In our latest question and answer, the pharmacist discusses the use of CBD (cannabidiol) and Lipitor (atorvastatin). CBD Vs Statins To Control Cholesterol While statins may lower your LDL cholesterol numbers, some researchers believe it does nothing to protect users from heart attacks or strokes. They also have CBD inhibits the metabolism of atorvastatin which could lead to increased concentration & side effects. The severity of their interaction, when used together, is moderate.
Is It Safe To Take CBD And Lipitor Together?
In our latest question and answer, the pharmacist discusses the use of CBD (cannabidiol) and Lipitor (atorvastatin).
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.
At a glance
- The majority of data from studies suggest that there is a low risk of an interaction between Lipitor and CBD (cannabidiol). Although CBD may inhibit CYP3A4, the enzyme responsible for Lipitor metabolism, it likely only occurs at doses higher than what is generally taken.
Yes, we did write an article about a year ago discussing whether or not CBD (cannabidiol) could interact with Lipitor (atorvastatin).
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.
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).
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.
Nevertheless, there have been some additional studies on CBD interactions which give us more insight. This is discussed below
CBD Interaction With 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. 
Since CBD is available in prescription products, we have more evidence than usual on how it could potentially interact with other drugs.
As mentioned above, we are concerned about how Epidiolex could affect CYP3A4, which is the liver enzyme principally responsible for the metabolism of Lipitor.
The prescribing information for Epidiolex (CBD) does not give any indication that it either inhibits or induces (i.e. increases activity) of CYP3A4.
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. 
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). 
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. 
CBD With Lipitor
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.
Additionally, the prescribing information for Epidiolex, the prescription CBD product, does not state that it can potentially affect CYP3A4 substrate drugs, like Lipitor.
There is far more data available stating that other drugs that inhibit or induce CYP3A4 affect CBD concentrations, not the other way around. 
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.
Other CBD Interactions
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.
CBD does have well-documented interactions with several others, including:
Aside from drug interactions, there may be other issues taking CBD with certain drugs.
For example, studies show that taking CBD with valproate, a commonly used drug for seizures, can increase liver enzymes. 
Until we have more information and studies on CBD interactions and its effects on the body, always be sure to talk to your doctor prior to use so you can be appropriately monitored for side effects and efficacy.
CBD Vs Statins To Control Cholesterol
While statins may lower your LDL cholesterol numbers, some researchers believe it does nothing to protect users from heart attacks or strokes. They also have many adverse side effects which may lead to long-term problems in the future. Studies suggest that CBD may lower blood cholesterol levels and remove plaque. In this article, I will discuss how statins work, list their adverse side effects, and explain the importance of cholesterol. I will cite studies that support the potential replacement of statins with CBD as well as further studies about possible CBD-statin interactions.
What Are Statins?
Statins are a class of drugs that reduce the blood lipid levels by changing the activity of the liver enzymes in their production.
Statins Side Effects
- May cause muscle damage
- May cause neurological problems
- May increase blood sugar levels
- May cause liver damage
The Importance of Cholesterol
Some people view cholesterol as bad. But, a substantial amount of cholesterol, a waxy fatty acid found in human cells, is required by the body to carry out essential functions. These include the production of hormones, vitamin D, digestive bile, and the maintenance of many brain functions. HDL is the good cholesterol and LDL is the harmful cholesterol.
The human body stores cholesterol for future use, but when there is an excess of cholesterol, it gets stored in the arteries. The HDL is used for necessary bodily functions, but the LDL turns into plaque in the arteries. Plaque buildup is what leads to heart disease and strokes. However, statins do not actually remove plaque. They simply block the cholesterol producing enzyme, HMG, which reduces the total amount of cholesterol in the bloodstream. This forces the body to reabsorb the cholesterol from the arteries.
Many studies suggest that an increase in HDL and a decrease in LDL may lead to a decrease in cardiovascular mortality. Some of the more recent studies suggest that there is no correlation between a higher LDL cholesterol number and the development of cardiovascular disease.
Can CBD Effectively Replace Statins?
While CBD is known for many therapeutic effects, there are few studies suggesting its impact on the removal of plaque and the reduction of LDL. Here are a few that do support this hypothesis:
- Hector Lopez led a study, published in May 2020 in the Journal of Dietary Supplements, that suggested that CBD may increase HDL levels through its impact on specific brain receptors.
- A 2016 study, published in Diabetes Care, indicated that CBD may regulate the production of insulin and metabolism of sugar and increase the capacity to process unhealthy fats. This process was seen to lower the LDL levels in overweight, but otherwise healthy individuals, within six weeks, even with a normal diet.
- A 2013 study, published in the British Journal of Clinical Pharmacology, showed that CBD oil may indirectly regulate blood cholesterol content and reduce cardiovascular disease risk by minimizing the stress response by the cardiovascular system.
While there is still no agreement by researchers on the effect that CBD has on the heart, here are some studies promoting the supposition that CBD may have cardi-protective properties:
- A 2010 study, published in the Journal of the American College of Cardiology, suggests that CBD may prevent heart attacks and other cardiovascular diseases in diabetic patients.
- A 2020 study, published in the Journal of Dietary Supplements, demonstrated that CBD may regulate the immune system and provide cardiovascular protection through its indirect activation of CB2 receptors by way of the 5-HT3A brain receptor.
- A 2019 paper, published in the Recent Advances in Cannabinoid Physiology and Pathology, makes the case that there is a close link between the endocannabinoid system (ECS) and its impact on cardiovascular diseases. CBD may act as a vasorelaxant, which allows more blood to flow through blood vessels. This reduces the stress on the heart.
Scientists are unclear on how CBD interacts with statins. Studies indicate that CBD inhibits several of the liver enzymes which are necessary for breaking down statins. The outcome may be an increase in the concentration of statins in the bloodstream approaching toxic levels. With long-term use, this could mean a risk to a patient’s health including more adverse side effects.
Here is what we know:
- Statins are metabolized by the liver’s Cytochrome P450 group of liver isoenzymes; CYP3A4, CYP3A5, CYP2C9, and CYP2C19
- Studies indicate that CBD inhibits these enzymes
- Long-term use of CBD can interfere with the normal functioning of these enzymes, thus lowering the blood statin clearance rate
- This causes higher concentrations of statins remaining in the bloodstream, leading to an increase in the severity of side effects
- While there is no conclusive evidence that combining CBD with statins is harmful, the aforementioned information suggests that it poses a possible health risk.
Here are a few publications which show the impact of combining CBD with statins:
- The March 2020 edition of the Pharmacist’s Guide to CBD Oil, suggested that CBD has the potential to reduce the effectiveness of statins by inhibiting the CYP3A4 liver enzyme.
- A 2020 study, published in the Canadian Medical Association Journal, found that certain other medications may cause an increase or decrease of CBD which may affect its impact on other drugs.
Anecdotal evidence shows significant interactions of the two medications only in rare cases of long-term usage and high doses of both. Clearly, if you notice any drug interactions, consult your physician.
Pharmacologists Waiting for Patent on a Cannabinoid-Statin Medication
Colorado-based pharmacology inventors, James Smeeding and Mathew Sherwood, of Indication BioScience, have developed a medication combining a cannabinoid with a statin and are awaiting patent approval.
Their findings indicate that the use of cannabinoids may increase the efficiency of the ECS. The fact that they have developed this medication suggests that their risk/benefit assessment of a potential interaction must be quite a low risk. However, in order to satisfy the FDA, it seems reasonable to conclude that more human clinical trials will be required.
Let us hope that the use of cannabinoids plays a major role in the future of cardiovascular therapies or at the very least, may be used to relieve some of the symptoms of cardiovascular diseases.
thecannabisradar.com, CBD & Statins: Can CBD Replace Statins as Cholesterol Medication?
Does CBD Interact With Atorvastatin?
Information on risks & possible interactions between CBD & artorvastatin.
Level of risk: mild to moderate.
Cannabidiol (CBD) slows the metabolism of atorvastatin — potentially leading to increased blood levels of the drug .
High levels of statin drugs can lead to side effects like muscle pain, joint pain, dyspepsia, hyperglycemia, and liver dysfunction.
There is no clinical evidence to suggest any effect on cholesterol levels when CBD and atorvastatin are used together.
Table of Contents
Does CBD Interact With Atorvastatin?
CBD interacts with atorvastatin by inhibiting its metabolism.
There are no other indications of increased side effects or decreased drug effectiveness when taken with CBD.
The level of risk for this combination is considered mild to moderate, and only appears to pose any threat if both substances are taken together repeatedly over several days, weeks, or months.
Interaction 1: Slowed Elimination (Metabolic competition)
The main interaction between CBD and atorvastatin takes place in the liver.
CBD and atorvastatin are both metabolized in the liver by the same enzyme (CYP3A4).
CBD competes with atorvastatin for metabolism through this enzyme.
This interaction might cause harmful side effects when taken for a long duration as atorvastatin accumulates in high concentrations in serum. This can cause side effects like liver dysfunction, muscle pain, joint pain, hyperglycemia, memory loss, and confusion .
However, factors like the strength of inhibition and the dose-dependent nature of inhibition also play an important role in the interaction between CBD and atorvastatin.
Interaction 2: Increased Effect (Agonistic Interaction)
Recent studies have provided some evidence regarding the role of CBD as a high-density lipid (HDL) increasing agent . HDL is a transport lipoprotein that transports excess cholesterol from different parts of the body to the liver for excretion. This helps lower cholesterol, triglycerides, and LDL.
An agonistic interaction occurs when two substances produce similar effects on the body.
CBD and atorvastatin may theoretically enhance each other’s lipid-lowering effects that each drug possesses when taken individually.
With that said, there are no studies or case reports that have reported this (theoretical) effect despite both CBD and atorvastatin being widely used in the general public.
Other Names For Atorvastatin
Atorvastatin is sold under many names, all of which share the same risk and potential interactions.
Some brand names for atorvastatin include:
Atorvastatin is classified as a statin drug. CBD and other statins share similar risks for interaction and side effects.
Here’s a list of medications that share a similar level of risk when combined with CBD:
- Lovastatin (Altoprev)
- Pitavastatin (Livalo, Zypitamag)
- Pravastatin (Pravachol)
- Rosuvastatin (Crestor & Ezalor)
- Simvastatin (Zocor)
Is It Safe To Take CBD And Atorvastatin?
The use of CBD and Atorvastatin is safe, and their interaction could be from mild to moderate.
But when these drugs are used together for a long period, atorvastatin can accumulate in the serum at toxic concentrations and produce unwanted effects.
You should always consult your doctor before combining these drugs to avoid possible interactions.
Is CBD A Viable Alternative To Atorvastatin?
There are very few studies that CBD has any role in lowering cholesterol. It has antioxidant, anti-inflammatory properties that might help improve overall cardiac health and lower risks of stroke and heart attack just as atorvastatin [2,3,7].
A recent study conducted on 65 overweight, otherwise healthy individuals with hemp-derived CBD ingestion for 6 weeks showed significant improvement in HDL levels .
But to recommend CBD as a lipid-lowering agent evidence of its efficacy through clinical trials in large cohorts is necessary.
Hence, CBD is not an alternative to atorvastatin.
What Is Atorvastatin?
Atorvastatin belongs to the statin group of drugs that acts by inhibiting the enzyme HMG-CoA reductase. This decreases the production of cholesterol in the liver.
It is prescribed as a first-line treatment to people with high cholesterol levels to lower the risk of stroke and heart attack. People with pre-existing diseases like type 2 diabetes, hypertension, obesity, and smoking with dyslipidemia are at increased risk.
Atorvastatin is taken orally and is available in doses of 10 mg, 20 mg, 40 mg, and 80 mg.
|CYP Metabolism||Enzyme CYP3A4|
|Interaction With CBD||Metabolic Competition|
|Risk Of Interaction||Mild|
What Does Atorvastatin Do?
Atorvastatin competitively inhibits the enzyme HMG-CoA reductase, which is a key step in cholesterol production in the liver.
Atorvastatin also increases the expression of LDL receptors on the surface of hepatocytes to compensate for the decreased cholesterol resulting in increased clearance of LDL (bad cholesterol) particles from the blood.
These mechanisms help lower the bad lipid particles from the blood like cholesterol, LDL, triglycerides, and apo-B and increase HDL, the good lipid.
When there are high levels of LDL and cholesterol in the body, they tend to build up against the walls of the arteries. The clogged arteries of the heart, brain, and other parts of the body cause decrease in blood flow to the organs, which can be life-threatening.
Atorvastatin is an FDA-approved prescription drug for people with high cholesterol levels to lower the risk of stroke and heart attack. Type 2 diabetes, hypertension, smoking, and dyslipidemia are high-risk factors for cardiovascular events. It is also used for secondary prevention of myocardial infarction, stroke, unstable angina, and revascularization in people with established coronary artery disease.
Side Effects Of Atorvastatin
Before jumping into medications, you should consider bringing changes in your lifestyle like diet modification, exercise, avoiding smoking and alcohol to lower your cholesterol first, or along with medications to sustain a healthy body.
Atorvastatin has many potential side effects which are dose-related.
Always consult your doctor before taking these drugs to avoid any potential risks.
Some of the common side effects of atorvastatin that you must be aware of are:
Some major side effects that might need discontinuation of atorvastatin are:
- Hepatic dysfunction: Persistent rise in liver enzymes to a severe liver injury can occur with atorvastatin use; hence, regular monitoring of liver function must be done while on the drug .
- Type 2 diabetes: A small number of patients on statins have developed diabetes 
- Myopathy and rhabdomyolysis: It is an uncommon but serious side effect. People experience muscle pain, muscle tenderness, weakness, and tea-colored urine . Rhabdomyolysis is the breakdown of muscle that can lead to acute kidney failure.
Who Should Avoid Atorvastatin?
- People with known hypersensitivity to atorvastatin or any of its compounds.
- People with active liver disease.
- Females during pregnancy should immediately discontinue atorvastatin.
- Breastfeeding mothers should avoid atorvastatin.
- People with decreased kidney function.
- People with hypothyroidism.
- People using CPY3A4 inducers (phenytoin, bosentan)
- People using CYP3A4 inhibitors (itraconazole, voriconazole)
Key takeaways: Is It Safe To Take Atorvastatin with CBD?
Atorvastatin is available with a doctor’s prescription for lowering high cholesterol levels.
It is safe to take atorvastatin with CBD. But it is best not to use them together for a long period of time. Combined intake should be discontinued if any harmful side effects appear.