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What to Consider About CBD Drug Interactions

Keegan Williams

By Keegan Williams

October 19, 2022

Cannabis leaf and many colorful pills on yellow background

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Here at High There, it’s no secret we love cannabidiol, or

. With states across the U.S., and countries around the world, loosening legislation around cannabis — alongside the that officially authorized the production of hemp and removed hemp and hemp seeds from the Drug Enforcement Administration’s schedule of Controlled Substances — the non-psychoactive cannabinoid has seen an unprecedented rise in popularity over the last few years.

And yes, the non-psychoactive status of CBD means that consumers can enjoy the cannabinoid’s many potential benefits without experiencing the

. While many have taken to CBD to relieve symptoms for a number of conditions, or simply to promote general wellness, that’s not to say it’s a substance fully without fault.

Just like adding any other medication to your day-to-day life, it’s important to understand the ways CBD interacts with other drugs you might be taking and, specifically, what drug interactions to take note of, or avoid entirely, when introducing CBD to your routine.

CBD gel capsule supplement. Microdosing concept. Golden color softgel collagen. Hand holding drug. Two bowl. Medicine immunity cosmetics
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Whether you’re already a regular CBD user looking to get more informed, or a CBD newbie doing some homework before starting up your own regimen, take a closer look with us as we explore CBD drug interactions so you know which medications to avoid when using it.

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Understanding CBD

Before we get into it, let’s chat a bit more about CBD. 

There is admittedly still a lot we have to learn about CBD, but research shows that it possesses anti-seizure, anti-inflammatory and anti-anxiety properties, along with potential to treat even more diseases and disorders. 

CBD has been clinically shown to reduce pain responses in our bodies. Anecdotal evidence has also found CBD can improve anxiety and depression as well as symptoms from

, like anorexia, chronic pain and inflammation, multiple sclerosis, neurodegenerative disorders like Parkinson’s, Huntington’s and Alzheimer’s disease, epilepsy, glaucoma, osteoporosis, schizophrenia, cardiovascular disorders, cancer, obesity and metabolic syndrome-related disorders. More research is still needed to pinpoint exactly how CBD works to treat these symptoms and what the true efficacy rate is for specific symptoms.

It’s not the only non-psychoactive cannabinoid, either. 

In fact, we’re continuing to discover other, unique benefits of other non-psychoactive cannabinoids, like CBN or

for example, have to offer. There are more than known to date.

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Hemp, or a Cannabis sativa plant containing less than 0.3 percent THC, and cannabis/marijuana with higher levels of THC, can both contain CBD. However, hemp was explicitly legalized, while cannabis as a whole remains illegal on the federal level. This is why you can now easily find legal hemp products for sale online, or at local retailers.

CBD extracted from hemp is legal as a cosmetics ingredient, but not as an ingredient in food, dietary supplements or animal food. While you might see CBD used in a variety of contexts, it’s only legal as a cosmetics ingredient and is not regulated by the FDA.

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Is CBD By Itself Safe?

That said, CBD is widely considered to be very safe, with most people reacting well to the cannabis compound. However, it still might not be for everyone.

Like most drugs, using this cannabinoid medicinally could come with some side effects. Users have reported fatigue, gastrointestinal issues (diarrhea) and weight and appetite changes. Some studies have shown that incredibly high doses of CBD could cause

, though others show that moderate doses can actually benefit the liver. 

found that CBD has a better side effect profile, when compared to other drugs used to treat the same medical conditions. 

Researchers also pointed to the need for further studies on the topic, noting there is still missing information regarding CBD’s effect on hormones or CBD’s effect on genotoxicity and the immune system.

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Potential side effects and their intensity can also come down to dosing, or the CBD product you are using. Folks experiencing

after ingesting CBD, for example, might be having an adverse reaction to the or could simply be using too hefty of a dose.

The safety profile of CBD on its own has been well-established, but what do we have to consider when it comes to using it with other drugs? 

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What Are the Dangers of Negative CBD Drug Interactions?

Now, before we get into the nitty gritty, if you happen to see a drug you are already prescribed on this list, it’s not necessarily the end-all-be-all, that you can never use CBD and that other drug. It’s only to say that negative drug interactions are possible, but as you’ll soon find out, there are a number of variables at play in this conversation.

Caucasian Woman Holding a Pill on White Background / Capsules and Pills / Medicine
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Studies from the

have provided a comprehensive list of drugs and medications to avoid taking with CBD:

  • Angiotensin II Blockers
  • Antiarrhythmics
  • Antibiotics
  • Antidepressants
  • Anticonvulsants / Anti-Seizure Medications
  • Antihistamines
  • Antipsychotics
  • Anesthetics
  • Beta-Blockers
  • Benzodiazepines
  • Calcium Channel Blockers
  • HIV Antivirals
  • HMG CoA Reductase Inhibitors (Statins)
  • Immune Modulators
  • Non-Steroidal Anti-Inflammatory Drugs
  • Oral Hypoglycemic Agents
  • Proton-Pump Inhibitors (PPIs)
  • Prokinetics
  • Steroids and Corticosteroids
  • Sulfonylureas

Generally, looking at these drug interactions with CBD, we see one of two issues.

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Drug Interactions That Intensify Side Effects

CBD has its side effects on its own, and taking it along with other medications that have similar effects can result in additional, unwanted symptoms or toxicity. 

For example, medications that cause

, like opioids, benzodiazepines (like Xanax or Ativan), antipsychotics, antidepressants, antihistamines or alcohol could intensify those effects, potentially resulting in increased sleepiness and fatigue, which could be problematic when navigating your daily life. This also applies to herbal supplements, like kava, melatonin and St. John’s wort.

Lamictal, an anticonvulsant, is another example, though increased side effects like dizziness, confusion, drowsiness and difficulty concentrating have been shown with cannabis use in general, not necessarily with CBD specifically. 

Similarly, taking CBD with stimulants, like Adderall, could lead to a decreased appetite, and taking CBD with the diabetes drug metformin or certain heartburn drugs, like Prilsec, could increase your risk of diarrhea.

Two orange pill bottles laying down next to one another.  One is filled with marijuana flower buds and the other is filled with white prescription pills.  Studio shot on a white background.
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Drug Interactions Altered By CBD

On the other side, you might find taking a drug with CBD leads to different effects entirely. This is because the liver’s enzymes break down many drugs, and CBD may have to compete for or interfere with these enzymes. As a result, there may be too much, or not enough, of the drug in the body. This is called altered concentration, which can result in meds not working or an increased risk of side effects. 

out of Penn State College of Medicine evaluated information surrounding five prescription CBD and delta-9 THC cannabinoid medications: anti-nausea medications for cancer treatment (Marinol, Syndros and Cesamet), a medication used for muscle spasms in patients with multiple sclerosis (Sativex) and an anti-seizure medication (Epidiolex).

The findings revealed that 139 medications may be affected by cannabinoids, though the list was later narrowed down to

where altered concentration is a concern. It’s important to note that, given that these medications may be affected by cannabinoids as a whole, not all of the drugs on this list will be affected by CBD-only products. Some are only affected by THC-containing products.

CBD has the potential to seriously interact with drugs including:

  • Warfarin, a common blood thinner
  • Amiodarone, a heart rhythm medication
  • Levothyroxine, a thyroid medication
  • Several medications for seizure treatment (Clobazam, Lamotrigine and Valproate)

Researchers also indicated that the list is meant to be a starting point to identify potential drug interactions with cannabis or CBD. Unlike the FDA-regulated prescription cannabinoid medicines mentioned, plant-derived cannabinoid products could deliver more highly variable cannabinoid concentrations, resulting in other compounds that could increase the risk of dangerous drug interactions.

So, does the type of CBD matter?

It sure does. Let’s break down the main ways you might consume CBD:

allows for the fastest “turnaround” so to speak. It gets to the bloodstream the quickest, meaning that it reaches high concentration quickly, typically within 30 minutes. This, in turn, can increase the risk of acute side effects.

Those who have tried a cannabis edible (

, capsules and tinctures included) know that they need a bit longer to kick in. Therefore, in this way lowers the chances of experiencing a high concentration peak. It is possible, however, for edibles to provide high enough levels of concentration to interact with other meds.

cannabis cosmetics , natural marijuana cream and green leaf on beauty yellow background.
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likely don’t sufficiently absorb into the bloodstream enough to interact with other medications in a significant way, though there is still a lack of information around how much CBD gets into the blood via topical application.

Echoing the sentiments of the Penn State researchers, it’s also important to note that many CBD products are not regulated or checked for purity, concentration or safety. This is all the more reason to pay attention to what products you are buying, where you are sourcing them and what is used to make them. 

If a lab is testing your product, you should be able to find a

(COA) on the label, listing out lab test results, including cannabinoid amounts, a microbial test for pathogens, a heavy metals test and pesticides tests. If you can’t find the COA on the website or label, it might be worth looking elsewhere.

The Final Answer?

Talk to a medical professional about CBD interactions. We are admittedly learning a lot about CBD, sure, but there’s still a lot we don’t know. While we have a pretty good idea of what medications could raise some red flags with CBD use, ultimately it’s dependent on a variety of factors, like the CBD dose, the dose of other medications, the overall health of the consumer and even age. 

There are numerous asterisks, so what’s right for one person may be a completely different story for another.

While you should surely have more knowledge surrounding the topic and a better understanding of how CBD can interact with other medications, ask your doctor or

if you are concerned about taking CBD with other drugs and medications. 

A medical professional can assist with specific questions pertaining to you, your body and your medication. Worst case, if CBD turns out not to be a match, they will be able to assist with alternative options and therapies.

We’ll always go to bat for cannabis and CBD. Even though this plant medicine offers an abundance of benefits, it is still a drug and should be treated with care. Just a bit of foresight as you look to add CBD to your daily routine could save you some turmoil in the long run!

Keegan Williams

About The Author

Keegan Williams

HIGH THERE MISSION

WE’RE A CREATIVE COMMUNITY — EXPLORING THE SCIENCE, CRAFT, AND CULTURE OF CANNABIS.
WE BELIEVE THAT WE HAVE A COLLECTIVE RESPONSIBILITY TOWARDS ERADICATING THE STIGMA, MISINFORMATION, AND INEQUITIES SURROUNDING THIS PLANT, SO WE CAN UNLOCK ITS TRUE POTENTIAL FOR ALL.

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