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Pain Relievers and CBD Oil: Possible Side Effects and Interactions

If you’re suffering from pain, it can be tempting to look for a quick-fix. While over-the-counter (OTC) pain relievers may provide short-term relief, they often don’t address the underlying cause and have unwanted side effects. It’s for this reason that CBD oil is gaining a following among people who suffer from occasional, acute, or chronic pain.

Here’s everything you need to know about using using CBD oil for pain relief, and its interaction with OTC pain medications

Risks of Combining CBD Oil and OTC Pain Relievers

While there may be hundreds of products on the shelves of your local drug store, OTC pain relievers are generally grouped into one of two categories: acetaminophen or NSAIDs.

Acetaminophen is widely used throughout the United States due to its effectiveness at reducing fever and pain symptoms. It is familiar to most under the brand name Tylenol. The most common side effects of acetaminophen are nausea, stomach pain, itchy skin, and headaches.

NSAIDs, or nonsteroidal anti-inflammatory drugs, cover a wide range of pain relievers including aspirin, ibuprofen, and naproxen. They work by inhibiting prostaglandin synthesis, compounds which encourage fever, inflammation, and pain. The most common side effects of NSAIDs include stomach pain and ulcers, bloating, heartburn, diarrhea, and nausea.

There’s a chance that combining these popular over-the-counter pain medications with CBD oil could cause a reaction. Both acetaminophen and NSAIDs are metabolized using the cytochrome P-450 (CYP450) enzyme system. This system is tasked with breaking down medications into smaller parts so your body can more easily process them.

By a mechanism referred to as the “grapefruit effect,” CBD oil can impact the CYP450 enzyme system, and cause the liver enzymes to work slower. When this system is inhibited by a compound like CBD, the unmetabolized medication remains in your body longer than it should. This can lead to an increased risk of experiencing the side effects of your OTC pain reliever.

While there is no concrete evidence to suggest that CBD oil interacts badly with OTC pain medications specifically, the fact that they both use the CYP450 pathway means it cannot be ruled out. 

For this reason, you should always speak to your doctor before you start taking CBD oil.

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Effects of CBD on Pain Symptoms

The more traditional pharmaceuticals used for treating pain are falling out of favor with a large number of people, many who are looking for less damaging, natural alternatives. CBD oil is quickly becoming the compound of choice for those wanting pain relief that is largely free of side effects.

While NSAIDs such as aspirin and ibuprofen may be easily accessible, their long-term use has been linked to a range of negative health effects, particularly in people who are older. In fact, research has found a link between NSAID use in the elderly and acute renal failure, myocardial infarction, and stroke.

CBD oil poses no such risk, with a review of nearly three decades of studies concluding that CBD (and cannabis in general) not only has very few side effects but is an effective tool for the management of pain. This makes CBD oil a promising treatment option for those who are suffering from chronic pain or who need easy access to pain relief, especially in their later years.

But how does CBD oil work?

CBD targets not only the experience of pain but also its source. CBD oil interacts with the body’s cannabinoid receptors to dull the perception of pain. For example, CBD can target the inhibitory glycine receptors in the central nervous system, increasing their function and reducing the experience of neuropathic pain caused by nerve damage.

More than just addressing pain sensations, CBD oil can reduce inflammation, one of the body’s major sources of pain and discomfort. CBD works to limit the reuptake of the neurotransmitter adenosine. This action increases the amount of adenosine in the brain which impacts adenosine receptors like the A2A receptor and decreases inflammation throughout the body.

CBD oil’s anti-inflammatory abilities extend to the source of inflammation as well. CBD is able to inhibit the release of small proteins called cytokines, which stimulate and perpetuate chronic inflammation. By addressing inflammation at its source, CBD may prevent pain symptoms before they even begin.

As if this wasn’t impressive enough, another benefit of CBD oil is its use as a muscle relaxant. This has the potential to make life easier and more comfortable for those who suffer from muscle spasticity due to conditions like Parkinson’s disease and multiple sclerosis. In less extreme cases, CBD could also provide relief for pain caused by muscle tightness or tension.

How to Safely Combine CBD Oil and OTC Pain Relievers

In order to safely combine CBD oil with over-the-counter pain relievers, there are a few factors to consider. Not only does the dosage affect how the two compounds will interact, but your weight, age, and metabolism will also influence the likelihood of you experiencing positive or negative effects.

One of the safest ways to use both CBD oil and OTC pain relievers is to stagger the intake of the two. The average half-life of acetaminophen and NSAIDs is 2-4 hours*. So, consider waiting 2-4 hours before taking CBD oil. This can allow one substance to work uninhibited without causing an interaction with the other.

With this strategic combination, you can find pain relief and decrease the amount of OTC pain medications you take throughout the day, lessening the chances you’ll experience their long-term side effects. You may even find that, over time, you require fewer over-the-counter medications, and make the full switch to CBD oil for pain management.

If you are concerned about any potential risk, it could be useful to initially reduce your dose of OTC pain relievers when taking them with CBD oil. From there, you can slowly adjust the doses if need be.

Again, it is always recommended that you seek advice from your doctor before you undertake any changes to your pain relief routine.

*The half-life may vary if you have an underlying condition that slows down the metabolism of OTC pain medications.

Safest CBD Oils to Take with OTC Pain Medication

All over-the-counter pain relievers have similar risks when combined with CBD oil due to their use of the cytochrome P-450 pathway. However, you can minimize the risk of a negative CBD oil experience by choosing high-quality products. Also, CBD topicals would be less likely to interfere with pain medication.

To find a safe and effective CBD product, look for one that’s grown organically, sustainably sourced, and undergone third-party lab testing. The reports from these third-party tests are called Certificates of Analysis (COAs), and will tell you the concentrations of CBD, THC, and harmful pesticides, heavy metals, and chemicals present in the product you’re thinking about buying. By always checking the COA, you can be sure you’re choosing the safest CBD oil for relieving your pain.

If you’ve spoken to your physician and are ready to choose a CBD oil, check out the Best CBD Oil Products for Pain.

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+ 4 sources


  1. Zachary A. Marcum et al. (2011) Recognizing the Risks of Chronic Nonsteroidal Anti-Inflammatory Drug Use in Older Adults - National Center for Biotechnology Information https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3158445/
  2. Ethan B Russo (2008) Cannabinoids in the management of difficult to treat pain - National Center for Biotechnology Information https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2503660/
  3. Wei Xiong et al. Cannabinoids suppress inflammatory and neuropathic pain by targeting α3 glycine receptors - National Center for Biotechnology Information https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3371734/
  4. Clementino Ibeas Bih et al. (2015) Molecular Targets of Cannabidiol in Neurological Disorders - National Center for Biotechnology Information https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4604182/

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