CBD and Fluticasone (e.g. Flovent, Flixotide, Flutide)
David ReichUpdated:Key points at a glance:
CBD may inhibit the enzyme CYP3A4, which is involved in the breakdown of fluticasone. This could lead to higher steroid levels, particularly with higher CBD doses, liver impairment, or when taken alongside strong CYP3A4 inhibitors such as ritonavir, clarithromycin or itraconazole. Inhaled and nasal forms are generally considered to pose a lower risk than oral formulations. Grapefruit may further increase this risk. Be mindful of possible signs of systemic steroid exposure and seek medical advice if you have any concerns.
There is only limited information on the direct interaction between CBD and fluticasone (e.g. Flovent, Flixotide, Flutide). However, because CBD may inhibit CYP3A4 – the main enzyme responsible for breaking down fluticasone – there may be an increased likelihood of systemic steroid effects, especially with moderate to higher CBD doses. Inhaled and nasal fluticasone are generally considered less likely to lead to systemic exposure than oral forms, but any combination of CBD and prescription medicines should be supervised by a healthcare professional.
What are CBD and fluticasone?
Cannabidiol (CBD) is a non‑psychoactive compound from the cannabis plant. It is often available as CBD oil and can be taken orally, inhaled, or applied topically (on the skin).
Fluticasone is a corticosteroid used in the management of asthma and COPD. It is mainly used by inhalation (e.g. Flixotide/Flovent) or as a nasal spray and is intended to act locally on inflammation in the airways.
Mechanisms of action and metabolism
How CBD affects liver enzymes (CYP3A4 and others)
CBD may influence drug‑metabolising enzymes in the liver, particularly CYP3A4 and CYP2C19. With higher CBD doses (very roughly: >100–300 mg/day) and/or pre‑existing liver disease, the likelihood of clinically relevant CBD drug interactions may increase. In addition, other strong CYP3A4 inhibitors (e.g. itraconazole, clarithromycin, ritonavir) or grapefruit can further increase enzyme inhibition. Lower “wellness” doses of CBD (e.g. 5–30 mg/day) are generally considered less likely to lead to interactions, but should still be discussed with a doctor. Further information on general mechanisms can be found in the article Effects of CBD in the body.
CBD can inhibit CYP3A4, an important liver enzyme involved in drug metabolism. This becomes more relevant at higher CBD doses and with liver problems, when interactions with prescription medicines are more likely.
How fluticasone is metabolised (CYP3A4)
Fluticasone is mainly metabolised by CYP3A4. With inhaled or nasal use, overall systemic exposure is usually low. Strong CYP3A4 inhibitors can increase fluticasone levels and, in individual cases, may be associated with systemic steroid effects. When used correctly, fluticasone acts mainly locally in the airways; correct inhalation technique and rinsing the mouth afterwards can lower the likelihood of local side effects.
CBD and fluticasone: What is known about the interaction?
The data on a direct interaction between CBD and fluticasone are limited. Based on the mechanism, CBD may inhibit CYP3A4 and thereby theoretically increase fluticasone levels (CBD CYP3A4 interaction). Inhaled and nasal applications are generally regarded as low to moderate risk, topical (dermatological) applications as very low risk, and oral fluticasone forms (rarely used) as higher risk. The interaction risk may increase with higher CBD doses, impaired liver function, or the additional use of strong CYP3A4 inhibitors (e.g. itraconazole, clarithromycin, ritonavir) or grapefruit.
CBD may slow down the metabolism of fluticasone via CYP3A4. With inhalers and nasal sprays the overall risk of a CBD–fluticasone interaction is usually low, but it can rise with higher CBD doses, liver problems, or additional CYP3A4 inhibitors such as grapefruit or certain medicines.
How significant is the interaction risk between CBD and fluticasone?
Interaction risk by fluticasone formulation
| Formulation | Example | Assessment of interaction risk |
|---|---|---|
| Inhaled | Fluticasone Diskus/Evohaler (Flixotide/Flovent) | Low–moderate; risk increases with higher CBD doses or additional CYP3A4 inhibition |
| Nasal | Fluticasone nasal spray | Similarly low–moderate |
| Topical (dermatology) | Ointments/creams | Very low |
| Oral | Tablets/suspension (rare) | Higher |
Note: Taking CBD and fluticasone at different times does not reliably reduce CYP3A4 inhibition. The key factors are CBD dose, liver function, and other medicines taken at the same time.
Influence of CBD dose, liver function and other inhibitors
| Factor | Example | What to do? |
|---|---|---|
| CBD dose | >100–300 mg/day | Seek medical advice, increase slowly, watch for side effects |
| Liver function | Raised transaminases, liver disease | Exercise particular caution; monitor liver values where appropriate |
| Other inhibitors | Ritonavir, itraconazole, clarithromycin | Avoid combinations where possible or use only under close medical supervision |
| Grapefruit | Grapefruit/juice | Avoid during a trial phase with CBD + fluticasone |
The risk of a CBD and fluticasone interaction depends on the steroid formulation, CBD dose, liver function, and other CYP3A4 inhibitors (including some medicines and grapefruit). These combinations should be reviewed by a doctor.
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Possible side effects and warning signs
With increased systemic steroid exposure, the following may occur: increased susceptibility to infections, easy bruising, rounding of the face, unusual weight gain, high blood pressure, persistent tiredness/weakness. If such signs appear, consider stopping CBD and seek medical advice.
Practical guidance: Using CBD with fluticasone more safely
- Consult a doctor before combining CBD with fluticasone – especially with higher CBD doses (>100–300 mg/day), liver problems, or additional medication.
- Start with a low CBD dose (e.g. 5–30 mg/day) and increase slowly; record perceived effects and possible side effects.
- Avoid grapefruit and strong CYP3A4 inhibitors (e.g. ritonavir, itraconazole, clarithromycin) while testing CBD together with fluticasone.
- Use the correct inhalation technique and rinse your mouth after inhaling fluticasone to lower the likelihood of oral thrush and local side effects.
- If warning signs of increased steroid effects occur (see above), pause CBD and seek medical assessment.
- Topical CBD products are considered to have a very low risk of systemic CBD metabolism interactions.
If you use CBD with fluticasone, keep doses low at first, avoid additional CYP3A4 inhibitors (including grapefruit), watch for signs of stronger steroid effects, and involve a healthcare professional in any dosing decisions.
Side effects of CBD (overview)
Commonly reported: tiredness/drowsiness, dry mouth, changes in appetite or digestion. Less common (especially at higher doses or with liver disease): increases in liver enzymes. CBD is not intoxicating. Suitability and dosing should be assessed individually by a healthcare professional.
Side effects of fluticasone (inhaled)
Mainly local: hoarseness, cough, sore throat, fungal infections in the mouth/throat (oral thrush). Systemic effects are uncommon; the likelihood may increase with high doses or interactions affecting fluticasone metabolism. Correct use and rinsing the mouth after inhalation can help reduce local risks.
Conclusion
CBD and fluticasone may influence each other via CYP3A4, especially at higher CBD doses and with additional CYP3A4 inhibition. Inhaled and nasal applications are generally considered less critical in terms of CBD–fluticasone interactions, but should still be medically supervised in the presence of risk factors.
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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.