Does CBD interact with digoxin, blood pressure and cholesterol medicines?

Medicines and the importance of their interactions

From peer-reviewed publications and drug labels: the warnings, most important first. The same warnings also appear in the interaction checker. A medicine that is not listed can still interact with CBD.

How does the interaction happen?

CBD may interact with the medicines in this group in two separate ways. The first is a drug-level interaction: by slowing the proteins that carry or break down some medicines, CBD can change the amount of them in the blood. The second is an effect interaction: because CBD itself can lower blood pressure slightly, it may add to the effect of blood pressure medicines. (EMA Epidyolex prescribing information 4.5, PMID 37313955, PMID 37093160)

Digoxin is carried by P-gp (a transporter protein that pumps medicines out of cells) as it is absorbed from the intestine and as it is removed through the kidneys and the bile; medicines that affect this transporter can change digoxin levels. Although CBD did not block P-gp in the laboratory, in healthy volunteers CBD raised the blood level of everolimus, which is carried by P-gp in the intestine, about 2.5-fold. This is why the product information says that the levels of P-gp medicines taken by mouth, such as digoxin, may also rise. (Digoxin prescribing information §7.1, EMA Epidyolex prescribing information 4.5 and 5.2, FDA Epidiolex label §7.2 and §12.3 (05/2026))

Losartan, propranolol and some statins are broken down in the liver by CYP enzymes. CBD's effect on these enzymes seems to differ by product and dose: a single dose of a CBD-dominant cannabis extract (640 mg CBD and 20 mg THC) slowed CYP2C19, CYP2C9, CYP3A and CYP1A2 but did not affect CYP2D6; approved CBD, on the other hand, did not change in healthy volunteers the levels of midazolam, which is broken down by CYP3A4, or of tolbutamide, which is broken down by CYP2C9. This is why each medicine has to be assessed separately. (PMID 37313955, FDA Epidiolex label §12.3 (05/2026), Losartan prescribing information §12.3, Propranolol prescribing information, PMID 41633759)

There is a lot that is not known. No published human study looking at digoxin, propranolol or statins together with CBD could be found. The blood pressure studies were small and short; no serious cardiovascular event was reported, but these studies were not designed to measure the risk of dizziness or fainting together with blood pressure medicines. (PMID 42321899, PMID 37093160, PMID 41633759)

What do studies and official drug information say?

Each finding shows the type of evidence it rests on. A case report describes a single patient; it does not prove cause and effect.

1. Official drug information

   Digoxin: the product information recommends monitoring levels

   The European and US product information for approved CBD says that the blood level of digoxin taken by mouth may rise with CBD and recommends that the doctor monitor digoxin levels and consider lowering the dose if needed. This warning is based on the healthy-volunteer study in which CBD raised everolimus levels about 2.5-fold; no direct study or reported case with digoxin could be found.

   Source: EMA Epidyolex prescribing information 4.5, FDA Epidiolex label §7.2 and §12.3 (05/2026)

2. Controlled study

   CBD lowered blood pressure in patients with high blood pressure (2024)

   In 70 patients with mild or moderate high blood pressure, with or without medication, CBD by mouth was compared with placebo for 5 weeks. After 2.5 weeks, CBD lowered average 24-hour systolic (upper) blood pressure by about 4.8 mmHg and diastolic (lower) blood pressure by about 2.3 mmHg; the fall did not get larger when the dose was increased. No change in liver enzymes and no serious side effects were seen.

   Source: PMID 37093160

3. Controlled study

   A single dose of CBD lowered blood pressure in healthy volunteers (2017)

   In 9 healthy men, a single 600 mg dose of CBD lowered resting systolic blood pressure by about 6 mmHg compared with placebo and raised heart rate. The rise in blood pressure in response to cold stress was also smaller.

   Source: PMID 28614793

4. Systematic review

   Review of controlled studies: a fall of a few mmHg (2026)

   In a systematic review of four controlled studies (120 people in total; 225–600 mg of CBD a day; from 2 hours to 5 weeks), systolic blood pressure fell compared with placebo in all the studies; the fall was more pronounced at high doses, during stress and during sleep. No serious cardiovascular event was reported. The authors state that the studies were small and short and that longer studies are needed.

   Source: PMID 42321899

5. Drug-level study

   Losartan: level rose, conversion to the active product fell (2023)

   In 18 healthy volunteers, a single dose of a CBD-dominant cannabis extract (640 mg CBD and 20 mg THC) raised the blood level of losartan by 63–77%, while the rate of conversion of losartan into its active breakdown product fell by about 30%. Most of losartan's blood pressure-lowering effect comes from this breakdown product. Losartan's product information describes a similar picture with fluconazole, which blocks CYP2C9. So how CBD changes losartan's effect on blood pressure is not known.

   Source: PMID 37313955, Losartan prescribing information §12.3

6. Official drug information

   Propranolol: not studied together

   No study looking at propranolol together with CBD could be found. Propranolol is broken down by the CYP2D6, CYP1A2 and CYP2C19 enzymes; its product information says that medicines that block these enzymes may raise propranolol levels. The US product information for approved CBD describes CBD as a weak inhibitor of CYP1A2 and a moderate inhibitor of CYP2C19; a single dose of a CBD-dominant cannabis extract also slowed these two enzymes in healthy volunteers but did not affect CYP2D6. Whether propranolol levels change is not known.

   Source: Propranolol prescribing information, PMID 37313955, FDA Epidiolex label §7.2 and §12.3 (05/2026)

7. Systematic review

   Statins: no published human data

   No published human study or case looking at statins together with CBD could be found. Reviews describe only a theoretical possibility, because CBD may slow CYP3A4 and CYP2C9, the enzymes that break down some statins. For CYP3A4, the human data conflict: approved CBD did not change midazolam levels, while a CBD-dominant cannabis extract raised them by 56%. The European patient information for approved CBD lists simvastatin among the medicines you should tell your doctor about, because doses may need adjusting. A lack of data does not mean that CBD is safe with statins.

   Source: PMID 41633759, FDA Epidiolex label §12.3 (05/2026), PMID 37313955, EMA Epidyolex prescribing information (patient information section 2)

What is monitored?

• Digoxin: your doctor may measure your digoxin blood level. Loss of appetite, nausea, vomiting, changes in vision or an irregular heart rhythm may be signs of digoxin toxicity; if you notice any such sign, tell your doctor right away. (Digoxin prescribing information §5.3 and §7, EMA Epidyolex prescribing information 4.5)
• Blood pressure: if you get dizzy or lightheaded after starting CBD or increasing the amount, tell your doctor. If you measure your blood pressure at home, write down the readings and show them to your doctor; do not change the dose of your blood pressure medicine yourself. (PMID 37093160, PMID 28614793, Losartan prescribing information §5.2 and §6.1)
• What is in the product: cannabis containing THC can raise heart rate. Find out whether the product you use contains THC from its label and its certificate of analysis. (PMID 26708108) How to read the label and certificate of analysis

Frequently asked questions

References

Last reviewed: October 27, 2026. On this date, each source was opened and checked against the related sentence.