CBD Drug Interactions

Even though CBD is a natural product, this does not mean it has no side-effects. Doctors are exploring CBD drug interactions—the interactions between CBD and other medication and drugs.

They are particularly interested in the fact that CBD is metabolized by the same enzymes the body uses to metabolize drugs as common as NSAIDs.

CBD drug interactions matter. CBD has become more common as hundreds of new CBD products reach the digital and physical shelves every year. People are getting accustomed to taking CBD to alleviate their health concerns and to relax.

But if CBD interacts with drugs, doctors have to take into account any drugs or medication a patient takes before suggesting they experiment with CBD. Correspondingly, patients need to consult with their doctor before trying CBD.

So, what effect does CBD have on specific medication? How do CBD drug interactions work? Find out here what the latest research has discovered.

What is CBD good for?

 CBD is derived from the hemp plant and is one of the hundreds of cannabinoids found in cannabis. In the UK, CBD is legal as long as it is produced from industrial hemp plants and contains less than 0.2% of THC.

CBD has been used for centuries to help with several conditions and ailments such as anxiety and depression, inflammation, pain management, insomnia, and more. Today, many are experimenting with CBD in an attempt to solve their health problems without taking prescription drugs and medication that may have serious side-effects or that have proven insufficient to help.

Does CBD interact with prescription drugs?

While people are exploring CBD’s potential, the medical community is being cautious until we know more about the effect of CBD on particular medication and possible CBD drug interactions.

Researchers have found that CBD is being metabolized in the human body in the same liver location as all other drugs.

Further research has shown that CBD often antagonizes other medication, making it difficult for people to assess how much of said medication has been metabolized.

In other words, CBD drug interactions occur because CBD affects the way the liver metabolizes drugs.

How does our body metabolize food?

The human body breaks down substances in order to use them. This is valid for food and drugs alike. The breaking down process is usually done in the gut and liver.

In the case of food, the body breaks it down into compounds. These compounds are converted by enzymes into metabolites. The body uses these metabolites as fuel for its cellular processes, to build body tissue, and to fix any problems.

What is drug metabolism?

The same process is followed when taking drugs or medication. Doctors often refer to “drug metabolism,” which is the rate at which the drugs are broken down by the body and then converted into metabolites by the enzymes.

Drug metabolism refers to how long these metabolites stay in the body and affect it before being discarded.

What is the life cycle of CBD in the human body?

The answer differs greatly, depending on the means of CBD administration. The way you consume CBD affects its bioavailability—how much of the substance actually enters the bloodstream.

So, let’s assume we are taking CBD orally. Once ingested, the CBD moves from the mouth to the digestive system where part of it is absorbed by the intestines into the bloodstream.

The blood transports the CBD to the liver where it is broken down and the metabolites distribute the CBD in the bloodstream in a format that the body understands and can use.

What happens in the liver during drug metabolism?

The human liver contains a special type of enzymes: the cytochrome P450 system. This is often referred to as CYP450.

The CYP450 system is tasked with converting fat-soluble compounds into water-soluble ones, to make their absorption easier and faster by the body. Since CBD is a fat-soluble compound, it is processed through this liver enzyme system.

The CYP450 system metabolizes almost 60% of any medication taken, making it essential for people taking drugs for their conditions, illnesses, or ailments.

That is why the CYP450 system is used by doctors to estimate the necessary dosage for any drug. When calculating the appropriate dosage for a particular drug, doctors assume the CYP450 system works properly in the human body and no other drug interacts with it. They then calculate the appropriate dosage for the drug to be effective.

How does CBD interact with the CYP450 system?

CBD is broken down in the CYP450 system in the same way as other drugs.

However, researchers have found that CBD is faster at reaching the CYP450 area and binds to the enzyme activity site more swiftly than other compounds.

As a result, CBD acts as a competitive inhibitor by forcing out other chemical compounds that require the CYP450 system to be broken down.

While the CYP450 system is metabolizing the CBD, it cannot metabolize correctly other drugs or medications, which are left lingering in the body. Due to its speed and strength in reaching the CYP450 enzyme system, CBD outperforms other drugs. 

Why does it matter if other drugs are not metabolized in the CYP450 system?

The dosage given on any medication packaging is calculated on the assumption that the CYP450 system works properly and there are no drug interactions. Doctors calculate the average amount of time it takes for any drug to be converted by the CYP450 system.

When taking CBD, this changes the balance in the enzyme system. CBD reaches the enzyme area first and challenges its competitors, leaving little metabolizing space for them.

The dosage for other medications becomes uncertain because it is uncertain how much of the other medication the CYP450 system ultimately manages to metabolize.

So, even though CBD does not necessarily interact directly with other drugs, CBD drug interactions occur indirectly, via liver enzymes.

What happens when drugs are not metabolized?

When drugs are not metabolized, they linger in the body and the bloodstream. This can have unwanted side-effects. A good example of that is blood thinners: un-metabolized drugs can cause internal bleeding, so taking CBD with blood thinners may be dangerous.

It is no surprise, then, that a 2018 research has shown possibly adverse CBD drug interactions between CBD and warfarin, a known anticoagulant.

Drugs and medication have been developed with a particular purpose in mind and with the premise that they will be metabolized in the body. Their function is not to idle in the bloodstream or liver, where they may cause damage.

Is CBD oil contraindicated with any medications?

Most drugs and medication are processed through the CYP450 system, therefore CBD drug interactions are quite possible.

However, the medical community has determined that the most critical types of medication interacting with CBD are steroids, statins, antihistamines, prokinetics, immune modulators, benzodiazepines, antibiotics, anesthetics, antidepressants, antiarrhythmics, NSAIDs, beta-blockers, blood thinners, and anticonvulsants.

CBD and alcohol

Interestingly, the CYP450 is also involved in the metabolism of alcohol, especially when a large quantity of alcohol is consumed.

In moderate alcohol consumption, two other enzymes are involved, namely ADH and ALDH. CBD appears to interact with both of these, which makes the mixing of alcohol and CBD potentially risky.

What drugs should not be taken with CBD?

The most important thing to do before exploring CBD is to talk with your GP who will assess your medical history and any medication you already take and will offer you sound and scientific advice.

While the medical community knows that CBD competes with other medication during the metabolizing phase, as a 2019 research has shown, there are a few details that play a big part in how CBD drug interactions occur.

CBD concentration

The higher the concentration of CBD, the more of it ends in the CYP450 system and needs metabolizing.

Conversely, lower concentrations of CBD are thought to be easier on the enzyme system and less competitive to other medications.

Timing and spacing out CBD consumption

In order to avoid flooding the enzyme system with too many chemical compounds all at once, it is often suggested to space out the CBD and any other medication you might be taking.

This gives the CYP450 system the time and space it needs to metabolize all compounds without interference between them.

Therefore, taking CBD in the morning and any other drug in the evening could potentially help the situation. Again, talking with your GP is crucial.

Genetics, age, and body size

All human bodies are different. Genetics, age, and body size vary from person to person. They all influence heavily how the CYP450 system works and metabolizes. Something that is problematic for some might be fine for others.

Methods of CBD consumption

There are many ways of taking CBD, some of which make it more bioavailable than others. For instance, taking a drug intravenously would be the most bioavailable method because the drug reaches the bloodstream immediately.

While very few might take CBD through an IV drip, many users choose to inhale or consume it sublingually. These methods of consumption have a high bioavailability, meaning that a large quantity of CBD ultimately reaches the bloodstream. As a result, a large quantity of CBD is processed through the CYP450 system and displaces other drugs and medication from the enzyme site.

Ingesting CBD, however, requires it to go through the digestive system before it reaches the CYP450 area. Part of CBD is broken down in the digestive tract and less CBD finally reaches the liver. Although this means that less CBD is bioavailable to the body, it also means that less CBD is processed through the CYP450 system and other medications might not be forced out.

So, and depending on the quantity, CBD edibles may be safer than inhaling CBD when it comes to CBD drug interactions.

CBD isolate

Most researchers run trials with pure CBD isolate, which contains 100% CBD since this makes it easier to calculate the dosage of CBD and isolate its effects.

However, it would appear that full-spectrum CBD with all the terpenes and other cannabinoids found in the hemp plant exhibit the entourage effect. Full-spectrum or broad-spectrum CBD appears to be more liver-friendly and could be less competitive during the CYP450 system process.

CBD drug interactions: always consult with your doctor

A doctor is the first person to discuss your health issues and concerns.

If you want to help your health concerns with CBD, the first step is to consult with your GP and mention all other drugs or medication you might be taking. Your doctor will evaluate your health and offer you guidance regarding the type and quantity of CBD to take.

CBD side-effects are relatively few, making it a particularly promising compound. It is generally well-tolerated and non-addictive. And it interacts with the endocannabinoid system to potentially improve your quality of life in myriads of ways.

However, you should always consult your doctor before experimenting with it, especially if you are on medication or suffer from an ailment or condition. 

For more fascinating details on CBD, click here: 4 Myths and 5 Surprising Facts about CBD.