CBD and Metamizole (e.g. Novalgin, Novaminsulfon, Nolotil)
David ReichUpdated:Key points at a glance:
CBD and metamizole may interact via liver enzymes. CBD can inhibit CYP3A4 and CYP2C19, while metamizole may induce CYP2B6 and CYP3A4. This could potentially lead to altered substance levels in the body. Possible effects may include dizziness, tiredness, low blood pressure and gastrointestinal discomfort. In rare cases, a serious condition called agranulocytosis has been reported with metamizole; warning signs can include fever, sore throat and an increased tendency to infections. Any combination should only be used following medical advice. Particular caution is advisable with higher CBD intakes and when multiple medications are being taken.
Cannabidiol (CBD) and metamizole (e.g. Novalgin, Novaminsulfon, Nolotil) can both influence the way medicines are processed in the body. This article summarises what is known so far about CBD and metamizole interactions, where the evidence is limited, and what to discuss with your doctor if you are considering combining CBD with prescription medicines.
- CBD may inhibit liver enzymes (CYP3A4/CYP2C19); metamizole may induce enzymes (including CYP2B6/CYP3A4).
- Possible consequences: altered effects and side effects (e.g. dizziness, drowsiness, drop in blood pressure).
- Warning signs: sudden fever, sore throat, increased susceptibility to infections → seek medical assessment immediately.
- Combination only after medical advice; particular caution with pre-existing conditions and multiple medicines.
CBD and metamizole may influence each other via liver enzymes (CYP450). The evidence for CBD–metamizole interactions is still limited, so an individual medical assessment is recommended.
What are CBD and metamizole?
CBD – effects and forms of administration
Cannabidiol (CBD) is a non-psychoactive cannabinoid from the hemp plant. It interacts with the endocannabinoid system and has been shown to affect, among others, serotonin and TRP receptors. In practice, CBD is often discussed in relation to general wellbeing, sleep and in the context of pain; how it is used can depend on the dose. CBD is available, among other things, as CBD oil.
Metamizole (Novalgin, Novaminsulfon, Nolotil) – uses and particularities
Metamizole (Novalgin/novaminsulfon; internationally also known as dipyrone, in Spain "Nolotil") is a centrally acting analgesic with antipyretic and spasmolytic components. It is available on prescription. The exact mechanism of action has not been fully clarified.
How the body processes CBD and metamizole
Liver enzymes (CYP450) explained simply
The liver breaks down many substances via cytochrome P450 enzymes. CBD may inhibit some of these enzymes (e.g. CYP3A4, CYP2C19), while metamizole may increase the activity of some of them (induction). This can alter blood levels and effects of both substances.
CBD: CBD mainly inhibits CYP3A4 and CYP2C19; clinical relevance has been observed particularly at higher doses (including data from Epidyolex studies).
Metamizole: Metamizole is a prodrug. It is rapidly hydrolysed to 4-MAA (4-methylaminoantipyrine) and other active metabolites. Metamizole can induce enzymes, including CYP2B6 and CYP3A4.
CBD can slow down certain liver enzymes (CYP3A4, CYP2C19), while metamizole can speed some of them up (CYP2B6, CYP3A4). As a result, the levels and effects of CBD and metamizole in the body may change.
CBD vs metamizole at a glance
| Aspect | CBD | Metamizole (Novalgin) |
|---|---|---|
| Mechanism of action | Modulation of the endocannabinoid system; influence on TRP/serotonin | Centrally acting analgesic; antipyretic, spasmolytic |
| Main enzymes | Mainly inhibits CYP3A4, CYP2C19 | Prodrug → 4-MAA; induces, among others, CYP2B6, CYP3A4 |
| Common side effects | Drowsiness, dizziness, dry mouth, drop in blood pressure | Gastrointestinal complaints, skin reactions |
| Specific risks | Enzyme inhibition → potential interactions at higher doses | Rare: agranulocytosis (changes in blood counts) |
| Form/onset | Oils, capsules, etc.; onset depends on the form | Tablets/drops/infusion; rapid onset of effect |
Are there interactions between CBD and metamizole?
What the liver enzymes might mean in practice
From a pharmacokinetic perspective: CBD inhibits CYP3A4/CYP2C19. Metamizole is converted into active metabolites and may induce enzymes (including CYP2B6/CYP3A4). This leads to two directions of possible interaction:
- CBD could slow the breakdown of metamizole metabolites, which may increase the likelihood of side effects.
- Metamizole could increase the breakdown of CBD and lower CBD levels, which may reduce CBD’s effects.
High-quality human studies on the specific combination of CBD and metamizole are lacking; indications come from pharmacokinetic data, case reports and enzyme studies. Spacing out doses does not reliably prevent interactions, as enzyme effects can last for hours to days.
Possible additive effects: Sedation/tiredness, dizziness, drop in blood pressure (especially when standing up quickly), gastrointestinal complaints.
Dosage range: The potential for interactions increases with CBD dose, particularly at higher doses (e.g. >10–20 mg/kg/day in studies). With low-dose products the risk is likely to be lower, but cannot be ruled out.
CBD may slow down the metabolism of metamizole, while metamizole may speed up the metabolism of CBD. The current evidence base for CBD–metamizole interactions is limited, so combining CBD with metamizole (Novalgin, Novaminsulfon, Nolotil) should be overseen by a doctor.
Who should be particularly careful with CBD and metamizole?
- Older adults
- People with impaired liver or kidney function
- People taking multiple medicines (polypharmacy)
- Those with a history of changes in blood counts
- Pregnant or breastfeeding people
This tool shows known interactions. It does not replace medical advice and does not cover every individual situation.
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Possible side effects – individually and in combination
- CBD: Commonly reported effects include drowsiness, dry mouth, dizziness, mild drop in blood pressure; less commonly nausea, diarrhoea or changes in appetite.
- Metamizole: Gastrointestinal complaints, skin reactions; rarely, serious reactions such as agranulocytosis (a marked reduction in certain white blood cells), which may increase susceptibility to infections.
- Combination: Potential additive effects include sedation/tiredness, dizziness, orthostatic symptoms (drop in blood pressure when standing up), gastrointestinal complaints. Any unusual or severe symptoms should be assessed by a doctor.
CBD and metamizole each have their own side-effect profile. When combined, dizziness, tiredness, low blood pressure and gastrointestinal symptoms may be more noticeable, and rare blood count changes linked to metamizole remain an important safety aspect.
Warning signs: when you need medical advice
- Sudden fever, sore throat, inflammation of the oral mucosa (possible warning signs of agranulocytosis)
- Severe dizziness, fainting, persistently low blood pressure
- Breathing difficulties, pronounced skin rash, swelling of the face or tongue
In practice: talking to your doctor or pharmacist about CBD and metamizole
- Prepare a list of all medicines and supplements (including the CBD product, strength in mg/ml or mg, dose and frequency).
- Mention underlying conditions (especially liver or kidney issues), allergies and any previous abnormalities in blood counts.
- Describe symptoms since starting CBD, metamizole, or the combination (e.g. dizziness, tiredness, fever, sore throat, skin reactions).
- Ask whether dose adjustments are needed and whether blood count or liver function tests are advisable in your situation.
Evidence and context
- What is established: CBD inhibits CYP3A4/CYP2C19; metamizole is a prodrug converted to 4-MAA and may induce CYP2B6/CYP3A4. Metamizole can, in rare cases, cause agranulocytosis (according to medicines safety communications).
- What is assumed: CBD could increase levels of metamizole metabolites; metamizole could lower CBD levels. Additive sedation/dizziness is possible. Robust human studies on the combination are not yet available.
- Consequence: The combination should only be used after discussion with a doctor; with higher CBD doses, close monitoring is particularly important.
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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.