CBD Oil and Drug Interactions
It’s good to be aware of potential drug interactions before purchasing CBD Oil
More and more people are using CBD Oil made from cannabis, as it can help with various health issues, often without significant side effects. Many who consider buying cannabis oil also take medications, so it’s important to understand how CBD interacts with other drugs. CBD can interact with medications such as antiepileptics, antidepressants, blood thinners, painkillers, and other commonly used drugs.
The American Institute of Medical Science and Biotechnology has compiled a comprehensive list of medications that may interact with CBD. This blog post is based on that list and the institute’s published articles.
Why does CBD affect medication intake?
The reason for interactions between CBD and certain medications lies in the CYP450 enzymes found in the liver, which are responsible for breaking down both CBD and many drugs. About 60% of medications on the market are metabolized by these liver enzymes, so there’s a good chance that prescribed drugs might affect CBD’s action, or vice versa.
But how exactly does this work?
Imagine our liver as a "medicine-processing factory," where enzymes act as workers breaking down various substances so the body can use them.
When someone takes CBD, these enzymes become occupied breaking down the CBD, leaving less capacity for other medications. This means drugs break down more slowly and can stay longer and act stronger in the body! It’s important to note that this is not a problem for all medications, but for some—such as blood thinners, antiepileptics, or certain anti-anxiety drugs—it can have serious consequences.
However, it doesn’t always mean CBD’s effect is stronger. Sometimes the active ingredient of a given drug occupies the enzymes, which can weaken CBD’s effect.
CBD’s effect on psychoactive medications
Psychoactive drugs are substances that affect brain function, influencing mood, perception, thinking, or behavior. These are used to treat various mental health conditions. Psychoactive drugs are categorized based on their effects on the nervous system.
Interactions between CBD and antiepileptics or antidepressants are of particular interest because they can be used together.
The most common groups of psychoactive drugs
1. Antidepressants
These are mainly prescribed for treating depression but are also used for anxiety disorders, post-traumatic stress disorder (PTSD), and other mental conditions.
- Examples: SSRIs (selective serotonin reuptake inhibitors, e.g., fluoxetine, sertraline), SNRIs (serotonin-norepinephrine reuptake inhibitors, e.g., venlafaxine), tricyclic antidepressants.
2. Anxiolytics and sedatives
These medications treat anxiety and help to relax tension but can also be used as sleeping aids.
- Examples: Benzodiazepines (diazepam, alprazolam), barbiturates, buspirone.
3. Antipsychotics
Primarily used for treating schizophrenia and bipolar disorder. They reduce psychotic symptoms, hallucinations, and delusions.
- Examples: Haloperidol, risperidone, quetiapine, olanzapine.
4. Stimulants
This group includes drugs that increase nervous system activity, often prescribed for attention deficit hyperactivity disorder (ADHD).
- Examples: Amphetamines (Adderall), methylphenidate (Ritalin)
5. Opioids
Primarily used for pain relief but can also have psychoactive effects.
- Examples: Morphine, oxycodone, fentanyl.
6. Mood stabilizers
Most commonly used for bipolar disorder to balance manic and depressive phases.
- Examples: Lithium, valproate, lamotrigine.
CBD and psychoactive drugs: interactions by active ingredient
Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8298645/
| Drug Active Ingredient |
Use | Type of Interaction |
Clinical Recommendations When Used Together with CBD |
|---|---|---|---|
| Carbamazepine | Epilepsy | Reduces cannabidiol levels or effects by influencing liver/gut CYP3A4 enzyme metabolism | Consider increasing the cannabidiol dose (based on tolerance) if used together! |
| Lamotrigine | Epilepsy | CBD increases lamotrigine levels or effects by inhibiting UGT2B7 activity. | Consider reducing CBD dose when using UGT2B7 substrates like morphine, losartan, diclofenac, tamoxifen, and ibuprofen! * Or reduce drug dosage with medical approval. |
| Oxcarbazepine | Epilepsy, bipolar disorder | Lowers CBD levels or effects by influencing liver/gut CYP3A4 enzyme metabolism. | Consider increasing CBD dose (based on clinical response and tolerance)! |
| Phenobarbital | Epilepsy | Reduces CBD levels or effects by influencing liver/gut CYP3A4 or CYP2C19 metabolism. CBD subtly enhances phenobarbital’s anticonvulsant effect. |
Consider increasing CBD dose (based on clinical response and tolerance)! Consider reducing sensitive CYP2C19 substrate doses, if clinically appropriate, when used together with CBD! |
| Phenytoin | Epilepsy, trigeminal neuralgia |
Reduces CBD levels or effects by influencing liver/gut CYP3A4/CYP2C19 metabolism. CBD may enhance phenytoin’s anticonvulsant effect. |
Consider increasing CBD dose based on clinical response and tolerance! Consider reducing sensitive CYP2C19 substrate doses if clinically appropriate when used with CBD! |
| Chlordiazepoxide Clonazepam Ethosuximide |
Benzodiazepine | CBD decreases the anticonvulsant effect of these drugs | Consider reducing CBD dose or, with doctor’s approval, reduce drug dose. |
| Clobazam or Diazepam |
Benzodiazepine | CBD increases clobazam or diazepam levels or effects by affecting liver enzyme CYP2C19 metabolism. CBD raises clobazam plasma concentration. | Consider reducing CBD dose or, with medical supervision, reduce drug dose. |
| Lorazepam | Benzodiazepine | CBD increases lorazepam levels or effect by reducing metabolism and potentially inhibiting UGT2B7 activity. | Consider reducing CBD dose or, with doctor's approval, reduce drug dose. |
| Morphine | Opioid | CBD increases morphine levels or effects. | Consider reducing CBD dose or, with medical approval, reduce drug dose. |
| Desipramine | Antidepressant | Desipramine increases CBD levels or effects by influencing liver/gut CYP3A4 metabolism. | Consider reducing CBD dose or, with medical approval, reduce drug dose. |
| Imipramine | Antidepressant | CBD raises imipramine levels or effects by affecting liver enzyme CYP2C19 metabolism | Consider reducing CBD dose or, with doctor’s approval, reduce drug dose. |
| Trimipramine | Antidepressant | CBD increases trimipramine levels or effects by affecting liver enzyme CYP2C19 metabolism. | Consider reducing CBD dose or, with doctor’s approval, reduce drug dose. |
CBD’s effect on other medications
Blood thinners and CBD
If someone is taking blood thinners, it’s important to know that CBD can affect these medications. It can slow down their breakdown, meaning the blood thinners may remain active longer in the body, increasing the risk of bleeding.
Which blood thinners should not be combined with CBD?
-
Coumarin-type blood thinners: This includes warfarin (e.g., Marevan). Warfarin's breakdown heavily depends on CYP450 enzymes, and CBD can disrupt this process. If warfarin breaks down more slowly, its blood-thinning effect may become excessive, posing a serious bleeding risk. Therefore, combining CBD and warfarin is not recommended without strict medical supervision.
-
Dabigatran (Pradaxa): Although dabigatran is not metabolized via the CYP450 pathway, CBD may still affect it, so their combination also carries an increased bleeding risk.
Which blood thinners can be used with CBD?
Among newer blood thinners, some depend less on the CYP450 enzyme system, reducing the risk that CBD affects their action. These drugs are sometimes called DOACs (direct oral anticoagulants).
1. Rivaroxaban (Xarelto): While rivaroxaban is partly metabolized by CYP450, the interaction with CBD is lower, so it can be used together under medical supervision.
2. Apixaban (Eliquis): This blood thinner has fewer interactions with CBD but it’s important to consult a doctor when taking it with CBD.
3. Heparin derivatives:
Heparin derivatives (e.g., heparin and low molecular weight heparins like dalteparin or enoxaparin) work differently from coumarin-based blood thinners like warfarin. Heparins directly inhibit clotting factors and are not metabolized via the CYP450 enzyme system, meaning CBD shows fewer interactions with these medications.
Is it safe to use CBD with heparin derivatives?
Since heparins are not broken down by the CYP450 enzyme system, the likelihood that CBD affects their action is lower. Therefore, in theory, it is safer to use CBD with heparin derivatives than with warfarin, for example.
What should you keep in mind?
Although interactions between heparin derivatives and CBD are less likely, CBD may still have blood-thinning effects that could potentially increase bleeding risk. Therefore, if someone is using heparin or low molecular weight heparin and wants to take CBD, it’s advisable to consult a doctor.
Painkillers and CBD
CBD is becoming increasingly popular among those seeking alternatives for pain relief with fewer side effects. Often at the start of using CBD Oil, it is used alongside medication, which raises the question: Can CBD be used with painkillers, and what effects should be expected?
How does CBD’s pain-relieving effect work?
CBD naturally influences our body’s endocannabinoid system, which plays a role in regulating pain perception and inflammation. CBD does not directly “numb” pain like traditional analgesics but can help reduce pain sensation and inflammation.
Which painkillers can be used with CBD?
1. Nonsteroidal anti-inflammatory drugs (NSAIDs):
Examples include ibuprofen, aspirin, and naproxen. These drugs are commonly used for mild pain such as headaches, muscle pain, or joint pain. CBD can generally be used safely with these because there’s no significant interaction in their metabolism. However, since both CBD and NSAIDs may have mild blood-thinning effects, it’s important to consider the risk of excessive bleeding
2. Paracetamol (acetaminophen):
One of the most common painkillers used for mild pain and fever reduction. There are no known serious interactions between paracetamol and CBD, so they are generally safe to use together. However, it’s important to adhere to proper dosing because excessive paracetamol can cause liver damage, and since both paracetamol and CBD are metabolized in the liver, combined use can significantly burden the liver!
3. Opioids:
Opioids such as morphine, oxycodone, and fentanyl are stronger analgesics used for severe pain, for example post-surgery or chronic conditions. While CBD can be used alongside these drugs, both have sedative effects, which can enhance each other, increasing drowsiness and fatigue. Using these combinations without medical supervision is not recommended, due to the risk of overdose!
Which painkillers are not recommended for use with CBD?
1. Painkillers that heavily strain the liver:
Drugs that significantly burden the liver (e.g., high-dose paracetamol or certain opioids) are not advised to be used together with CBD, as they are metabolized in the liver, greatly increasing the load on the liver and the risk of liver damage.
What to keep in mind when using painkillers and CBD?
- Dosing: It’s important to monitor proper dosing of both medications and CBD, as CBD can modify drug effects.
- Medical consultation: If regularly taking painkillers and wanting to use CBD, always consult a doctor to avoid possible interactions.
- Watch for side effects: Be alert for unusual side effects such as dizziness, drowsiness, excessive fatigue, or stomach issues.
Summary:
- CBD can be used with painkillers such as ibuprofen, paracetamol, and, under medical supervision, even opioids.
- It’s not recommended to combine CBD with painkillers that heavily burden the liver.
If you take painkillers, consult your doctor before purchasing CBD to avoid unwanted interactions.
Blood pressure medications and CBD
CBD Oil is increasingly used to relieve pain, anxiety, and other health issues. However, if someone takes blood pressure medications, it’s important to understand how CBD affects these drugs and under what conditions they can be used together.
How does CBD affect blood pressure?
CBD has a mild blood pressure-lowering effect because it helps relax blood vessels and reduces stress, which can lead to lower blood pressure. This can be beneficial for high blood pressure, but if someone is already on blood pressure medication, the combined effect could cause excessive lowering of blood pressure, leading to dizziness or even fainting.
Which blood pressure medications can CBD Oil be used with?
Different blood pressure medications affect the body in various ways. Generally, CBD can be used with most of these drugs, but always cautiously and under medical supervision.
1. ACE inhibitors and ARBs (angiotensin receptor blockers)
- These drugs help relax blood vessels, lowering blood pressure. Examples include ACE inhibitors like enalapril, ramipril, and ARBs like losartan, valsartan.
- CBD can theoretically be used together, but it might slightly enhance the blood pressure-lowering effect, so regular blood pressure monitoring is important.
2. Beta-blockers
- Examples include metoprolol and bisoprolol. They slow heart rate and reduce blood pressure.
- Using them with CBD carries a risk of blood pressure dropping too low, causing dizziness or drowsiness. Medical supervision makes this combination safer but requires frequent monitoring.
3. Calcium channel blockers
- Drugs like amlodipine relax blood vessels and lower blood pressure.
- Using them with CBD may increase their effectiveness, potentially leading to excessive blood pressure reduction. Regular monitoring and medical oversight are necessary.
4. Diuretics (water pills)
- Examples include furosemide and hydrochlorothiazide. They help the body eliminate excess fluid, lowering blood pressure.
- Generally safe to use with CBD, but since diuretics affect electrolyte levels, close attention to combined effects is important.
Under what conditions can CBD Oil be used with blood pressure medications?
-
Start with a low dose: If taking blood pressure medication and CBD, always begin with a small CBD dose to minimize the risk of blood pressure dropping too low.
-
Regular blood pressure monitoring: Because CBD can lower blood pressure, regularly check to ensure it’s not dropping too much.
-
Medical consultation: Always consult a doctor before starting CBD. They can monitor for interactions and adjust dosages if needed.
-
Watch for side effects: If you experience dizziness, drowsiness, weakness, or fainting-like symptoms when combining CBD Oil with blood pressure meds, notify your doctor immediately.
Which blood pressure medications are not recommended with CBD?
There are no specific blood pressure medications strictly forbidden to combine with CBD, but all the groups mentioned require caution. The key is preventing excessive blood pressure drops that can cause dizziness, fainting, or other complications. Keep in mind that CBD alone may also lower blood pressure.
Summary:
- CBD can be used with blood pressure medications such as ACE inhibitors, beta-blockers, calcium channel blockers, and diuretics, but with caution.
- Starting with a low dose, regular blood pressure monitoring, and medical consultation are essential for safety.
- Seek immediate medical attention if any unusual symptoms occur.
Medical oversight is key to safely using CBD with blood pressure medications.
Immunosuppressants and CBD
Immunosuppressants are drugs that weaken or suppress the immune system’s function. They are used to treat various medical conditions in which the immune system is overactive or causes harmful reactions. For example, they are prescribed when the immune system attacks the body's own cells or to prevent rejection of transplanted organs.
Autoimmune diseases: These are conditions where the immune system mistakenly attacks the body’s own cells and tissues. Examples include rheumatoid arthritis, systemic lupus erythematosus (SLE), and Crohn’s disease. Immunosuppressants help reduce the immune system’s attacking effect in these diseases.
Chronic inflammatory diseases: Some inflammatory conditions, such as severe asthma or inflammatory bowel diseases (IBD), can also be treated with immunosuppressants to reduce chronic inflammation caused by the immune system.
How do immunosuppressants work?
Immunosuppressants act on the immune system in various ways:
Some block the proliferation and activity of immune cells.
Others inhibit certain immune system proteins important for inflammatory and attacking responses.
Examples of immunosuppressant drugs:
Corticosteroids: Drugs like prednisone rapidly reduce inflammation and are widely used for autoimmune diseases.
Ciclosporin: Often used after organ transplantation to prevent organ rejection.
Azathioprine: Also used for transplant patients and autoimmune diseases.
Methotrexate: Used for rheumatoid arthritis and other autoimmune diseases.
Tacrolimus: Commonly used to prevent rejection after kidney and liver transplants.
How does CBD affect immunosuppressants?
CBD can alter the metabolism of immunosuppressants, leading to increased blood levels and heightened risk of toxic side effects. Therefore, it is not recommended to use CBD together with immunosuppressants!
Summary
Purchasing CBD Oil is becoming increasingly popular, so it’s important to understand potential drug interactions. The overview above, based on current evidence and knowledge, provides insight into possible interactions between CBD and commonly used drug groups. CBD Oil use should follow the “start low and go slow” approach, with careful patient monitoring. Certain drug ingredients make CBD use inadvisable or only with thorough caution. Further clinical studies are needed to enhance safe and optimal use. There are few case reports or clinical studies on CBD’s interactions with other drugs, so future research must address the mechanisms of these interactions.
Always consult your doctor before using CBD, especially if you take medication!
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