Does CBD interact with Primidone, Gabapentin, or Atorvastatin?
Joanne Asked
Does CBD interact with Primidone, Gabapentin, or Atorvastatin?
Summary
Answer
Thanks for reaching out with your question. Many patients taking cannabidiol (CBD) are using it alongside other prescription medications, and may have concerns about possible drug-drug interactions (DDIs).
While we have information about CBD's likelihood to interact with certain medications, there is often a lack of data about this topic. Let's take a look at each medication mentioned in your question below!
Does CBD interact with Primidone?
Primidone is an anticonvulsant medication, meaning it helps to control seizures in people with epilepsy. It's also sometimes used to manage a neurologic condition called tremor that causes involuntary shaking. Primidone is metabolized into phenobarbital and another active metabolite by enzymes in the liver, particularly CYP2C9, CYP2C19, and CYP2E1. Primidone is also a known CYP3A4 inducer. This means it speeds up the rate at which the enzyme functions, increasing the metabolism of drugs metabolized by CYP3A4.
CBD is also metabolized by CYP enzymes in the liver. The major enzymes that contribute to its metabolism are CYP2C19 and CYP3A4. CBD is capable of inhibiting the CYP2C19 enzyme, which could reduce primidone's metabolism and conversion into the active metabolite phenobarbital, resulting in reduced effectiveness of the medication. Since primidone induces or speeds up the CYP3A4 enzyme, this could increase the metabolism of CBD, leading to reduced effectiveness of your CBD supplement.
Does CBD Interact with Gabapentin?
Gabapentin is another anticonvulsant medication used to treat seizures and a specific type of pain called neuropathic pain. Fortunately, gabapentin isn't metabolized in the liver, so we don't have to worry about an interaction with CBD there. On the other hand, both medications can cause somnolence (drowsiness). Drowsiness occurs in about 20% of patients treated with gabapentin and about 20-30% of patients taking high doses of CBD (10-20mg/kg/day). Taking both medications might increase the risk of drowsiness. If you're on a lower dose of CBD the risk of drowsiness with the combination is likely much lower.
Does CBD interact with Atorvastatin?
CBD and atorvastatin (Lipitor) are both metabolized by CYP3A4; CBD could potentially inhibit or decrease the activity of the CYP3A4 enzyme. Theoretically, this could increase atorvastatin levels in the body, increasing the risk of certain side effects such as stomach upset, diarrhea, or rhabdomyolysis (muscle breakdown). For more on this topic, check out our dedicated article on this question.
To Summarize
CBD and gabapentin can both cause drowsiness, so using them together may increase that risk. CBD may also interfere with the metabolism of primidone and atorvastatin. It is important to note that these risks depend on the dose of CBD you're using and how you're using it. If you take CBD sublingually or via another route other than oral (pills, capsules), the interactions in the liver are less of a concern because these methods of administration avoid CBD making it to the liver. Using lower doses of CBD reduces the risk of an interaction across the board.
As with any herbal supplement, be sure to talk to your doctor about using CBD in conjunction with the medication you listed in your question.
- Epidiolex. Carlsbad, CA: Greenwich Biosciences; 2018. [package insert].
- Lipitor. Dublin, IR: Pfizer Pharmaceuticals; 2009. [package insert].
- Mysolin. Aliso Viejo, CA: Valeant Pharmaceuticals; 2009. [package insert].
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