A 2011 study performed on mice and published in the British Journal of Pharmacology also shows that CBD has potential nausea-reducing properties, which may help soothe side effects associated with metoprolol.
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.
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. Photo by: Gina Coleman/Weedmaps
Should I take CBD with metformin?
No research has explicitly documented interactions between Xanax and CBD. Patients taking Xanax who are interested in CBD should speak to their healthcare providers for more information.
Ibuprofen is a nonsteroidal anti-inflammatory (NSAID) medicine that reduces pain and inflammation in the body. Ibuprofen has a risk of blood-thinning and can cause dizziness, shortness of breath, and nausea.
Acetaminophen and CBD both are metabolized by CYP450, which lowers the effectiveness of both chemicals as they’re processed in the body. One controversial 2019 study, conducted by the University of Arkansas on mice and published in the journal Molecules, claimed that high doses of CBD contributed to liver toxicity, which could compound acetaminophen’s liver damage potential. However, the study’s authors have been accused of cherry-picking research and designing experiments to showcase potential CBD toxicity. The one study they cited with human test subjects did not show liver toxicity from CBD.
Xanax (generic name alprazolam) is a benzodiazepine medication used to treat panic disorders, anxiety, and depression. Common side effects of Xanax include drowsiness, lack of coordination, memory loss, and early-morning anxiety.
You may have heard of the grapefruit rule , which suggests that the citrus fruit can impair how your body absorbs certain drugs — mainly cholesterol medications, blood pressure drugs and allergy pills. That same mechanism is no different than CBD’s, Harvard Medical School reported . According to Henry, grapefruit inhibits the same set of liver enzymes that CBD blocks. So, like CBD, grapefruit juice can boost levels of other medications in your blood.
Little is known about how CBD could affect other medications a person is taking, according to Yasmin Hurd, a CBD researcher and the director of the Addiction Institute at the Icahn School of Medicine at Mount Sinai. Still, Hurd suspects the substance could very well negatively interact with most medications that are taken orally.
“Spacing out doses of medicine does help to reduce the workload on the liver,” Hurd explained. “For example, depending on the half-life of a drug, its ability to inhibit liver enzymes might be diminished after a couple of hours depending on dose, etc., thus liver enzymes could regain sufficient function by the time a second drug is consumed later on.”
Researchers suspect CBD could interact with most medications
On the flip side, very low amounts of CBD don’t seem to have that much of an effect on how well your body processes other medications. But unfortunately, there hasn’t been enough research to determine how much CBD is considered safe.
“It’s the wild, wild West right now,” said Michelle Henry , a board-certified dermatologist and Harvard-trained Mohs surgeon.
The same goes for benzodiazepines (or benzos) like Xanax or Ativan, which are used to treat anxiety. If CBD is taken in conjunction with one of these drugs, it could increase the side effects and potentially cause you to feel more sedated or drowsy. In some rare cases, the drug combo may become toxic or even interfere with your respiratory system, according to Henry. Doctors suspect that certain antibiotics and even NSAIDs (think Aleve or Advil) are altered by CBD consumption as well, Hurd said.
How intensely this all plays out in your body mainly depends on the dosage of both the medication and the CBD that you’re taking, Hurd said. “If the concentration of CBD is high enough, it could inhibit the activity of those enzymes, so you would get more of the other drug getting into your system,” she added.
Cannabidiol oil is extracted from the hemp plant, which is in the same family as marijuana. Unlike THC in marijuana, CBD does not cause a “high” or chemical dependence. CBD that is extracted from the hemp plant is legal, but individual states have laws to regulate it.
In one study , 10% of the subjects developed high liver enzymes—they had to stop using CBD for this reason. Other research suggests that CBD can improve liver function.
The FDA has approved a CBD-based drug named Epidiolex®. The drug was researched and made by Greenwich Biosciences, and the company’s vice-president of U.S. professional relations, Alice Mead, has stated to the FDA that CBD is “potentially” a liver toxin. She said this during the FDA’s first public hearing on CBD oil on May 31, 2019.
To further complicate the question, products with CBD oil may not give the exact amount listed on the package . Depending on the brand, the consumer may be using much more or less than they think. This is especially true of OTC supplements and e-cigarettes.
How much CBD is too much?