Cannabis is a sophisticated plant that contains more than a thousand different phyto or plant-based cannabinoids. Cannabidiol aka CBD is the second most prevalent phytocannabinoids present in cannabis Sativa plants. Some sparse study suggests that CBD might have therapeutic advantages for a variety of ailments. However, as CBD becomes more widely available, questions like: “What drugs should not be taken with CBD?“, “How will CBD interact with my existing medications?” often arise in consumers’ minds.
CBD may cause harmful interactions with several other existing prescribed drugs, according to somewhat limited studies. The conclusions aren’t definitive, and we look forward to exploring further research on CBD’s interactions with various medicines.
Most physicians and healthcare practitioners advise people who use CBD for medicinal or pleasurable purposes to avoid combining it with other prescribed regular medications. Most importantly, talk to your doctors first about potential interactions and side effects before introducing any CBD products for trial use.
In this post, we will try our best to answer all the questions mentioned above. Especially what drugs you should not take with CBD, plus its interactions with conventionally prescribed medications.
Have you noticed the term grapefruit warning before? Several pharmaceutical medicines will have grapefruit warning signs on their packaging label to recommend the ingestion of citrus fruits before treatment. A set of proteins called cytochrome P450 (CYPs) enzymes breaks down several medicines in the liver and small intestines. This process offers an advantage to some drugs to metabolize quickly in the body.
On the other hand, grapefruit alike CBD interrupts CYP activities and slows down the typical breakdown of some other drugs category. Therefore, you might want to consult your healthcare practitioner to know the interactions of CBD with your concurrent drug use. A 2013 research released in the Journal of the Canadian Medical Association entitled “Grapefruit Medication Interactions: Forbidden Fruit or Avoidable Consequences?” found that grapefruit can raise blood pressures by combining with around 85 medicines. The documented effects included the irregular beating of the heart, major organ failures, internal bleeding, and fatality.
Related: Can CBD Show Up in a Drug Test?
A 1993 research carried out at the University of California, San Francisco, by pharmacology experts found that CBD can impair hepatic drug metabolism in several animal species. The study suggested that while obstruction can cause patients to absorb lesser prescribed dosages, it might also trigger a lethal chemical compounds formation on the body. Following the release of this report, numerous medical and scientific publications have provided proof of the negative effects of CBD on people with active medication with certain drugs.
The category types, grade, and pureness of CBD significantly influence how it reacts to our body as well as prescribed common drugs. But CBD vs drugs interactions on any person, based on gender, age, weight & several variables naturally respond uniquely.
Now let’s explore the existing CBD drug interactions studies with a range of everyday prescription and pharmaceutical medicines.
The NSAID is a medication that lowers bodily pain and inflammation and is an anti-inflammatory non-steroidal medication. Ibuprofen is susceptible to blood thinning and may induce vertigo, breathlessness, and vomiting.
The danger of undesirable negative effects may possibly extend the duration and force of ibuprofen. Thus far, no research on the human subject has explicitly examined the interactions of CBD and NSAIDs. However, two experiments of the animal models in 2006 and 2008 respectively showed the use of NSAIDs such as ibuprofen with cannabinoids can synergize and work for pain reduction.
Warning: Before using ibuprofen with CBD, you must visit your health care practitioner.
Warfarin, sometimes called Coumadin under the brand name, is a blood-thinning (anticoagulant) drug that prevents the development of dangerous blood clots that may induce heart attacks as well as strokes. Serious hemorrhages, several headaches, edema, or abrupt ending pains are among the few side effects of Warfarin.
A 2017 study published in Epilepsy & Behavior Case Reports at the University of Alabama, Birmingham, demonstrated that CBC boosts the effectiveness of medicines prescribed for thinning blood, by decreasing the way the body metabolizes warfarin and prolonging its stay in the body system. CBD may worsen certain associated risks by extending the duration of warfarin’s presence in the body.
Warning: Patients who use standard warfarin and coumadin should check for customized information from their healthcare practitioner and take blood testing prior to starting any CBD program.
Common indications of thyroid medicines are to treat thyroid disorders. Mainly an underactive thyroid (hypothyroidism) by replacing thyroid hormones and overactive thyroid (hyperthyroidism) with antithyroid drugs. Various drugs accomplish such goals via alternative routes inside the human body. Thyroid hormone substitution treatments have side effects such as thoracic discomfort, anxiousness, hypertension, and nausea. Some other negative impacts of anti-thyroid drugs are rashes, irritation, temperature, pains, and headache.
There’s currently limited information on CBD oil and thyroid medication interactions, especially with standard thyroid hormone substitution and thyroid medicines. Thyroid patients should be consulted with their doctor first if they wish to try a CBD solution.
Eliquis often termed apixaban is a blood-thinning drug used in veins, heart, lungs, and limbs after any hip and knee replacement surgery. Apixaban reduces the risk of stroke or blood clots. One negative effect of Eliquis is that it increases the threat of serious hemorrhage. So doctors usually prescribe specific doses of Eliquis for general patients.
The Eliquis process the same proteins (CYP proteins) in the liver that CBD works to slow down metabolization. It might lead to a significant risk of serious bleeding.
Caution: Before utilizing CBD and Eliquis patients should contact their doctor first.
The brand name Plavix is clopidogrel medicine. People who have had or may have had cardiac disease usually take it. The medicine acts by inhibiting the formation of blood platelets in the arteries close to the heart.
A 2011 research published in Life Sciences shows CBD might have inhibiting effects on the CYP2C19 enzyme that metabolizes Plavix. This may lead to Plavix staying in the body longer and weakening its total effects.
N.B.: Patients who use Plavix or clopidogrel should check with their doctors before trying CBD.
Acetaminophen is the generic name of Tylenol, a popular medication for pain and fever. Acetaminophen is susceptible to liver and illness, causing nausea, various headaches, and sleeplessness.
CYP450 enzyme metabolizes both acetaminophen and CBD. It reduces the efficacy of both drugs. while digestion takes place inside the body. A disputed 2019 research published on mice by the University of Arkansas in ‘Molecules magazine’ said that higher doses of CBD lead to liver damage that can exacerbate liver toxicity along with acetaminophen compounds. But Project CBD criticized the authors of the study for cherry-picking and constructing research to indicate the possible toxicity of CBDs.
Further study needs to take place in order to determine possible interactions of CBD and acetaminophen. Patients who want to receive both should consult with their doctor in the first place.
Metoprolol is a beta-blocker. It helps cure high blood pressure by lowering the pace of the heart and altering epinephrine. Epinephrine is a hormone responsible for stress and other mechanisms. Beta-blockers reduce blood pressure and can cause unwanted symptoms like vertigo, lightheadedness, breathlessness, heartburn, and chilly arms and legs.
There was no study showing possible CBD interactions with metoprolol. Some placebo-controlled study in 2017 published on JCI Insight, from the University of Nottingham, England has connected CBD to reduced blood pressure when taken independently. Nonetheless, the people using metoprolol combined with CBD might have negatively affected CBD blood pressure levels.
A 2011 research on rats presented in the British Journal of Pharmacology also reveals that CBD has possible nausea-reduction characteristics that might help calm down metoprolol-related negative effects.
Caution: Patients using the CBD should visit their doctor to find out whether they are taking metoprolol or other beta-blockers.
Metformin is a grownup medicine for the management of blood sugar levels in Type-2 diabetes patients. Hypoglycemia, vomiting, diarrhea, nausea, and muscular discomfort are negative effects of metformin.
A 2006 research published in the Autoimmunity journal indicated that CBD decreased blood sugar levels in animal test subjects. To date, there is little research available on CBD’s therapeutic effect on people with diabetes. The same goes with its interaction with metformin. Only one 2016 research carried out by the American Diabetes Association, investigated CBD effectiveness and did not find any significant glucose effects in patients with Type-2 diabetes.
CBD interactions with diabetes require additional investigation. Patients who use metformin must discuss if CBD is appropriate for them with their doctor.
‘Xanax’ also known by the generic name ‘Alprazolam’ is a benzodiazepine drug. Use cases of this drug include panic disorder, anxiety, and depression management. Some common side effects of Xanax are dizziness, lack of balance, loss of memory, and anxiousness, particularly in the morning.
A CYP3A4 enzyme suppressed by CBD dissolves Xanax into the liver. With CBD in the body system, Xanax might possibly extend the time it takes to metabolize and prolong the chance of undesirable adverse reactions. Different studies including a 2011 study published in the journal called ‘Neuropsychopharmacology’ have revealed possible antidepressant effects of cannabinoids. It is possible that sometime in near future we will consider CBD as a substitute for Xanax.
N.B.: No studies have clearly reported Xanax vs. CBD interactions. Patients interested in CBD who use Xanax must seek additional information from their healthcare professionals.
Statins are a subclass of cholesterol-lowering and protective medicines for cardiovascular diseases. It helps prevent heart attacks and stroke. The common adverse effects of statins include muscular pain, increased sugar levels, nausea, and headaches.
The CYP activity in the liver with CBD inhibits Statin’s mechanism of action. No specific study took place to showcase special encounters between CBD and statins. The strength, duration of statins in the system, and the risk of adverse effects might increase with the presence of CBD.
Prior to utilizing CBD, those who take statins should contact their medical practitioner.
When you will evaluate: whether to take CBD with certain drugs or not, it is worth considering CBD’s known effects on liver function and enzymes. These enzymes significantly metabolize specific pharmaceutical drugs. The way CBD affects some metabolites are somewhat similar to grapefruit. Therefore, you can easily avoid those pharmaceutical drugs that have grapefruit warning signs. In other words, we can say, while on CBD avoid drugs with grapefruit warnings.
These classes of drugs include a substantial percentage of contemporary prescription medicines, such as benzodiazepines, antihistamines, haloperidol, anti-retroviral, statins, cyclosporine, sildenafil, warfarin, and other CYP3A4 and CYP2D6 metabolized medicines.
Also avoid taking CBD in conjunction with clobazam, a drug to treat epileptic seizures. However, Epidiolex is an epilepsy drug that contains CBD. FDA gave approval to Epidiolex for the treatment of epilepsy. And oftentimes doctors prescribe it for the treatment of epilepsy. There is substantial information from clinical trials on Epidiolex. However, a 2019 study, released in the F1000 Research journal by Columbia University researchers suggests that the medicine Epidiolex might produce negative side effects.
No studies demonstrated that the interaction between grapefruit and prescription medicines is fatal. Thus, drug interaction with CBD might not involve irregular heartbeat, sudden cardiac death, kidney failure, and muscle damage. While the 2013 survey previously referenced in Canadian Medical Association Journals showed that it can lead to severe effects. Each patient’s condition is distinct. If they contemplate using CBD, along with specific prescription medications, they should talk to their medical practitioners first.
As we mentioned above, a 2017 research showed, “A single dosage of cannabidiol in a randomized crossover study, lowers blood pressure in healthy volunteers”. This was released in the JCI Insight newspaper. It confirms CBD’s ability to decrease blood pressure levels. Experts also show that the angst and stress-reduction characteristics of CBD oil might help reduce blood pressure levels altogether. However, taking CBD oil with prescription medication for blood pressure or beta-blockers could lead to double medications. And, can also lead to critically lower blood pressure levels.
There are no studies showing that the blood can be diluted by CBD oil itself. As previously mentioned, a 2017 study confirms, CBD oil does not boost blood diluting like warfarin. Also might potentially push the presence of warfarin above appropriate limits.
So, before using CBD and blood thinner together patients should contact their doctor first.
Caffeine and CBD are becoming two highly popular consumer products, especially when combined together. Caffeine may revive and alert people who are suffering from narcolepsy. In addition, a 2007 study on rats demonstrated that caffeine is processed by CYP enzymes which are inhibited by CBD. This might prolong the duration of caffeine presence on the body and the stimulant effects of caffeine might increase.
You must consult your doctor before using any cannabidiol for the first time. Even if you are sure that CBD doesn’t interact with the drug you are currently taking. CBD like most other cannabinoids is safe, non-intoxicating, and non-addictive. But due to some contraindications, you should always avoid taking CBD along with prescription drugs whenever possible.