CBD And Drug Interaction: What You Need to Know

Table of Contents

CBD, short for cannabidiol, is a naturally occurring compound found in the cannabis plant. It has gained immense popularity in recent years due to its potential benefits, including pain relief, stress reduction, and improved sleep.
However, despite its numerous therapeutic properties, CBD can interact with other drugs in potentially harmful ways.
In this article, we will explore the various interactions between CBD and other drugs and provide a comprehensive table listing the most common drugs that interact with CBD.

Understanding CBD and Drug Interactions

CBD is metabolized in the liver by a group of enzymes collectively known as cytochrome P450 (CYP450).
These enzymes are responsible for breaking down many medications in the body, including over-the-counter drugs, prescription medications, and even some herbal supplements. When CBD is introduced into the body, it can inhibit the CYP450 enzymes, which can alter the metabolism of other drugs, leading to potentially harmful drug interactions.

Furthermore, many drugs are metabolized by the same CYP450 enzymes that CBD inhibits, which means that co-administration of these drugs with CBD can lead to increased blood levels of the drugs, potentially resulting in adverse effects.

CBD and Grapefruit: A Surprising Drug Interaction

CBD and grapefruit share a common metabolic pathway in the liver,
which means that they can interact with many of the same drugs.
In fact, the interaction between grapefruit and certain medications is so well-known that it has been dubbed the “grapefruit effect.”
Like grapefruit, CBD can also inhibit the CYP450 enzymes in the liver, leading to increased blood levels of certain medications.

Common Medications That Interact With CBD

The table below provides a list of common drugs that interact with CBD.
This list is not exhaustive, and there may be other medications that can interact with CBD that are not included here. It is important to speak with your healthcare provider before taking any new medications, including CBD, to ensure that they are safe to use together.

Disclaimer: This article is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional before making any changes to your medications or health regimen

Drug ClassDrug NameWhat it's Used to TreatRisk Level
AmphetaminesDextroamphetamine, Levoamphetamine, MethamphetamineADHD, narcolepsyHigh
Angiotensin II Receptor BlockersLosartan PotassiumHigh blood pressure, diabetic kidney diseaseModerate
Anti-anxietyBuspironeAnxietyModerate
AntiarrhythmicsAmiodarone HydrochlorideIrregular heartbeatModerate
AntiarrhythmicsDronedaroneIrregular heartbeatModerate
AntiarrhythmicsDofetilideIrregular heartbeatModerate
AntiarrhythmicsDisopyramide (Norpace)Irregular heartbeatModerate
AntiarrhythmicsPropafenone HydrochlorideIrregular heartbeatModerate
AntiarrhythmicsQuinidineIrregular heartbeatModerate
AntibioticsCiprofloxacinBacterial infectionsModerate
AntibioticsLevofloxacinBacterial infectionsModerate
AntibioticsDoxycycline HydrochlorideBacterial infectionsLow
AnticoagulantsWarfarin SodiumBlood clotsModerate
AnticonvulsantsCarbamazepineSeizures, nerve painModerate
AntidepressantsSertralineDepression, anxietyModerate
AntidepressantsFluvoxamine MaleateObsessive-compulsive disorderModerate
AntidepressantsAmitriptyline HydrochlorideDepression, nerve painModerate
Antidiabetic AgentsRepaglinideType 2 diabetesModerate
Antifungal agentsKetoconazoleFungal infectionsHigh
AntifungalsItraconazoleFungal infectionsModerate
AntihistaminesAstemizole, TerfenadineAllergiesHigh
AntiparasiticPraziquantelParasitic infectionsModerate
Antiplatelet agentClopidogrelBlood clot preventionModerate
AnxiolyticsBuspirone HydrochlorideAnxietyModerate
Aromatase inhibitorsLetrozoleBreast cancerModerate
BenzodiazepinesClonazepam (Klonopin)Anxiety, seizures, panic disorderModerate
BenzodiazepinesNitrazepam, Alprazolam, QuazepamAnxiety, insomnia, seizuresModerate
BenzodiazepinesClobazamAnxiety, seizuresModerate
BenzodiazepinesDiazepamAnxiety, seizures, muscle spasmsModerate
BenzodiazepinesMidazolamSedation, anesthesiaHigh
BenzodiazepinesTriazolamInsomniaHigh
Beta-blockersCarvedilolHigh blood pressure, heart failureModerate
ButyrophenonesHaloperidolPsychotic disordersModerate
Calcium Channel BlockersAmlodipineHigh blood pressure, anginaModerate
Calcium Channel BlockersDiltiazem HydrochlorideHigh blood pressure, anginaModerate
Calcium Channel BlockersFelodipineHigh blood pressureModerate
Calcium Channel BlockersNifedipineHigh blood pressure, anginaModerate
Calcium Channel BlockersVerapamil HydrochlorideHigh blood pressure, anginaModerate
Calcium channel blockersMibefradil, Verapamil Hydrochloride, NimodipineHigh blood pressure, migraines, subarachnoid hemorrhageHigh
Calcium channel blockersMibefradilHigh blood pressure, migraines, subarachnoid hemorrhageHigh
Calcium channel blockersNimodipineHigh blood pressure, migraines, subarachnoid hemorrhageHigh
Cardiac GlycosidesDigoxinHeart failure, atrial fibrillationModerate
DE4 InhibitorsApremilastPsoriasis, psoriatic arthritisModerate
Epidermal Growth Factor Receptor InhibitorsErlotinibNon-small cell lung cancer, pancreatic cancerModerate
Erectile Dysfunction AgentsSildenafilErectile dysfunctionModerate
Erectile Dysfunction AgentsTadalafilErectile dysfunctionModerate
Ergot alkaloidsErgotamineMigrainesHigh
HMG-CoA reductase inhibitors (statins)SimvastatinHigh cholesterolModerate
HormonesASTROGENHormone replacement therapyModerate
HormonesTestosterone EstersHormone replacement therapy, hypogonadismModerate
HormonesEstrogensHormone replacement therapyModerate
ImmunosuppressantsCyclosporinOrgan transplant rejectionHigh
ImmunosuppressantsTacrolimusOrgan transplant rejection, autoimmune diseasesHigh
Kinase InhibitorsImatinibChronic myelogenous leukemiaModerate
Macrolide antibioticsClarithromycinBacterial infectionsModerate
Macrolide antibioticsErythromycinBacterial infectionsModerate
Nitroimidazole AntibioticsMetronidazoleBacterial infections, parasitic infectionsModerate
Opioid AnalgesicsOxycodone HydrochlorideModerate to severe painModerate
OpioidsMethadonePain management, opioid dependenceModerate
OpioidsBuprenorphine HydrochlorideModerate to severe pain, opioid addiction treatmentModerate
OpioidsCodeine PhosphateMild to moderate painModerate
Protease inhibitorsRitonavirHIVHigh
Proton Pump InhibitorsEsomeprazoleGERD, ulcersModerate
Proton Pump InhibitorsOmeprazoleGastroesophageal reflux disease, ulcersModerate
Selective Estrogen Receptor ModulatorsTamoxifen CitrateBreast cancerModerate
StatinsAtorvastatinHigh cholesterolModerate
StatinsFluvastatinHigh cholesterolModerate
StatinsLovastatinHigh cholesterolHigh
Tricyclic antidepressantsClomipramineDepression, OCDModerate
BronchodilatorTheophyllineAsthma, chronic obstructive pulmonary disease (COPD)Moderate
Hormone Replacement TherapyEstrogenMenopausal symptoms, osteoporosisHigh

Amphetamines

Drug Name: Dextroamphetamine, Levoamphetamine, Methamphetamine

What it's Used to Treat: ADHD, narcolepsy

Risk Level: High

Angiotensin II Receptor Blockers

Drug Name: Losartan Potassium

What it's Used to Treat: High blood pressure, diabetic kidney disease

Risk Level: Moderate

Anti-anxiety

Drug Name: Buspirone

What it's Used to Treat: Anxiety

Risk Level: Moderate

Antiarrhythmics

Drug Name: Amiodarone Hydrochloride

What it's Used to Treat: Irregular heartbeat

Risk Level: Moderate

Antiarrhythmics

Drug Name: Dronedarone

What it's Used to Treat: Irregular heartbeat

Risk Level: Moderate

Antiarrhythmics

Drug Name: Dofetilide

What it's Used to Treat: Irregular heartbeat

Risk Level: Moderate

Antiarrhythmics

Drug Name: Disopyramide (Norpace)

What it's Used to Treat: Irregular heartbeat

Risk Level: Moderate

Antiarrhythmics

Drug Name: Propafenone Hydrochloride

What it's Used to Treat: Irregular heartbeat

Risk Level: Moderate

Antiarrhythmics

Drug Name: Quinidine

What it's Used to Treat: Irregular heartbeat

Risk Level: Moderate

Antibiotics

Drug Name: Ciprofloxacin

What it's Used to Treat: Bacterial infections

Risk Level: Moderate

Antibiotics

Drug Name: Levofloxacin

What it's Used to Treat: Bacterial infections

Risk Level: Moderate

Antibiotics

Drug Name: Doxycycline Hydrochloride

What it's Used to Treat: Bacterial infections

Risk Level: Low

Anticoagulants

Drug Name: Warfarin Sodium

What it's Used to Treat: Blood clots

Risk Level: Moderate

Anticonvulsants

Drug Name: Carbamazepine

What it's Used to Treat: Seizures, nerve pain

Risk Level: Moderate

Antidepressants

Drug Name: Sertraline

What it's Used to Treat: Depression, anxiety

Risk Level: Moderate

Antidepressants

Drug Name: Fluvoxamine Maleate

What it's Used to Treat: Obsessive-compulsive disorder

Risk Level: Moderate

Antidepressants

Drug Name: Amitriptyline Hydrochloride

What it's Used to Treat: Depression, nerve pain

Risk Level: Moderate

Antidiabetic Agents

Drug Name: Repaglinide

What it's Used to Treat: Type 2 diabetes

Risk Level: Moderate

Antifungal agents

Drug Name: Ketoconazole

What it's Used to Treat: Fungal infections

Risk Level: High

Antifungals

Drug Name: Itraconazole

What it's Used to Treat: Fungal infections

Risk Level: Moderate

Antihistamines

Drug Name: Astemizole, Terfenadine

What it's Used to Treat: Allergies

Risk Level: High

Antiparasitic

Drug Name: Praziquantel

What it's Used to Treat: Parasitic infections

Risk Level: Moderate

Antiplatelet agent

Drug Name: Clopidogrel

What it's Used to Treat: Blood clot prevention

Risk Level: Moderate

Anxiolytics

Drug Name: Buspirone Hydrochloride

What it's Used to Treat: Anxiety

Risk Level: Moderate

Aromatase inhibitors

Drug Name: Letrozole

What it's Used to Treat: Breast cancer

Risk Level: Moderate

Benzodiazepines

Drug Name: Clonazepam (Klonopin)

What it's Used to Treat: Anxiety, seizures, panic disorder

Risk Level: Moderate

Benzodiazepines

Drug Name: Nitrazepam, Alprazolam, Quazepam

What it's Used to Treat: Anxiety, insomnia, seizures

Risk Level: Moderate

Benzodiazepines

Drug Name: Clobazam

What it's Used to Treat: Anxiety, seizures

Risk Level: Moderate

Benzodiazepines

Drug Name: Diazepam

What it's Used to Treat: Anxiety, seizures, muscle spasms

Risk Level: Moderate

Benzodiazepines

Drug Name: Midazolam

What it's Used to Treat: Sedation, anesthesia

Risk Level: High

Benzodiazepines

Drug Name: Triazolam

What it's Used to Treat: Insomnia

Risk Level: High

Beta-blockers

Drug Name: Carvedilol

What it's Used to Treat: High blood pressure, heart failure

Risk Level: Moderate

Butyrophenones

Drug Name: Haloperidol

What it's Used to Treat: Psychotic disorders

Risk Level: Moderate

Calcium Channel Blockers

Drug Name: Amlodipine

What it's Used to Treat: High blood pressure, angina

Risk Level: Moderate

Calcium Channel Blockers

Drug Name: Diltiazem Hydrochloride

What it's Used to Treat: High blood pressure, angina

Risk Level: Moderate

Calcium Channel Blockers

Drug Name: Felodipine

What it's Used to Treat: High blood pressure

Risk Level: Moderate

Calcium Channel Blockers

Drug Name: Nifedipine

What it's Used to Treat: High blood pressure, angina

Risk Level: Moderate

Calcium Channel Blockers

Drug Name: Verapamil Hydrochloride

What it's Used to Treat: High blood pressure, angina

Risk Level: Moderate

Calcium channel blockers

Drug Name: Mibefradil, Verapamil Hydrochloride, Nimodipine

What it's Used to Treat: High blood pressure, migraines, subarachnoid hemorrhage

Risk Level: High

Calcium channel blockers

Drug Name: Mibefradil

What it's Used to Treat: High blood pressure, migraines, subarachnoid hemorrhage

Risk Level: High

Calcium channel blockers

Drug Name: Nimodipine

What it's Used to Treat: High blood pressure, migraines, subarachnoid hemorrhage

Risk Level: High

Cardiac Glycosides

Drug Name: Digoxin

What it's Used to Treat: Heart failure, atrial fibrillation

Risk Level: Moderate

DE4 Inhibitors

Drug Name: Apremilast

What it's Used to Treat: Psoriasis, psoriatic arthritis

Risk Level: Moderate

Epidermal Growth Factor Receptor Inhibitors

Drug Name: Erlotinib

What it's Used to Treat: Non-small cell lung cancer, pancreatic cancer

Risk Level: Moderate

Erectile Dysfunction Agents

Drug Name: Sildenafil

What it's Used to Treat: Erectile dysfunction

Risk Level: Moderate

Erectile Dysfunction Agents

Drug Name: Tadalafil

What it's Used to Treat: Erectile dysfunction

Risk Level: Moderate

Ergot alkaloids

Drug Name: Ergotamine

What it's Used to Treat: Migraines

Risk Level: High

HMG-CoA reductase inhibitors (statins)

Drug Name: Simvastatin

What it's Used to Treat: High cholesterol

Risk Level: Moderate

Hormones

Drug Name: ASTROGEN

What it's Used to Treat: Hormone replacement therapy

Risk Level: Moderate

Hormones

Drug Name: Testosterone Esters

What it's Used to Treat: Hormone replacement therapy, hypogonadism

Risk Level: Moderate

Hormones

Drug Name: Estrogens

What it's Used to Treat: Hormone replacement therapy

Risk Level: Moderate

Immunosuppressants

Drug Name: Cyclosporin

What it's Used to Treat: Organ transplant rejection

Risk Level: High

Immunosuppressants

Drug Name: Tacrolimus

What it's Used to Treat: Organ transplant rejection, autoimmune diseases

Risk Level: High

Kinase Inhibitors

Drug Name: Imatinib

What it's Used to Treat: Chronic myelogenous leukemia

Risk Level: Moderate

Macrolide antibiotics

Drug Name: Clarithromycin

What it's Used to Treat: Bacterial infections

Risk Level: Moderate

Macrolide antibiotics

Drug Name: Erythromycin

What it's Used to Treat: Bacterial infections

Risk Level: Moderate

Nitroimidazole Antibiotics

Drug Name: Metronidazole

What it's Used to Treat: Bacterial infections, parasitic infections

Risk Level: Moderate

Opioid Analgesics

Drug Name: Oxycodone Hydrochloride

What it's Used to Treat: Moderate to severe pain

Risk Level: Moderate

Opioids

Drug Name: Methadone

What it's Used to Treat: Pain management, opioid dependence

Risk Level: Moderate

Opioids

Drug Name: Buprenorphine Hydrochloride

What it's Used to Treat: Moderate to severe pain, opioid addiction treatment

Risk Level: Moderate

Opioids

Drug Name: Codeine Phosphate

What it's Used to Treat: Mild to moderate pain

Risk Level: Moderate

Protease inhibitors

Drug Name: Ritonavir

What it's Used to Treat: HIV

Risk Level: High

Proton Pump Inhibitors

Drug Name: Esomeprazole

What it's Used to Treat: GERD, ulcers

Risk Level: Moderate

Proton Pump Inhibitors

Drug Name: Omeprazole

What it's Used to Treat: Gastroesophageal reflux disease, ulcers

Risk Level: Moderate

Selective Estrogen Receptor Modulators

Drug Name: Tamoxifen Citrate

What it's Used to Treat: Breast cancer

Risk Level: Moderate

Statins

Drug Name: Atorvastatin

What it's Used to Treat: High cholesterol

Risk Level: Moderate

Statins

Drug Name: Fluvastatin

What it's Used to Treat: High cholesterol

Risk Level: Moderate

Statins

Drug Name: Lovastatin

What it's Used to Treat: High cholesterol

Risk Level: High

Tricyclic antidepressants

Drug Name: Clomipramine

What it's Used to Treat: Depression, OCD

Risk Level: Moderate

Bronchodilator

Drug Name: Theophylline

What it's Used to Treat: Asthma, chronic obstructive pulmonary disease (COPD)

Risk Level: Moderate

Hormone Replacement Therapy

Drug Name: Estrogen

What it's Used to Treat: Menopausal symptoms, osteoporosis

Risk Level: High

** It is important to note that the potential interactions listed in the table above are not absolute,
and the degree of interaction can vary depending on the individual and the specific drugs.

Risks and Side Effects of CBD and Drug Interactions

While CBD can have many potential health benefits, there are some risks and side effects associated with combining CBD with other medications. These include:

  1. Increased risk of side effects: When CBD interacts with other medications, it can increase the risk of side effects, including dizziness, nausea, and fatigue.
  2. Changes in medication effectiveness: CBD can also affect the effectiveness of certain medications, making them less effective.
  3. Potential for drug toxicity: In some cases, CBD can increase the levels of medication in the bloodstream, which can lead to drug toxicity.

How to Minimize the Risk of CBD and Drug Interactions

To minimize the risk of adverse drug interactions with CBD, it is important to speak with your healthcare provider before taking any new medications, including CBD.
Your healthcare provider can provide guidance on whether it is safe to use CBD with your current medications and recommend any necessary adjustments to your medication regimen.

Who is most at risk for CBD interactions?

While anyone taking medication should be aware of the potential for drug interactions, there are some groups of people who may be at higher risk for CBD interactions:

  1. Individuals taking multiple medications: Those who take multiple medications are more likely to experience drug interactions in general, including those with CBD.
  2. People with liver or kidney disease: CBD is metabolized in the liver and excreted through the kidneys, so those with liver or kidney disease may have difficulty processing CBD, leading to an increased risk of side effects or interactions.
  3. Elderly individuals: The elderly are more likely to be taking multiple medications and may also have age-related declines in liver and kidney function, making them more vulnerable to CBD interactions.
  4. Children: CBD is not typically recommended for use in children, but for those who do use it, they may be at increased risk for interactions due to differences in how their bodies process medications compared to adults. It’s important to consult with a pediatrician before giving any medication to a child, including CBD.

Does the CBD consumption method matter?

CBD can be consumed in a variety of ways, including via tinctures, oils, edibles, and topicals. Each consumption method offers its own benefits and drawbacks with regard to the speed at which CBD takes effect. While it is not always easy to predict how an individual might react to a specific form of CBD consumption, it is important to be mindful of possible drug interactions.

Inhaled forms of CBD, such as smoking or vaping, are more likely to reach high concentrations quickly than edibles. However, it is important to note that these inhalation methods may have a greater potential for possible drug interactions due to the higher concentration of the medication entering the bloodstream.
On the other hand, topical formulations are unlikely to absorb into the bloodstream enough to interact with other medications.

It is important to always speak with your doctor before consuming any form of CBD, as they can provide insight on possible drug interactions and recommend the safest course of action. Additionally, it is also wise to be mindful of how much CBD you are taking at one time

Can CBD interact with other cannabinoids?

Yes, CBD can interact with other cannabinoids.
These interactions are called the entourage effect and this is an important part of how CBD works to produce its beneficial effects on our bodies and mind.
The entourage effect describes the combined impact of various active compounds found in plants that synergize to create a stronger effect than any single compound would have on its own.
CBD interacts with other cannabinoids, such as THC, terpenes, and flavonoids, to create a stronger effect than one single compound would have on its own.

This is why full-spectrum CBD oils are more effective than many isolated compounds found in hemp extract. The entourage effect has been seen to produce greater therapeutic effects compared to CBD isolate and can help reduce many of the side effects associated with CBD. By including an array of cannabinoids, terpenes and flavonoids in your product, you can create a unique blend that has improved effectiveness compared to stand-alone products.

Summary

  • Cannabidiol (CBD), a naturally occurring compound found in the cannabis plant,
    It’s can interact with other drugs and herbal supplements in potentially harmful ways.
  • CBD is metabolized by the same CYP450 enzymes as grapefruit,
    leading to potential interactions with certain medications.
  • Common drugs that interact with CBD include antibiotics, anticoagulants, antidepressants, and more.
  • Those taking multiple medications are most at risk for experiencing drug interactions when using CBD; it’s important to speak with your healthcare provider before taking any new medication including CBD.
  • The method used for consuming CBD may affect its potential for interaction.


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