cbd
8 interactions related to cbd
cbd + tacrolimus
CBD inhibits CYP3A4, CYP3A5, and P-glycoprotein, the main pathways that clear tacrolimus. A published case report documented an approximately 3-fold rise in dose-normalized tacrolimus levels after adding CBD, posing serious nephrotoxicity, neurotoxicity, and over-immunosuppression risk in transplant patients.
cbd + sertraline
CBD inhibits CYP2C19, an enzyme that contributes to sertraline metabolism. A published case report describes severe hyponatremia and cognitive dysfunction in a CYP2C19 intermediate metabolizer who added over-the-counter CBD to chronic sertraline, consistent with phenoconversion to a poor-metabolizer phenotype.
cbd + simvastatin
Simvastatin is heavily dependent on CYP3A4 for first-pass and systemic clearance, and CBD inhibits CYP3A4. Co-administration is expected to raise simvastatin and active-metabolite exposure, increasing the risk of muscle pain, transaminase elevation, and rare rhabdomyolysis.
cbd + beta-blockers
CBD inhibits several CYP450 enzymes (notably CYP3A4, CYP2C19, CYP2C9, CYP1A2) and may modestly inhibit CYP2D6. Beta-blockers such as metoprolol, propranolol, and carvedilol are metabolized via CYP2D6 (and CYP1A2 for propranolol), so co-use can raise beta-blocker plasma levels, with additive blood-pressure lowering and bradycardia.
cbd + clobazam
CBD strongly inhibits CYP2C19, the enzyme that clears N-desmethylclobazam (the active metabolite of clobazam). Co-administration triples plasma N-desmethylclobazam levels, causing excess sedation, ataxia, and somnolence; this is documented in the FDA-approved Epidiolex prescribing information.
cbd + valproate
Concomitant CBD (Epidiolex) and valproate use produces a significantly higher rate of ALT/AST elevations than either drug alone - up to ~17% of patients in the combination group versus ~1-2% on valproate alone in pooled Epidiolex trial data. Postmarketing reports also describe hyperammonemia in patients on the combination.
cbd + warfarin
CBD inhibits CYP2C9 (and CYP3A4), the enzymes responsible for metabolizing the more potent S-enantiomer of warfarin. Co-use raises plasma warfarin concentrations, elevates INR, and increases bleeding risk; a published case report required a roughly 30% warfarin dose reduction after the patient started CBD.
hemp seeds + warfarin
Culinary hemp seeds (hulled or whole) contain only trace levels of CBD and very low vitamin K, so they are unlikely to meaningfully shift warfarin's effect. Hemp seed oil products vary widely, and a minority of products have been measured to contain detectable CBD that could theoretically inhibit warfarin metabolism via CYP2C9 at high enough doses.