Cannabidiol (cbd) + Sofosbuvir, Velpatasvir, Voxilaprevir
Sofosbuvir, Velpatasvir, Voxilaprevir brand name: Vosevi.
Sofosbuvir, Velpatasvir, Voxilaprevir falls into 4 drug categories that Cannabidiol (cbd) can interact with; the most serious is rated moderate. Cannabidiol may increase levels of drugs metabolized by CYP1A2.
Read the full interaction reportCannabidiol (cbd) and Sofosbuvir, Velpatasvir, Voxilaprevir
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. Sofosbuvir, Velpatasvir, Voxilaprevir 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 1A2 (CYP1A2) SUBSTRATES
1 of 4Why this applies to Sofosbuvir, Velpatasvir, Voxilaprevir
Sofosbuvir, Velpatasvir, Voxilaprevir falls under CYTOCHROME P450 1A2 (CYP1A2) SUBSTRATES — the group Cannabidiol (cbd) interacts with.
In vitro research shows that cannabidiol inhibits CYP1A2. Furthermore, clinical studies show that cannabidiol may inhibit the metabolism of caffeine, a CYP1A2 substrate. Two pharmacokinetic studies in healthy adults show that taking cannabidiol dosed 640 mg once up to 750 twice daily increases the area under the curve of caffeine. However, results are mixed over whether cannabidiol impacts peak serum levels of caffeine.
Interaction 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..
Here's the thing about this one: the interaction on file is built around CBD slowing down an enzyme called CYP1A2. But Vosevi (sofosbuvir, velpatasvir, and voxilaprevir) really isn't cleared in a meaningful way by CYP1A2. These three antivirals depend much more on transporters like P-glycoprotein and enzymes such as CYP3A4. So this particular CYP1A2 concern doesn't translate cleanly to Vosevi, and I wouldn't expect CBD to push its levels up through that pathway.
That said, CBD affects several liver pathways, and Vosevi is already taxing a liver that's fighting hepatitis C. To be safe, please run any CBD product past your pharmacist or doctor before combining the two, so they can check for other overlaps.
- Yamaori S, Kushihara M, Yamamoto I, Watanabe K. Characterization of major phytocannabinoids, cannabidiol and cannabinol, as isoform-selective potent inhibitors of human CYP1 enzymes. Biochem Pharmacol 2010;79(11):1691-8.
- Thai C, Tayo B, Critchley D. A Phase 1 Open-Label, Fixed-Sequence Pharmacokinetic Drug Interaction Trial to Investigate the Effect of Cannabidiol on the CYP1A2 Probe Caffeine in Healthy Subjects. Clin Pharmacol Drug Dev. 2021. PubMed
- Nasrin S, Watson CJW, Perez-Paramo YX, Lazarus P. Cannabinoid Metabolites as Inhibitors of Major Hepatic CYP450 Enzymes, with Implications for Cannabis-Drug Interactions. Drug Metab Dispos 2021;49(12):1070-1080. PubMed
- Bansal S, Zamarripa CA, Spindle TR, et al. Evaluation of Cytochrome P450-Mediated Cannabinoid-Drug Interactions in Healthy Adult Participants. Clin Pharmacol Ther 2023.
CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES
2 of 4Sofosbuvir, Velpatasvir, Voxilaprevir also falls under CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES.
In vitro and animal research shows that cannabidiol inhibits CYP3A4. In human studies and case reports, cannabidiol has been associated with an increase in plasma levels of the CYP3A4 substrates zonisamide, tacrolimus, everolimus, citalopram, midazolam, and methadone.
Interaction 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..
Here's the gist: Vosevi (the sofosbuvir, velpatasvir, and voxilaprevir combo) is partly handled by a liver enzyme called CYP3A4. CBD can slow that enzyme down, which means a little more of the medicine, especially the voxilaprevir piece, may linger in your system than expected.
In real terms, that could nudge up the chance of side effects like headache, nausea, tiredness, or diarrhea. It's usually a moderate concern rather than a dangerous one, but since you're clearing a stubborn hepatitis C infection and this is often a second-round treatment, you don't want anything throwing off how the medicine works. Please don't start or stop either one on your own. Just give your pharmacist or doctor a quick heads-up before adding CBD so they can keep an eye on you.
- Yamaori S, Ebisawa J, Okushima Y, et al. Potent inhibition of human cytochrome P450 3A isoforms by cannabidiol: role of phenolic hydroxyl groups in the resorcinol moiety. Life Sci 2011;88(15-16):730-6. PubMed
- Harvey DJ. Absorption, distribution, and biotransformation of the cannabinoids. Marijuana and Medicine. 1999;91-103. DOI
- Bornheim LM, Everhart ET, Li J, Correia MA. Characterization of cannabidiol-mediated cytochrome P450 inactivation. Biochem Pharmacol 1993;45(6):1323-31. PubMed
- Gaston TE, Bebin EM, Cutter GR, Liu Y, Szaflarski JP; UAB CBD Program. Interactions between cannabidiol and commonly used antiepileptic drugs. Epilepsia. 2017 Sep;58(9):1586-92. PubMed
- Leino AD, Emoto C, Fukuda T, Privitera M, Vinks AA, Alloway RR. Evidence of a clinically significant drug-drug interaction between cannabidiol and tacrolimus. Am J Transplant. 2019;19(10):2944-2948. PubMed
- Wiemer-Kruel A, Stiller B, Bast T. Cannabidiol Interacts Significantly with Everolimus-Report of a Patient with Tuberous Sclerosis Complex. Neuropediatrics. 2019. PubMed
- Madden K, Tanco K, Bruera E. Clinically Significant Drug-Drug Interaction Between Methadone and Cannabidiol. Pediatrics. 2020;e20193256. PubMed
- Anderson LL, Doohan PT, Oldfield L, et al. Citalopram and Cannabidiol: In Vitro and In Vivo Evidence of Pharmacokinetic Interactions Relevant to the Treatment of Anxiety Disorders in Young People. J Clin Psychopharmacol. 2021. PubMed
- Nasrin S, Watson CJW, Perez-Paramo YX, Lazarus P. Cannabinoid Metabolites as Inhibitors of Major Hepatic CYP450 Enzymes, with Implications for Cannabis-Drug Interactions. Drug Metab Dispos 2021;49(12):1070-1080. PubMed
- Treyer A, Reinhardt JK, Eigenmann DE, Oufir M, Hamburger M. Phytochemical comparison of medicinal cannabis extracts and study of their CYP-mediated interactions with coumarinic oral anticoagulants. Med Cannabis Cannabinoids. 2023;6(1):21-31. PubMed
- Bansal S, Zamarripa CA, Spindle TR, et al. Evaluation of Cytochrome P450-Mediated Cannabinoid-Drug Interactions in Healthy Adult Participants. Clin Pharmacol Ther 2023.
CYTOCHROME P450 2C8 (CYP2C8) SUBSTRATES
3 of 4Sofosbuvir, Velpatasvir, Voxilaprevir also falls under CYTOCHROME P450 2C8 (CYP2C8) SUBSTRATES.
In vitro research shows that cannabidiol inhibits CYP2C8. However, this interaction has yet to be reported in humans. Until more is known, use with caution. Theoretically, concomitant use of cannabidiol with CYP2C8 substrates might increase the risk for adverse effects from these substrates.
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 gist with Vosevi (sofosbuvir, velpatasvir, voxilaprevir) and CBD. In a lab dish, CBD slows down an enzyme called CYP2C8, which is one of the pathways your body can use to clear part of this hepatitis C combo. If that enzyme is blocked, the theory is that levels of the drug could creep up a bit, which might mean more chance of side effects like headache, tiredness, nausea, or diarrhea.
I want to be straight with you, though: this is only a theoretical concern based on test-tube data, and it hasn't actually been seen in real people. That's a pretty weak level of evidence. I wouldn't lose sleep over it, but since you're treating hepatitis C, it's worth a quick chat with your pharmacist or doctor before adding CBD so they can keep an eye on things.
- 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 2B6 (CYP2B6) SUBSTRATES
4 of 4Sofosbuvir, Velpatasvir, Voxilaprevir also falls under CYTOCHROME P450 2B6 (CYP2B6) SUBSTRATES.
In vitro research shows that cannabidiol inhibits CYP2B6. However, this interaction has yet to be reported in humans. Until more is known, use with caution. Theoretically, concomitant use of cannabidiol with CYP2B6 substrates might increase the risk for adverse effects from these substrates.
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 honest picture with Vosevi (sofosbuvir, velpatasvir, voxilaprevir) and CBD. The concern on file is that CBD can block a liver enzyme called CYP2B6, which might slow how some medicines are cleared and let their levels creep up. In theory, higher levels could mean more side effects, things like headache, tiredness, nausea, or diarrhea, which are the usual complaints people report with this hepatitis C combo.
But I want to keep this in perspective. This is a theoretical interaction based only on lab (test tube) data, and it has not actually been seen in people. So it's a reason for caution, not alarm. Since finishing a full hepatitis C course matters so much, don't change anything on your own. Just give your pharmacist or doctor a heads-up before adding CBD so they can keep an eye on you.
- Yamaori S, Maeda C, Yamamoto I, Watanabe K. Differential inhibition of human cytochrome P450 2A6 and 2B6 by major phytocannabinoids. Forensic Toxicol 2011;29:117-24. DOI
- Nasrin S, Watson CJW, Perez-Paramo YX, Lazarus P. Cannabinoid Metabolites as Inhibitors of Major Hepatic CYP450 Enzymes, with Implications for Cannabis-Drug Interactions. Drug Metab Dispos 2021;49(12):1070-1080. PubMed
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 Sofosbuvir, Velpatasvir, Voxilaprevir 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 Sofosbuvir, Velpatasvir, Voxilaprevir
This page covers Cannabidiol (cbd) only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Sofosbuvir, Velpatasvir, Voxilaprevir page lists 173 supplements it has a documented interaction with, worst first, each one explained.
The most serious there right now: Activated Charcoal (major), Grapefruit (major), St. John's Wort (major), Acacia Rigidula (moderate) and Adrafinil (moderate).
By severity: 3 major · 130 moderate · 40 minor.
From our pharmacist’s overview on the Sofosbuvir, Velpatasvir, Voxilaprevir page
“Vosevi (sofosbuvir, velpatasvir, and voxilaprevir) cures hepatitis C over a single short course, and that is exactly why I would be genuinely careful with supplements while taking it. Anything that drags its blood levels down can cost you the cure itself.”
Reviewed by 2 · Jul 18, 2026
Open the Sofosbuvir, Velpatasvir, Voxilaprevir interaction page
Where Cannabidiol (cbd) and Sofosbuvir, Velpatasvir, Voxilaprevir 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.
#372 of 1,452 supplements looked up here in the last 7 days
#537 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.
About Sofosbuvir, Velpatasvir, and Voxilaprevir
What Is Sofosbuvir, Velpatasvir, and Voxilaprevir Used For?
Brand name: Vosevi
Vosevi is used to treat chronic hepatitis C virus (HCV) infection in adults without cirrhosis (liver scarring) or with compensated cirrhosis (mild liver scarring, Child-Pugh A). It is specifically for people who have already tried an HCV treatment that did not fully work.
Vosevi is approved for adults with HCV genotypes 1, 2, 3, 4, 5, or 6 who were previously treated with a regimen containing an NS5A inhibitor. It is also approved for adults with genotype 1a or 3 who were previously treated with sofosbuvir without an NS5A inhibitor. Note: Vosevi has not been shown to offer additional benefit over sofosbuvir/velpatasvir for adults with genotype 1b, 2, 4, 5, or 6 who received sofosbuvir without an NS5A inhibitor.
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 ›
- Aspirin ›
- Rosuvastatin ›
- Tirzepatide ›
- Docusate ›
- Sumatriptan ›
- Valacyclovir ›
- Hydroxyurea ›
- Metformin ›
- Semaglutide ›
- Amoxicillin ›
- Methotrexate ›
- Lisinopril ›
- Levothyroxine, Liothyronine ›
- Azithromycin ›
- Doxycycline ›
- Acyclovir ›
- Methylene Blue ›
- Candesartan Cilexetil ›
- Amoxicillin, Clavulanate Potassium ›
- Acetylsalicylic Acid ›
- Insulin Degludec, Liraglutide ›
- Calcium Oxybate, Magnesium Oxybate, Potassium Oxybate, Sodium Oxybate ›
- Ezetimibe ›
- Cyclopentolate ›
- Cephalexin ›
- Thyroid Hormone ›
- Mannitol ›
- Carbidopa, Levodopa ›
- Levodopa ›
- Atenolol, Chlorthalidone ›
- Aluminum Hydroxide, Aspirin, Magnesium Hydroxide ›
- Avatrombopag Maleate ›
- Magnesium Hydroxide (otc Drug) ›
- Spironolactone ›
- Mitomycin ›
- Bendroflumethiazide, Rauwolfia Serpentina ›
- Alginic Acid, Aluminum Hydroxide ›
- Atenolol ›
- Flutemetamol F-18 ›
- Ceftolozane Sulfate, Tazobactam Sodium ›
- Canagliflozin, Metformin ›
- Levothyroxine Sodium ›
- Enalapril Maleate ›
- Aspirin, Butalbital ›
- Minoxidil ›
- Charcoal (otc Drug) ›
- Dexmethylphenidate ›
- Acarbose ›
- Articaine, Epinephrine ›
- Hydrocortisone, Clioquinol, Pramoxine ›
- Peginterferon Alfa-2a, Ribavirin ›
- Atropine Methyl Nitrate, Digestive Enzymes ›
- Cefaclor ›
- Alpha-1 Proteinase Inhibitor ›
- Insulin Human, Sodium Chloride ›
- Daunorubicin, Cytarabine ›
- Daptomycin ›
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
Taking Cannabidiol (cbd) and Sofosbuvir, Velpatasvir, Voxilaprevir Together: Common Questions
Can you take Cannabidiol (cbd) with Sofosbuvir, Velpatasvir, Voxilaprevir?
Why are there 4 interactions listed for Cannabidiol (cbd) and Sofosbuvir, Velpatasvir, Voxilaprevir?
How serious is the Cannabidiol (cbd) and Sofosbuvir, Velpatasvir, Voxilaprevir interaction?
Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy
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