Anita asked
I take Aspirin 100mg, Reaptan 5/10 BP Med (morning) and Atorvastatin 40mg (night). I'd like to know if CBD has any interaction with these meds. If so, what can I do? Especially with the Atorvastatin. I take CBD twice a day (0.2ml per day).
Answer
We have written extensively about potential interactions between CBD (cannabidiol) and prescription medication. One of these articles, which goes into depth about what CBD is and how it can potentially affect other medication, can be found here:
Below, we will list the highlights of that article and specifically look at aspirin and Lipitor (atorvastatin):
- Cannabidiol (CBD) is one of the many active constituents of the cannabis plant. It is a non-euphoric component, meaning it does not cause a "high". It would be incorrect to say it doesn't have psychoactive effects however, as studies show it can help with certain conditions like as anxiety and PTSD.
- CBD has been used to treat a variety of indications, including pain, inflammation, anxiety and epilepsy. In fact, the FDA recently approved a CBD prescription product (Epidiolex) for the treatment of epilepsy.
- There is a lack of data available regarding whether or not CBD interacts with prescription medication, including aspirin and Lipitor. However, CBD has been shown to affect certain liver metabolizing enzymes, which can therefore theoretically affect how drugs are metabolized.
- There is no specific data regarding an interaction between CBD, Lipitor and aspirin.
CBD Interaction With Lipitor And Aspirin
Recent studies do indicate that CBD can potentially affect the metabolism of a variety of drugs via inhibition of CYP metabolizing enzymes. Data indicates that CBD may inhibit the following liver metabolizing enzymes:
- CYP1A2
- CYP2B6
- CYP2C8
- CYP2C9
- CYP2C19
- CYP3A4
Metabolizing enzyme inhibition can lead to increased concentrations of drugs that are typical substrates for a particular enzyme. As an example:
- Drug X is metabolized via CYP2C9.
- Drug Y inhibits CYP2C9.
- Therefore, if taking Drug Y with Drug X, Drug X can have reduced metabolism, causing an overall increase in concentration.
- Increased concentrations of Drug X can increase the risk of side effects.
CBD And Aspirin
The likelihood of aspirin and CBD interacting is low. The vast majority of aspirin metabolism is not via CYP enzymes, and therefore, CBD shouldn't affect how aspirin is metabolized. Some studies suggest that aspirin, to a small extent, is metabolized via CYP enzymes, but if it is, it is minimal. So, there may be a small chance that CBD can prolong the metabolism time of aspirin, which may prolong the effects of the medication.
For what it's worth, the prescribing information for Epidiolex, the recently approved CBD product, does not list aspirin as an interacting drug and does not state that CBD can cause bleeding episodes.
CBD And Lipitor (Atorvastatin)
There is no data available regarding an interaction between CBD and Lipitor (atorvastatin). However, Lipitor is metabolized CYP3A4, which CBD may potentially inhibit. Per the prescribing information for Lipitor:
"LIPITOR is metabolized by cytochrome P450 3A4. Concomitant administration of LIPITOR with strong inhibitors of CYP 3A4 can lead to increases in plasma concentrations of atorvastatin."
Several studies have listed CBD as an inhibitor of CYP3A4. How strong of an inhibitor it is, and whether or not this inhibition is dose dependent (i.e. higher doses bring more effect) isn't well known. Some studies even note that while CBD does inhibit CYP3A4, the extent of the inhibition is not significant and the blood concentrations of CBD needed to affect it far exceeds what is possible with usual dosing.
Nevertheless, it is important to be aware of the potential interaction and the potential for increased side effects of Lipitor, most notably of which includes muscle pain or weakness.
Often times, when there is a significant interaction that involves increased Lipitor concentrations, a dose adjustment may be needed to reduce the risk of side effects. For examples, practitioners will sometimes recommend to "hold" or decrease the dose of Lipitor when taking a known strong inhibitor of CYP3A4, like clarithromycin. While this most likely is not necessary with CBD, it is a possibility for a small number of individuals.
Additional Information
As with all medication and supplements, it is important to make your doctor aware of everything you are taking so you can be appropriately monitored. Although the risk of significant interactions between CBD, aspirin and Lipitor don't appear to be high, there may simply be a lack of data available.
