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Can I take CBD with NSAIDs (ibuprofen, naproxen, aspirin, etc.)?

For a long time, Cannabis (Cannabis sativa) has been widely used for both medicinal and recreational purposes. The medicinal potential of cannabidiol (CBD) – both Farm Bill compliant hemp derived and non-Farm Bill compliant marijuana derived – have been increasingly well known in recent times, especially for pain management and inflammation. However, many people use other pain medications, including ibuprofen, naproxen, or aspiring – just to name a few. Therefore, the question naturally arises: Can I take CBD with NSAIDs? This article discusses whether you can safely use CBD with ibuprofen, naproxen, aspirin, and similar drugs, and gives recommendations for pain management.

Non-steroidal anti-inflammatory drugs

Non-Steroidal Anti-Inflammatory Drugs (or NSAIDs) are very fundamental for pain and inflammation management. Most NSAIDs serve a triple function: anti-inflammatory, antipyretic and analgesic. For this reason, they have an extensive use in treating fevers, muscular pains, arthritis, menstrual cramps etc. The common NSAIDs are naproxen, ibuprofen, aspirin, ketoprofen, and diclofenac. As people who suffer pain naturally would like to explore the best pain relief options, they may also opt to want to use CBD with NSAIDs. But is that a good idea?

Watch this 1:00 minute TED-Ed video “What are NSAIDs?”

Drug-drug interactions

Drug-dug interaction occurs when a drug interacts with another drug or substance. Such interaction  prevents the drug from acting as it should or it may also increase its side effects. The breakdown of many drugs occur in the liver with the help of enzymes. When using CBD with NSAIDs, CBD may compete for or interfere with these enzymes, leading to too much or too little of the drug in the body. This is known as altered concentration and it may lead to either the medication or the CBD not working, or an increased risk of side effects fo the medication.

Drug interaction when using CBD with NSAIDs

NSAIDs have various side effects such as gastrointestinal bleeding, increased blood pressure, renal disturbances, gastric ulcers, drowsiness and fatigue. On the one hand, CYP2C19 enzymes in the liver metabolize NSAIDs. On the other hand, cannabidiol inhibits the production of CYP2C19. Therefore, the body does not break down NSAIDs down due to inhibition of CYP2C19. As such, the levels of NSAIDs in the blood increase, thereby increasing their adverse effects. So a person taking CBD with NSAIDs might experience increased gastric disturbances and bleeding.

According to research, NSAIDs can cause drug-induced aseptic meningitis (DIAM), which is a rare adverse effect of NSAIDs. Drug-induced aseptic meningitis has symptoms similar to meningoencephalitis such as fever, headache, altered mental status, joint pain and muscle pain. Although DIAM is rare, taking CBD with NSAIDs increasese its risk of happening. The reason is that CBD inhibits the CYP2C19 enzymes, which will increase the concentration of NSAIDS in the blood. Therefore, taking CBD iwht NSAIDs increase the chances of DIAM in patients taking both substances at the same time for pain management, inflammation reduction, or other purposes.

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Studies have also showed that reducing dosage and increasing dosage spacing between taking NSAIDs and taking CBD might lead to a reduction in drug-drug interaction. Reducing the dosage of CBD and increasing the time until taking the next dose of the NSAID seem to reduce the risk of NSAIDs adverse effects related to also taking CBD.

It is important to state that there is a need for more research on the interaction between NSAIDs and CBD to have a better understanding of the drug-drug interaction between the two substances.

Conclusion: can I use CBD with NSAIDs?

If you are taking NSAIDs, but would like to also use CBD, it is advisable to consult your physician to know the possible risk of combining CBD with NSAIDs, given the risks described above.

Reference

Jiang R., Yamaori S., Takeda S., Yamamoto I., Watanabe K. Identification of cytochrome P450 enzymes responsible for metabolism of cannabidiol by human liver microsomes. Life Sci. 2011;89:165–170. doi: 10.1016/j.lfs.2011.05.018. [PubMed] [CrossRef] [Google Scholar]

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