CBD & THC Drug Interactions

Cannabidiol (CBD)

Metabolized through CYP3A4 and CYP2C19.

CYP3A4
 
Inhibitors** & Inducers same as above.

CYP2C19

Substrates – are processed into metabolites

Aripiprazole, Carisoprodol, Citalopram*, Clomipramine, Clopidogrel, Clozapine, Desipramine, Diazepam*, Diphenhydramine, Doxepin, Escitalopram*, Fluoxetine, Imipramine, Lansoprazole, Mephenytoin, Methadone, Moclobemide*, Nelfinavir, Olanzapine, Omeprazole*, Pantoprazole*, Pentamidine*, Phenobarbital, Phenytoin, Proguanil*, Propranolol, Rabeprazole, Sertraline*, Thalidomide*, Voriconazole, R-warfarin

*CYP2C19 is the primary pathway.

Inhibitors**
 
Chloramphenicol, Cimetidine, Clopidogrel, Delavirdine, Efavirenz, Esomeprazole, Felbamate, Fluconazole, Fluoxetine, Fluvoxamine, Isoniazid, Moclobemide, Modafinil, Omeprazole, Oxcarbazepine, Ticlopidine, Voriconazole

Inducers

Aminoglutethemide, Artemisinin, Barbiturates, Carbamazepine, Phenytoin, Primidone, Rifampin, Rifapentine, St. John’s wort

** Inhibitors raise the level of THC

THC

Metabolized through the cytochrome P450 system specifically CYP2C9 and CYP3A4.

CYP3A4
 
Inhibitors**

Ketoconazole, Clarithromycin, Erythromycin. Cyclosporine, Verapamil, Itraconazole, Voriconazole, Boceprevir
 
Inducers
 
Rifampin
 
CYP2C9*

Inhibitors**

Fluconazole, Efavirenz, Miconazole, Amiodarone, Nicardipine, Delavirdine, Gemfibrozil, Capecitabine, Fluorouracil, Floxuridine, Midostaurin, Curcumin, Sildenafil, Fluvoxamine, Valproic Acid, Sorafenib, Clotrimazole, Abiraterone, Crisaborole, Nabilone, Progesterone, Fluoxetine, Amitriptyline, Imipramine, Regorafenib, Phenylbutazone, Iproniazid, Genistein, Lenvatinib, Vemurafenib, Cimetidine, Dicoumarol, Lansoprazole, Omeprazole, Zafirlukast, Ethanol, Cyclosporine, Ritonavir, Rosuvastatin, Ketoconazole, Clevidipine, Felodipine, Nilvadiopine, Metronidazole, Quinidine, Oritavancin

* Patients who are poor metabolizers have a 3X higher THC concentration.
** Inhibitors raise the level of THC
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