Just about all chemical compounds, ranging 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 the effects that CBD might have when used in conjunction with other medications.
While CBD is safe to use, there is the possibility that it interferes with other drugs that 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.
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 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 actually knows how to use. The problem is that if you take a large dose of CBD, the body’s P450 enzymes will become temporarily inactive. When those enzymes are inactive, it becomes much harder for the body to process certain drugs out there.
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 are more likely to use CBD (and more of it), when compared to people who don’t suffer from this condition. Of course, there are many people who suffer from these conditions who also take prescription anti-depressants. This is why it’s important that medical professionals and patients are aware of the potential interaction that could arise from combining the two.
As most of us know, Prozac is a very well-known medication that’s used primarily to treat depression and panic attacks. It’s used to improve sleep, mood, energy levels, appetite, and may also help to restore interest in day-to-day living.
One of the major challenges that physicians face when it comes to prescribing antidepressants to patients who use CBD, is determining the correct dosage to prescribe. This combination leads to difficulties in measuring the degree each substance produces side effects, and how they affect behavior and mood.
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 from no ill side effects, there is the possibility that it could cause problems. Common blood thinners like Warfarin are subjected to prolonged activity and increased effect when taken together with CBD, and this could result in elevated INR, which is a test used to monitor the effects of warfarin).
A 2007 study published in “Phytomedicine,” for example, showed that CBD has some mild anti-coagulating effects. This means that CBD can increase warfarin levels, which means that people on warfarin should exercise caution when adding CBD to the mix.
Essentially, adding CBD to the mix can cause blood to thin temporarily. This could have the same dangerous effects as taking a double dose of warfarin, as it increases the risks but shouldn’t cause any long-term issues. As CBD is excreted from the body, the clotting factors and platelets should return to their previous levels.
3. Risperidone: Antipsychotic
Risperidone is an antipsychotic medication that is commonly prescribed to treat mild cases of schizophrenia, bipolar disorder, and ASD. While there is no reason to worry that the combination of risperidone and CBD will lead to life-threatening side effects, some users have reported severe anxiety attacks due to the combination.
Also, high doses of CBD could potentially lead to its prolonged activation. This is also the case for drugs like haloperidol, which is a similar antipsychotic medication of the same class. Ultimately, CBD has the potential to intensify the side effects associated with risperidone.
Moreover, antipsychotic medications are used as tranquilizers and are most effective in treating people who have hallucinations, psychotic episodes, and delusions associated with schizophrenia and other psychotic disorders. The way that CBD interacts with the enzyme cytochrome P450 is vital, as they can essentially deactivate each other.
4. 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 in both adults and children. In this same study, adults who were taking clobazam reported sedation more frequently.
Furthermore, a study conducted by Dr. Gaston and her team at the University of Alabama at Birmingham found that CBD could potentially alter the blood levels of commonly used antiepileptic drugs such as Clobazam. While it’s not fully understood why this happens, it is thought to be because CBD is a strong inhibitor of various enzymes in the human cytochrome P450 system.
Another interesting finding from one of the studies done on how CBD interacts with other medications revealed that when Clobazam is broken down, it may interact with CBD in some people resulting in fatigue and tiredness. Again, findings aren’t conclusive, but there does seem to be the possibility of negative effects when these two substances are used in conjunction with one another.
5. Nyquil: Cold and Flu relief
The problem here is actually with a substance called doxylamine, which is 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.
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, and since the liver is the primary detoxifying organ in the body, the action of blocking its enzymes can result in the possibility that over the counter drugs might not be effectively cleared from the system. This can significantly increase the chance of negative side effects.
6. HIV Antiretrovirals
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. For this reason, patients who start using CBD after using these medications are cautioned to start with a low dosage.
7. 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. Mixing Xanax and CBD may heighten the side effects of either or both substances, meaning you could experience severe drowsiness, concentration problems, or even confusion.
Also, keep in mind that the combination of CBD and Xanax could result in poor decision making. For example, you may be more likely to add alcohol to the mix, and consuming alcohol with Xanax can be very dangerous.
8. Buprenorphine: Pain Medication
Buprenorphine is an opioid pain medication that is thought to have a high potential for addiction. In high doses, this is a drug that could cause coma, respiratory distress, or even death. And when combined with CBD, the risk of these things is believed to increase as both substances are known to depress the central nervous system.
Cannabis and buprenorphine are both sedatives, which means that there is a high chance of becoming hypersedated when you combine the two. A list of drugs that contain buprenorphine includes: Bunavail, Probuphine, Butrans, Suboxone, and Belbuca among others. Symptoms to look out for are slowed speech, slowed or irregular heartbeat, difficulty controlling motor functions, or excessive sedation.
9. 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. In other words, it could make you more sensitive to a heart attack. This is especially true for individuals who have just started taking CBD and have not yet developed a tolerance. Even for regular consumers, CBD may slow down the heart rate.
In reality, beta blockers or other blood pressure medications can have opposite effects on the heart rate. For example Beta Blockers will reduce blood pressure but slow down the heart rate, and for regular consumers, there’s a chance that CBD will amplify the effects of the beta blockers by having an additive effect of slowing down the heart. Well-known beta blockers include Tenormin, Toprol-XL, Sectral, Bystolic, and Zebeta.
10. Sodium oxybate: anti-sleep medication
Sodium oxybate is an anti-sleep medication often used to treat narcolepsy. When combined with CBD, there is the risk of depressing the central nervous system to dangerous levels. In very severe cases, this could contribute to a coma. Other symptoms to look out for are depression, dizziness, low blood pressure, shallow breathing, and impaired motor function.
Final thoughts on Interaction between CBD and Other Medications
Always exercise caution when taking CBD along with other medications. While CBD is largely considered to be an incredibly 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.
And lastly, it is important to understand that we are not medical professionals, and thus 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.