This article describes CBD drug interactions with common pain and psych medications: 15 medications with CBD drug interactions and 13 without interactions. As such, this article is a must-read for patients who take both CBD and medications for pain and/or psychiatric symptoms.
What medications does CBD oil interact with? The article answers this question by covering the following topics:
Due to its anti-inflammatory properties, many people use CBD oil, CBD cream, and CBD gummies for pain. Moreover, due to their pain, rheumatology and pain patients often suffer from and take medications for psychiatric comorbidities, such as depression.
Patients often supplement their prescribed medications with CBD products. As such, patients are increasingly interested in and concerned about the safety of CBD oil and CBD drug interactions.
Harold Wilson-Morkeh and colleagues performed a thorough research in a number of medical databases that contain information about drugs and drug interactions. They identified:
Note: so far no reports of actual cases of adverse events exist that are due to the concomitant use of CBD and the following medications. However, due to the potential CBD drug interactions, doctors should monitor patients who take both CBD and these 18 medications. Additionally, patients should also be on alert for potential adverse side effects.
In summary, CBD inhibits the breakdown (metabolism) of the following 15 medications, so there is a risk of overdose-like symptoms of the medications when taken together with CBD.
Amitriptyline is used to treat mental illnesses, such as depression and anxiety. However, CBD inhibits the enzymes that metabolize amitriptyline (cytochrome P450 isozymes CYP2D6, CYP2C19, CYP3A4, CYP1A2 and CYP2C9). As such, taking CBD along with amitriptyline may lead not only to added therapeutic effects, but also to adverse effects as well, such as:
Celecoxib is a COX-2 selective nonsteroidal anti-inflammatory drug (NSAID). CBD inhibits the liver enzymes that metabolize celecoxib (CYP2C9 and CYP3A4). So far, however, no reports of adverse effects in humans linked to concomitant use of CBD exist, but it nevertheless is a possibility.
Citalopram is a selective serotonin reuptake inhibitor (SSRI) antidepressant medication. CBD inhibits the liver enzymes that metabolize citalopream (CYP2C9 and CYP3A4). Because CBD inhibits two enzymes together, it might decrease levels of the citalopram in the blood and increase the risk of adverse events.
The CBD – drug interaction risk with etoricoxib is similar to that with celecoxib.
Fluoxetine is an SSRI antidepressant. Cannabidiol inhibits the enzymes that metabolize fluoxetine (CYP2D6 and CYP2C9). Again, no adverse effects reported so far exist that have resulted from taking CBD with fluoxetine, but this possibility is something that we need to keep in mind.
The CBD – drug interaction risk with gabapentin is similar to that with amitriptyline.
Hydrocortisone (cortisol) and prednisolone are steroid medications to treat inflammatory conditions. CBD inhibits the enzyme that metabolizes hydrocortisone and prednisolone (cytochrome CYP3A). Concomitant CBD use might decrease cortisol breakdown and increase the risk of corticosteroid side effects. As such, doctors should monitor patients who take both cannabidiol and steroid medications, and they should decrease their steroid medication doses if the is any sign of adverse effects.
Mirtazapine is an antidepressant. CBD inhibits the liver enzymes that metabolize mirtazapine (CYP1A2, CYP2D6 and CYP3A4). No adverse event reports exist yet, but given the possibility, doctors should monitor patients who take both CBD and mirtazapine.
Naproxen is an NSAID used to treat pain. CBD inhibits the enzyme that metabolizes naproxen (cytochrome CYP2C9). Although no information exists, but this might increase the risk of side effects due to taking both naproxen and CBD.
Paroxetine is an SSRI antidepressant. CBD inhibits the enzyme that metabolizes paroxetine (cytochrome CYP2D6). Again, no reports about increased risk exist due to taking both CBD and paroxetine, but doctors should nevertheless monitor such patients.
The CBD – drug interaction risk with prednisolone is similar to that with hydrocortisone.
The CBD – drug interaction risk with pregabalin is similar to that with amitriptyline.
Sertraline is in SSRI antidepressant. CBD inhibits the enzyme that metabolizes sertraline (CYP3A4). Again, no reports about adverse events exist yet, but patients who take both CBD and sertraline should be cautious.
Tofacitinib is a medication used to treat arthritis and colitis. CBD inhibits the enzymes that metabolize tofacitinib (CYP3A4 and CYP2C19). Wilson-Morkeh and colleagues suggest that the treating physician reduces the dose of tofacitinib to 5 mg once a day if the patient also takes CBD.
Tramadol is an opioid pain medication. CBD inhibits the enzyme that metabolizes tramadol (CYP2D6). As such, adverse side effect might happen.
Wilson-Morkeh and colleagues do not expect to have any potential CBD – drug interactions with the following medications:
Wilson-Morkeh H, Al-Abdulla A, Sien L, Mohamed H, Youngstein T. Important drug interactions exist between cannabidiol oil and commonly prescribed drugs in rheumatology practice. Rheumatology (Oxford). 2020 Jan 1;59(1):249-251.