Does CBD Interact with Other Medications? [Answered]

Is it safe?

Just about all chemical compounds we take in, from over-the-counter drugs and prescription medications to illicit substances, interact with other compounds. With the use of cannabis for medicinal purposes being legalized in various states throughout the United States, many patients are now taking advantage of the phenomenal medical benefits of CBD. However, this raises the question of what effects CBD might have when used in conjunction with other medications.

While CBD is a generally safe substance, it has the potential to interfere with other drugs you are taking. In this article, we will take a closer look at how CBD interacts with 10 of the top medications that are used for different conditions.

How Does CBD Interact with Other Drugs?

In essence, the way that CBD is metabolized can interfere with how your body normally metabolizes other medications you take. If these medications aren’t metabolized properly, they may hang around and stay in your system more than you would want them to. This could cause various side effects and complications.

what drugs should not be taken with cbd

As most of us are aware, research has shown that CBD has the potential to treat various medical conditions by manipulating the endocannabinoid system (ECS), with very few unintended effects. The problem is that some of the CBD side-effects could be dangerous if they are not properly understood.

One of these effects is the inhibition of the cytochrome P-450 enzyme system.

This is the system in the body that is responsible for metabolizing about 90% of the drugs that we consume. It works by breaking down the substances that we put into our body and turning them into simpler substances that our body can use. The issue is that large doses of CBD can cause the body’s P450 enzymes to become temporarily inactive. When those enzymes are inactive, it becomes much harder for the body to process certain medications.

In fact, basically any drug that is metabolized by cytochrome P-450 enzymes has the potential to interact with CBD. Let’s take a closer look at some of these drugs.

1. Prozac (Antidepressant)

Cannabidiol (CBD) can be used to make people feel more relaxed, happier, and less stressed. As a result, people who suffer from anxiety or depression often turn to CBD to help improve their mental state. Since many of these patients are also on antidepressants, it’s important to consider how the two interact.

Prozac is a very well-known antidepressant that’s used primarily to treat depression and panic attacks. It’s used to improve sleep, mood, energy levels, and appetite.

Adverse interactions between CBD and selective serotonin reuptake inhibitors (SSRIs) are rare. However, there are speculations based on isolated reports that combining SSRIs (such as Prozac) with CBD could increase the risk of hypomania, which is a mild form of mania.

2. Warfarin (Blood Thinner)

While the majority of patients who use blood thinners along with CBD suffer no ill side effects, there is the possibility that CBD can lead to elevated levels of the blood thinners. This could result in elevated INR, which is a test used to monitor the effects of warfarin.

This is due to both warfarin and CBD being metabolized via the same pathway, essentially competing for enzymes in the cytochrome P450 enzyme complex. This leads to higher circulating levels of warfarin and thus an increase in the blood-thinning effects of warfarin, which can cause issues with bleeding. Thus, it’s important to closely monitor INR which combining the two, as less warfarin than usual may be necessary.

3. Clobazam (Epilepsy and Seizures)

Although CBD has proven to be an effective and safe treatment option for epilepsy and seizures, a 2015 publication in Epilepsia has shown that frequent use of CBD could increase the levels of Clobazam, an anti-seizure medication, in children. This is thought to be because as was the case with warfarin, CBD and Clobazam are both metabolized by enzymes in the human cytochrome P450 system. Their interaction can lead to increased levels of Clobazam, which can cause excessive sedation.

4. Nyquil (Cold and Flu Relief)

The CBD interaction, in this case, is actually with a substance called Doxylamine, an antihistamine that can be found in Nyquil and other over the counter allergy medicines. The combination of CBD and any of these types of medicines can lead to increased confusion, drowsiness, cognitive impairments, and decreased motor function.

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CBD is responsible for blocking the action of the enzymes in the liver that break down most of the medicines you find on pharmacy shelves, which can lead to increased levels of those medications and prolonged effects.

5. HIV (Antiretroviral)

All medications that enter the body are eventually metabolized, either to be activated so that they can work in the body or broken down for elimination from the body. Usually, this task is accomplished by enzymes – more specifically, cytochrome p450 enzymes. There are three ways in which medications can act on these enzymes: induce them to make more of them, break them down, or inhibit them from their functional roles.

The problem occurs when the same enzyme works on two different medications, as is the case with CBD and antiretrovirals. The outcome will depend on the interaction of the medicines with the enzyme.

To put it simply, if one medicine induces the enzyme to increase production, but the other is broken down by it, the effect of the second medicine would be reduced because its breakdown is sped up by the existence of the other medicine. If both medications inhibit the actions of the enzyme, the effect of both medications will be increased. However, if both medications induce the enzyme, the effects of both medications could be decreased.

Confusing, I know.

Moreover, when certain antivirals such as Atazanavir, Ritonavir, and Saquinavir are taken with CBD, they could increase the duration and effects of the CBD, but may also lead to an increase in their own side effects by increasing their serum concentration. For this reason, patients who start using CBD after using these medications are cautioned to start with a low dosage.

6. Xanax (Anti-Anxiety)

While mixing Xanax with CBD isn’t as dangerous as mixing it with certain other substances (like alcohol or opioids), you should still exercise caution. Thanks to that same cytochrome P450 system, mixing Xanax and CBD may lead to increased circulating levels of Xanax, which can both heighten the desired effects and the side effects of the drug. This means you could experience severe drowsiness, concentration problems, or even confusion.

7. Beta-Blockers (Blood Pressure)

Generally speaking, those with heart conditions need to be cautious when it comes to cannabis, as CBD can cause blood pressure and heart rate levels to fluctuate.

While beta-blockers are also metabolized by the cytochrome P450 system that, as stated above, CBD can interact with in many ways, it has yet to be shown exactly what effect this has. Please check with your doctor if you’re taking these medications before starting a CBD regimen.

Final Thoughts on the Interaction Between CBD and Other Medications

Always exercise caution when taking CBD along with other medications. While CBD is largely considered to be a safe and therapeutic medication, there is still the possibility that it will have a negative impact when combined with other drugs. If in doubt, do your research and make sure you are in the know about any potential side effects, however small they might be.

While CBD is considered a safe substance, there is still the possibility it will have a negative impact when combined with other drugs.

And lastly, it is important to understand that none of the aforementioned information should be taken as fact or medical advice. Everyone has different reactions and a different internal response to CBD, so your individual experience may be very different from those presented above. As such, it’s crucial to talk with your doctor before beginning a CBD regimen if you are on any prescription medications, pregnant, or breastfeeding.

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