Can You Take CBD With Paracetamol? Checking The Interactions

Paracetamol, often sold under the brand name Tylenol and known as acetaminophen in America, is the most popular over-the-counter painkiller in the U.K. and used extensively in the U.S. It’s considered the most effective non-prescription analgesic medication for most types of pain.

The many apparent benefits of CBD (the acronym for cannabidiol) include pain relief as well, and many users suffering from chronic pain caused by inflammation and anti-immune diseases say it’s an effective method of pain relief.

But can you take CBD and paracetamol together?

It’s always smart to first ask that question of your doctor or another healthcare professional, since they’ll be more familiar with your physical condition, the medications you take, and whether CBD is appropriate for you to use.

Here’s the basic information, though.

It’s usually safe to take normal doses of paracetamol and use a CBD product concurrently. Many experts recommend separating them by a few hours because there can be a somewhat problematic interaction between them.

Both paracetamol and cannabidiol are metabolised by the same liver enzymes, and that can put a strain on the liver’s processing capabilities. In addition, there’s some evidence that CBD can slow or prevent the enzymes from acting. Those two issues could cause a buildup of unmetabolised paracetamol in the bloodstream, leading to unwanted side effects.

Those potential side effects are mild and not life-threatening, though. They include stomach discomfort, headaches, and insomnia.

One other possibility that’s sometimes mentioned is a controversial subject. Very high doses or overuse of paracetamol may cause liver damage, and one study has warned that CBD also has the potential to cause liver toxicity, making their simultaneous use risky.

Most experts, however, say that CBD study was unfairly skewed to exaggerate cannabidiol’s danger to the liver, and a recent research review concluded there’s very little risk of liver damage even with high doses of CBD. In fact, some believe combining CBD and paracetamol might provide even more effective pain relief; more research into that possibility is underway.

Here’s the bottom line: check with your doctor first, but taking CBD with paracetamol should be safe for the vast majority of people. It could also make sense to take them a few hours apart.

Want to know more? Read on.

CBD and Its Effects

In order to understand the potential interactions between cannabidiol and paracetamol, it’s important to learn a little about each. We’ll begin with CBD.

What Is CBD?

Hemp and cannabis plants contain more than 100 plant compounds known as cannabinoids. The two most important are CBD and THC (tetrahydrocannabinol). They are each believed to provide laundry lists of health and wellness benefits, but they differ in one key way: THC makes users high while it delivers its apparent benefits, but CBD is non-intoxicating.

The cannabidiol used to make CBD products is extracted from hemp because the plants are rich in CBD but contain only a small amount of THC. Needless to say, cannabis has high THC levels, but it generally contains only low levels of CBD.

How Does CBD Deliver Its Apparent Effects?

Once inside the body, cannabidiol delivers its effects by interacting with a full-body network known as the endocannabinoid system (ECS). The ECS governs an enormous number of crucial bodily functions, including thinking and memory, sleep, appetite, immunity, inflammation — and pain.

It would make sense that CBD’s interaction with the system that controls inflammation and immunity, as well as pain, might be particularly beneficial for those suffering from the chronic pain caused by inflammatory and auto-immune diseases and conditions like arthritis, multiple sclerosis, diabetes, asthma, lupus, inflammatory bowel disease, fibromyalgia, and gout.

And while research is still in preliminary stages — meaning CBD is not yet an accepted prescription treatment for pain — the evidence shows that cannabidiol does appear to be an effective method of easing those issues and potentially other forms of chronic pain.

What Is Paracetamol?

Paracetamol is the most commonly used over-the-counter, non-opiate pain medication in Britain. It’s a common pain relief med in America as well, where it’s known as acetaminophen. It’s also sold under the brand names Tylenol or Panadol and is often combined with opiates like codeine or hydrocodone in prescription medications.

People often use paracetamol to relieve the mild-to-moderate pain caused by problems like headaches, backaches, toothaches, muscle strains, and menstrual cramps, and to treat colds, flu, and fever.

Paracetamol and its analgesic properties were discovered by accident nearly 150 years ago, and the medication was originally produced from coal tar (which was used to make several other medications as well). It’s now synthesized from several sources, including material from poplar, pine, and palm trees.

It’s still not fully understood why paracetamol is such an effective pain reliever. However, researchers believe that it may work in the brain and nervous system to block the creation of so-called COX enzymes, which produce chemicals that cause pain, inflammation, and fever.

Here’s what’s important to this discussion: paracetamol does not appear to deliver its effects by interacting with the endocannabinoid system. That means the medication’s mode of action in the body doesn’t conflict with the way that CBD may provide pain relief, limiting the potential for problematic interactions.

The only place the two substances may clash is in the liver.

Metabolising CBD and Paracetamol

Drugs and other substances can’t work in the body until they’re broken down into inactive forms to be expelled from the body, and active metabolites that deliver the drugs’ effects. In most cases, that happens in the liver through a process called metabolisation, with proteins called enzymes responsible for doing the work.

Cannabidiol and paracetamol each must be metabolised in the liver, and the same enzymes — CYP450 enzymes — break down both of them. And that’s where problems can arise.

There are a finite number of CYP450 enzymes, and if CBD and paracetamol are taken at the same time, there may not be enough enzymes available to metabolise both of them completely. Some studies have also found that cannabidiol may inhibit, or slow down, the liver’s metabolisation process.

Those potential roadblocks could mean that unmetabolised paracetamol would build up in the liver and bloodstream, causing two issues.

First, the number of active paracetamol metabolites released to the body would be reduced, so users wouldn’t receive the pain relief they’d expected. Second, a buildup of excess paracetamol can cause abdominal pain, nausea and vomiting, headaches, and insomnia.

Those potential side effects could be the first signs of a paracetamol overdose if a user has taken way too much of the medication all at once. An overdose is serious and potentially life-threatening.

However, a CBD-paracetamol interaction is not the same thing. The side effects may be disconcerting and uncomfortable, but they resolve quickly and are definitely not life-threatening — although they’re a signal to hold off on taking more paracetamol for the time being.

One other fact worth mentioning: warnings about possible liver damage from the use of both substances are most likely vastly overstated.

Paracetamol overdose can indeed damage the liver, but the warnings about CBD’s supposed worsening of that problem have been pretty much debunked. The study they’re based on appears to have used unreasonably skewed statistics, and a full review of research has shown there’s no increased danger of liver damage from CBD’s concurrent use with paracetamol.

So, what’s the takeaway from this discussion?

The potential conflicts between cannabidiol and paracetamol aren’t overly worrisome. In fact, many drug interaction guides don’t even list CBD and paracetamol as a combination to avoid. However, users could experience some temporary negative side effects and might not receive all of the benefits of paracetamol they had expected.

The best approach, if your doctor says it’s OK for you to use both substances together, is to wait a few hours after taking one before taking the other. That would minimize any conflicts in the liver and allow both the cannabidiol and paracetamol to work most effectively.

And some experts believe that might be a smart approach to pain control.

Is It Smart to Take CBD with Paracetamol?

As with most subjects involving the potential benefits of cannabidiol, research into whether paracetamol can provide better pain relief when combined with CBD use is still in its early stages.

One study conducted with patients suffering from osteoarthritis of the knee, recently published in the journal Lancet, concluded that there was “no additional analgesic effect” when cannabidiol was added to a course of paracetamol.

Research continues, however, because quite a few experts believe there could be an additive effect for pain relief. They base that belief on the fact that, as we’ve mentioned, CBD interacts with ECS receptors to provide its apparent pain relief benefits, while paracetamol seems to do its work in the brain.

Is the combination of CBD and paracetamol worth trying? To repeat what we’ve said several times, it’s best to consult with your doctor before deciding, and it’s smart to let a few hours pass after taking one before taking the other. But available evidence shows that there’s no serious risk from combining CBD and paracetamol, so the decision is up to you.

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