CBD, short for cannabidiol, is a cannabinoid people take to help with pain, inflammation, or anxiety. Whether it’s from hemp or cannabis, CBD has the potential to interact with any other medication or supplement you take. CBD is a stronger inhibitor of p450 enzymes, the enzymes in your liver that break down drugs, than THC or CBN. This means there is a greater chance of a drug interaction when using CBD than THC or CBN.
One class of drugs that can interact with CBD are benzodiazepines, commonly used to treat anxiety. Specifically, Xanax, also known by its generic name alprazolam, can interact with CBD. A liver enzyme called CYP3A4 is the main way Xanax is broken down, and thus taking CBD with Xanax make increase the amount of time Xanax is in your bloodstream, causing an increased risk of sedation, addiction, or suicidal thoughts.
"The initial step in alprazolam metabolism is hydroxylation catalyzed by cytochrome P450 3A (CYP3A). Drugs that inhibit this metabolic pathway may have a profound effect on the clearance of alprazolam. Consequently, alprazolam should be avoided in patients receiving very potent inhibitors of CYP3A. With drugs inhibiting CYP3A to a lesser but still significant degree, alprazolam should be used only with caution and consideration of appropriate dosage reduction. For some drugs, an interaction with alprazolam has been quantified with clinical data; for other drugs, interactions are predicted from in vitro data and/or experience with similar drugs in the same pharmacologic class."
There have been no case studies or clinical trials documenting a Xanax and CBD interaction, but based on how other potent inhibitors of CYP3A4, including ketoconazole, nefazodone, and cimetidine increase blood levels of Xanax, I suggest that Xanax dosage be reduced while taking CBD, and eliminated if possible under the care of your doctor.
For some people, there may be a huge drug interaction, while others, only a modest one. How big the drug interaction, if any, may depend on three things: 1) how you take the CBD 2) how much of the CBD you take and 3) your genetic profile. If you use a CBD topical cream, the CBD will not get into your bloodstream and will not inhibit p450 liver enzymes. Thus, the safest way to use CBD if are using a drug that interacts with it is a topical pain relief cream. However, this may do little for your anxiety unless applied to tense muscles in your neck and back.
One way to potentially avoid a drug interaction when taking CBD oil or gummies could be by making sure you space out your consumption of Xanax and CBD. For example, take your CBD in the morning, and your Xanax at night.
One word of extreme caution: if you take Xanax and CBD, please don’t drink alcohol, as the risk of sedation, overdose, and even death skyrockets.