CBD is phenomenally popular right now. It’s being used to treat pain, anxiety, epilepsy, psychosis, and even neurodegenerative diseases like Alzheimer’s and Parkinson’s. It’s been called a “wonder drug,” without irony, and it has essentially no known downsides. It is readily available and easy to take.
At the same time, it’s important to be aware that CBD can interact with some medications. Taking it at the same time as other drugs can affect CBD’s dosage and effects, and can even change how your body breaks it down.
This article is your guide to safely taking CBD alongside your other medications and supplements. First, it has a quick overview of how CBD interacts with other drugs in your body, and then it lists the most common drugs that interact with CBD, and which you should be careful about taking at the same time. If you want to skip ahead, you can find the list here.
The CYP450 Pathway
Once a drug enters your system, its molecules are circulated through your blood and interact with your cells and tissues, doing whatever it is they’re supposed to do. Painkillers reduce pain signals and can stop swelling, antidepressants interact with brain cells to change your brain chemistry, and so on.
Once they’ve done their work, your body needs to get rid of the drug molecules. Too much of any drug in your bloodstream is toxic, and can start to harm your body.
Your body uses all kinds of systems to get rid of drugs, and the most important of these are enzymes—chemicals that break down other chemicals. The largest set of enzymes are the cytochrome p-450 group (or CYP450), which are responsible for breaking down about 75% of the medications and recreational drugs that we take.
CBD and the CYP450 pathway
CBD interacts with the CYP450 system in three ways. First, some of the enzymes in the system are responsible for breaking down CBD molecules, as they are for molecules of other drugs. That’s normal—nothing to worry about there.
Second, CBD can affect how CYP450 enzymes are produced by your liver, making it produce not enough of some enzymes or too much of others. This can stop your liver from processing some drugs, like the epilepsy medications clobazam and valproic acid.
Third, and most importantly, CBD can actually stop many of the CYP system’s enzymes from working properly. This is called “inhibition,” and it can cause problems if it prevents the enzymes from breaking down other drugs. Sometimes, the enzymes are responsible for activating other drugs instead, but the same problem comes up—if CBD stops the enzyme from working, then it doesn’t do its normal job, and the other drug won’t behave normally, which can have negative consequences.
For instance, there’s a group of antidepressants called selective-serotonin reuptake inhibitors, which include drugs like citalopram, norfluoxetine, and sertraline. Normally, an enzyme called CYP3A4 breaks down molecules of those drugs, making sure they don’t build up to unsafe levels that can damage cells or tissues. CBD inhibits CYP3A4, though, which means that taking CBD and sertraline at the same time could be dangerous. CYP3A4 wouldn’t break the sertraline down, and it would accumulate for far too long.
It’s worth noting that CBD isn’t the only thing that does this. The herbs St. John’s Wort and goldenseal can also stop CYP450 enzymes from working properly, as can grapefruit and starfruit juice, and even tobacco.
Drugs that interact with CBD
That brings us to our list. Remember, the general rule is that you need to be careful taking CBD at the same time as any drug or medication that gets processed by CYP450 enzymes. If you’re thinking about doing so, be sure to check with your doctor first.
Here are the most common of those drugs and medications. They include many painkillers, anti-inflammatories, antipsychotics, antidepressants, anticonvulsants, statins, opioids, and other groups.
- Alprazolam (Xanax)
- Amitriptyline (Elavil)
- Amlodipine (Norvasc)
- Carbamacepin (Tegretol, Equetro)
- Carisoprodol (Soma)
- Celecoxib (Celebrex)
- Chlordiazepoxide (Librium)
- Chlormethiazole (Heminevrin)
- Chlorzoxazone (Lorzone)
- Clarithromycin (Biaxin)
- Clobazam (Onfi)
- Clorazepate (Tranxene-SD)
- Clozapine (Clozaril, FazaClo)
- Codeine (Tylenol)
- Cyclosporine (Sandimmune)
- Desipramine (Norpramin)
- Dexamethasone (Decadron)
- Diazepam (Diastat, Valium)
- Diclofenac (Cataflam, Voltaren)
- Disulfiram (Antabuse)
- Erlotinib (Tarceva)
- Eslicarbazepine acetate (Eslicarbazepine)
- Estazolam (ProSom)
- Fentanyl (Duragesic, Sublimaze)
- Fexofenadine (Allegra)
- Flecainide (Tambocor)
- Flurazepam (Dalmane)
- Flutamide (Eulexin)
- Glipizide (Glucotrol)
- Halazepam (Pazipam)
- Haloperidol (Haldol)
- Halothane (Fluothane)
- Ibuprofen (Motrin)
- Imipramine (Tofranil)
- Itraconazole (Sporanox, Onmel)
- Ketamine (Ketalar)
- Ketoconazole (Nizoral, Extina)
- Ketoconazole (Nizoral)
- Klonipin (Clonazepam)
- Lansoprazole (Prevacid)
- Lorazepam (Ativan)
- Losartan (Cozaar)
- Lovastatin (Mevacor)
- Meloxicam (Mobic)
- Methoxyflurane (Penthrox)
- Metoprolol (Lopressor, Toprol XL)
- Nelfinavir (Viracept)
- Nifedipine (Adalat CC, Procardia XL)
- Omeprazole (Prilosec, Omesec)
- Ondansetron (Zofran)
- Orphenadrine (Norflex)
- Oxaliplatin (Eloxatin)
- Oxezepam (Serax)
- Pantoprazole (Protonix)
- Paroxetine (Paxil)
- Pentobarbital (Nembutal)
- Phenobarbital (Luminal, Solfoton)
- Phenytoin (Dilantin)
- Piroxicam (Feldene)
- Progesterone (Endometrin, Prometrium)
- Propofol (Diprivan)
- Propranolol (Inderal)
- Quazepam (Doral)
- Rifampicin (Rifadin)
- Risperidone (Risperdal)
- Ritonavir (Norvir)
- Rufinamide (Banzel)
- Secobarbital (Seconal)
- Temazepam (Restoril)
- Theophylline (Theo-Dur, Theo-24, Theocron, Elixophylline)
- Thiopental (Pentothal)
- Topiramate (Topamax)
- Tramadol (Ultram)
- Triazolam (Halcion)
- Valproic acid (Depacon)
- Venlafaxine (Effexor)
- Verapamil (Calan, Isoptin, others)
- Warfarin (Coumadin)
- Zonisamide (Zonegran)
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