10 medications that interact negatively with CBD

CBD (cannabidiol) is a cannabinoid in cannabis with several health benefits, including:

• Pain relief
• Anxiety relief
• Insomnia relief

While CBD is generally safe on its own, combining it with certain medications can be dangerous.

Whether you’re considering trying CBD or you already use it, it’s important to be aware of its possible CBD drug interactions.

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Does CBD interact with medications? 

On its own, CBD is generally safe, with a low risk of side effects. And because it’s not intoxicating like tetrahydrocannabinol (THC), it’s unlikely to cause impairment or heavy sedation.

But like many organic compounds, CBD can interact with certain medications, including prescription and over-the-counter medications. How likely you are to experience a negative interaction depends on factors like:

• Your dosages of both substances
• Your metabolism
• The medication itself

How CBD interacts with medications

There are three common ways CBD can interact with other medications:

• Affects drug-metabolizing enzymes: CBD may affect the function of enzymes in your liver that help many medications break down and leave the body. This means that certain medications, when consumed with CBD, may stay in the bloodstream for longer than they’re supposed to, increasing the risk of side effects and overdose.
• Increases sedative effects: On its own, CBD may cause mild drowsiness. But when combined with certain medications like benzodiazepines or antidepressants, you may experience heavier sedation that makes activities like driving dangerous.

• Inhibits the immune system: CBD can suppress the immune system. Combining CBD with immunosuppressant medications may exaggerate this effect, making it harder for your body to defend itself against infections.

CBD drug interactions 

CBD interacts with hundreds of medications, and there may be more interactions that researchers haven’t discovered yet.

The following medications are the most well-known for their potential interactions with CBD.

Benzodiazepines

Benzodiazepines are a class of sedative medications commonly prescribed for anxiety, and include:

• Alprazolam (Xanax)
• Diazepam (Valium)
• Clonazepam (Klonopin)
• Lorazepam (Ativan)

Combining CBD with benzodiazepines can increase the risk of side effects, such as:

• Dizziness
• Confusion
• Drowsiness
• Difficulty concentrating

Most benzodiazepines are broken down by liver enzymes affected by CBD. Taking CBD with these medications may prevent them from fully leaving the body. This could potentially lead to dangerous levels of the drug accumulating in your system.

Antidepressants

Antidepressants are commonly prescribed for depression. Common antidepressants include:

• Fluoxetine (Prozac)
• Sertraline (Zoloft)
• Bupropion (Wellbutrin)
• Escitalopram (Lexapro)

These medications are broken down by liver enzymes, so taking them with CBD could prevent them from properly leaving the body between doses.

Combining antidepressants with CBD may also increase your risk of side effects like:

• Drowsiness
• Dizziness
• Lack of coordination

Corticosteroids

Corticosteroids are anti-inflammatory medications prescribed for conditions such as:

• Asthma
• Allergies
• Rheumatoid arthritis (RA)
• Inflammatory bowel disease (IBD)

Both CBD and corticosteroids affect the same liver enzymes. This could lead to stronger effects and cause both medications to stay in your body for longer.

Hormone medications

Certain hormone medications can interact negatively with CBD. This includes levothyroxine (Synthroid), a medication prescribed for hypothyroidism (underactive thyroid).

Many hormone medications are metabolized by your liver. Combining them with CBD can cause doses to build up in your body, which may lead to hyperthyroidism (overactive thyroid).

NSAIDs

Non-steroidal anti-inflammatory medications (NSAIDs) like ibuprofen (Advil, Motrin) and naproxen (Aleve) may interact with CBD in high doses.

These medications are broken down by your liver, so taking them with CBD may prevent them from properly breaking down and leaving the body.

Some people have anecdotally reported that combining the two causes upset stomach.

Anticoagulants

Anticoagulants (blood thinners) like warfarin are prescribed to prevent blood clots that could cause stroke or heart attack.

Combining CBD with anticoagulants can enhance their blood-thinning effects, potentially increasing the risk of bruising and preventing wounds from properly healing.

One study found that taking CBD with anticoagulants may reduce their effectiveness and increase the risk of stroke.

Antipsychotics

Antipsychotics are prescribed for certain mental health disorders including schizophrenia. They include:

• Chloropromazine (Thorazine)
• Quetiapine (Seroquel)
• Aripiprazole (Abilify)

CBD may prevent these medications from properly breaking down and leaving the body. It may also enhance certain side effects like:

• Dizziness
• Confusion
• Trouble with physical coordination

Immunosuppressants

Immunosuppressants are used to weaken the immune system. They’re commonly prescribed for autoimmune disorders, in which the body’s immune system attacks healthy parts of the body. Common immunosuppressants include:

• Cyclophosphamide (Cytoxan)
• Adalimumab (Humira)
• Infliximab (Avsola)

Combining these medications with CBD may increase their immune-suppressing effects, making it harder for the body to fight infections.

According to animal studies, high doses of CBD may not be well tolerated by the liver. Many immunosuppressants are also poorly tolerated by the liver in high doses. Combining the two may lead to liver damage.

Antihistamines

Antihistamines are used to manage allergy symptoms. Common antihistamine medications include:

• Diphenhydramine (Benadryl)
• Loratedine (Claritin)
• Fexofenadine (Allegra)

Many antihistamines — especially older ones, called first-generation antihistamines — cause drowsiness. Taking them with CBD may increase this effect.

Opioids

Opioids are narcotic medications that are prescribed for persistent or severe pain. Examples include:

• Oxycodone
• Vicodin
• Morphine

Opioids are broken down by liver enzymes. Taking them with CBD may prevent them from properly breaking down and leaving the body. CBD could also enhance the sedative effects of opioids, increasing drowsiness and impairment.

Tips for taking CBD with other medications

If you’re considering CBD while on any medication, speak with your doctor for personalized guidance and follow these general tips:

• Consider your dosing: The risk of a negative interaction may be dose-dependent. Generally, the risk is higher if you’re taking high doses of either CBD or a medication.
• Think about timing: Inhalable CBD products like vaporizers and pre-rolls can peak within minutes, increasing the risk of immediate side effects. CBD edibles can take 1 to 2 hours before reaching full effectiveness, and the effects can last for several hours. This could prolong interaction-related side effects. Edibles are also more likely to cause drowsiness, which can add to the sedating effects of medications like benzodiazepines.
• Try topical CBD: Topical CBD products are the least likely to interact with other medications. Their effects are localized, so the CBD doesn’t enter the bloodstream.
• Look for the “grapefruit warning”: Like CBD, grapefruit can lower liver enzymes that break down several medications. Consuming grapefruit alongside CBD and medications puts you at a greater risk of severe side effects.
• Keep a log of side effects: Consider writing down how you feel after consuming CBD with other medications. This way, you can track any changes in side effects over time.

Seek medical care if you experience any unusual or severe side effects after combining CBD with a medication.

The bottom line: Be aware of potential CBD drug interactions

Although CBD is widely considered to be safe when taken on its own, it can have potentially severe drug interactions depending on the medications you’re taking.

If you’re concerned about a potential drug interaction, speak with your doctor or a Leafwell telepharmacist. They can provide personal guidance, ensuring that you use CBD safely.

Resources 

• A review of cannabinoids and interactions with anticoagulant and antiplatelet agents. https://pubmed.ncbi.nlm.nih.gov/31724188/
• Cannabidiol drug interactions. https://www.medications.com/drug-interactions/cannabidiol-index.html
• Contemplating cannabis? The complex relationship between cannabinoids and hepatic metabolism resulting in the potential for drug-drug interactions. https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2022.1055481/full
• Hepatoxicity of a cannabidiol-rich cannabis extract in the mouse model. https://www.mdpi.com/1420-3049/24/9/1694
• Immune responses regulated by cannabidiol. https://www.liebertpub.com/doi/10.1089/can.2018.0073
• Nonlinear disposition and metabolic interactions of cannabidiol through CYP3A inhibition in vivo in rats. https://www.mdpi.com/1420-3049/24/9/1694
• NTI meds to be closely monitored when co-administered with cannabinoids. https://bpb-us-e1.wpmucdn.com/sites.psu.edu/dist/d/117691/files/2020/06/NTI-Meds-to-be-Closely-Monitored-when-Co-Administered-with-Cannabinoids_2020_04_25.pdf

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