CBD Drug Interactions You Need to Know About

September 25, 2020

Just over the past couple of years, we've learned a lot about CBD's therapeutic benefits. But as researchers complete ongoing studies and more people use it, we become aware of a possibility for drug interaction with CBD oil as well. If you're taking any medications, it's essential to understand how CBD may interact with drugs. Any substance you take has the potential to either intensify or counteract medications no matter how natural--Ashwagandha, Spirulina, Green Tea, Krill oil--it doesn't matter.

To understand how CBD can interact with medication, we'll look at how CBD works in your body.

What Is CBD Oil?

CBD oil is a combination of cannabidiol and a healthy carrier oil, such as coconut. Cannabidiol is one of the many cannabinoids found in cannabis and shown to have benefits for the human body and mind. Unlike THC, also found in cannabis, CBD doesn't cause psychotropic effects.

The CBD available in the US for sale comes from hemp, a type of cannabis that has insignificant amounts of THC. Any trace amounts can then be removed during processing.

What Does CBD Oil Do?

There is strong anecdotal and scientific evidence that CBD can help people do a lot of amazing things like better manage:

  • Stress, e.g. depression and anxiety
  • Sleep cycle, e.g. insomnia and awakeness
  • Pain
  • Inflammation, e.g. arthritis
  • Immune response, e.g. multiple sclerosis, IBS
  • Mood disorders
  • Epilepsy
  • Muscle recovery
  • And more

How Does CBD Oil Work?

In your body, you have something called a cannabinoid receptor. Actually, you have lots of them. Your body uses these receptors found on many types of cells to regulate balance in the body.

But it's not like physical balance, not falling over. This is the balance that helps your immune system fight infection without freaking out. It's the kind of balance you feel when you can stay calm in a tense situation.

CBD and THC both interact with these receptors but have very different effects. CBD increases balance. THC can disrupt it.

CBD is very similar to the neurotransmitters called endocannabinoids that your body produces to attach to the cannabinoid receptors and restore balance. So when you use CBD, you have more of these endocannabinoid-like substances to help you restore balance.

When you have chronic inflammation, pain that won't go away, mood swings, those are all signs of imbalance in your body. CBD can help restore a natural, healthy, balanced state.

How Does It Interact with the Body?

Why would drug interactions occur if something restores balance? Here's how that happens. There's an enzyme family called CYP450. These exist in the liver. They break down about 60% of medications. Doctors have to consider this when they decide what dose you need. They have to account for the fact that your liver is going to break it down and either store it or flush it out. Doctors also know that it takes a certain amount of time for this to happen. When a doctor says, "take this twice a day", that's because it takes about 12 hours for the liver to break down the medication.

Do you see where we're going here? What would happen if you took something that either slowed down or sped up how fast those enzymes break down a prescribed medication?

Now, you have a drug interaction.

CBD slows down CYP450, so medicine stays in your system longer. As an aside, grapefruit actually does the same thing, so this is common in nature. St. John's Wart has the opposite effect, speeding up this breakdown.

So CBD may impact how much of a particular drug you need. It can make drugs that CYP450 metabolizes more or less effective. Be advised: you should never, ever adjust your own dosing. Always talk to the prescribing doctor.

What Drugs Should Be Not Be Taken with CBD? 

CYP450 breaks down the following drugs, so you should generally not take CBD if you take any of these:

  • Antipsychotics: e.g. clozapine, risperidone
  • Beta-blockers: e.g. bisoprolol, propranolol
  • Antihistamines: e.g. loratadine, cetirizine
  • HIV antivirals: e.g. tenofovir, atazanavir
  • Steroids: e.g. hydrocortisone, prednisone
  • Prokinetics: e.g. metoclopramide, domperidone
  • HMG CoA reductase inhibitors: e.g. Lipitor, Zocor, Crestor
  • Immune modulators: e.g. antimetabolites, calcineurin inhibitors
  • Calcium channel blockers: e.g. amlodipine, diltiazem
  • Benzodiazepines: e.g. Xanax, valium, lorazepam
  • PPIs: e.g. omeprazole, lansoprazole
  • Antiarrhythmics: e.g. amiodarone, flecainide
  • Anti-epileptics: e.g. acetazolamide, clonazepam
  • Antibiotics: e.g. amoxicillin, doxycycline
  • Sulfonylureas: e.g. Amaryl, Tolinase
  • Oral hypoglycemic agents: e.g. repaglinide, glipizide
  • Antidepressants: e.g. sertraline, citalopram
  • Anesthetics: e.g. amobarbital, diazepam
  • NSAIDs: e.g. aspirin, diclofenac
  • Angiotensin II blockers: e.g. candesartan, valsartan

What Medications Can be Taken with CBD?

The above seems like a long list. But it definitely doesn't include all medications. Speak with your doctor if you're thinking about taking CBD and think you may be taking something that will interact. They may adjust your dosing. Or they may want to runs some tests.

Melatonin is an example of a drug that doesn't interact with CBD. Taking melatonin with CBD is generally safe. They can be very useful together.

Which CBD Product Is Right for Me? 

Different CBD products can have varied effects. For example, some broad-spectrum CBD products have naturally occurring terpenes. Some terpenes promote wakefulness. Others encourage relaxation and sleep. These can enhance the effects of CBD in one direction or the other. So if you are buying CBD for a specific purpose, you should consider the terpenes in it. Not all brands will tell you this.

Additionally, how you take, it can cause different effects. If you want localized effects for pain, muscle recovery, or inflammation, topical products work best because they deliver the CBD right where you need it. But if you're looking for whole body/mind balance, then taking CBD orally or sublingually may be a better choice for you.

If you prefer a dynamic CBD experience, you might choose to smoke a CBD flower, which has more pronounced effects.

All of this comes down to bioavailability. Taking CBD in specific ways makes it more available for your body to use now. CBD through the lungs, skin, or under the tongue is quickly accessible. Swallowing CBD means that some CBD will be processed through the liver, so it takes longer to feel the effects. But it tends to offer more sustained results if you take CBD regularly.

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