CBD or Cannabidiol is a compound from the cannabis plant known to provide a wide range of potential health benefits including anxiety relief, help with sleep disorders, chronic pain relief, and two forms of epilepsy. Studies on CBD have shown that CBD is generally safe and has fewer unwanted side effects. However, CBD does have the potential to interact with some medications such as blood thinners and may increase the levels of liver enzymes which can cause liver injury.

Before buying CBD products, check if they have a grapefruit warning on the label as grapefruit juice can slow down the metabolic process. This means that grapefruit interferes with proteins in the small intestine and liver that normally break down medications. Taking grapefruit while taking medications like CBD can lead to higher levels of them in your blood, thus more adverse effects. This article will provide you with all the information about the prescription medications that might interact with CBD.

How does CBD interact with medication?

CBD is known to interact with the endocannabinoid system (ECS)  and provides many different effects on the body. This includes balancing the body’s homeostasis, reducing pain sensation, and lessening the body’s reaction to injury or inflammation. CBD interacts with other medications by interacting with the cannabinoid receptors found in the ECS, thus increasing or reducing their effects. Additionally, CBD’s interaction with medications inhibits the activity of cytochrome P450. Cytochrome P450 (CYP450) is a group of liver enzymes that are responsible for breaking down drugs and toxins that enter the body. By inhibiting the enzyme activity, CBD can deactivate its activity, which can alter how compounds are metabolized.

If you’re unsure, talk to your healthcare provider first before trying any CBD products to know if they will interact with other medications you’re taking to avoid adverse side effects.

Should I take CBD with ibuprofen?

Ibuprofen is a medication in the nonsteroidal anti-inflammatory drug (NSAID) class that is commonly used to treat pain, fever, and inflammation. Since the introduction of the drug in 1969, ibuprofen has become one of the most common painkillers in the world. 

CBD and ibuprofen interact differently with pain response pathways CBD interacts with CB2 receptors, whereas ibuprofen blocks the COX-2 from producing extra prostaglandins, which play a key role in promoting inflammation. However, both have similar pain-relieving properties. Currently, there have been no reported potential drug interactions between CBD and ibuprofen, but you still need to be cautious. Experts suggest that the potential interactions may be dosage-dependent.

Should I take CBD with paracetamol?

Paracetamol or Acetaminophen is the most commonly taken analgesic in the world and is the first-line therapy in pain conditions by the World Health Organization (WHO). Introduced in 1951, paracetamol is commonly used for its antipyretic effects to reduce fever. 

There have been no reports of paracetamol and CBD interactions. While this doesn’t mean there won’t be, it’s highly unlikely.  

Should I take CBD with warfarin?

Warfarin is an anticoagulant drug and is widely used to prevent and treat deep-vein thrombosis and pulmonary embolism, to prevent stroke in patients who have atrial fibrillation, valvular heart disease, or a prosthetic heart valve. CBD and warfarin should not be taken together. Anticoagulants or blood thinners are medications that prevent the formation of blood clots. When taken with CBD, your body may slow down how quickly your body processes Warfarin.

Should I take CBD with thyroid medication?

Thyroid extracts or medications are used to treat underactive thyroid (hypothyroidism). They are usually made from animal thyroid glands. Before the first synthetic thyroid medication was FDA-approved, Levothyroxine, dried and ground thyroid glands from cows and pigs were the main treatment options.

CBD and thyroid medications play a role in regulating your metabolism. However, we do not know how exactly it interacts with thyroid medications such as levothyroxine, so you shouldn’t take them simultaneously. Doing this may lead to hyperthyroidism.

Should I take CBD with Eliquis?

Eliquis or apixaban is another blood thinner that reduces blood clotting and reduces the risk of stroke and systemic embolism in patients. Apixaban was approved for medical use in May 2011 and then was approved in the US  in 2012.

CBD should not be taken with Eliquis since it’s also a blood thinner and could potentially alter the metabolism of apixaban and increase bleeding.

Should I take CBD with Plavix?

Plavix or clopidogrel bisulfate is a thienopyridine drug that inhibits platelet that inhibits aspects of aggregation and thus inhibits blood clotting in patients with the acute coronary syndrome, and myocardial infarction (MI). Plavix was approved by the US FDA in 1997.

CBD should not be taken with Plavix as it may slow down how quickly your liver processes it to its active form.

Should I take CBD with Metoprolol?

Metoprolol is an FDA-approved medication to treat heart failure, angina, myocardial infarction (MI), and hypertension. Metoprolol was developed in 1969 by the US Pharmaceutical Holdings and approved by the FDA in 1978.

Metoprolol is a beta-blocker or a blocking agent that is known to treat high blood pressure by reducing the heart rate. Since CBD is also known to reduce high blood pressure, you should not take it with metoprolol as there is a chance that your blood pressure will drop too much.

Should I take CBD with Metformin?

Metformin is a biguanide antihyperglycemic used in conjunction with diet and exercise for glycemic control in type 2 diabetes mellitus. It is also used off-label for insulin resistance in polycystic ovary syndrome (PCOS). Metformin was discovered in 1922 and was introduced as a medication in France in 1957.

You should not take CBD with metformin. Taking CBD with metformin may increase or decrease levels of the medication in your bloodstream. This can also increase potential side effects or reduce the efficacy of the active compound. If you decide to take both, talk to your healthcare provider to know if you can reduce the common side effects by lowering the doses of your drugs.

Should I take CBD with statins?

Statins are a class of lipid-lowering medications that reduce illness and mortality in those who are at high risk of cardiovascular diseases. They are also the most common cholesterol-lowering drugs. The first statin, Lovastatin, was approved for commercial use in the US in 1987.

While the risk is minimal, CBD may interact with statins. This is mainly to do with how they are metabolized in the body. CBD’s interaction with statins can increase or decrease the effectiveness of the drug. If you want to take both, talk to your healthcare provider first.

Does caffeine counteract CBD?

Caffeine and CBD have widely varying results so it’s very difficult to predict how their different doses might interact with one another. At low doses, CBD can be a stimulant, and in higher doses, can cause sedation. Caffeine is also a stimulant, therefore the two must counteract each other. However, the combination of these compounds is not easily predictable because various doses of each would affect the response. Some consumers have reported that when they use CBD with their morning coffee, they ease some of the jitters that coffee tends to give. This means that they are calm but also alert.

While we don’t know much about how CBD and caffeine interact, the benefits we do know CBD can deliver can likely be useful to coffee drinkers and people taking caffeine supplements or a dietary supplement.

The Takeaway

The bottom line of this article is that you should consult your doctor first if you’d like to try taking CBD, especially if you have a health condition and are taking medications. Some medications are dose-dependent and doctors might be able to formulate a plan that would work best for you. 

Your health care provider may also be able to recommend a high-quality CBD product that fits your needs. Additionally, always remember that medications with a grapefruit warning would most likely interact with CBD so this should be avoided.