Products containing cannabidiol (CBD) are very popular, promising relief from a wide range of maladies. But if you are considering taking a product containing CBD, be aware that if you are taking any other prescription or over-the-counter medications, supplements, or herbal products, CBD can interact with them and cause unexpected … CBD can interact with escitalopram, an antidepressant, by slowing down its metabolism and increasing the risk of side effects. Find out how they interact. We take a look at how safe it is to take CBD oil alongside the antidepressant Lexapro. Here's everything you need to know.
CBD and other medications: Proceed with caution
Products containing cannabidiol (CBD) seem to be all the rage these days, promising relief from a wide range of maladies, from insomnia and hot flashes to chronic pain and seizures. Some of these claims have merit to them, while some of them are just hype. But it won’t hurt to try, right? Well, not so fast. CBD is a biologically active compound, and as such, it may also have unintended consequences. These include known side effects of CBD, but also unintended interactions with supplements, herbal products, and over-the-counter (OTC) and prescription medications.
Doubling up on side effects
While generally considered safe, CBD may cause drowsiness, lightheadedness, nausea, diarrhea, dry mouth, and, in rare instances, damage to the liver. Taking CBD with other medications that have similar side effects may increase the risk of unwanted symptoms or toxicity. In other words, taking CBD at the same time with OTC or prescription medications and substances that cause sleepiness, such as opioids, benzodiazepines (such as Xanax or Ativan), antipsychotics, antidepressants, antihistamines (such as Benadryl), or alcohol may lead to increased sleepiness, fatigue, and possibly accidental falls and accidents when driving. Increased sedation and tiredness may also happen when using certain herbal supplements, such as kava, melatonin, and St. John’s wort. Taking CBD with stimulants (such as Adderall) may lead to decreased appetite, while taking it with the diabetes drug metformin or certain heartburn drugs (such as Prilosec) may increase the risk of diarrhea.
CBD can alter the effects of other drugs
Many drugs are broken down by enzymes in the liver, and CBD may compete for or interfere with these enzymes, leading to too much or not enough of the drug in the body, called altered concentration. The altered concentration, in turn, may lead to the medication not working, or an increased risk of side effects. Such drug interactions are usually hard to predict but can cause unpleasant and sometimes serious problems.
Researchers from Penn State College of Medicine evaluated existing information on five prescription CBD and delta-9-tetrahydrocannabinol (THC) cannabinoid medications: antinausea medications used during cancer treatment (Marinol, Syndros, Cesamet); a medication used primarily for muscle spasms in multiple sclerosis (Sativex, which is not currently available in the US, but available in other countries); and an antiseizure medication (Epidiolex). Overall, the researchers identified 139 medications that may be affected by cannabinoids. This list was further narrowed to 57 medications, for which altered concentration can be dangerous. The list contains a variety of drugs from heart medications to antibiotics, although not all the drugs on the list may be affected by CBD-only products (some are only affected by THC). Potentially serious drug interactions with CBD included
- a common blood thinner, warfarin
- a heart rhythm medication, amiodarone
- a thyroid medication, levothyroxine
- several medications for seizure, including clobazam, lamotrigine, and valproate.
The researchers further warned that while the list may be used as a starting point to identify potential drug interactions with marijuana or CBD oil, plant-derived cannabinoid products may deliver highly variable cannabinoid concentrations (unlike the FDA-regulated prescription cannabinoid medications previously mentioned), and may contain many other compounds that can increase the risk of unintended drug interactions.
Does the form of CBD matter?
Absolutely. Inhaled CBD gets into the blood the fastest, reaching high concentration within 30 minutes and increasing the risk of acute side effects. Edibles require longer time to absorb and are less likely to produce a high concentration peak, although they may eventually reach high enough levels to cause an issue or interact with other medications. Topical formulations, such as creams and lotions, may not absorb and get into the blood in sufficient amount to interact with other medications, although there is very little information on how much of CBD gets into the blood eventually. All of this is further complicated by the fact that none of these products are regulated or checked for purity, concentration, or safety.
The bottom line: Talk to your doctor or pharmacist if using or considering CBD
CBD has the potential to interact with many other products, including over-the-counter medications, herbal products, and prescription medications. Some medications should never be taken with CBD; the use of other medications may need to be modified or reduced to prevent serious issues. The consequences of drug interactions also depend on many other factors, including the dose of CBD, the dose of another medication, and a person’s underlying health condition. Older adults are more susceptible to drug interactions because they often take multiple medications, and because of age-related physiological changes that affect how our bodies process medications.
People considering or taking CBD products should always mention their use to their doctor, particularly if they are taking other medications or have underlying medical conditions, such as liver disease, kidney disease, epilepsy, heart issues, a weakened immune system, or are on medications that can weaken the immune system (such as cancer medications). A pharmacist is a great resource to help you learn about a potential interaction with a supplement, an herbal product (many of which have their own drug interactions), or an over-the-counter or prescription medication. Don’t assume that just because something is natural, it is safe and trying it won’t hurt. It very well might.
Does CBD Interact With Escitalopram (Lexapro)?
Escitalopram (Lexapro) is an antidepressant of the serotonin reuptake inhibitor (SSRI) class.
It’s used to treat depression, anxiety, and obsessive-compulsive disorder.
CBD may slow down the metabolism of escitalopram and lead to its excess accumulation in the body , making it more potent but more liable to cause unwanted side effects.
Can CBD and escitalopram be taken together safely?
Table of Contents
Does CBD Interact With Escitalopram (Lexapro)?
CBD (cannabidiol) may interact with escitalopram (Lexapro). There are two ways by which CBD and escitalopram can act:
1. Slowed Elimination (Metabolic Inhibitor)
CBD can slow the metabolism of escitalopram and consequently increase its concentration in circulation.
Metabolic inhibition occurs when two drugs get metabolized by the same enzymes. Hence, they compete against each other for the said enzymes, slowing down the metabolism of one or both drugs.
Escitalopram is metabolized by CYP2C19, CYP2D6, and CYP3A4 enzymes. These same enzymes metabolize CBD as well.
CBD also has the additional feature of inhibiting these enzymes. Therefore, taking escitalopram and CBD together could slow down the metabolism of the former, leading to an unhealthy accumulation of this compound in the body .
It could lead to more side effects of escitalopram such as headache, nausea, drowsiness, etc.
There is a possibility that an excess of taking these two drugs together could give rise to serotonin syndrome, a condition where the body has too much amount of serotonin.
2. Increased Effect (Agonistic Interaction)
CBD can interact with escitalopram agonistically as well.
Agonistic interaction happens when two drugs have a similar effect on the body. They work on the same receptors causing the effects in the same direction.
Both escitalopram and CBD act on the central nervous system (CNS). While escitalopram acts by increasing the levels of serotonin, CBD acts by neuromodulation. Although their mechanism of action is different, they both have similar anxiolytic and antidepressant actions when consumed.
If taken together, the actions of these substances could have a synergistic effect. However, this may also cause an exaggeration in the intended effects leading to symptoms such as drowsiness and lethargy.
Other Names For Escitalopram
Escitalopram is sold under many different names. All share the same risk and potential interactions.
Other names for escitalopram (Lexapro) include:
Similar Medications: CBD & Escitalopram (Lexapro)
Escitalopram (Lexapro) is classified as a selective serotonin reuptake inhibitor (SSRIs). CBD and SSRIs all share similar risks for interaction and side effects.
Here’s a list of similar medications that share a similar level of risk when combined with CBD:
- Citalopram (Cipramil and Celexa)
- Dapoxetine (Priligy)
- Fluoxetine (Prozac, Rapiflux, Sarafem, Selfemra, and Oxactin)
- Fluvoxamine (Faverin)
- Paroxetine (Seroxat)
- Sertraline (Lustral)
- Vortioxetine (Brintellix)
Is It Safe to Take CBD & Escitalopram (Lexapro) Together?
While the risk of interaction with CBD and escitalopram is low, it’s not impossible. The potential side effects from this interaction can be severe, which make it a bad idea to combine these drugs unless you’ve consulted with your prescribing doctor first.
The interaction between CBD and escitalopram is considered moderate.
Is CBD a Viable Alternative to Escitalopram (Lexapro)?
CBD could be a viable alternative to escitalopram (Lexapro), but not if you’re currently using escitalopram.
CBD can help with depression and anxiety and might even help with OCD, but it might not be enough for some people.
If you’re currently using an antidepressant, you have to talk to your doctor about using CBD. Never adjust your dose or add CBD on your own.
CBD may act as an antidepressant as per some studies on animal models . It may possess fast-onset and sustained antidepressant effects through molecular changes in the brain cells and interactions with various neurotransmitters.
Via similar pathways, CBD may also decrease symptoms of anxiety and anxiety disorders .
What Is Escitalopram (Lexapro)?
Escitalopram (Lexapro) is an antidepressant of the selective serotonin reuptake inhibitor (SSRIs) family.
It is an FDA-approved prescription drug that’s used as a treatment for major depressive disorder (MDD), generalized anxiety disorder (GAD), and other psychiatric disorders such as obsessive-compulsive disorder (OCD).
|Trade Names||Lexapro, Cipralex, Jolivel, Cilentra, Elorpax, Nexito|
|Classification||Selective Serotonin Reuptake Inhibitor (SSRIs)|
|CYP Metabolism||CYP2C19, CYP2D6, and CYP3A4.|
|Interaction With CBD||Metabolic competitor|
|Risk of Interaction||Moderate|
What Does Escitalopram (Lexapro) Do?
Escitalopram (Lexapro) works as an antidepressant and an anxiolytic by stopping the serotonin (5-HT) reuptake in the brain.
Serotonin stabilizes the mood, happiness, and feeling of well-being in the body. Studies have found that the level of serotonin in the brain is lower in people with depression. This action could lead to the effects commonly experienced in depression, such as low mood, lack of interest in previously enjoyable activities, etc.
Escitalopram increases the level of serotonin in the brain by stopping its reuptake into the presynaptic neuron. It binds to the orthosteric or the primary binding site on the serotonin transporter (SERT). SERT is the same site where the endogenous serotonin binds. By binding to the SERT, escitalopram thus prevents the reuptake of serotonin. Escitalopram has almost no affinity at other receptors such as histamine and muscarinic receptors.
Escitalopram is the S-enantiomer of racemic citalopram. It is nearly 150 times more potent than citalopram’s R-enantiomer and is responsible for most of the citalopram’s activity. Of all the SSRIs, escitalopram has the highest selectivity for the serotonin transporter. It means it has the lowest rates of adverse effects as compared to other drugs of SSRI. It is also more efficacious and has a faster onset compared to other SSRIs.
Escitalopram, like other SSRIs, can cause abnormal bleeding. Patients at risk of bleeding or those receiving other serotonergic drugs need to be highly cautious.
Side Effects of Escitalopram (Lexapro)
The following list includes the most common side effects of escitalopram:
- Ejaculation disorder
- Dry mouth
- Decreased appetite
- Weight gain
Key Takeaways: Is It Safe to Take Escitalopram (Lexapro) With CBD?
CBD carries a moderate risk of interaction with escitalopram by slowing down the metabolism of escitalopram in the body and acting synergistically with its antidepressant effects.
This may increase the potency of escitalopram by increasing its concentration in the body.
Always discuss new supplements with your doctor if you’ve been prescribed any medications, including escitalopram.
In most cases, CBD won’t interact with SSRIs. However, in rare cases, this combination could result in serious side effects.
Does CBD Oil Interact with Lexapro?
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Is it safe to use CBD with Lexapro? We take a look at the facts…
CBD oil is becoming popular for relieving the symptoms of various medical conditions. Among the most common reasons that people use CBD oil is to alleviate anxiety and depression.
This poses a potential problem as CBD oil may interact with many medications – including antidepressants.
In this article, we explore whether CBD oil interacts with the antidepressant Lexapro.
What Is Lexapro?
Lexapro is the brand name for a drug called escitalopram. It is a selective serotonin reuptake inhibitor (SSRI). SSRIs are a class of antidepressant. They’re used to treat major depressive disorder and generalized anxiety disorder.
SSRI antidepressants work by boosting the amount of serotonin in the brain. Serotonin is a neurotransmitter associated with feelings of happiness and well-being. Furthermore, low serotonin levels are associated with conditions like depression.
Initially, Lexapro was introduced in 2002. It became widely available by 2012. Although escitalopram may cause fewer side effects than similar medications, they can still occur in some cases.
The most common Lexapro side effects include:
- Reduced libido
- Ejaculation disorders
- Inability to orgasm
In addition to these, there is a small chance that Lexapro can worsen the symptoms of depression. As a result, this can lead to suicidal thoughts and behavior. In some patients, Lexapro may also cause several other serious side effects, including:
- Serotonin syndrome
- Hyponatremia (low sodium levels)
- Abnormal bleeding
- Cognitive and motor impairment
Lexapro should be used with caution for people with other medical conditions, including seizures and angle-closure glaucoma. Pregnant or breastfeeding women should only use Lexapro if the benefits outweigh the risks.
Since many antidepressants carry a long list of potential side effects, more and more people are turning to natural alternatives. One such option that has gained much attention in recent years is CBD.
How Can CBD Help Depression and Anxiety?
CBD (cannabidiol) is one of the many active compounds found in cannabis. These compounds are called cannabinoids. Unlike its cousin THC (delta-9-tetrahydrocannabinol), CBD does not cause an intoxicating ‘high.’
However, that is not to say that CBD has no psychoactive effects whatsoever. In fact, it has become well known for its supposed anti-anxiety and antidepressant properties.
According to a 2018 piece published in the journal Cannabis and Cannabinoid Research, anxiety and depression are the third and fourth most common issues for which people use CBD. As an aside, the first and second most common issues are chronic pain and arthritis/joint pain.
Nowadays, more people are turning to CBD to relieve the symptoms of anxiety and depression. However, scientists are still trying to ascertain exactly how the cannabinoid works for these conditions.
How Does the Body Process CBD?
There are several theories, but it seems likely that CBD influences the brain by acting on the endocannabinoid system (ECS). The ECS is a complex system of cell receptors (known as endocannabinoid receptors) and chemicals called endocannabinoids.
The body naturally produces these endocannabinoids. When they bind with cannabinoid receptors, they trigger a series of physiological reactions. These reactions help to maintain a state of homeostasis (balance) within the body.
One of the best-known endocannabinoids is called anandamide. It gets its name from the Sanskrit word for ‘bliss,’ which should give you some idea of its function. Among other things, anandamide regulates the serotonin system in the brain. It is released under stressful conditions and helps to restore a sense of calm.
Research has shown that CBD can slow down the rate at which anandamide is broken down by the body. This means that more of this endocannabinoid becomes available and its effects are greatly enhanced.
Therefore, in many ways, CBD works similarly to an SSRI antidepressant. It increases the levels of ‘feel-good’ chemicals in the brain, like serotonin, to reduce depression and anxiety.
Does CBD Interact with Lexapro?
If someone is considering using CBD to relieve any medical condition, it is important to know that it can interact with numerous medications.
Drug interactions happen because many different substances break down in the liver during a process called drug metabolism. The majority of prescribed medications metabolize in a particular pathway known as the CYP450 pathway.
This CYP450 pathway is comprised of several different enzymes that act on various substances. Therefore, when one takes two drugs that are metabolized by the same enzymes together, an interaction can occur.
In this situation, the two drugs compete with one another for the enzymes, so one or the other breaks down more slowly than usual. This increases the amount of that drug in the body, which can raise the risk of adverse effects.
Lexapro metabolism involves three different enzymes, which means it is less likely to cause interactions than some other medications. Even if it has competition for one of its pathways, there are still two more from which to choose.
The following enzymes metabolize Lexapro:
The CYP450 pathway also metabolizes CBD in the liver. The specific enzymes responsible for breaking down CBD are:
As it turns out, CBD inhibits the enzymes CYP3A4 and CYP2C6. As you can see, Lexapro and CBD share many of the same enzymatic pathways and, therefore, have a strong chance of interacting.
Is It Safe to Take Lexapro and CBD Together?
Taking CBD alongside Lexapro may increase the amount of antidepressants in the body. One might assume this is a positive thing, but it significantly increases the risk of harmful side effects if taken together.
The Depression Alliance recommends that anyone wanting to try CBD for depression should stop taking their medication first and then make the switch. However, it is essential that one does this gradually, carefully, and under the supervision of a doctor.
Stopping an antidepressant medication suddenly can cause the original symptoms to return. One may also experience withdrawal symptoms, including:
- Mood changes
- Sleep disturbances
- Flu-like symptoms
- Digestive issues
It is important to have an honest discussion with one’s doctor before making any changes so that they can help reduce dosages safely and effectively.
Using CBD for Depression and Anxiety
There are many different methods of taking CBD for anxiety and depression. For instance, one of the most popular ways is CBD oil. To do so, one can drop CBD under the tongue. Most manufacturers recommend holding the oil under the tongue for at least 30 seconds so that it can be absorbed effectively into the bloodstream.
Similarly to antidepressants, CBD oil can take a while to start working. However, one should not exceed the maximum dose recommended by their doctor.
If using CBD oil is inconvenient or doesn’t taste great, one could also try CBD capsules, edibles, or vaping.
Each of these consumption methods has its own advantages and disadvantages. To find out more, read our related article on the best forms of CBD products.
Does CBD Oil Interact with Lexapro? Final Thoughts
In conclusion, both Lexapro and CBD oil are popular remedies for depression and anxiety. However, taking the two together may cause a drug interaction as they are both metabolized by the same enzymes in the liver.
If you are taking Lexapro and would like to give CBD a try, talk to your physician first. They will guide you in managing your drug regimen safely and finding an effective dose.
If you have made the switch from antidepressants to CBD oil, we would love to hear from you. Share your experiences in the comments and help our community learn about the benefits and risks of CBD for depression and anxiety.