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CBD and your prescription medications
what you need to know

Cannabidiol (CBD), for its ability to alleviate symptoms of insomnia, anxiety, chronic pain, and a host of other health conditions, has received widespread attention. While research on how effective CBD is are ongoing, several individuals are giving it a try.

To date, research shows that CBD is normally stable and has few, if any, mild side effects. But there’s one major caveat: the CBD has a strong one: CBD has the ability to interfere with them.

How the body metabolizes such compounds has to do with it. It’s important to speak with your doctor about all the vitamins, nutrients, prescriptions, and over-the-counter drugs you’re taking before you try CBD. Here’s a closer look at why it matters to have a conversation.


Metabolism of medications and CYP450 enzymes


Your body has to metabolize, or break it down, when you take a drug or other substance. Drug metabolism, such as in the gut occurs in the body, but the liver does a major part of the work, too. The essential work of processing substances is performed by a family of enzymes named cytochrome P450 (CYP450), so they can be easily removed from the body. But CYP450 is affected by certain medicines or substances, either by slowing or speeding up the metabolism of drugs. The change in the rate of metabolism can alter how the drugs or supplements you take are processed by your body.

Why does CYP450 matter when it comes to CBD and medications?


Research shows that the CYP450 family of enzymes is responsible for metabolizing many cannabinoids, like CBD. CYP3A4, an essential enzyme in the family of CYP450, explicitly performs the role. But CBD interferes with CYP3A4 during this process as well.

Around 60 percent of clinically approved drugs are metabolized by the CYP3A4 enzyme. But if CBD inhibits CYP3A4, it will not be able to work as effectively to break down the medications in your system. Around 60 percent of clinically approved drugs are metabolized by the CYP3A4 enzyme. If your body metabolizes a drug too slowly, even if you have kept to your usual dosage, you can have more medicine in your system at one time than expected. An increased amount of a drug in your system, including unexpected or adverse side effects, may exaggerate its effects. The function of the CYP450 enzyme family is also speeded up by certain substances. If your body metabolizes a drug fast because another substance is inducing the enzymes, you may not have enough of the medication in your system at one time to treat a health issue.

Trying CBD safely while taking medications

Speak to the doctor about it first if you want to use CBD as an add-on treatment to relieve symptoms of a certain disorder. They might be able to help decide a safe CBD product, dose, and schedule for your drugs. Your doctor may want to monitor the blood plasma levels of some drugs you are taking in certain cases. Don’t stop trying all of your CBD drugs unless you talk to a specialist.

Note that topical CBD can also be an option, such as lotions, creams, and salves. Topicals do not usually penetrate the bloodstream, as long as they are not a transdermal solution designed to do so, unlike oils, edibles, and vaping solutions.


Potential drug interactions

Look for the grapefruit warning

While research to establish possible interactions between CBD and specific medicines are still underway, there is one rule of thumb that can aid consumers in the meantime. Avoid CBD if your medicines are labelled with a grapefruit alert. This warning means that the intake of grapefruit or grapefruit juice should be avoided by people taking the drug.

According to the Food and Drug Administration, eating grapefruit while taking one of these drugs can lead to a higher bloodstream concentration of the medication and adverse side effects or even overdose. Grapefruit and some closely related citrus juices, such as Seville oranges, pomelos, and tangelos, interact with more than 85 drugs. That’s because, in a similar way to CBD, chemicals in grapefruit known as furanocoumarins inhibit CYP3A4. The effect is a decelerated metabolization of drugs. In some types of drugs, grapefruit alerts are popular, although not all medications within a group would require the avoidance of grapefruit. Check the details for your prescription or ask your doctor.

Forms of drugs that typically have a warning about grapefruit

  • antibiotics and antimicrobials
  • anticancer medications
  • antihistamines
  • antiepileptic drugs (AEDs)
  • blood pressure medications
  • blood thinners
  • cholesterol medications
  • corticosteroids
  • erectile disfunction medications
  • GI medications, such as to treat GERD or nausea
  • heart rhythm medications
  • immunosuppressants
  • mood medications, such as to treat anxiety, depression, or mood disorders
  • pain medications
  • prostate medications

Current research on interactions between CBD and medications

Researchers are trying to analyze the particular relationships between CBD and different medications. Animal trials for some drugs have been performed, but in certain cases, scientists are still evaluating how certain findings translate to humans. There have been several minor clinical trials performed. In one study of 25 children with difficult-to-treat epilepsy, for instance, 13 children were given both clobazam and CBD.

In these children, researchers found elevated concentrations of clobazam. They report that it is safe to take CBD and clobazam together, but recommend that dosage levels during treatment be controlled. In another study, CBD, in the form of Epidiolex, was also offered to 39 adults and 42 children taking AEDs The CBD doses were increased every 2 weeks.

The serum levels of the AEDs in subjects were controlled over time by the researchers. While the serum levels for most of them stayed within the agreed therapeutic range, two drugs, clobazam and desmethylclobazam, had serum levels outside the therapeutic range.

Initial studies indicate that even though you’re taking your recommended dose, CBD will certainly mess with drug levels in your system even if you’re taking your prescribed dosage. In order to evaluate the significance of CBD interactions across various drugs, however, further research is required and to establish guidelines for taking them along with CBD.

Side effects and Safety

You will still be able to use CBD safely with drugs, including those that have a grapefruit warning, under your doctor’s close supervision. Your doctor will monitor the plasma serum levels of the drug you are taking, if necessary. They can want to control the functioning of your liver as well. If you’re taking CBD with medications, it’s important to keep an eye out for any potential changes in how the medication or the CBD affects you.

Side effects to watch for

Increased or new side effects of treatment, such as:

  • Sleeplessness 
  • sedation
  • Nausea  

A drop in the effectiveness of treatment, such as:

  • Breakthrough seizures

 Side effects of CBD or changes , such as:

  • Tiredness
  • Diarrhea
  • Appetite
  • Changes in weight

Talk to your doctor

If you want to try CBD, particularly if you have a health problem and are taking medicine, the bottom line is to always consult your doctor first. Until you have the go-ahead from your doctor, do not quit taking your prescription drugs to pursue CBD. It is possible that drugs that come with a grapefruit alert would interfere with CBD.

 However, your doctor can be able to devise a plan that works for you by carefully tracking the drug levels in your system, even if you take one of these drugs. That way, both the prescription and CBD can be used as therapy.

It may also be possible for your doctor or pharmacist to prescribe a better CBD product that suits your needs.  You can find reputable products with a little research and closely read CBD labels.


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