Does CBD Gummies Interact With Medications

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Learn more about CBD interactions with drugs and how to stay safe when you use CBD for pain or other symptoms. When you take CBD alongside certain medications, it can trigger negative drug interactions. Here we explain what drugs shouldn’t be taken with CBD — and when to consult your doctor if you’re not sure about the potential interactions. CBD is broken down by the same enzyme as 75% of medications and drugs. Here is a list of the medications that interact with CBD and if it's safe to mix.

Does CBD Interact or Interfere with Medication? What Arthritis Patients Must Know Now

CBD (cannabidiol) is seemingly everywhere, with oils, tinctures, pills, chocolates, gummy bears, and creams available all over the internet, at national drugstore chains, and perhaps at your local farmer’s market — even if you don’t live in a state where medical or recreational marijuana is legal.

CBD, a type of chemical known as a cannabinoid, is a mainingredient in hemp, one type of cannabis plant. Marijuana, another type of cannabis plant, also has some CBD but an abundance of THC (tetrahydrocannabinol), an intoxicating cannabinoid known for making users feel “stoned” or “high.” While CBD won’t get you high, it interacts with cannabinoid receptors in your body and may have effects that are sought by people with arthritis, such as pain relief, reduced inflammation, and improvements in sleep and anxiety.

According to CreakyJoints research presented at the 2019 Annual European Congress of Rheumatology meeting earlier this year, 52 percent of respondents reported having tried CBD for a medical reason. Of those who did, 93 percent said it helped. More than half said they wanted more information on CBD from their doctor, but 58 percent of those who told their doctors about their CBD use did not get the information on safety, effectiveness, and dosing they were looking for.

One common concern among people with chronic illness who use CBD is whether CBD can interfere with prescription drugs you may take for arthritis or other conditions.

We put commonly asked questions to Nina M. Bemben, PharmD, BCPS, a specialist in drug interactions who is trying to educate other pharmacists about possible drug-drug interactions with CBD, as well as Rachna Patel, DO, a physician who does consultations about medical marijuana and CBD and sells her own line of CBD products.

What kind of drug interactions can happen with CBD?

A huge number of medications, including CBD, are broken down by the same large family of liver enzymes, called CYP450.

CBD inhibits some enzymes in this family. This makes them break down certain drugs more slowly, which could potentially increase side effects unless your doctor adjusts the dose. On the other hand, CBD induces other enzymes in this family, which speeds the breakdown of certain drugs so they may potentially be less effective unless the dose is increased.

As examples, you may experience increased side effects if CBD is used along with these drugs:

  • Antidepressants (such as fluoxetine, or Prozac)
  • Medications that can cause drowsiness (antipsychotics, benzodiazepines)
  • Macrolide antibiotics (erythromycin, clarithromycin)
  • Heart medications (some calcium channel blockers)

“There is still a lot of uncertainty about how CBD interacts with drug-metabolizing enzymes in the body. We know that there are some drug-metabolizing enzymes that are affected by CBD, some that are not, and many others where we just don’t have any information yet,” says Dr. Bemben.

What do we know for sure about CBD’s interactions with other drugs?

The most direct information comes from studies on the only FDA-approved CBD product, Epidiolex, which is used to treat rare forms of epilepsy. Epidiolex has been found to increase blood levels of the blood thinner warfarin about 30 percent, which raises the risk of bleeding. It also interacts with other medications used for epilepsy.

“The manufacturer of Epidiolex was asked by the FDA to conduct more drug-drug interaction studies, so we will learn more about CBD’s interactions with other drugs in the future,” says Dr. Bemben.

Can CBD interact with medications I take specifically for arthritis?

“Based on what we know now about the way CBD is metabolized, I would not expect significant drug-drug interactions with drugs commonly used in arthritis treatment, such as methotrexate, and most nonsteroidal anti-inflammatory drugs (NSAIDs). I would advise caution on one NSAID, diclofenac, because there isn’t information on how CBD affects — if at all — the enzyme that metabolizes it,” says Dr. Bemben.

Rheumatologists are always on the alert for liver problems that may result from arthritis medications, and that includes CBD as well as NSAIDs and methotrexate.

Are older people more at risk of CBD drug interactions?

Yes, for several reasons. “As we age, our livers and kidneys may be slower to eliminate drugs from the body. In addition, older patients and those with chronic health problems are more likely to be using multiple medications, so the risk for drug interactions increases,” says Dr. Bemben.

Dr. Patel worries in particular about any side effects or interactions that result in dizziness and may increase the risk of falls in the elderly. For example, using the antidepressant fluoxetine together with cannabis products can increase dizziness and drowsiness.

Are there some people who should stay away from CBD?

Hold off if you have known liver damage, says Dr. Patel. In a study done on mice published earlier this year, the dose of CBD used to protect against seizures was found to induce liver damage. According to other animal research, CBD may increase levels of liver enzymes, raising concerns about liver toxicity in patients taking methotrexate.

“We use other therapies that cause liver injury, like nonsteroidal anti-inflammatories (NSAIDs). If liver enzymes go up in someone on methotrexate, we would generally hold the drug other than methotrexate [for example, CBD or an NSAID] to see if the enzyme levels normalize,” says Michael Weinblatt, MD, professor of medicine at Harvard Medical School in Boston.

People who take Epidiolex for epilepsy are more likely to develop abnormal liver enzymes, as well as sleepiness and other symptoms, if they are also using valproic acid to control seizures.

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“This is important for people with arthritis to know because valproic acid is sometimes used for pain that isn’t controlled by other medications,” says Dr. Patel.

If I stick with a CBD cream, does that reduce the risk of drug interactions?

Probably, since little if any of a topical product is likely to be absorbed into your system. “Unfortunately, we just don’t have good information about how much of a topical CBD product gets absorbed. This can be influenced by the inactive ingredients in the product, where on the body it’s applied, and whether you apply a bandage over the area after applying it,” says Dr. Bemben.

While topical CBD products may not be absorbed deeply enough to raise concerns about drug interactions, that also means they may not be as effective for arthritis pain. “If you just have one joint hurting and it’s close to the surface, using a topical would be appropriate. It’s not as likely to help a hip or other deep joint,” says Dr. Patel.

Which health professionals need to know I’m trying CBD?

Tell your rheumatologist and anyone else who prescribes medication for you. If you need surgery, an anesthesiologist may choose a different dose or type of anesthesia if you’re using CBD.

“If you fill all of your medications at the same pharmacy, your pharmacist will be able to assess for drug interactions for all of them, regardless of who prescribed them. You should still let the pharmacist know about over-the-counter medications, herbs, and supplements — including CBD — that you don’t get through the pharmacy. It is important to bring the CBD product to your doctor and pharmacist so they can check the amount of CBD and other ingredients it contains,” says Dr. Bemben.

“While patients may be wary of stigma surrounding CBD products, I believe most health care providers understand this is a growing area and one strategy patients are trying in hopes of getting relief,” she says.

Is there an online source I can use to figure out which of my medications might interact with CBD?

Online databases are available to help health professionals evaluate potential drug-drug interactions, at a price. “Freely available resources tend to be less reliable, and this highlights the importance of discussing all your medications, including CBD, with your doctor and pharmacist,” says Dr. Bemben.

One source available to patients is drugs.com, where you can plug in either cannabidiol (which will give you the FDA-approved oral product Epidiolex) or cannabis (which will give you both THC and CBD) and check for possible interactions with other medications you take.

Has anyone had a life-threatening drug interaction with CBD?

“There haven’t been reports of serious drug-drug interactions with over-the-counter CBD products. However, these products are relatively new and it typically takes time for reports to be published. We have very little information about over-the-counter CBD products and how they may interact with other drugs,” says Dr. Bemben.

CBD Drug Interactions – Mixing Cannabidiol and Medications

Are you worried about potential CBD-drug interactions? In this article, we explain the mechanism behind drug metabolism and how CBD may interfere with it.

The range of therapeutic properties offered by CBD (cannabidiol) has spurred its popularity in recent years. This natural compound is known to relieve a host of symptoms, allowing for safer and more effective management of different health conditions.

And unlike THC (tetrahydrocannabinol), CBD is non-intoxicating, so it won’t get you high.

CBD can assist in the treatment of anxiety disorders and depression, inflammation and pain, neurodegeneration, seizure disorders, sleep deprivation, metabolic conditions, neuropathy, migraines, inflammatory bowel disease, and more.

Considering CBD has so many potential health benefits, you may start wondering if it can interact with certain medications used to address the same symptoms — and whether you should or shouldn’t take these drugs with CBD.

Below you’ll find the dos and don’ts of using CBD along with medications.

Let’s start with the don’ts.

What Drugs Should Not Be Taken with CBD

Studies from the Indiana University Department of Medicine have provided a list of pharmaceutical drugs and medications which shouldn’t be taken with CBD.

The list below covers all groups of drugs that can negatively interact with CBD oil.

  • Angiotension II Blockers
  • Antiarrhythmics
  • Antibiotics
  • Antidepressants
  • Anticonvulsants / Anti-Seizure Medications
  • Antihistamines
  • Antipsychotics
  • Anesthetics
  • Beta-Blockers
  • Benzodiazepines
  • Calcium Channel Blockers
  • HIV Antivirals
  • HMG CoA Reductase Inhibitors (Statins)
  • Immune Modulators
  • Non-Steroidal Anti-Inflammatory Drugs
  • Oral Hypoglycemic Agents
  • Proton-Pump Inhibitors (PPIs)
  • Prokinetics
  • Steroids and Corticosteroids
  • Sulfonylureas

There’s also a group of drugs called “prodrugs” that first need to be processed into their therapeutic compounds instead of being therapeutic compounds on their own. In plain English, the inactive compound is consumed, and once in the body, it turns into the active compound.

If this mechanism is dependant on the CYP450 system (more on that later), a drug interaction can lead to insufficient concentrations of the therapeutic agent in the bloodstream — reducing its potency.

CBD Interaction with Drugs & Medications

This section covers the most common interactions between CBD and medications. If you take any of the substances listed below, make sure to consult your doctor before buying CBD oil.

CBD and Ibuprofen Interaction

Ibuprofen is one of the Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), meaning it can produce similar benefits to CBD in terms of inflammation and pain relief. Previously we’ve mentioned that NSAIDs interact with CBD, which may raise concerns about potential negative interactions between CBD oil and Ibuprofen.

According to a study from the Journal of Neurology Research, there have been no reported interactions between CBD and ibuprofen, although it doesn’t mean they do not exist. Health experts suggest that potential interactions may be dosage-dependent. If a certain dosage threshold is breached, CBD and NSAIDs like Ibuprofen can lead to unforeseen and potentially severe nervous system pathology.

CBD and Adderall Interaction

A 2020 study found that higher doses of medical cannabis led to a decreased use of ADHD medication in adults. Products containing a higher concentration of CBD were linked to lower ADHD scores. This means that CBD can interact with ADHD meds, decreasing their efficacy while providing more pronounced benefits. The potential side effects of interactions between CBD and Adderall may lead to decreased appetite.

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CBD and Lamictal Interaction

Using medical cannabis and Lamictal may increase side effects such as dizziness, confusion, drowsiness, and difficulty concentrating. Elderly consumers may also experience impairment in judgment. That being said, none of these side effects were proven to result from CBD use per se. When it comes to interactions between CBD and Lamictal, it can make the medication more or less effective, depending on the dosage.

CBD Oil and Antibiotics

There is no known interaction between CBD and antibiotics, although these interactions may occur if an antibiotic is metabolized through the cytochrome P450 enzyme system. Some studies indicate that taking CBD and antibiotics together may amplify the effects of one another without any negative side effects. However, more research is needed to confirm these findings on a larger scale.

CBD Oil and Omeprazole

CBD can inhibit the enzymes that are targeted by omeprazole and other Proton Pump Inhibitors (PPIs). Taking CBD with certain heartburn medications can increase the risk of diarrhea.

CBD and Thyroid Medications

Some people report mild nausea when taking CBD oil together with their thyroid medications. Since both substances are processed by the CYP450 enzyme system, taking CBD with a thyroid medication may cause hyperthyroidism because more thyroxine would be secreted than the body could metabolize.

CBD and Lisinopril

CBD can temporarily lower blood pressure, so taking it alongside medications like Lisinopril might reduce it even more, making you feel lethargic and weak. Always consult your doctor before adding CBD to your routine if you use anti-hypertension meds.

CBD and Prednisone

Since both CBD and corticosteroids are potent inhibitors of the CYP450 enzyme system, concomitant use may increase the risk of systemic side effects from corticosteroid use due to decreased glucocorticoid clearance. Corticosteroids like prednisolone and hydrocortisone should never be taken with CBD.

How Drugs Interact: Understanding Drug Metabolism

Metabolism can refer to how your body uses energy for weight management, or the way drugs are metabolized in your body.

The former is known as the basal metabolic rate, or in simple terms, the number of calories a person needs to maintain healthy body functions while at rest.

The latter is very different from the basal metabolic rate. Drug metabolism refers to how a substance is processed and used by the body — with the majority of this processing happening in the liver.

Scientists call it the ‘first-pass effect’ or ‘first-pass metabolism.’

Using straightforward terms, when you take a medication, it is broken down in the liver into its active compounds so that the body can use them. Just like carbohydrates are broken down into sugars, fats into triglycerides, and proteins into amino acids — drugs break down into their individual ingredients.

From there, they are controlled by specific enzymes, which transform these compounds into metabolites. These metabolites then influence different processes in your body and are flushed with urine once used up.

How Is CBD Metabolized?

Drug metabolism determines the rate at which the body processes medications and other therapeutic compounds into their individual metabolites and how long they can stay in your system.

When you take CBD in the form of an oil, capsule, or gummy, it has to pass through your gut, where it is released into the bloodstream. From then, they travel through the bloodstream to the liver, where it absorbs through the hepatic portal. The liver breaks CBD down into its metabolites using enzymes, after which it can circulate throughout the body in the bloodstream again.

What Is the Cytochrome P450 System?

Aside from breaking compounds down into metabolites, the liver also detoxifies and excretes foreign substances and other types of toxic compounds. This can happen through a system of enzymes referred to as the Cytochrome P450 (CYP450). These enzymes contain heme as a cofactor to convert cannabinoids into more water-soluble molecules, increasing their absorption and efficacy.

Researchers estimate that the CYP450 system is responsible for metabolizing 60% of any drugs out there. And interestingly, doctors and pharmacists use this system to understand, evaluate, and predict the benefits of the drug and potential side effects based on their dosages.

However, certain compounds have the ability to compromise the CYP system’s functioning, negatively affecting the metabolism of certain medications. Once these interactions occur, the drugs can be metabolized faster or slower than normal.

CBD And the Cytochrome P450 System

As mentioned earlier, CBD can interact directly with the CYP450 system in the liver. According to preclinical studies, CBD binds to the site where the enzyme activity occurs, competing with other compounds and thus preventing this system from breaking down other substances.

This inhibitory effect on the CYP450 enzymes mainly depends on how much CBD a person takes, their unique physiology, and the type of CBD used (e.g., full-spectrum CBD vs. CBD isolate). The dosage determines the strength used by the CBD to bind to the active site of the metabolic enzymes. The tighter the bond, the more competitive inhibition.

Contraindications for Taking CBD with Medications

The mechanism behind CBD’s health benefits proves that it’s not a biologically inert compound. Instead, the pharmacokinetics and pharmacodynamics of CBD are complex and similar to any other medication. Therefore, it has the potential to compromise the metabolism of certain medications.

Any therapeutic substance that relies on the CYP450 system can be potentially affected by CBD. A common indicator for such interaction is when your medication has a grapefruit warning on the bottle. However, this is by no means a solid point of reference, and you should always check with your doctor and pharmacist before taking the two compounds together.

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Why You Should Always Consult Your Doctor First

The list of drugs that we’ve mentioned above is by no means definite and doesn’t include all the pharmaceutical substances that may interact with CBD. Similarly, not all the medication from these categories will necessarily cause an interaction — as is the case for antibiotics and Ibuprofen.

A consultation with a doctor experienced in CBD and cannabis use can help you establish the right routine for your medications and supplements to avoid potentially negative interactions. Some compounds work synergistically with CBD, so asking your doctor can help you maximize the effect of your treatment.

Not to mention that the doctor can guide you on finding the optimal dosage for yourself.

Key Takeaways on CBD Drug Interactions

The safety profile of CBD has been acknowledged by major health agencies, such as the World Health Organization (WHO), showing that it’s well-tolerated by animals and humans and rarely produces any dangerous side effects.

CBD also has a profound impact on an array of systems, which explains its therapeutic versatility. That being said, this versatility is also the reason why CBD interacts with so many prescription meds and over-the-counter (OTC) PRODUCTS.

Again, if you’re not sure if CBD will interact with the medication that you might be taking, a consultation with a health professional will not harm — unlike trying to figure out these interactions on your own.

Livvy Ashton

Livvy is a registered nurse (RN) and board-certified nurse midwife (CNM) in the state of New Jersey. After giving birth to her newborn daughter, Livvy stepped down from her full-time position at the Children’s Hospital of New Jersey. This gave her the opportunity to spend more time writing articles on all topics related to pregnancy and prenatal care.

CBD Drug Interaction List: Is it Safe to take CBD with your Medications?

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 List

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.

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