CBD is broken down by the same enzyme as 75% of medications and drugs. Here is a list of the medications that interact with CBD and if it's safe to mix. The Portland Clinic pharmacy team offers important cautions for those thinking about trying cannabidiol, more commonly known as CBD.
CBD Drug Interaction List: Is it Safe to take CBD with your Medications?
CBD is phenomenally popular right now. It’s being used to treat pain, anxiety, epilepsy, psychosis, and even neurodegenerative diseases like Alzheimer’s and Parkinson’s. It’s been called a “wonder drug,” without irony, and it has essentially no known downsides. It is readily available and easy to take.
At the same time, it’s important to be aware that CBD can interact with some medications. Taking it at the same time as other drugs can affect CBD’s dosage and effects, and can even change how your body breaks it down.
This article is your guide to safely taking CBD alongside your other medications and supplements. First, it has a quick overview of how CBD interacts with other drugs in your body, and then it lists the most common drugs that interact with CBD, and which you should be careful about taking at the same time. If you want to skip ahead, you can find the list here.
The CYP450 Pathway
Once a drug enters your system, its molecules are circulated through your blood and interact with your cells and tissues, doing whatever it is they’re supposed to do. Painkillers reduce pain signals and can stop swelling, antidepressants interact with brain cells to change your brain chemistry, and so on.
Once they’ve done their work, your body needs to get rid of the drug molecules. Too much of any drug in your bloodstream is toxic, and can start to harm your body.
Your body uses all kinds of systems to get rid of drugs, and the most important of these are enzymes–chemicals that break down other chemicals. The largest set of enzymes are the cytochrome p-450 group (or CYP450), which are responsible for breaking down about 75% of the medications and recreational drugs that we take.
CBD and the CYP450 Pathway
CBD interacts with the CYP450 system in three ways. First, some of the enzymes in the system are responsible for breaking down CBD molecules, as they are for molecules of other drugs. That’s normal–nothing to worry about there.
Second, CBD can affect how CYP450 enzymes are produced by your liver, making it produce not enough of some enzymes or too much of others. This can stop your liver from processing some drugs, like the epilepsy medications clobazam and valproic acid.
Third, and most importantly, CBD can actually stop many of the CYP system’s enzymes from working properly. This is called “inhibition,” and it can cause problems if it prevents the enzymes from breaking down other drugs. Sometimes, the enzymes are responsible for activating other drugs instead, but the same problem comes up–if CBD stops the enzyme from working, then it doesn’t do its normal job, and the other drug won’t behave normally, which can have negative consequences.
For instance, there’s a group of antidepressants called selective-serotonin reuptake inhibitors, which include drugs like citalopram, norfluoxetine, and sertraline. Normally, an enzyme called CYP3A4 breaks down molecules of those drugs, making sure they don’t build up to unsafe levels that can damage cells or tissues. CBD inhibits CYP3A4, though, which means that taking CBD and sertraline at the same time could be dangerous. CYP3A4 wouldn’t break the sertraline down, and it would accumulate for far too long.
It’s worth noting that CBD isn’t the only thing that does this. The herbs St. John’s Wort and goldenseal can also stop CYP450 enzymes from working properly, as can grapefruit and starfruit juice, and even tobacco.
Drugs that Interact with CBD List
That brings us to our list. Remember, the general rule is that you need to be careful taking CBD at the same time as any drug or medication that gets processed by CYP450 enzymes. If you’re thinking about doing so, be sure to check with your doctor first.
Here are the most common of those drugs and medications. They include many painkillers, anti-inflammatories, antipsychotics, antidepressants, anticonvulsants, statins, opioids, and other groups.
Does CBD Gummies Interact With Medications
If you’ve been thinking about trying cannabidiol — more commonly known as CBD — welcome to the rapidly growing club. Interest in CBD as a treatment for pain, insomnia, anxiety and other complaints has been rising steadily ever since Oregon and other states legalized cannabis (marijuana).
CBD is one of many natural chemical compounds found in cannabis, but unlike the plant’s other well-known chemical, THC, it has no psychoactive or mind-altering effects. Instead, CBD owes its popularity to its therapeutic effects. Before you try it, however, be aware that it carries potential risks, as well — especially if you take other medications or have liver problems.
To date, the only FDA-approved use of CBD is a prescription medication called Epidiolex, which treats seizure disorders. Other over-the-counter uses, while widely promoted, need further study to support their claims. These include the following:
With its naturally sedating effects, CBD is used by many people as a sleep aid.
Anxiety and depression
CBD has shown promising results for many people with these issues.
Pain and inflammation
Some patients with arthritis and cancer find CBD helpful in reducing these symptoms.
Much remains unknown about how CBD works, its therapeutic benefits and its safety. For your own safety, it’s important to be aware of the known risks. They include the following:
CBD liver harm
CBD can be harmful to the liver. People with liver impairment should be cautious or avoid it.
CBD medication interactions
Because of its effect on the liver and liver enzymes, CBD can interfere with many medications, either increasing their levels in the blood to potentially toxic levels, or decreasing levels and reducing their effectiveness. Certain seizure medications, antidepressants, muscle relaxers, and drugs that can suppress the central nervous system (such as benzodiazepines, sleeping pills and opioids), among many other medications, may have strong interactions.
It’s important to talk to your doctor or pharmacist before using CBD to make sure you’re not taking a medication that will interact badly with it.
CBD drowsiness and other side effects
Because CBD causes drowsiness on its own, it also increases the drowsiness caused by other medications, including antihistamines (such as Benadryl), benzodiazepines (Xanax, Ativan, Valium), antipsychotics, antidepressants and opioids, as well as alcohol and supplements such as kava, melatonin and St. John’s Wort.
CBD’s sedating effects are similar to alcohol, so it’s not a good idea to use it if you need to drive or to do anything that requires mental alertness. Other common side effects of CBD include diarrhea and changes in appetite and mood.
CBD safety and regulation
Over-the-counter CBD products are not regulated by the FDA. Although most are extensively tested, there is still a possibility of error (such as the mix-up reported last September in The Oregonian), so be wary that products might not be 100% CBD as labeled.
Considering CBD? Talk to your doctor or pharmacist first
If you have questions about how your medications will interact with CBD, reach out to your doctor or local pharmacist for help. Pharmacists are great resources and can help come up with alternative therapies if CBD is not a good option for you.