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Does CBD Interact With Fluoxetine (Prozac)?

Fluoxetine (Prozac), is a common prescription SSRI medication used in the treatment of anxiety and depression. 

There’s a moderate risk of CBD interacting with fluoxetine.

Article By
Daily CBD , last updated on November 25, 2021

According to the CDC, roughly 13% of the population takes antidepressant medications. Another survey found that nearly 14% of the population takes CBD.

Unsurprisingly, there are a lot of people who take both CBD (cannabidiol) and SSRIs at the same time. 

Is this combination safe? Are there any dangers to be aware of? We’ll explore the potential risks and interactions when combining CBD with fluoxetine (Prozac).

Illustration of fluoxetine capsule

Does CBD Interact With Fluoxetine (Prozac)?

There is a moderate risk of increased side effects when using CBD with antidepressants such as fluoxetine (Prozac) [1]. 

The chances of users experiencing a serious interaction are low. However, some of the rare but possible side effects are severe — including seizures and serotonin syndrome. 

There are two main ways CBD can interact with fluoxetine.

Interaction 1: Slowed Elimination (Metabolic Inhibition)

CBD strongly interacts with other drugs metabolized by CYP2C19 and moderately interacts with drugs metabolized by CYP2D6 [2]. 

Most SSRIs, including fluoxetine, are also metabolized by CYP2D6 [3]. Fluoxetine is a moderate inhibitor of drugs metabolized by CYP2D6 but a strong inhibitor of drugs metabolized by CYP2C19. 

Since CBD and fluoxetine compete for metabolism in the liver, serum levels of both compounds can elevate. This slows fluoxetine’s metabolization, which, in turn, increases the possibility of side effects.

Adverse effects from mixing CBD with fluoxetine include nausea, diarrhea, and headaches.

Interaction 2: Increased Effect (Agonistic Interaction)

Simultaneously taking two substances with similar actions results in an agonistic interaction. CBD and fluoxetine may compound each other’s actions as they are both used to treat depression, anxiety, and panic disorders. 

This interaction can result in serious side effects.

Therefore, before taking CBD and fluoxetine together, you must consult with your physician first. They may want to reduce your dose of Prozac or advise you to separate your dose of SSRIs and CBD by about 2-hours to minimize your risk. 

Other Names for Fluoxetine

Fluoxetine is a generic drug marketed under many different brand names. All of the following medicines share the same risk and potential for interaction with CBD. 

Some of the other names for fluoxetine are:

  • Prozac
  • Sarafem
  • Rapiflux
  • Selfemra
  • Fludac
  • Fludep
  • Flugen
  • Fluoxee
  • Flutrac

Similar Medications

Fluoxetine (Prozac) is classified as an SSRI drug. CBD and SSRIs interact and share the same risks.

  • Fluvoxamine (Luvox, Faverin, Fluvoxin, Boxamine, Fluvator)
  • Paroxetine (Aropax, Paxil, Pexeva, Seroxat, Sereupin, Brisdelle)
  • Sertraline (Zoloft, Lustral, Actiser, Dazolin, Depsert, Insert, Mares)
  • Citalopram (Celexa, Cipramil, C-pram, Celepra, Celica, Cipam, Citalent, Citalomine)
  • Escitalopram (Lexapro, Alwel, Anipram, Rhopram S, Talo, Szetalo, Stalopam, S Celepra)
  • Dapoxetine (Priligy, Dasutra, Duralast, Kutub, Dapox, Ejalong, Prilyxet, Xydap)

Is It Safe to Take CBD & Fluoxetine (Prozac) Together?

Safety concerns with the co-administration of CBD and fluoxetine (Prozac) are still a topic of debate. Few studies exist on potential drug interactions between these two substances.  

CBD and fluoxetine, when taken together, may lead to some undesirable side effects such as dizziness, drowsiness, difficulty in concentrating, and confusion. Older individuals may experience impairment in motor coordination along with judgment and thinking.

A lower dosage of fluoxetine, when taken with CBD, may have fewer side effects than higher dosages. However, it’s best to avoid the co-administration of CBD and fluoxetine.

Consult your doctor before you combine CBD with any other medication, including fluoxetine. 

Is CBD a Viable Alternative to Fluoxetine (Prozac)?

CBD could be a natural alternative in treating depression, substituting fluoxetine due to its similar effects, but it depends on what fluoxetine is prescribed for [4]. If it’s for anything other than mild depression, CBD is unlikely to help. It appears to be better tolerated than routine psychiatric medications [5]. 

According to the WHO, there have been no reports of a lethal overdose with CBD, and it has an exceedingly low potential for abuse or dependency [6]. 

CBD has a low overall risk of side effects with short-term use compared to most antipsychotics. However, further research is needed to evaluate possible long-term dangers and damages.

However, do not stop taking fluoxetine or adjust the dose as it can lead to withdrawal symptoms. Always consult your physician first before switching between drugs or supplementing prescribed antidepressants with CBD.

What Is Fluoxetine (Prozac)?

Fluoxetine (Prozac) is a prescription-only medication belonging to the selective serotonin reuptake inhibitor (SSRI) class of antidepressants. It is a generic drug with trade names such as Prozac, Rapiflux, Sarafem, Barazac, and Selfemra. 

It’s the drug of choice in treating obsessive-compulsive disorders, panic disorders, social phobias, eating disorders, premenstrual dysphoric disorder, and post-traumatic stress disorder.

These drugs also treat anxiety and bipolar disorders, body dysmorphic disorder, compulsive buying, kleptomania, and premature ejaculation. 

It’s for use in children seven years or older only and is available in dosages of 10 mg, 20 mg, 40 mg, and 90 mg capsules.

Fluoxetine Specs

Drug nameFluoxetine
Trade NamesProzac, Rapiflux, Sarafem, Barazac, Selfemra, etc
ClassificationSelective Serotonin Reuptake Inhibitor (SSRI)
CYP MetabolismMetabolized by CYP2C19 and CYP2D6
Interaction with CBDMetabolic Inhibitor and Agonistic Interaction
Risk of interactionModerate

What Does Fluoxetine Do?

Fluoxetine (Prozac), belonging to the SSRI class of drugs, blocks serotonin’s reabsorption (reuptake) into neurons

This leads to increased levels of serotonin in the brain. SSRIs mainly affect serotonin, not other neurotransmitters. Serotonin, famously known as the happy hormone, stabilizes our mood, feelings of well-being, and happiness.   

Side Effects of Fluoxetine

These are the common and mild side effects of fluoxetine that usually disappear after a week of use.

  • Rash
  • Sweating
  • Altered appetite and weight
  • Insomnia
  • Nervousness
  • Anxiety
  • Abnormal dreams
  • Weakness
  • Flu-like syndrome
  • Nausea
  • Diarrhea

The following are serious side effects that need immediate medical attention. Call your healthcare provider right away if you have any of these symptoms.

  • Allergic reactions and rash
  • Seizures
  • Abnormal bleeding
  • Potential for cognitive and motor impairment
  • Suicidal thoughts and behaviors in children, adolescents, and young adults under twenty-five years of age
  • Serotonin syndrome (change in mental status, overactive reflexes, fever) 

Precautions While Taking Fluoxetine

Besides side effects, there are other things to be aware of if you’re using fluoxetine. 

Concomitant Use With Alcohol

Do not mix CBD or fluoxetine with alcohol. The adverse effects of both substances may be fatal when taken with alcohol.

Use With Other Medication

Do not use fluoxetine if you have previously used monoamine oxidases (MAO) inhibitors such as phenelzine and tranylcypromine. It may lead to a condition known as serotonin syndrome, which is life-threatening. 

Other drugs that increase serotonin levels include tricyclic antidepressants (TCA), triptans, amphetamine, methamphetamine, MDMA, buspirone, and serotonin-norepinephrine reuptake inhibitors.

Patients using blood-thinning medications should also avoid fluoxetine.

Opioids

Opioids like pethidine, tramadol, dextromethorphan, and tapentadol will increase serotonergic activity. Fentanyl and methadone have similar effects but to a lesser degree. 

A combination of opioids and fluoxetine may increase the risk of serotonin toxicity. Fluoxetine also blocks the metabolism of opioids leading to reduced analgesic effects [7].

Use In Pregnancy

Fluoxetine should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus (Pregnancy Category C). It is not for use in breastfeeding women as fluoxetine is excreted in breast milk.

Dose Adjustments

Dose adjustments are required in patients with liver cirrhosis; these patients need lower or less frequent dosing. Unlike other drugs, dose adjustment for fluoxetine is not necessary for patients with impaired renal functions.

Cessation

Do not stop fluoxetine without talking to your healthcare provider. Stopping the drug suddenly may cause serious withdrawal symptoms such as anxiety, irritability, high or low mood, feeling restless, or changes in sleep habits. Other symptoms include headache, sweating, nausea, dizziness, electric shock-like sensations, shaking, and confusion.

Key Takeaways: Is It Safe to Take Fluoxetine (Prozac) With CBD?

CBD is a natural, relatively nontoxic chemical with antidepressant action. There is a moderate risk if you use CBD and fluoxetine (Prozac) together. 

Adverse effects of co-administration include dizziness, drowsiness, difficulty in concentrating, and confusion. 

Always consult with your healthcare provider to ensure that CBD does not interact with any medication you are currently taking. 


References

  1. Larsen, C., & Shahinas, J. (2020). Dosage, efficacy, and safety of cannabidiol administration in adults: a systematic review of human trials. Journal of clinical medicine research, 12(3), 129.
  2. Vaughn, S. E., Strawn, J. R., Poweleit, E. A., Sarangdhar, M., & Ramsey, L. B. (2021). The impact of marijuana on antidepressant treatment in adolescents: clinical and pharmacologic considerations. Journal of personalized medicine, 11(7), 615.
  3. Brown, J. D., & Winterstein, A. G. (2019). Potential adverse drug events and drug-drug interactions with medical and consumer cannabidiol (CBD) use. Journal of clinical medicine, 8(7), 989.
  4. Hicks, J. K., Bishop, J. R., Sangkuhl, K., Müller, D. J., Ji, Y., Leckband, S. G., … & Gaedigk, A. (2015). Clinical Pharmacogenetics Implementation Consortium (CPIC) guideline for CYP2D6 and CYP2C19 genotypes and dosing of selective serotonin reuptake inhibitors. Clinical Pharmacology & Therapeutics, 98(2), 127-134.
  5. R de Mello Schier, A., P de Oliveira Ribeiro, N., S Coutinho, D., Machado, S., Arias-Carrión, O., A Crippa, J., … & C Silva, A. (2014). Antidepressant-like and anxiolytic-like effects of cannabidiol: A chemical compound of Cannabis sativa. CNS & Neurological Disorders-Drug Targets (Formerly Current Drug Targets-CNS & Neurological Disorders), 13(6), 953-960.
  6. Shannon, S., Lewis, N., Lee, H., & Hughes, S. (2019). Cannabidiol in anxiety and sleep: a large case series. The Permanente Journal, 23.
  7. Geneva. (n.d.). Cannabidiol (CBD) Critical Review Report Expert Committee on Drug Dependence Fortieth Meeting. 

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