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Did you know that CBD can be dangerous when combined with some psychiatric medications? Read this on HealthyPlace. CBD drug interactions Drug interactions may take place if CBD is taken at the same time as another course or dose of medication. CBD can affect how our bodies process other drugs, which may Products containing cannabidiol (CBD) are very popular, promising relief from a wide range of maladies. But if you are considering taking a product containing CBD, be aware that if you are taking any other prescription or over-the-counter medications, supplements, or herbal products, CBD can interact with them and cause unexpected …

CBD and Some (Psychiatric) Medications: Dangerous Together

CBD and Some (Psychiatric) Medications: Dangerous Together

Did you know that CBD can be dangerous when combined with some psychiatric medications?

Cannabidiol, or CBD, is skyrocketing in popularity. According to a poll conducted by SingleCare in 2020, 33 percent of the 2,000 respondents had tried CBD 1 . It’s touted as wellness-enhancing, and people use it for many reasons, among them reducing symptoms of anxiety, depression symptoms, and insomnia. It’s generally considered safe and effective for mental health concerns, with even a 2019 Psychology Today article encouraging people to use it for a variety of mental health challenges 2 . What many sources don’t tell you, and what the Psychology Today article only glosses over, is that CBD can be dangerous when combined with certain prescription medications, including many psychiatric medications.

How to Tell If CBD Shouldn’t Be Combined with Your Mental Health Medication

If you are taking a medication that carries the “grapefruit warning,” a statement on the bottle notifying you to avoid eating grapefruit or drinking grapefruit juice while taking the prescription, CBD is dangerous 3,4 . Both grapefruit and CBD block a group of enzymes made by the body called cytochrome P450. These enzymes are largely responsible for the body’s metabolization of medication. When grapefruit and CBD block those enzymes, medication isn’t processed correctly in the body. Depending on the drug, either too much remains in the system, leading to toxicity and increased side effects, or the medication doesn’t absorb properly, and you don’t benefit from it the way you need to. Either way, your physical and mental health can suffer. 5

This is particularly worrisome given that more people are taking prescription medications for anxiety and depression than ever before 6 . According to Harvard Medical School, a partial list of common psychiatric medications that carry the grapefruit warning and are unsuitable to take with CBD includes 7 :

  • Diazepam (Valium)
  • Triazolam (Halcion)
  • Midazolam (Versed)
  • Buspirone (BuSpar)
  • Sertraline (Zoloft)
  • Carbamazepine (Tegretol)

This is an incomplete list of psychiatric medications disrupted in the body by CBD. If you are taking any prescription medication and are also taking (or are considering taking) CBD, check your label to see if it carries the grapefruit warning. Also, check with your doctor or pharmacist for more information.

  1. SingleCare Team. (2020, April). The 2020 CBD survey. SingleCare. Retrieved from https://www.singlecare.com/blog/cbd-survey/
  2. Bongiorno, P. (2019, January). CBD oil for mental health—should you take it, too? Psychology Today. Retrieved from https://www.psychologytoday.com/us/blog/inner-source/201901/cbd-oil-mental-health-should-you-take-it-too
  3. DiSalvo, D. (2019, June). What CBD and grapefruit have in common when it comes to drug interactions: Risks you should know. Forbes. Retrieved from https://www.forbes.com/sites/daviddisalvo/2019/06/30/what-cbd-and-grapefruit-have-in-common-when-it-comes-to-drug-interactions-risks-you-should-know/?sh=40f3b71d719d
  4. Chesak, J. (2019, November). CBD and drug interactions: What you need to know. Retrieved from https://www.healthline.com/health/cbd-and-drug-interactions-what-you-need-to-know#the-basics
  5. U.S. Food and Drug Administration (FDA). (2017, July). Grapefruit juice and some drugs don’t mix. Retrieved from https://www.fda.gov/consumers/consumer-updates/grapefruit-juice-and-some-drugs-dont-mix
  6. Marsh, T. (2019, May). Depression and anxiety prescriptions are climbing nationwide. GoodRx. Retrieved from https://www.goodrx.com/blog/depression-and-anxiety-prescriptions-are-climbing-nationwide/
  7. Harvard Health Publishing. (2020, October). Grapefruit and medication: A cautionary note. Harvard Medical School. Retrieved from https://www.health.harvard.edu/staying-healthy/grapefruit-and-medication-a-cautionary-note

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CBD drug interactions

Drug interactions may take place if CBD is taken at the same time as another course or dose of medication. CBD can affect how our bodies process other drugs, which may impact how much of the medication ends up in our system as well as alter its reaction in the body, potentially causing negative side effects.

This article explores possible CBD drug interactions based on the effect that CBD has on the cytochrome P-450, a system in the body that is responsible for processing many different drugs and medications.

Before taking a new medication or food supplement it’s highly important to consult your doctor or healthcare professional. This article does not substitute for medical advice.

CBD and beta blockers ( β-blockers)

CBD has been linked with lowering blood pressure, however can have negative interactions with beta blockers and other blood pressure medication if taken together. CBD can affect how our bodies process beta blockers and can cause undesired effects – consult your prescribing doctor.

CBD and statins

Cholesterol reducing medications like statins can be impacted by CBD. CBD can pre-occupy the body’s system for processing certain drugs, this can cause medicines to remain in one’s system for longer, resulting in a potentially dangerous accumulation – consult your prescribing doctor.

CBD is safe:

CBD is a naturally occurring extract of the cannabis plant and many people use it as a daily supplement. It is non-addictive and non-psychoactive, meaning it won’t get you high like the other cannabis extract, THC.

In November 2017 the World Health Organisation (WHO) released its assessment of CBD, where it described the substance as having a “good safety profile” and noted that there were “no public health related problems associated with the use of pure CBD”. Despite this good safety profile, CBD does impact how your body processes other drugs and medications, which, if unaccounted for, can cause your body harm.

How CBD is processed in the body

Within the body, CBD is broken down by CYP enzymes and then processed by the body’s cytochrome P-450 system, which is also responsible for processing and metabolising a number of other drugs. A side effect of CBD is that it preoccupies the cytochrome P-450 system, slowing down the processing of particular drugs.

If your body’s cytochrome P-450 system is busy metabolising CBD rather than your medication, it can cause the medicine to remain in your system for longer than it is meant to. In some cases this may result in the medication accumulating or building up in the body to potentially toxic levels.

CBD and grapefruit

Naturally occurring compounds in grapefruit also impact CYP enzymes, just as CBD does. That’s why it’s recommended to avoid grapefruits and their juice while taking certain medicines. If a warning like this exists on your current medications, it is an indication that they may also be impacted by CBD.

The myth of the “two-hour rule” for taking CBD while on other medications

A worrying trend among online CBD communities and forums is risky and careless advice being given around taking CBD with other medications. Known as the “two-hour rule”, many community members looking to help newcomers advise a two-hour gap between taking other medications and CBD, in order to “give the liver a break” and avoid drug interaction.

While given in good nature, and far better than not leaving any gap, this kind of advice is risky given the vastly different medications, conditions and situations people are in. The advice should be that anyone taking other medication should consult their doctor before supplementing CBD products. A two-hour window is not enough time to guarantee that CBD and other medicines will not interact in a negative or dangerous way in your body.

CBD and alcohol

Despite no negative interactions having been reported between CBD and alcohol, it’s still advisable to exercise caution and be wary of excessive alcohol consumption in combination with CBD use, as both substances are processed by the liver.

It’s noteworthy that CBD can actually reduce blood alcohol levels if taken with alcohol. The study ‘Interaction of cannabidiol and alcohol in humans’ found:

“The combination of alcohol plus CBD resulted in significantly lower blood alcohol levels compared to alcohol given alone”.

CBD can also be a useful tool for recovering alcoholics, as it can help alleviate some of the symptoms of alcohol withdrawals and alcohol addiction.

CBD and recreational cannabis

No negative interactions having been reported between CBD and recreational cannabis use. In fact, CBD has shown to counteract some of the negative side effects of recreational cannabis, particularly anxiety. Many use CBD bud or flowers as an alternative to cannabis when trying to quit or cut down usage.

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How to use hemp buds / CBD bud

CBD-rich strains of cannabis are an exciting product of the CBD and medicinal cannabis movement. Hemp buds offer an alternative to CBD oil as a source of CBD that can be smoked, vaped or used to make edibles and ingested.

CBD drug interaction warnings

The medications and substances highlighted in the following section have the potential to have an interaction with CBD, as many are processed by the cytochrome P-450 system. This list is not exhaustive and there are many other medications that may interact with CBD.

The result of the CBD/drug interaction is different for each, potentially increasing or decreasing the effectiveness of the medication, resulting in possibly dangerous side effects if not taken into account by your medical professional. This doesn’t mean the medications cannot be taken alongside CBD, but it’s of utmost importance you notify your doctor.

CBD and epilepsy treatments:

In clinical studies CBD has reduced the severity of seizures caused by epilepsy. However, some study participants experienced negative side effects from CBD interacting with their other epilepsy medications, such as Carbamazepine (Tegretol). Possible side effects include diarrhea, vomiting, fatigue and pyrexia (increased body temperature).

Consulting your doctor before treating epilepsy with CBD is crucial, as CBD interactions with epileptic medicines have been proven.

CBD and chemotherapy

CBD interacts with many chemotherapy drugs. CBD can increase the amount of time it takes for the body to process the chemotherapy drugs, resulting in a toxic buildup.

These are some common chemotherapy drugs which are processed by the cytochrome P-450 system and could strongly interact with CBD:

  • Etoposide (VePesid, Eposin, Etopophos)
  • Methotrexate
  • Paclitaxel (Taxol)

CBD with heart and cardiovascular medications

CBD has the potential to interact with many different heart medications, such as statins, a class of lipid-lowering medication and beta blockers ( β-blockers), which are medications that treat abnormal heart rhythms and are employed following heart attacks. Examples of heart medications that have interaction warnings include:

  • Ticagrelor (Brilinta)
  • Quinidine
  • Pitavastatin (Pravachol)
  • Talinoloa
  • Atorvastatin (Lipitor)
  • Celiprolol (Celicard)
  • Amiodarone (Cordarone)
  • Clopidogrel (Plavix)
  • Carvedilol (Coreg)
  • Nifedipine (Adalat, Procardia)
  • Valsartan (Diovan)

CBD and antidepressants

While most antidepressants do not interact with CBD, it’s still advisable to let your healthcare provider know you plan to start supplementing CBD. As always, reducing or tapering off antidepressant medication without medical supervision is not advised.

The anti-anxiety medication Buspirone, sold as BuSpar, is used to treat generalised anxiety disorder and is also often prescribed in addition to antidepressants. Buspirone is processed in the liver by cytochrome P-450 and may have a strong drug interaction with CBD, just as its warning not to consume it with grapefruit suggests.

Another antidepressant that comes with a strong interaction warning is Clomipramine (Anafranil).

CBD and blood pressure medications (calcium channel blockers)

Calcium channel blockers, blood thinners, and medications treating blood pressure and abnormal heart rhythms have a strong interaction warning with CBD. For example, CBD reduces the body’s ability to break down the prescription blood thinner warfarin, thereby amplifying its intended effect. Other examples of medications that may interact with CBD include:

  • Valsartan (Diovan)
  • Verapamil (Calan, Isoptin, Verelan)
  • Nifedipine (Adalat, Procardia)
  • Diltiazem (Cardizem)
  • Isradipine (DynaCirc)
  • Torsemide (Demadex)
  • Felodipine (Plendil)
  • Amlodipine (Norvasc)

CBD and sedative medications (benzodiazepine)

Benzodiazepines (sometimes called ‘benzos’) are used for treating: anxiety, insomnia, nausea, depression and panic attacks. CBD can slow down the body’s ability to process some benzodiazepines, namely the widely used alprazolam (Xanax) and diazepam (Valium). This may result in higher blood concentrations of the drug, causing side effects. Other common benzodiazepines which may have an interaction with CBD include:

  • Alprazolam (Xanax)
  • Triazolam (Halcion)
  • Diazepam (Valium)
  • Midazolam (Versed)
  • Pitavastatin (Pravachol
  • Quazepam (Doral)
  • Triazolam (Halcion)

CBD and antibiotics

Fluoroquinolone antibiotics in particular can interact with CBD. They are commonly used to treat a variety of illnesses, such as respiratory and urinary tract infections. Examples include:

  • Ciprofloxacin (Cipro)
  • Gemifloxacin(Factive)
  • Levofloxacin (Levaquin)
  • Moxifloxacin(Avelox)
  • Norfloxacin (Noroxin)
  • Ofloxacin (Floxin)

Other medications that have CBD interaction warnings:

  • Cholesterol treatment: Lovastatin (Mevacor)
  • Anti-fungal medications: Ketoconazole (Nizoral) & Itraconazole (Sporanox)
  • Anti-inflammatory drug: Troglitazone and Methylprednisolone
  • Anti-histamines: fexofenadine (Allegra) & Terfenadine (Seldane)
  • Viagra (Sildenafil)
  • Cholesterol and lipid-lowering medication:Simvastatin (Zocor)
  • Malaria medications: Artemether (Artenam, Paluther) & Halofantrine
CBD cream for pain

Regularly using a topical cannabidiol (CBD) cream is an effective source of targeted pain relief for many, especially for people suffering from multiple sclerosis, arthritis, or those who often have sore or inflamed muscles.

CBD and other medications: Proceed with caution

Products containing cannabidiol (CBD) seem to be all the rage these days, promising relief from a wide range of maladies, from insomnia and hot flashes to chronic pain and seizures. Some of these claims have merit to them, while some of them are just hype. But it won’t hurt to try, right? Well, not so fast. CBD is a biologically active compound, and as such, it may also have unintended consequences. These include known side effects of CBD, but also unintended interactions with supplements, herbal products, and over-the-counter (OTC) and prescription medications.

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Doubling up on side effects

While generally considered safe, CBD may cause drowsiness, lightheadedness, nausea, diarrhea, dry mouth, and, in rare instances, damage to the liver. Taking CBD with other medications that have similar side effects may increase the risk of unwanted symptoms or toxicity. In other words, taking CBD at the same time with OTC or prescription medications and substances that cause sleepiness, such as opioids, benzodiazepines (such as Xanax or Ativan), antipsychotics, antidepressants, antihistamines (such as Benadryl), or alcohol may lead to increased sleepiness, fatigue, and possibly accidental falls and accidents when driving. Increased sedation and tiredness may also happen when using certain herbal supplements, such as kava, melatonin, and St. John’s wort. Taking CBD with stimulants (such as Adderall) may lead to decreased appetite, while taking it with the diabetes drug metformin or certain heartburn drugs (such as Prilosec) may increase the risk of diarrhea.

CBD can alter the effects of other drugs

Many drugs are broken down by enzymes in the liver, and CBD may compete for or interfere with these enzymes, leading to too much or not enough of the drug in the body, called altered concentration. The altered concentration, in turn, may lead to the medication not working, or an increased risk of side effects. Such drug interactions are usually hard to predict but can cause unpleasant and sometimes serious problems.

Researchers from Penn State College of Medicine evaluated existing information on five prescription CBD and delta-9-tetrahydrocannabinol (THC) cannabinoid medications: antinausea medications used during cancer treatment (Marinol, Syndros, Cesamet); a medication used primarily for muscle spasms in multiple sclerosis (Sativex, which is not currently available in the US, but available in other countries); and an antiseizure medication (Epidiolex). Overall, the researchers identified 139 medications that may be affected by cannabinoids. This list was further narrowed to 57 medications, for which altered concentration can be dangerous. The list contains a variety of drugs from heart medications to antibiotics, although not all the drugs on the list may be affected by CBD-only products (some are only affected by THC). Potentially serious drug interactions with CBD included

  • a common blood thinner, warfarin
  • a heart rhythm medication, amiodarone
  • a thyroid medication, levothyroxine
  • several medications for seizure, including clobazam, lamotrigine, and valproate.

The researchers further warned that while the list may be used as a starting point to identify potential drug interactions with marijuana or CBD oil, plant-derived cannabinoid products may deliver highly variable cannabinoid concentrations (unlike the FDA-regulated prescription cannabinoid medications previously mentioned), and may contain many other compounds that can increase the risk of unintended drug interactions.

Does the form of CBD matter?

Absolutely. Inhaled CBD gets into the blood the fastest, reaching high concentration within 30 minutes and increasing the risk of acute side effects. Edibles require longer time to absorb and are less likely to produce a high concentration peak, although they may eventually reach high enough levels to cause an issue or interact with other medications. Topical formulations, such as creams and lotions, may not absorb and get into the blood in sufficient amount to interact with other medications, although there is very little information on how much of CBD gets into the blood eventually. All of this is further complicated by the fact that none of these products are regulated or checked for purity, concentration, or safety.

The bottom line: Talk to your doctor or pharmacist if using or considering CBD

CBD has the potential to interact with many other products, including over-the-counter medications, herbal products, and prescription medications. Some medications should never be taken with CBD; the use of other medications may need to be modified or reduced to prevent serious issues. The consequences of drug interactions also depend on many other factors, including the dose of CBD, the dose of another medication, and a person’s underlying health condition. Older adults are more susceptible to drug interactions because they often take multiple medications, and because of age-related physiological changes that affect how our bodies process medications.

People considering or taking CBD products should always mention their use to their doctor, particularly if they are taking other medications or have underlying medical conditions, such as liver disease, kidney disease, epilepsy, heart issues, a weakened immune system, or are on medications that can weaken the immune system (such as cancer medications). A pharmacist is a great resource to help you learn about a potential interaction with a supplement, an herbal product (many of which have their own drug interactions), or an over-the-counter or prescription medication. Don’t assume that just because something is natural, it is safe and trying it won’t hurt. It very well might.

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