Penn State College of Medicine, Dept of Pharmacology

Cannabinoid Drug-Drug Interactions Delta-9-Tetrahydrocannabinol (∆9-THC) & Cannabidiol (CBD) Drug-Drug Interactions

Cannabinoid (as Precipitant) Drug-Drug Interactions

   Although regulatory agency approved prescribing information is often the initial source of information when identifying potential drug-drug interactions, it may only provide for a limited number of exemplars or only reference a class of medications without providing any specific medication examples.  However, with the recent deregulation of CBD oil (hemp oil) and the steady increase in states and countries that have legalized recreational and medical marijuana, these products are often not associated with regulatory agency approved prescribing information.

One of the objectives of this website, and associated journal article, is to develop a comprehensive and detailed cannabinoid drug-drug interaction list aligned with regulatory approved prescribing information.  Also, as newer medications are approved, and real-world evidence accumulates, another objective is to routinely update this drug-drug interaction list.

   The following cannabinoid drug-drug interaction information is predicated on regulatory agency approved  cannabinoid manufacturer prescribing information, and then supplemented with the FDA Drug Development and Drug Interactions: Table of Substrates, Inhibitors and Inducers’ online document and the DrugBank database


Narrow Therapeutic Index (NTI) Medications to be Closely
Monitored when Coadministered with Cannabinoids

   We have identified a list of 57 prescription medications displaying a narrow therapeutic index that are potentially impacted by concomitant cannabinoid use (whether through prescription use of cannabinoid medications or recreational/medical use of cannabis and its extracts).

Information on these 57 NTI medications can be accessed via this hyperlink:
Delta-9-THC and Cannabidiol DDI – Table 2 – Updated 2020_08_17


Comprehensive List of Cannabinoid (as Precipitant) Medications
Affecting the Metabolism of an (OBJECT) Medication

   In addition to the list of NTI medications, we have identified a comprehensive list of 139 medications that could have a potential drug-drug interaction with a cannabinoid (prescription, OTC, or illicit).  These medications are presented in alphabetical order and primarily identify the cannabinoid as a PRECIPITANT medication that either INHIBITS, INDUCES, or competes as a SUBSTRATE for a specific enzyme/receptor of an OBJECT (OTHER) medication.

Information on these 139 medications can be accessed via this hyperlink:
Cannabinoid (as PRECIPITANT) Medication Affecting the Metabolism of ANOTHER (OBJECT) Medication_04_25


Medical Cannabis and Cannabinoids

We ask that if these above-mentioned drug-drug interaction lists are replicated for use
in any type of publication, please cite the following journal article:

Kocis P, T, Vrana K, E: Delta-9-Tetrahydrocannabinol and Cannabidiol Drug-Drug Interactions.
Med Cannabis Cannabinoids 2020. doi: 10.1159/000507998


Penn State ScholarSphere


The associated datasets reported in this website and manuscript have been deposited and can be accessed in Penn State ScholarSphere


Disclaimer:   While every attempt has been made to provide the most up-to-date and comprehensive list of drug-drug interactions, there may be OTC, herbal, and prescription medications not included.  These potential drug-drug interactions are intended to provide a resource when reviewing a patient’s medication regimen containing OTC, herbal, and prescription medications and, perhaps, also factoring in the illicit or unregulated use of cannabinoid-containing products.  This resource is NOT intended to be a substitute for medical decision making, since individual patient characteristics (e.g., age, genomic profile, hepatic and renal function, comorbidities) need to be considered. 


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