CBD Drug Interactions: Which Medications Should You Avoid
Next to CBD and the benefits that can help treat a long list of medical disorders, the other thing that has driven its popularity is its low risk for causing side effects. In fact, research shows CBD can be so safely used that it has the potential to replace other drugs typically used to manage pain, inflammation, anxiety, and on. In fact, in the case of certain epilepsy disorders, there are even times when CBD is the only thing that truly helps. None of this isn’t saying that using CBD doesn’t carry along minor side effects, which we will discuss in more detail later on.
While generally noted for its low side-effect profile, research shows CBD does have one significant side effect of note. And that is the potential for it to interact with certain prescription drugs that are metabolized by a family of enzymes. Known as Cytochrome P450, these enzymes, in particular, CYPA4, are responsible for breaking down about 60 percent of clinically prescribed medications.
While this news jumps out to many as incredibly alarming, it’s not uncommon for foods, supplements, and common medications themselves to inhibit CYP enzymes, causing drug interactions. Grapefruit, St. John’s wort, and kale can all cause drug interactions by inhibiting the same enzymes CBD products can. Then foods such as broccoli, spices like cumin, and drinks like coffee can all interact with the medication we take.
Because many of these are common items in a human’s diet, one way to quickly find out if CBD could interact with the medications you’re taking is to look on the drugs’ label for warnings about eating certain foods, in particular, grapefruit. This isn’t so easy with medications for our pets, however that’s why we are here to help. Because including CBD in our dogs and cats’ health regime is a great way to give them the health they deserve. The therapeutic effects of CBD are countless, and we will be covering the main health benefits in addition to advising you on how to safely use CBD alongside other medications.
What Happens When CBD Inhibits The Cytochrome P450 System?
By temporarily inhibiting cytochrome P450 enzymes, CBD along with the other cannabinoids found in all cannabis plants are able to delay the rate they break down their intended medication.
The metabolism rate of a drug is quite important for several reasons and must be known before an appropriate dosage can be prescribed. By delaying a drug’s metabolism rate, CBD can allow for too much medication to be in your system at once. And in essence, by raising the drug’s potency, this acts as if you took a higher dosage of that drug than normal. By effectively raising the dosage, you’re often increasing the risk for the said drug to cause side effects.
Research on the significance CBD can interact with other medications is still heavily being looked into, and discussed below. Anecdotally, we know that both marijuana and hemp products are commonly used alongside other medications. As we know, there is no great worry in the marijuana community at large about their use interacting with their prescribed medication. The same can’t be said when it comes to the side effects to memory and motor control due to the high amounts of THC found in these plants.
We can theorize from this, that while cannabis products can cause drug interactions and it is not something to take lightly, it’s not significant enough by large to cause a great concern amongst its users. It is important to note that Delta-9-tetrahydrocannabinol (THC), limited to 0.3% in CBD products vs 20%+ in marijuana is heavily involved in inhibiting CYP enzymes. Both CBD and THC are metabolized by CYP3A4 while THC is also metabolized by CYP2C9 and CBD by CYP2C19. From what we currently know, the less CYP are enzymes inhibited, the less chance it can interact with other medications. Along with its inability to cause a high, along with being available for kids and pets, this is another reason CBD oil may be the preferable choice vs medical marijuana.
However, don’t let this trick you into thinking that there isn’t good evidence that we shouldn’t be concerned about it. We have studies that show evidence of CBD itself raising the potency of blood-thinning medication along with seizure medication, causing a higher occurrence of side effects vs. the control groups.
Using CBD Safely With Other Medication
While CBD and other CBD products have the ability to interact with around 60% of prescribed medication, there are several ways to safely use CBD in conjunction with other medications.
First, never stop giving your pet medication prescribed by your veterinarian until you’ve consulted them. This goes for medication that may have a potential interaction with CBD and medication that doesn’t.
From starting CBD off at a lower dose than normal to timing out when CBD should be given to allow for the prescription drug to break down first, there are lots of little things that you can do to improve the safety of CBD. Your veterinarian can help you with these. As well, they can monitor blood plasma levels to ensure your pet’s medication is being properly metabolized or if it could do for a dosage adjustment.
There are times when CBD is touted for its ability to lower the reliance or dosage of prescription medication. One reason this happens is that CBD offers its own benefits. But the other reason we speculate this happens is that CBD may be raising the potency of the other medication in the body.
Last, even in the rare case your pet can’t ingest CBD due to a drug interaction, all hope of ever giving them CBD isn’t lost. The beneficial compounds found in CBD, and in hemp and cannabis products can be administered topically. CBD lotions, salves, and creams are great for help with surface-level aches and pain, skin breakout, inflammation, and more, These do this by avoiding entering the bloodstream, largely preventing CBD from interacting with Cytochrome p450 enzymes.
The skin is the largest organ and the first level of defense against nasties that can put severe stress on the body. Including CBD and hemp in your pet’s skincare regime is a great way to care for their general health.
Side Effects Of CBD
Without a doubt, the biggest and in most cases, the only side effect that comes from using CBD is its ability to interact with other medications. However, there are some minor side effects to be aware of. In most cases, these side effects occur when too large of a dose is given. CBD has a biphasic effect where low and common dosages can put a slight pip in your pet’s step. However, give your dog or cat too much, and you may find them catching some heavy Zzzz’s on the couch.
Another side effect of CBD, along with other cannabis products, is dry mouth. CB1 and CB2 receptors which make up the endocannabinoid system — the system cannabis largely interacts with — are found heavily in the mouth where they help regulate saliva production. But by the same token, the opposite of dry mouth can happen, and CBD may temporarily boost saliva product/release. CB1 receptors are overstimulated with high-THC products like marijuana. Because there are only trace amounts of it in CBD products, issues like dry mouth are much less commonly seen.
High doses of CBD can lower resting blood pressure causing some lightheadedness, which should quickly pass. One 2017 study found the potential for CBD to help lower blood pressure in those with high blood pressure.
Nausea and stomach discomfort are frequently cited side effects seen with nearly every medication. This especially happens when first starting a medication due to the body needing to take time to realize it’s not a threat or allergy. The same can happen with CBD, despite it usually having adverse effects and helping with nausea and stomach discomfort. Changing the dosage while the body learns to recognize CBD can help. Usually, a lower than normal dose for a few days to a week is a great course of action for this side effect.
What Research Says
Research on CBD, and cannabidiol itself, and the potential for drug interactions so far has been a bit of a mixed bag. Some researchers have found a low dose of CBD is effective enough in avoiding interactions with the drugs they were studying. While other researchers have found a precise dosage – that can be either low or high – is preferable and dependent on the patients’ and their medications. So how do we interpret this data?
First, the big thing that comes from the studies we have found is while CBD can cause interactions with the medication we take, studies still find CBD is a safe and effective treatment. With simple monitoring and potential adjustments in the dosage, there is little risk to continue using CBD. This is awesome news!
The reason a low dose usually works, but not always for avoiding a drug’s side effects is likely due to the individual cytochrome that’s responsible for the metabolism of the drug. Researchers have found CBD can both speed up and slow down the metabolism rate depending on the drug and the cytochrome it interacts with. Again, while there is some risk with CBD, when given the appropriate care, the data shows CBD is very low risk.
Clinical trials show care and safety should be given in the case of epilepsy because while CBD can significantly help seizures, they can easily interact with seizure medications increasing their side effects, which can produce seizures of their own. However, again, researchers have found CBD and seizure medications can be used together with a smart medical treatment plan. In fact, epilepsy is currently the only thing the FDA has approved the use of CBD for.
Frequently Asked Questions Concerning CBD and Drug Interactions
We hope our article has provided you with all the information you need when deciding if CBD is something you should give to your pet. Especially if they are already on medications. Because we’ve taken such an extensive look at CBD and its potential for causing a drug interaction, we wanted to quickly answer some of the most asked questions concerning the topic.
Can You Take CBD With Medication?
In the large majority of cases, CBD can safely be used with most medications. Using CBD in tandem with over-the-counter medications warrants little to no concern. If using an OTC drug long-term or at a higher than normal dosage due to medical advice from your doctor or vet, please consult said authority before using a CBD product. While a CBD product has the potential to cause drug-drug interplay in about 60% of prescription drugs, for the most part, with the proper medical advice and guidance, CBD can be safely used.
What Meds Does CBD Interact With?
CBD has been shown to interact with blood-thinning drugs like Warfarin, raising abnormal liver enzymes along with inducing tiredness when used in conjunction with Valproic Acid – sometimes used for controlling seizures. This information comes from research on Epidiolex, an FDA-approved cannabis extract for help with epilepsy. Epidiolex is an isolate, meaning it only contains the single cannabinoid, cannabidiol, in very high amounts. Most CBD products aren’t a single cannabinoid but contain the full range including high amounts of cannabidiol.
For a full list of potential drug interactions, please see our list at the end of the article.
Can CBD Interfere With Arthritis Medications?
In the large majority of cases, it’s very unlikely CBD would interfere with the metabolism of drugs used to treat arthritis and other inflammatory joint disorders. For help with pain and joint issues, veterinarians commonly prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) that are safe for dogs. Except for diclofenac, it appears CBD will not have a drug-drug interaction with an NSAID drug. While NSAIDs are commonly given to dogs, the over-the-counter medications we commonly take – like Ibuprofen – should only be given to your dog under the supervision of your vet due to their ability to easily pass the safety threshold in dogs.
Does CBD Interfere With Blood Pressure Medicine?
While high blood pressure and hypertension occur in humans more, our dogs are susceptible to the disease and put on similar medications, as well. Because CBD can lower blood pressure and potentially help those with hypertension, it can seem like a good idea to use it in conjunction with drugs designed to do the same, but caution is advised. While CBD can be used in tandem with blood pressure medications, it’s recommended you discuss it with your veterinarian first.
There are several medications used to treat high blood pressure, including angiotensin converting enzyme (ACE) inhibitors, angiotensin II receptor antagonists (ARBs), diuretics, and calcium channel blockers. Because of this, if your vet finds they like what CBD is offering your pet, but they see it interacting with their medication, they have the option to switch to a different medication.
Has CBD Ever Caused A Life-Threatening Drug Interaction?
To the best of our knowledge and thorough research, we can not find an example of CBD or any cannabis product causing life-treating drug interactions.
Again, this should not make you disregard potential drug interactions. Instead, we are simply saying that while cannabis can cause such, it’s frequently used alongside other medications, often without the guidance of a health provider, yet for whatever reasons, a crisis has not occurred.
Discussing CBD And Drug Interactions With Your Vet
CBD has a world of therapeutic benefits that can improve our pets’ health in both small and big ways. Backed by research, CBD oil and other CBD products have been shown to be extraordinarily low-risk options for the benefits it has. However, while you can use CBD in tandem with other medications, there is a chance for an interaction that can increase the risk of the drug causing side effects. Interactions cannot happen with all drugs, but a majority of prescription medications (about 60%) have potential. This includes medication commonly used to treat epilepsy, for which CBD is commonly used to help as well.
If your dog or cat is on medication, and you’re concerned about CBD and its potential for drug interactions, your best bet for advice is their vet. While CBD may interact with medications your pet is on, your vet can safely assess if CBD is still the correct choice for them. Often timing out the dosages or changing the dose of CBD or the other medications can allow them to be used together for the best of both worlds.
With proper care, current research indicates CBD can offer a treatment plan an irreplaceable tool for improving health without causing serious adverse side effects, even when there is potential for a drug interaction.
List Of Known Drugs CBD Interacts With
If either you or your pet is on one or more of the medications listed below, please consult the appropriate medical professional before using CBD. Just because a medication is listed below does not indicate that it can never be used in conjunction with CBD or another cannabis product. Nor does it mean you will personally see drug interactions or side effects from them. Instead, it simply means there is potential for an interaction that you should be aware of.
Our aim for this list is to give a comprehensive reference point. However, there is always the chance we could have missed some medications. As well, there are studies and clinical trials dedicated to the research of CBD and drug interactions currently in operations that could change our list.
Can my Dog take CBD Oil While Taking Other Medications?
With the pet CBD market industry exploding globally, it’s no surprise that we need to look out for any drug interactions. What many people don’t know is that dog CBD oil can interact with other medications by either enhancing the effect, or by interfering with the metabolism of some.
In this blog, we’ll discuss why it’s important to consult with your veterinarian first before using CBD pet products.
Not only is this important so that you can get a proper diagnosis for a medical condition, but your veterinarian will be able to discuss any possible side effects if CBD is used together with other pet meds.
Here’s what you need to know to fully protect your pet, and to make sure that there are no drug interactions.
CBD can alter the way your dog processes certain medications
Yes, although cannabidiol (CBD) is a natural supplement that is beneficial for numerous health conditions in pets, as well as for chronic pain, insomnia, depression , and anxiety, CBD does have the potential to interact with certain medications.
CBD is derived from the hemp plant, yet it can also come from the marijuana plant. CBD hardly ever contains delta-9-tetrahydrocannabinol (THC), which is the compound that gives marijuana its “high” effect. High-quality CBD is non-toxic and considered safe for pets and humans alike.
There are almost no side-effects, apart from those coming from a low-quality CBD oil that may contain contaminants. It’s always best to look out for the compromised quality of some CBD oils.
You’ll need to discuss with your veterinarian all supplements, over-the-counter meds and prescription meds that your pet may be taking. Today research continues to demonstrate how effective CBD oil is for pets, yet one still needs to examine how it can interfere with the metabolism of pet meds and other supplements.
Benefits of CBD Oil for Dogs
Cannabidiol (CBD) extract is quickly gaining popularity as a natural alternative for managing pain, inflammation, and a variety of medical conditions, including epilepsy. However, recent reports have called into question the safety of CBD when used together with other pet meds. It’s also good to note that using a compromised quality or low-quality CBD oil raises the risk of side effects.
A recent 2019 study by the University of Korea, demonstrates that the CBD anti-cancer protein shows potential in killing tumor cells. The researchers tested the synergistic effect of CBD with a cancer destroying protein called TRAIL. (TNF related apoptosis- inducing ligand.)
The study concluded that TRAIL and CBD created apoptosis separately in colorectal cancer cells. The researchers also found that together, both reduced cancer cells a lot. “ To the best of our knowledge,” they wrote, “this is the first report that cannabidiol induces significant TRAIL-induced apoptosis of colorectal cancer cells,” noting that earlier reports suggested that a different protein response was responsible for cancer-cell death.” via MDPI Journals.
FDA & CBD
The FDA has also tested the chemical content of cannabinoid compounds in some of the products, and many were found to not contain the levels of CBD they claimed to have. We have also heard reports of CBD potentially containing contaminants (e.g., pesticides, heavy metals); we are looking into this.
Some cannabis products are also being marketed as pet food and health products for animals. The FDA has not approved cannabis for any use in animals and recommends pet owners talk with their veterinarians about appropriate treatment options for their pets.” via FDA, 2019.
Blood Pressure and CBD Oil
High doses of CBD oil may potentially drop blood pressure resulting in lightheadedness and possibly dizziness in people. It’s always best to consult with your veterinarian for the best advice prior to purchasing a CBD product. That said, the positive side of CBD oil use is that it may be good for patients with high blood pressure. CBD together with regular exercise and a healthy diet help to regulate hypertension.
A 2017 study by Dr. K Jadoon on CBD and its effects on blood pressure demonstrated the following:
The study concludes that “acute administration of CBD reduces resting BP and the BP increases stress in humans, associated with increased HR. These hemodynamic changes should be considered for people taking CBD. Further research is required to establish whether CBD has a role in the treatment of cardiovascular disorders.”
CBD Oil Interacts with Anti-Seizure Meds
A study researching CBD interactions with seizure meds in people added that “ Because all of the participants are also taking other seizure drugs while they are receiving the investigational therapy, investigators checked the blood levels of their other seizure drugs to see if they changed. “With any new potential seizure medication, it is important to know if drug interactions exist and if there are labs that should be monitored while taking a specific medication,” said lead author Tyler Gaston, MD,” via Science Daily.
Dr. Gaston and her colleagues found that there were significant changes in levels of the drugs clobazam (and its active metabolite N-desmethylclobazam), topiramate, and rufinamide in both adults and children, and zonisamide and eslicarbazepine in adults only.
Except for clobazam/desmethylclobazam, however, the drug levels did not change outside of the normally accepted range. In addition, adult participants in the study taking clobazam reported sedation more frequently.
Additionally, when seizure patients were using valproate, they added that “Tests also showed that participants taking valproate and CBD had higher ALT and AST (liver function tests) compared with participants not taking valproate.
Very high ALT and AST indicate abnormal liver function, but significant ALT and AST elevation occurred only in a small number of participants (4 children and 1 adult), and the levels returned to normal after discontinuation of valproate and CBD.”
The study concludes that “The findings emphasize the importance of monitoring blood levels of antiepileptic drugs as well as liver function during treatment with CBD. “
A perception exists that since CBD is plant based, that it is natural and safe; and while this may be mostly true, our study shows that CBD, just like other antiepileptic drugs, has interactions with other seizure drugs that patients and providers need to be aware of,” said Dr. Gaston.”
CBD as a natural supplement does not cause a “high” in pets, but may cause a reaction when used together with anti-seizure meds. Cannabinoids have been shown to inhibit cytochrome P450 enzymes by using up these enzymes, and by inhibiting how other enzymes work.
When cannabidiol oil is consumed by dogs in large amounts, a large group of enzymes may be altered in the same way that grapefruit alters enzymes.
Most pet meds are metabolized in the liver via certain enzymes that are made in it. CBD works in the same way that grapefruit does, and may use up all the enzymes and also alter the effectiveness of pet meds.
NSAIDs and Corticosteroids
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) are a class of drugs commonly used to control pain and inflammation in dogs. NSAIDs help many dogs lead a life that is more comfortable for them, but what about interactions with CBD oil? CBD oil has the potential to make pet meds less effective.
That said, pet parents should take every precaution to ensure that there are no interactions with any of their pet meds or supplements, and even NSAID’s, corticosteroids, pet herbal supplements and vitamins. The potential for adverse reactions will also depend on the body chemistry of your pet and the dose of the prescription or supplement.
Administer CBD oil 2 hours before or 2 hours after giving pet meds or supplements.
NSAID’S include the following:
Meds like Gabapentin when taken together with CBD can cause lethargy in pets. It’s important to discuss CBD use with your veterinarian prior to administering.
Common corticosteroids include the following:
The most common symptoms when using these are gastrointestinal issues like lack of appetite, vomiting, diarrhea, and even ulcers. We all know that pets cannot take both NSAID’s and corticosteroids at the same time, but what about cannabidiol oil and NSAID’s and corticosteroids?
CBD oil can also enhance the effectiveness of certain drugs and one may be able to lower the dose of pet meds or therapy when using CBD oil. Pet meds that are used for pain relief need to be administered carefully when using them together with CBD oil.