Within our current health and wellness sphere, the list of things CBD has been claimed to help with is constantly growing. From headaches, arthritis, sleep, schizophrenia, and COVID-19, CBD has become known as somewhat of a ‘miracle cure’ within the community. With the caveat of being regularly described a ‘natural remedy,’ CBD is often seen as risk free, or a preferred alternative to prescription medication.

This isn’t necessarily the case, however, and some of the narratives being pushed about CBD may lead to misunderstandings. First of all, a lot of the health benefit claims about CBD can’t be backed up by science yet. This is important, particularly when it comes to health, wellness, and what we’re putting in our bodies. Claims about being ‘risk free’ and a ‘natural remedy’ may lead individuals to believe CBD is completely safe, which, when it comes to mixing substances, is not entirely true.

To date, CBD has been known to interact with certain medications. For those looking for ways to transition off prescription drugs, or for people already on medication, taking the proper precautions is important. If you’re considering taking CBD and are also taking any form of medication, talking with your doctor should always be the first step.

That said, we also thought it was important to break down some of the current information we’ve been able to find about how CBD interacts with medications. While more research needs to be done before we have a full understanding of potential interactions and risks, thankfully, we do have some initial insights.

Enzymes and Drug Metabolization

Although the research that we have so far suggests that CBD has few known side effects, what effects have been reported when CBD is taken in isolation include things like digestive issues, nausea, and dry mouth. Therefore, there seems to be a possibility of CBD’s side effects compounding with similar side effects of other medications. For example, medications that may cause drowsiness could have those effects exaggerated with the use of CBD.

Additionally, when we ingest a substance, our bodies go to work trying to break it down. Much of this work happens in the liver using enzymes, specifically a family of them called cytochrome P450 (CYP450). However, medication and other substances can impact these enzymes, changing the rate in which things are metabolised.

CBD isn’t just processed by enzymes, it affects them too, specifically being known to inhibit CYP3A4. This makes the metabolism process slower and substances take longer to be absorbed into our bodies. The drugs, therefore, hang out for a lot longer than we realize they do. If we still have these lingering drugs in our system when it comes time to take another dose, the substance just continues to pile up. Ultimately, this heightens the risk of overdose and other adverse effects of consuming too much medication. This effect was noted in one study conducted with clobazam and CBD, which found that when taken together, elevated levels of both substances were found in participants.

Penn State University released a list of medications with high CBD interaction risks. They also released a lower risk list as well. That said, many more studies are needed before we fully understand how various medications interact with CBD, which, thankfully, are currently being conducted.

In a recently released CBD review, Health Canada spoke about potential medication interactions being a safety concern when it comes to CBD use.

Grapefruit warnings

One thing we’ve often heard discussed within the CBD community is the grapefruit warnings listed on medications. Put simply, grapefruit juice is shown to inhibit CYP3A4 enzymes in a similar way that CBD does. Interestingly enough, depending on the medication, grapefruit may also slow down the actual transport cells that contribute to a substance’s processing. Again, this means that less of the substance is being absorbed, so the medication may not be available in your body when you need it. Although more research needs to be done on CBD and absorption, since it is known to interact with metabolism enzymes in a very similar way, it may have the potential to also delay these transport cells.

In general, avoiding CBD usage when taking medications with grapefruit warnings tends to be a commonly given word of advice.

That said, checking in with your doctor is always important and should be the first step when considering mixing any medications and substances.

A Matter of Full Spectrum

One of the big challenges with CBD, or cannabis research in general, is that studies tend to use Isolate, or the pure form of whatever it is they’re researching. If they’re looking into CBD and anxiety, for example, they’re testing with high doses of CBD Isolate. This means that any sort of Full Spectrum effects, such as the entourage effect and how the various compounds in cannabis all work, is mostly unstudied.

This is the same when it comes to medication interactions. Whether things like other cannabinoids, terpenes, or flavonoids impact how medication is metabolized in our bodies or makes the situation worse, we’re not sure.

When it comes to THC more specifically (or cannabis in general), this study found similar things to how CBD interacts with some medications. This report in particular highlights several medications that are considered much larger risks when taking in conjuncture with cannabis. In general, it seems that the medication interaction and enzyme inhibiting qualities aren’t just limited to CBD, but cannabis use in general.

TL;DR

Although research into CBD and how it affects our bodies is still new, we do know that it interacts with other medications. Among other interactions, CBD is known to inhibit CYP450 enzymes, which are known for breaking down substances within our bodies. This can lead to elevated levels of medication in your system, resulting in heightened risk of overdose. As this is the case, it’s always important to check in with your doctor before mixing any substances and medications.