CBD and Anxiolytics (e.g. Diazepam, Lorazepam)
David ReichUpdated:Key points at a glance:
CBD may slow the breakdown of diazepam via the enzymes CYP3A4 and CYP2C19. For lorazepam, additive effects and potential interactions with UGT2B7 are discussed. Using them together is commonly associated with increased tiredness, slower reaction times, dizziness and a higher risk of falls, especially at the start of use or after dose changes. Particular caution is advised for older people, those with liver problems, and when combined with alcohol, opioids or multiple medicines. Use only after consulting a doctor, start with a low amount and monitor for side effects.
CBD is sometimes used alongside prescription medicines for anxiety such as diazepam (Valium) and lorazepam (Ativan/Temesta). Because CBD can affect drug‑metabolising liver enzymes and has its own calming effects, combining CBD with these benzodiazepines can change how they work and increase side effects. This article explains what is known so far about CBD and anxiolytics, with a focus on safety and practical precautions.
- CBD may slow the breakdown of diazepam (Valium) via CYP3A4/CYP2C19; with lorazepam (Ativan/Temesta), additive effects and possible UGT2B7 interactions should be considered.
- Main risk of combining them: stronger sedation, slower reactions, dizziness/ataxia and increased risk of falls – especially at the beginning or after dose changes.
- Caution is advised in older people, those with impaired liver function, and with concurrent use of alcohol, opioids or multiple medicines.
- Only use CBD after medical advice if you are taking benzodiazepines; start low and monitor for side effects.
CBD & benzodiazepines in brief
Some people use CBD alongside other approaches for relief from feelings of restlessness or stressful symptoms. Benzodiazepines such as diazepam (Valium) and lorazepam (Ativan/Temesta) are prescription anxiolytics used, among other things, for anxiety and acute tension. When taken at the same time as CBD, interactions are possible – this article outlines the most relevant points in practical terms.
More about how CBD acts in the body ·
Mechanism: Why CBD can alter the effects of diazepam and lorazepam
CBD, liver enzymes and benzodiazepine metabolism
CBD can inhibit certain liver enzymes involved in breaking down prescription medicines. Particularly relevant for CBD drug interactions are the cytochrome P450 enzymes CYP3A4 and CYP2C19, and some UGT enzymes.
Diazepam (Valium) is metabolised mainly via CYP3A4 and CYP2C19. If this breakdown is slowed by CBD, diazepam levels may increase – its sedative effects may then be stronger or last longer.
Lorazepam (Ativan/Temesta), on the other hand, is mainly broken down by glucuronidation via UGT2B7. In vitro data suggest that CBD can influence UGT enzymes (including UGT2B7). The clinical relevance of this UGT interaction appears to vary between individuals and is less well documented than CYP3A4/CYP2C19 inhibition.
CBD can inhibit CYP3A4/CYP2C19, which helps break down diazepam, and may affect UGT enzymes such as UGT2B7, which help metabolise lorazepam. This can potentially slow elimination and intensify effects.
Additive central nervous system depression (sedation, coordination, reaction)
Regardless of the metabolic pathway, the calming effects of CBD and benzodiazepines on the central nervous system can add up. In practice, this may mean increased tiredness, slower reactions, drowsiness, dizziness/ataxia and a higher risk of falls. At higher doses or in sensitive individuals, slowed breathing and confusion are also possible. This is particularly important at the start of treatment, after dose changes or in combination with alcohol or other sedatives.
Overview of CBD and benzodiazepines
| Substance | Metabolic pathway | Possible CBD interaction | What may happen? | Evidence |
|---|---|---|---|---|
| Diazepam (Valium, etc.) | CYP3A4, CYP2C19 | CBD inhibits CYP3A4/CYP2C19 → slower elimination | Stronger/prolonged sedation, confusion, ataxia | Mechanistically plausible; limited human data |
| Lorazepam (Ativan/Temesta) | UGT2B7 (glucuronidation) | In vitro CBD inhibition of UGT enzymes possible | Additive sedation; clinical relevance varies individually | Very limited direct human data |
State of research on CBD and anxiolytics: What is established and what is uncertain?
Mechanistic data and case reports
Inhibition of CYP3A4/CYP2C19 by CBD has been documented in laboratory and interaction studies. For benzodiazepines such as diazepam and lorazepam, evidence is mainly mechanistic; robust clinical studies specifically on CBD combined with these anxiolytics are scarce.
An interaction within the same drug class is well documented for clobazam: CBD increases levels of its active metabolite (via CYP2C19 inhibition) and enhances sedation. This is often considered indicative of potential enhancement with other benzodiazepines as well, although direct data for diazepam and lorazepam remain limited.
Strength of evidence and remaining uncertainties
For diazepam, interaction with CBD is mechanistically plausible (CYP3A4/CYP2C19 inhibition), but clinical real‑world data are limited. For lorazepam, additive sedative effects from combining CBD and benzodiazepines are considered very likely, while the significance of UGT2B7 inhibition by CBD is mainly inferred from in vitro data.
Overall, the potential risk of CBD–benzodiazepine interaction is recognised, but the individual effect varies depending on CBD dose, liver function, age, concomitant prescription medicines and the form in which CBD is used.
There are strong mechanistic reasons to expect CBD interactions with diazepam and lorazepam, but very few direct human studies. Individual responses vary, so caution and monitoring are important.
Interactions between CBD and benzodiazepines in practice
Are you considering taking CBD together with diazepam (Valium) or lorazepam (Ativan/Temesta)? Because CBD can affect drug metabolism and has its own sedative potential, it is advisable to check for possible CBD drug interactions first and to involve a healthcare professional.
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Side effects, everyday risks and CBD safety with benzodiazepines
CBD is generally regarded as well tolerated; reported effects include sleepiness, dry mouth, dizziness or a drop in blood pressure. Benzodiazepines can cause sleepiness, drowsiness, reduced attention, coordination difficulties and memory problems.
When CBD and prescription benzodiazepines are combined, additive effects are possible: stronger sedation, slower reactions, ataxia, an increased risk of falls and, in some cases, slowed breathing. Do not drive or operate machinery until you are confident about how you personally respond.
Note on forms of use: topical CBD products (such as creams/balms) act mainly locally and usually have low systemic absorption – for some users they may represent an option with a lower interaction risk, although this should still be discussed with a healthcare professional.
CBD with diazepam or lorazepam can make you more drowsy and slow your reactions, and alcohol may further increase these effects. Initially, avoid driving and other tasks that require full alertness.
Who should be particularly careful with CBD and anxiety medicines?
- Older people (higher risk of falls and delirium)
- People with impaired liver function
- People with sleep apnoea or breathing problems
- Those using alcohol, opioids, antihistamines or other sedating substances at the same time
- People taking multiple medicines with potential interactions (polypharmacy)
In practice: Using CBD with diazepam or lorazepam as safely as possible (with medical supervision)
If, after medical advice, you and your doctor decide to try CBD alongside diazepam or lorazepam, the following cautious approach is often recommended:
- Discuss CBD use with your doctor or pharmacist before starting if you are taking any benzodiazepine.
- Begin with a low amount of CBD and increase gradually if needed, under supervision.
- Monitor for changes in sleepiness, drowsiness, daytime fatigue, confusion or balance problems, and inform your healthcare professional if these occur or worsen.
- Avoid alcohol completely when combining CBD with benzodiazepines.
- Do not drive or operate machinery until you know how this combination affects your alertness and coordination.
- Seek prompt medical assessment if you notice marked sleepiness, confusion, breathing difficulties, pronounced coordination problems or any falls.
- Ask your doctor whether topical CBD products could be an option if you wish to minimise systemic interactions.
- Be aware that taking CBD and benzodiazepines at different times of day does not reliably prevent interactions, as their effects and metabolism can overlap.
Questions to discuss with your doctor
- Is CBD appropriate alongside my current benzodiazepine (diazepam/lorazepam) and dose?
- Which warning signs (such as marked tiredness, confusion or falls) mean I should contact the practice?
- Are there alternatives (for example, topical CBD products) with a lower interaction risk?
- How will we monitor liver function and take my other medicines into account?
Use CBD with diazepam or lorazepam only under medical supervision, at low initial doses and with close attention to side effects such as sedation, confusion and balance problems.
Conclusion
CBD and benzodiazepines such as diazepam (Valium) and lorazepam (Ativan/Temesta) can interact. Inhibition of CYP3A4/CYP2C19 (relevant for diazepam) and a possible influence on UGT enzymes (relevant for lorazepam) are mechanistically plausible; on top of this, there may be additive central nervous system depression. With medical supervision, a cautious introduction and careful monitoring, the associated risks can be managed more effectively.
Further information and sources
- Diazepam information (NHS)
- Lorazepam information (NHS)
- Gaston TE et al. (2017): Interactions between CBD and antiepileptic drugs (clobazam as an example)
- Yamaori S. et al. (2011): CBD inhibition of CYP2C19
- Yamaori S. et al. (2011): CBD inhibition of CYP3A isoforms
Disclaimer: This article is for information purposes only and does not replace medical advice. Do not change medicines or dosages without consulting your doctor. No claims are made regarding the treatment or cure of illnesses.