CBD and Drugs: The Potential Interactions You Should Know About

CBD is known for the health benefits it can provide. But what if you’re taking other drugs and medications? Here are some potential interactions you should know about.

If you’ve heard about CBD, you probably know that it is a compound derived from the cannabis plant. CBD health benefits are documented on many studies in recent years. You probably also know that it provides limited side effects making it the perfect alternative to other drugs that may treat symptoms but be harmful in other ways.

But what about drug interactions? Do we need to be careful when taking CBD with other drugs or medications? Well, the simple answer to that is yes. Read on to find out more about how CBD may have unwanted effects when mixed with other drugs.


It’s All About the Cytochrome P-450 System

The way certain drugs interact with others can be traced to the Cytochrome P-450 system. Found in the liver, this enzyme system is responsible for metabolizing potentially toxic compounds including 60% of the drugs consumed in the human body. The system has over 50 enzymes that work to process and eliminate toxins.

When doctors prescribe medication to patients, they make dosage recommendations based on the average time it takes for the medications prescribed to be processed in the cytochrome P450 system.

When one drug is being processed, the system is generally healthy, and the dosages prescribed will be accurate. However, the presence of other drugs could change processing times causing medications to metabolize slower or faster than they normally would. Changes in processing times can also be due to health issues such as liver problems and other pre-existing conditions.

Cannabidiol (CBD) has been known to inhibit the cytochrome P450 system affecting its ability to metabolize drugs leading to an overall increase in processing time. Increased levels of drugs in the system caused by the introduction of CBD can lead unwanted side effects even, in some cases, an overdose.

On the other hand, sometimes CBD can enhance the way other drugs can work in the body. This can be the case if CBD provides the same benefits that a certain drug does, or if it speeds up or boosts the way the drug works in the body.

What Drugs Cause Reactions with CBD?

Now that we understand how CBD works and can interact with certain drugs, let’s’ take a look at what drugs interactions with CBD actually cause side effects.

Drugs That Affect Blood Sugar Levels: There has been evidence that suggests cannabis may decrease insulin resistance and improve the metabolic process and blood sugar control. However, far fewer studies have been conducted to determine how CBD interacts with drugs that have been prescribed for diabetes.

It’s possible that CBD can work with the drugs to lower glucose levels, or it’s possible that the combination of both drugs can bring glucose levels down to a point where levels are dangerously low.

Individuals with diabetes who use CBD are warned to keep careful track of their symptoms to monitor the effects the medications may be having and to adjust dosages accordingly.

Drugs that Lower Blood Pressure: Studies have shown that a single dose of CBD can reduce blood pressure in healthy volunteers. It does so by simultaneously activating the CB1 and CB2 receptors to induce a cardiovascular response that elevates oxygen levels while reducing blood flow in the coronary arteries.

While there have been minimal reports of any adverse effects, users who take blood pressure medication combined with CBD should be aware of possible risks.

Drugs that Increase the Risk of Bleeding: Studies have been conducted on how the effects of drugs like warfarin, that are used for blood thinning, can be modified when combined with CBD. The concern is that the cannabinoids may increase the effects of these drugs to a harmful level.

THC, in particular, has been shown ability to displace warfarin from protein building sites.

One study conducted on the interactions between CBD and warfarin showed that both medications were beneficial in blood thinning so that the dosage of warfarin could be reduced.

However, it is recommended that a medical professional closely monitor those who use warfarin and CBD, as there could be unwanted side effects if there is no reduction in the primary medication.

Users should be warned that drugs like ibuprofen and naproxen can also have blood thinning effects that can be increased with the use of CBD.

Opioids: Opioid addiction has reached epidemic levels. Usually opioids are being used for pain management. Many individuals become addicted to these drugs and they are one of the leading causes of death in the United States.

Because CBD is also effective at reducing pain, it has been looked at as a non addictive alternative to opioids. It has been shown to reduce pain in a number of studies.

One study that is particularly relevant was conducted by Dr. Donald Abrams, an oncologist from UC San Francisco. The study looked at patients who took both opioids and CBD to reduce pain symptoms. Results showed that there was no significant change in opioid blood level concentrations after exposure to cannabis but patients did report a 27% decrease in pain.

The results of this study showed the CBD was effective at reducing pain and could be safely used in conjunction with opioids. However, it is always recommended to speak to a medical professional to determine what doses of each are recommended.

CBD and Alcohol

Cannabis and alcohol have been a popular combination for many years, particularly when thinking of THC. Now that CBD is becoming more accepted, scientists are studying this cannabinoid to determine its reaction with alcohol.

Although effects are still being researched this is what we know so far. When alcohol enters the body, it is metabolized by the enzymes ADH (alcohol dehydrogenase), ALDH (Aldehyde dehydrogenase) as well as the good old CYP450 system.


When people drink occasionally, the ADH and ALDH do the job of metabolizing ethanol. But when there is an excessive amount of alcohol present, the CYP450 gets involved.

CBD inhibits the CYP450 system to play a significant role in alcohol metabolism. It also alters levels of ADH and ALDH to varying degrees.

Here are some other interesting facts on the CBD and alcohol combination:

  • Studies show that CBD lowers blood alcohol levels however the effects of alcohol remains the same with or without CBD.
  • The CB1 receptor plays a key role in reinforcing and motivating attributes of alcohol.
  • CBD reduces the reinforcement, motivation and relapse for alcohol.
  • CBD protects the liver from damage due to drinking excessive amounts.
  • CBD protects the brain from alcohol induced neurodegeneration.
  • CBD reduces alcohol induced liver steatosis, metabolic dysregulation, inflammation and neutrophil-mediated injury.
  • CB1 receptor agonists (THC) encourage alcohol consumption while CB1 receptor antagonists (CBD) decrease it.
  • CBD and other cannabinoids can make drinkers drink less.

Cannabinoids can have positive and negative effects when mixed with alcohol, but, as always, it is recommended not to overdo it on either when combining the two.

CBD and Caffeine

Caffeine is the world’s most commonly consumed psychoactive drug. Let’s find out the effects it has when combined with CBD.

If you think about the molecular makeup of caffeine, it is very similar to adenosine, a compound produced in our bodies that activates the A2a receptor. Caffeine binds to this receptor inhibiting the reuptake of adenosine. The blockage of the adenosine results in a process called vasodilation which increases alertness and clarity.

CBD is also a partial agonist of the A2a receptor so combining CBD and caffeine blocks adenosine across the board which results in more stimulation. Due to CBD’s effects on the neurotransmitters systems, anxiety that may be caused by caffeine alone is reduced.

Caffeine is metabolized by the CYP450 system. CBD inhibits the system slowing the excretion rate of caffeine to make its effects more prolonged, which can work for you or against you, depending on whether you need the extra energy or would rather go to sleep!

But, as with any drug combination, both drugs should be taken in modified doses.

CBD and Sedatives

Sedatives, antidepressants and barbiturates have a calming effect on the nervous system. CBD has a similar effect to promote calm, help against depression and more.

CBD and the sedative diazepam has been given to rats to study the effects they had on anxiety levels and were proven to lower stress reactions with no unwanted side effects. However, labels on the diazepam drug warns that interactions with CBD can lead to increased side effects like dizziness, drowsiness, confusion and difficulty concentrating.

Other Drugs That May Interact with CBD

Although more research is needed to determine how these drugs interact with CBD, any drug that is metabolized by CYP450 enzymes could potentially react with cannabidiol. Therefore, you should use extreme caution when taking CBD in combination with any of the following:

  • Steroids
  • HMG CoA reductase inhibitors
  • Calcium channel blockers
  • Antihistamines
  • Prokinetics
  • HIV antivirals
  • Immune modulators
  • Benzodiazepines
  • Antiarrhythmic
  • Antibiotics
  • Anesthetics
  • Antipsychotics
  • Antidepressants
  • Anti-epileptics
  • Beta blockers
  • PPIs
  • NSAIDs
  • Angiotensin II blockers
  • Oral hypoglycemic agents
  • Sulfonylureas

intravenous drug


CBD can provide many health benefits but there is evidence that it can cause side effects and interactions when combined with certain drugs and medications. Therefore, it is important to discuss risks with a medical professional before proceeding with usage and to pay close attention to dosages and any unwanted side effects. That way all your medications will be as beneficial as possible in improving your quality of life.


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