Knowing what potential interactions may occur will enable you to be aware of any warning signs. For reference, the table below breaks down the most common antidepressant medications and their side effects, many of which you may feel more keenly if a negative interaction occurs with CBD oil.
These stipulations are not definite, partially because there is little research published on CBD and drug interactions, and partially because CBD oil possesses anti-depressive qualities of its own.
While CBD oil is generally well-tolerated and taken without side-effects, there are a few medications which, when used with CBD oil, can create adverse reactions. These interactions occur because CBD oil inhibits the cytochrome P-450 enzyme system.
Avoiding the Side Effects
In a recent review of data, the New York Times published that 25 million Americans have been on antidepressants for at least two years, a 60% increase from 2010. While antidepressants have helped millions of people, their efficacy as a long-term solution for managing depression and anxiety is debated due to users experiencing unwanted side effects and having difficulty getting off the medication.
When combining CBD oil and antidepressants, or replacing current medication with CBD oil, it is always recommended to seek medical advice. Together, you and your doctor can create a plan to ensure there is minimal disruption to your system.
The cytochrome P-450 system, found in the liver, breaks down medications into smaller substances that the body can more easily process. There are a range of natural foods and compounds that slow down this system, including grapefruit, St. John’s Wort, and of course, cannabidiol (CBD). When the system is inhibited, some medications, like monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants (TCAs), remain in the system for a longer period, increasing the chance you will experience some of their unpleasant side effects.
If you’ve considered transitioning from antidepressants to CBD oil, or are thinking about combining the two, here’s what you need to know.
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.
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.
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.
Does the form of CBD matter?
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.
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.
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
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.