Cannabidiol (CBD) is one of the hundreds of compounds present in hemp plant (part of the cannabis family). Recently, CBD has become very popular for its therapeutic effects with little or no side effects.
CBD is being used to manage a certain types of seizure disorders including epileptic and non-epileptic seizures. Some sources have also reported, that it could be used to treat some health illnesses such as anxiety, depression, neuropathic pain, weight conditions, and Parkinson’s disease. While the preceding should always be consulted with your physician, it is very important to understand about drug interactions and what drugs not to take with CBD.
Unlike tetrahydrocannabinol (THC), which is found in the marijuana plant and with trace amounts associated with hemp, CBD is non-psychoactive and non-intoxicating. Evidence indicates CBD is a safe naturally occurring plant compound on its own but does has the potential to interact with a good number of medications in the body. As such CBD when using certain some pharmaceutical drugs it is important to know how they potentially interact with CBD.
Here is why...
Before we discuss how CBD affects other medications, we need to first take a brief look at how the body’s metabolic system functions, how CBD metabolism takes place, and how CBD interacts with the Cytochrome P-450 system which are enzymes in our bodies that are essential to the metabolism of medications.
What is Metabolism?
Many people think of food metabolism as something that has to do with how easily they gain or lose weight. In scientific terms, however, this phenomenon rather describes what is often referred to as “basal metabolic rate”.
Simply put, basal metabolic rate is the amount of food calories required by an individual to maintain optimal body conditions, while at rest. But the basal metabolic rate is different from the normal metabolic process.
Instead, metabolism is the process by which food substances are broken down and then digested in the body. This process is often called the ‘first-pass’ metabolism and a greater part of it takes place in the liver.
This means that when a person consumes carbohydrates, for example, the food needs to be broken down in the liver into its constituent compounds for it to be absorbed by the body. The liver converts carbohydrates into sugars, proteins into smaller amino acids, while fats are converted into triglycerides.
From there, the metabolic process transforms these substances called metabolites into final products with the action of enzymes. The end products are used as building blocks for body tissues and systems, or as fuel for different cellular processes.
CBD Metabolism: What Is It?
Just as explained earlier, food substances have to undergo metabolism in order for them to be useful to the body. Similarly, therapeutic compounds such as CBD and medicinal drugs have to go through what is called drug metabolism.
In essence, drug metabolism is the rate at which therapeutic compounds and other medications are broken down by enzymes into their individual constituents and how long these compounds are retained in the body.
Therefore, when CBD or any other therapeutic drug is ingested either as capsule, edible, oil, or tincture, it has to go through the body's digestive system where it can be absorbed by the intestines into the bloodstream. From there, the blood transports the CBD to the liver through the hepatic portal.
Once in the liver, the CBD is broken down by enzymes into its metabolites which are then circulated around the body via the bloodstream.
The Cytochrome-P450 System
Apart from its role of breaking down foods and drugs into metabolites, the liver also plays an important role in detoxifying and excreting medications (or xenobiotics) and other toxic substances.
This detoxification and excretion process is accomplished through a mechanism known as the Cytochrome-P450 System (CYP). It consists of a group of enzymes that contain ‘heme’ as a cofactor used to convert ‘fat-soluble’ food substances into more ‘water-soluble’ food substances to ease their digestion.
It has been estimated by some researchers that the so-called CYP system helps in metabolizing more than 60% of medications consumed. Interestingly, medical and pharmaceutical professionals also use the CYP to understand and predict the possible effects of drug dosages and their side effects on people.
Take for example, if the liver is processing only one therapeutic compound at a particular time, and the body system is healthy in general, a researcher can determine accurate dosage information from the average time required for the substance to be taken through the Cytochrome P450 system at a time.
However, there are some substances that can affect the ability of the CYP to process therapeutic drugs in such a way as to either quicken or slow the whole process.
Does CBD Interact or Interfere with Medication?
Preclinical research has shown that CBD may directly affect the CYP system in the liver. This is because CBD often binds itself to the site of enzyme activity and acts as a kind of "competitive inhibitor", which displaces its chemical competitors from being metabolized.
Actually, the extent to which cannabidiol inhibits the CYP system depends on the person's unique physiology, the type of cannabidiol product consumed, and the quantity ingested. This is because these factors determine how tightly the cannabidiol molecules will bind to the active enzyme site; with tighter bonds causing more competitive inhibition.
In other words, CBD sometimes outcompetes other medications in getting metabolized by the CYP system. When this occurs, higher concentrations of the other medications are retained in the bloodstream. Invariably, the high levels of foreign compounds in the body may cause unwanted side effects such as a suppressed immune system.
CBD and Drug Interactions: What You Need to Know
Contrary to popular opinion, cannabidiol is not biologically inert. In fact, it has a complex pharmacodynamic and pharmacokinetic profile similar to many other medications. In addition, it has a great potential of impacting the metabolism of other drugs as mentioned earlier.
For instance, therapeutic drugs that are metabolized by the Cytochrome-P450 system can be inhibited by cannabidiol. One such indication that your medication may be affected by CBD is if your physician tells you not to eat grapefruit or use goldenseal supplements when taking CBD. A few drug-drug interactions that may warrant contraindications are highlighted below.
CBD and anticancer drugs: In recent years, some CBD-based drugs have been approved for treating seizures associated with Dravet and Lennox-Gastaut syndromes. This has encouraged scientists to study the adverse drug events (ADEs) and other drug-drug interactions (DDIs) between CBD and other traditional anti-epileptic drugs such as clobazam, rufinamide, topiramate, and valproate.
When the interactions of CBD and other anticancer drugs were investigated, findings showed that there were no deaths during trials. But most subjects reported moderate ADEs involving intoxication, menstrual discomfort, and even mild rashes. Despite these effects, however, the researchers wrote that the effective dosage of 750-mg of CBD was well tolerated when administered with clobazam or valproate.
CBD and pain medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) work by inhibiting cyclooxygenase 2 or COX2. The function of COX2 enzyme is to produce prostaglandins from endocannabinoids and arachidonic acid, which is a type of inflammatory lipid.
NSAIDs help reduce inflammation by inhibiting COX2 and promoting activity at cannabidiol receptors. Thus, this stimulatory effect on the body's endocannabinoid system points to potential interactions with CBD. Since NSAIDs are primarily metabolized by CYP, this indicates that CBD can potentially prolong their metabolism and also accentuate their side effects.
CBD and metabolic symbolic medications (e.g. Insulins): There is enough preclinical data to suggest that cannabidiols affect insulin and glucose sensitivity, which could have serious impacts on persons with type 1 and type 2 diabetes.
Given that insulin sensitivity is likely affected by CBD and THC compounds found in cannabis, available epidemiological data, however, complicates the picture. For instance, while there is a growing prevalence of pre-diabetes among CBD users, there is hardly any difference in the rate when compared to what is found among the general population.
As a consequence, researchers are not sure whether the observed effects could be attributed to uncontrolled confounding factors. As a matter of fact, there is a possibility that the cannabinoid system helps to control insulin sensitivity in the body, rather than outrightly inhibiting it.
CBD and blood-thinning drugs (e.g. Warfarin): Studies have revealed that CBD can potentially increase the side effects of medications used for blood-thinning such as warfarin, or those drugs with risks of blood-thinning such as ibuprofen.
By inhibiting the drugs’ metabolism at the CYP system, CBD prolongs the retention of such medications in the body before excretion. Hence, the usage of both types of medications simultaneously must be closely monitored by a medical expert.
CBD Drug Interactions: What Drugs Should Not Be Taken With CBD?
Grapefruit is known to interact with certain medications in the same manner that cannabidiol does. The only difference in this case is that grapefruit is usually contraindicated on drug labels, while CBD is not.
Since both CBD and grapefruit could affect metabolism in the same way, logically speaking, any drug that is contraindicated with grapefruit should also not be used with CBD.
According to a findings made by the Department of Medicine (Indiana State University), the list of medications which should not be taken with CBD include:
- Antidepressants (e.g. citalopram, fluoxetine, paroxetine, vortioxetine, and vilazodone)
- Antipsychotics (e.g. ariprazole, cariprazine, lurasidone, and ziprasidone)
- Antibiotics (e.g. amoxicillin, cephalexin, metronidazole, clavulanate, and levofloxacin)
- Benzodiazepines (e.g. alprazolam, clonazepam, chlordiazepoxide, estazolam, and lorazepam)
- HIV Antivirals (e.g. abacavir, emtricitabine, tenofovir alafenamide, and zidovudine)
- Prokinetics or motility drugs (e.g. domperidone, levosulpiride, and pruclopride)
- Steroids and corticosteroids (e.g. hydrocortisone, prednisone, and dexamethasone)
- Calcium channel blockers (e.g. amlodipine, felodipine, nicardipine, nisoldipine, and verapamil)
- Proto-Pump Inhibitors (PPIs) (e.g. omeprazole, pantoprazole, esomeprazole, and dexlansoprazole)
Without doubt, CBD is a powerful therapeutic agent that can deliver many benefits including pain relief. However, it can also interact with other drugs due to its inhibiting effect on the body’s CYP system as discussed earlier.
It must be noted that the above list of Rx drugs that don’t mix with CBD products is by no means exhaustive, as there are many more. At the same time, not all the drugs cause harm when taken with CBD. Hence, the need to first consult with your physician before using any cannabidiol product with other drugs. After all, it is good to err on the side of caution.
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To ensure the high quality standards demanded by elite athletes, our full range of custom formulated CBD is tested six times throughout the manufacturing process. We make sure it works, so you can work harder.