CBD and Ibuprofen (e.g. Advil, Motrin, Nurofen, Ibu-ratiopharm, Dolormin)

You occasionally take ibuprofen and are considering trying CBD (for example as CBD oil)? This article summarises what is known about using CBD and ibuprofen together, where potential CBD–ibuprofen interactions may lie, and what to keep in mind in everyday life. At present, there are only limited direct clinical data on this combination. Theoretical risks arise from the CBD–CYP450 interaction (including CYP2C9, CYP2C19, CYP3A4) and the known side effects of NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen.

• Direct clinical data on CBD and ibuprofen are scarce; in theory, CBD can increase blood levels of some medicines by inhibiting CYP2C9/CYP3A4.
• Depending on dose and duration, ibuprofen can place a strain on the stomach and kidneys; CBD can affect liver parameters at higher doses.
• Particular caution: people with stomach/intestinal ulcers, liver or kidney disease, older adults, pregnancy/breastfeeding, and those taking anticoagulants/corticosteroids/other NSAIDs.
• In practice: involve your doctor or pharmacist, start with a low CBD dose, consider separating the timing of doses, and watch for warning signs.
• Topical CBD products (e.g. creams) are generally thought to have a lower interaction risk than oral forms – but robust data are lacking.

• have current or previous gastric/duodenal ulcers or gastrointestinal bleeding,
• have liver or kidney disease,
• take blood-thinning medicines, corticosteroids or other NSAIDs,
• are pregnant, breastfeeding or over 65 years of age,
• regularly drink large amounts of alcohol.

How CBD and ibuprofen act in the body

How CBD works: endocannabinoid system and liver enzymes (CYP450)

CBD (cannabidiol) interacts with the endocannabinoid system (ECS), which is involved in sleep, mood, pain processing and immune responses. CBD may indirectly increase the activity of the body’s own endocannabinoids by slowing their breakdown.

For CBD drug interactions, its effect on liver enzymes is particularly important. CBD can inhibit several enzymes of the CYP450 family – especially CYP2C9, CYP2C19 and CYP3A4. These enzymes metabolise many commonly used prescription medicines. If an enzyme is inhibited, the breakdown of other active substances can be slower and their blood levels may rise. This does not automatically mean problems will occur, but it helps explain the theoretical risk with combinations (key terms: CBD–CYP450 interaction, CBD–CYP2C9, CBD–CYP3A4).

Read our article on how CBD works in the body

How ibuprofen works: COX inhibition and metabolism via CYP2C9

Ibuprofen belongs to the group of NSAIDs. It inhibits COX enzymes and thereby reduces the formation of prostaglandins, which play a role in pain and inflammation. From a pharmacokinetic perspective, ibuprofen is metabolised mainly via CYP2C9 and then excreted largely via the kidneys.

NSAIDs such as ibuprofen can irritate the gastrointestinal tract (up to and including bleeding) and place a strain on kidney function in susceptible individuals. These risks increase with dose, age, pre-existing conditions and duration of use.

Possible CBD–ibuprofen interactions: what does the research say?

Theoretical risk: altered ibuprofen levels due to enzyme inhibition

Because CBD can inhibit the enzymes CYP2C9 and CYP3A4, it is theoretically possible that the breakdown of some medicines is delayed and their concentration in the blood increases. As ibuprofen is mainly metabolised via CYP2C9, this suggests a theoretical potential interaction between CBD and ibuprofen. The actual relevance may vary depending on dose, frequency of intake, individual enzyme activity and other medicines being taken.

Evidence base: what is known, what is missing?

• Direct clinical studies examining the combination CBD + ibuprofen are currently limited.
• There are, however, laboratory and review papers describing CBD–CYP450 inhibition (including CYP2C9, CYP2C19, CYP3A4) and possible effects on drug metabolism.
• From authorised CBD-based medicines it is known that higher CBD doses can affect liver values and interact with other medicines – this supports a cautious approach to combinations with ibuprofen and other painkillers.

Organs under strain: stomach, liver and kidneys

• Stomach/intestines (NSAIDs): Ibuprofen can cause nausea, heartburn and abdominal pain. Warning signs include black stool and vomiting blood, which may indicate gastrointestinal bleeding.
• Kidneys (NSAIDs): NSAIDs can reduce blood flow to the kidneys, particularly in people with pre-existing kidney impairment, older adults or those who are dehydrated.
• Liver (CBD): High CBD doses have been associated with increased transaminases in some studies. In people with liver disease or altered liver enzymes, caution and medical supervision are advisable.
• Combination: When CBD and ibuprofen are used together, pay attention to unusual fatigue, yellowing of the skin or eyes, dark urine, dizziness, persistent stomach complaints or signs of bleeding.

Oral vs topical CBD: differences in interaction risk

With topical CBD (e.g. creams, gels or balms), systemic absorption is generally lower than with oral forms such as CBD oil or capsules. Therefore, the interaction risk with ibuprofen is likely to be lower. However, high-quality studies are lacking; actual absorption depends on the product formulation, application area and how often it is used.

Read our article on CBD drug interactions

Who should be especially cautious with CBD and ibuprofen?

The following groups should avoid the combination or use it only under close medical supervision:

• People with current or previous gastric/duodenal ulcers or gastrointestinal bleeding
• People with liver or kidney disease, or reduced kidney function
• Older adults (≥ 65 years)
• Pregnancy and breastfeeding
• Those taking anticoagulants, corticosteroids or other NSAIDs at the same time
• People with heavy, regular alcohol consumption

Planning to use CBD and ibuprofen together? A practical 5-step approach

1. Seek medical advice: Discuss your plans with your doctor or pharmacist, especially if you have pre-existing conditions, take prescription medicines or use ibuprofen regularly.
2. Start low with CBD: Begin with a low CBD dose and increase only slowly if needed. Do not adjust the dose of prescription medicines without professional guidance.
3. Use ibuprofen as cautiously as possible: Take the lowest effective ibuprofen dose for the shortest necessary time. Follow the patient information leaflet or official sources such as NHS information on ibuprofen.
4. Consider timing and monitor symptoms: Some people choose to leave a few hours between CBD and ibuprofen doses to reduce overlap in peak levels. Monitor for dizziness, unusual bleeding, black stool, severe tiredness, yellowing of the skin, dark urine or persistent stomach complaints.
5. Keep an up-to-date medicines list: Maintain a list of all prescription medicines, over-the-counter medicines (including ibuprofen), CBD products and supplements. Have your overall regimen reviewed regularly by your doctor or pharmacist.

Common side effects of CBD and ibuprofen compared

CBD side effects and important notes

CBD (cannabidiol) is generally considered to have a good tolerability profile. Possible effects include dry mouth, tiredness, dizziness, low blood pressure and gastrointestinal complaints. In studies with cannabidiol-based medicines, increased liver enzymes (transaminases) have been observed at higher doses. If you have liver disease or already altered liver values, discuss CBD use with your doctor beforehand.

Ibuprofen side effects and safe use

Ibuprofen is widely used and is generally well tolerated. Possible side effects include gastrointestinal complaints (nausea, heartburn, pain), headaches and dizziness. Less commonly, gastrointestinal bleeding, allergic reactions and kidney problems can occur. The risk increases with dose and duration. Use the lowest effective dose and avoid long-term use without medical supervision. Guidance on dosing is provided by official sources such as MedlinePlus: Ibuprofen – Information and the patient information leaflet.

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.