How does CBD interact with medications?

Author: Joy Hughes

When ingesting CBD, it first must metabolize through the digestive system and then filter through the liver. It is in the liver that CBD, along with other medications, must filter through a system known as the cytochrome P450 (CYP 450) — a family of various enzymes. It is through this system that drugs and substances are broken down into metabolites so that our cells can either absorb or dispose of them.

However, when CBD enters this system it prevents other drugs or substances from breaking down or metabolizing. This then causes other drugs or substances to stay in the blood longer than normal. This can be problematic as the drugs or substances can become more potent as they remain in the system without breaking down.1 Combining CBD with other medications can either cause unwanted effects on the body, or synergistically help them both produce positive effects.

Below, we’ll look at a few examples of how CBD interacts with other medications.

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CBD & Medication Interactions

Effects of CBD and NSAIDs

Over 17 million Americans consume Nonsteroidal anti-inflammatory drugs (NSAIDs) daily, causing them to be the most common anti-inflammatory medications on the market today.

NSAIDs such as ibuprofen and aspirin work to reduce pain and inflammation. They do this by blocking cyclooxygenase 1 and 2 (COX1 and COX2) — a family of various enzymes that produce prostaglandin (a hormone-like fatty acid).2

Prostaglandins produced by COX 2 promote inflammation, pain and sometimes fever when needed. Whereas, prostaglandins produced by COX1 stimulate platelets which protect the lining of the stomach and intestines continuously.

The pain relief we feel when we consume NSAIDs is brought on from blocking COX 2; however, they are also blocking COX 1 which causes a number of side effects in our body.3

NSAIDs side effects include:

  • Dizziness
  • Headaches
  • Indigestion
  • GI complications
  • Liver issues
  • Ulcers
  • GI bleeding
  • Kidney damage
  • Fluid retention

Cannabidiol (CBD) is widely known for its anti-inflammatory properties. For some, combining CBD and NSAIDs seem to make sense. When CBD is consumed, it can boost the concentration of anandamide (an endocannabinoid) also known as the happiness or “bliss molecule”.4

A study, conducted in 2005, showed how anandamide along with ibuprofen reduced sensitivity to pain.5

Although there isn’t enough conclusive evidence or studies on the interactions of CBD and NSAIDs, some studies suggest that combining the two may help in harmoniously signaling cannabinoids with little impact of side effects.

However, some scientists suggest that CBD may slow the metabolism of NSAIDs, which can cause them to stay in the system longer, thus causing adverse effects within the body.

Summary: For now, it’s likely safer to avoid taking CBD and NSAIDs together, as the metabolism and filtering process is still unknown.

Effects of CBD and Caffeine

According to the National Coffee Association survey in 2018, 64% of Americans drank at least one cup of coffee every day. Caffeine is known to stimulate the central nervous system causing alertness, energy, and preventing sleepiness.6

Excessive daily consumption of caffeine can lead to a number of side effects:

  • Insomnia
  • Headaches
  • GI problems
  • Irregular heart rhythm
  • Anxiety
  • Dizziness
  • Dehydration
  • Dependency7

When caffeine enters the body, it inhibits the adenosine receptors — cells associated with the heart, sleep, blood flow, inflammation, and immune response. Typically, lower doses of caffeine affects these cells in a safe minimal way. However, higher doses block phosphodiesterase (PDE, an enzyme in the body). These enzymes help in sending chemical messengers that create both adenosine receptors and cannabinoids.

The phytocannabinoid CBD helps in lifting levels of adenosine, which in high doses can lead to a sedative effect. Combining CBD with caffeine could counteract the sedative and calming effects of CBD, according to some experts. The argument of these two together suggests that caffeine stimulates the regions of the brain where cannabinoid receptors communicate with CBD. This may lead to a reduction of CBD’s effects.8

However, others believe that combining CBD with caffeine may actually calm the unwanted effects of caffeine — promoting energy without feeling anxious or panicky. According to one study, researchers suggest that CBD promotes wake-inducing properties, which potentially encourage some caffeine users to consume much less caffeine.9

Summary: As of now, there’s not enough research regarding the interactions of CBD and caffeine to be conclusive, but many users reported positive effects from this combination. 

Effects of CBD and Alcohol

Excessive alcohol consumption can cause a number of health issues, which include:

  • Cirrhosis of the liver
  • Fibrosis of the liver
  • Alcoholic hepatitis
  • Steatosis (fatty liver)
  • Stroke
  • Irregular heart rhythm
  • Cardiomyopathy
  • High blood pressure
  • Pancreatitis
  • Dependency
  • Cancer10

Fortunately, studies have shown that CBD is a neuroprotectant; it protects by preventing brain injury from excessive alcohol consumption.11 What happens when CBD is consumed with alcohol?

A study was conducted on the interactions of CBD and alcohol in humans. In this double-blind, crossover study, healthy volunteers (four female and six male) received a placebo, CBD, alcohol, and a mixture of CBD plus alcohol. Surprisingly, this study showed that CBD combined with alcohol actually lowered the levels of alcohol in the blood in comparison to alcohol given alone. However, combining CBD and alcohol could impair you mentally and physically based on your reaction time — how quickly the two are metabolized.12

Summary: Although CBD may help protect the brain from alcohol, we do not recommend consuming CBD and alcohol together until more research is completed.

Effects of CBD and Antiepileptic medications

Antiepileptic drugs (AEDs) help in controlling the seizures brought on by epilepsy. AEDs are either consumed by mouth, injected into the body, or given as a suppository. AEDs work by reducing the electrical activity in the brain that causes a seizure. They do this by primarily targeting specific neurotransmitters: glutamate receptor antagonists, the GABA system and receptor agonists, sodium ion and calcium ion channels.13

As with all medications, AEDs also have side effects despite their ability to control some seizures.

  • Irritability
  • Nausea
  • Drowsiness
  • Rash
  • Fever
  • Fatigue
  • Loss of appetite
  • Mouth ulcers
  • Sore throat
  • Double vision
  • Weight gain
  • Gum dysplasia
  • Liver damage
  • Aplastic anemia
  • Mood changes14

Due to cannabinoid receptors found in the brain, many studies and anecdotal evidence have shown CBD to be a powerful antiepileptic substance. However, for some making the switch from AEDs to CBD, very little research has been done in how the two interact.

In one study, 42 children and 39 adults were given CBD in addition to their AEDs. Researchers monitored their blood levels and saw that certain AEDs, such as clobazam, refunamide, and topiramate, were increasingly higher when given with CBD. Elevated levels of zonisamide and eslicarbazepine were found only in the adults when taking CBD. This study concluded that clobazam significantly exceeded the normal range, causing sedation more often when taking CBD as opposed to taking it alone.

Summary: Researchers suggest that patients taking CBD should reduce their dose of AEDs and always consult their doctor before doing so. 15

Effects of CBD and Anticoagulant drugs

Anticoagulants such as heparin and warfarin are blood thinners. These medications help in decreasing potential clotting of the blood. They work by blocking various proteins in the liver that clot the blood when they work together. Although anticoagulants help many people, there are several serious side effects:

  • Bleeding in any organ
  • Gangrene of the skin
  • Diarrhea
  • Bloating
  • Hair loss
  • Itchy feet
  • Excessive bruising
  • Nosebleeds
  • Jaundice16

As mentioned before, when ingested, CBD filters through the CYP450 enzymes in the liver (the same family of enzymes that warfarin filters through). When these two substances are taken together, CBD prevents these enzymes from fully metabolizing warfarin, causing adverse effects within the body. Some effects could lead to excessive bleeding caused by the increased anticoagulant effect of warfarin thinning the blood.

A recently published study concluded that patients taking warfarin must monitor their INR levels when taking CBD.17 Monitoring International Normalised Ratio (INR) levels helps prevent risks of possible hemorrhaging.18

Summary: Since CBD can lead to excessive bleeding when combined with Anticoagulant drugs you should not take the two substances together.

Effects of CBD and other drugs

As mentioned throughout this article, there’s not enough conclusive studies or evidence on the interactions of CBD and certain medications or substances. However, from the studies that have been done, CBD can either enhance or decrease the potency of medications and substances.

Effects of CBD and Opioids

Phytocannabinoids such as CBD and THC have been taken along with opioids to see how they affect the body. Studies are slim; however, researchers suggest that combining THC and opiates actually promotes a painkilling effect. And CBD helps in lowering opioid dependency and reduces withdrawals.19

Summary: CBD may help reduce opioid dependency and withdrawal symptoms, but more research needs to be conducted to confirm this theory.

Effects of CBD and Antidepressants

Antidepressants produce a calming, relaxed effect within the nervous system. CBD produces the same sedative-like effect, while increasing natural endorphins within the body. Combining the two may enhance the potency of an antidepressant, suggesting that CBD can help reduce the amount of medication needed. This ultimately may help individuals discontinue antidepressants all together.20

Summary: CBD can increase the potency of Antidepressants and can help reduce the need for these drugs. It’s best to consult with your doctor before consuming these drugs together.

Effects of CBD and Antibiotics

CBD interactions with antibiotics have yet to be studied. Although, studies have shown CBD to be a more effective antibacterial agent against bacterial strains that have become resistant to pharmaceutical antibiotics.2122

Summary: CBD may be an effective substitute for Antibiotic-resistant bacteria, but more research is needed to confirm this theory. 

Consult with your doctor

Keep in mind that combining any two substances together could be harmful to the body. Each person is different and may react to a common combination completely different from others. CBD has been proven to be well tolerated and safe to use, but always be cautious when introducing a new substance to your daily medications.

It’s very important to let your doctor know if you are taking or plan on taking CBD. They may need to monitor blood levels or run tests to see if there are any alarming influences on vital organs such as the liver or kidneys. When used carefully, CBD can help in reducing prescription drugs that produce harmful side effects. However, the key is to start slow and consume low doses.

Summary: The findings presented in this article should not be perceived as health advice. It's always best to consult with your doctor before adding CBD to your health regimen (especially if you are on medication).

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