CBD and Medication Interactions

The fastest growing demographic of cannabis usersare seniors, so it’s not surprising that we get a lot of questions about how CBD interacts with other medications. There are several factors that come into play when determining the chance of medication interactions. Liver metabolism, route and sequence of administration are important when deciding the best product for you. If you are taking any prescription medications, It is important that you consult with your healthcare provider before starting to also take CBD.

When you ingest a medication orally, the drug is metabolized by your liver in a process known as the first pass effect. The first pass effects the amount of medication that is absorbed into your blood stream, which is referred to as the bioavailability. The P450 enzyme in your liver is responsible for the metabolism of 60-80% of the pharmaceuticals currently on the market. Grapefruit disrupts the function of this P450 enzyme and is a common food you see advised to avoid on many medications. CBD affects this enzyme in the same way as grapefruit, so blood levels of many pharmaceuticals can increase or decrease when ingested with CBD.  

The route of administration is also correlated with bioavailability. When taken sublingually (drops under your tongue) the effects typically occur within an hour, topically (rubbing cream, salve or balm on your skin) is less effective, but good for targeting aches and pains, or via inhalation (smoking or vaping), which tends to have the most immediate effect; for each of these methods the first pass effect is avoided. This results in a higher bioavailability of the drug in your bloodstream. Consideration of this should be given when deciding dosage.

The most common drug we get asked about at Two Moons CBD is Coumadin (Warfarin), which is an anticoagulant with a very narrow therapeutic window. The P450 enzyme metabolizes Coumadin. When taken with CBD, blood levels of Coumadin can increase. Too much Coumadin in the blood stream increases your risk of a life threatening bleed. It is important that your consult with your healthcare provider prior to starting CBD. He or she might want to increase the frequency of your INR draws to closely monitor your blood levels.

I offer several tips to customers who take a medication that is metabolized by the P450 enzyme. Most importantly, consult with your healthcare provider first. He or she can decide if your current medications are safe to take with CBD. When your provider has given you the green light, I would recommend to take your CBD and medications at least 2 hours apart. Remember that oral consumption is subject to the first pass effect. Consider sublingual to avoid this. Learn more about medication interactions in a newly published report here: 


If you would like to schedule a free consultation to help you decide on the best product for you, please email me at TwomoonsCBDnurse@gmail.com 

FDA DisclaimerThe statements made regarding these products have not been evaluated by the Food and Drug Administration. The efficacy of these products has not been confirmed by FDA-approved research. These products are not intended to diagnose, treat, cure or prevent any disease. All information presented here is not meant as a substitute for or alternative to information from healthcare practitioners. Please consult your healthcare professional about potential interactions or other possible complications before using any product.