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Taking CBD (Cannabidiol) With Lipitor (Atorvastatin) And Aspirin

The pharmacist discusses whether or not CBD interacts with Lipitor or aspirin.

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:

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.

The pharmacist discusses whether or not CBD interacts with Lipitor or aspirin.

CBD and blood-thinning drugs

Some studies found that CBD may increase the effects of medications used for blood thinning like warfarin or drugs with a risk of blood-thinning including ibuprofen 2 .

CBD can increase the action/effect of these medications, and prolong their presence in the human body. As a result, taking CBD with blood-thinning drugs may increase the risk of bleeding. CBD users should keep in mind that it is safer to monitor the usage of both simultaneously by a medical professional.

CBD and sedatives

CBD interacts with receptors in the central nervous system, and it can have sedative effects like calming and wake-inducing. When combined with sedative drugs, CBD may produce an additive effect 3 .

But in most cases, it depends on the individual. Some CBD consumers do not experience any adverse effect after they use both simultaneously. But before combining them, it is better to know your reaction and to play safe; it is recommended to avoid taking CBD with sedatives.

CBD and anti-seizure medications

CBD is known to help in epileptic seizures 4 . But simultaneous usage of CBD with anti-seizure drugs can lead to specific problems.

Some studies found that CBD may interfere with the metabolism of certain anti-seizure drugs in the liver and thus leading to severe interactions.

Thought CBD might potentiate the action of epilepsy drugs, but it may also increase chances of side effects like dizziness, constipation, breathing problems and even depression 5 .

CBD and statins

Statins are drugs used to reduce cholesterol levels in the human body and help reduce the risk of heart diseases. Some findings show that statins interact with CBD. If a person uses both frequently, it can lead to the increased concentration of medicines causing dangerous chemical accumulation 3 .

CBD and muscle relaxants

Muscle relaxants, according to some findings, can also cause some interactions with CBD. Researchers classify muscle relaxants interactions with CBD as moderate. But some people experience side effects like dizziness, lack of concentration and confusion 6 .

CBD and antibiotics

There are little or no drug interactions between CBD and antibiotics. Some findings show that taking CBD and antibiotics like rifampin together may decrease the effect of CBD 6 .

CBD and other supplements

Using CBD with some sleep-inducing supplements can lead to the additive sleepy effect. It does not mean that all CBD users will feel it. But medical experts recommend avoiding combining CBD and herbs causing sleepiness when you have to perform some technical operations.

CBD can be beneficial but it can cause some unwanted interactions when you combine it with other drugs. Therefore, knowing about such interactions may help avoid complications.

CBD and blood-thinning drugs Some studies found that CBD may increase the effects of medications used for blood thinning like warfarin or drugs with a risk of blood-thinning including ibuprofen 2