Cannabis is complex, with many chemicals and more than 100 cannabinoids.
There is little evidence that cannabidiol, CBD the second most commonly found cannabinoid in cannabis, has health benefits.
The key question is “How will CBD interact my current medication?”
This question is best answered by a medical professional, but based on international research and studies, we have put together a list of the medications you should be aware of when taking CBD oil, or other CBD products.
There is limited research suggesting that CBD may cause interactions with prescription drugs.
These findings are not conclusive. Further research is needed to determine how CBD interacts with other medications.
Researchers and doctors advise anyone using CBD to be cautious when mixing it with prescriptions for medical or recreational purposes.
They also recommend that they consult their healthcare providers about potential interactions.
Doctors advise people who use CBD to be careful about mixing it with prescriptions. They should also consult their healthcare providers to ensure that they are not in any way interacting.
Most information and research available for CBD and its interaction with medications & drugs are from North America. We will be citing American & Australian sources.
CBD interaction with medications & drugs
The grapefruit test is a common term.
Grapefruit warnings are included on prescription medications. They warn against the consumption of citrus fruits while taking medication.
A group of proteins known as cytochrome P450 enzymes (CYPs), is responsible for the breakdown of many medications in the liver and small intestine.
This is how a medication delivers its benefits to the intended target.
Grapefruit can disrupt the activity of CYPs, and slow down the process by which these proteins normally break down medication.
Grapefruit can also increase side effects and the time that the drug remains in the system.
A 2013 study entitled “Grapefruit Medication Interactions: Forbidden Fruits or Avoidable Consequences?” was published in the Canadian Medical Association Journal.
It showed that grapefruit could increase blood sugar levels when it interacts with at least 85 other drugs.
These reported effects included irregular heartbeats, death, organ failure, internal bleeding and even death.
A 1993 study by pharmacology experts at the University of California San Francisco revealed that CBD, similar to grapefruit, interferes with the normal function of cytochrome P450 enzymes. This study suggested that although patients could be allowed to take lower dosages of their prescriptions, the blockage could cause toxic buildup in the body.
Numerous scientific and medical journals published evidence that CBD has grapefruit-like effects in humans since the publication of this study.
How CBD interacts with your body will depend on the quality and purity of CBD that you use.
How CBD interacts with your body depends on when you take it and taking prescription drugs. Every person reacts differently to medication due to genetics, age, and weight.
How CBD interacts with your body will depend on how high quality and pure it is.
You can find CBD (cannabidiol), oils, tinctures and pills everywhere.
The main ingredient in hemp (a type of cannabis plant) is CBD.
Marijuana, a different type of cannabis plant, has CBD, but high levels of THC (tetrahydrocannabinol), which is an intoxicating chemical known to cause users to feel “stoned” or high.
CreakyJoints research showed that 52 per cent of respondents had tried CBD for medical reasons. 93% of those who tried CBD said that it helped.
Over half of respondents said they needed more information about CBD. However, 58 per cent of respondents who disclosed their CBD use to their doctors did not receive the necessary safety, effectiveness, and dosage information.
People with chronic illnesses who use CBD are often concerned about whether CBD could cause side effects to prescription drugs for arthritis and other conditions.
What drug interactions could CBD have with other drugs?
Many medications, including CBD, are broken down by the same family of liver enzymes called CYP450.
CBD blocks some enzymes within this family. If your doctor does not adjust the dosage, this can cause them to break down drugs more slowly.
On the other hand, CBD stimulates other enzymes within this family, which speed up the breakdown of certain drugs.
This could make them less effective if the dose is increased.
You may experience side effects such as increased nausea and vomiting if CBD is combined with other drugs.
There is still much uncertainty regarding how CBD interacts with drug-metabolizing proteins in the body.
Let’s take a look at the latest research regarding CBD’s interactions with various prescription and over-the-counter medications.
Do I need to take CBD along with ibuprofen
Ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID), reduces inflammation and pain in the body. Ibuprofen can cause blood loss and dizziness.
CBD could potentially increase the strength and duration of ibuprofen.
This can lead to adverse side effects. CBD interaction with NSAIDs has not been studied in humans.
Two studies on animals in 2008 and 2006, published in Pain and Pharmacology respectively, show that CBD may be able to work in conjunction with NSAIDs such as ibuprofen in pain relief.
Before taking ibuprofen containing CBD, patients should consult their healthcare provider.
Do I need to take CBD along with warfarin
Warfarin (also known as Coumadin) is an anticoagulant.
This medication prevents the formation of blood clots which could lead to strokes or heart attacks. Warfarin can cause severe bleeding, headaches and swelling.
Researchers at the University of Alabama in Birmingham published a 2017 study in Epilepsy and Behavior Case Reports that showed CBD could increase blood-thinning drugs by slowing down the body’s metabolization of warfarin and prolonging its existence in the system.
CBD may increase the amount of warfarin in the body and possibly worsen some of the risks.
Patients who are taking Coumadin or generic warfarin should consult their healthcare provider to get individualized information. Before beginning a CBD regimen, they should also have blood tests.
Can I combine CBD with thyroid medication?
Thyroid medication can be used to treat thyroid diseases.
Most commonly, hypothyroidism is an underactive thyroid.
This can be treated with thyroid hormone replacement or hyperthyroidism via anti-thyroid medication.
These goals can be achieved by different medications using different pathways within the body.
Thyroid hormone replacement therapies can cause chest pain, anxiety, headaches, vomiting, and other side effects.
Side effects of anti-thyroid medications can be rare but include itching, fever and headaches.
There is very little research on CBD interactions with common anti-thyroid medication and thyroid hormone replacement medications.
Patients on thyroid medication should consult their doctor if they are interested in CBD.
Do I need to take CBD with Eliquis
Eliquis (also known as apixaban) is a blood thinner that lowers the risk of stroke.
It also helps prevent blood clots in the veins, heart, lungs and legs after knee or hip replacement surgery. Eliquis can increase the risk of severe bleeding. Patients taking Eliquis will usually be prescribed a specific dosage by their doctor.
CYP proteins, which process Eliquis in the liver, are the same proteins that CBD works to delay metabolization. This could lead to an overdose of Eliquis chemicals and severe bleeding.
Before using CBD products, patients who take Eliquis should consult their doctor.
Do I need to take CBD with Plavix
Plavix, the drug Clopidogrel brand name, is often prescribed to patients who have suffered or are likely from a heart attack.
This drug prevents blood platelets (blood platelets) from forming clots near the heart.
A 2011 study published by the journal Life Sciences suggests that CBD may have an inhibitory effect upon CYP2C19, the enzyme responsible for metabolizing Plavix.
This could lead to Plavix remaining longer in the body, and possibly weakening its overall effects. Plavix’s ability to prevent heart attacks is subject to further research.
Plavix and Clopidogrel patients should talk to their doctors about CBD.
Do I need CBD and Tylenol?
Acetaminophen is the generic name of Tylenol.
It is a common medication used to relieve fever and pain. Acetaminophen can cause liver damage and other diseases. Side effects include nausea, headaches and insomnia.
Both Acetaminophen (and CBD) are metabolized in the body by CYP450. This reduces their effectiveness.
A controversial 2019 study by the University of Arkansas, on mice, found that CBD high levels could cause liver toxicity.
Further research is needed to confirm possible interactions between CBD oil and acetaminophen. Patients who wish to take both should consult their doctor.
Do I need to take CBD along with metoprolol
Metoprolol, a beta-blocker, is used to lower blood pressure. It also changes the release of epinephrine (a hormone that plays a role in stress and other processes). Side effects of beta-blockers can include dizziness, nausea and stomach pain.
Potential interactions between CBD oil and metoprolol have not been studied.
A placebo-controlled study on healthy individuals at the University of Nottingham, England published in 2017 in JCI Insight found that CBD can reduce blood pressure when taken alone. However, patients who are taking metoprolol may experience negative effects from CBD combined with it.
A 2011 study on mice published in The British Journal of Pharmacology shows that CBD may have potential nausea-reducing properties. This could help to soothe the side effects of metoprolol.
Patients who are taking beta-blockers or metoprolol should talk to their doctor about CBD.
Do I need to take CBD along with metformin
Metformin is a medication that is prescribed to type 2 diabetics to control their blood sugar. Metformin side effects include low blood sugar, muscle pain, diarrhea, vomiting and nausea.
A 2006 study published by the journal Autoimmunity found that CBD decreased the incidence of diabetes in animal models. However, there has been very little research on CBD’s role in diabetes treatment and interactions with metformin.
One study by the American Diabetes Association, published in 2016 in Diabetes Care, examined CBD’s effectiveness in type 2 diabetes patients. It found no significant effect on glucose levels.
CBD and diabetes interactions require more research. Metformin patients should speak to their doctor about CBD.
Can I take CBD with Xanax or Alprazolam
Xanax, also known as alprazolam, is a benzodiazepine medication that’s used to treat panic disorders and anxiety. Xanax can cause drowsiness and memory loss.
CYP3A4, an enzyme that breaks down Xanax in the liver, is blocked by CBD. CBD can prolong the time Xanax stays in the body and increase or decrease the chance of side effects.
CBD could one day be considered an option to Xanax. Numerous studies, including a 2011 study published by Neuropsychopharmacology have documented CBD’s potential anti-anxiety effects.
There have been no studies that explicitly show CBD and Xanax interactions. For more information on CBD, patients taking Xanax should consult their healthcare providers.
Do I need to take CBD along with statins or not?
Statins are a class of drugs that lower cholesterol and protect you from heart attack and stroke. Statins can cause muscle soreness, blood sugar rise, headaches, nausea, and other side effects.
The liver processes statins by CYP function, which CBD inhibits.
Although no studies have been done to examine interactions between CBD and statins, it is possible that CBD could increase statin strength and duration and reduce the chance of side effects.
Before using CBD, patients who are taking statins must consult their healthcare provider.
Should you avoid CBD when taking other drugs or medications?
Medicinal CBD oil is legally available in Australia, and even though you can purchase it over the counter, you should still consult a medical professional about the use of CBD product with other medications.
CBD has been shown to affect the liver positively and can be used in combination with other medications.
CBD interacts with the same metabolites that grapefruit, so many prescription drugs may be at risk when CBD is combined with them. CBD acts on the same metabolites as grapefruit, so many prescription drugs that carry warning labels for grapefruit may have similar risks when taken with CBD.
CBD is the same metabolite as grapefruit, so many prescription drugs with grapefruit warning labels could have similar risks when CBD is added to them.
These drug classifications cover a large number of prescriptions such as benzodiazepines and antihistamines, haloperidol and antiretrovirals. They also include statins and statins.
Although no research has been conclusively done to warn patients against CBD-containing drugs, the 2013 Canadian Medical Association Journal study that showed grapefruit and drug interactions could cause severe side effects including sudden death, muscle damage, kidney failure, irregular heartbeat, and sudden death has been cited.
Each patient is different, so it is important to speak with your healthcare provider if you are thinking of taking CBD along with prescription drugs.
How does CBD oil impact blood pressure?
An 2017 study entitled “A single dose cannabidiol lowers blood pressure in healthy volunteers in an randomized crossover study”, published in JCI
Insight, supports CBD’s ability to lower blood pressure. Research suggests that CBD’s anxiety- and stress-reducing qualities may also contribute to lower blood pressure. But, CBD when taken with beta-blockers or blood pressure medication could cause the drugs to interact and lead to increased blood pressure.
Is CBD oil able to thin the blood?
There is no evidence that CBD oil can be taken alone to thin the blood. CBD oil can increase blood-thinning drugs like warfarin and may even cause it to be more effective than therapeutic levels, according to the 2017 Epilepsy & Behavior case report.
Can caffeine be used to counter CBD?
Two substances that are gaining popularity are CBD and caffeine. Caffeine is known to keep people who are sleep-deprived alert and clear-headed. A 2007 study of rats revealed that caffeine is metabolized using CYP enzymes.
CBD inhibits this process. This could prolong the duration of caffeine’s stay in the body and increase caffeine’s stimulating effects.
This article contains current research that should not be taken as medical advice. If you have any questions about your CBD or medication, please consult your doctor.
Conclusion: CBD oil and other medications
Here is a brief list of medications that you should speak to a medical professional about when seeking therapeutic treatment for CBD oil.
Corticosteroids and steroids: Hydrocortisone (or cortisone), prednisone or triamcinolone, and dexamethasone are some examples
HMG CoA inhibitors(statins): For example, atorvastatin or fluvastatin.
Calcium channel blockers: For example, amlodipine (diltiazem), felodipine (felodipine), nicardipine and nifedipine (nisoldipine)
Antihistamines: Brompheniramine is an example. Cetirizine, chlorpheniramine and diphenhydramine are all available.
Prokinetics: (motility drugs), such as domperidone and metoclopromide.
Antivirals for HIV: Abacavir, didanosine and emtricitabine are some examples.
Immune modulators: For example, immune globulins and immunosuppressive drugs and immunostimulants such as bacterial and virus vaccines.
Benzodiazepines: Alprazolam, Clobazam and Clonazepam are all examples.
Antiarrythmics: For example, amiodarone and flecainide, propafenone and propafenone.
Antibiotics: For example, cephalexin and amoxicillin.
Anesthesia: For example, barbiturates and methohexital., thiamylal., ketamine., propofol.
Antipsychotics: For example, aripiprazole (asenapine), cariprazine and clozapine.
Antidepressants: For example, citlopram, escitalopram and fluoxetine.
Anticonvulsants/Anti-Seizure Medicines: For example, acetazolamide and carbamazepine.
Beta-blockers: For example, acebutolol (atenolol), betaxolol/betaxolol fumarate, bisoprolol fumarate, bisoprolol fumarate, bisoprolol fumarate, carvedilol, metoprolol, nadolol, nebivolol, penbutolol, propranol, etc.
Proton-Pump Inhibitors, (PPIs): For example, omeprazole (lansoprazole), pantoprazole (pantoprazole), rabeprazole esomeprazole or dexlansoprazole
Non-Steroidal Anti Inflammatory Drugs (NSAIDs): For example, celecoxib and aspirin.
Angiotension II Blockers: For example, azilsartan or candesartan; eprosartan; irbesartan; losartan; olmesartan; telmisartan.
Oral Hypoglycemic Drugs: For example, sulfonylureas. meglitinides. biguanides. thiazolidinediones. a-Glucosidase inhibits. DPP-4 inhibitors. SGLT2 inhibitors. cycloset.
Sulfonylureas: For example, glynase or micronase.
Why you should always speak to your doctor first
This list is not exhaustive and may not contain all medications that CBD could interact with. Not all medications listed above can cause an interaction with CBD. However, it is a good idea to be cautious if you take one of these drugs.
Before using any CBD oil or product, consult your doctor.
Your doctor can not only advise you about possible CBD-drug interactions but also monitor the side effects and therapeutic effects of CBD oil and medications.
Your doctor can also adjust the dosages for both CBD and medicine to ensure you can take them both safely.
Study after study has shown that CBD is safe and well-tolerated. It also rarely causes any side effects. CBD has a powerful effect on many systems in the body.
This is why it is such a helpful therapeutic agent for so many ailments. It is essential to keep in mind that CBD can interact with other drugs, so it should be taken with caution.
James is an experienced writer and legal cannabis advocate in Australia. He answers all the questions about business, legalisation and medicinal cannabis.
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