Pharmacist’s Guide to CBD Oil ABSTRACT: Cannabidiol (CBD) is becoming more prevalent, and pharmacists must be knowledgeable about these products in order to counsel patients effectively. CBD When you take CBD alongside certain medications, it can trigger negative drug interactions. Here we explain what drugs shouldn’t be taken with CBD — and when to consult your doctor if you’re not sure about the potential interactions. What drugs should not be taken with CBD? We know that drugs interact inside your body with supplements if you take them at the same time. What about CBD?
Pharmacist’s Guide to CBD Oil
ABSTRACT: Cannabidiol (CBD) is becoming more prevalent, and pharmacists must be knowledgeable about these products in order to counsel patients effectively. CBD laws and regulations are determined at the state level in the United States. Non–FDA-approved CBD products are not regulated and may contain harmful chemicals. Pharmacists must counsel patients on where and how to obtain products and to check the amount of CBD and delta-9-tetrahydrocannabinol in the product. CBD has numerous drug interactions that should be evaluated by a pharmacist. CBD is most promising for treatment-resistant seizures, and more research is necessary to evaluate its use for other indications. Sativex is currently being investigated in the U.S. for treatment of spasticity associated with multiple sclerosis and schizophrenia. In general, more studies of CBD are needed.
Cannabidiol (CBD) is gaining popularity across the United States. Pharmacists must be able to answer patients’ questions about CBD and make recommendations. This article will provide specific information about CBD, including laws, how to select a non–FDA-approved CBD product, indications for use, side effects and warnings, drug interactions, dosing and directions, pharmacokinetics, and the future of CBD oil. After reading this article, pharmacists should feel confident about counseling patients about CBD and recommending CBD products.
Laws Concerning CBD
CBD was first isolated from the Cannabis sativa plant in the 1930s. CBD is a nonpsychoactive part of the plant, whereas delta-9-tetrahydrocannabinol (THC) is the major psychoactive part of the plant. In the 1970s, researchers evaluated CBD as a pharmacologic agent. 1 Epidiolex, a 100 mg/mL oral solution with less than 0.01% THC, became the first FDA-approved CBD-containing drug in June 2018. 2 The drug is Schedule V and indicated only as an anticonvulsant for Lennox-Gastaut syndrome or Dravet syndrome in patients aged 2 years and older. 3
In December 2018, the Agriculture Improvement Act, which removed hemp from Drug Enforcement Administration (DEA) regulation as a controlled substance, was passed and signed into U.S. law. Hemp is defined as a cannabis plant that contains no more than 0.3% THC. (In contrast, marijuana has a higher THC.) Hemp is now regulated by the U.S. Department of Agriculture and is legal in all 50 states. Laws and restrictions regarding the selling of hemp products vary by state, making it questionable to travel with CBD products. 2
U.S. laws and regulations concerning CBD are determined at the state level. Currently, 33 states have legalized CBD use for medical purposes, and 10 states (Alaska, California, Colorado, Maine, Massachusetts, Michigan, Nevada, Oregon, Vermont, and Washington) and the District of Columbia have legalized marijuana for recreational use. In states such as New York, Minnesota, and Connecticut, pharmacists are required to dispense the products in authorized dispensaries. Marijuana-derived CBD oil is still considered illegal under the Controlled Substances Act in accordance with the DEA’s classification of marijuana as a Schedule I substance. 2
Selecting a Non–FDA-Approved CBD Product
Pharmacists must educate patients about how to select an appropriate non–FDA-approved CBD product. These products are not tested for safety, efficacy, or quality. 4 The main concerns in picking a non–FDA-approved CBD product are that it may contain harmful chemicals and may not accurately list the correct amounts of CBD and THC it contains. These products could contain harmful contaminants (e.g., pesticides, heavy metals) or have high levels of THC, which would result in a positive urine drug test. 5 The patient should be advised to obtain CBD products from a medical dispensary because these products are regulated. The patient should also consider ordering products from states where CBD is legal because more testing is done in those states. When selecting a product, the patient should check the label to see if it lists the amount of CBD in each dose. 5,6 The manufacturer should provide a Certificate of Analysis, which shows an independent laboratory’s assessment of the product’s potency and the presence of contaminants. 5 When assessing quality, the patient should look for the Hemp Authority seal, which means that the product is legal and the manufacturer is adhering to quality standards. 7
Indications for CBD
As consumer demand in the U.S. has risen, along with the number of dispensaries, the number of studies addressing the therapeutic effects of CBD has increased. The studies performed, however, are insufficient; large randomized, placebo-controlled trials need to be conducted. CBD seems most promising for treatment-resistant seizures. There is limited evidence concerning the use of CBD for psychotic symptoms in Parkinson’s disease and for anxiety related to public speaking. CBD has not been proven effective for pain, nausea, or depression. 4 THC, conversely, is thought to be effective for these conditions because it has a different mechanism of action. THC activates the CB1 and CB2 receptors in the brain, and CBD does not. As mentioned previously, CBD does not have psychotropic effects and THC does. These differences are believed to account for the different uses of CBD and THC. 7,8
Patients with early-onset epilepsy who are resistant to conventional therapy may benefit from CBD oil. A trial that investigated the effect of CBD on drop seizures of Lennox-Gastaut syndrome found that CBD 10 mg/kg/day or 20 mg/kg/day, when added to conventional therapy, led to a greater reduction of drop seizures compared with placebo. 9 The most common adverse reactions were somnolence, decreased appetite, and diarrhea. Specific adverse events from CBD included elevated liver aminotransferase concentrations. 9
Clinical findings on the use of CBD oil in Parkinson’s disease (PD) remain unclear. Past studies have evaluated CBD’s efficacy in minimizing nonmotor symptoms of PD, such as cognitive deficits, sleep disturbances, psychosis, depression, and anxiety. 10 The neuroprotective properties of CBD have been studied in animals with PD, with results indicating that CBD appears to reduce psychotic symptoms. 11 Although patients with PD have reported fewer sleep disturbances as well as improvements in quality of life, treatment in humans requires further investigation on a larger scale, with longer durations and more standardized dosing. 12 Most studies have used combinations of CBD and THC extracts, including nabilone, a synthetic CB1 receptor agonist. CBD dosages of 150 mg/day for 4 weeks and titrated by 140 mg/week were found to be safe and well tolerated and did not worsen motor function. 10
More evidence is needed to support the use of CBD for anxiety. Studies have found that CBD 300 mg may be effective for anxiety related to public speaking, and doses of 400 mg to 600 mg may help patients with social anxiety disorder and public speaking–related anxiety. Studies are inconclusive concerning the utility of CBD for anxiety. 13
Side Effects and Warnings
Studies have reported various properties and potential benefits of CBD. Some undesired side effects of CBD use are decreased appetite, dry mouth, diarrhea, dizziness, drowsiness, fatigue, lightheadedness, orthostatic hypotension, psychomotor slowing, sedation, somnolence, weight loss, and increased risk of liver injury with dosages of 20 mg/kg/day or the use of clobazam or valproate. Monitoring of liver enzymes, weight, and cognitive function may be warranted. CBD can pass through the placenta, so it is recommended that CBD be avoided during pregnancy and while breastfeeding. Because CBD oils may contain trace amounts of THC, operating heavy machinery and driving should be avoided when treatment is initiated. 1
CBD is metabolized in the liver, mainly by CYP2C19, CYP3A4, and UGT. This can lead to interactions with prescription drugs, OTC medications, and herbal supplements. 1,14
The inhibition of CYP2C19 by CBD can increase levels of carisoprodol, citalopram, clopidogrel, diazepam, phenytoin, proton pump inhibitors (PPIs), valproic acid, and warfarin. As a strong CYP3A4 inducer, CBD may lessen the efficacy of amlodipine, atorvastatin, buprenorphine, bupropion, diltiazem, eplerenone, fentanyl, loperamide, midazolam, paclitaxel, pioglitazone, sildenafil, solifenacin, tamsulosin, testosterone, topiramate, zolpidem, and other 3A4 substrates. 7
More serious effects may occur with concomitant use of central nervous system depressants, such as barbiturates, benzodiazepines, fentanyl, morphine, and propofol. These effects are the result of the synergistic effects of sedation and hypnotic effects at high doses. Increased sedative effects may also be seen with herbal supplements, including kava, melatonin, S-adenosylmethionine, and St. John’s wort. 13,14
Other interactions to be aware of are presented in TABLE 1.
Dosing and Directions
In unregulated dispensaries, CBD oil sold comes in a sublingual formulation known as CBD tincture and is generally available in 30-mL bottles with dropper caps. 15 A bottle costs approximately $20. The concentration of the tincture ranges from about 1,500 mg to 3,000 mg per bottle. If a drop equals 0.05 mL, one bottle contains approximately 600 drops of CBD oil. Drops are usually placed under the tongue, and the patient should let the oil absorb into the lining of the mouth, without swallowing, for 30 seconds to 1 minute. Capsules and gummies are also available. 15
As noted earlier, Epidiolex (CBD) is an FDA-approved oral solution for treatment of seizures associated with Lennox-Gastaut syndrome or Dravet syndrome. The cost of Epidiolex is approximately $2,708 per month. It is supplied as 100 mL of solution containing CBD 100 mg/mL. For both indications, the initial starting dosage is 2.5 mg/kg orally twice daily for 1 week. The dosage may be titrated weekly in increments of 2.5 mg/kg twice daily to a maintenance dosage of 5 mg/kg twice daily. The maximum dosage is 10 mg/kg twice daily or 20 mg/kg/day. Gradual tapering is recommended when Epidiolex is discontinued. 3
Starting at a low dosage is recommended for elderly patients and patients with moderate or severe hepatic impairment. The dosage should be 1.25 mg/kg to 5 mg/kg twice daily or 0.5 mg/kg to 2 mg/kg twice daily, respectively. 3
CBD reaches its maximum concentration in 2.5 to 5 hours. High-calorie and high-fat meals can increase the maximum concentration of drug fivefold and the AUC fourfold. 14 Owing to the first-pass effect, CBD is poorly absorbed, with a bioavailability of 13% to 19%. Better bioavailability has been reported with inhaled CBD (11% to 45%). CBD is 94% protein bound; therefore, interactions may occur with other highly protein bound drugs or in patients who have abnormal albumin levels. The volume of distribution is 20,963 L to 42,849 L, meaning that the drug is largely distributed into the tissues. CBD is metabolized by the gut and primarily by the liver. Epidiolex has an active metabolite, 7-OH-CBD, and is a 2C19 and 3A4 substrate and inhibitor of 2C19, 1A2, UGT1A9, and UGT2B7. Its elimination half-life is 56 to 61 hours. CBD is excreted primarily in the feces and urine. 3
The Future of CBD
Sativex (nabiximols) is an oromucosal spray that contains CBD and THC in a 1:1 ratio. The active ingredients are absorbed sublingually or buccally. Sativex is currently under investigation in the U.S.; however, more than 25 countries worldwide have approved Sativex for the treatment of spasticity associated with multiple sclerosis. Sativex is also being researched for potential treatment of schizophrenia and other conditions. 16
The Pharmacist’s Role
Some pharmacists are hesitant to get involved with CBD. Prosecution by federal law could lead to severe consequences, including fines, imprisonment, or loss of DEA registration for pharmacies, ultimately stripping them of their ability to dispense controlled substances. If U.S. laws and regulations were more uniform across states, many of the concerns surrounding CBD would be eliminated. Until then, patients must use caution when selecting a product from an unregulated source because of the possibility of contamination and product misbranding. 17 Although more testing is needed, it is imperative for pharmacists to understand what to recommend to patients. Pharmacists should counsel patients on the risks and benefits of treatment. Patients who are are using CBD should be reminded to obtain the product from a reputable manufacturer. 17
Pharmacists need to keep abreast of current information on CBD in order to assist patients who are interested in using it. While most studies are inconclusive, there currently is enough information to effectively guide patients in choosing a treatment. CBD has the most evidence for treatment-resistant seizures; other indications need further study. Patients must be counseled to choose an appropriate product from a reputable source. CBD may be misbranded or contaminated with harmful chemicals. Pharmacists are uniquely positioned to assess the numerous potential drug interactions with CBD. New prescription CBD products are currently being investigated in the U.S.
CBD Drug Interactions – Mixing Cannabidiol and Medications
Are you worried about potential CBD-drug interactions? In this article, we explain the mechanism behind drug metabolism and how CBD may interfere with it.
The range of therapeutic properties offered by CBD (cannabidiol) has spurred its popularity in recent years. This natural compound is known to relieve a host of symptoms, allowing for safer and more effective management of different health conditions.
And unlike THC (tetrahydrocannabinol), CBD is non-intoxicating, so it won’t get you high.
CBD can assist in the treatment of anxiety disorders and depression, inflammation and pain, neurodegeneration, seizure disorders, sleep deprivation, metabolic conditions, neuropathy, migraines, inflammatory bowel disease, and more.
Considering CBD has so many potential health benefits, you may start wondering if it can interact with certain medications used to address the same symptoms — and whether you should or shouldn’t take these drugs with CBD.
Below you’ll find the dos and don’ts of using CBD along with medications.
Let’s start with the don’ts.
What Drugs Should Not Be Taken with CBD
Studies from the Indiana University Department of Medicine have provided a list of pharmaceutical drugs and medications which shouldn’t be taken with CBD.
The list below covers all groups of drugs that can negatively interact with CBD oil.
- Angiotension II Blockers
- Anticonvulsants / Anti-Seizure Medications
- Calcium Channel Blockers
- HIV Antivirals
- HMG CoA Reductase Inhibitors (Statins)
- Immune Modulators
- Non-Steroidal Anti-Inflammatory Drugs
- Oral Hypoglycemic Agents
- Proton-Pump Inhibitors (PPIs)
- Steroids and Corticosteroids
There’s also a group of drugs called “prodrugs” that first need to be processed into their therapeutic compounds instead of being therapeutic compounds on their own. In plain English, the inactive compound is consumed, and once in the body, it turns into the active compound.
If this mechanism is dependant on the CYP450 system (more on that later), a drug interaction can lead to insufficient concentrations of the therapeutic agent in the bloodstream — reducing its potency.
CBD Interaction with Drugs & Medications
This section covers the most common interactions between CBD and medications. If you take any of the substances listed below, make sure to consult your doctor before buying CBD oil.
CBD and Ibuprofen Interaction
Ibuprofen is one of the Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), meaning it can produce similar benefits to CBD in terms of inflammation and pain relief. Previously we’ve mentioned that NSAIDs interact with CBD, which may raise concerns about potential negative interactions between CBD oil and Ibuprofen.
According to a study from the Journal of Neurology Research, there have been no reported interactions between CBD and ibuprofen, although it doesn’t mean they do not exist. Health experts suggest that potential interactions may be dosage-dependent. If a certain dosage threshold is breached, CBD and NSAIDs like Ibuprofen can lead to unforeseen and potentially severe nervous system pathology.
CBD and Adderall Interaction
A 2020 study found that higher doses of medical cannabis led to a decreased use of ADHD medication in adults. Products containing a higher concentration of CBD were linked to lower ADHD scores. This means that CBD can interact with ADHD meds, decreasing their efficacy while providing more pronounced benefits. The potential side effects of interactions between CBD and Adderall may lead to decreased appetite.
CBD and Lamictal Interaction
Using medical cannabis and Lamictal may increase side effects such as dizziness, confusion, drowsiness, and difficulty concentrating. Elderly consumers may also experience impairment in judgment. That being said, none of these side effects were proven to result from CBD use per se. When it comes to interactions between CBD and Lamictal, it can make the medication more or less effective, depending on the dosage.
CBD Oil and Antibiotics
There is no known interaction between CBD and antibiotics, although these interactions may occur if an antibiotic is metabolized through the cytochrome P450 enzyme system. Some studies indicate that taking CBD and antibiotics together may amplify the effects of one another without any negative side effects. However, more research is needed to confirm these findings on a larger scale.
CBD Oil and Omeprazole
CBD can inhibit the enzymes that are targeted by omeprazole and other Proton Pump Inhibitors (PPIs). Taking CBD with certain heartburn medications can increase the risk of diarrhea.
CBD and Thyroid Medications
Some people report mild nausea when taking CBD oil together with their thyroid medications. Since both substances are processed by the CYP450 enzyme system, taking CBD with a thyroid medication may cause hyperthyroidism because more thyroxine would be secreted than the body could metabolize.
CBD and Lisinopril
CBD can temporarily lower blood pressure, so taking it alongside medications like Lisinopril might reduce it even more, making you feel lethargic and weak. Always consult your doctor before adding CBD to your routine if you use anti-hypertension meds.
CBD and Prednisone
Since both CBD and corticosteroids are potent inhibitors of the CYP450 enzyme system, concomitant use may increase the risk of systemic side effects from corticosteroid use due to decreased glucocorticoid clearance. Corticosteroids like prednisolone and hydrocortisone should never be taken with CBD.
How Drugs Interact: Understanding Drug Metabolism
Metabolism can refer to how your body uses energy for weight management, or the way drugs are metabolized in your body.
The former is known as the basal metabolic rate, or in simple terms, the number of calories a person needs to maintain healthy body functions while at rest.
The latter is very different from the basal metabolic rate. Drug metabolism refers to how a substance is processed and used by the body — with the majority of this processing happening in the liver.
Scientists call it the ‘first-pass effect’ or ‘first-pass metabolism.’
Using straightforward terms, when you take a medication, it is broken down in the liver into its active compounds so that the body can use them. Just like carbohydrates are broken down into sugars, fats into triglycerides, and proteins into amino acids — drugs break down into their individual ingredients.
From there, they are controlled by specific enzymes, which transform these compounds into metabolites. These metabolites then influence different processes in your body and are flushed with urine once used up.
How Is CBD Metabolized?
Drug metabolism determines the rate at which the body processes medications and other therapeutic compounds into their individual metabolites and how long they can stay in your system.
When you take CBD in the form of an oil, capsule, or gummy, it has to pass through your gut, where it is released into the bloodstream. From then, they travel through the bloodstream to the liver, where it absorbs through the hepatic portal. The liver breaks CBD down into its metabolites using enzymes, after which it can circulate throughout the body in the bloodstream again.
What Is the Cytochrome P450 System?
Aside from breaking compounds down into metabolites, the liver also detoxifies and excretes foreign substances and other types of toxic compounds. This can happen through a system of enzymes referred to as the Cytochrome P450 (CYP450). These enzymes contain heme as a cofactor to convert cannabinoids into more water-soluble molecules, increasing their absorption and efficacy.
Researchers estimate that the CYP450 system is responsible for metabolizing 60% of any drugs out there. And interestingly, doctors and pharmacists use this system to understand, evaluate, and predict the benefits of the drug and potential side effects based on their dosages.
However, certain compounds have the ability to compromise the CYP system’s functioning, negatively affecting the metabolism of certain medications. Once these interactions occur, the drugs can be metabolized faster or slower than normal.
CBD And the Cytochrome P450 System
As mentioned earlier, CBD can interact directly with the CYP450 system in the liver. According to preclinical studies, CBD binds to the site where the enzyme activity occurs, competing with other compounds and thus preventing this system from breaking down other substances.
This inhibitory effect on the CYP450 enzymes mainly depends on how much CBD a person takes, their unique physiology, and the type of CBD used (e.g., full-spectrum CBD vs. CBD isolate). The dosage determines the strength used by the CBD to bind to the active site of the metabolic enzymes. The tighter the bond, the more competitive inhibition.
Contraindications for Taking CBD with Medications
The mechanism behind CBD’s health benefits proves that it’s not a biologically inert compound. Instead, the pharmacokinetics and pharmacodynamics of CBD are complex and similar to any other medication. Therefore, it has the potential to compromise the metabolism of certain medications.
Any therapeutic substance that relies on the CYP450 system can be potentially affected by CBD. A common indicator for such interaction is when your medication has a grapefruit warning on the bottle. However, this is by no means a solid point of reference, and you should always check with your doctor and pharmacist before taking the two compounds together.
Why You Should Always Consult Your Doctor First
The list of drugs that we’ve mentioned above is by no means definite and doesn’t include all the pharmaceutical substances that may interact with CBD. Similarly, not all the medication from these categories will necessarily cause an interaction — as is the case for antibiotics and Ibuprofen.
A consultation with a doctor experienced in CBD and cannabis use can help you establish the right routine for your medications and supplements to avoid potentially negative interactions. Some compounds work synergistically with CBD, so asking your doctor can help you maximize the effect of your treatment.
Not to mention that the doctor can guide you on finding the optimal dosage for yourself.
Key Takeaways on CBD Drug Interactions
The safety profile of CBD has been acknowledged by major health agencies, such as the World Health Organization (WHO), showing that it’s well-tolerated by animals and humans and rarely produces any dangerous side effects.
CBD also has a profound impact on an array of systems, which explains its therapeutic versatility. That being said, this versatility is also the reason why CBD interacts with so many prescription meds and over-the-counter (OTC) PRODUCTS.
Again, if you’re not sure if CBD will interact with the medication that you might be taking, a consultation with a health professional will not harm — unlike trying to figure out these interactions on your own.
Livvy is a registered nurse (RN) and board-certified nurse midwife (CNM) in the state of New Jersey. After giving birth to her newborn daughter, Livvy stepped down from her full-time position at the Children’s Hospital of New Jersey. This gave her the opportunity to spend more time writing articles on all topics related to pregnancy and prenatal care.
What Drugs Should not be Taken With CBD?
Do you know what drugs should not be taken with CBD?
We have known for some time now that medications can interact inside your body with supplements if you take them at the same time. Every single time you go into the doctor’s office, they ask you what medications you are taking for a reason.
They aren’t just being nosey, the doctor actually needs to know if a medication they prescribe you will have a negative interaction with that medication you are already taking. That’s why it is important to always be very clear with your doctor about everything you take! Even over-the-counter medications and supplements can produce unpredictable, harmful effects when mixed with the wrong drug in your system.
CBD is still fairly new to the world, and what drugs should not be taken with CBD is still being discovered.
CBD is short for cannabidiol , one of over 100 chemicals known as cannabinoids found in cannabis plants. It is found in all cannabis plants, including industrial hemp and the two strains of marijuana, cannabis sativa and cannabis indica. Depending on the strain, people can consume a significant amount of CBD when they consume cannabis. In most strains, you’ll find more THC than CBD, which is known for its psychoactive properties that cause the cannabis “high”.
Unlike THC, CBD is not a psychoactive substance, it creates no “high.”
With CBD being such a popular thing, we can expect more research professionals to conduct more studies that will provide new data. It will likely take years for the studies to be completed and papers to be published, to set expectations, so time will be needed to fully understand the data on what drugs should not be taken with CBD. Until then, experiments with CBD will always be conducted at the user’s own risk.
Generally speaking, mixing CBD with any other medication that depends on CYP450 enzymes, inhibits the production of CYP450, or induces the production of CYP450 enzymes, and is asking for trouble. Medical science can’t quite tell us exactly what kind of trouble and how much of it, but do you really want to find out?
Since more than half of all medications depend on CYP450 enzymes to be metabolized, check carefully which of your prescribed and over-the-counter medications fit this criterion and look for delayed or suppressed effectiveness, as well as extended side effects and possible signs of drug toxicity.
There is one class of drugs that you should also keep an eye on and they are called prodrugs. In order for these drugs to become active and therapeutic compounds, they need to be metabolized. The version of the drug you ingest is actually inert and depends on the biochemical reaction with CYP3A4 to become active at all. If CBD suppresses your CYP3A4 levels, a prodrug might not even work at all.
Examples of prodrugs include codeine, which gets synthesized into morphine in the liver. ADHD drugs Concerta and Vyvanse are two others.
How CBD May Interact with The Most Commonly Prescribed Prescription Drugs
Vicodin and CBD
When it comes to pain killers, Vicodin is the most commonly-prescribed. It is a habit forming opioid that can produce bad side effects including dizziness, nausea, impaired breathing, and cognitive impairment.
Opioids are not known to interact adversely with CBD. The exception is codeine, a prodrug that only activates as a painkiller when it is metabolized, a process that CBD can inhibit. Vicodin does not share this property with codeine.
Simvastatin and CBD
In a drug class known as “statins”, Simvastatin is the first type of drug prescribed to persons suffering from high cholesterol. It happens to be the most frequently prescribed statin.
Simvastatin is metabolized by CYP3A4. If you end up taking CBD in conjunction with simvastatin it’s possible that it can decrease the drugs efficacy. It can prolong the drugs side effects, and possibly lead to medication toxicity due to the drug’s prolonged presence in the bloodstream.
Lisinopril and CBD
When people are close to kidney failure, and are suffering from high blood pressure, they are usually prescribed Linisopril. Sometimes it can be prescribed for people suffering from diabetes and congestive heart failure.
Lisinopril is classified as angiotensin converting enzyme (ACE) inhibitor. While its function is to inhibit the production of enzymes, it is not known to inhibit CYP3A4, meaning it is unlikely to inhibit the function of CBD. It is also not a prodrug, unlike some of its analogs, meaning it is less likely to be affected by an inhibition of CYP3A4 that may result from ingestion of CBD.
Levothyroxine and CBD
Lovothyroxine is the generic form of the thyroid medication Synthroid. It is a synthetic thyroid hormone used to treat hypothyroidism (an underactive thyroid). An excess of this hormone can produce chest pain, rapid heart rate, headache, sweating, anxiety, and weight loss.
Lovothyroxine is known to inhibit CYP450 enzymes, meaning it could inhibit the effects of CBD oil.
Azithromycin and CBD
The antibiotic azithromycin is usually prescribed to treat throat, sinus, and ear infections. It can also be prescribed to treat bronchitis, pneumonia, and certain bacterial sexually transmitted infections. It may produce the side effects of vomiting, gas, bloating, and diarrhea.
Unlike its relative erythromycin, azithromycin only metabolizes weakly with CYP450 enzymes and is not known to either stimulate or inhibit the production of CYP450 enzymes. There is little or no indication that azithromycin will interact adversely with CBD.
Metformin and CBD
Metformin is a drug that is used to treat type 2 diabetes. It’s the generic version of a drug called Glucophage. Common side effects include gas, nausea, bloating, reduced appetite, and diarrhea.
Metformin is not metabolized in the way most other drugs are, meaning changes in CYP3A4 due to CBD ingestion will most likely not affect it. However, metformin is known to be a strong CYP3A4 inhibitor in its own right, meaning it could inhibit the effectiveness of CBD metabolism.
Lipitor and CBD
Another statin drug is Lipitor. Lipitor is commonly prescribed to patients suffering from high cholesterol. It is also prescribed to patients suffering from coronary artery diseases as a safeguard against stroke, heart attack, and chest pain. It may also cause diarrhea, constipation, muscle pain, fatigue, gas, heartburn, and headaches.
Lipitor is metabolized by CYP3A4. Taking CBD in conjunction with Lipitor may decrease the drug’s effectiveness, prolong its side effects, and possibly lead to medication toxicity due to the drug’s prolonged presence in the bloodstream just like Simvastatin.
Amlodipine and CBD
Amlodipine is the generic form of the drug called Norvasc. These drugs are both calcium channel blockers. It is prescribed to prevent chest pain and treat high blood pressure. Side effects it can cause include headaches, dizziness, chest pain, and swollen extremities.
Amlodipine is metabolized by CYP3A4. Taking CBD in conjunction with Amlodipine may decrease the drug’s effectiveness, prolong its side effects, and possibly lead to medication toxicity due to the drug’s prolonged presence in the bloodstream.
Amoxicillin and CBD
Amoxicillin , a relative of the revolutionary antibiotic penicillin, is used to treat many kinds of bacterial infections, including skin, throat, ear, tonsil, and urinary tract infections. Possible side effects include heartburn, nausea, rash, diarrhea, itching, and abdominal pain. Some people are also allergic to amoxicillin.
Studies have not demonstrated the propensity for amoxicillin to inhibit the production of CYP3A4, meaning it is unlikely to produce an adverse reaction with CBD.
Hydrochlorothiazide and CBD
One of the most common diuretics on the market is Hydrochlorothiazide. It is prescribed to patients suffering from high blood pressure. It is known to produce side effects like electrolyte imbalance, rash, fatigue, light sensitivity, and low blood pressure.
Hydrochlorothiazide is not metabolized by CYP3A4, nor is it known to inhibit or stimulate the production of the enzyme. This means it is not likely to produce an adverse reaction with CBD.
Hopefully we’ve helped you get a better understanding on what drugs should not be taken with CBD. It’s important to understand drug interactions with CBD and what the potential risks are. Consult with your physician if you have any doubt.