Linda asked
I started taking CBD hemp oil for insomnia. If it doesn’t make me sleep all night, can I take a 0.25 Xanax? I have been taking Xanax for sleep and I am trying to stop. I just want to do CBD.
At a glance
- CBD can potentially increase the effects of Xanax (alprazolam).
Answer
There is a potential interaction between CBD (cannabidiol) and Xanax (alprazolam).
There are actually two issues here:
- CBD can decrease the metabolism of Xanax, increasing its effects.
- Taking both together could cause additive sedation.
It is important to note that we don't have a lot of data or historical information regarding CBD drug interactions, so we don't know exactly how significant these potential effects can be. Nevertheless, I discuss both in greater detail below.
Potential Interaction
There are several ways to characterize a drug interaction and they occur via more than one mechanism.
Regarding CBD and Xanax, we not only have a 'pharmacokinetic' interaction in that the metabolism of Xanax may be reduced, but we also have the risk of additive side effects.
Xanax Metabolism
Xanax is metabolized in our body via the liver metabolizing enzyme CYP3A4.[1]
There is some evidence (although it isn't strong), that CYP3A4 may be partially inhibited by CBD.[2][3] Therefore, Xanax won't be metabolized as efficiently, leading to increased concentrations of the drug for longer periods of time. This obviously has the potential to potentiate the effects of Xanax.
I mention that the evidence isn't strong regarding CYP3A4 inhibition because while lab studies do confirm that the enzyme is at least partially inhibited by CBD, many drug interaction studies note they haven't seen any clinically significant effects from it.[4]
It would be prudent to monitor yourself for side effects with Xanax (like sedation, drowsiness and shallow breathing) if you do take it with CBD.
Additive Sedation
Both Xanax and CBD can cause sedation.
Xanax is a well-known CNS depressant and some sources classify CBD as one as well.
While CBD may certainly cause CNS depression in some form, it is not known to cause respiratory depression like Xanax (and all benzodiazepines for that matter), even at high doses.[5][6]
Nevertheless, the prescribing information for Epidiolex, a prescription CBD product, does warn about its use with other CNS depressants.
"Concomitant use of EPIDIOLEX [CBD] with other CNS depressants may increase the risk of sedation and somnolence."
Final Words
As mentioned at the outset, there certainly is some interaction between CBD and Xanax, but how significant it is isn't well known.
There does certainly appear to be at least some risk of additive effects, like sedation, but beyond that, they may be safe together.
Perhaps the biggest concern is the risk of respiratory depression. If CBD increases Xanax concentrations, this risk could be increased, but again, whether or not CBD inhibits CYP3A4 to a significant degree isn't known.
Be sure to discuss the use of CBD with your doctor before using see you can be appropriately monitored for side effects and effectiveness.
References
- ^ Elsevier ClinicalKey: Alprazolam Monograph. ClinicalKey
- ^ An Update on Safety and Side Effects of Cannabidiol: A Review of Clinical Data and Relevant Animal Studies. PubMed
- ^ Potent inhibition of human cytochrome P450 3A isoforms by cannabidiol: role of phenolic hydroxyl groups in the resorcinol moiety. PubMed
- ^ Human Metabolites of Cannabidiol: A Review on Their Formation, Biological Activity, and Relevance in Therapy. PubMed
- ^ Cannabis and the Opioid Crisis. PubMed
- ^ Safety and pharmacokinetics of oral cannabidiol when administered concomitantly with intravenous fentanyl in humans. PubMed
