1. Blood Thinners & Anticoagulants
Cannabinoids may affect liver enzymes that help break down blood-thinning medications. [1, 2, 3]
• Medications: Warfarin, Eliquis, Xarelto, Plavix, aspirin.
• Risk: May increase the effect of some blood thinners, which could raise the risk of bruising, nosebleeds, bleeding gums, or more serious internal bleeding. People taking blood thinners should consult a doctor before using CBD or CBG. [1, 2, 3]
2. Anti-Epileptic Drugs (AEDs) & Anti-Seizure Medications
Cannabinoids may impact the metabolism of seizure medications, particularly clobazam and valproate. [5, 6]
• Medications: Clobazam, stiripentol, valproate, diazepam.
• Risk: Can increase exposure to clobazam’s active metabolite, which may lead to increased sedation or other side effects. CBD used with valproate has also been linked with a higher risk of liver enzyme elevations. [5, 6]
3. Statins & Cholesterol Medications
Many cholesterol medications are processed by liver enzymes that CBD may influence, including CYP3A4. [1, 2]
• Medications: Atorvastatin, simvastatin, lovastatin, rosuvastatin.
• Risk: May increase levels of certain statins, which could raise the chance of muscle aches, weakness, fatigue, or other medication side effects. [1, 2]
4. Heart Rhythm & Blood Pressure Medications
Some heart and blood pressure medications are processed through enzyme pathways that CBD may affect. [1, 2, 4]
• Medications: Amiodarone, diltiazem, verapamil, metoprolol, carvedilol, losartan.
• Risk: May change medication levels, which could contribute to dizziness, low blood pressure, changes in heart rate, or increased medication side effects. [1, 2, 4]
5. Immunosuppressants & Transplant Medications
Some transplant and immune-suppressing medications require very precise blood levels and may be affected by cannabinoid-related enzyme or transporter changes. [1, 2, 6]
• Medications: Tacrolimus, cyclosporine, sirolimus, everolimus.
• Risk: May affect how these medications are processed, potentially causing levels to become too high or too low. Patients using transplant medications should not start CBD or CBG without medical supervision. [1, 2, 6]
6. Medications That May Affect the Liver
CBD has been associated with liver enzyme elevations, especially at higher doses or when combined with certain medications. [6, 7]
• Medications: Valproate, acetaminophen, methotrexate, leflunomide, terbinafine.
• Risk: Combining with medications that may stress the liver could increase the risk of liver enzyme changes. People with liver disease or liver-sensitive medications should consult a healthcare professional first. [6, 7]