Learn more about CBD interactions with drugs and how to stay safe when you use CBD for pain or other symptoms. The Portland Clinic pharmacy team offers important cautions for those thinking about trying cannabidiol, more commonly known as CBD. Can you take CBD and painkillers at the same time? This is a very common question. If you do, please be aware of one major issue. Read more.
Does CBD Interact or Interfere with Medication? What Arthritis Patients Must Know Now
CBD (cannabidiol) is seemingly everywhere, with oils, tinctures, pills, chocolates, gummy bears, and creams available all over the internet, at national drugstore chains, and perhaps at your local farmer’s market — even if you don’t live in a state where medical or recreational marijuana is legal.
CBD, a type of chemical known as a cannabinoid, is a mainingredient in hemp, one type of cannabis plant. Marijuana, another type of cannabis plant, also has some CBD but an abundance of THC (tetrahydrocannabinol), an intoxicating cannabinoid known for making users feel “stoned” or “high.” While CBD won’t get you high, it interacts with cannabinoid receptors in your body and may have effects that are sought by people with arthritis, such as pain relief, reduced inflammation, and improvements in sleep and anxiety.
According to CreakyJoints research presented at the 2019 Annual European Congress of Rheumatology meeting earlier this year, 52 percent of respondents reported having tried CBD for a medical reason. Of those who did, 93 percent said it helped. More than half said they wanted more information on CBD from their doctor, but 58 percent of those who told their doctors about their CBD use did not get the information on safety, effectiveness, and dosing they were looking for.
One common concern among people with chronic illness who use CBD is whether CBD can interfere with prescription drugs you may take for arthritis or other conditions.
We put commonly asked questions to Nina M. Bemben, PharmD, BCPS, a specialist in drug interactions who is trying to educate other pharmacists about possible drug-drug interactions with CBD, as well as Rachna Patel, DO, a physician who does consultations about medical marijuana and CBD and sells her own line of CBD products.
What kind of drug interactions can happen with CBD?
A huge number of medications, including CBD, are broken down by the same large family of liver enzymes, called CYP450.
CBD inhibits some enzymes in this family. This makes them break down certain drugs more slowly, which could potentially increase side effects unless your doctor adjusts the dose. On the other hand, CBD induces other enzymes in this family, which speeds the breakdown of certain drugs so they may potentially be less effective unless the dose is increased.
As examples, you may experience increased side effects if CBD is used along with these drugs:
- Antidepressants (such as fluoxetine, or Prozac)
- Medications that can cause drowsiness (antipsychotics, benzodiazepines)
- Macrolide antibiotics (erythromycin, clarithromycin)
- Heart medications (some calcium channel blockers)
“There is still a lot of uncertainty about how CBD interacts with drug-metabolizing enzymes in the body. We know that there are some drug-metabolizing enzymes that are affected by CBD, some that are not, and many others where we just don’t have any information yet,” says Dr. Bemben.
What do we know for sure about CBD’s interactions with other drugs?
The most direct information comes from studies on the only FDA-approved CBD product, Epidiolex, which is used to treat rare forms of epilepsy. Epidiolex has been found to increase blood levels of the blood thinner warfarin about 30 percent, which raises the risk of bleeding. It also interacts with other medications used for epilepsy.
“The manufacturer of Epidiolex was asked by the FDA to conduct more drug-drug interaction studies, so we will learn more about CBD’s interactions with other drugs in the future,” says Dr. Bemben.
Can CBD interact with medications I take specifically for arthritis?
“Based on what we know now about the way CBD is metabolized, I would not expect significant drug-drug interactions with drugs commonly used in arthritis treatment, such as methotrexate, and most nonsteroidal anti-inflammatory drugs (NSAIDs). I would advise caution on one NSAID, diclofenac, because there isn’t information on how CBD affects — if at all — the enzyme that metabolizes it,” says Dr. Bemben.
Rheumatologists are always on the alert for liver problems that may result from arthritis medications, and that includes CBD as well as NSAIDs and methotrexate.
Are older people more at risk of CBD drug interactions?
Yes, for several reasons. “As we age, our livers and kidneys may be slower to eliminate drugs from the body. In addition, older patients and those with chronic health problems are more likely to be using multiple medications, so the risk for drug interactions increases,” says Dr. Bemben.
Dr. Patel worries in particular about any side effects or interactions that result in dizziness and may increase the risk of falls in the elderly. For example, using the antidepressant fluoxetine together with cannabis products can increase dizziness and drowsiness.
Are there some people who should stay away from CBD?
Hold off if you have known liver damage, says Dr. Patel. In a study done on mice published earlier this year, the dose of CBD used to protect against seizures was found to induce liver damage. According to other animal research, CBD may increase levels of liver enzymes, raising concerns about liver toxicity in patients taking methotrexate.
“We use other therapies that cause liver injury, like nonsteroidal anti-inflammatories (NSAIDs). If liver enzymes go up in someone on methotrexate, we would generally hold the drug other than methotrexate [for example, CBD or an NSAID] to see if the enzyme levels normalize,” says Michael Weinblatt, MD, professor of medicine at Harvard Medical School in Boston.
People who take Epidiolex for epilepsy are more likely to develop abnormal liver enzymes, as well as sleepiness and other symptoms, if they are also using valproic acid to control seizures.
“This is important for people with arthritis to know because valproic acid is sometimes used for pain that isn’t controlled by other medications,” says Dr. Patel.
If I stick with a CBD cream, does that reduce the risk of drug interactions?
Probably, since little if any of a topical product is likely to be absorbed into your system. “Unfortunately, we just don’t have good information about how much of a topical CBD product gets absorbed. This can be influenced by the inactive ingredients in the product, where on the body it’s applied, and whether you apply a bandage over the area after applying it,” says Dr. Bemben.
While topical CBD products may not be absorbed deeply enough to raise concerns about drug interactions, that also means they may not be as effective for arthritis pain. “If you just have one joint hurting and it’s close to the surface, using a topical would be appropriate. It’s not as likely to help a hip or other deep joint,” says Dr. Patel.
Which health professionals need to know I’m trying CBD?
Tell your rheumatologist and anyone else who prescribes medication for you. If you need surgery, an anesthesiologist may choose a different dose or type of anesthesia if you’re using CBD.
“If you fill all of your medications at the same pharmacy, your pharmacist will be able to assess for drug interactions for all of them, regardless of who prescribed them. You should still let the pharmacist know about over-the-counter medications, herbs, and supplements — including CBD — that you don’t get through the pharmacy. It is important to bring the CBD product to your doctor and pharmacist so they can check the amount of CBD and other ingredients it contains,” says Dr. Bemben.
“While patients may be wary of stigma surrounding CBD products, I believe most health care providers understand this is a growing area and one strategy patients are trying in hopes of getting relief,” she says.
Is there an online source I can use to figure out which of my medications might interact with CBD?
Online databases are available to help health professionals evaluate potential drug-drug interactions, at a price. “Freely available resources tend to be less reliable, and this highlights the importance of discussing all your medications, including CBD, with your doctor and pharmacist,” says Dr. Bemben.
One source available to patients is drugs.com, where you can plug in either cannabidiol (which will give you the FDA-approved oral product Epidiolex) or cannabis (which will give you both THC and CBD) and check for possible interactions with other medications you take.
Has anyone had a life-threatening drug interaction with CBD?
“There haven’t been reports of serious drug-drug interactions with over-the-counter CBD products. However, these products are relatively new and it typically takes time for reports to be published. We have very little information about over-the-counter CBD products and how they may interact with other drugs,” says Dr. Bemben.
Can I Take CBD Oil With Painkillers
If you’ve been thinking about trying cannabidiol — more commonly known as CBD — welcome to the rapidly growing club. Interest in CBD as a treatment for pain, insomnia, anxiety and other complaints has been rising steadily ever since Oregon and other states legalized cannabis (marijuana).
CBD is one of many natural chemical compounds found in cannabis, but unlike the plant’s other well-known chemical, THC, it has no psychoactive or mind-altering effects. Instead, CBD owes its popularity to its therapeutic effects. Before you try it, however, be aware that it carries potential risks, as well — especially if you take other medications or have liver problems.
To date, the only FDA-approved use of CBD is a prescription medication called Epidiolex, which treats seizure disorders. Other over-the-counter uses, while widely promoted, need further study to support their claims. These include the following:
With its naturally sedating effects, CBD is used by many people as a sleep aid.
Anxiety and depression
CBD has shown promising results for many people with these issues.
Pain and inflammation
Some patients with arthritis and cancer find CBD helpful in reducing these symptoms.
Much remains unknown about how CBD works, its therapeutic benefits and its safety. For your own safety, it’s important to be aware of the known risks. They include the following:
CBD liver harm
CBD can be harmful to the liver. People with liver impairment should be cautious or avoid it.
CBD medication interactions
Because of its effect on the liver and liver enzymes, CBD can interfere with many medications, either increasing their levels in the blood to potentially toxic levels, or decreasing levels and reducing their effectiveness. Certain seizure medications, antidepressants, muscle relaxers, and drugs that can suppress the central nervous system (such as benzodiazepines, sleeping pills and opioids), among many other medications, may have strong interactions.
It’s important to talk to your doctor or pharmacist before using CBD to make sure you’re not taking a medication that will interact badly with it.
CBD drowsiness and other side effects
Because CBD causes drowsiness on its own, it also increases the drowsiness caused by other medications, including antihistamines (such as Benadryl), benzodiazepines (Xanax, Ativan, Valium), antipsychotics, antidepressants and opioids, as well as alcohol and supplements such as kava, melatonin and St. John’s Wort.
CBD’s sedating effects are similar to alcohol, so it’s not a good idea to use it if you need to drive or to do anything that requires mental alertness. Other common side effects of CBD include diarrhea and changes in appetite and mood.
CBD safety and regulation
Over-the-counter CBD products are not regulated by the FDA. Although most are extensively tested, there is still a possibility of error (such as the mix-up reported last September in The Oregonian), so be wary that products might not be 100% CBD as labeled.
Considering CBD? Talk to your doctor or pharmacist first
If you have questions about how your medications will interact with CBD, reach out to your doctor or local pharmacist for help. Pharmacists are great resources and can help come up with alternative therapies if CBD is not a good option for you.
Can You Take CBD with Painkillers?
Another question that we get asked a lot is, “Can I take CBD with painkillers?” It seems like a logical question, right? Many of the same people who take these painkiller medications would be a prime candidate for CBD use. Mixing CBD and painkillers might be common already, but it’s important you understand the risks associated with drug interactions by doing this.
TL;DR – It appears that there are multiple potential interactions between certain prescription medications and CBD. Please verify using CBD with painkillers through your health care provider to be safe.
Similarities Between CBD and Painkillers
If you’re reading this blog on answering the question, “Can I mix CBD with painkillers” you are probably already familiar with some of the more commonly prescribed painkillers on the market.
Many of these popular painkillers include Vicodin, Percocet, and Oxycodone. If you are taking these medications and are curious about CBD and drug interactions, you’ll find this section interesting and worth reading.
Related article: How to Use CBD Oil For Pain
CBD, more formally known as cannabidiol, has gained a lot of attention over the last year and a half since it was legalized at a federal level in 2018.
Even though the Food and Drug Administration still has not approved it for use as a dietary supplement, many people still choose to try it and see if any of the potential effects on pain management or anti-inflammatory properties will work for them.
How Do Painkillers Work?
Painkillers and CBD are both metabolized by the human body and inhibit certain enzymes before they can take effect. This is why you should be concerned about drug interactions. We’ll get more into this later.
While the effects of these two substances might come about in different ways, studies show the end results might be similar, but not exactly the same.
In order for painkillers to work, they must target different receptors in our bodies. For the purposes of this article, we will examine receptors targeted by opiates, since opiates are a very popular form of a painkiller today. At a very basic level, the painkillers (opioids) latch on to different forms of proteins known as ‘opioid receptors.’
Related article: Does CBD Hemp Migraines?
These receptors are located on nerve cells in the brain, spinal cord, and other areas within our bodies.
When this happens, the opioids can then prevent pain messages that are otherwise delivered from the body through the spinal cord to the brain.
The end result is an effective blocking of the pain you would otherwise feel – hence the name ‘painkiller.’
The bad part about most painkillers is the fact that they negatively affect liver enzymes. This results in a liver that is working harder than it needs to when processing substances you consume.
Some clinically prescribed medications, can be quite harsh on the liver and kidneys. These are our bodies internal filtration system, and vital for us to survive.
Related article: Is CBD Safe for Use?
Potential drug interactions between CBD and painkillers might result in illicit problematic interactions. If you are on prescription medication and curious about supplementing with CBD use, you should consider speaking with your doctor to help avoid adverse side effects.
Let’s take some time into reviewing how our body is able to process CBD and get the amazing effects you always hear about.
How Does Our Body Process CBD Products?
Cannabidiol, or CBD, works in a similar manner in that CBD is able to target receptors as well. Did you know our bodies contains an Endocannabinoid System?
This system contains both CB1 and CB2 receptors, in addition to some enzymes that researchers are still discovering. Taking CBD oil may affect our bodies in a similar method that taking painkillers would.
Related: CBD Ointment
CBD oil is also proving to be more affective, and more safe, than many over the counter medications are. This, obviously, makes CBD oil safe for many to use – and your don’t need a prescription.
CB1 and CB2 Receptors
CB1 receptors are mainly found within our Central Nervous System (brain and spinal cord). CB2 receptors can found (mainly) in our peripheral nervous system (nerves outside of the brain and spinal cord, and some immune cells).
When you ingest CBD, it is made available for use. Exactly how CBD is used by the Endocannabinoid System is still up for debate, interestingly enough.
Related article: CBD Gummies for Pain
Experts aren’t completely sure how CBD oil interacts with the ECS or it’s receptors.
Researchers are confident CBD doesn’t attach to cannabinoid receptors the way they know THC does. Some believe that cannabinoids, like CBD oil, bind to a receptor that hasn’t yet been discovered.
Others believe CBD interacts with receptors that we haven’t even discovered yet.
While the details of how it works are still under debate, research suggests that CBD can help with pain, nausea, and treat high blood pressure – among many other potential benefits.
It also contains enzymes that manufacture and degrade endocannabinoids. What is an endocannabinoid? The two most popular endocannabinoids are:
Our bodies produce these on their own. They help keep everything running smoothly and efficiently.
Endocannabinoids are produced by your body, while cannabinoids are found externally in products like CBD oil. Cannabinoids come from plants, and simply mean ‘plant chemical.’
Studies on CBD and Pain Responses
Some studies show that CBD helps dull out pain responses, similar to how painkillers can dull out chronic pain. CBD oil regulates pain by stimulating the reuptake of adenosine, which can boost adenosine levels in the brain. This will block feelings of pain.
Furthermore, CBD may also dull pain signals from reaching the brain by binding to TPRV1, which is responsible for pain and inflammation.
For example, if we apply a topical CBD balm to an area, the CBD will penetrate the skin and indirectly stimulate these different receptors.
The result is a decrease in pain signals in that localized area.
Can I Take CBD with Painkillers?
Before mixing any medications, you need to speak with your doctor first. They should be your most trusted source of medical advice, and they know you and the potential for any drug interactions better than any online article ever will.
As great as taking a natural product like CBD oil and mixing it with a pharmaceutical opioid may sound, the bottom line is: we don’t know enough about the interactions between CBD and painkillers to know the right answer.
A researcher in 2019 discovered that adults who take prescription opioids for severe pain are more likely to have increased anxiety, depression and substance abuse issues if they also use marijuana.
While we don’t exactly what cannabinoid within the marijuana was causing the bad reaction, we have to keep in mind that CBD is in marijuana, too. It could be any number of things, like THC, responsible for the negative reaction. It also could be the CBD oil.
We just don’t know enough about the interactions between CBD and painkillers to be able to answer the question, “Can I mix CBD with painkillers?” It may be okay, it may not be okay.
When dealing with prescription drugs and prescription medications, you need to be extra careful. There is a very good reason prescription drugs are a controlled substance, and the adverse affects from a poorly processed drug metabolism could be quite bad for your health.
Summary – Mixing CBD with Painkillers
For those who like to skip to the bottom for their answers, here it is: we don’t know enough about mixing CBD with painkillers to determine if it is safe or not. Drug interactions may, or may not, occur depending on the medications you are currently prescribed.
For this reason, I cannot ethically endorse doing so.
What I can recommend is to give CBD a try. If it works for you, then great! You can ditch the harsh opioids and try for a more natural approach. If It doesn’t work, then it doesn’t work. No harm, no foul, right?
New Phase Blends offers one of the best money back guarantees in the CBD oil industry, too. Try our product for up to 30 days. If you don’t LOVE it, please, return it for a refund in full. You’ll have 30 days from the purchase date to send in the item for a full refund.