duration of warfarin’s presence in the body, CBD could potentially exacerbate some of the associated risks.
Grapefruit disrupts the activity of CYPs and slows the way these proteins usually break down medication. The fruit also increases the side effects and duration the drug stays in the system. One 2013 study titled “Grapefruit Medication Interactions: Forbidden Fruit or Avoidable Consequences?” published in the Canadian Medical Association Journal showed that grapefruit can increase blood content levels when interacting with at least 85 different drugs. The reported consequences were severe, including irregular heartbeat, organ failure, internal bleeding, and death.
Once you have decided on your preferred delivery format, look for top-rated CBD oil products that are sustainably sourced, organically grown, and third-party lab tested to ensure quality and purity. Taking these steps is the best way to ensure that your CBD oil product is free from any harmful pesticides, herbicides, and added chemicals.
You will want to be conscientious of dosage especially since CBD oil may amplify the effects of the medications you’re taking. CBD products generally come with an information leaflet that provides a recommended dosage, but you may want to start with an amount lower than what is recommended and gradually increase your dosage over time as needed. This will allow your body to build a tolerance to CBD oil and reduce the risk of having a sudden drop in your blood pressure.
While the majority of people new to CBD oil opt for capsules and edibles because of their convenience and familiarity, it is worth keeping in mind that these will enter your body through the digestive system and therefore lose some potency and take longer before you feel the effects. Inhalants or sublingual drops meanwhile, allow the CBD oil to enter the bloodstream more readily, providing quick and effective results. Experiment with the different delivery methods to decide which works best for your needs and lifestyle.
How to Safely Use CBD Oil and Blood Pressure Medication Together
Furthermore, because cannabidiol is an inhibitor of the cytochrome P-450 enzyme system , CBD oil should be used cautiously when combined with medications that use this pathway; in the case of high blood pressure medications, metoprolol and amlodipine besylate specifically.
CBD oil’s anti-anxiety and stress-relieving properties encourage a lower heart rate, which ultimately reduces blood pressure. CBD oil’s ability to dilate blood vessels allows for easier blood flow in arteries with plaque build-up, which also reduces the symptoms of hypertension. In fact, a 2017 study found that a single dose of cannabidiol significantly lowered the blood pressure of test subjects both when at rest and in stressful conditions.
The cytochrome P-450 system is comprised of liver enzymes that break down medications into smaller substances that the body can more easily process. Cannabidiol and other natural substances like grapefruit slow down this pathway. This may cause medications that rely on the P-450 system, including metoprolol and amlodipine besylate, to remain for longer periods in the system and increase the likelihood that you experience their adverse side effects.
CBD oil is generally recognized as a safe and well-tolerated compound with little to no known side effects. However, while conclusive studies have not been published, it has been suggested that CBD oil may affect the efficacy of blood pressure medication in controlling hypertension. Conversely, blood pressure medication is also believed to potentially reduce the efficacy of CBD oil.
“There is no role right now for CBD in managing mental disorders that I [treat], such as depression, bipolar disorder … anxiety and ADHD,” he says. “We just don’t have the evidence that supports [it].”
And shoppers are buying it, so to speak—one recent report indicated that CBD sales are expected to hit $16 billion by 2026, up from just over $1 billion in 2018. But what exactly is CBD, and is it safe for people who are using prescription medications? Before using it, it’s important to learn about the potential CBD drug interactions.
Are the concentrations in commercially available CBD high enough to cause this interaction? The evidence doesn’t really say one way or another. Dr. Alloway’s research involved a high dosage of CBD that wouldn’t be found in a retail product. However, it “highlights that a drug interaction is there,” she says. Plus, tacrolimus is metabolized in the body by a group of enzymes called cytochrome P450 and CBD is a known inhibitor of this process. What does that mean? If CBD inhibits the metabolism of tacrolimus, the patient can end up with too-high levels of tacrolimus in the body. In light of this, she urges anyone taking tacrolimus to speak with their transplant team before using CBD. Don’t get your hopes up, though—using herbal remedies, particularly those with potential interactions, is generally frowned upon by doctors looking after transplant recipients (including Dr. Alloway).
Does CBD interact with medications?
Case in point: tacrolimus , an immunosuppressive medication used to prevent organ rejection in patients who have had heart, liver, or kidney transplants. CBD interferes with the metabolism of tacrolimus, according to research conducted by Dr. Alloway , who specializes in post-transplant immunosuppression. And because tacrolimus is a narrow therapeutic index drug (meaning the window between efficacy and toxicity is very small), this interference can lead to clinically significant negative outcomes (such as kidney problems or organ rejection), she says.
CBD is thought to act on certain receptors in your brain and other parts of the body, in ways that could relieve pain, or help certain health conditions, like childhood seizure disorders. However, as with any “natural” product, the fact that it comes from plants doesn’t automatically render it innocuous. For some people, particularly those taking certain prescription medications, using CBD is risky. It has anticoagulant effects that can thin blood; it can also modestly lower blood pressure. These effects could be dangerous for people with certain medical conditions.
As for other drugs, well, most haven’t been studied yet. There is preliminary evidence that CBD could have a similar effect to grapefruit juice, impairing how your body metabolizes drugs, and raising serum levels of those medications in your body. And, because cytochrome P450 is responsible for the metabolism of numerous medications , proceed with caution before mixing any prescription pharmaceutical with CBD, Dr. Alloway says.
Dr. McIntrye, who co-authored a 2018 study that concluded that healthcare providers need more information about drug-drug interactions with CBD and psychotropic medication, says much of the information out there is confusing and contradictory. Therefore, he echoes Dr. Alloway’s statement that it is absolutely prudent that patients clear the use of CBD with their doctor before giving it a go.