Cannabidiol (cbd) + Isoniazid, Pyrazinamide, Rifampin
Isoniazid, Pyrazinamide, Rifampin brand name: Rifater.
Isoniazid, Pyrazinamide, Rifampin falls into 4 drug categories that Cannabidiol (cbd) can interact with; the most serious is rated moderate. Theoretically, CYP2C19 inhibitors might increase cannabidiol levels.
Read the full interaction reportCannabidiol (cbd) and Isoniazid, Pyrazinamide, Rifampin
These two interact in 4 distinct ways. Each one is explained separately below.
Why Are There 4 Interactions?
Cannabidiol (cbd) interacts with whole categories of medication. Isoniazid, Pyrazinamide, Rifampin falls into 4 of those categories, so it can interact with Cannabidiol (cbd) in 4 different ways. We’ve listed each one below — your overall risk is driven by the most serious of them (Moderate).
CYTOCHROME P450 2C19 (CYP2C19) INHIBITORS
1 of 4Why this applies to Isoniazid, Pyrazinamide, Rifampin
Isoniazid, Pyrazinamide, Rifampin falls under CYTOCHROME P450 2C19 (CYP2C19) INHIBITORS — the group Cannabidiol (cbd) interacts with.
Cannabidiol is a substrate of CYP2C19 enzymes. Theoretically, drugs that inhibit CYP2C19 enzymes might increase levels of cannabidiol, increasing its effects and adverse effects.
Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.
Here's the thing to know if you're taking Rifater (a combo of isoniazid, pyrazinamide, and rifampin) for tuberculosis along with CBD. One of these ingredients, isoniazid, can block a liver enzyme called CYP2C19. Since your body uses that same enzyme to clear CBD, isoniazid could slow CBD's breakdown and let it build up a bit. That might mean more of CBD's usual effects, like drowsiness, tiredness, diarrhea, or changes in appetite.
I'll be honest with you though, this is a theoretical concern based on how the drugs work, not something we've seen cause real problems in studies. Rifampin actually pulls the opposite direction. Still, since TB treatment is something you don't want to mess with, just check in with your pharmacist or doctor before adding CBD.
- Epidiolex (cannabidiol) prescribing information. Greenwich Biosciences, Inc., Carlsbad, CA, 2019. Available at: https://www.epidiolex.com/sites/default/files/EPIDIOLEX_Full_Prescribing_Information.pdf (accessed 5/9/2019)
CYTOCHROME P450 3A4 (CYP3A4) INHIBITORS
2 of 4Isoniazid, Pyrazinamide, Rifampin also falls under CYTOCHROME P450 3A4 (CYP3A4) INHIBITORS.
Cannabidiol is a substrate of CYP3A4 enzymes. Theoretically, drugs that inhibit CYP3A4 enzymes might increase levels of cannabidiol, increasing its effects and adverse effects.
Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.
Here's an interesting wrinkle with this combination pill (Rifater). One of its ingredients, isoniazid, can gently block a liver enzyme called CYP3A4, which is one of the pathways your body uses to break down CBD. In theory, that could let CBD build up a bit higher than expected, making its effects, and side effects like drowsiness, fatigue, diarrhea, or appetite changes, more noticeable.
I'll be honest with you: this is a theoretical concern based on how these drugs work on paper, not something proven in studies. Worth keeping in mind, but no reason to panic. Since CBD products vary so much and TB treatment is important, just give your pharmacist or doctor a heads-up before adding CBD so they can keep an eye on how you feel.
- Product information for Marinol. AbbVie. North Chicago, IL 60064. August 2017. Available at: https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/018651s029lbl.pdf.
CYTOCHROME P450 2C19 (CYP2C19) INDUCERS
3 of 4Isoniazid, Pyrazinamide, Rifampin also falls under CYTOCHROME P450 2C19 (CYP2C19) INDUCERS.
Cannabidiol is a substrate of CYP2C19 enzymes. Theoretically, drugs that induce CYP2C19 enzymes might decrease the levels and effects of cannabidiol.
Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.
Here's the key thing to know if you're using CBD while on Rifater (a combo of isoniazid, pyrazinamide, and rifampin for tuberculosis): this combo, mainly because of rifampin, is a strong activator (an 'inducer') of certain liver enzymes, including one called CYP2C19 that helps process CBD. The concern runs in one direction here. By speeding up those enzymes, Rifater could lower the amount of CBD in your system, so your CBD may simply work less well than expected.
This is a theoretical concern based on how the drugs behave, not something proven in studies, so I wouldn't be alarmed. Importantly, your TB medicines aren't the worry, your CBD is just less likely to do its job. Keep your treatment on track and chat with your pharmacist or doctor before adding CBD.
- Epidiolex (cannabidiol) prescribing information. Greenwich Biosciences, Inc., Carlsbad, CA, 2019. Available at: https://www.epidiolex.com/sites/default/files/EPIDIOLEX_Full_Prescribing_Information.pdf (accessed 5/9/2019)
CYTOCHROME P450 3A4 (CYP3A4) INDUCERS
4 of 4Isoniazid, Pyrazinamide, Rifampin also falls under CYTOCHROME P450 3A4 (CYP3A4) INDUCERS.
Cannabidiol is a substrate of CYP3A4 enzymes. Theoretically, drugs that induce CYP3A4 enzymes might reduce the levels and effects of cannabidiol.
Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.
Here's the key thing with Rifater (which combines isoniazid, pyrazinamide, and rifampin): in this pairing, the medication is acting on your CBD, not the other way around. Rifampin in particular is a strong booster of a liver enzyme called CYP3A4, which is one of the enzymes your body uses to break down CBD. So when you take them together, your body may clear the CBD faster, leaving lower CBD levels and potentially less of whatever benefit you were hoping to get from it.
The good news is this is a theoretical concern based on how the drugs work, not on strong human studies, so don't be alarmed. Your TB medications themselves should keep working as prescribed. Since CBD product quality and dosing vary so much, it's worth a quick chat with your pharmacist or doctor before combining them, and never adjust your TB regimen on your own.
- Epidiolex (cannabidiol) prescribing information. Greenwich Biosciences, Inc., Carlsbad, CA, 2019. Available at: https://www.epidiolex.com/sites/default/files/EPIDIOLEX_Full_Prescribing_Information.pdf (accessed 5/9/2019)
What These Ratings Mean
Every interaction above is graded three ways — here’s the key to each label.
Clinically significant. Avoid the combination, or use only under close professional supervision.
Usually worth avoiding or managing — may need monitoring, a dose change, or timing apart.
Generally not serious. Be aware of it and mention it to your pharmacist.
- LikelyWell-controlled human studies have demonstrated the likely existence of this interaction.
- ProbableInteraction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports.
- PossibleInteraction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.
- UnlikelyInteraction has been demonstrated in animal or in lab research but has been shown not to occur in humans.
- AHigh-quality meta-analysis (quantitative systematic review).
- BCase-control study.
- CConsensus.
- DAnecdotal evidence.
These ratings are for information only. Never start, stop, or otherwise change your therapy before speaking with your provider.
Cannabidiol (cbd) Also Interacts With Other Medications
Cannabidiol (cbd) has 1,050 moderate known drug interactions in our database — the Isoniazid, Pyrazinamide, Rifampin one above is among them. If you take anything else, check it against the full list below.
Check Another of Your Medications Against Cannabidiol (cbd)
We haven’t checked that one against Cannabidiol (cbd) yet — ask our pharmacists directly.
Covers the 2,830 medications we’ve checked against Cannabidiol (cbd). Pick one to open its full report.
See Every Supplement That Interacts With Isoniazid, Pyrazinamide, Rifampin
This page covers Cannabidiol (cbd) only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Isoniazid, Pyrazinamide, Rifampin page lists 137 supplements it has a documented interaction with, worst first, each one explained.
The most serious there right now: Activated Charcoal (major), Apple (major), Asarabacca (major), Beer (major) and Grapefruit (major).
By severity: 8 major · 109 moderate · 20 minor.
From our pharmacist’s overview on the Isoniazid, Pyrazinamide, Rifampin page
“Rifater combines isoniazid, pyrazinamide, and rifampin for tuberculosis, a regimen that runs for months and already works the liver hard, so this list warrants genuine care rather than a quick skim. Of the 137 supplements and herbs on file, eight rate major, and the largest single group, 38 ingredients, adds extra liver strain on top o…”
Reviewed by 2 · Jul 18, 2026
Where Cannabidiol (cbd) and Isoniazid, Pyrazinamide, Rifampin Sit Against Everything Else
Out of every supplement and medication people look up on HelloPharmacist, here is where these two land this week — and which way each has been moving.
#424 of 1,452 supplements looked up here in the last 7 days
#113 of 2,830 medications looked up here in the last 7 days
Position among everything looked up on this site, not a measure of how commonly either one is used or how important it is. A supplement can climb this list because of a news story. It counts every request to the page, automated ones included, and nothing here identifies anyone.
About Cannabidiol (cbd)
What is Cannabidiol (cbd)?
- Anxiety and stress
- Sleep problems
- Chronic pain
- Certain seizure disorders
- Inflammation
CBD is a compound from the cannabis (hemp) plant that does not cause a 'high.' It has strong evidence only for certain rare seizure disorders (as a prescription drug), while most other popular uses are still backed by limited or early research. Product quality varies a lot, so talk with your pharmacist or doctor before using it, especially if you take other medicines.
Other Drugs & Cannabidiol (cbd)
Browse every other medication we’ve checked against Cannabidiol (cbd) — both the ones with a known interaction and the ones without. Select any drug for the full detail.
No drugs match “”.
1,050 interactions
- Diclofenac Sodium ›
- Diltiazem ›
- Theophylline ›
- Nifedipine ›
- Ibuprofen ›
- Metronidazole ›
- Diphenhydramine ›
- Hydrocortisone ›
- Naproxen ›
- Erythromycin ›
- Estradiol ›
- Propranolol ›
- Lidocaine ›
- Norethindrone ›
- Testosterone ›
- Verapamil ›
- Levonorgestrel ›
- Prednisone ›
- Quinidine ›
- Cyclosporine ›
- Dexamethasone ›
- Flurazepam ›
- Glyburide ›
- Triazolam ›
- Zopiclone ›
- Bupropion ›
- Ciprofloxacin ›
- Colchicine ›
- Fentanyl ›
- Flurbiprofen ›
- Isotretinoin ›
- Orphenadrine ›
- Oxybutynin ›
- Oxycodone ›
- Phenytoin ›
- Prednisolone ›
- Tacrolimus ›
- Temazepam ›
- Apomorphine ›
- Budesonide ›
- Carbamazepine ›
- Clindamycin ›
- Dextromethorphan ›
- Diclofenac Potassium ›
- Doxorubicin ›
- Fluticasone ›
- Formoterol ›
- Indomethacin ›
- Miconazole ›
- Morphine Sulfate ›
- Nitrazepam ›
- Trimipramine ›
- Acetaminophen ›
- Amphetamine ›
- Buprenorphine ›
- Conjugated Estrogens ›
- Diazepam ›
- Everolimus ›
- Griseofulvin ›
- Ivabradine ›
Showing 60 of 1,050 moderate interactions — see all 1,050 on the Cannabidiol (cbd) page.
No interaction 1,779 drugs checked — show the list
We also checked Cannabidiol (cbd) against these medications and found no known interaction in our sources. Open any page to confirm.
- Levothyroxine ›
- Methylphenidate ›
- Ivermectin ›
- Rosuvastatin ›
- Aspirin ›
- Tirzepatide ›
- Docusate ›
- Valacyclovir ›
- Metformin ›
- Hydroxyurea ›
- Levothyroxine, Liothyronine ›
- Sumatriptan ›
- Semaglutide ›
- Methotrexate ›
- Lisinopril ›
- Amoxicillin ›
- Azithromycin ›
- Doxycycline ›
- Acyclovir ›
- Methylene Blue ›
- Candesartan Cilexetil ›
- Amoxicillin, Clavulanate Potassium ›
- Acetylsalicylic Acid ›
- Aluminum Hydroxide, Aspirin, Magnesium Hydroxide ›
- Insulin Degludec, Liraglutide ›
- Calcium Oxybate, Magnesium Oxybate, Potassium Oxybate, Sodium Oxybate ›
- Ezetimibe ›
- Cephalexin ›
- Atenolol, Chlorthalidone ›
- Avatrombopag Maleate ›
- Cyclopentolate ›
- Bendroflumethiazide, Rauwolfia Serpentina ›
- Levodopa ›
- Enalapril Maleate ›
- Canagliflozin, Metformin ›
- Aspirin, Butalbital ›
- Thyroid Hormone ›
- Carbidopa, Levodopa ›
- Mannitol ›
- Daunorubicin, Cytarabine ›
- Alginic Acid, Aluminum Hydroxide ›
- Bismuth Subcarbonate, Calcium Carbonate, Opium ›
- Ceftolozane Sulfate, Tazobactam Sodium ›
- Acarbose ›
- Spironolactone ›
- Hydrocortisone, Clioquinol, Pramoxine ›
- Efgartigimod Alfa-fcab ›
- Saxagliptin, Metformin Xr ›
- Cytomegalovirus Immune Globulin ›
- Charcoal (otc Drug) ›
- Peginterferon Alfa-2a, Ribavirin ›
- Atenolol ›
- Atropine Methyl Nitrate, Digestive Enzymes ›
- Aminolevulinic Acid Hydrochloride ›
- Magnesium Hydroxide (otc Drug) ›
- Sodium Bicarbonate (otc Drug) ›
- Levothyroxine Sodium ›
- Insulin Aspart, Insulin Degludec ›
- Alpha-1 Proteinase Inhibitor ›
- Articaine, Epinephrine ›
Showing the 60 most looked-up of 1,779 medications checked with no known interaction — see the full Cannabidiol (cbd) list.
Sources & How We Checked
Interaction details are evidence-graded and sourced from the Natural Medicines database. The medication overview comes from MedlinePlus.
- Natural Medicines (Therapeutic Research Center) — Evidence-graded clinical reference for vitamins, herbs and supplements — the basis for our interaction data.
- MedlinePlus, U.S. National Library of Medicine — NIH consumer drug information, used for the medication overviews.
- NIH Dietary Supplement Label Database (DSLD) — Official supplement product labels.
Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.
Parts of this content are provided by the Therapeutic Research Center, LLC.
DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.
© 2021 Therapeutic Research Center, LLC
Isoniazid, Pyrazinamide, Rifampin Is Linked to Lower Levels of 5 Nutrients
Natural Medicines records Isoniazid, Pyrazinamide, Rifampin as a medicine that can lower these. This is not an interaction with Cannabidiol (cbd) — it is a separate effect of the medicine, and it is a reason some people are advised to supplement rather than to avoid one:
Read the full Isoniazid, Pyrazinamide, Rifampin nutrient depletion report ›
Depletion records come from the licensed Natural Medicines database. Do not start a supplement on the strength of this page — ask your pharmacist or doctor whether it applies to you.
Taking Cannabidiol (cbd) and Isoniazid, Pyrazinamide, Rifampin Together: Common Questions
Can you take Cannabidiol (cbd) with Isoniazid, Pyrazinamide, Rifampin?
Why are there 4 interactions listed for Cannabidiol (cbd) and Isoniazid, Pyrazinamide, Rifampin?
How serious is the Cannabidiol (cbd) and Isoniazid, Pyrazinamide, Rifampin interaction?
Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy
Still Have a Question About Isoniazid, Pyrazinamide, Rifampin and Cannabidiol (cbd)?
Our pharmacists answer your medication & supplement questions — free.
This information is for education only and is not a substitute for professional medical advice. Always check with your pharmacist or doctor before starting, stopping, or combining supplements and medications.