If you take prescription drugs or over-the-counter medications, it’s vital you understand how taking CBD may impact you.

Ongoing research is examining CBD’s influence on the metabolism of various medications to better understand its potential effects and implications for drug effectiveness and side effects.

Research into CBD’s potential benefits and its interactions with medications is ongoing, highlighting the importance of understanding its full range of effects.

Keep reading to learn how CBD interacts with various medications (including prescription drugs, over-the-counter meds, and herbal and dietary supplements) and what this means for you.

What You’ll Discover

• Studies suggest CBD interacts with enzymes that metabolize drugs, potentially altering drug concentrations, which underscores the need for careful monitoring of potential side effects.
• There are specific drugs that are particularly impacted by taking CBD that should be closely monitored when used together, including certain anti-epileptic drugs, blood thinners, antidepressants, and opioids.
• Given CBD’s interactions, it’s prudent for older adults, those on multiple medications, and users of OTC medications to consult a healthcare provider before incorporating CBD.

CBD and the Cytochrome P450 Enzyme System

There’s been a lot of research in recent years that supports CBD’s therapeutic potential. Experts, however, are still learning how the compound works on a cellular level within the body.

The cytochrome P450 enzyme system is crucial for medication metabolism. Research aims to understand how CBD’s interaction with this system may influence medication processing. The effects of CBD on different medications is caused by the complex relationship it has with several CYP enzymes. (1)

For one, taking CBD can inhibit medication levels in the body. This means that it could alter the drug concentration of certain medications, increasing the risk of adverse reactions and potential side effects.

There’s an investigation into whether CBD might decrease the bioavailability of certain medications, potentially affecting how much drug the body can absorb and its implications.

If you’re taking any medications, especially if they affect CYP450 enzymes, it’s recommended to talk to your healthcare provider before using CBD.

Common CBD Interactions with Prescription Medications

CBD affects certain prescription drugs more than others.

Understanding the drug-drug interactions between CBD and specific meds is important. Following is a list of a few types of commonly prescribed drugs shown to interact with CBD.

Individuals taking any of the following prescription medications should be aware of potential interactions with CBD.

Antiepileptic Drugs

There is growing interest in researching the interaction between CBD and blood thinners, particularly regarding any potential impact on bleeding risk. These include:

• Carbamazepine
• Oxcarbazepine
• Phenobarbital
• Phenytoin
• Valproic acid

The way CBD interacts with these medications may increase sedation, particularly in users with elevated N-desmethylclobazam levels. It could also reduce the effects of CBD, elevate liver enzymes, and increase the risk of toxicity from some AEDs. (2)

Individuals considering combining AEDs with CBD should undergo close monitoring for any liver-related issues and might need dosage adjustments to mitigate potential side effects.

Antidepressants

CBD drug interactions should also be noted for individuals taking antidepressants.

Research indicates that CBD may influence the CYP2D6 enzyme, potentially affecting the metabolism of certain antidepressants. It may also potentially elevate drug levels in the body. (3)

Ultimately, this can alter the effects of antidepressants and increase the risk of side effects. Taking CBD alongside antidepressants has been studied for potential interactions, including effects on sleep and digestion. Individuals should consult a healthcare professional before combining CBD with prescribed medications.

Blood Thinners

The interaction of CBD with blood thinners is an area of ongoing research, particularly regarding its potential effect on bleeding risk. Studies are examining how CBD may interact with the CYP450 enzyme system, which plays a role in metabolizing certain blood thinners. (4)

Some blood thinners rely on CYP450 enzymes for metabolism, and CBD has been studied for its potential to inhibit these enzymes, which may influence drug levels in the body and their duration of action. (5)

However, not all blood thinners are processed by CYP450 enzymes, which may reduce the likelihood of interaction with CBD. These include Dabigatram, Edoxaban, and Heparin.

It is always recommended to consult with your healthcare provider before using any CBD product, especially if you are taking blood thinners.

Opioid Analgesics

Opioid analgesics are drugs that act on opioid receptors to reduce pain. The relationship between CBD and opioids involves complex interactions with the central nervous system’s opioid receptors, necessitating further study. (6)

Researchers are examining whether CBD may influence the metabolism of morphine, which could impact how the body processes it. Some studies are also investigating the potential interactions between CBD and opioids, though findings remain inconclusive.(7, 8)

That said, it’s important to keep in mind that more research is needed to determine the effect of CBD on opioid analgesics.

CBD and Over-the-Counter Medications

It’s not just prescription meds associated with potential CBD drug interactions. It can also interact with over-the-counter (OTC) medications.

The combination of ibuprofen and CBD is under investigation for potential risks, including an increased chance of stomach ulcers and bleeding. Especially when both are taken in high doses for an extended length of time. (9)

Keep in mind, however, that research that specifically addresses the risks of combining CBD and ibuprofen is limited. If you take ibuprofen, talk to your healthcare provider before you start taking CBD.

Something else to consider is that CBD products should be avoided if medications, such as ibuprofen, come with a grapefruit warning. CBD affects certain enzymes that slow down the metabolism of these medications.

CBD and Alcohol: Risks and Precautions

If you enjoy the occasional cocktail or two, it’s important to understand the potential implications of drinking alcohol while taking CBD.

The concurrent use of CBD and substances that impact the central nervous system (CNS) is being studied, with a focus on understanding any increased risk of liver damage. While the amount and frequency of alcohol use plays a large role, mixing CBD and alcohol should be avoided. (1)

CBD and alcohol are both commonly used in social and relaxation settings. Some studies suggest that combining them may influence alertness and coordination, potentially leading to drowsiness or changes in perception. It is recommended to use caution when consuming them together, especially before engaging in activities requiring full attention, such as driving.

While research on CBD and alcohol is limited, it’s not recommended to combine the two, especially in high doses. If you do decide to drink while taking CBD, consider limiting your consumption of both. This might mean having just 1-2 drinks and decreasing your typical CBD serving size.

Increased Risk of Experiencing Interactions in Older Adults and People Taking Multiple Medications

Some people have a higher risk of experiencing CBD interactions with other drugs. Both older adults and individuals who take multiple medications are particularly vulnerable.

Older adults may have a heightened risk of experiencing interactions between CBD and other drugs, prompting ongoing research into these potential interactions. Especially those experiencing age-related changes who are taking multiple meds. Drug elimination is less rapid in older adults, leading to an increased risk of CBD drug interactions. (10)

Reduced hepatic function might also increase the adverse effects of CBD, especially increased drowsiness and sedation. Ultimately, this can increase the risk of injury or experiencing adverse reactions.

Individuals who take multiple medications, despite their age, should also keep CBD’s interactions with other drugs in mind.

Do Topical CBD Products Reduce Drug Interaction Risks?

Topical CBD products, such as lotions, creams, salves, and balms, tend to pose less of a risk than other products, as they don’t make their way into the bloodstream. (11)

This means that using CBD topicals has a lower chance of interacting with the CYP enzyme system and causing adverse effects. However, CBD topicals could cause local skin reactions or react with other medications applied to the same area.

Your healthcare provider might suggest a CBD cream or other CBD topicals if you’re at risk of drug interactions or take multiple medications. More research is needed to fully understand the potential reaction of CBD topicals with other medications.

How to Safely Use CBD When Taking Other Medications

Although CBD can indeed interact with a range of other substances, some steps can be taken to guarantee its safe usage. Before starting to use CBD with other medications, it is important to consult with a healthcare provider to ensure safety.

Why It’s So Important to Talk To a Healthcare Professional about Using CBD

You’ve probably noticed talking to a healthcare provider is mentioned quite a bit in this article. This is because using CBD can modify the way certain prescription drugs work. Ultimately, this could result in some serious health issues.

Always talk to your doctor or a healthcare professional before trying CBD to avoid unnecessary drug interactions. Older adults and individuals with preexisting health conditions are particularly at risk.

Your doc may be able to recommend quality CBD products that can meet your unique needs. If you’re taking other meds, they can also monitor for potential interactions.

The importance of doctors being informed about the potential therapeutic effects of CBD and possible drug interactions is crucial.

Always inform any prescribing healthcare professionals about your CBD usage to ensure you receive comprehensive care and avoid possible drug interactions.

Summary

Taking CBD can completely alter the effects of some substances, including certain prescription medications, OTC meds, and herbal and dietary supplements.

Older adults and people who take multiple medications are particularly susceptible to negative drug interaction when taking CBD with other substances. If you fall into either of these categories, it’s important to use caution before taking CBD.

It’s advisable to consult your healthcare provider before incorporating CBD with other medications to ensure safety and efficacy.

Frequently Asked Questions

Is CBD safe with blood pressure meds?

The safety of CBD used with blood pressure meds is something to consider, as CBD could affect blood pressure levels and interact with hypertension medications. Consult with your doctor first before trying CBD if you’re on blood pressure medications.

How does it affect cholesterol meds?

CBD can interfere with cholesterol meds by potentially raising their levels in the body, which can increase the risk of side effects. Consult with your doctor first before trying CBD if you’re on blood pressure medications.

Can CBD and alcohol be taken together?

Taking CBD and alcohol isn’t recommended because it may lead to potential liver injury.

References

1. Balachandran, P., ElSohly, M. A., & Hill, K. P. (2021). Cannabidiol Interactions with Medications, Illicit Substances, and Alcohol: a Comprehensive Review. Journal of General Internal Medicine, 36(7), 2074–2084. https://doi.org/10.1007/s11606-020-06504-8

2. Gaston, T. E., Bebin, E. M., Cutter, G. R., Liu, Y., Szaflarski, J. P., & Uab Cbd Program. (2017). Interactions between cannabidiol and commonly used antiepileptic drugs. Epilepsia, 58(9), 1586-1592. https://doi.org/10.1111/epi.13852

3. Yamaori, S., Okamoto, Y., Yamamoto, I., & Watanabe, K. (2011). Cannabidiol, a major phytocannabinoid, as a potent atypical inhibitor for CYP2D6. Drug Metabolism and Disposition, 39(11), 2049-2056. https://doi.org/10.1124/dmd.111.041384

4. Jiang, R., Yamaori, S., Okamoto, Y., Yamamoto, I., & Watanabe, K. (2013). Cannabidiol is a potent inhibitor of the catalytic activity of cytochrome P450 2C19. Drug metabolism and pharmacokinetics, 28(4), 332-338. https://doi.org/10.2133/dmpk.DMPK-12-RG-129

5. Greger, J., Bates, V., Mechtler, L., & Gengo, F. (2020). A review of cannabis and interactions with anticoagulant and antiplatelet agents. The Journal of Clinical Pharmacology, 60(4), 432-438. https://doi.org/10.1002/jcph.1557

6. Cichewicz, D. L. (2004). Synergistic interactions between cannabinoid and opioid analgesics. Life Sciences, 74(11), 1317–1324. https://doi.org/10.1016/j.lfs.2003.09.038

7. Vázquez, M., Guevara, N., Maldonado, C., Guido, P. C., & Schaiquevich, P. (2020). Potential pharmacokinetic drug-drug interactions between cannabinoids and drugs used for chronic pain. BioMed research international, 2020. https://doi.org/10.1155/2020/3902740

8. Jesus, C. H. A., Ferreira, M. V., Gasparin, A. T., Rosa, E. S., Genaro, K., De Souza Crippa, J. A., Chichorro, J. G., & Da Cunha, J. M. (2022). Cannabidiol enhances the antinociceptive effects of morphine and attenuates opioid-induced tolerance in the chronic constriction injury model. Behavioural Brain Research, 435, 114076. https://doi.org/10.1016/j.bbr.2022.114076

9. Brown, J. D., & Winterstein, A. G. (2019). Potential adverse drug events and drug–drug interactions with medical and consumer cannabidiol (CBD) use. Journal of clinical medicine, 8(7), 989. https://doi.org/10.3390/jcm8070989

10. Solomon, H. V., Greenstein, A. P., & DeLisi, L. E. (2021). Cannabis use in older adults: a perspective. Harvard review of psychiatry, 29(3), 225-233. https://doi.org/10.1097/HRP.0000000000000289

11. Casiraghi, A., Musazzi, U. M., Centin, G., Franzè, S., & Minghetti, P. (2020). Topical administration of cannabidiol: influence of vehicle-related aspects on skin permeation process. Pharmaceuticals, 13(11), 337. https://doi.org/10.3390/ph13110337