Last updated: 11 November 2026
CBD has no well-documented interaction with paracetamol or ibuprofen at food supplement amounts, but some combinations need care. High-dose CBD and paracetamol can both strain the liver, and codeine, co-codamol, tramadol, pregabalin, gabapentin and amitriptyline can add to drowsiness. Ask your pharmacist first, and never stop or change a prescribed painkiller yourself.
iBelow: each common painkiller, whether CBD helps pain, what to ask your pharmacist and when to get urgent help. This is general information, not medical advice.
CBD and painkillers: what is known
CBD is broken down in the liver, mainly by enzymes called CYP2C19 and CYP3A4. The UK product information for Epidyolex, the licensed prescription CBD medicine, says CBD slows CYP2C19, is predicted to slow CYP2C9 and may affect some UGT enzymes, and can cause sleepiness that other sedating medicines and alcohol add to. “No known interaction” below means none is reported in the sources we checked, not that the pair has been tested.
| Painkiller | What is known with CBD | What to do |
|---|---|---|
| Paracetamol | No known interaction on levels. High-dose CBD with paracetamol raised liver enzymes more often than paracetamol alone in one trial | Keep to the paracetamol dose on the pack. Ask a pharmacist if you take it every day |
| Ibuprofen, naproxen, diclofenac | No studies in people. These rely on CYP2C9, which CBD is predicted to slow, so levels could rise in theory | Ask a pharmacist, especially if you take an anti-inflammatory regularly |
| Codeine, co-codamol, dihydrocodeine | No studies on levels. Both can cause drowsiness, so the effects may add up | Ask a pharmacist. Don’t drive if you feel sleepy; avoid alcohol |
| Tramadol, morphine, oxycodone | No studies on levels for most. Lab data predict CBD could raise morphine. Drowsiness adds up | Speak to your prescriber before adding CBD |
| Pregabalin and gabapentin | Not broken down by the liver, so a level change is unlikely. Drowsiness and dizziness add up | Ask your prescriber or pharmacist first |
| Amitriptyline, nortriptyline | No studies in people. Amitriptyline partly relies on CYP2C19, which CBD slows. Drowsiness adds up | Ask your prescriber or pharmacist first |
If you take low-dose aspirin or another blood thinner, that is a separate and more important question: see CBD and blood thinners and can CBD interact with medication?
Can you take CBD with paracetamol?
CBD is not known to change paracetamol levels, but both are processed by the liver, and high-dose CBD can raise liver enzymes. In a 2023 trial, 86 people with knee osteoarthritis took paracetamol 3g a day plus either 600mg of CBD or a placebo for 8 weeks. Rises in liver enzymes were more common with CBD (15 people) than placebo (5 people), and CBD gave no extra pain relief.
That dose is 60 times the FSA’s 10mg a day advice, and there is no evidence of the same problem at 10mg. Still, if you take paracetamol most days, drink alcohol regularly or have a liver condition, check with your pharmacist before adding CBD. The NHS says adults should take no more than eight 500mg paracetamol tablets in 24 hours, with at least 4 hours between doses, and that people who weigh under 50kg may need less. Our guide is CBD bad for your liver? covers the liver trials in detail.
Can you take CBD with ibuprofen?
No interaction between CBD and ibuprofen has been reported in people. Ibuprofen, naproxen and diclofenac are broken down mainly by CYP2C9, and lab data predict that CBD slows this enzyme, which is why the Epidyolex product information flags medicines that use it, such as warfarin.
The bigger risks with anti-inflammatories are their own: stomach bleeding, kidney strain and interactions with blood thinners. Use the lowest dose for the shortest time, as the NHS advises, and ask a pharmacist if you take them regularly. Ibuprofen gel puts much less into the blood than tablets. Our guide on CBD and ibuprofen for muscle recovery looks at the research on each.
CBD with co-codamol and tramadol
Codeine (in co-codamol) and tramadol are opioid painkillers. Both are converted in the liver into stronger forms, partly by an enzyme called CYP2D6, and both can make you drowsy. We found no study of CBD with codeine or tramadol in people. The main concern is drowsiness adding up: the NHS advises not to drive, cycle or use machinery if co-codamol makes you sleepy, and not to drink alcohol with it.
For strong opioids such as morphine and oxycodone, the Epidyolex product information predicts that CBD could raise morphine levels through a UGT enzyme, though this has not been tested. If you take any opioid, speak to your prescriber before adding CBD, and don’t change your dose to make room for it.
CBD with pregabalin or gabapentin
Pregabalin and gabapentin, often prescribed for nerve pain, pass out of the body mostly unchanged through the kidneys rather than being broken down by liver enzymes. So CBD is unlikely to change their levels. The concern is that both can cause drowsiness and dizziness, and the NHS says pregabalin can make these effects worse when taken with other medicines that cause them.
The NHS also says there isn’t enough information to know that herbal remedies and supplements are always safe with pregabalin, and asks you to tell your doctor or pharmacist about them. Do that before adding CBD. If you have nerve pain, our guides to peripheral neuropathy and sciatica cover what the NHS offers.
CBD with amitriptyline for pain
Low-dose amitriptyline is commonly prescribed for nerve pain, migraine prevention and long-term pain. It is partly broken down by CYP2C19, the enzyme CBD is best known to slow (it raised a breakdown product of the epilepsy medicine clobazam three to four-fold in people). So amitriptyline levels could rise in theory, although no study has tested this. Both can also make you drowsy, and amitriptyline is usually taken in the evening for that reason.
iAsk your prescriber or pharmacist before adding CBD, and never stop amitriptyline suddenly. For duloxetine and other antidepressants, see CBD and antidepressants.
Does CBD help with pain?
CBD sold as a food supplement is not a painkiller and cannot be sold as one. NICE’s guideline on cannabis-based medicines (NG144) says not to offer CBD to manage chronic pain in adults except in a clinical trial. Placebo-controlled trials in knee and hand arthritis found CBD no better than a dummy treatment, and a 2024 review in the Journal of Pain concluded that CBD products for pain are ineffective, expensive and carry potential harms.
So please don’t use CBD in place of a painkiller your doctor has recommended. Our guides CBD oil for pain: what the evidence says and CBD for pain: what the trials show go through the research, and CBD and arthritis covers the joint trials.
What to ask your pharmacist
- Bring the CBD product, or a photo of the label, and say how much CBD a day you plan to take.
- List every painkiller you take, how often, and any others you buy over the counter.
- Mention liver or kidney problems, alcohol intake and any other medicines or supplements.
- Ask: “Is it safe for me to add CBD, and should I watch for anything, such as drowsiness?”
Our guide to CBD side effects lists the common ones, and CBD and driving covers the law if CBD or a painkiller makes you drowsy.
When to get urgent help
- Call 999 or go to A&E if someone has slow, shallow or difficult breathing, is very sleepy and hard to wake, has a fit, or has signs of a serious allergic reaction (swollen lips, mouth or throat). Don’t drive yourself.
- Call 999 or go to A&E if you vomit blood.
- Call 111 now if you have taken more paracetamol than the packet says, even if you feel well, if you have black, sticky, tar-like poo while taking an anti-inflammatory, or if your skin or the whites of your eyes turn yellow.
Next step
If your GP or pharmacist has said CBD is fine with your medicines, Relief CBD Oil is broad spectrum CBD (0% THC) in MCT oil with 35mg turmeric extract and 35mg black pepper extract per half pipette. 10mg of CBD is about 0.2ml of the 500mg oil. It is on the FSA public list (validated application RP438), vegan and made in the UK from US-grown hemp. It isn’t a painkiller. Turmeric can interact with blood thinners, so mention it to your pharmacist; see CBD with turmeric.
Add Relief CBD Oil 500mg to bag or choose another strength
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For adults only. If you take any regular medicines, check with your GP or pharmacist first. We don’t recommend our products during pregnancy or breastfeeding. Subscribe and save 25% on your first order, then 20%. New to Evopure? Join our emails for 20% off a one-off first order. Free UK delivery over £40.
The FSA’s 10mg a day figure is precautionary advice rather than a legal limit, set while longer-term safety research continues. At Evopure we think it is a very cautious figure, and many adults use more. If you go above it, increase slowly, and check with your GP or pharmacist first if you take any medication.
Prefer a fixed amount with nothing to measure? Our capsules give one 10mg capsule (the 25mg capsule is above the FSA’s 10mg advice); see best CBD capsules UK. For how to use a balm, read our CBD balm guide.
Sources 10
- emc. Epidyolex 100 mg/ml oral solution: summary of product characteristics (sections 4.4, 4.5, 4.8 and 5.2; revised 8 June 2026).
- Pramhas S et al. Oral cannabidiol (CBD) as add-on to paracetamol for painful chronic osteoarthritis of the knee. Lancet Reg Health Eur, 2023.
- Florian J et al. Cannabidiol and liver enzyme level elevations in healthy adults: a randomized clinical trial. JAMA Intern Med, 2025.
- Moore A et al. Cannabidiol (CBD) products for pain: ineffective, expensive, and with potential harms. J Pain, 2024.
- NICE. Cannabis-based medicinal products (NG144).
- NHS. Paracetamol for adults.
- NHS. Ibuprofen for adults.
- NHS. Side effects of co-codamol for adults.
- NHS. Taking pregabalin with other medicines and herbal supplements.
- Food Standards Agency (gov.uk). Cannabidiol (CBD): consumer advice, including vulnerable groups.
This guide is general information, not medical advice. Evopure makes Relief CBD Oil, Broad Spectrum CBD Capsules and the CBD Balm, Muscle and Joint Support.
