What Happens When CBD Inhibits The Cytochrome P450 System? Using CBD Safely With Other Medication Side Effects Of CBD What Research Says Frequently Asked Questions Concerning CBD and Drug Interactions Discussing CBD And Drug Interactions With Your Vet List Of Known Drugs CBD Interacts With Next to CBD and the benefits CBD has a lot to offer, but why stop there? Where CBD falls short, other supplements can pick up the slack. Here are five other supplements to take with CBD. WebMD provides information about interactions between St. John’s Wort and antipsychotics-sibutramine.
CBD Drug Interactions: Which Medications Should You Avoid
Next to CBD and the benefits that can help treat a long list of medical disorders, the other thing that has driven its popularity is its low risk for causing side effects. In fact, research shows CBD can be so safely used that it has the potential to replace other drugs typically used to manage pain, inflammation, anxiety, and on. In fact, in the case of certain epilepsy disorders, there are even times when CBD is the only thing that truly helps. None of this isn’t saying that using CBD doesn’t carry along minor side effects, which we will discuss in more detail later on.
While generally noted for its low side-effect profile, research shows CBD does have one significant side effect of note. And that is the potential for it to interact with certain prescription drugs that are metabolized by a family of enzymes. Known as Cytochrome P450, these enzymes, in particular, CYPA4, are responsible for breaking down about 60 percent of clinically prescribed medications.
While this news jumps out to many as incredibly alarming, it’s not uncommon for foods, supplements, and common medications themselves to inhibit CYP enzymes, causing drug interactions. Grapefruit, St. John’s wort, and kale can all cause drug interactions by inhibiting the same enzymes CBD products can. Then foods such as broccoli, spices like cumin, and drinks like coffee can all interact with the medication we take.
Because many of these are common items in a human’s diet, one way to quickly find out if CBD could interact with the medications you’re taking is to look on the drugs’ label for warnings about eating certain foods, in particular, grapefruit. This isn’t so easy with medications for our pets, however that’s why we are here to help. Because including CBD in our dogs and cats’ health regime is a great way to give them the health they deserve. The therapeutic effects of CBD are countless, and we will be covering the main health benefits in addition to advising you on how to safely use CBD alongside other medications.
What Happens When CBD Inhibits The Cytochrome P450 System?
By temporarily inhibiting cytochrome P450 enzymes, CBD along with the other cannabinoids found in all cannabis plants are able to delay the rate they break down their intended medication.
The metabolism rate of a drug is quite important for several reasons and must be known before an appropriate dosage can be prescribed. By delaying a drug’s metabolism rate, CBD can allow for too much medication to be in your system at once. And in essence, by raising the drug’s potency, this acts as if you took a higher dosage of that drug than normal. By effectively raising the dosage, you’re often increasing the risk for the said drug to cause side effects.
Research on the significance CBD can interact with other medications is still heavily being looked into, and discussed below. Anecdotally, we know that both marijuana and hemp products are commonly used alongside other medications. As we know, there is no great worry in the marijuana community at large about their use interacting with their prescribed medication. The same can’t be said when it comes to the side effects to memory and motor control due to the high amounts of THC found in these plants.
We can theorize from this, that while cannabis products can cause drug interactions and it is not something to take lightly, it’s not significant enough by large to cause a great concern amongst its users. It is important to note that Delta-9-tetrahydrocannabinol (THC), limited to 0.3% in CBD products vs 20%+ in marijuana is heavily involved in inhibiting CYP enzymes. Both CBD and THC are metabolized by CYP3A4 while THC is also metabolized by CYP2C9 and CBD by CYP2C19. From what we currently know, the less CYP are enzymes inhibited, the less chance it can interact with other medications. Along with its inability to cause a high, along with being available for kids and pets, this is another reason CBD oil may be the preferable choice vs medical marijuana.
However, don’t let this trick you into thinking that there isn’t good evidence that we shouldn’t be concerned about it. We have studies that show evidence of CBD itself raising the potency of blood-thinning medication along with seizure medication, causing a higher occurrence of side effects vs. the control groups.
Using CBD Safely With Other Medication
While CBD and other CBD products have the ability to interact with around 60% of prescribed medication, there are several ways to safely use CBD in conjunction with other medications.
First, never stop giving your pet medication prescribed by your veterinarian until you’ve consulted them. This goes for medication that may have a potential interaction with CBD and medication that doesn’t.
From starting CBD off at a lower dose than normal to timing out when CBD should be given to allow for the prescription drug to break down first, there are lots of little things that you can do to improve the safety of CBD. Your veterinarian can help you with these. As well, they can monitor blood plasma levels to ensure your pet’s medication is being properly metabolized or if it could do for a dosage adjustment.
There are times when CBD is touted for its ability to lower the reliance or dosage of prescription medication. One reason this happens is that CBD offers its own benefits. But the other reason we speculate this happens is that CBD may be raising the potency of the other medication in the body.
Last, even in the rare case your pet can’t ingest CBD due to a drug interaction, all hope of ever giving them CBD isn’t lost. The beneficial compounds found in CBD, and in hemp and cannabis products can be administered topically. CBD lotions, salves, and creams are great for help with surface-level aches and pain, skin breakout, inflammation, and more, These do this by avoiding entering the bloodstream, largely preventing CBD from interacting with Cytochrome p450 enzymes.
The skin is the largest organ and the first level of defense against nasties that can put severe stress on the body. Including CBD and hemp in your pet’s skincare regime is a great way to care for their general health.
Side Effects Of CBD
Without a doubt, the biggest and in most cases, the only side effect that comes from using CBD is its ability to interact with other medications. However, there are some minor side effects to be aware of. In most cases, these side effects occur when too large of a dose is given. CBD has a biphasic effect where low and common dosages can put a slight pip in your pet’s step. However, give your dog or cat too much, and you may find them catching some heavy Zzzz’s on the couch.
Another side effect of CBD, along with other cannabis products, is dry mouth. CB1 and CB2 receptors which make up the endocannabinoid system — the system cannabis largely interacts with — are found heavily in the mouth where they help regulate saliva production. But by the same token, the opposite of dry mouth can happen, and CBD may temporarily boost saliva product/release. CB1 receptors are overstimulated with high-THC products like marijuana. Because there are only trace amounts of it in CBD products, issues like dry mouth are much less commonly seen.
High doses of CBD can lower resting blood pressure causing some lightheadedness, which should quickly pass. One 2017 study found the potential for CBD to help lower blood pressure in those with high blood pressure.
Nausea and stomach discomfort are frequently cited side effects seen with nearly every medication. This especially happens when first starting a medication due to the body needing to take time to realize it’s not a threat or allergy. The same can happen with CBD, despite it usually having adverse effects and helping with nausea and stomach discomfort. Changing the dosage while the body learns to recognize CBD can help. Usually, a lower than normal dose for a few days to a week is a great course of action for this side effect.
What Research Says
Research on CBD, and cannabidiol itself, and the potential for drug interactions so far has been a bit of a mixed bag. Some researchers have found a low dose of CBD is effective enough in avoiding interactions with the drugs they were studying. While other researchers have found a precise dosage – that can be either low or high – is preferable and dependent on the patients’ and their medications. So how do we interpret this data?
First, the big thing that comes from the studies we have found is while CBD can cause interactions with the medication we take, studies still find CBD is a safe and effective treatment. With simple monitoring and potential adjustments in the dosage, there is little risk to continue using CBD. This is awesome news!
The reason a low dose usually works, but not always for avoiding a drug’s side effects is likely due to the individual cytochrome that’s responsible for the metabolism of the drug. Researchers have found CBD can both speed up and slow down the metabolism rate depending on the drug and the cytochrome it interacts with. Again, while there is some risk with CBD, when given the appropriate care, the data shows CBD is very low risk.
Clinical trials show care and safety should be given in the case of epilepsy because while CBD can significantly help seizures, they can easily interact with seizure medications increasing their side effects, which can produce seizures of their own. However, again, researchers have found CBD and seizure medications can be used together with a smart medical treatment plan. In fact, epilepsy is currently the only thing the FDA has approved the use of CBD for.
Frequently Asked Questions Concerning CBD and Drug Interactions
We hope our article has provided you with all the information you need when deciding if CBD is something you should give to your pet. Especially if they are already on medications. Because we’ve taken such an extensive look at CBD and its potential for causing a drug interaction, we wanted to quickly answer some of the most asked questions concerning the topic.
Can You Take CBD With Medication?
In the large majority of cases, CBD can safely be used with most medications. Using CBD in tandem with over-the-counter medications warrants little to no concern. If using an OTC drug long-term or at a higher than normal dosage due to medical advice from your doctor or vet, please consult said authority before using a CBD product. While a CBD product has the potential to cause drug-drug interplay in about 60% of prescription drugs, for the most part, with the proper medical advice and guidance, CBD can be safely used.
What Meds Does CBD Interact With?
CBD has been shown to interact with blood-thinning drugs like Warfarin, raising abnormal liver enzymes along with inducing tiredness when used in conjunction with Valproic Acid – sometimes used for controlling seizures. This information comes from research on Epidiolex, an FDA-approved cannabis extract for help with epilepsy. Epidiolex is an isolate, meaning it only contains the single cannabinoid, cannabidiol, in very high amounts. Most CBD products aren’t a single cannabinoid but contain the full range including high amounts of cannabidiol.
For a full list of potential drug interactions, please see our list at the end of the article.
Can CBD Interfere With Arthritis Medications?
In the large majority of cases, it’s very unlikely CBD would interfere with the metabolism of drugs used to treat arthritis and other inflammatory joint disorders. For help with pain and joint issues, veterinarians commonly prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) that are safe for dogs. Except for diclofenac, it appears CBD will not have a drug-drug interaction with an NSAID drug. While NSAIDs are commonly given to dogs, the over-the-counter medications we commonly take – like Ibuprofen – should only be given to your dog under the supervision of your vet due to their ability to easily pass the safety threshold in dogs.
Does CBD Interfere With Blood Pressure Medicine?
While high blood pressure and hypertension occur in humans more, our dogs are susceptible to the disease and put on similar medications, as well. Because CBD can lower blood pressure and potentially help those with hypertension, it can seem like a good idea to use it in conjunction with drugs designed to do the same, but caution is advised. While CBD can be used in tandem with blood pressure medications, it’s recommended you discuss it with your veterinarian first.
There are several medications used to treat high blood pressure, including angiotensin converting enzyme (ACE) inhibitors, angiotensin II receptor antagonists (ARBs), diuretics, and calcium channel blockers. Because of this, if your vet finds they like what CBD is offering your pet, but they see it interacting with their medication, they have the option to switch to a different medication.
Has CBD Ever Caused A Life-Threatening Drug Interaction?
To the best of our knowledge and thorough research, we can not find an example of CBD or any cannabis product causing life-treating drug interactions.
Again, this should not make you disregard potential drug interactions. Instead, we are simply saying that while cannabis can cause such, it’s frequently used alongside other medications, often without the guidance of a health provider, yet for whatever reasons, a crisis has not occurred.
Discussing CBD And Drug Interactions With Your Vet
CBD has a world of therapeutic benefits that can improve our pets’ health in both small and big ways. Backed by research, CBD oil and other CBD products have been shown to be extraordinarily low-risk options for the benefits it has. However, while you can use CBD in tandem with other medications, there is a chance for an interaction that can increase the risk of the drug causing side effects. Interactions cannot happen with all drugs, but a majority of prescription medications (about 60%) have potential. This includes medication commonly used to treat epilepsy, for which CBD is commonly used to help as well.
If your dog or cat is on medication, and you’re concerned about CBD and its potential for drug interactions, your best bet for advice is their vet. While CBD may interact with medications your pet is on, your vet can safely assess if CBD is still the correct choice for them. Often timing out the dosages or changing the dose of CBD or the other medications can allow them to be used together for the best of both worlds.
With proper care, current research indicates CBD can offer a treatment plan an irreplaceable tool for improving health without causing serious adverse side effects, even when there is potential for a drug interaction.
List Of Known Drugs CBD Interacts With
If either you or your pet is on one or more of the medications listed below, please consult the appropriate medical professional before using CBD. Just because a medication is listed below does not indicate that it can never be used in conjunction with CBD or another cannabis product. Nor does it mean you will personally see drug interactions or side effects from them. Instead, it simply means there is potential for an interaction that you should be aware of.
Our aim for this list is to give a comprehensive reference point. However, there is always the chance we could have missed some medications. As well, there are studies and clinical trials dedicated to the research of CBD and drug interactions currently in operations that could change our list.
Five Supplements You Should Be Taking With Your CBD
CBD has a lot to offer, but why stop there? Where CBD falls short, other supplements can pick up the slack. Here’s five other supplements to take with CBD.
Cannabidiol (CBD) is quickly becoming one of the most popular nutritional supplements on the market. It’s highly revered for its ability to regulate metabolic, immune, and neurological homeostasis — which is a fancy word meaning “balance.”
Negative health conditions can be attributed to an imbalance of one organ system or another. As a result, CBD is suggested to offer a wide range of health benefits throughout the body.
Although CBD has many uses, combining it with other synergistic nutritional and herbal supplements can optimize its effects.
In this article, we’re going to highlight why you should be combining your CBD with other supplements and which supplements you should consider for different symptoms.
Let’s get started by discussing exactly why you shouldn’t rely on just CBD to manage your symptoms.
Table of Contents
Why You Should Combine CBD with Other Supplements
The use of CBD as a form of medicine isn’t a new concept — people have been using it for centuries to treat everything from pain and inflammation to age-related cognitive decline.
However, people rarely use cannabis on its own to treat conditions.
In all forms of herbal medicine, plants are combined to enhance their effects based on the symptoms presented.
This is a common practice in herbal medicine, even in the modern world.
Only in the modern era have health practitioners chosen to take a more reductionist approach to medicine. Instead of combining multiple herbs or medicines to leverage their strengths and weaknesses, a single compound is prescribed.
Using a single compound (pharmaceutical) has advantages during the research stage because it’s easier to see what is responsible for a given result. Compounded medicines, on the other hand, are much harder to study because it’s challenging to identify exactly what effect each component is producing.
However, most people don’t care about knowing exactly which compound is producing the bulk of the effects — they just want to feel better.
By far the best way to leverage health supplements is through intelligent formulation. This works by taking 2 to 5 supplements that work well together to produce a more significant overall benefit.
For example, let’s say you’re taking CBD for joint pain — a popular application of the compound. Now, you could stop there and let the CBD do its job alone, but it’s going to have limitations.
CBD helps block pain and lower inflammation — both of which are common causes of the pain associated with the condition.
However, what happens if the cause of pain is a loss of cartilage tissue? CBD isn’t going to do much to support that process — so it’s better to combine it with something such as glucosamine, which is beneficial for repairing cartilage. Taken together, you can both speed the repair of your cartilage tissue in the joint and provide symptomatic support for the pain.
This is just one example of when it’s more beneficial to combine other supplements with CBD to achieve better results. Let’s go through five more examples.
Top Five Supplements to Take with Your CBD
Choosing which supplements to use alongside your CBD is going to depend on the symptoms you’re trying to address.
1. CBD & L-Theanine for Anxiety
There are many causes of anxiety, but the effects we feel during an anxiety attack are a direct result of overactivation of the nervous system — known as the fight-or-flight response.
CBD calms the nervous system through its ability to increase the activity of a neurotransmitter known as GABA — which acts as the brake pedal for the nervous system.
When our nervous system speeds up too fast, GABA slows it back down again.
Stepping on the brake pedal is great, but only if you ease off the gas pedal at the same time.
This is where L-theanine comes in.
L-theanine is an amino acid found in the tea plant (Camellia sinensis). Its structure closely resembles a neurotransmitter known as glutamate — which is essentially the gas pedal in the brain. It’s one of the primary stimulatory neurotransmitters in the brain.
The similarity in the chemical structure of L-theanine to glutamate allows it to bind to glutamate receptors — only it doesn’t produce any effects . Instead, L-theanine blocks glutamate from hitting these receptors — effectively stepping off the gas pedal to allow CBD to calm us down.
2. CBD & Ashwagandha (KSM-66) for Stress
An effective stress response is critical for maintaining optimal health.
Stress comes in all forms, but all stress has a similar effect on the body. It activates a region deep within the body known as the hypothalamus. The hypothalamus then sends hormones to the adrenal glands, which initiate the production of a hormone known as cortisol.
- Inhibits the immune system
- Inhibits digestion
- Increases heart rate
- Increases blood pressure
- Dilates the airways
- Stimulates the brain
- Forces the liver to dump glucose into the bloodstream
Cortisol is helpful in the short term for activating the stress response when it’s necessary — but if allowed to persist for too long, it can cause serious long-term problems, including insomnia, brain fog, lowered immunity, and weight gain, and even more serious complications such as diabetes and heart disease.
Ashwagandha supplementation has been shown to lower cortisol levels over time with regular use [1, 2]. There are several theories as to how it achieves this. The predominant idea is that it increases the conversion of cortisol to inactive metabolites by increasing the ability of the hypothalamus to regulate cortisol levels and handle stress.
CBD pairs nicely with ashwagandha because it achieves similar results by acting on other areas of the nervous system, including GABA .
These compounds may work together to alleviate chronic stress from the top down.
3. CBD, Curcumin, & Boswellia for Chronic Inflammation
Inflammation is incredibly complex — entire textbooks are dedicated to the topic without even grazing the surface.
Inflammation can vary a lot depending on the cause of the inflammation, which means that the inflammation experienced during an autoimmune disorder is very different from the inflammation experienced when you injure yourself.
Long-term (chronic) inflammation is also very different from short-term (acute) inflammation.
CBD is excellent for addressing both chronic and acute inflammation because it blocks many of the molecules involved in triggering inflammation. However, it has its limits.
Adding curcumin (the active constituent in turmeric) and Boswellia (another name for frankincense) may further enhance the effects of CBD by offering additional anti-inflammatory benefits through different mechanisms.
Curcumin and Boswellia stop inflammation by blocking key enzymes involved with manufacturing inflammatory compounds known as COX and 5-LOX.
Curcumin blocks COX , while Boswellia is better for stopping the related enzyme 5-LOX .
Taking all three supplements together is going to offer the most profound benefits because all of these actions are important for stopping inflammation.
By blocking these enzymes on top of key inflammatory messengers by CBD, the inflammation process comes to a screeching halt.
4. CBD, Glucosamine, & Chondroitin Sulphate for Joint Pain
CBD is useful for alleviating joint pain involved with both rheumatoid arthritis and osteoarthritis because of its analgesic and anti-inflammatory benefits.
Inflammation is a key component of the underlying causes of arthritis, but it’s not the only cause.
One of the biggest problems leading to chronic joint pain as a result of arthritis is a gradual breakdown of cartilage in the joints. Cartilage is designed to protect the joints so that bone doesn’t rub directly against another bone. Instead, the cartilage and a slippery fluid called synovial fluid allow the joints to move freely without causing any damage to the bones.
As the cartilage disappears, the rubbing of bone on bone causes extreme pain and worsens inflammation — ultimately leading to even faster degeneration of the cartilage and a buildup of scar tissue.
CBD is effective for reducing symptomatic pain in the joints and fighting inflammation — but it does very little for restoring lost bone cartilage.
This is where glucosamine and chondroitin sulfate comes in.
Both of these supplements are known for their ability to provide essential precursors for the body to repair both the cartilage and the cells responsible for producing synovial fluid (chondrocytes).
Taken together, the CBD can help lower inflammation and treat pain, while the glucosamine and chondroitin sulfate help to restore cartilage tissue over time.
5. CBD & St. John’s Wort for Depression
Depression can be debilitating to our health, especially if allowed to persist for long periods.
CBD is a good option for treating depression primarily for its anti-inflammatory benefits. Neuroinflammation is a key driver of depression , but it’s not the only cause.
Most antidepressant medications work by increasing serotonin levels in the brain — something that CBD isn’t able to do.
However, another herb — St. John’s Wort (Hypericum perforatum) — can do this.
This herb works similarly to common SSRI medications used to treat depression . It blocks the reuptake and breakdown of serotonin in the brain, causing levels to increase outside the neurons.
This ability to increase serotonin, combined with the powerful anti-inflammatory effects of CBD, provides a powerful combination for alleviating symptoms of depression.
Of course, always consult with your doctor before taking any supplements to treat depression, especially if you’re already taking antidepressant medications. Both CBD and St. John’s Wort may interact negatively with this type of medication — in which case, they should be avoided.
Bonus CBD Supplementation Tip
Grapefruit Juice to Prolong the Effects of CBD
CBD — like any other compound we consume — is eventually metabolized and deactivated by the liver.
The liver is an incredibly versatile organ. It can break down nearly any compound that enters the bloodstream thanks to a set of enzymes known as the cytochrome P450 isoenzyme complex.
Depending on the chemical structure of the compound being metabolized, different enzymes will step up for the job.
When it comes to CBD, the liver mainly relies on two enzymes — CYP3A4 and CYP3A5 .
Therefore, if we inhibit the activity of these enzymes, it will take much longer for the liver to break the CBD down.
There are a few things that can achieve this, but nothing as strong, or as readily available, like grapefruit juice .
This has led to a lot of people drinking grapefruit juice or taking grapefruit juice extracts, alongside their CBD supplementation — effectively lowering their required daily dose of CBD and providing long-lasting relief.
Cautionary Note: Grapefruit juice also inhibits other liver enzymes, so you should never take this supplement if you’re taking other medications as it may cause side effects. It’s especially important to avoid grapefruit juice if you are taking blood thinners or other medications to treat high blood pressure.
Key Takeaways: Supplements to Take with CBD
CBD is an incredible health supplement. It has a lot to offer a wide range of different medical conditions. However, like many other compounds, CBD is even better when combined with other herbs and supplements.
Choosing which supplements to combine it with depends on the symptoms you’re treating.
By leveraging the benefits of CBD alongside other supplements, we’re able to provide even greater benefits toward reversing, preventing, or alleviating symptoms.
This is the difference between a holistic approach versus a reductionist approach. Which one will you choose?
Cannabidiol; Tetrahydrocannabinol/Strong CYP3A4 Inducers Interactions
This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.
Moderate. These medicines may cause some risk when taken together. Contact your healthcare professional (e.g. doctor or pharmacist) for more information.
How the interaction occurs:
Your medicine may speed up how quickly your liver processes cannabidiol (CBD) and tetrahydrocannabinol (THC).
What might happen:
Your blood levels of CBD and THC may decrease and they may not work as well.
What you should do about this interaction:
Let your healthcare professional (e.g. doctor or pharmacist) know that you are taking these medicines together. Your doctor may want to change or adjust the dose of one of your medicines.Your healthcare professionals (e.g. doctor or pharmacist) may already be aware of this interaction and may be monitoring you for it. Do not start, stop, or change the dosage of any medicine before checking with them first.
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CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.