Can you take CBD while taking metformin? Can they interact when taken together? We’ll explain the details about their interactions in this article. Since metformin is capable of treating type 2 diabetes, it may be used with CBD to improve the quality of life for people with the condition. Learn more.
Does CBD Interact With Metformin?
Information on risks & possible interactions between CBD & metformin.
Metformin is an anti-diabetic drug. It is the most common medication used in lowering blood sugar levels in type II diabetes and polycystic ovarian disease.
Unfortunately, metformin also comes with a host of negative side effects. Many people wonder whether or not CBD is a viable alternative to this common prescription medication or if they are safe to use together.
We’ll explore the potential interactions to watch out for between CBD (and other cannabinoids) and metformin.
Table of Contents
Does CBD Interact With Metformin?
Yes, CBD and metformin, when taken together, may cause a dramatic drop in blood sugar levels — leading to side effects like dizziness, fainting, and injury.
It’s best to take CBD and metformin about 2 hours apart to avoid these potential side effects.
CBD can interact with metformin in two ways:
1. Increased Effect (Agonistic Interaction)
CBD may have an agonistic reaction when used with metformin. Both medications act on the blood sugar in the body. Both metformin and CBD can cause a decrease in the blood glucose level, though the mechanisms by which they do this are very different from one another.
Metformin makes the cells more responsive to insulin and increases lipid metabolism. CBD works on the endocannabinoid system (ECS) of the body and may be responsible for the increased insulin amount in the body. These interactions between the two can help lower blood sugar in diabetic patients. However, it largely depends on the physiology of the individual’s body as it may lead to a rapid drop in blood sugar in some patients, causing dizziness, fainting, etc.
2. Slowed Elimination (Metabolic Inhibition)
The second interaction that these two medications can have is the metabolic one. Both of them can compete for the same liver enzymes, mainly CYP3A4. It may cause a rise in the concentrations of both drugs for a longer duration and take a longer time for the removal from the body. This interaction could lead to several side effects.
There have been no reported incidents of the side effects of using these two drugs together to date. There is no available research to determine how these two drugs interact with one another and the complications they may have. Thus, the risk of interaction is less, but not completely nonexistent.
Other Names For Metformin
Metformin is sold under many different names. All share the same risk and potential interactions.
Other names for metformin include:
- Xigduo XR
- Kombiglyze XR
Is It Safe to Take CBD & Metformin Together?
It is possible to take both CBD and metformin as they have a very mild chance of interaction. But it is always best to take caution, as both drugs have their side effects and may cause the blood sugar to lower more than needed if used together. Talk to your doctor first and get their expert opinion. Never take these two medications by yourself without any medical supervision.
If you decide to take both drugs, it is possible to reduce the side effects by taking only small doses of both drugs at first. The dosage of both drugs depends on your body’s condition and needs. Avoid taking them together and try spacing between the doses of the two drugs.
Depending on your body’s response to these two medications, the dosage of CBD and metformin can be decreased or increased. If you feel any abnormal side effects at all, contact your doctor immediately.
Is CBD a Viable Alternative to Metformin?
CBD does not contain any psychoactive elements and has many benefits. It works by acting on the endocannabinoid system of the body by working on its receptors. This ability may play a vital role in energy regulation by affecting the cells’ response to insulin. Hence, CBD may help the cells to respond better to insulin and decrease the level of lipid in the body.
CBD, combined with the cannabis compound tetrahydrocannabivarin (THCV), can increase insulin production and lower blood sugar in diabetic patients.
A study has shown that CBD can cause the ‘fat browning’ process, which can help in lipid metabolism and prevent obesity.
CBD also has anti-inflammatory and anti-oxidative properties and may help reduce inflammation in the pancreas and help to produce insulin.
Because of the many benefits of CBD, it may be possible for it to become an alternative for anti-diabetic treatment. However, adequate research and studies about it are still lacking. There is not much information about its positive and negative effects on diabetic patients, so CBD is not a perfect replacement for metformin.
If you decide to use CBD while using metformin, you must consult your healthcare professionals first and get yourself assessed. Use the medications as directed, at the right time, and do not take more than needed.
What is Metformin?
Metformin is a type of biguanide antihyperglycemic drug. It is used as a first-line treatment for type II diabetes and in treating polycystic ovarian disease.
It can control the level of blood sugar in the body by decreasing the glucose production in the liver, increasing the sensitivity of the cells to insulin, and increasing the GDF (growth differentiation factor 15), which reduces appetite and calorie intake.
|Drug Name||Metformin hydrochloride|
|Trade Name||Fortamet, Glucophage, Glucophage XR, Glumetza, Riomet, Kazano, Invokamet|
|Other Names||1,1-Dimethylbiguanide hydrochloride|
|CYP Metabolism||Not metabolized gets excreted unchanged in the urine|
|Interaction With CBD||Agonistic, increased effect|
|Risk of Interaction||Mild|
What Does Metformin Do?
Metformin lowers the level of blood glucose in diabetic patients without causing hypoglycemia.
Diabetes is a chronic condition in which there will be a high level of sugar in the blood. Typically, when the body receives sugar from the diet, the pancreas releases the hormone insulin. Insulin controls blood sugar levels and enables the cells to absorb glucose to use as an energy source.
Several factors such as genetics, excess body fat, and others can cause the blood cells to become insensitive to insulin. It causes the cells to absorb less sugar, causing a high amount of it to flow in the blood circulation instead, making the insulin ineffective. This leads to an elevation in blood glucose, insulin resistance, and insulin deficiency as well. With time, it can cause many effects such as kidney damage, high blood pressure, etc.
Metformin decreases the liver’s ability to produce glucose (gluconeogenesis) and opposes the action of glucagon. It also activates the 5′-AMP-activated kinase (AMPK), which increases the uptake of glucose by the cells. It also decreases lipid synthesis and increases the oxidation of fatty acids. It also increases insulin sensitivity and increases peripheral glucose uptake and use.
Metformin is prescribed along with a suggestion of a proper diet and exercise program. The combination of these can normalize blood sugar and maintain weight.
Metformin shows to be effective in treating high blood sugar, restoring ovulation, and reducing weight in polycystic ovarian disease (PCOD). It is also undergoing studies for its potential anti-cancer abilities.
The liver does not metabolize metformin; instead, it’s excreted unchanged in the urine. But it does affect the workings of the liver enzyme called CYP3A4.
Metformin is not recommended for use in several conditions. This includes metformin hypersensitivity, congestive, cardiac failure, diabetic ketoacidosis with or without coma, severe renal disease, and abnormal creatinine clearance.
Side Effects of Metformin
- Abdominal distention
- Chest discomfort
- Gastrointestinal upset
- Lactic acidosis
Types of Drug Interactions With CBD
CBD has shown to be safe and useful in the treatment of many conditions. But like most other drugs, CBD can interact with other medicines. Thus, any combination of drugs with CBD must be supervised. If you take any medications alongside CBD, always remain vigilant and look out for abnormal side effects.
There are three ways that CBD can interact with other drugs:
1. Agonistic Interaction
This happens when two medicines work on the same receptors on the body leading to increased effects.
Examples of medications that could cause agonistic interaction with CBD are:
- Antihypertensive medications— These include beta-blockers, calcium channel blockers, central agonists, diuretics, ACE inhibitors, alpha-blockers, and angiotensin II receptor blockers. CBD can react with these and cause a drop in blood pressure.
- Anti-diabetic medications —These include GLP-1 receptor agonists, meglitinides, SGLT-2 inhibitors, sulfonylureas, and insulin, alpha-glucosidase inhibitors, and DPP-4 inhibitors.
- Anti-anxiety medications —These include drugs like benzodiazepines and barbiturates. CBD could make their effects last longer.
2. Antagonistic Interactions
This is the opposite of the agonistic interaction. It happens when two drugs have effects opposite of each other. If taken together, one drug would cross out the effects of the other, causing a decreased efficacy of the second drug.
Drugs that have antagonistic interaction with CBD are:
- Immunosuppressants — These include azathioprine, mycophenolate cyclosporine, methotrexate, etc. CBD’s immune-stimulating properties may decrease the effects of these drugs.
- Stimulants — These include amphetamine and modafinil. CBD can cause their effects to lessen.
- Immunomodulators —These include antihistamines like carbinoxamine, desloratadine, levocetirizine. CBD could increase their sedative action.
- Asthma Medications — These include drugs like albuterol, fluticasone, montelukast, ipratropium bromide, and theophylline. CBD may counteract their abilities, especially theophyllines’.
3. Metabolic Inhibition
Some medications need similar enzymes to break down the drug molecules. It leads to both drugs competing against each other, causing their metabolism to slow down.
These include medications like:
- Blood thinners— CBD could cause an increase in the action of warfarin, enoxaparin, heparin, and others that could be very unsafe.
- NSAIDs— These include ibuprofen, naproxen, and high-dose aspirin. CBD could make them last longer in the body.
- Opiate analgesics— These include morphine, codeine, and hydrocodone. CBD could make them last longer in the bloodstream, causing complications.
- Antidepressants —CBD can make these drugs last longer in the body by slowing down their metabolism. Antidepressants include trazodone, mirtazapine, vortioxetine, vilazodone, and others.
Key Takeaways: Is it Safe to Take Metformin With CBD?
CBD has the potential to become an alternative for the treatment of diabetes in the future.
CBD and metformin can have a mild interaction where both drugs last longer in the body and lower blood sugar levels below normal.
While they have very little chance of interaction, you must exercise caution on using both. Use them only under the guidance of a certified physician, and in case of any abnormal side effects, get medical attention immediately.
CBD and Metformin – August 2022
Metformin is a U.S. Food and Drug Administration (FDA) approved medicine commonly used to treat type 2 diabetes. Doctors often prescribe this drug on its own or in combination with other diabetes medications to manage high glucose levels (6 ) .
The medication has proven to be effective in preventing diabetes in high-risk individuals while also lowering the majority of its complications. Although there are some adverse reactions to metformin use, reports state that these effects are trivial when considering the benefits (7 ) .
Cannabidiol (CBD), on the other hand, is a phytocannabinoid present in the Cannabis sativa plant. It is the non-euphoric component in cannabis that is said to contain therapeutic properties.
A study in 2016 on diabetic mice reveals that CBD treatment is capable of lowering the incidence of diabetes in the subjects. The mice were given a daily dose of 5 mg/kg CBD at least five times a week for ten weeks (8 ) .
Additional research in 2018 investigates the mechanism of action of phytocannabinoids as anti-diabetic and anti-obesity agents. The study shows that cannabinoids can potentially support the treatment of insulin resistance caused by diabetes and obesity (9 ) .
Seeing as metformin can effectively treat diabetes while CBD has possible healing properties, it is only natural to think of combining the two of them. However, there is no study proving that these products are compatible with each other.
There are enzymes in the liver that metabolize the number of active ingredients in medications taken by an individual. These are also the same proteins that the body uses to break down CBD.
In past research, CBD is seen as a potent inhibitor of cytochrome P450 enzymes. As an inhibitor, this means that taking it along with other medications may hinder liver enzymes from correctly processing other drugs (10-11 ) .
Such a scenario could lead to increased or decreased levels of active medicines in the blood, causing problems related to toxicity or being subtherapeutic.
CBD interaction with CYP450 can alter how it affects the endocannabinoid system (ECS). The ECS is a complex system found in humans and animals that regulates the central nervous system, among others (12) .
Metformin use comes with its side effects, and the more this medication enters the bloodstream, the higher the possibility of harmful reactions. Although its effects are not significant, it may cause a condition known as lactic acidosis. This condition brings with it symptoms such as muscle pain, drowsiness, dizziness, chills, and difficulty in breathing (13 ) .
Since there is no clear indication of whether metformin users are at risk or not, if they use CBD, it is always better to err on the side of caution. People using metformin for diabetes should consult a doctor knowledgeable in cannabis before applying CBD in their regimen.
Only these professionals can provide a concept of the right dosage of these two products to avoid any adverse side effects.
Can Another Antihyperglycemic Be a Substitute for Metformin So CBD Oil Can Be Taken?
Insulin is an antihyperglycemic agent that is used to lower high blood sugar in people who have diabetes. Doctors often apply it by subcutaneous injection, but there are other forms that they can inject intravenously.
Research in 2016 on 62 subjects with type 2 diabetes reveals that a combination of tetrahydrocannabinol (THC) and CBD can decrease insulin resistance while stimulating the effect of insulin in the body. These same subjects were non-insulin-treated and were able to tolerate both CBD and THC well (14 ) .
Another study in 2018 shows that low dosage CBD increases glucose uptake, lowers fat accumulation, and reverses insulin resistance in rats (15 ) . This may be an additional indication that CBD can be used together with insulin to improve its effectiveness.
Although CBD and insulin intake in rodents may not be the same in humans, there is still a possibility that cannabidiol can enhance insulin efficacy. This is especially true since animal models are often used to understand how drugs work in human beings (16 ) .
More research is needed to understand further the effectiveness and safety of using these two to treat diabetes.
Can CBD Replace Metformin?
As of this time, no research proves CBD to be a safe alternative to metformin use in humans who have diabetes. The majority of studies on how CBD can affect diabetes were carried out on rats and mice.
A study as early as 2006 on non-obese diabetic mice shows that CBD is capable of lowering the incidence of possible diabetes by changing the immune response system in rodents. The non-treated mice had a probability of 86% to develop diabetes, while CBD-treated subjects only had 30% (17 ) .
The CBD treatment also significantly reduced plasma blood levels of the pro-inflammatory cytokines, while also lowering the possibility of pancreatic disease.
In 2016, research showed that cannabidiol could delay the onset of type 1 diabetes while remarkably reducing inflammation in the pancreas caused by the said condition. Female non-obese diabetic mice were administered daily intake of CBD for several weeks (18 ) .
Another study in 2019 carried out on middle-aged diabetic rats wanted to test the beneficial effects of CBD on both ischemic diseases and diabetes. It revealed that CBD has effects on neuropathic pain , can improve memory performance, and lowers hippocampal levels of inflammation markers (19 ) .
Experts suggest that perhaps medical marijuana and cannabinoids like CBD gummies can be used to treat the symptoms of diabetes. Since the studies on CBD as an antihyperglycemic are limited, it is always best to seek advice from a medical expert before considering replacing current anti-diabetic medication.
Drugs That Can Interact with Metformin
Metformin contains positively charged molecules (cationic) that can compete with similarly charged drugs for renal secretion via organic cation transporters found in the kidneys.
Quinidine, procainamide, trimethoprim, digoxin, and vancomycin are cationic medications that can interact with metformin. However, only cimetidine, which can be bought over-the-counter for heartburn, is linked to a case of metformin-associated lactic acidosis (MALA) (20 ) .
The following are other medications that can have drug interactions with metformin:
- Corticosteroids medications
- Estrogen and oral contraceptives
- Calcium channel blockers
Mixing the drugs listed above, together with metformin, may affect blood sugar control in the body. Patients need to monitor their blood sugar levels frequently and notify their doctors of any sudden changes.
These drugs can reduce the ability of the kidneys to eliminate metformin from the blood and thus lead to lactic acidosis:
Individuals should consult a doctor to see if these drug combinations are worth the risk. There may be safer options available that do not have the same probability of danger.
Below are medications that may increase the risk of lactic acidosis on metformin users:
- Carbonic anhydrase inhibitors (CAIs) such as acetazolamide or topiramate
Regular monitoring of patients taking CAIs together with metformin may be necessary as this can aid in detecting early signs of lactic acidosis.
It is always best to consult a doctor to be aware of the possible side effects of metformin use. Physicians can change the dosage or even suggest a safer, alternate medication.
People switching from immediate-release to extended-release metformin tablets may experience fewer instances of diarrhea, as suggested by a study in 2004 (21 ) .
Doctors continually monitor for signs of anemia and vitamin B-12 deficiency in individuals that have been taking metformin for at least a few months. Consuming iron and vitamin B-12 supplements may help prevent these issues if they arise in long-term metformin users.
Metformin is an FDA-approved medication that is prescribed to individuals who have type 2 diabetes. It is often given on its own or with other prescription drugs to manage high blood glucose levels in the body.
The said medication can effectively prevent diabetes in high-risk individuals, while also reducing most of its complications. There may be adverse reactions associated with metformin use, but most reports mention that these are only minor considering its benefits.
Cannabidiol, also known as CBD, is said to contain cannabinoid receptors that can benefit people with diabetes. Several clinical trials on mice and rats reveal the antihyperglycemic potential of the phytocannabinoid.
Since metformin can treat diabetes effectively, most people consider taking it together with the healing properties of CBD edibles. There are no studies, however, that prove these two products can be used together.
In fact, they may not work well with each other due to how the body processes both metformin and CBD products. Lactic acidosis is the most severe side effect that a person may experience with metformin overdose, which has symptoms such as dizziness, muscle pain, chills, and difficulty in breathing.
As no clear indication of whether metformin users are at risk or not when using CBD, it is best to avoid using them together for now. At the very least, seeking medical advice from a healthcare provider knowledgeable in the cannabis plant may be a possible option.
Insulin may be a potential antihyperglycemic agent that can work well in conjunction with CBD oil help. A placebo-controlled study in 2016 shows that CBD is capable of lowering insulin resistance while improving the effects of insulin in the body.
In 2018, a study on rats revealed that low tincture doses of CBD could enhance glucose uptake, improve weight loss, and reverse insulin resistance in the subjects. All these are potential indications that CBD can be used together with insulin to improve its effectiveness.