cbd and lipitorDecember 15, 2021
Below, we will list the highlights of that article and specifically look at aspirin and Lipitor (atorvastatin):
We have written extensively about potential interactions between CBD (cannabidiol) and prescription medication. One of these articles, which goes into depth about what CBD is and how it can potentially affect other medication, can be found here:
There is no data available regarding an interaction between CBD and Lipitor (atorvastatin). However, Lipitor is metabolized CYP3A4, which CBD may potentially inhibit. Per the prescribing information for Lipitor:
Often times, when there is a significant interaction that involves increased Lipitor concentrations, a dose adjustment may be needed to reduce the risk of side effects. For examples, practitioners will sometimes recommend to “hold” or decrease the dose of Lipitor when taking a known strong inhibitor of CYP3A4, like clarithromycin. While this most likely is not necessary with CBD, it is a possibility for a small number of individuals.
For what it’s worth, the prescribing information for Epidiolex , the recently approved CBD product, does not list aspirin as an interacting drug and does not state that CBD can cause bleeding episodes.
Recent studies do indicate that CBD can potentially affect the metabolism of a variety of drugs via inhibition of CYP metabolizing enzymes. Data indicates that CBD may inhibit the following liver metabolizing enzymes:
I take Aspirin 100mg, Reaptan 5/10 BP Med (morning) and Atorvastatin 40mg (night). I’d like to know if CBD has any interaction with these meds. If so, what can I do? Especially with the Atorvastatin. I take CBD twice a day (0.2ml per day).
Metabolizing enzyme inhibition can lead to increased concentrations of drugs that are typical substrates for a particular enzyme. As an example:
The likelihood of aspirin and CBD interacting is low. The vast majority of aspirin metabolism is not via CYP enzymes, and therefore, CBD shouldn’t affect how aspirin is metabolized. Some studies suggest that aspirin, to a small extent, is metabolized via CYP enzymes, but if it is, it is minimal. So, there may be a small chance that CBD can prolong the metabolism time of aspirin, which may prolong the effects of the medication.
Several studies have listed CBD as an inhibitor of CYP3A4. How strong of an inhibitor it is, and whether or not this inhibition is dose dependent (i.e. higher doses bring more effect) isn’t well known. Some studies even note that while CBD does inhibit CYP3A4, the extent of the inhibition is not significant and the blood concentrations of CBD needed to affect it far exceeds what is possible with usual dosing.
Nevertheless, it is important to be aware of the potential interaction and the potential for increased side effects of Lipitor, most notably of which includes muscle pain or weakness.
The pharmacist discusses whether or not CBD interacts with Lipitor or aspirin.
As with all medication and supplements, it is important to make your doctor aware of everything you are taking so you can be appropriately monitored. Although the risk of significant interactions between CBD, aspirin and Lipitor don’t appear to be high, there may simply be a lack of data available.
CBD And Lipitor (Atorvastatin)
The prescribing information for Epidiolex (CBD) does not give any indication that it either inhibits or induces (i.e. increases activity) of CYP3A4.
More often than not, it is difficult to find thorough drug interaction information on over the counter supplements and herbal products.
Fortunately, when it comes to CBD (cannabidiol), it is not only available over the counter, but is an FDA approved active ingredient in the prescription product Epidiolex, which is approved for the treatment of rare seizure disorders. 
However, more recent studies suggest that while CBD can inhibit CYP3A4, the doses required for such inhibition are extremely high , higher than a dose that anyone would feasibly take. 
Additionally, the prescribing information for Epidiolex, the prescription CBD product, does not state that it can potentially affect CYP3A4 substrate drugs, like Lipitor.
In fact, since CBD itself is metabolized by CYP3A4, it only warns against using drugs known to inhibit or induce that enzyme since they could potentially influence the effectiveness of CBD. 
In that article, we wrote that CBD could potentially decrease the activity of the liver metabolizing enzyme CYP3A4, which is responsible for the metabolism of Lipitor.
Aside from drug interactions, there may be other issues taking CBD with certain drugs.
Unfortunately, since the time we wrote that article, we still don’t know much more about how CBD could affect Lipitor as there have been no studies that have specifically evaluated this potential interaction .
For example, studies show that taking CBD with valproate, a commonly used drug for seizures, can increase liver enzymes. 
At a glance.
So overall, it appears that the risk of an interaction between CBD and Lipitor is low , but it should not be ruled out. It is unlikely that you will need a dose adjustment of either drug but as always, you should speak with your doctor about CBD use with other drugs prior to combining them.
I have been looking at trying CBD oil. Looking around, I see where it may be a problem with the Atrovastatin 40mg that I take in the evening. I’d like to get off the Lipitor and get tested down the road and see what the numbers are. I’m very new to CBD oil and want to get the benefit without causing other issues. Not sure if I need to get off atorvastatin or have my Dr. adjust the dose. There was a simaler question on this subject but it’s a year old and maybe some current info on this.
There is far more data available stating that other drugs that inhibit or induce CYP3A4 affect CBD concentrations, not the other way around. 
Even though there doesn’t appear to be a high risk of a Lipitor interaction, it is important to consider how CBD could interact with other drugs.
The result of CYP3A4 inhibition by CBD could potentially increase concentrations of Lipitor in the body, increasing the risk of side effects such as stomach cramping, diarrhea or even the more serious ones, like rhabdomyolysis (the breakdown of muscle).
CBD Interaction With CYP3A4.
As stated above, there have been no studies looking specifically at an interaction between CBD and Lipitor.
An interaction could be inferred based on studies that show that CBD can inhibit CYP3A4, but human studies are lacking and most animal or laboratory studies show that only very high doses of CBD result in any sort of clinically significant effect.
CBD does have well-documented interactions with several others, including:
In our latest question and answer, the pharmacist discusses the use of CBD (cannabidiol) and Lipitor (atorvastatin).
As mentioned above, we are concerned about how Epidiolex could affect CYP3A4, which is the liver enzyme principally responsible for the metabolism of Lipitor.
Older studies (ones completed in the early 2010’s) showed that CBD had the potential to inhibit CYP3A4, and therefore, there was some concern administering with other drugs that were metabolized by the enzyme (like Lipitor).