CBD Oil and Drug Interactions
It’s good to be aware of possible drug interactions before buying CBD Oil!
CBD Oils made from cannabis are increasingly used because they may help treat various health issues without notable side effects. Many who consider purchasing cannabis oil also take medications, so it's important to examine how CBD interacts with other drugs. CBD can interact with, for example, epilepsy medications, 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 CBD interacts with certain drugs is because enzymes in the liver called CYP450 are responsible for breaking down both CBD and these medications. About 60% of drugs on the market are metabolized by these liver enzymes, so there’s a good chance that either your prescribed medication could affect how CBD works, or CBD could alter the effects of your medication.
But how exactly does this work?
Imagine your liver as a "medication processing plant," where the enzymes are the workers breaking down various substances so your body can utilize them.
When someone takes CBD, these enzymes are busy metabolizing CBD, so they have less capacity to process other medications. This means those drugs break down more slowly and stay active in the body longer, potentially intensifying their effects! It’s important to know this isn’t an issue with every drug, but for some—like blood thinners, epilepsy medications, or certain anti-anxiety drugs—it can have serious consequences.
However, CBD doesn't always make drugs "stronger." Sometimes, the active ingredient in a medication occupies these enzymes, which can weaken the effects of CBD.
CBD’s effects on psychoactive drugs
Psychoactive drugs influence brain function, impacting mood, perception, thinking, or behavior. They are commonly used to treat various mental health conditions. Psychoactive drugs are categorized based on their specific effects on the nervous system.
The interaction of CBD with antiepileptics and antidepressants is a highly discussed topic since combined use is a possibility.
The most common psychoactive drug groups
1. Antidepressants
These medications are mainly prescribed for depression but are also used to treat anxiety disorders, post-traumatic stress disorder (PTSD), and other mental health conditions.
- Examples: SSRIs (selective serotonin reuptake inhibitors, e.g., fluoxetine, sertraline), SNRIs (serotonin-norepinephrine reuptake inhibitors, e.g., venlafaxine), tricyclic antidepressants.
2. Anti-anxiety and sedatives
These medications are used to treat anxiety and tension and can also serve as sleep aids.
- Examples: Benzodiazepines (diazepam, alprazolam), barbiturates, buspirone.
3. Antipsychotics
Primarily used to treat schizophrenia and bipolar disorder, these reduce psychotic symptoms like hallucinations and delusions.
- Examples: Haloperidol, risperidone, quetiapine, olanzapine.
4. Stimulants
This group includes substances that increase nervous system activity and are commonly used to treat attention deficit hyperactivity disorder (ADHD).
- Examples: Amphetamines (Adderall), methylphenidate (Ritalin)
5. Opioids
Primarily used for pain relief, these substances may also have psychoactive effects.
- Examples: Morphine, oxycodone, fentanyl.
6. Mood stabilizers
Mainly used to treat bipolar disorder by balancing manic and depressive phases.
- Examples: Lithium, valproate, lamotrigine.
CBD and psychoactive drug 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 with CBD |
|---|---|---|---|
| Carbamazepine | Epilepsy | Reduces cannabidiol levels or effects by affecting liver/gut CYP3A4 enzyme metabolism. | Consider increasing the cannabidiol dose (based on tolerability) if used together! |
| Lamotrigine | Epilepsy | CBD increases lamotrigine levels or effects by inhibiting UGT2B7 enzyme activity. | Consider reducing CBD dose when used with UGT2B7 substrates (e.g., morphine, losartan, diclofenac, tamoxifen, ibuprofen)!* Or reduce medication dose with doctor’s permission. |
| Oxcarbazepine | Epilepsy, Bipolar Disorder | Reduces CBD levels or effects by affecting liver/gut CYP3A4 enzyme metabolism. | Consider increasing CBD dose (based on clinical response and tolerability)! |
| Phenobarbital | Epilepsy | Reduces CBD levels/effects by influencing liver/gut CYP3A4 or CYP2C19 metabolism. CBD subtly enhances phenobarbital’s anticonvulsant effects. |
Consider increasing CBD dose (based on clinical response and tolerability)! Also consider reducing doses of sensitive CYP2C19 substrates when clinically appropriate, if used with CBD. |
| Phenytoin | Epilepsy, facial nerve neuralgia |
Reduces CBD levels/effects by influencing liver/gut CYP3A4/CYP2C19 metabolism. CBD may enhance phenytoin’s anticonvulsant effects. |
Consider increasing CBD dose based on clinical response and tolerability! Consider reducing doses of sensitive CYP2C19 substrates clinically appropriately if used with CBD. |
| Chlordiazepoxide Clonazepam Ethosuximide |
Benzodiazepine | CBD reduces the anticonvulsant effects of these medications. | Consider reducing CBD dose or, with doctor’s permission, reduce medication dose. |
| Clobazam or Diazepam |
Benzodiazepine | CBD increases clobazam or diazepam levels or effects by affecting liver CYP2C19 metabolism. CBD increases clobazam plasma concentration. | Consider reducing CBD dose or, with doctor’s permission, reduce medication dose. |
| Lorazepam | Benzodiazepine | CBD increases lorazepam levels or effects by reducing metabolism and potentially inhibiting UGT2B7 activity. | Consider reducing CBD dose or, with doctor’s permission, reduce medication dose. |
| Morphine | Opioid | CBD increases morphine levels or effects. | Consider reducing CBD dose or, with doctor’s permission, reduce medication dose. |
| Desipramine | Antidepressant | Desipramine increases CBD levels or effects by affecting liver/gut CYP3A4 metabolism. | Consider reducing CBD dose or, with doctor’s permission, reduce medication dose. |
| Imipramine | Antidepressant | CBD increases imipramine levels or effects by affecting liver CYP2C19 metabolism. | Consider reducing CBD dose or, with doctor’s permission, reduce medication dose. |
| Trimipramine | Antidepressant | CBD increases trimipramine levels or effects by affecting liver CYP2C19 metabolism. | Consider reducing CBD dose or, with doctor’s permission, reduce medication dose. |
CBD’s effects on other medications
Blood thinners and CBD
If you are taking blood thinners, it’s important to know that CBD can affect these medications. It can slow down the breakdown of blood thinners, which means they stay active longer in the body, increasing the risk of bleeding.
Which blood thinners should you avoid combining with CBD?
-
Coumarin-type blood thinners: This includes warfarin (e.g., Marevan). Warfarin’s breakdown is closely linked to CYP450 enzymes, and CBD can disrupt this process. If warfarin breaks down more slowly, its blood-thinning effect can become excessive, posing a serious bleeding risk. Therefore, combining CBD with warfarin is not recommended without strict medical supervision.
-
Dabigatran (Pradaxa): Although dabigatran isn’t metabolized by the CYP450 system, CBD can still affect it, so this combination also carries an increased risk of bleeding.
Which blood thinners can be used with CBD?
Among newer blood thinners, some rely less on the CYP450 enzyme system, thus the risk of interaction with CBD is lower. These drugs are sometimes called DOACs (direct oral anticoagulants).
1. Rivaroxaban (Xarelto): Although rivaroxaban is partly metabolized by CYP450, it is less affected by CBD, and with controlled use and medical supervision, it can be combined.
2. Apixaban (Eliquis): This blood thinner also shows fewer interactions with CBD, but consulting a doctor is essential if taking both.
3. Heparin derivatives:
Heparin derivatives (such as heparin and low molecular weight heparins like dalteparin or enoxaparin) work differently than coumarin-based blood thinners like warfarin. Heparins directly block coagulation factors and are not metabolized by the liver’s CYP450 enzyme system, which means CBD shows fewer interactions with these drugs.
Can CBD be used with heparin derivatives?
Since heparins aren’t metabolized by the CYP450 system, there's a lower chance that CBD will affect their action. Therefore, theoretically, CBD use with heparin derivatives is safer compared to warfarin.
What should you consider?
Although the interaction between heparin derivatives and CBD is unlikely, CBD can still have blood-thinning effects, potentially increasing bleeding risk. Therefore, if you’re taking heparin or low molecular weight heparin and want to use CBD as well, it’s wise to seek medical advice.
Painkillers and CBD
CBD is becoming popular among those seeking alternative pain relief options with fewer side effects. Often, CBD is initially taken alongside painkillers, raising an important question: Can CBD be used with painkillers, and what effects can be expected?
How does CBD relieve pain?
CBD naturally influences our body’s endocannabinoid system, which plays a role in regulating pain perception and inflammation among other functions. CBD doesn’t directly “numb” pain like traditional painkillers, but it can help reduce pain sensation and inflammation.
Which painkillers can safely be used with CBD?
1. Non-steroidal anti-inflammatory drugs (NSAIDs):
Examples include ibuprofen, aspirin, and naproxen. These are often used for mild pains, such as headaches, muscle pain, or joint pain. CBD is generally safe to use with these because there’s no significant interaction affecting their metabolism. However, since both CBD and NSAIDs can have mild blood-thinning effects, it’s important to consider the risk of excessive bleeding
.
2. Paracetamol (acetaminophen):
One of the most commonly used painkillers for mild pain and fever reduction. There are no known serious interactions between paracetamol and CBD, making their combination generally safe. However, proper dosage is crucial because excessive paracetamol can cause liver damage, and since CBD is also metabolized by the liver, using both together can significantly stress the liver!
3. Opioids:
Opioids such as morphine, oxycodone, and fentanyl are stronger painkillers used for severe pain, post-surgery, or chronic conditions. While CBD can be used alongside these, both have sedative effects, which can amplify each other, potentially increasing sleepiness and fatigue. Combining these without medical supervision is not recommended due to overdose risks!
Which painkillers should you avoid using with CBD?
1. Painkillers with heavy liver burden:
Drugs that significantly strain the liver (e.g., high-dose paracetamol or some opioids) are not recommended to be used with CBD, since both are metabolized by the liver, increasing the risk of liver damage.
What to watch for if you use painkillers and CBD?
- Dosage: Pay attention to correct dosing of both medications and CBD because CBD can alter the effects of drugs.
- Medical consultation: If you regularly take painkillers and want to use CBD, always consult your doctor to avoid possible interactions.
- Watch for side effects: Be alert for unusual symptoms such as dizziness, drowsiness, excessive fatigue, or stomach issues.
Summary:
- You can use CBD with painkillers like ibuprofen, paracetamol, and, under medical supervision, even opioids.
- Avoid combining CBD with painkillers that heavily tax the liver.
If you take painkillers, consult your doctor before buying CBD Oil to avoid unwanted interactions.
Blood pressure medications and CBD
More people use CBD Oil to relieve pain, anxiety, and other health issues. However, if you take blood pressure medication, it’s important to understand how CBD affects these drugs and under what conditions they can be safely combined.
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 hypertension, but if you already take blood pressure meds, combining CBD and medication can cause excessively low blood pressure, which may cause dizziness or fainting.
Which blood pressure medications can be safely used with CBD Oil?
Different blood pressure drugs act differently on the body. In most cases, CBD can be used alongside them, but always carefully and under medical supervision.
1. ACE inhibitors and ARBs (angiotensin receptor blockers)
- These drugs help relax blood vessels and lower blood pressure. Examples of ACE inhibitors: enalapril, ramipril. Examples of ARBs: losartan, valsartan.
- CBD can theoretically be combined with these, though it may slightly increase their blood pressure-lowering effect, so regular blood pressure monitoring is important.
2. Beta blockers
- Medications like metoprolol and bisoprolol slow heart rate and reduce blood pressure.
- When used with CBD, there is a risk of blood pressure dropping too low, causing dizziness or drowsiness. Under medical supervision, they can be safely used together but require frequent blood pressure checks.
3. Calcium channel blockers
- Drugs like amlodipine relax blood vessels to lower blood pressure.
- They may become more effective with CBD, raising the risk of excessive blood pressure drop. Regular monitoring and medical supervision are essential.
4. Diuretics (water pills)
- Medications like furosemide and hydrochlorothiazide help the body eliminate excess fluid, reducing blood pressure.
- Generally safe with CBD, but because diuretics affect blood electrolyte levels, it's important to monitor their combined effects closely.
What precautions should be taken when using CBD Oil with blood pressure medications?
-
Start low: If taking blood pressure medication and starting CBD, always begin with a low dose of CBD to minimize risk of excessive blood pressure lowering.
-
Regular blood pressure monitoring: Since CBD may lower blood pressure, frequent measurement is necessary to ensure it doesn't drop too much.
-
Consult a doctor: Always consult your physician before starting CBD. They can monitor drug interactions and adjust medication doses if needed.
-
Watch for side effects: If you experience dizziness, drowsiness, weakness, or near-fainting when combining CBD Oil and blood pressure meds, inform your doctor immediately.
Which blood pressure medications should be avoided with CBD?
There is no specific blood pressure medication that is strictly forbidden to combine with CBD, but all the groups mentioned require caution. The key is avoiding too much blood pressure lowering, which can lead to dizziness, fainting, or other complications. Keep in mind that CBD itself may have blood pressure-lowering effects.
Summary:
- You can use CBD with blood pressure meds such as ACE inhibitors, beta blockers, calcium channel blockers, and diuretics, but with caution.
- Start with a low dose, monitor blood pressure regularly, and consult your doctor to ensure safety.
- If any unusual symptoms occur, seek medical attention promptly.
Medical supervision is essential to ensure safe combined use of CBD and 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 where the immune system overreacts or causes harmful effects. For example, these drugs are used when the immune system attacks its own cells or to prevent a transplanted organ from being rejected.
Autoimmune diseases: These occur when the immune system mistakenly attacks the body’s own cells and tissues. Diseases like rheumatoid arthritis, systemic lupus erythematosus (SLE), and Crohn’s disease fall into this category. Immunosuppressants help reduce the immune system’s attacking effects in these diseases.
Chronic inflammatory diseases: Certain inflammatory diseases like 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 target the immune system in various ways:
Some block the proliferation and activity of immune cells.
Others interfere with functions of specific immune proteins critical for inflammatory and attacking responses.
Examples of immunosuppressant drugs:
Corticosteroids: Such as prednisone, which reduce inflammation quickly and are widely used in autoimmune diseases.
Ciclosporin: Often used after organ transplants to prevent rejection.
Azathioprine: Used in transplant patients and autoimmune diseases.
Methotrexate: Treats rheumatoid arthritis and other autoimmune conditions.
Tacrolimus: Commonly used after kidney and liver transplants to prevent organ rejection.
How does CBD affect immunosuppressants?
CBD can influence the metabolism of immunosuppressants, potentially raising their blood levels and increasing the risk of toxic side effects. Therefore, using CBD together with immunosuppressants is not recommended!
Summary
CBD Oil purchasing is becoming increasingly popular, so it’s important to understand its possible drug interactions. The overview above, based on current evidence and knowledge, sheds light on possible interactions between CBD and commonly used drug groups. The use of CBD Oil should follow a “start low and go slow” approach, with careful patient monitoring. Certain active ingredients should not be combined with CBD or only with thorough caution. Further clinical studies are needed to improve safe and optimal use. There are few case reports or clinical studies about CBD’s interactions with other drugs, so future research must explore these interaction mechanisms more deeply.
Always consult your doctor before using CBD, especially if you’re on medication!
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