Drug & supplement interaction

Delta-9-tetrahydrocannabinol (thc) + Phenobarbital

Phenobarbital brand names: Phenobarbital, Solfoton, Luminal.

Moderate Interaction
The bottom line Moderate

Phenobarbital falls into 4 drug categories that Delta-9-tetrahydrocannabinol (thc) can interact with; the most serious is rated moderate. Theoretically, THC might have additive effects if used with other CNS depressants.

Read the full interaction report
SeverityModerate
LikelihoodPossible
Interactions4
EvidenceD
What do Severity, Likelihood & Evidence mean?
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Interaction report

Delta-9-tetrahydrocannabinol (thc) and Phenobarbital

These two interact in 4 distinct ways. Each one is explained separately below.

Why Are There 4 Interactions?

Delta-9-tetrahydrocannabinol (thc) interacts with whole categories of medication. Phenobarbital falls into 4 of those categories, so it can interact with Delta-9-tetrahydrocannabinol (thc) in 4 different ways. We’ve listed each one below — your overall risk is driven by the most serious of them (Moderate).

Moderate

CNS DEPRESSANTS

1 of 4

Why this applies to Phenobarbital

Phenobarbital falls under CNS DEPRESSANTS — the group Delta-9-tetrahydrocannabinol (thc) interacts with.

Theoretically, THC might have additive effects if used with other CNS depressants.
Cannabis containing THC can have CNS depressant effects. Combining THC with other CNS depressants might result in additive or synergistic effects.
Severity Moderate Likelihood Possible Evidence D

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.

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Here's the simple version: both THC and phenobarbital slow down activity in the brain. Phenobarbital is a barbiturate, so it already makes you drowsy and calm. Add THC, which has its own sedating effect, and the two can stack on top of each other. You might feel extra sleepy, foggy, dizzy, or unsteady, and in bigger amounts that could mean slowed breathing or trouble staying alert.

I want to be honest that this concern is theoretical, based on how these two work rather than strong studies. Still, it's worth taking seriously since phenobarbital is a powerful drug. Please don't change anything on your own. Talk with your doctor or pharmacist before combining them, and avoid driving until you know how you feel.

References
  1. Marinol Prescribing Information. Solvay Pharmaceuticals, Rev March 2008. Available at: http://www.solvaypharmaceuticals-us.com/static/wma/pdf/1/3/2/5/0/004InsertText500012RevMar2008.pdf (Accessed 2 July 2009).
  2. Hollister, L. E. Interactions of cannabis with other drugs in man. NIDA Res.Monogr 1986;68:110-116. DOI
  3. van Dam CJ, van der Schrier R, van Velzen M, et al. Inhaled Delta(9)-tetrahydrocannabinol does not enhance oxycodone-induced respiratory depression: randomised controlled trial in healthy volunteers. Br J Anaesth 2023;130(4):485-493.
Moderate

BARBITURATES

2 of 4

Phenobarbital also falls under BARBITURATES.

Theoretically, THC might increase the levels and adverse effects of barbiturates.
Some research shows that synthetic THC (dronabinol) increases the elimination half-life of pentobarbital by 4 hours when dosed concomitantly. Also, in animal research, THC potentiated pentobarbital-induced sleep by more than three-fold.
Severity Moderate Likelihood Possible Evidence D

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.

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Here's the gist with THC and phenobarbital: both calm down brain activity, and the concern is that putting them together could add up. The research we have is limited (mostly lab and animal studies, plus one small finding that THC slowed how the body clears a related barbiturate), so think of this as a theoretical heads-up rather than a proven problem.

Still, it's worth taking seriously. If THC lets phenobarbital build up or simply piles onto its sedating effect, you could feel unusually drowsy, foggy, dizzy, or slow to react, and at worst very deep, hard-to-wake sleepiness. Phenobarbital is a touchy drug to begin with, so please don't change anything on your own. Check in with your pharmacist or doctor before combining the two.

References
  1. Marinol Prescribing Information. Solvay Pharmaceuticals, Rev March 2008. Available at: http://www.solvaypharmaceuticals-us.com/static/wma/pdf/1/3/2/5/0/004InsertText500012RevMar2008.pdf (Accessed 2 July 2009).
  2. Kimura T, Takaya M, Usami N, Watanabe K, Yamamoto I. ?9-Tetrahydrocannabinol, a major marijuana component, enhances the anesthetic effect of pentobarbital through the CB1 receptor. Forensic Toxicol. 2019;37(1):207-214. DOI
Moderate

CYTOCHROME P450 3A4 (CYP3A4) INDUCERS

3 of 4

Phenobarbital also falls under CYTOCHROME P450 3A4 (CYP3A4) INDUCERS.

Theoretically, CYP3A4 inducers might reduce the levels and clinical effects of THC.
THC is a substrate of CYP3A4 enzymes.
Severity Moderate Likelihood Possible Evidence D

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.

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Here's the key thing to understand: in this pairing, phenobarbital is the one doing the affecting, not THC. Phenobarbital is a strong inducer, meaning it revs up a liver enzyme called CYP3A4. Since your body uses that same enzyme to break down THC, taking them together could clear the THC out faster than usual.

In plain terms, your cannabis or dronabinol may feel weaker or wear off sooner. This is theoretical, based on how the drugs work rather than solid studies, so don't be alarmed. Phenobarbital itself isn't made riskier by THC here, but both can cause drowsiness, so combined sleepiness is worth watching. Never adjust your phenobarbital on your own. Check with your pharmacist or doctor first.

References
  1. Product information for Marinol. AbbVie. North Chicago, IL 60064. August 2017. Available at: https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/018651s029lbl.pdf.
Moderate

CYTOCHROME P450 2C9 (CYP2C9) INDUCERS

4 of 4

Phenobarbital also falls under CYTOCHROME P450 2C9 (CYP2C9) INDUCERS.

Theoretically, drugs that are CYP2C9 inducers might decrease the levels and clinical effects of THC.
THC is a substrate of CYP2C9 enzymes.
Severity Moderate Likelihood Possible Evidence D

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.

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Here's the gist of this one: phenobarbital is a strong enzyme inducer, meaning it revs up liver enzymes (including CYP2C9) that help break things down. Since THC is partly cleared by CYP2C9, taking phenobarbital alongside it could speed up how fast your body removes THC. The likely result is that the THC simply doesn't work as well or wears off faster, so you may notice less of its effect.

I'll be honest with you, this is a theoretical concern based on how these enzymes work, not something proven in studies, so I wouldn't lose sleep over it. The bigger thing to remember is that both THC and phenobarbital can make you drowsy and foggy, which can add up. Since phenobarbital controls seizures, don't change anything on your own. Just loop in your doctor or pharmacist first.

References
  1. Product information for Marinol. AbbVie. North Chicago, IL 60064. August 2017. Available at: https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/018651s029lbl.pdf.

What These Ratings Mean

Every interaction above is graded three ways — here’s the key to each label.

Severity how clinically significant the interaction is
Major

Clinically significant. Avoid the combination, or use only under close professional supervision.

Moderate

Usually worth avoiding or managing — may need monitoring, a dose change, or timing apart.

Minor

Generally not serious. Be aware of it and mention it to your pharmacist.

Likelihood how strong the evidence is that the interaction actually happens in people
  • 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.
Evidence the quality of the studies behind the rating (graded A–D)
  • 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.

Keep it in perspective

Delta-9-tetrahydrocannabinol (thc) Also Interacts With Other Medications

Delta-9-tetrahydrocannabinol (thc) has 761 moderate, 336 minor known drug interactions in our database — the Phenobarbital one above is among them. If you take anything else, check it against the full list below.

Taking anything else?

Check Another of Your Medications Against Delta-9-tetrahydrocannabinol (thc)

Covers the 2,830 medications we’ve checked against Delta-9-tetrahydrocannabinol (thc). Pick one to open its full report.

From our Q&A

Questions About Delta-9-tetrahydrocannabinol (thc) or Phenobarbital

These are real questions from readers, answered by the pharmacists at HelloPharmacist — written by a person, not generated from a database. Each one covers Delta-9-tetrahydrocannabinol (thc) or Phenobarbital, not necessarily both, but if one is close to what you were about to ask it will usually go further than a database entry can:

Not quite your question? Ask our pharmacists directly — it is free, there is no account required, and answers usually come back within 24 hours.

Everything else you take

See Every Supplement That Interacts With Phenobarbital

This page covers Delta-9-tetrahydrocannabinol (thc) only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Phenobarbital page lists 174 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: 1,4-butanediol (major), Activated Charcoal (major), Beer (major), Gamma-hydroxybutyrate (ghb) (major) and Henbane (major).

By severity: 10 major · 143 moderate · 21 minor.

Open the Phenobarbital interaction page

How much people look this up

Where Delta-9-tetrahydrocannabinol (thc) and Phenobarbital 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.

Supplement Delta-9-tetrahydrocannabinol (thc)
Top half

#489 of 1,452 supplements looked up here in the last 7 days

29 days ago today
Medication Phenobarbital
Top half

#1,169 of 2,830 medications looked up here in the last 7 days

29 days ago today

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.

Supplement

About Delta-9-tetrahydrocannabinol (thc)

What is Delta-9-tetrahydrocannabinol (thc)?

Delta-9-tetrahydrocannabinol (thc)
  • Chronic or nerve pain
  • Nausea and vomiting from chemotherapy
  • Appetite loss and weight loss
  • Muscle spasticity
  • Sleep problems
  • Anxiety and stress

THC is the main mind-altering compound in cannabis and is best known for causing a 'high.' A prescription form (dronabinol) is approved for chemotherapy-related nausea and appetite loss, but for most other uses the evidence is mixed or limited, and THC can impair thinking and driving. It should be avoided in pregnancy and breastfeeding and used only with medical guidance.

Read the full Delta-9-tetrahydrocannabinol (thc) monograph & all interactions
Medication

About Phenobarbital

What Is Phenobarbital Used For?

Brand names: Phenobarbital, Solfoton, Luminal

Phenobarbital tablets and oral solutions are used to treat generalized and partial seizures and as a sedative. Phenobarbital Sodium injection is used as a long-term anticonvulsant for generalized tonic-clonic and focal seizures, for emergency control of acute convulsive episodes (including status epilepticus), for sedation, short-term treatment of insomnia, and as a preanesthetic. It is also used in pediatric patients as an anticonvulsant and sedative, including before and after surgery.

Sezaby (phenobarbital injection, intravenous) is specifically indicated for the treatment of neonatal seizures in term and preterm infants. It is not approved for use in adolescents or adults.

See full Phenobarbital drug information
Keep checking

Other Drugs & Delta-9-tetrahydrocannabinol (thc)

Browse every other medication we’ve checked against Delta-9-tetrahydrocannabinol (thc) — both the ones with a known interaction and the ones without. Select any drug for the full detail.

0Major
761Moderate
336Minor
1,732No known interaction
Moderate

761 interactions

Showing 60 of 761 moderate interactions — see all 761 on the Delta-9-tetrahydrocannabinol (thc) page.

Minor

336 interactions

Showing 60 of 336 minor interactions — see all 336 on the Delta-9-tetrahydrocannabinol (thc) page.

No interaction 1,732 drugs checked — show the list
Sources

Sources & How We Checked

Interaction details are evidence-graded and sourced from the Natural Medicines database. The medication overview comes from MedlinePlus.

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

Keep exploring
Pharmacist Counseling Corner

Taking Delta-9-tetrahydrocannabinol (thc) and Phenobarbital Together: Common Questions

Can you take Delta-9-tetrahydrocannabinol (thc) with Phenobarbital?
There is a moderate interaction, so it may be acceptable with monitoring or timing changes — but check with your pharmacist first. Read the full details on this page and confirm with your pharmacist before combining them.
Why are there 4 interactions listed for Delta-9-tetrahydrocannabinol (thc) and Phenobarbital?
Phenobarbital belongs to more than one drug category, and Delta-9-tetrahydrocannabinol (thc) interacts with each of those categories a little differently. We list every one so nothing is missed — your overall risk is driven by the most serious of them.
How serious is the Delta-9-tetrahydrocannabinol (thc) and Phenobarbital interaction?
We rate it Moderate. This combination may require monitoring, a dose adjustment, or separating the times you take each one. Consult your pharmacist before using them together.

Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy

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