CBD Drug Interactions

List of CBD Drug Interactions

Before I get to the list of drugs there is a need to at least briefly talk about how CBD interacts with other drugs, and to give you a little information to clarify what the list is all about.

While Cannabidiol (CBD) is for the most part quite safe, with reasonably mild side effects, when taken with other drugs there is the possibility of interactions that may be of concern.

You may want to review our article What is Cannabidiol (CBD)?. It contains relevant information.

If you ask, ‘Can CBD interact with Drugs?’, the answer is certainly ‘Yes’. However, to date, there have not been many studies on CBD drug interactions. For most drugs, little is known about specifics, such as at what dosage levels CBD interacts with a drug, or even if the interactions are a significant health risk.

The only real study of interactions came from studies for the drug Epidiolex, which is used to treat a few uncommon forms of epilepsy. Those studies found that high doses of CBD can interact and produced high blood levels of other antiepileptics drugs[1]. These include drugs such as clobazam, eslicarbazepine, rufinamide, topiramate, valproate, and zonisamide. This interaction can result in more aggressive seizures.

How does CBD Interact with Other Drugs?

Interactions primarily happen because Tetrahydrocannabinol (THC) and Cannabidiol (CBD) are both substrates and inhibitors of cytochrome P450 enzymatic pathways.[2] Due to this strong interaction with the enzyme system in the liver,[3] CBD prevents other medications from accessing the enzymes and this can lead to a build-up of those medications in the system.

Our article What is Tetrahydrocannabinol (THC) is well worth reviewing.

A study by Lester Bornheim in 1992 found that even a low dosage of CBD can inhibit the enzymes and contribute to prolonged concentrations of clobazam and norclobazam.

A complication is that this enzyme system in the liver is responsible for processing about 60% of all pharmaceuticals.[4]

Types of drugs that are processed by these enzymes include –

  • Anesthetics
  • Angiotension II blockers
  • Anti-arrythmics
  • Antibiotics
  • Anticoagulants and antiplatelets
  • Antiepileptics
  • Antidepressants
  • Antihistamines
  • Antipsychotics
  • Benzodiazepines
  • Beta blockers
  • Calcium channel blockers
  • Chemotherapy drugs
  • Estrogen Modulators
  • HIV antivirals
  • HMG-CoA reductase inhibitors
  • Immune modulators
  • Nonsteroidal anti-inflammatory drugs
  • Oral hypoglycemic agents
  • Proton-pump inhibitors
  • Prokinetics
  • Sedatives
  • Steroids
  • Sulfonylureas

The Grapefruit Connection with CBD

Interestingly, grapefruit juice interacts with the enzymes in the liver in the same way as CBD, and many medications actively warn that they should not be taken in conjunction with grapefruit juice.

We have included in our list below such medications for this very reason.

It seems that a good rule of thumb is that if you are taking medications that have a warning about grapefruit juice then you should absolutely talk to your medical professionals about taking CBD.

Summary

Because there is a lack of knowledge about CBD dosage regards interactions and even the actual concentration of CBD in available products, care is essential when taking CBD in conjunction with other drugs.

There is a real risk that patients, especially those that are taking high doses of CBD, may inadvertently overdose on other medications due to the build-up in their system. These higher doses can cause a whole range of issues. For example, chemotherapy drugs require very specific doses to be effective. Too high a dose may cause toxicity and too low a dose can be ineffective.

In summary, mixing CBD with other drugs is not a well-documented subject. We need a great deal more research and studies to understand all the side effects.

It is certain that CBD does affect the cytochrome P450 enzymatic pathways and thus can result in higher levels of drug in the system. This can then lead to overdoses and ineffectiveness of prescribed medications. But we don’t really know all the drugs or even the dosage of CBD involved.

In short, before taking CBD, it is essential that you discuss taking CBD with your medical professionals to reduce the risk of any drug interactions.

A List of Drugs that May Interact with CBD

It is important to note that the drug groups mentioned above include far more drugs than we have listed below. We have listed only drugs, and the brand names, that were specifically mentioned throughout our research.

The list includes drugs that have some reported drug interaction, but please note that the product used may have include some level of THC. It is possible the interaction may have been due to the presence of THC.

Some of these were also included because they are drugs that have warnings about drinking grapefruit juice while using the drug. As mentioned, grapefruit juice interacts with the enzymes in the liver in a very similar way to CBD, and the interaction with grapefruit juice for these drugs can have dangerous side effects.

Mostly, a drug is included because CBD interaction will potentially result in an increase in the drug in the system due to the liver not being able to break it down. Where possible we have added other relevant notes.

Please note that some of these drugs are known by other names and this list is certainly not complete.

We have highlighted in red the drugs that were mentioned as having major interactions.[5]

Please don’t assume that these drugs can’t be taken with CBD, or that your drug is safe if it isn’t listed here. You must consult with your medical professionals regards your drugs and using CBD.

DrugNotes
Abstral ®See Fentanyl.
Accurbron ®See Theophylline.
Actiq ®See Fentanyl.
Adalat ®See Nifedipine.
Addaprin ®See Ibuprofen.
Advil ®See Ibuprofen.
Aerolate ®See Theophylline.
Afeditab ®See Nifedipine.
AlcoholAdditive CNS depressant effects
Allegra ®See Fexofenadine.
Alprax ®See Alprazolam.
AlprazolamInteracts with grapefruit juice. Can have dangerous side effects.
Altocor ®See Lovastatin.
Altoprev ®See Lovastatin.
AmiodaroneInteracts with grapefruit juice. Can have dangerous side effects.
Amitid ®See Amitriptyline.
Amitril ®See Amitriptyline.
Amitriptyline
Amlodipine
Amvaz ®See Amlodipine.
Antabuse ®See Disulfiram.
Aption ®See Eslicarbazepine.
Aquaphyllin ®See Theophylline.
Arymo ® ERSee Morphine.
Asbron ®See Theophylline.
Ativan ®See Lorazepam.
AtorvastatinInteracts with grapefruit juice. Can have dangerous side effects.
Avinza ®See Morphine.
Banzel ®See Rufinamide.
Biaxin ®See Clarithromycin.
Brisdelle ®See Paroxetine.
Bronkodyl ®See Theophylline.
CaffeineHigh doses may counter the stimulant effect and result in a sedative effect.
Calan ®See Verapamil.
Cambia ®See Diclofenac.
CarbamazepineInteracts with grapefruit juice. Can have dangerous side effects.
Carbatrol ®See Carbamazepine.
Carisoprodol
Cataflam ®See Diclofenac.
Cedaprin ®See Ibuprofen.
Celebrex ®See Celecoxib.
Celecoxib
Chlormethiazole
ChlorpromazineIncrease in clearance of chlorpromazine, but in the study, users were smoking cannabis.
Chlorzoxazone
CilostazolInteracts with grapefruit juice. Can have dangerous side effects.
Clarithromycin
ClobazamDecreases liver function and increases the concentration of Clobazam, thus its side effects.
Clonazepam
Clozapine
Clozaril ®See Clozapine.
CodeineWe have not included the brand names for Codeine. Follow the link to discover more.
ColchicineInteracts with grapefruit juice. Can have dangerous side effects.
Colcrys ®See Colchicine.
Conzip ®See Tramadol.
Cordarone ®See Amiodarone.
Coumadin ®See Warfarin.
Coumarin
Covera ®See Verapamil.
Cozaar ®See Losartan.
Crixivan ®See Indinavir.
Cyclosporine
Decadron ®See Dexamethasone.
Depakene ®See Valproic Acid.
Depakote ®See Valproic Acid.
Desipramine
Dexamethasone
Dexpak ®See Dexamethasone.
Diazepam
Diclofenac
Dilantin ®See Phenytoin.
Disipal ®See Orphenadrine.
Disulfiram
DronedaroneInteracts with grapefruit juice. Can have dangerous side effects.
Duraphyl ®See Theophylline.
EES ®See Erythromycin.
Effexor ®See Venlafaxine.
Elavil ®See Amitriptyline.
Elixicon ®See Theophylline.
Elixomin ®See Theophylline.
Elixophyllin ®See Theophylline.
Eloxatin ®See Oxaliplatin.
Endep ®See Amitriptyline.
Epitol ®See Carbamazepine.
Equetro ®See Carbamazepine.
Erlotinib
ERY-C ®See Erythromycin.
Ery-Tab ®See Erythromycin.
Erythrocim ®See Erythromycin.
ErythromycinInteracts with grapefruit juice.
Eslicarbazepine
Eulexin ®See Flutamide.
FazaClo ®See Clozapine.
Feldene ®See Piroxicam.
FelodipineInteracts with grapefruit juice. Can have dangerous side effects.
Fentora ®See Fentanyl.
FexofenadineInteracts with grapefruit juice.
FentanylInteracts with grapefruit juice.
Flecainide
Fluotha ®See Halothane.
Flutamide
Gengraf ®See Cyclosporine.
Glipizide
Gloperba ®See Colchicine.
Glucotrol ®See Glipizide.
Halcion ®See Triazolam.
Haldol ®See Haloperidol.
Haloperidol
Halothane
Heminevrin ®See Clomethiazole.
I-Prin ® See Ibuprofen.
Ibuprofen Increased blood thinning.
Imipramine
Inderal ®See Propranolol.
IndinavirInteracts with grapefruit juice.
InnoPran ®See Propranolol.
Isoptin ®See Verapamil.
Itraconazole
Jantoven ®See Warfarin.
Kadian ®See Morphine.
Kalma ®See Alprazolam.
Ketoconazole
Klonapin ®See Clonazepam.
Labid ®See Theophylline.
Lansoprazole
Lipitor ®See Atorvastatin.
Lanophyllin ®See Theophylline.
Lopressor ®See Metoprolol.
Lorazepam
LosartanInteracts with grapefruit juice.
Lovastatin
Meloxicam
Methoxyflurane
Metoprolol
Mevacor ®See Lovastatin.
Midol ®See Ibuprofen.
Mobic ®See Meloxicam.
Morphabond ®See Morphine.
Morphine
Motrin ®See Ibuprofen.
MS Contin ®See Morphine.
Multaq ®See Dronedarone
Nelfinavir
NeoProfen ®See Ibuprofen.
Neoral ®See Cyclosporine.
Nifedical ®See Nifedipine.
Nifedipine
Nifeditab ®See Nifedipine.
Niravam ®See Alprazolam.
Nizoral ®See Ketoconazole.
Nolvadex ®See Tamoxifen.
Norflex ®See Orphenadrine.
Norpramin ®See Desipramine.
Norvasc ®See Amlodipine.
Omeprazole
Omesec ®See Omeprazole.
Ondansetron
Onfi ®See Clobazam.
Onmel ®See Itraconazole.
Onsolis ®See Fentanyl.
Oramorph ® SRSee Morphine.
Orphenadrine
Oxaliplatin
Pacerone ®See Amiodarone.
Paraflex ®See Chlorzoxazone.
Parafon Forte ®See Chlorzoxazone.
Paroxetine
Paxil ®See Paroxetine.
PCE ®See Erythromycin.
Pediamycin ®See Erythromycin.
Pentobarbital
Pexeva ®See Paroxetine.
Phenobarbital
Penthrox ®See Methoxyflurane.
Piroxicam
Phenytek ®See Phenytoin.
Phenytoin
Plendil ®See Felodipine.
Pletal ®See Cilostazol.
Prevacid ®See Lansoprazole.
Prilosec ®See Omeprazole.
Procardia ®See Nifedipine.
Profen IB ®See Ibuprofen.
Progesterone
Promapar ®See Chlorpromazine.
Prometrium ®See Progesterone.
Pronol ®See Propranolol.
Propranolol
Proprinal ®See Ibuprofen.
Qudexy XR ®See Topiramate.
Quibron-T ®See Theophylline.
Ralozam ®See Alprazolam.
Rela ®See Carisoprodol.
Risperdal ®See Risperidone.
Risperidone
Roxanol-T ®See Morphine.
Rufinamide
Rybix ®See Tramadol.
Ryzolt ®See Tramadol.
Sandimmune ®See Cyclosporine.
Secobarbital
Seconal ®See Secobarbital.
Slo-Bid ®See Theophylline.
Slo-Phyllin ®See Theophylline.
Soltamox ®See Tamoxifen.
Soma ®See Carisoprodol.
Somophyllin ®See Theophylline.
Sporanox ®See Itraconazole.
Strifon Forte ®See Chlorzoxazone./td>
Sustaire ®See Theophylline.
Sympazan ®See Clobazam.
Synophylate ®See Theophylline.
T-Phyll ®See Theophylline.
Tambocor ®See Flecainide.
Tamoxifen
Taperpak ®See Dexamethasone.
Tarceva ®See Erlotinib.
Tegretol ®See Carbamazepine.
Testosterone
Theo-24 ®See Theophylline.
Theo-Dur ®See Theophylline.
Theobid ®See Theophylline.
Theochron ®See Theophylline.
Theoclear ®See Theophylline.
Theolair ®See Theophylline.
Theolixir ®See Theophylline.
Theophyl ®See Theophylline.
Theophylline
Theovent ®See Theophylline.
Thorazine ®See Chlorpromazine.
Tofranil ®See Imipramine.
Topamax ®See Topiramate.
Topiramate
Toprol ®See Metoprolol.
Tramadol
Triazolam
Trokendi XR ®See Topiramate.
Ultram ®See Tramadol.
Ultraprin ®See Ibuprofen.
Uni-dur ®See Theophylline.
Uniphyl ®See Theophylline.
Valium ®See Diazepam.
ValproateSee Valproic Acid.
Valproic AcidCan cause liver damage and the CBD can increase the chance of injury.
Valrelease ®See Diazepam.
Venlafaxine
Verapamil
Verelan ®See Verapamil.
Versacloz ®See Clozapine.
Viracept ®See Nelfinavir.
Voltaren XR ®See Diclofenac.
WarfarinIncreased blood thinning.[6]
Xanax ®See Alprazolam.
Zipsor ®See Diclofenac.
Zofran ®See Ondansetron.
Zonegran ®See Zonisamide.
Zonisamide
Zorvolex ®See Diclofenac.
Zuplenz ®See Ondansetron.

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