CBD and Omeprazole (e.g. Prilosec, Antra, Omeprazole-ratiopharm)
David ReichUpdated:Key points at a glance:
CBD may inhibit the liver enzymes CYP2C19 and CYP3A4. Omeprazole is mainly broken down via CYP2C19 and can also inhibit this enzyme. This may lead to higher levels of both substances in the body, particularly omeprazole. Current evidence on the combined use is limited. Be aware of new or unusual effects such as tiredness, dizziness, headache, abdominal pain or diarrhoea. The potential risk may be higher with higher CBD doses, existing liver problems, older age and the use of multiple medicines.
CBD may inhibit the liver enzymes (CYP2C19/CYP3A4) that help break down omeprazole (e.g. Prilosec, Antra, omeprazole‑ratiopharm). This may increase blood levels of omeprazole and, to a lesser extent, CBD. Always speak to your doctor before combining CBD with prescription medicines and use our interaction check to support the conversation.
CBD and omeprazole are both processed by the CYP2C19 and CYP3A4 liver enzymes. CBD can inhibit these enzymes, which may slow the breakdown of omeprazole and increase the risk of side effects. Medical supervision is recommended if you use CBD alongside omeprazole.
What does omeprazole do in the body?
Omeprazole is a proton pump inhibitor (PPI) used to reduce the production of stomach acid. It is commonly prescribed for heartburn, acid reflux, and related conditions such as gastro‑oesophageal reflux disease (GORD).
Omeprazole lowers stomach acid and is widely used for heartburn and reflux‑related symptoms.
What does CBD do in the body?
CBD (cannabidiol) is a plant compound from hemp that interacts with the body’s endocannabinoid system and other signalling pathways. Many people use CBD oil and other CBD products to support general wellbeing. Its effects vary between individuals and depend on dose, product quality, and personal sensitivity.
Why CBD may influence other medicines (CYP450)
CBD can inhibit several liver enzymes in the cytochrome P450 (CYP450) system that are involved in the metabolism of many prescription medicines. CYP2C19 and CYP3A4 are particularly relevant here, as they help determine how quickly medicines are broken down and what blood levels are reached.
CBD can slow down certain CYP450 liver enzymes (including CYP2C19 and CYP3A4). As a result, blood levels of some medicines may rise, which can increase the likelihood of side effects.
How might CBD and omeprazole interact?
Enzymes (CYP2C19, CYP3A4): mechanism and relevance
CBD strongly inhibits CYP2C19 and moderately inhibits CYP3A4. Omeprazole is mainly broken down via CYP2C19 and also has an inhibitory effect on this enzyme. Because both CBD and omeprazole rely on – and can inhibit – CYP2C19 (and to a lesser extent CYP3A4), higher levels of omeprazole and possibly CBD are theoretically possible.
This assessment is mainly based on knowledge of CYP mechanisms and data from interactions with other substances. At present, there are only limited direct clinical data specifically on the combination of CBD and omeprazole.
| Substance | Role | Enzymes involved | Possible consequence | Relevance |
|---|---|---|---|---|
| CBD (cannabidiol) | Substrate and inhibitor | CYP2C19 (strong), CYP3A4 (moderate) | Higher omeprazole levels are possible; CBD levels may also increase | Mechanism-based; limited clinical data |
| Omeprazole | Substrate and inhibitor | CYP2C19 (main pathway), CYP3A4; inhibits CYP2C19 | May affect the breakdown of CBD (more likely moderately) | Bidirectional interaction possible |
CBD and omeprazole both use and inhibit CYP2C19 (and, to a lesser extent, CYP3A4). This overlap can slow metabolism and may increase blood levels of both substances, especially omeprazole. Current evidence is largely theoretical and mechanism‑based.
Further reading: CBD and medicines: complete guide to interactions
Who may have a higher risk of CBD–omeprazole interaction?
Extra caution is advisable if you:
- are older
- have impaired liver function
- use higher doses of CBD or take CBD several times a day
- take several medicines at the same time (polypharmacy)
- are on long‑term omeprazole or other PPI treatment
Possible signs of increased levels
Watch for new symptoms or changes such as:
- new or stronger tiredness or dizziness after taking CBD or omeprazole
- increase in headaches, abdominal discomfort, nausea or diarrhoea
- persistent or changing reflux symptoms despite omeprazole treatment
Seek medical advice promptly if you notice new or worsening side effects, feel very tired or dizzy, or if your reflux or heartburn symptoms persist despite treatment.
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Side effects at a glance
CBD: common and less common effects
Commonly reported CBD side effects include tiredness, dizziness, dry mouth, changes in appetite and mild diarrhoea. Overall tolerability is often described as good; the likelihood of side effects may increase with higher doses, product strength and individual sensitivity. It is generally advisable to start low and monitor how you respond.
Side effects of omeprazole
Short‑term side effects of omeprazole can include headaches, nausea, abdominal pain, diarrhoea or constipation. With long‑term use, there may be additional risks such as vitamin B12 or magnesium deficiency and certain infections. Long‑term PPI treatment should be regularly reviewed and monitored by a doctor, especially if CBD or other medicines are used at the same time.
Practical guidance: using CBD with omeprazole safely
If you are considering CBD while taking omeprazole, discuss the following points with your doctor or pharmacist and monitor yourself carefully:
- Share your exact omeprazole dose, how long you have been taking it, and when you take it during the day.
- List all CBD products you use (e.g. oil, capsules, gummies), including strength, brand and daily dose.
- Mention all other prescription medicines, over‑the‑counter products and supplements (e.g. St John’s wort, antacids, painkillers).
- Ask whether any recent or planned liver function tests are relevant in the context of CBD use.
- Explain why you want to take CBD (e.g. general wellbeing) and describe any effects or side effects you have already noticed.
- Agree on what warning signs to look out for and when you should seek medical review.
Tip: Check CBD product quality. Look for clear manufacturer information, certificates of analysis (CoA) from independent laboratories, and a defined THC content. Precise information on the CBD product helps your doctor or pharmacist to assess possible interaction risks more realistically.
Alternative or lower‑risk option: For localised issues, topical CBD products (e.g. creams, balms or gels applied to the skin) may have a lower potential for systemic interactions because they generally lead to lower CBD levels in the blood. Whether this is suitable depends on the individual purpose of use and should be clarified with a healthcare professional.
Conclusion
CBD and omeprazole may influence each other via the CYP2C19 and CYP3A4 liver enzymes. This can increase the levels of these substances in the body – mainly omeprazole, and to a lesser extent CBD. Direct evidence for this specific combination is currently limited; assessment is based largely on known CYP mechanisms and data from related substances.
If you plan to use CBD while taking omeprazole, a cautious, structured approach is advisable: talk to your doctor, review all your medicines, watch for warning signs, check CBD product quality, and ensure that any long‑term PPI treatment is closely monitored.
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.