RX Interactions: Drugs to Avoid Taking with CBD

August 05, 2020 0 Comments

RX Interactions: Drugs to Avoid Taking with CBD

Since its legalization in 2018, non-psychoactive Cannabidiol (CBD) has gained widespread attention from both scientists and consumers for its potential health applications.

Even with only a few years of research, CBD has proven useful in reducing seizures in patients with rare forms of epilepsy. It also relieves symptoms of anxiety and depression, reduces neuropathic pain and inflammation, and may help fight cancer cells.

CBD is generally safe and has few to no side effects. However, because of the way your body, specifically drug-metabolizing enzymes in your liver, metabolizes CBD, it can potentially interact with some prescription medications.

Why Does Metabolism Matter?

When food enters the body, it has to be broken down into individual compounds. For example, if you eat a piece of pizza, the carbohydrates in the crust will be broken down into sugars. The proteins in the cheese and meat contribute amino acids, and the fats provide triglycerides. With the help of enzymes, the body then transforms these compounds into building blocks and fuel for the body.

Like food, any therapeutic compound that you ingest has to be broken down. This includes CBD and prescription medications.

CBD can change the way your body processes certain medications by either promoting the enzymatic activity or through a competitive inhibitory effect.

The same family of liver enzymes, called CYPs, metabolizes CBD and many prescription medications. Essentially, if there is a competition between CBD and another substance, CBD will take priority and be broken down first.

Drug Interactions and CBD

CBD may influence any therapeutic compound broken down by the CYP family of enzymes. Some drugs may break down more slowly, which could increase side effects or in extreme cases cause an overdose. Other drugs may metabolize more quickly, which make them less effective.

Your doctor can address both situations by adjusting your dosage and through close monitoring of medication levels in your system. It is wise to consult your physician before adding CBD.

The Grapefruit Warning

One quick way to know that your medication may interact with CBD is the grapefruit warning in the insert. Like CBD, grapefruit, Seville oranges, tangelos, and pomelos can disrupt the normal function of CYPs. More than 85 drugs interact with grapefruit.

Similar warnings to watch for include St. John's wort, watercress, and goldenseal.

Here are some medications that commonly contain a grapefruit warning or that are likely to interact with CBD:

  •       Antibiotics
  •       Anti-cancer medications
  •       Antiarrhythmic
  •       Antihistamines
  •       Anesthetics
  •       Angiotensin II blockers
  •       Antipsychotics
  •       Antiepileptic drugs
  •       Anxiety, Depression, and other mood disorder medications
  •       Benzodiazepines
  •       Beta-blockers
  •       Blood pressure medications
  •       Blood thinners
  •       Calcium channel blockers
  •       Cholesterol medications
  •       Corticosteroids
  •       Erectile dysfunction medications
  •       Heart rhythm medications
  •       HIV antivirals
  •       HMG CoA reductase inhibitors
  •       Immunosuppressant and Immune modulators
  •       NSAIDs
  •       Oral hypoglycemic agents
  •       Pain medications
  •       PPIs
  •       Prokinetics
  •       Prostate medications
  •       Steroids
  •       Sulfonylureas

Not all medications that may potentially interact with CBD are on this list, nor will every category of drugs listed cause an interaction. The best plan is to tell your prescribing doctor you plan to take CBD.

CBD and Side Effects

CBD may specifically increase side effects in a few common drugs. They include:

  •       Antidepressants like fluoxetine or Prozac.
  •       Medications that may cause drowsiness like antipsychotics and benzodiazepines
  •       Heart medications, including some calcium channel blockers.
  •       Macrolide antibiotics, such as clarithromycin and erythromycin.

If you have added CBD to existing medications, symptoms to watch for include drowsiness, nausea, breakthrough seizures, fatigue, or diarrhea.

Alcohol and CBD

In the human body, a few different metabolic pathways break down alcohol. One of them is in the same CYP family as the enzymes that process CBD.

For individuals who drink occasionally, other pathways will metabolize the alcohol entirely, and there should be no interaction with CBD.

However, people who drink heavily or chronically are overloading the primary metabolic pathways used to process alcohol. Their bodies will need to use the CYP enzymes in their liver to assist with the overload.

Unlike THC, which interacts with the CB1 receptor to encourage alcohol consumption, CBD has powerful potential applications to fight alcohol addiction and prevent alcohol-induced neurodegeneration.

However, because of the dependence of both substances on the CYP enzymes, it is crucial to be aware and cautious when mixing CBD and alcohol.

CBD is Great Medicine, but Consult Your Doctor

Study after study shows CBD is well tolerated and safe to use, while at the same time rarely producing any serious side effects. People with a spectrum of conditions experience notable benefits from CBD tinctures, oils, and lotions. In a 2019 study, 52 percent of patients with arthritis tried CBD or marijuana, and 93 percent of those said it helped.

However, CBD interacts with many systems in the body and is metabolized by the same liver enzymes as many medications. If you are older, have liver damage, or are taking medicine for a health condition, consult your doctor before adding CBD to your regime.

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