The short answer is yes. CBD can react with prescribed medications as well as over-the-counter medications. Dr. Jordan Tishler, president of Inhale MD, medical marijuana practitioners association, says: “In practical terms, CBD in therapeutic doses (10 to 20 mg per kilogram) can have harmful interactions with many conventional medicine drugs, such as epilepsy agents.” or heart diseases, as well as with anticoagulants and a number of others. ”

So how do you know if a drug reacts with CBD? According to the book CBD Treatment: How Cannabinoids Heal Without Getting High, written by Registered Nurse Eileen Konieczny and Lauren Wilson, a good indicator of whether CBD is interacting with the drug you are taking is the caveat to avoid grapefruits by taking your prescribed medication. The authors explain: “CBD reacts with drugs in a similar way to grapefruit, but with much stronger effects. So when it is advised to avoid grapefruits, CBD is often the same as well.

One may ask what is this grapefruit all about? The way CBD, grapefruit and more than half of the various pharmaceuticals are metabolized by the liver is important. Enzymes known as cytochrome P450 are responsible for the breakdown of toxins, which are later excreted in the urine. They are also responsible for the metabolism of 60 percent of pharmaceuticals (according to the book Healing with CBD).

The problem arises when more than one drug is metabolized by cytochrome P450, because then these enzymes react with each other. In fact, one enzyme may inhibit or degrade the action of the other. This means that one drug like CBD can stop another drug that is prescribed by your doctor from working effectively. The more drugs are involved in these processes, the more complex interactions will take place as the drugs will compete with each other to be metabolized by these enzymes.

CBD turns out to be a potent inhibitor of other drugs metabolized by cytochrome P450. CBD will struggle to be metabolized first, so the next drugs will have a reduced effectiveness. In this sense, CBD is similar to grapefruit, it can inhibit the metabolism of drugs metabolized by cytochrome P450.

Before we panic, however, we must remember that medicine has been studying drug interactions for years and it is important that the patient receives an “effective dose” appropriate to the treatment of his ailments. It is your doctor’s job, when prescribing a series of medications for you, to carefully study drug interactions and to adjust dosages correctly.

The book CBD Treatment devotes an entire chapter to CBD’s interactions with individual drugs. The authors list the types of drugs that also use cytochrome P450 and therefore have the potential to interact with CBD. They include:

Steroids
HMG-CoA reductase inhibitors
Calcium channel blockers
Antihistamines
Prokinetics
Antiviral agents for HIV patients
Immunity modulating agents
Antiarrhythmic drugs
Anesthetics
Antiepileptic drugs
Beta blockers
Proton pump inhibitors (PPIs)
Non-steroidal anti-inflammatory drugs (NSAIDs)
Angiotensin II blockers
Oral hypoglycemic agents
Sulfonylureas

Unfortunately, we do not have a definite answer to this question. On the one hand, the authors of the book Treatment with CBD say yes. Antibiotics also make use of cytochrome P450 enzymes, so an interaction may occur.

On the other hand, Dr. Tishler sees no reason to worry about it. So, if you are given a prescription antibiotic, tell your doctor about your CBD intake so that he can prescribe the correct dosage.

Interestingly, CBD can react with chemotherapy in a very different way than with the drugs on the list above. “CBD reacts with chemicals, but rather in a positive way,” says Tishler. “Interestingly, there is evidence to suggest that CBD, in very high doses, creates a beneficial interaction with radiotherapy as well.”

There is no clear answer in this regard. According to CBD Treatment, antidepressants, antipsychotics, and benzodiazepines, such as Klonopin, use cytochrome P450, so they can interact. However, according to Tishler, “(CBD) does not appear to interact with antidepressants or anti-anxiety medications.” This is why it is important to inform your doctor or psychiatrist that you are taking prescribed medications with CBD.

In this case, the answer is definitely yes. Dr. Tishler says: “Certain anticoagulants can be a problem, particularly Wafarin or Clopidigrel (Plavix).” So, if you are prescribed one of the drugs mentioned above, do not take CBD without consulting your doctor or pharmacist. However, Dr. Tishler points out that drugs such as “heparin or factor Xa inhibitors” can be safely taken with CBD.

We may not like the answer on this point as it is unclear whether CBD reacts with ibuprofen or not. According to Treatment with CBD, NSAIDs use cytochrome P450. At the same time, Dr. Tishler claims that he has not heard of the interaction of NSAIDs and CBD. If we take these two drugs at the same time for a long time, we should consult our doctor about possible interactions.

What if we use a cream or ointment prescribed by a doctor? Dr. Tishler believes this shouldn’t be a problem for two reasons. First, “topical drugs are not degraded by P450 enzymes.” Because they are applied to the skin, they cannot react with the cytochrome P450 in the liver.

The second point seems to be even more interesting. For Dr. Tishler believes that, “there is no evidence that topical cannabinoids work at all on ailments unrelated to dermatological problems.”

As we already mentioned, it is very important to talk to your doctor about taking CBD along with other prescription medications. When prescribing medications, the physician should know what supplements should be avoided so as not to cause adverse interactions, and must administer effective doses of medications taking into account possible reactions.

“I believe all health care professionals should know about all the substances they are taking,” says Tishler. “There are many medications that interact with cannabis, with each other, and with seemingly innocent over-the-counter supplements. It is crucial that the team that cares about your health knows what you are taking in order to be able to effectively and safely take care of your health ”.

When we understand that the topic of cannabis use may be stigmatized, fearful, anxious or legal, it is nevertheless important not to avoid the topic. If you are completely unsuccessful in discussing it with your healthcare professional, look for one who incorporates cannabis into their practice. In the book, Treatment with CBD, the authors recommend sources of where to find such doctors. Examples include the Association of Cannabis Specialists or the Society of Cannabis Clinicians.

CBD helps people around the world eliminate the use of much more potent prescription drugs in the healing process. However, even CBD may not be completely “non-toxic.” It may or may not cause moderate side effects and may interact with other medications. Take care of yourself and talk to your doctor before using CBD while taking other prescription medications.