It’s no secret that CBD oil has become a household name, with many CBD products now sold online and in stores worldwide. Medical cannabis and cannabidiol CBD products are making waves among those looking for alternatives to over-the-counter medications. Does CBD interact with medications, though?
Some are considering taking CBD right along with their prescription medications.
However, is it safe to take CBD with prescription medications? Will it interact with other substances creating adverse reactions?
Let’s explore the possible interactions of cannabidiol (CBD) and other medications.
The Concerns About CBD Oil, Medicine, and Potential Health Conditions
Cannabidiol (CBD) is claimed by many to have healing properties for several health conditions affecting the body and mind. In randomized clinical trials, it has been touted as helping ease the symptoms of insomnia, multiple sclerosis, chronic pain, anxiety, depression, and so much more!
Some researchers suggest that cannabidiol reduces intestinal inflammation, but there is a concern people have about mixing CBD with medications.
And while research is ongoing with many of the studies still in their infancy, mainly because of CBD’s dose-dependent analgesic effects (or to ease the pain), many people are getting onboard the CBD train.
The one main issue that needs to be addressed is the interaction that CBD seems to possess. The main concern is regarding how certain substances are metabolized in the body.
Even though CBD is shown to be relatively safe, and the side effects are few, the potential for adverse interactions with other medications is worth noting.
Before you try CBD or take CBD with other medicines, it is best to talk to a doctor or healthcare professional who will let you know if CBD interacts with any other drugs you may be taking.
Drug Metabolism and Cytochrome P450 Enzymes
When you take any approved prescription drug, supplement, or other substance, the body needs to metabolize it by breaking it down. Drug metabolism happens everywhere in the body, especially the gut and digestive systems.
However, the liver does most of the work to metabolize things like oral cannabidiol oil or prescription medication.
As the metabolism occurs, a family of enzymes (cytochrome P420 or CYP450) does most of the work converting any unknown substance to be easily eliminated from the body. However, other drugs or medications may affect cytochrome P450 by altering the rate of metabolism.
This change in the rate may alter how the body processes medications like thyroid medication, over-the-counter medications like pain killers, cannabidiol oral capsules, and many more. This process is called “drug interactions.”
Cytochrome P450 and How CBD Interacts With Other Medications
The family of enzymes CYP450’s primary function is to help metabolize the several cannabidiol extracts of the cannabis Sativa plant. This includes CBD, THC, and many other minor cannabinoids. One specific enzyme in this family is, CYP3A4 which helps with metabolism.
However, any CBD may create an inhibitory effect during the metabolic process and interfere with CYP3A4’s function.
Nearly 60 percent of all clinically prescribed medications are processed by CYP3A4. And if there is any CBD present, the cannabidiol inhibits the breakdown of medications in this system. The flip side of this dilemma is if a person is taking any prescription medications and also attempts to take CBD, the effects of the CBD will be lessened and prevent the effectiveness of the CBD.
One thing to consider is that if your body already has a slow metabolism, you may have a build-up of medication in your system.
With that increased level of medication already present in your system, it may alter the effects of the CBD or possibly create unwanted or harmful side effects.
On the other hand, some substances may actually speed up the work that the CYP450 enzyme family has to do. Suppose you’re metabolizing a medication too quickly due to a foreign substance that is inducing the enzymes. In that case, the amount of medication in your system might not be enough to help treat your health condition.
Can CBD Interact Safely With Medications?
If you are considering taking CBD, medical marijuana (or medicinal cannabis) with one or multiple medications and wish to avoid a cannabis/drug interaction, talk to your doctor first.
Your doctor may be able to find a CBD product that is suitable to take with your medications.
They will know about any allergic reactions to ingredients, dosage, and if a cannabidiol initiation in your system will create any adverse effects on you or the effectiveness of the drugs. In certain situations, your doctor can monitor the cannabidiol exposure in your system by checking the blood plasma levels of the specific medications you are taking to see if they have been altered.
The bottom line is that you should avoid stopping any prescribed medications to switch to CBD as an alternative unless your doctor says so. This is especially important for chronic pain patients, cancer patients, or mental health concerns such as depression or anxiety disorders.
Adding CBD to your system could create a cannabidiol inhibitory effect that may be potentially dangerous.
Another option is to ask your doctor about trying CBD topical products like lotions, salves, and creams. They are vastly different than products like tinctures, capsules, gummies, and edibles that are taken orally because their effects don’t enter the bloodstream immediately.
The only exception to this rule is a transdermal solution that is intended to work quickly.
Potential Drug Interactions
One of the most critical warnings when taking CBD and any other substance is the “grapefruit warning.” Always avoid CBD if your medication or supplement has a grapefruit warning on the label.
Although more research is needed to determine potential interactions of CBD with other medications, consuming grapefruit to grapefruit juice should be avoided entirely.
According to the FDA (Food and Drug Administration), web site consuming grapefruit, grapefruit juice, or products that contain grapefruit can elevate the concentration of the medication in the bloodstream. When this happens, it can create adverse side effects, and in some cases, an overdose can occur.
Check out this chart straight from the FDA for more information:
There are more than 85 known drugs that interact with grapefruit. And some other citrus fruits must also be considered potentially dangerous, like Seville oranges, tangelos, and pomelos. The potential dangers of grapefruits are related to chemicals found in the fruit called furanocoumarins.
These chemicals inhibit CYP3A4 the same way that CBD does. The result is the slower metabolism of medications and a potentially dangerous situation for patients taking specific drugs. You can find the grapefruit warning in several types of medications.
However, not all medications within a specific category require grapefruit avoidance. Always check the information on your medication or ask your doctor.
Below are the types of medicines that will typically have a grapefruit warning:
- Antibiotics, antimicrobials
- Some anticancer medications
- (AEDs) or antiepileptic drugs
- Blood pressure or blood-thinning medications
- Cholesterol medications
- Erectile dysfunction medications
- Medications to treat GERD or nausea (GI medications)
- Heart rhythm medications
- Immunosuppressants (drugs that suppress the immune response)
- Mood modification medications (drugs to help treat anxiety disorders, depression, or mood disorders)
- Pain relief medications
- Prostate medications
Current Studies on The Interactions Between CBD and Medications
Researchers are studying the effects of the specific interactions between various medications and CBD. However, most of these studies are done on animal models to determine how CBD interacts with particular medicines.
Many scientists are still trying to figure out how those studies will translate to a human subject.
However, there has been a small controlled clinical trial involving 25 children and specific treatment-refractory epilepsy. Thirteen of the kids were given a combination of clobazam and CBD.
Researchers discovered that the clobazam levels in these children were elevated. The report notes that the combination of taking CBD and clobazam together is generally safe, but it was recommended that medication levels be monitored during the treatment.
And another study involving 42 children and 39 adults taking AEDs was also taking a form of CBD called Epidiolex, with doses increased every two weeks.
Researchers spent time monitoring the subject’s serum levels of the AED over some time.
Although serum levels remained within an accepted therapeutic range for most subjects, the two medications desmethylclobazam and clobazam produced serum levels outside of the accepted therapeutic range.
The initial studies showed that taking CBD can mess with the medication levels in your system, even though the subject is taking a prescribed dosage. The severity of a CBD interaction with various medications will require much more research to determine specific recommendations for taking CBD along prescription medications.
People who take Epidiolex to aid the symptoms of epilepsy are far more likely to develop abnormal liver enzymes, resulting in a liver injury or liver disease. They may also develop other symptoms like sleepiness if they take valproic acid to control seizures.
Other Research on the Interaction of Combining CBD with Medications
Researchers studied the acute cannabidiol administration on subjects experiencing anxiety or tremors from a simulated public speaking experience. Facilitators administered a specific dosage and monitored anxiety levels. This study shows great promise in helping reduce anxiety.
They tested cognitive and motor impairments in mice with a bile duct litigation using cannabidiol and found that it alleviates symptoms.
Results also showed that the cognitive function of the mice in specially designed maze tests and the locomotor function of the mice in an open field test was impaired by the bile duct ligation yet were improved by CBD dosage.
Safety and Side Effects Of Mixing CBD With Medications
With the careful supervision of a trained medical professional, it is possible to safely use CBD along with prescription medications, even with those that have the grapefruit warning. In such cases, a doctor may have to closely monitor your liver and the plasma serum levels of any medications you are currently taking.
If you take CBD alongside medications, it is important to closely watch for any potential changes in how the CBD and medications affect your health.
Watch out for the following side effects if there is an increase or a new medication is added:
- Drowsiness or general feelings of fatigue
- Sedation or lack of energy
- Nausea or vomiting
Watch out for breakthrough seizures if there is a decrease in medication. You can define this type of seizure as a seizure that occurs after it was previously controlled by a specific drug and/or therapy for an extended period.
Some common CBD side effects or changes to watch out for:
- Fatigue, drowsiness, or irregular sleep patterns.
- Diarrhea and digestive issues.
- Changes in appetite such as loss of appetite or increased appetite.
- Weight gain or weight loss.
People may experience toxicity from cannabidiol gummy ingestion. Although infrequent, it is a side effect that may occur. There is also a chance that some CBD products may contain ingredients that could produce an allergic reaction in the user.
We don’t use any artificial ingredients or harsh chemicals to make our products, and each product comes with a COA (Certificate Of Analysis). This means you can check information about every step of the manufacturing process. From harvesting the hemp in the field, all the way to the delivery to your doorstep.
Talk To A Healthcare Professional
When adding any new supplement to your daily routine, it is best to talk to your doctor first, especially if you are thinking about taking CBD. Never stop taking prescribed medications without being told to do so by your doctor.
Conditions like depression, multiple sclerosis, chronic pain, and more can become potentially dangerous if prescribed medications are stopped or altered.
However, even with such warnings, your doctor will know if you can take such products while being closely monitored for any medication level changes in your system. This may be one way to continue your prescription while also experiencing the benefits of CBD.
Talk to your doctor or pharmacist today for recommendations on a quality CBD product that will suit your specific needs.