One of the primary concerns of our customers is how (or if) CBD will interact with their current medications. We completely understand your concern and apprehension, given the ambiguity of what compounds are actually in any prescription, as well as how the body processes it, compared to how the body processes cannabidiol (CBD).

The short answer is every substance (to include CBD) will interact with other substances – it is the very nature of chemical compounds. As an example, patients are often advised to avoid grapefruit when consuming certain prescription drugs because grapefruit can significantly affect how the body metabolizes the drug.

Although CBD has a multitude of potential benefits and is safe to take with different medications, CBD can negatively interact with certain drugs. This is particularly true for CBD-isolate (vs. broad-spectrum or full-spectrum products), as well as oral applications that are metabolized through a pathway in our liver (which is where common prescriptions and OTCs are metabolized). Therefore, our intention is to address the concerns of our customers by identifying which drugs interact with CBD and to what degree.

How CBD Interacts with Drugs and Medication

CBD may help with inflammation,  pain, and anxiety by interacting with various receptors throughout the body. This collection of receptors is commonly referred to as the Endocannabinoid System (ECS), which is responsible for multiple physiological processes such as appetite, pain-sensation, mood, memory, and many more.  Although these interactions are what make CBD a potential alternative for relieving both pain and anxiety, these interactions with receptors can also reduce or increase the effects of certain medications by inhibiting the activity of cytochrome P450.

Cytochrome P450 enzymes are predominantly found in liver cells, but they are also located in other cells throughout the body. These enzymes are responsible for metabolizing ingested medications, as well as toxins that enter the body. Similar to how grapefruit can affect metabolic rates, CBD can also temporarily affect how medications are metabolized by inhibiting the activity of P450.

Interactions Between CBD and Drugs that Increase Risk of Bleeding

Research shows CBD and other cannabinoids can enhance the effects of compounds used for blood-thinning (such as warfarin) or compounds with a risk of blood-thinning (such as ibuprofen). By slowing down how the body breaks down these drugs, CBD can prolong the presence of the drug in the body. Meaning, CBD can prolong the effect of the blood-thinning compounds. As such, individuals using a blood-thinning drug in combination with CBD should be closely monitored by their physician.

Interactions Between CBD and Sedatives

Many sedatives interact with GABA neurotransmitters in the central nervous system, which results in a calming effect. Cannabinoids (like THC and CBD) also interact with neurotransmitter receptors, which can result in different (sometimes opposing) effects. Depending on how the individual metabolizes cannabinoids and the concentration of the dose, THC may both relieve anxiety disorders or cause paranoia. CBD’s potential anti-anxiety benefits can be both calming, while also hindering sleep.

When combined with sedatives, cannabinoids can produce what is known as an additive effect, which means CBD can increase the effects of the medication. Although the potential impact of CBD on sedatives is not fully known, we do recommend avoiding the combination of sedatives with CBD.

Interactions Between CBD and Anti-Seizure Medications

CBD is most widely discussed as an effective treatment for epileptic seizures, following various reports from major news outlets, as well as the FDA-approval of Epidiolex. However, without medical oversight, CBD can be problematic when combined with certain anti-seizure medications.

Research shows that although a low dosage of CBD cannot provide anti-epileptic benefits, it can still inhibit the cytochrome P450 enzymes, thereby causing more aggressive seizures. A similar study from 2015 discovered CBD elevated blood concentrations of clobazam (an anticonvulsant, commonly prescribed). As such, it is highly recommended one consult their physician prior to combining CBD with any anti-seizure medication.

The Grapefruit Comparison

The way in which grapefruit and CBD interact with various drugs is identical – by inhibiting the cytochrome P450 enzymes. The primary difference between grapefruit and CBD is grapefruit warnings are commonly displayed on medication labels, whereas CBD warnings are not.

If we acknowledge both grapefruit and CBD similarly inhibit the metabolic process, then we can logically deduce that any medication with a grapefruit juice warning should also not be consumed with CBD. For a comprehensive list of drugs that interact with grapefruit juice, click here.

• alprazolam

• amiodarone

• atorvastatin

• carbamazepine

• cilostazol

• clarithromycin

• colchicine

• dronedarone

• erythromycin

• felodipine

• fentanyl

• fentanyl transdermal system

• fexofenadine

• indinavir

• loratadine

• losartan

Please note, this list does not include all drugs that may interact with grapefruit juice or CBD. As such, we highly recommend consulting your physician prior to consuming a CBD product.