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Taking CBD with Other Medications

Healthcare costs are rising in the United States and the world over. Keeping healthy means high insurance premiums, co-pays, and deductibles. In most cases, these are beyond the reach of the average person.

Factoring in inflation, healthcare spending in the US rose by nearly $1 trillion between 2009 and 2019.

Several factors have contributed to this astronomical rise in healthcare spending—a bulging population, disease prevalence, an aging demographic, medical service utilization, service intensity, and price, to mention a few.

Incidentally, the rise in healthcare costs has driven many people to be more health conscious, perhaps to avoid exposing themselves to conditions that might make them ill.

Subsequently, increased concerns over diet, weight, mental health, etc., have seen consumers gravitate towards preventive healthcare and turn to health-impacting herbal supplements.

Innovative alternative therapies by manufacturers to treat wide-ranging diseases and health conditions, such as insomnia, menopausal hot flashes, muscle spasms, and chronic pain, are on the rise.

Herbal offerings, such as fish oils, probiotic drinks, detoxes, and—the new kid on the block—cannabis supplements, are increasingly gaining traction among many.

And as consumers become more comfortable with these supplements, advancements in research are expected to yield higher quality supplements and alternative treatment options. 

One that has taken the world by storm is cannabidiol (CBD), and you've probably run into products containing this cannabis compound. It appears to be in everything: drinks, skin care creams, food products, pet products; you name it! 

CBD is a generally non-psychoactive cannabinoid derived from cannabis and hemp plants. The most well-known member of the cannabinoids is tetrahydrocannabinol (THC), and rightfully so because it is responsible for the "high" associated with marijuana use. 

Cannabis research is in its early stages, so the entire pharmaceutical value of cannabis compounds is still unclear. However, early studies suggest that cannabinoids have intrinsic health-impacting properties that may be utilized in managing numerous health conditions. 

For instance, CBD has been shown to possess analgesic, anti-inflammatory, antioxidant, and neuroprotective qualities that can be exploited in healthcare. 

However, CBD's efficacy is still under review. So, medical experts do not recommend quitting conventional medicine for CBD or other cannabis-based supplements, for that matter. This then begs the question: can CBD be taken with other medications? Let's find out.


Can you take CBD with other medications?

Before providing a conclusive answer to this question, let's start by understanding the dynamics of drug metabolism and how CBD affects this process.

When you take medicine, it is metabolized in the digestive tract into metabolites that are usable by the body. Any leftovers are ejected as waste. A class of liver enzymes called cytochrome P450 (CYP450) plays a critical role in metabolism. They process foreign substances for easy elimination from the body. 

However, some substances, including medicines, have been shown to affect how these enzymes work. These either slow down drug metabolism or speed up the process, thus affecting how the body processes drugs or supplements.

Research shows that the CYP450 can also metabolize cannabinoids, including CBD. In particular, the CYP3A4, an enzyme belonging to the CYP450 family, does this job. However, in the process of breaking down CBD, this enzyme is also affected.

Considering that the CYP3A4 also metabolizes 60% of the medicines we take, it won't do its job effectively if CBD affects how it works. But it's not only CBD that can hinder CYP3A4 from working effectively.

Some medications are known to inhibit this enzyme, meaning taking CBD while on such medications may affect how the body processes CBD.

So, if your body is processing medicine either too fast or too slowly, the likely outcomes are as follows: you may end up having higher drug levels than intended despite sticking to the usual dose.

This may mean more intense effects, including unwanted side effects. Conversely, it may mean having less than the required drug concentration in your system.

In sum, depending on the type of medication you're on, you may or may not take CBD.

Is CBD safe to take with other medications?

Given that CBD can potentially interfere with drug metabolism in the body, we can conclude that it may not be safe to take CBD with other medications.

Despite its decent safety profile, CBD may cause side effects such as nausea, drowsiness, dry mouth, diarrhea, lightheadedness, and, rarely, liver injury. Taking CBD with other medications may probably worsen these adverse effects, especially if the drugs have similar side effects.

Medicines like opioids, benzodiazepines, antidepressants, and antihistamines are known to cause sleepiness and fatigue. Therefore, taking CBD while on such medications may increase the intensity of their side effects.

While these side effects may not hurt you per se, they may put you in a precarious situation if you are handling potentially dangerous machinery or driving.

Ultimately, the best thing you can do is ask your doctor before taking any cannabis supplement while on medication.


Does CBD interact with other medications?

A piece of advice you should abide by in the meantime, as researchers work to find out what medications are affected by CBD, is to stay away from it if your drugs have a grapefruit warning.  

Grapefruit has a chemical compound called furanocoumarins that inhibits CPY3A4, just like CBD. 

So, if your medication is contraindicated against grapefruit, you shouldn't take CBD either. Besides grapefruit, starfruit, and herbs such as St. John's Wort and Goldenseal (Hydrastis Canadensis) can also interfere with CYP450.

Grapefruit and its juice are known to affect how medicines work in the body, raising concerns about harmful food and drug interactions. As a result, the FDA requires that some over-the-counter prescriptions taken orally should have warnings on their labels against taking grapefruit while on those medications.

Researchers from Penn State College of Medicine undertook an evaluative study to determine drugs for which altered concentration could be dangerous. They identified several medications that can potentially be affected by cannabinoids, particularly CBD.

These include:

  • Levothyroxine
  • Warfarin
  • Amiodarone
  • Lamotrigine
  • Valproate
  • Clobazam

So, back to the question of interest, does CBD interact with other medications? CBD likely interacts with some medications. Here is a list of drugs likely to interact with CBD.


What kind of drug interactions can happen with CBD?

A few studies have shown that CBD can interfere with drug metabolism. Although it does not affect all medicines, those whose metabolism is likely to be affected include macrolide antibiotics, antidepressants, antipsychotics, and heart medications. 

This is not the complete list of drugs that can be affected by CBD. Research is ongoing to establish more information in this regard.

Other studies suggest that CBD may also impact the metabolism of Epidiolex, a CBD-based drug used to manage a stubborn type of childhood epilepsy. The drug was found to raise warfarin levels in the blood by about 30%. This predisposes patients on Epidiolex to bleeding risks.

Another recent study investigated the effects of CBD on seizures independent of its interaction with Clobazam. It showed that besides inducing clinically significant reductions in seizure frequency and intensity, there was a five-fold increase of the active metabolite norclabazam in blood plasma, resulting in better anti-seizure outcomes.

As mentioned earlier, increasing the concentration of a drug can be beneficial or detrimental. In pharmacokinetics, variability in bioavailability may sometimes not affect therapeutic equivalence. 

In other words, there are drugs whose efficacy and safety are not affected by bioavailability differences due to a broad therapeutic index. This is true for antibiotics such as penicillin. Note, however, that this does not apply to all antibiotics. 

How CBD interacts with the body's drug-metabolizing enzymes is still mostly unknown. Some drug-metabolizing enzymes are impacted by CBD, while others are not. There are many others about which not much is known.

Keep in mind that the CYP450 class of enzymes affected by CBD contains other sub-classes:

  • CYP1A1
  • CYP1A2
  • CYP2D6
  • CYP2C19
  • CYP2C9
  • CYP3A4

Evidently, there is still so much work for researchers to do!


CBD oil and magnesium for sleep

Magnesium is a crucial element that the human body uses in many enzymatic processes. The endocannabinoid system is affected by CBD, and for the most part, CBD is not viable as a substitute for magnesium.

This mineral is vital for good sleep; it aids relaxation by calming your mind and promoting deeper sleep. CBD's sedative and anxiolytic properties are also well-established in science.

So, combining a product like our Sleep Drops with a magnesium supplement  would appear to be a good way of enhancing their individual properties.

CBD and magnesium use different action pathways, making them less likely to interact. Nevertheless, there is a chance magnesium may affect how your body absorbs CBD, affecting its effectiveness. To avoid potential interactions, take these supplements 1-2 hours apart.


Trazodone and CBD oil for sleep

Trazodone belongs to the group of drugs known as serotonin modulators and is mainly used to treat depression. It works by upregulating serotonin levels in the brain while reducing cortisol plasma concentrations, thus supporting mental stability. This medicine is now widely used as a sleep aid by people with insomnia.

The CYP3A4 enzyme metabolizes both trazodone and CBD. So, there is a high probability that taking these two together may lead to adverse side effects. Moreover, CBD inhibits trazodone's ability to lower blood cortisol levels when taken together. This is attributed to CBD's potential inhibitory effect on the P450 family of enzymes. 

The elderly are likely to experience side effects like impaired thinking, coordination, and judgment if they combine CBD and trazodone. Talk to a doctor before combining CBD supplements and trazodone to be safe. 


CBD oil and melatonin for sleep

Your brain releases melatonin when it gets dark. This hormone enhances sleep by regulating your circadian rhythms. However, exposure to bright lights at night can affect your body's ability to produce melatonin.

Melatonin supplements are frequently used to alleviate conditions such as jet lag, sleep disorders, and general anxiety (e.g., before and after surgery). Melatonin helps with sleep onset, while CBD may support better sleep during the night. 

However, some people may experience enhanced alertness with CBD without experiencing increased anxiety. In others, using CBD may have a detrimental effect on sleep, although taking it during the day may have a positive effect. 

This phenomenon explains why using melatonin and CBD together in the short term may promote better sleep. However, in the long-term, melatonin may counteract CBD's wake-inducing properties.

CBD and melatonin are a popular combination. Some CBD supplements even have melatonin as an ingredient; by all indications, these two seem to work well together.


Can CBD interact with medications I take specifically for arthritis?

Based on existing knowledge regarding how CBD is metabolized, it is unlikely to have significant drug-drug interactions with NSAIDs. Animal studies suggest that CBD may benefit people with rheumatoid arthritis (RA), manage pain and inflammation, promote better sleep, and reduce anxiety symptoms. 

A recent study showed that CBD could help reduce RA inflammation and pain by regulating the activity of immune cells that attack healthy body cells. Even though these findings are based on animal studies, the growing number of people using CBD to manage various arthritic-related conditions suggests a strong likelihood of positive effects.

Nonetheless, there are indications that CBD may affect some medications used to manage arthritis, such as Naproxen, Tofacitinib, Celecoxib, corticosteroids, and Tramadol.


To learn more about how CBD interacts with certain medications, watch the following video: