For those of you who are serious about trying the cannabis-based compound for its medicinal effects, however, you really need to know what sorts of interactions (if any) the drug may have with your current medications. And unfortunately, this is probably not something that your general practitioner will be able to help out too much with.
What medications does CBD interact with?
To be clear, we are not doctors here and we emphasize the fact that none of the information in this article should be taken as medical advice. All of the information presented has been pulled from the most reliable sources possible, but due to the lack of quality research available, even these sources do not fully claim to understand the complex molecular pathways of CBD.
That being said, both the District of Columbia Department of Health (DCDOH) and the FDA have issued reliable reports in regard to CBD’s interactions with other medications. The DCDOH, for example, has pointed out that CBD is a “potent inhibitor” of CYP3A4 and CYP2D6 enzymes, meaning it can affect serum levels of certain medications which are metabolized by these enzymes. In other words, blood concentration levels of the following medications may potentially fluctuate when taken together with CBD:
- Antiretrovirals (medications that treat HIV)
- Calcium Channel Blockers
As you can see, this is quite a list. The CYP3A4 enzyme in particular is known for metabolizing about 25% of all drugs, though, which explains why CBD consumption can potentially have an effect on so many different medications.
Moreover, the serum levels of some statins have also been known to increase after CBD administration, with the DCDOH stating that atorvastatin and simvastatin, but NOT pravastatin or rosuvastatin, may be affected.
Additionally, CBD has also been known to increase the levels of warfarin (Coumadin, Jantoven), a common blood thinner, as well as clobazam (Frisium, Urbanol), which is a pediatric epilepsy medication.
What does the FDA have to say?
In light of the recent FDA-approval of Epidiolex, a prescription CBD drug for child epilepsy, the federal government has also issued documentation regarding the potential effects of cannabidiol on other medications, stating that “dose adjustments” may be needed when taken along with drugs that either inhibit or induce the following enzymes:
CYP3A4, CYP2C19, UGT1A9, UGT2B7, CYP1A2, CYP2B6, CYP2C8, CYP2C9
We realize this information is likely of no use to you, which is why it’s recommended you speak with a doctor before administering any dose of CBD along with other medications. Even if they are not familiar with the specific properties of CBD, a doctor will at least be able to guide you on whether or not you should be taking it along with your current meds.
The current FDA report (which is actually the official prescription information for Epidiolex) does, however, point out that concomitant (simultaneous) use of cannabidiol with depressants and alcohol may “increase the risk of sedation and somnolence (drowsiness),” as well as increase the incidence of liver enzyme elevations when taken along with valproate, which is a drug commonly prescribed for intractable epilepsy, bipolar disorder, and migraine headaches.
All in all, if you are currently taking any of the above medications and are wondering whether or not it is safe to take CBD at the same time, make sure you speak with your physician first before making any changes to your current routine.
CBD and cancer treatment
Another consideration that should be taken in terms of using CBD with other medical treatments is the role of CYP activity in cancer treatment – specifically its role in oxidizing chemotherapy agents.
Since CYP activity is crucial to the metabolic breakdown of chemotherapy-induced toxins, it has been suggested that frequent high doses of cannabidiol may result in increased levels of toxic agents in the blood, which of course is a very serious matter that could potentially end with catastrophic consequences.
However, there have been no known instances of such consequences among cancer patients who medicate with CBD, and this is considering the fact that CBD (as well as other cannabis-based treatments) are a commonly-used therapy for chemotherapy-induced pain, nausea, immunosuppression, and other symptoms.
It could be that the neuroprotective effects of CBD negate the increased blood toxicity levels, or that the synergistic effects of the accompanying terpenes and phytocannabinoids work to limit the blockage of CYP activity on toxic chemotherapy agents. Whatever the case, it appears that using CBD while undergoing radiation or chemotherapy treatment does not pose any major risks. Regardless, it is still thoroughly advisable to speak with your physician before doing so, as they will be able to monitor blood levels and keep an eye on any accumulations of potentially toxic agents.