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Does CBD Interact With Celecoxib (Celebrex)?

Both Celecoxib and CBD are widely used for their pain alleviating and anti-inflammatory properties — but are they safe to mix?

Article By
Daily CBD , last updated on December 20, 2021

Celecoxib, a non-steroidal anti-inflammatory drug, is a prescription drug widely used for managing pain and inflammation. 

CBD, a cannabinoid, has a growing popularity for its effectiveness in acute and chronic pain. 

Here, we’ll discuss whether CBD can be used safely with celecoxib (Celebrex) and whether CBD is a safer alternative for celecoxib.

Does CBD Interact With Celecoxib? 

Yes, CBD interacts mildly with NSAIDs like celecoxib (Celebrex).

CBD may potentiate the analgesic and anti-inflammatory action of celecoxib — acting synergistically to alleviate pain. 

CBD may also inhibit the breakdown and excretion of the drug from the body. This could lead to elevated serum levels of celecoxib over time. High serum levels of celecoxib may increase the risk of thrombotic events and gastric ulcers.

It’s wise to separate the doses of CBD and celecoxib by about 2 hours in order to minimize risk further. 

A) Slowed Elimination (Metabolic Inhibition)

Celecoxib is metabolized primarily by the cytochrome P450, CYP2D6, and CYP2C9 isoenzymes and has an elimination half-life of about 11 hours in healthy individuals [1]. Celecoxib may become a potential target of CYP2D6-associated drug-drug interactions, particularly in individuals with reduced CYP2C9 activity [2]. 

CBD is a potent inhibitor and substrate for CYP isoenzymes, mainly CYP3A4, CYP2D6, CYP2C9, CYP2C19, CYP1A2, CYP2C8, CYP2B6, and CYP2E1. Inhibition of these enzymes slows down the metabolism of celecoxib.

Celecoxib’s longer duration of stay in the serum may increase the probability of adverse events. This type of interaction is referred to as metabolic inhibition, which is the most common drug-drug interaction (DDI) between celecoxib and CBD. This necessitates using a lower dose of celecoxib to gain the optimum effect if it needs to be taken along with CBD. 

B) Increased Effect (Agonistic Interaction)

The concurrent use of CBD and celecoxib (Celebrex) helps to alleviate pain and inflammation. This combination enhances the action of each other when taken together

Celecoxib is a potent, selective cyclooxygenase-2 (COX-2) inhibitor. It inhibits the formation of prostaglandins responsible for pain and inflammation. 

On the other hand, CBD works by modulating endocannabinoid (CB1) receptors present in the central nervous system and CB2 receptors in the immune system. CBD reduces pain by dopaminergic regulation and attenuates inflammation by the dysregulation of cytokine production by immune cells and disruption of the well-regulated immune response [3].

Both CBD and celecoxib can reduce pain and inflammation, but they act through different receptors. Nevertheless, when CBD and celecoxib are consumed together their final effects may be more harmful than beneficial.

Other Names For Celecoxib

Celecoxib is sold under different names. All share the same risk and potential interactions.

Other names for celecoxib includes:

  • Celebrex
  • Onsenal
  • Consensi
  • Elyxyb
Celebrex (celecoxib) box with 100 capsules.

Similar Medications: CBD and Celecoxib

Celecoxib is classified as an NSAID (non-steroidal anti-inflammatory drug) under the sub-classification of selective COX-2 inhibitors. CBD and NSAIDs all share similar risks for interaction and side effects.

Here’s a list of medications that share a similar level of risk when combined with CBD:

  • Ibuprofen (Motrin, Advil, Nuprin, Caldolor & Neoprofen)
  • Aspirin (Ascriptin, Aspergum, Aspirtab, Bayer, Easprin, Ecotrin, Ecpirin, Entercote)
  • Naproxen (Aleve)
  • Etodolac (Ultradol)
  • Ketorolac (Toradol)
  • Meloxicam (Mobic)

Is It Safe to Take CBD and Celecoxib Together?

CBD is unlikely to result in a severe interaction with celecoxib. However, side effects are still possible, so it’s wise to speak to your doctor about taking CBD if you’ve been given a prescription for celecoxib or any NSAID drug. 

It’s also a good idea to use a lower dosage of CBD if taking this combination. 

Adequate spacing (2 hours apart) can also significantly reduce the chances of experiencing adverse side effects. 

It’s best to consult your doctor before you decide to take CBD while using celecoxib.

Is CBD A Viable Alternative to Celecoxib (Celebrex)?

For mild to moderate arthritis, pain, and inflammation, CBD may be a viable alternative to celecoxib. 

Both substances work to reduce inflammation and alleviate pain — however, the COX-2 anti-inflammatory activity of celecoxib is many times stronger than CBD.

Many people are using CBD to help alleviate symptoms of arthritis effectively. However, some find it isn’t strong enough to alleviate symptoms entirely and turn to pharmaceuticals instead. 

What is Celecoxib?

Celecoxib belongs to the class NSAID (non-steroidal anti-inflammatory drug) family. It’s available under the trade name Celebrex

Celebrex is used to treat osteoarthritis (OA), rheumatoid arthritis (RA), juvenile rheumatoid arthritis (JRA), ankylosing spondylitis (AS), acute pain, and primary dysmenorrhoea (painful menstruation). 

This substance acts by selectively inhibiting the COX-2 pathway — which is one of the primary enzymes responsible for producing inflammatory messengers. This effect reduces various mediators of pain and inflammation. 

Celecoxib is available by prescription-only as per the FDA.

Celecoxib Specs:

Drug Name Celecoxib
Trade Name  Celebrex
Classification NSAIDS
CYP Metabolism CYP2D6, CYP2C9
Interaction With CBD Agonistic and Metabolic Inhibition
Risk of Interaction Mild

How Does Celecoxib Work? 

Phospholipids present in the membranes of the human body are converted to compounds called arachidonic acids. These arachidonic acids are metabolized via two pathways, COX-1, and COX-2 pathways, producing different prostaglandins and thromboxanes. These different prostaglandins are responsible for mediating pain and inflammation through various metabolites. 

Celecoxib is a potent, selective cyclooxygenase-2 (COX-2) inhibitor and exerts minimal action on the cyclooxygenase-1 (COX-1) pathway. The COX-2 pathway, when inhibited, prevents the formation of different prostaglandins responsible for pain and inflammation.

The COX-1 pathway is responsible for prostaglandin-mediated maintenance of gut epithelium and thromboxane-mediated promoting platelet aggregation. Since celecoxib relatively spares the COX-1 pathway, gastrointestinal side effects are rare, while the imbalance between prothrombotic and antithrombotic mediators leads to the risk of thrombo-vascular events.

Celecoxib is readily absorbed when taken orally and binds to plasma proteins. Its half-life is approximately 11 hours, so it is given once or twice daily for optimal therapeutic benefits.

Simultaneous use of CBD enhances the effect on pain and inflammation while also increasing the risk of side effects. Concurrent use might lead to headaches, dyspepsia, gastrointestinal bleed, and renal toxicities.

Celecoxib (Celebrex) should be used during pregnancy only if needed and if the benefit outweighs the risk. Its side effect warrants precaution with its use. 

Celecoxib should be avoided in the following conditions:

  • Patients with heart failure.
  • Patient with chronic kidney disease.
  • Patient with peptic ulcer disease.
  • Patient with vascular and hematologic conditions.
  • Children less than two years of age.

Side Effects of Celecoxib 

  • Esophagitis
  • Gastritis
  • Jaundice
  • Dizziness
  • Hypertension
  • Stroke
  • Myocardial Infarction
  • Cold symptoms
  • Acute Kidney Injury

Key Takeaways: Is it Safe to Take Celecoxib With CBD?

CBD and celecoxib are both used for managing pain and inflammation, but their mechanism of action is not similar. 

There’s a mild risk of interaction between CBD and celecoxib, but only when used in high doses or for long periods. CBD potentiates the analgesic and anti-inflammatory action of celecoxib. CBD also increases the serum concentration of celecoxib over time.

It’s usually safe to take CBD with celecoxib. However, it is best not to take these medications of your own accord and always talk to your prescribing physician first


References 

  1. Davies NM, McLachlan AJ, Day RO, Williams KM. Clinical pharmacokinetics and pharmacodynamics of celecoxib: a selective cyclo-oxygenase-2 inhibitor. Clin Pharmacokinet. 2000 Mar;38(3):225-42.
  2. Siu YA, Hao MH, Dixit V, Lai WG. Celecoxib is a substrate of CYP2D6: Impact on celecoxib metabolism in individuals with CYP2C9*3 variants. Drug Metab Pharmacokinet. 2018 Oct;33(5):219-227.
  3. Klein TW, Newton CA, Nakachi N, Friedman H. Delta 9-tetrahydrocannabinol treatment suppresses immunity and early IFN-gamma, IL-12, and IL-12 receptor beta 2 responses to Legionella pneumophila infection. J Immunol. 2000 Jun 15;164(12):6461-6.

Learn More About CBD-Drug Interactions

Learn More About CBD-Drug Interactions

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