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CBD interactions with medications

“You know this sentence from advertising and your doctor will probably have given you a lecture on the subject at some point. Side effects are well known to us. They are undesirable effects of drugs or products after taking them.

Since CBD is experiencing a real hype, of course we all wonder if the use of CBD is associated with side effects or interactions. Interactions are different than side effects in that they only occur in combination with certain medications. Let’s take a look at whether CBD products can trigger interactions and which active ingredient you need to be careful with.

What does interaction mean anyway?

If you take medication, you have probably already taken a look at the package insert. There you will find a long list of side effects and also information about interactions. If you take two medications at the same time, they can weaken or strengthen their effect. Interactions of CBD are usually neglected in the package insert. This is because the last version was often published years ago and CBD products have only experienced real hype in the last few years.

Of course, research is also interested in the topic of CBD interactions, but so far tests have only been done with CBD in its pure form. Whether a CBD oil itself can also be responsible for an interaction has not yet been scientifically proven. Like almost all information on the subject of cannabidiol/CBD, we only have empirical values based on user experience.

Interactions with medications – CBD can enhance the effect

In fact, there are medications whose effects can be enhanced by cannabinoids like CBD. These include a neuroleptic, but also a gastroprotectant (omeprazole), which is responsible for binding stomach acid. The reason for this is that metabolization occurs via an enzyme called CYP2C10. CBD is responsible for inhibiting the enzyme, preventing the body from breaking down the drug at a typical rate.

So if you take two tablets of omeprazole a day, your body will break down the drug more slowly (due to the CBD oil). As a result, your active level is still elevated when you take the second tablet. This can result in side effects called interactions.

So far, there are only a few studies, but this one has shown that the effect can also occur with the active ingredient Diclofenac (this is a painkiller that is often taken for rheumatic complaints and chronic inflammations).

CBD and the influence on enzymes - how interactions can occur

Although CBD is an herbal cannabinoid and is usually well tolerated, patients may react with drug interactions. The reason for this is the metabolism of drugs, which can be inhibited by CBD. CBD affects various enzymes in the liver that are tasked with breaking down drugs. These include enzymes with complicated names like CYP3A4, CYP2D6 and CYP2C19. Let’s be honest: Who has ever heard of these enzymes unless they work in a medical field?

The enhancement of CBD effect may occur with some agents

Studies have shown that medicines can also have an influence on the effect of CBD. Thus, a drug can ensure that the effect of CBD oil is strengthened. Unfortunately, studies on this are still pending, but in the context of field reports, some active substances can be identified as triggers. Evidence will certainly be provided within the next few years, because doctors know about the popularity of CBD. This means that researchers have an incentive to gather more accurate information. The following substances can possibly increase the effect of a CBD oil:

Clarithromycin-type antibiotics: (it is a commonly used drug to treat bacterial infections in humans).
HIV medications: (ritonavir is the standard medication used to treat HIV-positive patients)
Antifungal drugs: (antifungal drugs containing the active ingredients itraconazole and ketoconazole).

The attenuation of CBD effects due to the intake of medications.

Some drugs enhance the effect of CBD oil, while others can inhibit the cannabidiol in its effectiveness. The trigger in this case is that the enzyme CYP3A4 is accelerated in its activity. It breaks down substances (like CBD oil) faster and thus reduces the effectiveness. Here, for example, antiepileptic drugs, phenobarbitals and antibiotics called rifampicin come into question.

Is CBD compatible with medications?

In very many cases, medicines and CBD oil can be combined without any problems. Nevertheless, this question should always be put to the doctor if there is already a treatment with medication. If the doctor is informed about it, he can assess whether adverse reactions are side effects of the drugs or interactions. Theoretically, interactions with drugs of different classes are possible. These include:

  • Antiepileptic drugs (used in epilepsy).
  • painkillers with anti-inflammatory properties (ibuprofen, diclofenac, but not paracetamol)
  • Neuroleptics (used in patients with psychoses such as schizophrenia)
  • Anticoagulants (drugs used to thin the blood. They are commonly used in heart patients or after a stroke)
  • Antifungals (used for skin fungus, intestinal fungus, and other yeast infections)
  • Antibiotics (not all antibiotics have influence on cannabinoids and vice versa)

Who should avoid the use of CBD?

Basically, the hemp plant is a very safe product and many people use CBD products to increase their well-being. CBD cannot cure any diseases and does not replace medication prescribed by a doctor. However, secondary plant compounds, cannabinoids and terpenes can have positive effects on the human body.
The effectiveness is based on the usability of the body’s own cannabinoid receptors CB1 and CB2. Humans and also animals have an endocannabinoid system, therefore they can process cannabidiol in the form of CBD oil and use it for themselves.
The use of CBD oil should always be avoided if the doctor recommends it. The reason could be the intake of medicines that could trigger interactions with the cannabis plant. Even if the connection is sometimes not obvious at first glance, the doctor should always be informed directly about possible problems. As a general rule, pregnant women should also refrain from using CBD. There are no data yet on how the use during pregnancy works.

Should side effects be expected when using CBD?

To increase well-being and vitality, many people have chosen CBD extract, CBD oil, CBD paste and other legal products. Side effects are basically rare as long as CBD is used in normal dosages. This means, above all, that at the beginning of the application, the dosage is gradually increased. Initially, one drop of CBD is sufficient, later the dose can be increased as desired. Caution is always advised if side effects have already occurred, for example with the (illegal) consumption of THC. In this case, the body must be closely monitored.

Even an overdose with CBD usually triggers only mild, unpleasant effects. Since CBD products contain a maximum of 0.2% THC, the risk of intoxication is excluded. The hemp plant itself does not have a toxic effect, CBD oils are also considered well tolerated according to the WHO. At the beginning of the use of CBD products, the following side effects may occur:

  • mild dizziness
  • Nausea up to vomiting (in case of a single overdose or too high dosage)
  • fatigue and drowsiness after initial use

If a drug is taken in parallel with cannabidiol, drug interactions may have occurred. If the doctor treating you has not yet been informed about this, you should do so as soon as possible. He can tell you if you are affected by a cannabidiol interaction or if you are suffering from general CBD side effects.

Can CBD replace the intake of medication?

We know that medical cannabis is now approved as a medicine. So you can get THC-containing products prescribed by a medical professional. Caution is advised with over-the-counter THC, because it is still illegal in Germany (as of 2023). The alternative is cannabidiol, which is approved in Europe and only contains a maximum of 0.2% THC.

So far, there are already a number of studies that indicate a good effect of CBD. For example, cannabidiol is used by users for depression, pain, chronic inflammation, anxiety, sleep disorders and much more.

If you have been prescribed something by your doctor for your symptoms, you cannot simply stop taking the medicine without being asked. You risk your symptoms getting worse again. CBD is not a miracle drug, so switching from your medication to CBD is not advisable.

You may be able to reduce your medications if CBD is effective. This is especially true if you are taking painkillers to reduce chronic pain and your medications are not vital. Again, you should always talk to your doctor first to rule out potential CBD interactions and to be on the safe side.

How can CBD interactions and side effects be reduced?

If you are using CBD for the first time and are being treated with medications at the same time, ask your practitioner if it is okay to use it. To reduce side effects and interactions, it is advisable to always start with a small dose. You can also get different CBD items on the market, start with a CBD oil with a low dosage (5%) and slowly increase.

When you feel that you tolerate CBD well and there are no CBD interactions with any other active ingredient, you can increase the dose bit by bit. Cannabidiol/CBD is generally considered to be very well tolerated, which is why it has been classified as safe by the WHO.

Conclusion: Only rarely problems with side effects and interactions

Although some medications may have an effect on CBD, CBD interactions and general side effects are rare. You can further reduce the risk by only ever buying CBD from reputable retailers and being careful when taking it. Don’t overdose, consult with your doctor, and recognize on your own if your well-being is suffering from the drug.