Is It Safe to Take CBD with Other Drugs?

The popularity of CBD and its range of therapeutic properties are fast growing. There is a fair amount of data about the potential effects of using CBD and other drugs. In this article, we discuss the mechanism of CBD and drug metabolism and how their interaction could impact the effectiveness of such drugs.

Cannabidiol (CBD) has become popular in today's living. By now, you have probably run into a product containing CBD. CBD has been widely known for its health benefits to the body. The compound is an extract from the cannabis plant. Unlike tetrahydrocannabinol, CBD does not change a person's state of mind or behavior. In addition, the cannabis derivative comes in different forms like oils, gummies, or topicals such as creams, lotions, ointments, and balms. CBD can be prescribed for epilepsy, anxiety, pain, muscle disorder, and other mental health conditions. Research shows that CBD is safe and has fewer side effects. However, its metabolism could have negative effects on other medications.

Drug Interaction and Metabolism

According to Alsherbiny & Li (2018), drug interactions occur when two or more drugs with similar or different effects are co-administered. The interaction may lead to enhanced drug response or modified or unexpected adverse reactions. Further, Alsherbiny & Li (2018) suggested that drug interactions caused by CBD depend on the drugs involved and the chemical components of the CBD formulation used.

Drug metabolism is a highly variable process that is influenced by several factors. One major factor that disrupts drug metabolism is the coupling of drug molecules with inactive sites in the body, so the drug is not accessible for metabolism. Another factor is enzyme induction. Repeated substance use can cause the body to become accustomed to the constant presence of the drug, thereby increasing the production of enzymes necessary for drug metabolism. 

CBD Interaction with Other Medications

Many medications are metabolized in the liver by cytochrome (CYP450) enzymes in a process that delivers medication to the intended place of the target. Grapefruit is known to interrupt the activity of CYP450 enzymes and slow the metabolism rate. Grapefruit also increases side effects and the duration with which the drug stays in the body. Bailey et al. (2013) showed that grapefruit could increase blood content levels and other severe consequences such as irregular heartbeat, organ failure, internal bleeding, or death when used with other drugs. Ujváry & Hanuš (2016) found that, much like grapefruit, CBD can also disrupt the normal functioning of CYP450 enzymes. The study assumes that the disruption allows patients to take lower doses of their prescription, causing a toxic buildup of chemicals in the body. 

CBD with Ibuprofen

Ibuprofen is a nonsteroidal anti-inflammatory medicine that relieves pain and inflammation. However, ibuprofen has been associated with adverse side effects such as nausea, shortness of breath, and dizziness. 

CBD increases the duration and strength of ibuprofen, thereby increasing the risk of negative side effects of ibuprofen.

CBD with Warfarin

Warfarin is a medication used to prevent the formation of harmful blood clots that could potentially cause a heart attack or stroke. Warfarin is associated with adverse side effects such as bleeding, swelling, headache, and pain. CBD administration and warfarin may increase its effects and slow down its metabolism process, prolonging its stay in the system. The prolonged presence of warfarin might also lengthen the side effects and other associated risks of CBD.

CBD with Eliquis

Eliquis is a drug used to lower the risk of stroke or blood clots in veins, heart, lungs, and legs following surgery. Eliquis normally have severe side effects such as bleeding and are typically prescribed dosages by the doctor. CBD delays the metabolism of the eliquis drug causing the patient to consume an overdose. This may risk the body to severe bleeding.

CBD and Tylenol

Tylenol is a common drug used for pain relief and fever. 

Administering CBD and Tylenol would lower the effectiveness of Tylenol as it is processed in the body. This may lead to the patient taking high doses of Tylenol to feel the effects. However, high doses of Tylenol carry the risk of liver damage and other side effects such as nausea, headache, and insomnia.

The form and quality of CBD administered to your body determines how it will interact with your body and the medication. The time you choose to take CBD with other drugs also affects how the two will interact in your system. However, each person responds to medication differently based on genetic history, age, and body weight.

CBD Metabolism

 When you take drugs, including CBD, your body breaks them down by the large family of liver enzymes called CYP450. CBD and other cannabinoid compounds of the cannabis plant can interact with many drugs inhibiting the activity of some liver enzymes. These enzymes are responsible for metabolizing any drug consumed in the body. According to Ibeas Bih et al. (2015), CBD interacts with the cytochrome P450 (CYP450) group of enzymes in a very crucial manner. CBD acts as a competitive inhibitor to these enzymes. The cannabis derivative occupies the enzymatic activity sites and displaces its chemical competitors, thus preventing CYP450 enzymes from metabolizing other components. How CBD behaves as a competitive inhibitor depends on how it binds to the active sites of metabolic enzymes. CYP45 group of enzymes, specifically CYP3A4, is responsible for several cannabinoid metabolisms, including CBD. However, CBD might interfere with the enzyme's activity during this process. 

CYP3A4 metabolizes about 60% of pharmaceutical drugs (Goey et al., 2013); if CBD inhibits its activity, it cannot work effectively to break down those drugs in your system. Metabolism can be slow or fast. A too slow metabolism can have you taking more medication into your body than intended. A high level of medication is equally harmful and may cause exaggerated effects. Besides, some substances can speed up the activity of CYP450 enzymes causing you to take less medication into your system. However, these medications may not be enough to treat your health condition. 

Meissner & Marco (2021) observed that CBD could cause dose-related liver damage. Concurrent use of CBD and other medications such as leflunomide, mipomersen, and lomitapide can increase the risk of liver damage. 

Alsherbiny & Li (2018) noted that concomitant administration of CBD significantly changed serum levels of topiramate, rufinamide, clobazam, eslicarbazepine, and zonisamide in patients with treatment-resistant epilepsy. 

Conclusion

The documented effects of CBD on liver function and enzymes responsible for drug metabolism, is a relevant considerations when taking CBD with other drugs. CBD acts the same as grapefruit, therefore serving similar risks to medications that carry grapefruit warning labels. Currently, no studies show risks against taking CBD and other drugs. However, people are different; you should always consult your doctor before taking CBD with other medications.

References

Alsherbiny, M. A., & Li, C. G. (2018). Medicinal cannabis—potential drug             interactions. Medicines, 6(1), 3.

Bailey, D. G., Dresser, G., & Arnold, J. M. O. (2013). Grapefruit–medication interactions: Forbidden fruit or avoidable consequences?. Cmaj, 185(4), 309-316.

Goey, A. K., Mooiman, K. D., Beijnen, J. H., Schellens, J. H., & Meijerman, I. (2013).          Relevance of in vitro and clinical data for predicting CYP3A4-mediated herb–  drug interactions in cancer patients. Cancer treatment reviews, 39(7), 773-783.

Ibeas Bih, C., Chen, T., Nunn, A. V., Bazelot, M., Dallas, M., & Whalley, B. J. (2015).

Molecular Targets Of Cannabidiol In Neurological Disorders. Neurotherapeutics, 12(4), 699-730.

Meissner, H., & Cascella, M. (2021). Cannabidiol (CBD). In StatPearls [Internet].    StatPearls Publishing.

Ujváry, I., & Hanuš, L. (2016). Human metabolites of cannabidiol: a review on their         formation, biological activity, and relevance in therapy. Cannabis and cannabinoid     research, 1(1), 90-101.