When your doctor or another healthcare professional prescribes a medication for you, they’ll check what other meds and over-the-counter supplements and vitamins you take. They’ll probably ask about illegal drug use, too.
That’s because they’re cautious — as they’re supposed to be. Many medications, drugs, and supplements interact with each other, potentially causing problematic, dangerous, or even fatal results.
You won’t be asked those questions when you buy CBD (cannabidiol), since doctors can only prescribe it to treat rare forms of childhood epileptic seizures. If you try a CBD product, it’s your responsibility to make sure there are no drug interactions to worry about (although it certainly would be smart to check with your doctor before using any CBD-infused product).
Most people don’t think about the subject, but they should. Cannabidiol is broken down in the body by the same enzymes that metabolize more than half of all prescription drugs, so there’s a good chance the effectiveness of your CBD or one of your meds could be affected. The effects of one or the other could be greatly magnified, decreased, or even blocked.
What’s worse, there could be very serious interactions with some blood thinners, thyroid medications, heart meds, and those used to control seizures.
Hopefully, that’s enough information to make you want to learn the details before you grab some CBD online or at your local shop.
What Happens When CBD Enters Your Body?
Cannabidiol is sourced from the hemp plant, and it’s one of more than 100 chemical compounds known as cannabinoids found in that plant (as well as in cannabis, its close relative). The other key cannabinoid in both hemp and cannabis is psychoactive THC. However, there are only small amounts of THC in hemp, so the CBD products sold in Britain aren’t intoxicating.
The chemical structure of CBD (and THC) is extremely similar to substances produced in the body, known as endocannabinoids. The latter carry messages between receptors in the endocannabinoid system (ECS), which controls an enormous number of important bodily functions. And since cannabidiol is so similar to ECS messengers, it can interact with the receptors to send or block “control messages.” That’s how CBD supplies its potential medical, health, and wellness benefits, which apparently include boosting immunity and reducing inflammation, easing pain and neurodegenerative conditions, relieving pain, and helping with sleep. Before CBD can reach the bloodstream and ECS, however, it first must be broken down in the body so the cannabidiol can do its work and what’s left can be excreted. Cannabidiol is metabolized in several organs, including those in the intestinal system, but the liver does most of the heavy lifting. That’s where many of the “interaction problems” occur. The majority of medications and drugs are broken down in the liver, too. Proteins known as enzymes are responsible for metabolizing those substances in the liver, separating them into active (to be used by the body) or inactive (to be expelled) forms. That work is done primarily by a family of enzymes known as cytochrome P450, or CYP450 for short. So far, so good. But here’s the problem: one of those enzymes, CYP3A4, breaks down around 60% of all medications — and it’s also the enzyme that breaks down cannabidiol. So, when you use CBD, it interacts with the CYP3A4 enzyme and can interfere with CYP3A4’s ability to metabolize many other drugs. That could lead to too much medication in your system. On the other hand, some meds speed up the work of CYP450 enzymes, causing them to metabolize CBD and other substances too quickly. The result is that there may not be enough in your system to do the intended job. That’s the cause of the most common interactions between CBD and other medications. And since 60% is a very large percentage, there’s a good chance that users are taking at least one substance that could be affected by cannabidiol use, or that they’re taking a med that could affect the metabolism of CBD. We’ll get to a list of the types of drugs that could be problematic when used together with CBD shortly. First, though, here’s a helpful “cheat” you can use. If you take more than a few medications, you’ve probably seen warnings on their labels (or been warned by your doctor) that users shouldn’t eat grapefruit while on the meds. Here’s why. Some of the chemicals in grapefruit interact with the CYP3A4 liver enzyme in the same way that CBD does. Eating grapefruit slows the metabolism of those medications, leaving more of them in the body than there should be. That can lead to the meds delivering more of their intended effects than intended, unwanted side effects, or even an overdose. Cannabidiol has the same effect on CYP3A4 enzymes, so it can create those same problems. If you take a prescription medication that calls for you to avoid grapefruit, you’re at risk for the issues we’ve just mentioned by using any CBD product. At the very least, speak with your doctor first; they may be able to reduce your dose so the med can be used safely with CBD. (Random fact you may not have known: the warnings only specify grapefruit, but other citrus fruits like tangelos and pomelos affect the CYP34A enzymes in the same way and should also be avoided.) Not all drugs in these classes will be affected by cannabidiol’s effects on liver enzymes, but many will. If you take the following types of medications, you should (at the very least) look for a grapefruit warning, or (ideally) check with your doctor to be sure it’s safe for you to use a CBD product. That’s not an exhaustive list. Some antibiotics, antihistamines like diphenhydramine (Benadryl), blood thinners, ED meds, proton pump inhibitors (for GI problems), immunosuppressants, pain meds like opioids, prostate medications, and over-the-counter meds such as allergy pills like fexofenadine (Allegra), can also cause the CBD interaction issues we’ve discussed. Always check with a medical professional to be sure you won’t be affected before deciding to give CBD products a try. Even if there aren’t issues metabolizing medications or CBD in the liver, taking some drugs or substances in combination with cannabidiol can worsen the side effects of those meds or substances. One of the most common is drowsiness. Some CBD users notice a degree of fatigue after using a product containing cannabidiol. When added to meds (or OTC pills) that can cause tiredness, CBD products may exacerbate those effects leading to excessive sleepiness, decreased motor control, or accidents when operating a car or machinery. Notable drugs and substances that can cause this increase in drowsiness are anti-anxiety and anti-depressant meds, antihistamines, pain relief products, alcohol, and some street drugs. Even herbal supplements like St. John’s wort and melatonin can trigger this problem. Other increased side effects reported when combining CBD use with medications include severe diarrhoea (when mixed with the use of heartburn meds like Prilosec or diabetes meds like Metformin), and lower appetite (when combined with the use of stimulant medications like Adderall). Using some medications together with CBD products can cause problematic drug interactions. Most are due to the fact that an enormous number of meds and OTC products are metabolized by the same enzyme as cannabidiol, making one or the other less (or more) effective. That can lead to unwanted side effects or ineffective medications at best, and serious issues at worst. Those taking multiple medications and those who are older are most at risk for these CBD drug interactions — but anyone who is taking prescription or over-the-counter drugs should always check with their doctor before beginning CBD use.
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The Role of Liver Enzymes
Potential CBD-Medication Interactions
Look for the “Grapefruit Warning”
Medication Classes that May Interact With CBD
Possibility of CBD-Medication Side Effects
In Conclusion
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