What is the potential for CBD drug interactions? Learn more about how CBD metabolizes and affects other compounds in your body. CBD may interact antagonistically with lisdexamfetamine (Vyvanse), a stimulant, and cause side effects. Find out if they’re safe to use together.
CBD & Drug Interactions : The Science
As interest in Cannabidiol increases, questions around CBD drug interactions naturally also increase.
When taken together or within a short period of each other, many drugs have the potential to interact.
Cannabidiol, although a naturally occurring compound, still acts as a drug as soon as it enters the body.
When we talk about drugs interacting with each other in the body, we mean when the intended effects or side effects are altered by the simultaneous ingestion of another substance (a food, supplement, or beverage can also cause this).
Join us below for a scientific conversation about how Cannabidiol can interact with medications.
Types of Interactions
There are two different but related classifications of drug interactions – pharmacokinetic and pharmacodynamic.
Pharmacokinetic interactions refer to how one substance affects the rate at which another is absorbed and transported around the body.
Additionally, it may also affect the rate at which the drug is metabolized and excreted.
This type of interaction will result in varying levels of the drug in your body.
Pharmacodynamics relates to the effect of a drug on the body: Two drugs may have similar effects, and when taken together, may heighten or lessen the intended impact of one another.
For example, two drugs that cause sedation when taken together may result in an increased sedative effect.
Conversely, one may counteract the effect of another, like taking one drug to increase your blood pressure while taking another that may reduce it.
CBD Drug Interactions: Top Line Summary
Currently, there is little tangible evidence referring to interactions between CBD and other compounds due to the limited number of clinical studies.
On the flip side, several small studies have looked into how CBD is thought to metabolize in the body, which is a helpful proxy.
So what drugs should not be taken with CBD?
One study looked into interactions between CBD and commonly used antiepileptic drugs, resulting in raised levels of these drugs in the body. Also, finding elevated Liver Function Test markers (LFT), which in some cases can represent liver toxicity or potential damage.
Clobazam is another drug that is used to treat epilepsy and, in some cases, anxiety.
A small study of 13 children investigated the use of CBD and clobazam in children, revealed that after four weeks of treatment, clobazam levels rose significantly, resulting in increased side effects such as drowsiness, ataxia, and irritability.
On the more positive side, the study revealed a 50% decrease in seizures amongst 9 (69%) of the patients.
The use of CBD in epilepsy is one of the most documented use cases of cannabidiol. In the US, the FDA approved the medicine Epidiolex in 2018, a highly concentrated form of CBD for use in treatment-resistant epilepsy such as Lennox-Gastaut syndrome or Dravet syndrome.
There is a limited amount of research that has looked into the effects of CBD and anticoagulants/antiplatelets (drugs that ‘thin’ your blood to reduce blood clotting). Commonly prescribed medicines in this class include aspirin, clopidogrel, warfarin, and apixaban.
Studies indicate that CBD can have similar effects to these drugs, therefore increasing the likelihood of bleeding.
The Human Body & Metabolism
Metabolism refers to the way different compounds are broken down and absorbed by the body.
Any substance we consume must first get broken down to become ready for absorption. Much of this crucial process takes place in the gut and the liver. It’s called the first-pass effect or first-pass metabolism.
Even though CBD is a plant-derived compound, it’s also a powerful one. This is because it interacts with different crucial systems in the body.
CBD metabolic processes involve various enzymes and molecular pathways.
Let’s take, for example, how metabolism works when it comes to the food we consume.
Metabolism allows the body to properly use the food we intake. But, first, food has to be broken down into individual compounds. In this sense, carbohydrates are broken down into sugars.
Next, the metabolism works to transform sugars. This process happens thanks to specific enzymes. Thus, enzymes help to turn sugars into metabolites.
Metabolites have a whole array of complex functions. For instance, they can be used as building blocks for different tissues and internal systems. Or they can be used as fuel for various cellular processes.
The way cannabinoids are metabolized is somewhat similar to the way we metabolize food. In the case of CBD metabolization, though, we’re talking about drug metabolism.
To start with, CBD must pass through the digestive system. Afterward, it’s absorbed into the bloodstream. Then it has to be transported to the liver before entering the body’s general bloodstream.
It’s in the liver where cannabinoids get broken down into metabolites. Once broken down into metabolites they can finally circulate throughout the body and be excreted.
Only a small fraction, about 13-16%, of edibly ingested CBD goes unbroken and is biologically available.
Metabolites can have very different properties than the initial drugs.
That’s why CBD can potentially interact with many pharmaceuticals. By doing so, it can affect drug metabolism by speeding up or slowing down enzymes that also commonly process most known drugs.
As a result, it can alter the effects of certain prescription medications and even supplements.
How does this work?
CBD can inhibit the activity of a family of enzymes known as cytochrome P450.
The Cytochrome P450 System & Prescription Medications
It’s Cytochrome P450 enzymes that contribute to drug metabolism. Ultimately, drugs like CBD can inhibit or induce cytochrome P450 enzymes.
Why does this matter?
The Cytochrome P450 system is a key enzyme group. It metabolizes most of the drugs we consume, including more than 60% of marketed prescription medications.
The available research highlights that this class of enzymes consists of more than 50 enzymes. Yet only 6 of them are in charge of metabolizing 90% of drugs.
And yes, this includes when we take CBD.
The Link Between CBD, Medications & Grapefruit Juice
Ever noticed the “grapefruit warnings” on some type of medication? Or maybe your doctor has warned you not to consume grapefruit when prescribing you a certain medication?
Well, that’s because both Cannabidiol and grapefruits have something important in common.
When it comes to CBD and drug interactions, Cannabidiol can have a similar effect to grapefruit juice. That’s according to the available preliminary research.
The thing is, grapefruits contain compounds known as flavonoids and furanocoumarins. When combined with certain enzymes, furanocoumarins and flavonoids can significantly slow them. One of these enzymes is exactly CYP450.
As mentioned above, the CYP450 enzyme serves a crucial function in drug interactions. It breaks down and removes drugs from your system. That’s why with some health conditions, your doctor may warn you to restrain from grapefruits.
Similar to grapefruits, CBD can impair how your body metabolizes some drugs. Furthermore, it can raise the serum levels of those medications in your system.
When serum levels are raised, the CBD product you’ve consumed can theoretically create a dangerous elevation of certain medicines. However, recent systematic reviews have found a low risk of these interactions actually being clinically significant.
So, we have plenty of solid reasons why people must always consult with their healthcare providers before they attempt to take CBD.
Your doctor will check on the compatibility between CBD products and other medications you may use to treat certain health conditions. Thus, you can receive reliable information and guidance to establish the best routine.
CBD Interactions With Prescription Drugs
The available research on possible interactions with prescription drugs is rather inconclusive at this point. It depends more on the potential side effects of the prescription drug being too high, rather than any toxicity from CBD itself.
So, as a rule of thumb, you must always consult with your healthcare provider or doctor first and foremost before you take CBD, especially if you’re prescribed medications.
Below is a summary of information from the latest studies regarding specific interactions for medications available both on prescription and over-the-counter.
CBD And Gabapentin
Gabapentin is often used to treat neuropathic pain and epilepsy. In addition, medications derived from CBD and Gabapentin are frequently used to offer respite from seizure disorders.
Italian researcher Emilio Perucca was the first one to provide evidence that CBD can have a beneficial effect on two rare types of epilepsy: Lennox-Gastaut Syndrome and Dravet syndrome.
According to a 2011 study, researchers concluded that Gabapentin is relatively safe from drug interaction. In addition, the study showed that it bypasses the first-pass enzyme interaction, and most of it is excreted via urination.
However, in 2017 researchers found out that CBD could bind with the GABAA receptors.
By binding with GABAA receptors, it can slow down the firing frequency of neurons.
Meanwhile, Gabapentin is a structural analog of gamma-aminobutyric acid (GABA). So, potential interactions between CBD and gabapentin can lead to unwanted effects due to this relationship.
Potential side effects of such an interaction include:
- difficulty concentrating,
CBD And Antidepressants
Zoloft is one example of a common selective serotonin uptake inhibitor (SSRI).
Serotonin is the “feel-good” hormone and vital neurotransmitter. When its levels decrease, people can feel depressed and have mood swings.
- impairment in judgment and motor coordination,
- changes in thoughts and mood, possibly warranting emergency medical attention
- difficulty concentrating.
CBD Oil And Antibiotics
At this point, there is very little data on the relationship between antibiotics and CBD.
Yet, there is an associated risk when taking CBD and antibiotics together. That’s because the cytochrome P450 enzyme system breaks both down.
When it comes to science, there are two notable pieces of research:
In a first-of-its-kind study led by the University of Westminster, CBD was found to increase the effectiveness of certain antibiotics.
This was further confirmed by another study led by researchers from the University of Southern Denmark. Although, this increased effectiveness was shown to only work on specific types of bacteria.
CBD Oil And Vyvanse
Vyvanse is a pro-drug. A prodrug refers to a medication or a compound that turns into a pharmacologically active drug. It becomes active only after being absorbed and then metabolized in the body.
The same enzyme metabolizes Vyvanse as CBD (the P-450 enzyme). Thus, combining CBD and Vyvanse could lead to unforeseen, increased side effects.
While there are no formal studies on interactions between CBD and Vyvanse, anecdotal reports are growing.
Nonetheless, consult your physician to discuss how Vyvanse may interact with CBD.
CBD Oil And Tramadol
According to a 2020 study, CBD could improve sleep and chronic pain among patients who use opioids like Tramadol to manage pain.
However, another study conducted by the American Society for Pharmacology and Experimental Therapeutics concludes that CBD may slow the metabolization of Tramadol.
That’s because CBD use may relate to inhibiting the liver enzyme CYP2DC responsible for the breakdown of tramadol and other over-the-counter medications.
Moreover, high doses of CBD were shown to lessen the analgesic effectiveness of Tramadol despite the fact CBD actually may raise the levels of opioids including codeine and oxycodone. Such CBD and opioid interactions could potentially cause more sedation and be dangerous.
Ultimately, there aren’t enough studies available on the specific drug interaction between CBD and Tramadol.
Reach out to your qualified health provider for advice.
CBD And Ibuprofen
Ibuprofen is one of the Non-Steroidal Anti-Inflammatory Drugs (NSAIDs). Similar to CBD, it is used in the treatment of pain and inflammation.
A study published in the Journal of Neurology Research highlights there have been no reported interactions between CBD and ibuprofen.
But health experts further suggest that potential interactions may be dosage-dependent, leading to unforeseen side effects.
CBD And Prednisone
Corticosteroids like hydrocortisone and prednisolone should be cautiously taken with CBD.
This is because CBD and corticosteroids are inhibitors of the CYP450 enzyme system.
According to the District of Columbia Department of Health, this can increase the risk of systemic side effects. This is due to decreased glucocorticoid clearance.
CBD Oil And Lamictal Medication
Like other anti-epileptic (AED) medications, Lamictal use often comes accompanied by unwanted side effects.
More people are starting to become interested in CBD as a less debilitating option.
Moreover, a 2019 clinical trial highlights no significant drug-drug effects on treatment response in patients with treatment-resistant epilepsy. However, in general, other research suggests that caution should be used and your doctor may need to monitor liver enzymes (LFTs) if you are on AEDs.
Additionally, studies show that CBD may inhibit an enzyme known as UGT2B7.
This enzyme is necessary for the metabolization of Lamictal. So, the combination of CBD and Lamictal may increase both of their levels and the risk of aggravation of Lamictal-related side effects.
CBD And Omeprazole
Omeprazole is a proton pump inhibitor. CBD can inhibit the enzymes that are targeted by Proton Pump Inhibitors (PPIs).
One of the most common side effects is the risk of diarrhea.
Drugs That Should Not Be Taken With CBD
According to recently reviewed science, certain medications should be taken with caution if concomitantly taking cannabinoids like THC and CBD.
Taking such medications along with cannabinoids must be closely monitored by qualified healthcare providers. These include but are not limited to:
- Amiodarone (heart rhythm medication)
- Levothyroxine (thyroid medication)
- Warfarin (common blood thinner)
- Lamotrigine, Valproate, Clobazam (seizure medications)
Other drugs that relate to adverse reactions concerning CBD use include:
- Oral hypoglycemic agents,
- Prokinetic steroids,
- Immune modulators,
- Calcium channel blockers,
- Valproic acid.
Patients must be especially careful when combining CBD with any OTC or prescription medications that cause sleepiness (such as opioids or antipsychotics, among others). You should never stop taking nor alter prescription medications unless directed by your provider.
Poor Regulation Plays A Part
Research warns us about the potential risks related to drug interactions between marijuana- or hemp-derived products and certain medications.
One of the hidden dangers of such interactions relates to the still poorly regulated CBD market. Many CBD products are mislabeled or improperly checked for purity and cannabinoid concentration. This can increase the risks of unforeseen side effects.
Furthermore, researchers highlight older adults are more susceptible to drug interactions as they are generally (but not necessarily) more likely to be on greater numbers of prescription medications, have more dry weight, and slower metabolisms.
Wrapping Up: CBD & Drug Interactions
Ultimately, some patients should not take CBD.
This is especially true for persons with cardiovascular disease, certrain pulmonary disease, renal disease, severe psychiatric disease, or other critical illness.
With certain medications, the CBD treatment has to be monitored closely by a qualified doctor.
All in all, if you’re taking medication and using cannabis in any form, including CBD, you should always consult your doctor for advice regarding potential undesired consequences and appropriate personalized guidance.
About The Author
Milena (MJ) comes from a family of generational herbalists. Ganja is central to her mission to keep spreading knowledge about the incredible wisdom of the ancient cannabis plant through her love for writing. In her free time, you will probably find MJ dancing!
Does CBD Interact With Lisdexamfetamine (Vyvanse)?
CBD may interact antagonistically with lisdexamfetamine (Vyvanse), a stimulant, and cause side effects.
The risk of this interaction is mild to moderate.
Lisdexamfetamine (Vyvanse) is a neuro-stimulant used to treat attention deficit hyperactivity disorder (ADHD) and binge eating disorder. It belongs to the amphetamine family of drugs.
Cannabidiol or CBD , a cannabinoid with many health-promoting properties, may behave antagonistically with or slow down the metabolism of lisdexamfetamine and cause side effects.
Are the two safe to take together?
Table of Contents
Does CBD Interact With Lisdexamfetamine (Vyvanse)?
Yes, CBD is likely to interact with Vyvanse — however, the severity of this interaction is low and unlikely to result in any lasting side effects.
There are two primary ways CBD can interact with stimulant drugs like lisdexamfetamine (Vyvanse).
1. Decreased Effects (Antagonistic Interaction)
CBD may counteract some of the stimulating effects of Vyvanse — preventing it from doing its job effectively.
Antagonistic interaction occurs when two drugs act in opposite ways. If taken together, one drug could interfere and even stop the actions of the other drug, causing the second drug to become less effective.
Lisdexamfetamine is a stimulant drug that enhances brain activities such as awareness, wakefulness, emotional regulation, attention, learning, and memory.
In contrast, CBD is a neuromodulator that exerts its effects on the central nervous system (CNS) via multiple pathways that are not yet fully understood. CBD is used as an anticonvulsant and anxiolytic. These effects may happen through its actions on endogenous systems such as neuronal inhibition and intracellular calcium modulation.
Because of their opposite effects, they are likely to cancel each other out, and CBD may reduce the activity and efficacy of lisdexamfetamine.
2. Slowed Elimination (Metabolic Inhibitor)
CBD may interfere with the body’s ability to metabolize Vyvanse — leading to elevated levels. This could lead to an increased risk of side effects from the medication.
Drugs are metabolized in the body due to the actions of the cytochrome P450 class of enzymes. When two medications that need similar enzymes for metabolism are taken together, they compete for the enzyme. This action could result in slowing down the metabolism of both drugs.
Lisdexamfetamine is extensively metabolized and eliminated by the CYP2D6 enzyme. While CYP2D6 also metabolizes CBD, CYP3A4 is the major enzyme responsible for its metabolism. However, CBD has inhibitory effects on CYP2D6, which can slow down the metabolism of lisdexamfetamine. This could cause lisdexamfetamine to accumulate within the body and cause unintentional side effects.
Other Names for Lisdexamfetamine
Lisdexamfetamine is sold under different names. All of them have the same base ingredient and have similar possible interactions.
Other names for lisdexamfetamine include:
Similar Medications: CBD & Stimulants
Lisdexamfetamine (Vyvanse) is a stimulant. CBD and stimulants all share similar risks for interaction and side effects.
Some of the medications that share similar risks when combined with CBD are:
- Amphetamine (Adderall, Adzenys ER, Mydayis)
- DextroamphetamineSulfate (Zenzedi, Dexedrine)
- Methylphenidate (Ritalin)
- Atomoxetine (Strattera)
- Modafinil (Provigil, Nuvigil)
Is It Safe to Take CBD & Lisdexamfetamine (Vyvanse) Together?
Yes, CBD is unlikely to pose any danger when taken with Vyvanse (when used in responsible doses).
However, CBD may negate some of the beneficial effects of the drug, causing it to be insufficient for managing the symptoms it was prescribed for.
Because the conditions Vyvanse is used to treat aren’t life-threatening, there’s a low chance of this effect resulting in any serious consequences.
The main indication for lisdexamfetamine is ADHD, and taking the two drugs together may make symptoms of ADHD worse due to decreased efficacy of lisdexamfetamine.
Always consult your prescribing physician first before you start these drugs, and never adjust the dose or stop taking Vyvanse on your own.
Is CBD a Viable Alternative to Lisdexamfetamine (Vyvanse)?
CBD is not considered a viable alternative to lisdexamfetamine (Vyvanse).
However, there are a few conditions where CBD may work for which lisdexamfetamine is indicated or even work as an adjunct to it.
Researchers had initially believed that CBD could worsen the symptoms of ADHD, but studies have not found any evidence to support this. In fact, some research shows positive results using CBD for ADHD .
Depending on the severity of the problem, maybe CBD could be enough to help, but it’s always best to talk to your doctor before changing or adjusting medications.
CBD may also help patients who binge eat but, again, the research lacks anything conclusive .
One of the most significant differences between CBD and lisdexamfetamine is that the latter is more likely to result in dependence and withdrawal symptoms. Therefore, there is a chance that lisdexamfetamine can be misused and overdosed.
What Is Lisdexamfetamine (Vyvanse)?
Lisdexamfetamine (Vyvanse) is a derivative of the drug amphetamine and belongs to a class called central nervous system stimulant.
Vyvanse is the brand name of the drug lisdexamfetamine. It is a prodrug of the psychostimulant d-amphetamine.
It’s used mainly to treat attention deficit hyperactivity disorder (ADHD) and binge eating disorder. It’s a prescription medicine approved by the FDA that works by increasing the production and decreasing the metabolism of the neurotransmitters like dopamine, serotonin, and norepinephrine.
Lisdexamfetamine (Vyvanse) Specs:
|Trade Name||Vyvanse, Tyvense, Elvanse|
|Classification||Central nervous system stimulant|
|CYP Metabolism||CYP2D6 enzyme|
|Interaction With CBD||Antagonistic and Metabolic Inhibition|
|Risk of Interaction||Mild|
What Does Lisdexamfetamine (Vyvanse) Do?
Lisdexamfetamine (Vyvanse) can increase the attention span and decrease restlessness in children and adults with ADHD.
It’s also used for binge-eating disorders because of its appetite suppressant qualities.
Lisdexamfetamine for ADHD
ADHD is a disorder of the brain where the person tends to lack the ability to concentrate, has difficulty controlling impulsive behaviors, and is overly active.
The exact mechanism of ADHD is not completely understood. However, it is linked to genetics, exposure to environmental risks, and toxins during pregnancy, among other things.
People with ADHD may have a higher concentration of dopamine transporters in the brain. This means these transporters remove dopamine from the brain too fast, causing a decreased level of dopamine in the brain. There also tend to be low levels of serotonin and norepinephrine in the brain in those with ADHD.
Once consumed, lisdexamfetamine turns into dextroamphetamine and L-lysine. This drug has two optical isomers called trace-amine associated receptor 1 (TAAR1) and vesicular monoamine transporter 2 (VMAT2). It can enter monoamine neurons and release monoamine neurotransmitters like dopamine, serotonin, and norepinephrine from their storage places in presynaptic neurons.
These neurotransmitters help in alertness and increase and maintain concentration and motivation. It can also prevent the reuptake of these neurotransmitters from the synaptic cleft but does not bind to the sites of the reuptake of norepinephrine and dopamine.
Lisdexamfetamine for Binge Eating
The exact action of lisdexamfetamine (Vyvanse) on binge eating disorders is unknown. In binge eating disorders, food may trigger the brain to make more dopamine, the hormone that makes us feel pleasure.
It’s possible that lisdexamfetamine raises the dopamine levels in the brain and sustains it enough so that the person does not consume more food than necessary. However, this has not been proven yet.
Lisdexamfetamine may have less abuse potential compared to other amphetamines but can still cause dependence.
Side Effects of Lisdexamfetamine (Vyvanse)
Symptoms vary from minor to severe. It’s good to know what can happen so you can inform your doctor if you experience any.
- Loss of appetite
- Stomach upset
- Increased blood pressure
- Increased heart rate
- Blurred vision
- High possibility of substance abuse
If you’re using lisdexamfetamine and suspect you’re becoming dependant on it, speak to your doctor immediately. They can help you reduce the dose gradually to avoid withdrawal.
Lisdexamfetamine withdrawal symptoms include:
If you want to stop taking lisdexamfetamine and shift to CBD, you should talk to your doctor first. They may recommend slowly tapering this drug to avoid or to reduce the withdrawal symptoms.
Key Takeaways: Is It Safe to Take Lisdexamfetamine (Vyvanse) With CBD?
CBD can decrease the effects of lisdexamfetamine (Vyvanse) and even slow down its metabolism from the body, causing more unintended side effects.
This interaction is considered mild and low risk — but caution is still advised.
If you experience any adverse effects after taking CBD with Vyvanse, seek medical attention immediately.