What Drugs Should Not Be Taken with CBD?

CBD continues to gain popularity at an incredible pace, and many people view this non-intoxicating cannabinoid as perfectly safe since it does not have any serious side effects. At the same time, however, cannabidiol is a powerful compound that can dramatically alter your biochemistry, so it’s only natural that CBD interacts with certain prescription drugs.

In most cases, these potential interactions between CBD and prescription drugs only cause mild negative effects, and you might be surprised by how many prescription drugs CBD doesn’t interact with at all. If you plan to use CBD or you’re already using this cannabinoid, however, you should be aware of CBD’s potential to interact with popular prescription drugs and what you can do to avoid any resulting unwanted effects.

Does CBD interact with prescription drugs?

Whenever you take a drug, supplement, or another kind of bioactive substance, your body needs to break that substance down via a process called metabolism. In the context of prescription drugs, this process is called drug metabolism, and various substances you ingest can change how your body metabolizes prescription drugs. In recent years, scientists have learned a lot about how CBD affects your body, and they’ve identified one mechanism in particular by which this cannabinoid could dramatically affect the drug metabolism process.

CBD and CYP450 enzymes

Your body primarily uses digestive enzymes within the CYP450 family to metabolize CBD and most other cannabinoids. Within this family, one enzyme, in particular, CYP3A4, is mainly responsible for breaking CBD down and making it usable within your body’s various tissues.

While it is being used to break down CBD, CYP3A4 is prevented from metabolizing other drugs that you take subsequently or that were already in your system before you ingested CBD. Research indicates that up to ⅔ of all prescription drugs rely on CYP3A4 for proper metabolism, which means that taking CBD is more likely to interfere with drug metabolism than not.

Taking prescription drugs can also reduce the effectiveness of CBD since substances that use CYP3A4 for metabolism have to “fight” over this enzyme when they are ingested together. If you rely on prescription medication for your health, however, your primary concern is how CBD might make your prescribed drugs less effective.

CBD and the grapefruit warning

Have you ever seen a prescription drug label that warns you not to eat grapefruit while using the drug in question? These warnings are provided because grapefruit, like CBD, contains substances that can inhibit the action of CYP3A4 in your body.

While most prescription drugs that might interact negatively with CBD don’t offer warnings stating as much, it’s become the norm to add grapefruit warnings to drugs that are reliant on CYP3A4 for proper metabolism. As a result, it’s relatively easy for prospective or current CBD users to determine whether their medications might be unsafe to use with CBD.

It’s not only grapefruits that contain substances that interfere with CYP3A4. Many types of citrus fruits, such as pomelos, tangelos, and oranges can also cause problems with drug metabolism. Consult with your doctor if you’re not sure whether a drug you’re taking might be inhibited by ingesting grapefruit, other citrus fruits, or CBD. 

How does CBD interact with popular prescription drugs?

Just because CBD interacts with the majority of prescription drugs doesn’t mean that this cannabinoid necessarily interacts with the drugs you’re taking. Plus, the severity of CBD’s potential drug interactions varies from drug to drug. It’s always a good idea to consult with a doctor before you start using CBD if you’re using prescription medications, but start by looking through the following information to learn more about how CBD interacts with prescription drugs you might be taking:

CBD and opioids

Most opioids do not interact with CBD since they metabolize into your system without using enzymes in the CYP450 family. Codeine is the only opioid drug known to interact with CBD, and in recent years, this drug has mainly been replaced with hydrocodone and other modernized opioids.

CBD and metformin

Metformin is a drug that is commonly used to treat diabetes. This drug is not metabolized using CYP3A4 enzymes, so its effects are not hindered by CBD. Metformin does, however, inhibit CYP3A4 even though it isn’t dependent on this digestive enzyme, which means that taking metformin could reduce the potency of CBD that you ingest.

CBD and benzodiazepines

Benzodiazepines, such as Xanax, are reliant on CYP3A4 for metabolism. Taking CBD with Xanax, therefore, may increase the amount of time this benzodiazepine remains in your system, which could intensify this common anti-anxiety medication’s adverse effects.

CBD and statins

Statins, which are used to lower cholesterol and decrease the likelihood of developing cardiovascular conditions, are metabolized using CYP3A4. CBD may, therefore, increase the intensity and duration of the effects provided by statins, making it more likely that you will experience adverse effects.

CBD and metoprolol

Metoprolol is a beta-blocker that reduces your heart rate by decreasing the amount of epinephrine your body produces. Since one of the most commonly reported side effects of CBD is reduced blood pressure, taking metoprolol and CBD together could result in dangerously low blood pressure levels.

CBD and amlodipine

Amlodipine is a cardiovascular drug that reduces blood pressure and treats heart pain. Your body metabolizes this drug using CYP3A4, so taking amlodipine and CBD together could decrease this drug’s effectiveness and lead to toxicity issues.

Which types of drugs might interact negatively with CBD?

In general, any drug that interacts with the CYP450 family of enzymes in your body could negatively interact with CBD. When used without the presence of any prescription drugs in your system, CBD’s inhibition of CYP3A4 is harmless and could even be beneficial. Since so many prescription drugs are reliant on CYP3A4 for their metabolism, however, using CBD in combination with your prescriptions could cause harmful effects that may even become seriously dangerous under certain circumstances.

Keep in mind, however, that these negative effects are not caused by CBD specifically. Rather, it’s the fact that both CBD and many prescription drugs have to “fight” over CYP3A4 enzymes that makes it potentially dangerous to take CBD with drugs you’ve been prescribed. Just because CBD can interact with prescription drugs does not make this cannabinoid dangerous or toxic. Rather, you simply need to be careful about which drugs you take when you decide to use CBD.

After trying CBD, many people have decided to stop using their prescription drugs altogether. This is not a decision that should be taken lightly, and you should always consult with your doctor before making any changes in your daily drug intake. With everything we’re learning about CBD and its potential benefits, however, you may find this natural, largely side-effect-free cannabinoid to be preferable to conventional prescription treatments, which can cause serious side effects.

How do the different ways you can take CBD to affect drug interactions?

In most cases, research into the potential interactions between CBD and prescription drugs has been conducted in the context of orally ingested CBD. Based on the limited studies that have been published, the greatest risk for interaction between CBD and prescription drugs occurs when you ingest this substance orally, and other routes of administration may decrease the potential of harmful interactions.

Any substance that enters your bloodstream, however, eventually needs to be metabolized by CYP3A4 or a similar metabolic system. This means that even if you don’t take CBD orally, the potential for this cannabinoid to interact with drugs you’ve been prescribed still exists as long as the ingestion method you’ve chosen introduces CBD into your bloodstream.

The only CBD administration method that doesn’t deliver this cannabinoid into your bloodstream in high concentrations is topical administration. Unless a CBD topical has specifically designed for transdermal absorption (absorption through the skin and into the bloodstream), the effects of topical creams, salves, and lotions containing CBD generally remain localized to the site of application.

What about inhaling CBD?

While it would be convenient if smoking or vaping CBD overcame the drug interaction potential associated with orally ingesting this cannabinoid, inhaling CBD delivers this cannabinoid into your bloodstream with even greater bioavailability than oral ingestion. As a result, the potential of a drug interaction occurring when you inhale CBD is even higher than when you orally ingest a CBD tincture, capsule, or edible.

Therefore, it’s important to be incredibly cautious when using CBD in conjunction with prescription medications. Even applying this cannabinoid topically could result in negative drug interactions, and we still don’t know enough about CBD to appreciate the true scope of this cannabinoid’s ability to interact with common prescription drugs. The results of interactions between prescription drugs and CBD are usually so mild that they aren’t even noticed, but an abundance of caution is still merited.

Is CBD safe if I’m not taking prescription drugs?

Over the years, scientists have done their best to discover any side effects of CBD that may merit removing this cannabinoid from the consumer market. Try as they might, however, the best drug researchers of our time have been unable to come up with a coherent argument that CBD is fundamentally unsafe.

While it’s true that CBD’s interactions with your body’s CYP3A4 enzymes can cause issues when you use this cannabinoid in conjunction with prescription drugs, CBD does not appear to cause any serious harmful effects at all when used on its own.

In some cases, CBD can cause minor digestive discomforts such as indigestion, diarrhea, or nausea, and this cannabinoid is also commonly reported to cause drowsiness, sedation, or dry mouth. Compared to the sometimes life-threatening side effects of common prescription drugs, however, it’s clear why so many consumers have decided to accept these minimal risks and use CBD for a wide variety of different serious conditions.

Always consult with your doctor

If you are unsure whether CBD will interact with a prescription medication that you are currently taking, you should consult with your doctor before using cannabidiol for the first time. This non-intoxicating, non-addictive cannabinoid exerts remarkably gentle effects, and the same even holds true for CBD’s potential drug interactions.

In every case, it isn’t CBD that’s the culprit behind the dangerous effects that occur when you take this cannabinoid with other drugs. It’s just the fact that many prescription drugs on the market are only safe when they’re metabolized at a specific rate, and CBD can inadvertently make these drugs become toxic by causing them to stay in your system for longer than they should.

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