In our latest question, our cannabis pharmacist discusses whether using CBD alongside the antidepressant medication sertraline is safe. CBD is a popular alternative treatment for anxiety and depression, but will it help or worsen the side effects of sertraline (Zoloft) if used together? Considering taking CBD and sertraline? Or looking to replace sertraline with CBD? Here's the guide on what you need to do, potential outcomes, and studies.
Is it Safe to Use CBD and Zoloft (sertraline) at the same time?
In our latest question and answer, the medical cannabis pharmacist discusses if it is ok to use CBD oil while taking sertraline.
Answered by: Dr. Geoffrey Brown, PharmD
I take Zoloft for my depression and would like to start supplementing CBD to reduce inflammation and help with anxiety. Is it safe to use with Zoloft?
There is limited data available on CBD’s potential to cause interactions with sertraline (Zoloft).
CBD may inhibit metabolic enzymes involved in the metabolism of sertraline but, the chances of CBD causing clinically significant interactions with sertraline are rather low.
Be sure to let your psychiatrist or doctor that manages your sertraline therapy know that you’re using CBD.
Hi Khia, and thank you for your question. While I couldn’t find any studies investigating this interaction in particular, I was able to find some information regarding the metabolism of both of drugs which can help us answer questions about the likelihood of an interaction.
In short, CBD may inhibit some of the enzymes that’re involved in the metabolism of sertraline (Zoloft). Therefore, theoretically, there is a possibility the two could interact. However, the likelihood that this interaction would be clinically significant or something you need to be concerned with is rather low.
Sertraline (Brand name Zoloft) is a selective serotonin reuptake inhibitor or SSRI and is the most commonly prescribed antidepressant medication in the United States. Sertraline is metabolized by a number of CYP enzymes present in the liver including CYP2B6 and to a lesser extent CYP2C19, CYP2C9, CYP3A4, and CYP2D6 . According to the manufacturer’s package insert for sertraline, that’s reviewed by the FDA, dose reductions may be warranted in patients treated with sertraline that are taking other drugs metabolized by these enzymes.
Cannabidiol (CBD) is the primary non-euphoric cannabinoid in cannabis/hemp and is now a common ingredient in many health and consumer products. One of the most commonly claimed indications for CBD is anxiety. Preliminary evidence suggests CBD shows promise as a potential treatment for anxiety, but the doses researched vary greatly between studies.
CBD is also metabolized by CYP enzymes in the liver, so using CBD may alter the way these enzymes function in regard to their ability to metabolize other drugs such as sertraline.
According to the package insert for the FDA approved CBD oral solution, CBD is metabolized by CYP3A4 and CYP2C19, and has the potential to inhibit CYP1A2, CYP2B6, CYP2C8, CYP2C9, and CYP2C19. Therefore, because CBD can inhibit some of the same enzymes that’re responsible for the metabolism of sertraline, there’s a possibility that CBD could reduce the metabolism of sertraline leading to increased concentrations of the drug in the body increasing the risk of adverse effects due to sertraline.
While there’s certainly a theoretical basis for this interaction, I would not be too concerned about this from a safety standpoint for two reasons. For one, the blood concentrations of CBD needed to inhibit these enzymes aren’t likely to be achieved by CBD taken at usual doses. The second reason is because multiple CYP enzymes are responsible for the metabolism of sertraline it would be difficult for CBD alone to cause a serious interaction by interfering with just one or even a couple of those enzymes. That being said, i t’s still a good idea to let your doctor of psychiatrist that manages your sertraline therapy know that you’re using CBD. That way they can monitor for any changes or adverse effects from changes in sertraline metabolism.
To summarize, there’s a possibility an interaction between CBD and sertraline could occur, but unless you’re consistently using high doses of CBD (upwards of 100 mg multiple times per day) I wouldn’t worry too much about it. I hope this helps answer your question.
Thanks again Khia. Please don’t hesitate to reach out again in the future with any cannabis questions you have.
Zoloft [package insert]. New York, NY: Pfizer, Inc. 2016.
Epidiolex [ package insert ]. Carlsbad, CA: Greenwich Biosciences, Inc. 2020.
Does CBD Interact With Sertraline (Zoloft)?
Information on risks & possible interactions between CBD & sertraline.
Zoloft, or sertraline, is an antidepressant of the selective serotonin reuptake inhibitor (SSRI) class. It’s used in treating depression, panic attacks, obsessive-compulsive disorder, post-traumatic stress disorder, and premenstrual dysphoric disorder.
Cannabidiol or CBD has been gaining attention for its positive effects on anxiety, insomnia, inflammation, and depression.
Studies are still underway, though, and not much is known about the many other effects it could cause. CBD decreases particular enzymes’ abilities to metabolize Zoloft, so using them together could worsen the latter’s effects; however, the research is limited.
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Does CBD Interact With Sertraline?
CBD may act as a competitive inhibitor for the same enzymes that metabolize sertraline (Zoloft). It can prevent the actions of cytochrome P450 enzymes, the same enzymes that metabolize sertraline; theoretically, using them together could decrease sertraline’s metabolization and, thus, increase its effects.
Because of this, sertraline might remain in the body for longer and could cause some side effects, ranging from simple ones to serious ones, such as serotonin syndrome.
However, there are not enough studies to determine exactly how much of an effect there will be by using sertraline and CBD together.
Other Names For Sertraline
Sertraline is sold under many different names. All share the same risk and potential interactions.
Other names for sertraline include:
Similar Medications: CBD & SSRIs
Sertraline is classified as an SSRI (selective serotonin reuptake inhibitor). CBD and SSRIs all share similar risks for interaction and side effects.
Here’s a list of similar medications that share a similar level of risk when combined with CBD:
- Citalopram (Cipramil & Celexa)
- Dapoxetine (Priligy)
- Escitalopram (Cipralex & Lexapro)
- Fluoxetine (Prozac, Rapiflux, Sarafem, Selfemra & Oxactin)
- Fluvoxamine (Faverin)
- Paroxetine (Seroxat)
- Vortioxetine (Brintellix)
Is It Safe to Take CBD & Sertraline Together?
Because of CBD’s effects on the enzymes that metabolize sertraline (Zoloft), the latter drug is likely to be more potent than usual. This could lead to side effects and, at worst, may cause excessive serotonin levels, leading to symptoms similar to serotonin syndrome.
There’s not much information on the side effects of mixing these two drugs, but be on the safe side and exercise extreme caution.
If you want to mix CBD with sertraline (Zoloft), talk to your doctor first.
Is CBD a Viable Alternative to Sertraline?
Because CBD lacks extensive studies on its effectiveness, it cannot be considered a good alternative to sertraline (Zoloft). For now, it’s best to continue your regular dosage of Zoloft and talk to your doctor.
Under the advice of your medical practitioner, you may take both medications, but if you experience any abnormal symptoms, immediately stop CBD and contact your doctor.
What Is Sertraline (Zoloft)?
Sertraline hydrochloride was invented and marketed by Pfizer with the brand name Zoloft. It was approved for use by the FDA in 1999.
Sertraline is metabolized in the liver by several cytochrome enzymes, including CYP2B6, CYP2C19, CYP2C9, CYP3A4, and CYP2D6.
|Other Names (other generics)||Lustral, Setrona, Zosert, Certrafine, Psyline, Sertima|
|CYP Metabolism||CYP2B6, CYP2C19, CYP2C9, CYP3A4, and CYP2D6|
|Interaction With CBD||Metabolic Competitor|
|Risk of Interaction||Moderate; patient needs careful monitoring|
What Does Sertraline (Zoloft) Do?
Sertraline (Zoloft) is an SSRI and inhibits the reuptake of serotonin in the brain.
Zoloft is used in treating depression, panic attacks, obsessive-compulsive disorder, post-traumatic stress disorder, social anxiety disorder, and premenstrual dysphoric disorder. Zoloft can also improve mood and sleep and make the patient feel a better sense of well-being.
Depression is a mental disorder characterized by persistent low mood and lack of interest in activities that the person had previously enjoyed. In most patients with depression, serotonin levels are deficient.
Serotonin is the hormone that stabilizes mood, feelings of happiness, and well-being. Its level decreases in conditions such as depression.
Sertraline binds to the serotonin transporter (SERT) and inhibits the CNS neuronal retaking of serotonin (5HT). It prevents the fast metabolism of serotonin, thus allowing it to last longer in the brain, long enough for the person to function well again.
Side Effects of Sertraline
Like most other medications, sertraline (Zoloft) also has side effects. It affects the body as a whole and not just one system. These side effects usually happen on overdosing or incorrect dosing of the medication.
Side Effects In More Than 10% of Patients:
- Ejaculation disorder
- Dry mouth
Side Effects In Less Than 10% of Patients:
Rare Side Effects:
- Back pain
- Chest pain
- Increased appetite
- Weight gain
Possible Complications With Sertraline
There are some things about sertraline (Zoloft) that one should know before taking it. In some instances, Zoloft can be more dangerous. Here are a few situations:
1. Monoamine Oxidase Inhibitors (MAOI)
It can interact with MAOIs causing a decrease in serotonin metabolism, leading to an increased serotonin level, called Serotonin Syndrome. Its symptoms are high blood pressure, rapid heart rate, nausea, vomiting, and anxiety, and can be dangerous.
The oral solution of sertraline contains alcohol, so using them together can cause flushing, headaches, nausea, and vomiting.
3. Liver & Kidney Impairment
Patients with liver and kidney problems cannot properly remove sertraline from the body; low doses under supervision are required.
Using sertraline during pregnancy can cause congenital heart defects in the newborn.
Breastfeeding mothers with depression can use sertraline since its appearance in breast milk is minimal.
6. Patients Under 25
One of sertraline’s significant side effects is an increased risk of suicide in people under 25 years. This age group requires constant monitoring.
What Is CBD?
CBD, or cannabidiol, is a compound extracted from cannabis, usually hemp, to comply with federal law. It’s the second most common cannabinoid in cannabis, making up almost 40% of it.
There are many ways to take CBD, including inhalation, orally, or topically — topical application only works on the area it’s applied to. It does not cause alterations in mood or intoxication like another popular cannabinoid, delta-9 tetrahydrocannabinol (THC).
CBD has been the topic of many studies over the past few decades. It’s useful in treating anxiety, cognition, movement disorders, and pain.
In 2018, a cannabidiol drug, Epidiolex, was approved by the FDA. Epidiolex is used for the treatment of two rare epilepsy conditions. In some parts of the world, CBD combined with THC in a 1:1 combination is approved for use in symptomatic relief for adults with Multiple Sclerosis.
What Does CBD Do?
CBD interacts with the endocannabinoid system (ECS); this complex system is found throughout the body and is composed of endocannabinoids, enzymes, and cannabinoid receptors.
There are two receptors of most importance in the ECS, called CB1 and CB2. CB1 is associated with the nervous system, while CB2 is found mainly in the immune system.
THC binds directly to the CB1 and CB2 receptors. CBD, however, alters the behavior of the receptors, causing a reaction.
CBD can activate 5-HT1A/2A/3A serotonergic receptors. While it doesn’t necessarily increase serotonin levels in the brain, it may affect the chemical receptors’ response to the already available serotonin .
CBD is metabolized in the liver by several cytochrome P450 enzymes and acts as a competitive inhibitor for these same enzymes. It occupies sites of enzymatic activity and displaces its chemical competitors. Due to this, these enzymes of cytochrome P450 are unable to metabolize other compounds.
CBD may have a benefit over other medications used in depression. While antidepressants take a few weeks to start working, CBD can show antidepressant-like effects much sooner.
CBD does not have side effects like most antidepressants do. There are no side effects like insomnia, sexual dysfunction, or mood swings with CBD .
Side Effects of CBD
- Potential liver damage
- Decrease in blood pressure
Important Points To Consider About CBD
You need to know a few things about CBD that may impact how you buy and use it.
The FDA Does Not Regulate CBD
Two drugs, Epidiolex and Sativex, contain CBD and have received approval for use.
CBD and CBD products are largely unregulated and are not FDA-approved. Unfortunately, this leaves a large gap, and the quality and safety of these products are often called into question. There are many good companies, but you have to watch out for the bad ones.
Often, companies lie about the amount of CBD in the products or add chemicals to make them seem more potent.
Even though many studies find CBD to be beneficial, the research is still lacking. We don’t know the full extent of its abilities and side effects yet, especially long-term.
Types of Drug Interactions With CBD
There are three different ways that CBD can interact with other drugs.
1. Agonistic Interaction (Increased Effect)
This happens when two substances have the same effects in the body due to both of them acting on the same receptors to push in the same direction.
These include drugs like:
- Antihypertensive medications — ACE inhibitors, alpha-blockers, angiotensin II receptor blockers, beta-blockers, calcium channel blockers, central agonists, and diuretics.
- Anti-anxiety medications — Benzodiazepines and barbiturates.
- Antidiabetic medications — Alpha-glucosidase inhibitors, biguanides, DPP-4 inhibitors, GLP-1 receptor agonists, meglitinides, SGLT-2 inhibitors, sulfonylureas, and insulin.
Antagonistic Interaction (Decreased Effect)
This decreases the effects of the medication.
These include medications like:
- Stimulants — Amphetamine, modafinil
- Immunomodulators — Antihistamines like carbinoxamine, desloratadine, levocetirizine
- Immunosuppressants — Azathioprine, mycophenolate cyclosporine, methotrexate
These medications need similar enzymes to break down the drug molecules, causing both types of medications to compete against each other, leading to a slow metabolism rate for both of them. They may increase the effects or decrease the effects.
These include medications like:
- Blood Thinners — Enoxaparin, heparins, and others
- NSAIDs — Ibuprofen, naproxen, high-dose asprin
- Opiate analgesics — Morphine, codeine, hydrocodone
- Antidepressants — Trazodone, mirtazapine, vortioxetine, and vilazodone
Key Takeaways: Is it Safe to Take Sertraline (Zoloft) With CBD?
While theoretically, taking sertraline with CBD could cause some serious side effects, the studies are still limited. It’s better to exercise caution and talk with your doctor before you use CBD with sertraline. If you feel any side effects on using these drugs together, seek medical attention immediately.
CBD and Sertraline, Read This Before Taking Both – Interactions and Side Effects
Considering taking both CBD and sertraline? If so, then you will need to understand the interactions and potential implications this might cause.
In this article, we’ll be guiding you through what happens if you take both CBD and sertraline, starting with a quick sum-up answer.
CBD and Sertraline? CBD and sertraline taken together are believed to interact adversely, increasing the side effects of sertraline. This includes increased dizziness, drowsiness, confusion, and difficulty concentrating. But the clinical significance of this is vague. CBD also reflects some sertraline properties.
The outcome for CBD and sertraline is not that promising, so do not stop taking your medication at this point. Proceed with caution and consult your doctor before taking these elements together.
What are CBD and sertraline?
Before beginning with this topic, it’s important to get a breakdown of what these two components are.
What is CBD
CBD is short for cannabidiol and is a known chemical compound of the cannabis sativa plant. This compound is naturally occurring and is added to products such as oils and other edibles.
Unlike some other components of the cannabis sativa plant – CBD is not psychoactive. Meaning it will exhibit its benefits without the feeling of becoming high.
CBD is a supplement used mainly to provide the user with a feeling of calmness and relaxation, including promoting positive sleep patterns.
CBD is also used for treating conditions such as anxiety, insomnia, and a variety of chronic pain. But it can cause side effects such as headaches.
What is sertraline
Sertraline is an antidepressant sold under the brand name Zoloft.
Sertraline is known as a “selective serotonin reuptake inhibitor” or (SSRI) and works by restoring the balance of serotonin in the brain.
It is used for treating a variety of conditions starting from, but not limited to:
- Obsessive-compulsive disorder
- Panic attacks
- Stress disorder
- Social anxiety disorder (social phobia)
- Severe forms of premenstrual syndrome (premenstrual dysphoric disorder)
Aside from its benefits, drugs like sertraline do have their side effects. Still, sertraline helps improve your overall mood, supports quality of sleep, and boosts appetite and energy levels to restore your interest in daily living. It also reduces fear, anxiety, and other unwanted thoughts.
Moreover, it can reduce your urge to perform repeated tasks that disturb your daily routine.
When comparing CBD with sertraline, they both exhibit general characteristics in terms of treating anxiety and promoting a sense of calmness and relaxation.
However, the use of both in combination has a different perspective as to its safety and effectiveness.
Can you take CBD with sertraline?
Firstly, it’s important to mention that CBD has gained much popularity recently. This popularity is what helped CBD reveal its medicinal nature. Consumers then began mixing CBD with prescription medications in the hope of maximizing effectiveness.
Because of this recent trend of using CBD for medicinal purposes, there is a distinct lack of studies to validate drug interactions for many drugs, including CBD and sertraline.
The studies we know of that we can fall back on help us answer whether you can take CBD with sertraline.
It’s believed that using CBD with sertraline is likely to worsen the side effects of sertraline.
Specifically, using sertraline with CBD can increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. To add to this, the elderly may experience impairment in thinking, judgment, and motor coordination when sertraline is taken alongside CBD.
In general, it’s believed that CBD does have some theoretical drug interactions. However, many believe that the interactions are only mild or rare and would not bring about any severe reactions. However, there is not enough clinical evidence to say for sure.
A solid answer to whether you can take CBD with sertraline is still largely unknown because of unstudied potential interactions.
So with that in mind, it’s best to understand more about how CBD could interact with sertraline. Let’s tackle that next.
How can CBD interact with sertraline?
Sertraline is an SSRI (Selective Serotonin Re-uptake Inhibitor) that requires extensive metabolization by various CYP enzymes, including ones like CYP2B6, CYP2C19, CYP2C9, CYP3A4, and CYP2D6.
The metabolization of any medications is essential to get rid of the pharmaceutical compounds from the body.
The slower the drug metabolization process is, the more the drug stays in the system, causing potential toxicity and other dangerous outcomes.
In contrast to this process, research indicates that CBD inhibits many of the metabolizing enzymes listed above. This increases the risk of adverse effects as a result of increasing sertraline concentration in the body.
Meaning, the longer sertraline stays in the body because CBD inhibits its metabolizing enzymes, the greater the concentration of sertraline remains in the system, which can be toxic and cause adverse effects.
Can CBD and sertraline interaction severe?
Although theoretical reasoning says that CBD and sertraline interactions can pose adverse effects, some data and studies say otherwise.
Firstly, additional data on CBD interaction states that the risk of CBD interacting with sertraline is specifically is low.
Secondly, many studies project that even if CBD inhibits certain specific enzymes necessary for metabolizing sertraline, it is not significant. The blood concentration required to affect and inhibit these enzymes significantly exceeds regular CBD dosages.
Third and finally, another study states that because sertraline is metabolized with the help of several enzymes, it would be complex for a single agent like CBD to cause a severe or clinically important interaction.
However, while clinical reasonings opposed the conclusions of theoretical reasoning, we can only make general educated guesses until studies are completed that provide a more substantial data set and a solid conclusion.
So, be advised, it is crucial that you consult your doctor if you want to combine CBD with sertraline and follow any guidance they provide.
Can CBD replace sertraline?
With such interaction-based confusions, it’s common to wonder whether CBD can replace sertraline, given the fact that they have similar properties.
Starting with a study undertaken in 2018, published in the Frontiers in Immunology, CBD was demonstrated as a potential remedy for depression, similar to how sertraline is taken for depression.
The study found that CBD exhibits anxiolytic (anti-anxiety), antiepileptic, and antipsychotic properties, which can reduce depression linked to stress. This benefit of CBD for depression tends to be linked to its positive impact on serotonin receptors in the brain.
In another study published in Frontiers in Neuroscience, also in 2018, it was stated that CBD might help treat a variety of psychological conditions. Such conditions include mental health and post-traumatic stress disorder (PTSD) – the same conditions for which sertraline is commonly prescribed.
CBD also appears to work faster than most antidepressant medications, including sertraline, which in most cases takes weeks to start performing.
To back this up, a study published in the British Journal of Pharmacology found that CBD induced fast and sustained antidepressant-like effects in animal models comparable to those of imipramine. Imipramine is a tricyclic antidepressant (TCA) used mainly for the treatment of depression.
Dependent on brain serotonin
However, deviating from these positive statements, a further study published in Progress in Neuro-Psychopharmacology & Biological Psychiatry Journal shows that these antidepressant-like effects induced by CBD are dependent on brain serotonin levels.
Moreover, as of now, no study has provided evidence that CBD can be used specifically to replace sertraline.
So, to conclude on this point, replacing sertraline with CBD is not recommended, and as always, we would recommend that you consult with your doctor if you plan to do so.
We hope this has helped you to understand the interactions, risks, and benefits around CBD and sertraline.
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