Does CBD Gummies Interact With Medications

There is a lot that’s still unknown about CBD, but some research indicates there are CBD drug interactions with certain prescriptions, like tacrolimus. Learn more about CBD interactions with drugs and how to stay safe when you use CBD for pain or other symptoms.

CBD drug interactions: Is CBD safe to take with prescription medications?

If you’ve visited a store that sells health and beauty products lately, you may have noticed that products containing CBD, or cannabidiol, seem to be all the rage. Oil, chocolate, supplements, even carbonated beverages, are filling up shelves—enticing shoppers with claims that using one of these products will cure insomnia, alleviate anxiety, reduce inflammation, or treat PTSD.

And shoppers are buying it, so to speak—one recent report indicated that CBD sales are expected to hit $16 billion by 2026, up from just over $1 billion in 2018. But what exactly is CBD, and is it safe for people who are using prescription medications? Before using it, it’s important to learn about the potential CBD drug interactions.

Is CBD marijuana?

While CBD is one of the active ingredients in marijuana, using CBD itself will not get you high (the component that does that is called tetrahydrocannabinol, or THC). CBD is really just a molecule within the hemp variety of the cannabis plant, and there is at least some anecdotal evidence and preliminary research suggesting that the extraction created from this molecule has some health benefits.

CBD is thought to act on certain receptors in your brain and other parts of the body, in ways that could relieve pain, or help certain health conditions, like childhood seizure disorders. However, as with any “natural” product, the fact that it comes from plants doesn’t automatically render it innocuous. For some people, particularly those taking certain prescription medications, using CBD is risky. It has anticoagulant effects that can thin blood; it can also modestly lower blood pressure. These effects could be dangerous for people with certain medical conditions.

“Herbal products are drugs,” says Rita Alloway, Pharm.D. , research professor of nephrology at the University of Cincinnati College of Medicine. “Just because [something] is herbal … doesn’t mean it can’t interact with any of the pharmaceutically manufactured drugs that you may be taking.”

Does CBD interact with medications?

Case in point: tacrolimus , an immunosuppressive medication used to prevent organ rejection in patients who have had heart, liver, or kidney transplants. CBD interferes with the metabolism of tacrolimus, according to research conducted by Dr. Alloway , who specializes in post-transplant immunosuppression. And because tacrolimus is a narrow therapeutic index drug (meaning the window between efficacy and toxicity is very small), this interference can lead to clinically significant negative outcomes (such as kidney problems or organ rejection), she says.

Are the concentrations in commercially available CBD high enough to cause this interaction? The evidence doesn’t really say one way or another. Dr. Alloway’s research involved a high dosage of CBD that wouldn’t be found in a retail product. However, it “highlights that a drug interaction is there,” she says. Plus, tacrolimus is metabolized in the body by a group of enzymes called cytochrome P450 and CBD is a known inhibitor of this process. What does that mean? If CBD inhibits the metabolism of tacrolimus, the patient can end up with too-high levels of tacrolimus in the body. In light of this, she urges anyone taking tacrolimus to speak with their transplant team before using CBD. Don’t get your hopes up, though—using herbal remedies, particularly those with potential interactions, is generally frowned upon by doctors looking after transplant recipients (including Dr. Alloway).

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As for other drugs, well, most haven’t been studied yet. There is preliminary evidence that CBD could have a similar effect to grapefruit juice, impairing how your body metabolizes drugs, and raising serum levels of those medications in your body. And, because cytochrome P450 is responsible for the metabolism of numerous medications , proceed with caution before mixing any prescription pharmaceutical with CBD, Dr. Alloway says.

How about CBD’s therapeutic benefits?

Despite the not-so-great news about CBD for patients using tacrolimus, for some people, CBD is actually life-changing in a positive way. In 2018, for example, the CBD-derived medication Epidiolex received FDA approval for the treatment of Lennox-Gastaut syndrome and Dravet syndrome, two very rare and very severe forms of epilepsy.

But claims that CBD aids in the treatment of certain mental health and psychiatric conditions, don’t pass muster, says Roger McIntyre, MD , professor of psychiatry and pharmacology at the University of Toronto.

“There is no role right now for CBD in managing mental disorders that I [treat], such as depression, bipolar disorder … anxiety and ADHD,” he says. “We just don’t have the evidence that supports [it].”

Furthermore, most prescription medications used to manage these conditions are metabolized by cytochrome P450, making it entirely possible that CBD could interfere with—rather than enhance—treatment.

Dr. McIntrye, who co-authored a 2018 study that concluded that healthcare providers need more information about drug-drug interactions with CBD and psychotropic medication, says much of the information out there is confusing and contradictory. Therefore, he echoes Dr. Alloway’s statement that it is absolutely prudent that patients clear the use of CBD with their doctor before giving it a go.

“[The provider] knows the individual and knows what other treatments they may or may not be taking,” Dr. McIntyre explains. “They have a panoramic view of the patient’s medications, and would have [a better idea] of whether the patient is taking another medication that may have an interaction.”

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.

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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.

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“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.