CBD has become a popular wellness option for many people, but if you’re already taking medications, you might be wondering: is it safe to mix the two? The truth is, while CBD is generally considered safe and well-loved by many, it’s important to know that it can interact with certain medications. And those interactions could mess with how your body breaks down both CBD and your meds, potentially leading to some unexpected or even dangerous results.
But don’t worry, we’re here to help you make sense of it all—without the scare tactics. In this article, we’ll explore the science behind how CBD oils, CBD edibles, and other forms of CBD might interact with your medications and what you need to watch out for.
Always Avoid Taking CBD With Medications That Have a Grapefruit Warning
First thing’s first: most CBD products come with a grapefruit warning. That’s because, like CBD, there’s more to certain citrus fruits than meets the eye. You might also find a grapefruit warning on some medications, and it’s there for a good reason: grapefruit and some of its citrus relatives (like Seville oranges and pomelos) contain natural chemical compounds that can interfere with how your body processes certain drugs. And believe it or not, CBD can do something very similar.
Both CBD and fruits in the grapefruit family contain compounds that mess with a group of enzymes in your liver known as CYP450. These gut enzymes are responsible for breaking down many of the medications you take. When you consume grapefruit or CBD, they can inhibit these enzymes, leading to higher levels of the medication in your bloodstream than intended. This isn’t usually an issue for all medications, but for those with a “grapefruit warning” on the label, it’s something you definitely shouldn’t ignore.
For example, medications for blood pressure, cholesterol, and certain heart conditions often carry this warning. This is because even small changes in how these drugs are metabolized can lead to side effects or reduced effectiveness. So, if you’ve been told to avoid grapefruit, you should definitely avoid CBD altogether or talk to your doctor before using CBD products to make sure they won’t interfere with your current medications.
Understanding How CBD Interacts with Medications
With that little disclaimer out of the way, let’s get into the nitty-gritty of how CBD interacts with other medications. While CBD is generally considered safe, it’s essential to know that CBD can influence how your body processes different drugs. Many medications are broken down by enzymes in your liver—specifically, a group called CYP450 enzymes. These enzymes help metabolize everything you take in, from food to medications.
However, CBD can compete with or even inhibit these enzymes, affecting how medications are broken down. This process, called “altered concentration,” can mean one of two things: either your medication doesn’t work as well because it’s not broken down enough, or it becomes too potent because it’s not being broken down fast enough. And when medications reach these unexpected levels, it can lead to unwanted side effects—or worse, serious health issues.
A study from Penn State College of Medicine identified 139 medications that could be affected by cannabinoids like CBD, narrowing it down to 57 that can be particularly dangerous if their concentration is altered. Some examples include:
- Blood thinners like warfarin
- Heart rhythm medications such as amiodarone
- Thyroid medications like levothyroxine
- Seizure medications, including clobazam, lamotrigine, and valproate
It’s also worth noting that some over-the-counter CBD products can drastically vary in concentration, unlike FDA-regulated options. Some products may be much stronger or weaker than advertised, which adds another layer of risk when you’re considering mixing CBD with other medications. That’s why it’s crucial to choose high-quality, third-party-tested products—like those from Lazarus Naturals—to ensure you know exactly what you’re getting.
Remember, while these interactions might not apply to everyone, it’s always better to proceed with caution. If you’re taking any medications, it’s best to discuss supplementing with CBD with your doctor before taking it— especially if you have underlying conditions or take multiple prescriptions.
Which Drugs Interact With CBD?
CBD is a popular option for many people looking to manage life’s little everyday stresses or bring a little bit of balance into their day to day. But if you’re taking prescription medications, it’s crucial to understand how CBD interacts with them.
The liver processes nearly 60% of all prescription drugs using enzymes—the same enzymes that break down CBD. When CBD and certain medications compete for these enzymes, it can either increase or decrease the concentration of these drugs in your body, leading to unexpected effects. Let’s walk through some of the most common medications that could be affected when combined with CBD.
Antidepressants
If you take antidepressants like SSRIs, SNRIs, and tricyclic antidepressants (TCAs), adding CBD to your routine might affect how these drugs work. CBD can block the enzyme CYP2D6, which is responsible for breaking down certain antidepressants. This could cause higher levels of the medication in your body, which may lead to increased side effects like sleep disturbances, dizziness, or drowsiness. Since CBD and antidepressants both impact the central nervous system, their effects could overlap, potentially making you feel extra tired or sluggish.
Some examples of antidepressant drugs that may interact with CBD include:
- Amitriptyline
- Clomipramine
- Desipramine
- Imipramine
- Nortriptyline
- Doxepin
- Trimipramine
Anti-Anxiety Medications (Benzodiazepines)
Benzodiazepines, such as Xanax or Ativan, are commonly used for managing anxiety, insomnia, or even certain types of seizures. However, CBD can change how these drugs are processed by your liver, specifically by slowing down the enzymes that break them down. This could result in higher levels of the medication in your system, which might make you feel more sedated than expected. If you’re using CBD and also prescribed a benzodiazepine, you could experience increased drowsiness or even issues with coordination, raising the risk of accidents or falls.
Some examples of anti-anxiety drugs that may interact with CBD include:
- Clorazepate
- Clobazam
- Alprazolam
Blood Pressure Medications
Ongoing research suggests that CBD might lower blood pressure, which might sound like a plus if you’re already taking blood pressure medications. But combining CBD with ACE inhibitors, beta-blockers, or diuretics could lower your blood pressure too much, causing dizziness, fainting, or even falls. Because CBD can interact with the same enzymes that metabolize these medications, it may also lead to fluctuations in their concentration levels, affecting how well those medications work on their own.
Some examples of blood-pressure drugs that may interact with CBD include:
- ACE Inhibitors
- Enalapril
- Lisinopril
- Beta-Blockers
- Propranolol
- Metoprolol
- Calcium Channel Blockers
- Diltiazem
- Verapamil
- Amlodipine
- Other Blood Pressure Medications
- Clonidine
Blood Thinners
Blood thinners like warfarin or antiplatelet agents (e.g., clopidogrel) are used to prevent blood clots and reduce stroke risk. CBD can alter the enzymes responsible for breaking down these medications, which may lead to higher concentrations in the blood and increase the risk of bleeding. In some cases, people taking CBD with warfarin have needed to adjust their dosage by up to 30% to reduce this risk. If the concentration of these medications gets too high, it can cause excessive bleeding or other complications, like an increased risk of stroke.
Some examples of blood-thinning drugs that may interact with CBD include:
- Vitamin K Antagonists (VKAs)
- Warfarin
- Acenocoumarol
- Phenprocoumon
- Dicoumarol
- Diphenadione
- Direct Oral Anticoagulants (DOACs)
- Dabigatran
Heart Medications
Certain heart medications, including beta-blockers and calcium channel blockers, help regulate heart function and manage conditions like high blood pressure. CBD may interact with these drugs by influencing how they’re metabolized in the liver, which may either increase or decrease their levels in your body. This could cause changes in your heart rate or blood pressure, leading to potential side effects like dizziness or fatigue.
Some examples of heart medications that may interact with CBD include:
- Amiodarone
- Digitoxin
- Dofetilide
- Tacrolimus
- Sirolimus
- Temsirolimus
Thyroid Medications
Thyroid medications are used to manage thyroid hormone levels. CBD may interfere with these medications by altering the enzymes that break them down. This might cause changes in hormone levels, leading to symptoms like fatigue, weight fluctuations, or mood changes if the medication isn’t metabolized properly.
- Levothyroxine
Seizure/Anticonvulsant/Antiepileptic Medications
Antiepileptic drugs like carbamazepine, oxcarbazepine, and valproate are designed to control seizures by regulating electrical activity in the brain. When combined with CBD, these drugs might interact in a few different ways. For example, CBD may alter how your body processes these medications, potentially lowering the levels of CBD or the antiepileptic drug, reducing their effectiveness. On the flip side, CBD could increase the concentration of some seizure medications, like clobazam, leading to stronger effects and a higher risk of side effects such as sedation.
Some examples of epilepsy medications that may interact with CBD include:
- Carbamazepine
- Ethosuximide
- Phenobarbital
- Phenytoin
- Valproic Acid
Opioid Painkillers
Opioid painkillers, like morphine or oxycodone, are powerful medications for managing severe or chronic pain. However, CBD can slow the metabolism of these drugs, leading to higher concentrations in your bloodstream. This can alter opioid effects and may lead to more of the undesirable effects of opioids, such as drowsiness, fatigue, and lethargy. Additionally, taking CBD and opioids together can amplify their shared central nervous system effects, increasing the risk of sedation or, in severe cases, respiratory depression.
Some examples of opioids that may interact with CBD include:
- Fentanyl
- Meperidine
Antimicrobials
Certain antibiotics and antifungals can also interact with CBD. These drugs inhibit the same liver enzymes that process CBD, so when taken together, the levels of CBD in your body may increase, potentially leading to more intense effects like dizziness or drowsiness. Since antimicrobial medications are often essential for treating infections, you should take a break from CBD until you’re finished with your course of medication.
Some examples of antimicrobials that may interact with CBD include:
- Clindamycin
- Ketoconazole
- Itraconazole
Immunosuppressants
Immunosuppressants help prevent your immune system from rejecting transplanted organs or attacking your own body in autoimmune conditions. CBD can increase the concentration of these drugs, which may lead to higher levels in your bloodstream. This can cause severe side effects, such as an increased risk of infection, because of the immunosuppressive nature of these medications.
Some examples of immunosuppressants that may interact with CBD include:
- Cyclophosphamide
- Cyclosporine
- Mycophenolic acid
- Tacrolimus
- Everolimus
Proton Pump Inhibitors (PPIs)
PPIs, like omeprazole and pantoprazole, are used for managing acid reflux and other stomach issues. These medications rely on liver enzymes to be processed, which is the same pathway CBD uses. Taking CBD if you’re prescribed PPIs could cause higher concentrations of these medications, leading to intensified side effects like headaches or digestive issues.
Some examples of PPIs that may interact with CBD include:
- Omeprazole
- Pantoprazole
- Esomeprazole
Vitamins and Herbal Supplements
Even some over-the-counter supplements and herbal products, like St. John’s wort or melatonin, can interact with CBD. Since these products also depend on liver enzymes for metabolism, taking them with CBD might alter their effectiveness. In some cases, combining CBD with these supplements could amplify drowsiness or fatigue.
Some examples of supplements that may interact with CBD include:
- St. John’s Wort
- Ginkgo Biloba
Alcohol
CBD and alcohol both affect the central nervous system, leading to effects like sedation and drowsiness. When taken together, these effects can be amplified, making you feel more tired or unsteady. Additionally, both CBD and alcohol can impact liver function, and combining them might increase the risk of liver damage over time. To minimize risks, it’s best to avoid mixing CBD with alcohol.
The Bottom Line
If you're taking any of the medications or supplements we listed, don't use CBD without consulting your doctor first. Further, if you’re taking any medications in these families of drugs, it’s best to always talk to a doctor first. Your doctor can help you determine whether or not it’s safe to take CBD while also taking prescribed medications. Remember, nothing in this guide is intended as medical advice.
Do Different Forms of CBD Have Different Implications with Medications?
By now, you may have already talked to your doctor and got the green light to give CBD a try. But sometimes how you take CBD is just as important as if you take it. Different methods of consuming CBD can affect how it interacts with other medications and how your body absorbs it.
By understanding how each method works, you can make an informed choice about which form of CBD is right for you, especially if you’re on medications. Remember, it’s essential to monitor your body’s response and keep your doctor in the loop. We recommend keeping a CBD journal to monitor how you feel when you take CBD with certain medications so you can share your experiences with your doctor. Detailed notes and regular communication with your doctor can help keep you safe if you’re set on mixing CBD with your medications.
Inhalation: Smoking and Vaping
If you choose to smoke or vape CBD, the cannabinoids enter your bloodstream through your lungs. This method is fast, delivering effects within minutes. However, it doesn’t pass through the liver immediately, so drug interactions are less likely to be a concern right away. That said, as CBD eventually makes its way through the liver via your blood, it can still impact how medications are processed. Vaping and smoking may also come with other respiratory risks, so be cautious. Smoking and vaping offer quick effects, but the risk of drug interactions may still arise after initial inhalation. Proceed with caution, especially if you’re using other medications.