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can cbd oil interact with medications

CBD Drug Interactions Explained: What Drugs Should Not Be Taken With CBD

Last update: February 2021

Table of contents:

  • Understanding Metabolism
  • The Cytochrome P450 System
  • CBD and Drug Interactions: Contraindications
  • CBD and Drug Interactions in Studies
  • List of drugs and medications which could be contraindicated for use with CBD
  • Speak to Your Doctor
  • Key Takeaways

Cannabidiol, or CBD, is one of over a 100 different types of a specific kind of compound called phytocannabinoids found in the Cannabis sativa plant.

CBD is has become increasingly popular in recent years due to its wide range of therapeutic effects as well as its ability to relieve a host of symptoms effectively , but also to do so safely and with few side effects. And unlike tetrahydrocannabinol (THC), the other most abundant phytocannabinoid found in the cannabis plant, CBD is non-intoxicating and non-psychoactive – something that for many people is an undesirable yet unavoidable part of taking a high-THC containing cannabis extract.

CBD is most widely known and has been popularized as being used for seizure disorders such as epilepsy, but has also proven to be effective in helping to relieve the symptoms of other conditions. These include anxiety, depression, schizophrenia, inflammatory and neuropathic pain, Parkinson’s disease, Crohn’s and other forms of inflammatory bowel disease, as well as certain types of cancer.

However, despite the fact that the vast majority of the science indicates CBD oil is safe to use on its own, CBD is a powerful compound that interacts with a variety of systems within the body. And as such, CBD not only shows potential as a powerful therapeutic agent, but can become less benign when taken together with other substances such as pharmaceutical drugs.

Let’s find out why.

Understanding Metabolism

Before we take a look at how CBD interacts with medications, first we need to understand how the body’s metabolism works in general, the systems involved in CBD metabolism, how CBD is metabolized and how CBD affects something called the Cytochrome P-450 system.

What Is Metabolism?

A lot of people think of metabolism in terms of how easily or slowly they gain and lose weight, often claiming to have a “fast” or “slow” metabolism. In scientific terms, this is what is known as the basal metabolic rate, or the amount of calories an individual requires in order to sustain normal body functions while at rest.

However, this basal metabolic rate is very different to metabolism – the way in which substances such as different types of food are broken down and used by the body – with much of this process happening in the gut and the liver in what is known as the ‘first-pass effect,’ or ‘first-pass metabolism’.

Explained very simplistically, when food is eaten, it is broken down by the liver into its individual compounds in order for it to be used by the body. So, for example, carbohydrates are broken down into sugars, fats into triglycerides, and proteins into amino acids. From there, the metabolism, under the control of chemicals called enzymes, transforms these compounds into metabolites that can then be used by the body, for instance as fuel for cellular processes or as building blocks for various systems and tissues.

Metabolism of CBD

Just like food has to go through this process, so too does a therapeutic compound such as CBD, but in what is more specifically called drug metabolism. Drug metabolism refers to the rate at which medications and other therapeutic compounds are broken down by the body into its individual metabolites and how long these metabolites stay in the body.

So, when CBD is ingested by mouth, either as an oil, tincture, capsule or edible, it has to pass through the digestive system where it is absorbed into the bloodstream by the intestines. From there, the CBD is transported by the blood to the liver where it enters the liver via the hepatic portal. Once the CBD is in the liver, it is broken down into its metabolites by enzymes, after which it can be circulated throughout the body in the bloodstream.

The Cytochrome P450 System

However, in addition to breaking compounds down into metabolites, is also has one other very specific and important role it plays during this metabolic process – the detoxification and excretion of foreign drugs (called xenobiotics) and other types of toxic substances.

It does through a system called the cytochrome P450 system (CYP) which consists of a special group of enzymes containing heme as a cofactor to convert fat-soluble compounds into more water-soluble compounds and aiding in their absorption and use.

It is estimated that the CYP system is responsible for metabolizing over 60% percent of any drug that has been consumed. And interestingly, pharmaceutical researchers and doctors also use cytochrome P450 system to understand, calculate and predict drug dosages effects as well as its potential side effects.

For instance, if only one therapeutic compound is being processed by the liver, and the system in general is healthy, scientist can use the average amount of time it takes for the drug or medication to be processed through the CYP to calculate accurate dosage information.

However, there are certain substances that have the ability to affect the way in which the CYP system processes compounds such as CBD that cause certain drugs to metabolize faster or slower than what they would normally have done.

CBD And The Cytochrome P450 System

As mentioned, CBD also has the ability to interact directly with the CYP system in the liver. Preclinical research is showing that the way in which CBD does is by binding to the site where the enzyme activity occurs acting as a “competitive inhibitor”, displacing its chemical competitors, and thus preventing the CYP system from metabolizing other compounds.

The extent to which CBD acts as a competitive inhibitor of the cytochrome P450 binding proteins is mainly dependent on how much CBD is ingested, the unique physiology of the individual as well as the type of CBD product used (e.g. CBD isolate vs. full-spectrum CBD extracts). This is due to these factors determining how tightly the CBD molecules bind to the active site of the metabolic enzyme, with increased and tighter bonds resulting in more competitive inhibition.

What this means in plain English is that CBD sort of “outcompetes” other medications when it comes to reaching first place for getting metabolized by the CYP enzymes. This, in essence, means that CBD deactivates the effects of all the other therapeutic compounds that pass through the CYP system.

How successful it is in its competition with other medicines depends on a few factors, but mostly the amount of CBD that enters into the bloodstream. If it’s not very much, it will have very little to no noticeable effect on the CYP activity and the majority of the medicine will be metabolized. On the other hand, if a large dose of CBD is taken, it will bind to a lot more of the site of enzyme activity and leave a lot more of the other medicine to not be metabolized.

Why CBD’s Competitive Inhibitory Effect On The Cytochrome P450 System Is Important

When the CYP system is affected in this way by CBD, it both changes and the way in which certain other drugs are metabolized as well as prevent a lot of the drug to be metabolized. When this happens, it leads to higher levels of other drug compounds to remain in the body at a single time.

At the very least these elevated concentrations can cause unwanted side effects like an increased risk of bleeding or a suppressed immune system, but more worryingly, it can quite easily result in an overdose.

CBD and Drug Interactions: Contraindications

As mentioned, and contrary to popular belief and anecdotal evidence, CBD is not a biologically inert compound. Rather, CBD has a complex pharmacokinetic and pharmacodynamic profile similar to any other medication, and has the potential to interact with other medications and medical conditions.

For instance, any therapeutic compound that is metabolized by the CYP system has the potential of being affected by CBD. One indication that your medicine might be metabolized by the CYP system is if your pharmacist told you not to eat grapefruit, or watercress or use St. John’s Wort or goldenseal supplements. However, this is by no means a solid test and you should always check with your pharmacist of doctor first (more on that later).

This, along with the rise in the popularity of the medical and complimentary use of CBD, researchers are also starting to investigate drug interactions with CBD more directly.

CBD and Drug Interactions in Studies

For instance, the CBD based drug, EPIDIOLEX® approved in the United States for seizures associated with Lennox‐Gastaut and Dravet syndromes, is increasingly either being used as a supplementary treatment, or even replacing the traditionally used anti-epileptic drugs clobazam, and valproate, as well as stiripentol, topiramate, rufinamide, and N‐desmethylclobazam respectively.

CBD and anti-epileptic drugs

This has spurred researchers to investigate whether there are drug–drug interactions (DDIs) and/or adverse drug events (ADEs) between these traditionally used anti-epileptic drugs and CBD. Data showed that, although there were no serious ADEs, deaths, or pregnancies during the trial, most subjects reported some ADEs of mild severity, while 10.4% subjects reported moderate ADEs, and 2.6% subjects reported severe ADEs, with severe events being characterized by popular rashes. Other moderate ADEs included feeling intoxicated, menstrual discomfort or other mild rashes.

Despite these ADEs, the researchers concluded that the effective dose of 750 mg of cannabidiol (approximately 20 mg/kg/day for a 75‐kg adult), was mostly well tolerated when co-administered with clobazam, stiripentol, or valproate and that ADEs only occurred in patients for which there was no dosage titration.

In another study investigating the interactions between CBD and commonly used anti-epileptic drugs, concluded that, although serum levels of the drugs topiramate, rufinamide, and N‐desmethylclobazam were found when use in conjunction with and increased CBD dosages. However, all changes were within the accepted therapeutic range but did underscore the importance of monitoring serum AED levels and LFTs during treatment with CBD.

CBD and anticancer agents

In yet another such study, but with researchers this time looking into the clinical implications and importance of DDIs between anticancer agents and CBD in patients with cancer, the reviewers found that there was limited information available, with most of the data coming from in vitro studies and that the true in vivo implications are not well-known. This lead them to believe that erring on the side of caution is the best option, and that doctors and pharmacists should always consider the possibility of interactions and their consequences whenever they are aware of a patient using CBD products.

Similarly, a study investigating the potential ADEs and DDIs the researchers highlighted that medical CBD users under clinical supervision should be screened for potential DDIs and ADEs between CBD, other pharmacotherapies, and their underlying conditions. They also recommended that an increase in awareness is needed among the lay public who are recreational or consumer CBD users. Similarly, healthcare providers should also be made aware of the potential for DDIs and ADEs with CBD and strategically prescribe and manage patient regimens while also considering patient desires for complementary or alternative therapies.

List of drugs and medications which could be contraindicated for use with CBD

According to the Indiana University Department of Medicine, pharmaceutical drugs and medications which could be contraindicated for use with CBD include:

  • Steroids and corticosteroids for example hydrocortisone, cortisone, prednisone, triamcinolone and dexamethasone
  • HMG CoA reductase inhibitors (statins) for example atorvastatin, fluvastatin, lovastatin, pravastatin, pitavastatin, simvastatin and rosuvastatin
  • Calcium channel blockers for example amlodipine, diltiazem, felodipine, isradipine, nicardipine, nifedipine, nisoldipine and verapamil
  • Antihistamines for example brompheniramine. cetirizine, chlorpheniramine, clemastine, diphenhydramine, fexofenadine and loratadine
  • Prokinetics (motility drugs) for example domperidone, metoclopromide, levosulpiride, renzapride and pruclopride
  • HIV antivirals for example abacavir, didanosine, emtricitabine, lamivudine, stavudine, tenofovir alafenamide and disoproxil fumarate as well as zidovudine
  • Immune modulators for example immune globulins, immunosuppressive agents and immunostimulants, for example bacterial and viral vaccines
  • Benzodiazepines for example alprazolam, clobazam, clonazepam, clorazepate, chlordiazepoxide, diazepam, estazolam and lorazepam
  • Antiarrythmics for example amiodarone, flecainide, procainamide, propafenone, quinidine and tocainide
  • Antibiotics for example amoxicillin, doxycycline, cephalexin, ciprofloxacin, clindamycin, metronidazole, azithromycin, sulfamethoxazole-trimethoprim, amoxicillin-clavulanate and levofloxacin
  • Anesthetics for example barbiturates, amobarbital, methohexital, thiamylal, etomidate., ketamine and propofol
  • Antipsychotics for example aripiprazole, asenapine, cariprazine, clozapine, lurasidone, olanzapine, quetiapine, risperidone and ziprasidone
  • Antidepressants for example citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, vortioxetine and vilazodone
  • Anticonvulsants / Anti-Seizure Medications for example acetazolamide, carbamazepine, clobazam, clonazepam, ethosuximide, fosphenytoin, gabapentin, lacosamide, lamotrigine, levetiracetam, methsuximide, nitrazepam, oxcarbazepine, paraldehyde, phenobarbital, phenytoin, primidone, topiramate, valproic acid, vigabatrin, felbamate, tiagabine hydrochloride and zonisamide
  • Beta blockers for example acebutolol, atenolol, betaxolol, betaxolol, bisoprolol fumarate, carvedilol, esmolol, labetalol, metoprolol, nadolol, nebivolol, penbutolol, propranolol, sotalol and timolol
  • Proton-Pump Inhibitors (PPIs) for example omeprazole, lansoprazole, pantoprazole, rabeprazole, esomeprazole and dexlansoprazole
  • Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) for example aspirin, celecoxib, diclofenac, diflunisal, etodolac, ibuprofen, indomethacin, ketoprofen, ketorolac, nabumetone, naproxen, oxaprozin, piroxicam, salsalate, sulindac, tolmetin
  • Angiotension II Blockers for example azilsartan, candesartan, eprosartan, irbesartan, losartan, olmesartan, telmisartan and valsartan
  • Oral Hypoglycemic Agents for example sulfonylureas, meglitinides, biguanides, thiazolidinediones, α-Glucosidase inhibitors, DPP-4 inhibitors, SGLT2 inhibitors and cycloset
  • Sulfonylureas for example glynase, micronase, amaryl, diabinese, glucotrol, tolinase and tolbutamide

There are also other medications known as “prodrugs” that first need to be metabolized into its therapeutic compounds as opposed to being a therapeutic compound in and of itself (like most medications). In other words, the inactive compound is ingested, and once in the body, it is processed into its active compound.

If this processing is dependent on the CYP system, then inhibitors can cause an insufficient amount of the active drug compound to be available in the body, which can result in the desired therapeutic effect not being reached.

One such prodrug for example is codeine which is metabolized into morphine. Similarly, lisdexamfetamine under the brand names Vyvanse and Concerta are two other popular ADHD medications which also fall into this category.

Why You Should Always Speak To Your Doctor First

The above mentioned list of drugs that could interact with CBD is by no means exhaustive and does not include all the medications on which CBD may have an interaction with. Similarly, not all the medication categories listed above will necessarily cause and interaction (although if you are taking one of these medications it is recommended to rather err on the side of caution).

For this reason, it is vital that you should consult your doctor or treating physician before using any CBD oil or product. Your doctor is not only able to advise you with regard to a possible CBD-drug interaction, but can also monitor the therapeutic as well as side effects of both the CBD and the medications you are on. Similarly, your doctor can also help you adjust the dosages of both the medication and CBD so you can take both simultaneously but also do so safely.

Key Takeaways

The safety profile of CBD is well established with study after study showing that it is well tolerated and safe to use, while at the same time rarely producing any serious side effects. Similarly, CBD is a compound that has a profound impact on a wide variety of systems within the body, which is what makes it such an effective therapeutic agent for so many conditions. But at the same time it is good to remember that it is also this, that is the reason why it has the potential to interact with other drugs and why CBD should be consumed with care and respect.

CBD shows potential as a powerful therapeutic agent, but can become less benign when taken together with other substances such as pharmaceutical drugs.

What drugs should not be taken with CBD?

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Contents

  1. CBD interaction with drugs & medication
  2. Drugs that should not be taken with CBD
  3. Does CBD oil affect blood pressure?
  4. Does CBD oil thin the blood?
  5. Does caffeine counteract CBD?

Cannabis is a complex plant, with hundreds of chemicals and over 100 distinct cannabinoids. The little research that examines cannabidiol or CBD, the second most common cannabinoid found in cannabis, shows evidence of potential health benefits for a wide range of conditions. As CBD becomes more mainstream, however, a key question comes to mind, “How will CBD interact with my current medication?”

Currently, sparse research suggests that CBD can illicit problematic interactions with certain other prescription drugs. The findings are far from conclusive — further research is still needed on CBD’s interaction with different medications. Many doctors and researchers urge individuals using CBD medically or recreationally to be cautious about mixing it with other prescriptions and to consult healthcare providers about possible interactions.

Many doctors urge individuals using CBD to be cautious about mixing it with other prescriptions and to consult healthcare providers about possible interactions.

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CBD interaction with drugs & medication

Have you heard of the grapefruit test? Many prescription drugs will include grapefruit warnings on the label, advising against consuming the citrus fruit while taking medication. Many medications are broken down in the liver and small intestine by a group of proteins called cytochrome P450 enzymes (CYPs). This process is what delivers a medication’s benefits to the intended target.

Grapefruit disrupts the activity of CYPs and slows the way these proteins usually break down medication. The fruit also increases the side effects and duration the drug stays in the system. One 2013 study titled “Grapefruit Medication Interactions: Forbidden Fruit or Avoidable Consequences?” published in the Canadian Medical Association Journal showed that grapefruit can increase blood content levels when interacting with at least 85 different drugs. The reported consequences were severe, including irregular heartbeat, organ failure, internal bleeding, and death.

Further, a 1993 study conducted by pharmacology researchers at the University of California, San Francisco, and published in the journal Biochemical Pharmacology, discovered that CBD, much like grapefruit, disrupts the normal function of cytochrome P450 enzymes in mice. The study postulated that while the blockage could allow patients to take lower doses of their prescriptions, it could also cause a toxic buildup of chemicals in the body. Since this study’s publication, several scientific and medical journals have published evidence of the grapefruit-like effects of CBD in humans.

The type, quality, and purity of CBD administered all affect how it interacts with your body and medication. The timing of when you take CBD and any other prescription drug also factors into how the two may interact in your body. And of course, every individual responds to medications differently, depending on genetics, age, weight, and other factors.

medical CBD

The type, quality, and purity of CBD administered all affect how it interacts with your body and medication. Photo by: Gina Coleman/Weedmaps

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medical CBD

Let’s examine the current research on CBD’s interaction with several common prescription and over-the-counter medications.

Should I take CBD with ibuprofen?

Ibuprofen is a nonsteroidal anti-inflammatory (NSAID) medicine that reduces pain and inflammation in the body. Ibuprofen has a risk of blood-thinning and can cause dizziness, shortness of breath, and nausea.

Potentially, CBD can increase the duration and strength of ibuprofen, thereby increasing the risk of adverse side effects. No human studies to date examine CBD’s interaction with NSAIDs specifically. Still, two studies conducted on animal models in 2006 and 2008 and published respectively in the journals, Pain and Pharmacology, suggest that other cannabinoids may work synergistically with NSAIDs like ibuprofen to reduce pain.

Patients should consult with their healthcare provider before taking ibuprofen with CBD.

Should I take CBD with warfarin?

Warfarin, also known under the brand name Coumadin, is an anticoagulant (blood thinner) medication used to prevent the formation of harmful blood clots that could potentially cause heart attacks or strokes. Warfarin’s risks include severe bleeding, headaches, swelling, or sudden pain in extremities.

In 2017, researchers at the University of Alabama, Birmingham, conducted a study published in Epilepsy & Behavior Case Reports which showed that CBD increases the effects of drugs used for blood-thinning by slowing down how the body metabolizes warfarin and prolonging its presence in the system. By increasing the duration of warfarin’s presence in the body, CBD could potentially exacerbate some of the associated risks.

Patients taking generic warfarin or Coumadin should consult their healthcare provider for individualized information and get blood tests before beginning a CBD regimen.

Should I take CBD with thyroid medication?

Thyroid medication is used to treat thyroid disorders, most commonly hypothyroidism (an underactive thyroid) via thyroid hormone replacement, and hyperthyroidism (an overactive thyroid) via anti-thyroid medication. Different medications achieve these objectives through different pathways in the body. Side effects of thyroid hormone replacement therapies include chest pain, anxiety, headaches, and vomiting. While rare, anti-thyroid medication side effects can include rash, itching, fever, aches, and headaches.

Little research studying interactions between CBD and common thyroid hormone replacement and anti-thyroid medications currently exists. Patients taking thyroid medication who want to try CBD should consult with their physician.

Should I take CBD with Eliquis?

Eliquis (generically called apixaban) is a blood thinner used to lower the risk of stroke or a blood clot in veins, the heart, the lungs, and the legs following knee or hip replacement surgery. Eliquis increases the risk of severe bleeding, and patients taking Eliquis are typically prescribed precise dosages by their doctor.

CYP proteins process Eliquis in the liver, the same proteins on which CBD acts to delay metabolization. This process could cause an overdose of Eliquis’ chemicals in the body and a high risk of severe bleeding.

Patients taking Eliquis should speak to their doctor before using CBD products.

Should I take CBD with Plavix?

Plavix is the brand name of the drug clopidogrel, frequently prescribed for patients who have had or are likely to have a heart attack. The drug works by blocking blood platelets from forming clots in arteries near the heart.

According to a 2011 study published in the journal Life Sciences, it is possible that CBD has an inhibitory effect on CYP2C19, the enzyme that metabolizes Plavix. This could cause Plavix to remain longer in the body and weaken its overall effects. Further research is required to determine whether this could lower Plavix’s effectiveness in preventing heart attacks.

Patients using Plavix or clopidogrel should consult their physicians as to whether they should use CBD.

Should I take CBD with Tylenol?

Acetaminophen, the generic name for Tylenol, is a common drug used for pain and fever relief. Acetaminophen carries a risk of liver damage and disease, with side effects including nausea, headaches, and insomnia.

Acetaminophen and CBD both are metabolized by CYP450, which lowers the effectiveness of both chemicals as they’re processed in the body. One controversial 2019 study, conducted by the University of Arkansas on mice and published in the journal Molecules, claimed that high doses of CBD contributed to liver toxicity, which could compound acetaminophen’s liver damage potential. However, the study’s authors have been accused of cherry-picking research and designing experiments to showcase potential CBD toxicity. The one study they cited with human test subjects did not show liver toxicity from CBD.

More research is required to confirm potential interactions between CBD and acetaminophen. Patients looking to take both simultaneously should consult their physician.

Should I take CBD with metoprolol?

Metoprolol is a beta-blocker designed to treat high blood pressure by reducing the heart rate and changing the release of epinephrine, a hormone involved in stress and other processes. Beta-blockers lower blood pressure and sometimes produce side effects such as dizziness, nausea, stomach pain, heartburn, and cold hands and feet.

No studies have examined potential interactions between CBD and metoprolol. However, some placebo-controlled research conducted on healthy people at the University of Nottingham in England and published in 2017 in the journal JCI Insight has linked CBD with decreased blood pressure when taken on its own. For patients taking metoprolol, however, the combination with CBD could potentially have negative impacts on blood pressure.

A 2011 study performed on mice and published in the British Journal of Pharmacology also shows that CBD has potential nausea-reducing properties, which may help soothe side effects associated with metoprolol.

Patients taking metoprolol or other beta-blockers should consult their doctor as to whether to consume CBD.

Should I take CBD with metformin?

Metformin is a medication prescribed to adults with type 2 diabetes to help control blood sugar levels. Side effects of metformin include low blood sugar, nausea, diarrhea, vomiting, and muscle pain.

One 2006 study published in the journal Autoimmunity showed that CBD reduced the incidence of diabetes in animal models. To date, however, very little research has specifically covered CBD’s potential in human diabetes treatment or interactions with metformin. Only one study, conducted by the American Diabetes Association and published in 2016 in the journal Diabetes Care, has examined the efficacy of CBD in patients with type 2 diabetes and found it had no significant impact on glucose levels.

More research is needed on CBD’s interaction with diabetes. Patients taking metformin should talk to their doctor about whether CBD is right for them.

Should I take CBD with Xanax?

Xanax (generic name alprazolam) is a benzodiazepine medication used to treat panic disorders, anxiety, and depression. Common side effects of Xanax include drowsiness, lack of coordination, memory loss, and early-morning anxiety.

Xanax breaks down in the liver via an enzyme called CYP3A4, which is inhibited by CBD. Taking CBD could potentially increase the amount of time Xanax is in the system and prolong or increase the likelihood of unwanted side effects. CBD may one day be considered an alternative to Xanax as various research, including a 2011 study published in the journal Neuropsychopharmacology, has documented the cannabinoid’s potential anti-anxiety properties.

No research has explicitly documented interactions between Xanax and CBD. Patients taking Xanax who are interested in CBD should speak to their healthcare providers for more information.

Should I take CBD with statins?

Statins are a classification of drugs designed to lower cholesterol and protect against heart attack and stroke. Common side effects of statins are muscle soreness, blood sugar increase, headaches, and nausea.

Statins are processed by CYP function in the liver, which CBD inhibits. While no research has specifically studied interactions between statins and CBD, the cannabinoid could potentially increase the strength and duration of statins in the system and the risk of unwanted side effects.

Patients taking statins should speak to their healthcare provider before using CBD.

Drugs that should not be taken with CBD

CBD’s documented effects on liver function and enzymes that metabolize several medications are relevant when considering whether or not to consume CBD with certain drugs. CBD acts on the same metabolites as grapefruit — therefore, many of the prescription drugs that carry grapefruit warning labels may have similar risks when taken with CBD.

CBD acts on the same metabolites as grapefruit — therefore, many of the prescription drugs that carry grapefruit warning labels may have similar risks when taken with CBD. Photo by: Gina Coleman/Weedmaps

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These drug classifications include a large percentage of existing prescriptions, such as benzodiazepines, antihistamines, haloperidol, antiretrovirals, statins, cyclosporine, sildenafil, warfarin, and other drugs metabolized by CYP3A4 and CYP2D6.

Clobazam, used to treat epileptic seizures, is another type of drug that may not be advisable to take in conjunction with CBD. However, Epidiolex is an FDA-approved, CBD-based drug that physicians may prescribe to treat epilepsy. A significant amount of data, derived from clinical trials, exists on Epidiolex, although the drug can also cause adverse effects, according to a 2019 study conducted by researchers at Columbia University and published in the journal F1000Research.

No research conclusively warns patients against taking these drugs with CBD, though the previously cited 2013 study published in the Canadian Medical Association Journal has shown that grapefruit and drug interactions can lead to severe effects, including irregular heartbeat and sudden death, kidney failure, and muscle damage. Every patient’s case is unique, and individuals should speak to their healthcare providers if they are considering taking CBD in combination with particular prescription medications.

Does CBD oil affect blood pressure?

A previously cited 2017 study titled, “A single dose of cannabidiol reduces blood pressure in healthy volunteers in a randomized crossover study” published in the journal JCI Insight, supports CBD’s ability to lower blood pressure. Researchers also suggest that the anxiety- and stress-reducing properties of CBD may contribute to the overall ability to lower blood pressure. However, CBD taken with blood pressure medication or beta-blockers could potentially cause both drugs to double up on each other and lower blood pressure to unhealthy levels.

Does CBD oil thin the blood?

No research shows that CBD oil taken on its own can thin the blood. CBD oil does increase the effects of blood-thinning medications, such as warfarin, and could potentially push the presence of warfarin beyond therapeutic levels, as the previously cited 2017 study published in Epilepsy & Behavior Case Reports showed.

Does caffeine counteract CBD?

Caffeine and CBD are two substances gaining in popularity, particularly when they’re mixed. Caffeine can keep sleep-deprived individuals alert and clear-headed. Further, a 2007 study on rats published in the journal Pharmacology Reports showed that caffeine is metabolized by CYP enzymes, which CBD inhibits. This could extend the time caffeine stays in the body and has the potential to extend the stimulating effects of caffeine.

The information in this article is based on current research and should not be construed as medical advice. Please speak to your doctor or healthcare provider if you have questions regarding your medication and CBD use.

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