What Drugs Should Not Be Taken With CBD?

Woman in green shirt holding Tanasi CBD capsules

Posted on July 17th, 2020

Does your doctor ask you about the medications or supplements you take before prescribing something new? Why do you think he or she does that? It’s because trained healthcare providers don’t want to prescribe any medicine that could have adverse effects on your body, given its interaction with drugs you are already taking. In fact, some medications may produce harmful effects if they mix with other drugs in your body. 

The same concept holds true when it comes to CBD. Today, you can enjoy so many cannabidiol CBD products, such as salves, lotions, tincture oils, and drink concentrates, and you may be excited to try them because of their reported benefits. But if you are already on medication, can you still take CBD? Or if you are taking CBD, what drugs should you avoid? To be safe, only your healthcare provider should answer these questions. But to help you ask the right questions, we’re here to explain why consuming CBD affects the way certain medications work in your body.

Woman holding Tanasi Water Soluble and glass of waterHow CBD Affects Some Drugs

To better understand how CBD interacts with medications, you must first explore how your body metabolizes various substances. When you ingest food or medications, your body’s metabolism breaks it down for use. Actually, this process occurs in two parts: catabolism, which breaks down substances, and anabolism, which builds up substances. Both these processes are parts of biochemical reactions. Enzymes in your body cause these two reactions that comprise your metabolic system.

CYP3A4 is the enzyme responsible for metabolizing 50 to 60% of the clinically-prescribed medications that you take. It is a subclass of another enzyme, called CYP450. Some medications, including ciclosporin (cyclosporine), erythromycin, diazepam (Valium), codeine, and acetaminophen (Tylenol), depend on CYP3A4 for catabolism. This enzyme hangs out in your liver. As soon as you take one of these medications, it gets dissolved in your bloodstream. Then, it passes through your liver and comes in contact with CYP3A4 where catabolism takes place. And, in addition to the above-mentioned medications, CYP3A4 also metabolizes cannabinoids like CBD.

According to several research studies, consuming CBD prevents your body from producing sufficient CYP3A4. This impacts your overall metabolic process. And, without sufficient CYP3A4, your body will not be able to properly metabolize certain drugs, especially the ones mentioned above. As a result, the medications then linger longer in your bloodstream. And, they can’t produce their expected effects. Perhaps most dangerously, this metabolic slow down can lead to toxic levels of drug buildup. 

On the other hand, if you consume a potent CYP3A4 inhibitor before using CBD, your body may not process the CBD product as efficiently as it should. This reduces the overall effect of CBD while maintaining CBD levels in your blood for a long time. Many medications, such as phenobarbital, phenytoin, and rifampin help produce CYP450. So, taking one of these medicines along with a CBD-product can help your body metabolize CBD faster. This is because of the higher percentages of metabolic enzymes in your liver.

Drugs to Avoid While Taking CBD

Taking medication with CBD depends entirely on your body’s CYP450 enzymes. You need to know whether the drug-CBD combination prevents or induces CYP450 production. And remember, a significant number of drugs rely on CYP450 for their metabolism. This means that if you are taking CBD and start taking a new medication, it may not produce your needed health-benefits or protections. In fact, it may even trigger drug toxicity. So you should always mention CBD use to your healthcare provider, especially before starting a new medication. 

Some of the medications that depend on CYP450 and shouldn’t be taken with CBD include Antidepressants, Antiarrhythmics, Anti-epileptics, Antipsychotics, Angiotensin II blockers, Anesthetics, Antihistamines, Antibiotics, Beta-blockers, Benzodiazepines, Calcium channel blockers, Sulfonylureas, Prokinetics, PPIs, Steroids, NSAIDs, HMG CoA reductase inhibitors, and HIV antivirals. 

You should also stay away from prodrugs while taking CBD. They require CYP3A4 for metabolism, after which they become therapeutic compounds. CBD can suppress CYP3A4 levels and make a prodrug ineffective. A few examples of prodrugs are Vyvanse, Concerta, and Codeine.

Does the Method of Taking CBD Make Any Difference?

There are tons of CBD products available, all providing promising effects. But you need to determine how to properly and safely use these products. Here are some of the most commonly used methods.

Man in dark coat holding CBD tinctureTinctures

Tinctures are a blend of CBD oil and a carrier oil, delivering a concentrated CBD dose sublingually (underneath your tongue). When you dose a CBD tincture, the active ingredients are absorbed in your mouth’s lower lining. But CBD tinctures have a very bitter taste. If you don’t want to let the bitterness linger in your mouth for hours, you can put a couple of drops of the tincture in a smoothie.

You shouldn’t take any of the above-mentioned medicines for at least an hour before taking a CBD tincture. These tinctures start working within 20 minutes of consumption and can linger in your system for several hours. If you take your daily dose of CBD in the morning, you shouldn’t consume CYP3A4-dependant drugs until evening at the earliest. And never combine them without your doctor’s approval. 

Topicals

CBD creams, moisturizers, and oils can be applied topically. Infused CBD creams and moisturizers may provide combination skin healing. They are highly effective at addressing symptoms of various skin diseases, as well as muscle and joint pain. When applied topically, CBD is absorbed through your skin before entering your bloodstream.

Compared to tinctures, topical CBD products take a relatively long time to reach their peak effectiveness. The skin absorbs CBD slowly and in small amounts. It may take as long as 90 minutes for creams, moisturizers, and oils to start producing their effects. And so, it’s better not to take any CYP3A4-dependant medicine during this time.

Capsules and Gummies

CBD Capsules and gummies work faster in your body than creams and moisturizers. These products depend on gut absorption. Their effect kicks in within 30 to 60 minutes after consumption. And, depending on the potency of the capsule of gummy, effects can last for a few hours. Make sure you don’t take any CYP3A4-dependant drug for at least a few hours after consuming these products. And again, be sure to consult your physician before using CBD.

Vaping

Vaping is a popular method of ingesting CBD. The e-juice in your vape contains concentrated CBD that you inhale using an electrically powered vaporizer. People like vaping because the CBD enters your bloodstream quickly, through your lungs, just like oxygen. It reaches its peak effectiveness within a few minutes. But vaping has been associated with serious lung injuries, so exercise caution when considering this form of CBD. 

What’s the one uniting factor between all these forms of CBD delivery? Well, they all pass CBD into your bloodstream, allowing you to enjoy its effects for an extended time period. Whether you absorb CBD through your gut or drop it under your tongue, the cannabinoids enter your bloodstream, making their way to your liver. It then comes in contact with CYP3A4 enzymes for metabolism. 

This means that no matter what method of consumption you choose, CBD will interact with drugs in the same way. In fact, the drugs may block CBD and prevent it from providing its purported benefits. The only difference in these CBD consumption methods is their onset times. So, even if your doctor approved CBD use with your medication, you should carefully consider the times of day at which you take your pills and cannabidiol.

For example, if you take codeine and don’t want it to interfere with CBD, you should take your pill an hour before taking CBD. This gives your body an extra hour to allow CYP3A4 enzymes to metabolize the codeine before CBD hits your liver. Similarly, if you want to vape CBD, then you should take codeine several hours before vaping. This would help CYP3A4 process the codeine before CBD enters your bloodstream.

How to Safely Take Medications with CBD 

Research suggests that CBD products are usually harmless. But every person is different, so you need to know how your body reacts to CBD when it enters your bloodstream. The most crucial part of CBD is its metabolism. It must interact with CYP3A4 enzymes to work efficiently. But its effects can reduce or even nullify the health benefits of various drugs. 

It is better to focus on drugs that increase the production of CYP3A4 enzymes. This would improve the speed of CBD metabolism. But many drugs inhibit or slow down the effectiveness of CBD when they interact with CYP3A4 enzymes. This means the two products can’t coexist in your body. In other words, you need to take an inhibitor drug at least a few hours before or after consuming CBD. 

Taking CBD with a drug that depends on CYP3A4 will make the medicine ineffective. This often leads to toxic levels of medication in your blood, even if you stick with your prescribed dose. Therefore, it’s wise to reconsider the time when you take these drugs or avoid CBD use altogether. To be safe, discuss all dosing options with your doctor, and make any necessary changes in your medication schedule or CBD routine, depending on the type of CBD product you’re using and the method of application or consumption.

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