For some people, CBD is the go-to remedy for all sorts of health issues such as pain, nausea, lack of appetite, mood disorders and much more. Research has actually shown that CBD may be of help in the above situations. With this, should you go ahead and mix CBD with your regular doctor-prescribed drugs for faster healing?
The answer to this is “maybe not.” CBD has far-reaching effects beyond what is known in the public domain. CBD interacts with the cytochrome P450 metabolic pathway and through this interaction, it is able to influence the metabolism of many drugs.
What is the Cytochrome P-450 System?
The cytochrome P450 metabolic system is found in the liver and is responsible for metabolizing most drugs. It is a system comprising of over 50 metabolic enzymes that work together to eliminate toxins from the body. It needs to be functioning optimally to be able to carry out this vital task, failure to which there will be total chaos in the body.
How CBD interacts with the Cytochrome P-450 System
CBD inhibits the CyP450 metabolic system and diminishes its ability to metabolize some drugs. When this happens, the drugs will accumulate in your system for longer. This same effect is observed with grapefruits and watercress among others. That is why you are cautioned against mixing grapefruits or watercress with drugs. When these drugs accumulate in your body they may produce unwanted side effects.
Other drugs known as prodrugs are diminished in the system when the CYP450 enzyme is inhibited. Pro drugs are consumed in their inactive form and have to be broken down by the enzyme to be converted into the active form. When the CYP450 enzymes are inhibited, there will be diminished amounts of the prodrug in the body. Codeine is an example of a prodrug.
Most drugs are metabolized through the CYP450 pathway, but their effects are influenced in different ways. Here is a list of drugs that may interact with CBD.
Drugs that interact with CBD
It is not practical to come up with all the drugs that interact with CBD. But as a rule of thumb, any drug that passes through the CYP 450 pathway has a high chance of interacting with CBD. Considering that most drugs fall in this category, it is important to consult with your physician before starting on CBD oil.
Depression has been labeled as America’s hidden epidemic; at least 10% of adults (40y-59y) have suffered from moderate to severe depression. As a result, antidepressant use is rampant. Antidepressant medications such as Prozac are metabolized by the CYP 450 enzymes and thus are able to interact with CBD. CBD can inhibit the metabolism of some antidepressants leading to adverse symptoms such as anxiety and hypomania.
2. Blood thinners
It is not clear whether mixing CBD with blood thinners can result in long-term negative effects. However, mixing the two could prolong the elimination time of blood thinners such as Warfarin. This may lead to bleeding.
Antipsychotic medications such as Risperidone are often prescribed for the treatment of psychiatric disorders. High CBD levels in the blood could lead to prolonged activation and accumulation of antipsychotic drugs. Therefore it is advisable to consult with your healthcare provider before combining the two drugs.
4. HIV Antiretrovirals
ARVs are metabolized by the cytochrome p450 enzymes. Taking CBD with ARVs such as atazanavir, ritonavir, and saquinavir will lead to the accumulation of these substances in the blood. This will eventually cause toxicity.
Benzodiazepines are popular anxiety-relieving drugs. When mixed with CBD, the effect would be sedation. Benzodiazepines are broken down by CYP450 enzymes, when this is in shortage they will remain in the blood and may cause severe adverse effects.
6. Cold and Flu medication
Doxylamine is a compound that is present in most cold and flu medications. By inhibiting CYP 450enzymes, CBD causes doxylamine to accumulate in the blood. This leads to adverse effects such as confusion, drowsiness, cognitive impairments, and decreased motor function.
Coffee is the most abused psychoactive drug, but fortunately, it has minimal adverse effects even in high doses. Other than the fact that it may keep you awake at night and probably trigger palpitations, there isn’t much to worry about caffeine.
Both caffeine and CBD inhibit the reuptake of adenosine. Adenosine is an inhibitory neurotransmitter whose actions promote sleep and suppresses arousal. Caffeine is also metabolized by CYP450 enzymes. Combining CBD with caffeine will lead to greater stimulation as there will be more caffeine in circulation. Inhibiting the action of adenosine will result in further arousal and stimulation.
Alcohol is metabolized in the body following three different metabolic pathways and the CYP450 pathway is one of them. This pathway only comes in when a person is binge drinking, it comes in to help in “clearing the backlog.” The effects of combining alcohol with CBD are not very apparent. However, what is known is that the two interact through the CYP450 pathway and therefore one should exercise caution when taking the two.
So Should You Mix CBD With Other Drugs?
90% of the drugs that we consume are metabolized by CYP450 enzymes. This means that there is a high likelihood that CBD will interact with most drugs. Due to this, it is important to inform your physician that you are taking CBD oil in case you need to be put on any treatment.
To minimize CBD interactions with other drugs you can do the following:
- Stop taking CBD until you are done with other medication
- Space out the CBD so that you are taking medication when the CBD is out of your system
- Reduce the CBD dosage that you are taking
- Consult with your physician to prescribe alternative drugs that do not interact with CBD
Finally, remember that everyone reacts differently to a different medication. All your individual characteristics contribute to how you metabolize a drug and the effects that you experience. Because of this, it is important to avoid making generalizations on the effects of drugs. Instead, seek the counsel of a qualified medical practitioner who can advise you on whether you can take CBD with any other drug or not.
- Project CBD: CBD-Drug Interactions: Role of Cytochrome P450. Retrieved from https://www.projectcbd.org/science/cannabis-pharmacology/cbd-drug-interactions-role-cytochrome-p450
- Hindawi (2014): Updates on the Clinical Evidenced Herb-Warfarin Interactions. Retrieved from https://www.hindawi.com/journals/ecam/2014/957362/
- Leafly: How Does Cannabis Interact With Other Drugs? Retrieved from https://www.leafly.com/news/health/cannabis-cannabinoids-drug-interactions
- Compassionate certification centers: The Potential Benefits of CBD for the Symptoms of Bipolar Disorder. Retrieved from https://www.compassionatecertificationcenters.com/the-potential-benefits-of-cbd-for-the-symptoms-of-bipolar-disorder/