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Your Favorite Relaxation Habit Might Be Secretly Screwing With Your Meds

Yep, even OTC cold meds.

Considering that Martha Stewart now co-hosts a stoner-friendly TV show with Snoop Dogg (thank you, Potluck Dinner Party), it’s pretty safe to say that smoking weed is no longer a habit you need to hide from your mom. (Or your doctor, for that matter.)

But as medical marijuana (and, let’s be real, casual marijuana) use continues to rise, have you ever considered the fact that your weed pen might actually be screwing with some of the other medications you take? Yep, kind of scary.

“There are literally hundreds of of chemicals in the cannabis plant, including the psychoactive chemicals that give us a traditional marijuana high and chemicals that just happen to be in the plant,” says Timothy Brennan, M.D., director of the Addiction Institute at Mount Sinai West and Mount Sinai St. Luke’s Hospitals. “All of those, of course, are free to interact with prescription, over-the-counter, or any other medications one might be using.”

In fact, some of the compounds in cannabis can trigger certain enzymes that impact the way your body processes medications, Brennan explains. (This isn’t limited to cannabis; if you’ve ever seen a note to avoid grapefruit on your pill bottles, that’s because grapefruit can have the same effect.)

Related: 5 Women Who Use Pot In Their Everyday Lives Share How They Do It

“The problem is that cannabis is still listed as a Schedule I drug through the Drug Enforcement Agency,” he says, which effectively means that researchers aren’t supposed to study it. “That makes it’s very challenging for physicians and medical scientists to do any research on cannabis.”

So, where does that leave you? If you’re going to use marijuana (prescribed or otherwise) while you’re taking other drugs, “being truthful and open with your physician about your medication use is the most important thing, because you could be setting yourself up for potential marijuana drug interactions,” says Brennan. “It could at least plant the seed in a doctor’s mind that if you are suffering from certain side effects related to your other drugs the doctor can investigate if cannabis might be causing that.”

That said, there are a few types of drugs to watch out for if you’re planning on smoking pot.

Antidepressant Medications, or SSRIs and SNRIs

“The key point here is that cannabis is fundamentally a psychoactive compound,” says Brennan. “People use it because it exerts its action on the brain, on the central nervous system receptors.” But antidepressant medications—the most common of which are selective serotonin reuptake inhibitors (SSRIs), like Zoloft (or sertraline) or Celexa (or ditalopram), and serotonin norepinephrine reuptake inhibitors (SNRIs), like Cymbalta (or duloxetine)—also exert psychoactive effects on some of the same receptors.

“The challenge for people who have mood disorder or depression is that every time they’re using cannabis, they’re taking another psychoactive drug,” says Brennan. “And that can make it very challenging for a patient or physician to figure out what drug is actually having an effect on what.” Plus, he adds, the cannabis could actually negate the positive effects of prescription medication.

This is what it’s like to suffer from depression:

Anti-Anxiety Medications, or Benzodiazepines

Anti-anxiety medications like Ativan (Lorazepam), Klonopin (Clonazepam), or Xanax (Alprazolam) are all part of a class of medications called benzodiazepines, says Brennan. “Again, you have two psychoactive compounds interacting with each other in the brain,” he says. “If somebody’s really struggling with anxiety, I’d like to know what products are going in their brain so I can better understand how I’m medicating them. But if they’re smoking cannabis at the same time as using Ativan or Klonopin, it’s really hard to figure out what’s going on.”

A lot of people will smoke marijuana and say, “This is the only thing that helps my anxiety!” Other people will say they’re never more paranoid than when they smoke pot. That’s true for prescription drugs, too—people have different reactions to different products. “The challenge with cannabis is there’s no scientific data out there to say it tested against Ativan or Klonopin—the data doesn’t exist,” says Brennan.

Related: ‘How I Told My Partner That I’m HIV-Positive’

Sleeping Pills

You’re already aware that mixing alcohol with sleeping pills is a bad idea. Same goes for pot. “This depends on how much cannabis someone is using and what effect cannabis has on them, but mixing any product that with the opportunity to sedate someone or alter their consciousness is potentially dangerous,” says Brennan. “When you combine cannabis with a sedative hypnotic like Zolpidem or Ambien, I think people could perhaps find themselves in a very usual psychological state.”

If you’ve been prescribed sleeping medication, whether you use it regularly or just to get through those tough red-eye flights, you’re better off sticking to just the prescription medication for the duration of the dose, versus mixing it with cannabis or any other drugs.

Related: 5 Signs Your Exhaustion Is A Symptom Of A Much Bigger Problem

Allergy and Cold Meds

You might think that allergy and cold medicines like Benadryl (diphenhydramine) or Mucinex (guaifenesin) are NBD because you can grab them straight off the drugstore shelves—but if you take them with marijuana, they could have unanticipated effects.

“Benadryl, or allergy and cold meds, are sedative products,” says Brennan. “Some people can take them and go about their day, others take one dose and they’re on the couch for the rest of the day. I think it’s really important for people to remember that cannabis is not a harmless product, and we don’t know how it might interact with even over-the-counter drugs.”

So if you’re sick, stick to just one drug (the cold meds, please) if you want it to work its magic as fast as possible.

Smoking pot can mess with cold medicines, anti-depressants, and more. Experts share potential marijuana drug interactions and how to avoid them.

Mixing the Pot? 7 Ways Marijuana Interacts with Medicines

Marijuana interactions

Marijuana is currently not approved by the U.S. Food and Drug Administration as a treatment for any medical condition, but a number of states do allow people to use the drug for medical or recreational purposes. Still, users should be aware that marijuana may interact with other prescription medications.

Although there’s been limited research on marijuana’s potential drug interactions, here’s what doctors know about how marijuana interacts with other medications:

Viagra

Marijuana may interact with drugs, including Viagra, that are broken down by chemicals in the liver known as cytochrome P450 enzymes, according to the Mayo Clinic. That’s because compounds in marijuana can inhibit these enzymes. Therefore, marijuana may prevent other drugs from being broken down properly.

As a result, people who smoke marijuana and take these drugs may have increased levels of these other drugs in their blood, which “may cause increased effects or potentially serious adverse reactions,” the Mayo Clinic said.

In one case, reported in 2002 by researchers in the United Kingdom, a 41-year-old man had a heart attack after taking marijuana and Viagra together. The researchers said they could not prove that the marijuana-Viagra combination was definitely the cause of the man’s heart attack; however, they did say that doctors “should be aware” of the effects of inhibiting cytochrome P450 enzymes when prescribing Viagra.

Warfarin

Another commonly prescribed drug that’s broken down by the cytochrome P450 enzymes is the blood thinner warfarin, which is prescribed to treat and prevent blood clots. In 2009, doctors at the Cheyenne Veterans Affairs Medical Center in Wyoming reported the caseof a 56-year-old man who was admitted to the hospital with stomach bleeding after smoking marijuana frequently while taking warfarin. He went home after a week in the hospital, but then was readmitted just 15 days later with a nosebleed and bruising. He told his doctors that he smoked marijuana, and he was counseled on the potential interactions of marijuana and warfarin.

Because marijuana affects the cytochrome P450 enzymes, it may inhibit the breakdown of warfarin, leading to an increase in warfarin’s effects, the report said. The man stopped smoking marijuana and did not experience further bleeding complications over the next nine months during which the researchers followed up with him.

Benzodiazepines

When people take benzodiazepines — which include muscle relaxants as well as drugs that treat anxiety, such as Valium — in combination with marijuana, the result can be “central nervous system depression,” according to according to a 2007 review paper in the American Journal of Health-System Pharmacy. This means that people can experience decreased breathing and heart rates, and loss of consciousness.

According to the Mayo Clinic, marijuana can increase the drowsiness caused by benzodiazepines and some other drugs (such as barbiturates and codeine). Therefore, people need to be cautious if they drive or operate machinery after using these drugs with marijuana, the Mayo Clinic said.

Ketoconazole

The antifungal medication ketoconazole also inhibitscytochrome P450 enzymes. When this medication is taken with marijuana, it slows the breakdown of tetrahydrocannabinol, or THC, the active ingredient in marijuana, in the body. So, taking the two drugs together may increase the concentration of THC in the body, according to a 2014 article in the trade journal Pharmacy Times.

Prozac

The antidepressant fluoxetine, commonly called by its brand name Prozac, can inhibit cytochrome P450 enzymes. This means that, like ketoconazole, fluoxetine mayslow down the metabolism of THC and therefore increase the concentration of THC in the body.

In 1991, researchers reported a case of a 21-year-old who experienced severe mania and psychosis after taking fluoxetine and using marijuana. The researchers hypothesized that marijuana might also increase levels of the chemical serotonin in the brain, which would enhance the effects of fluoxetine, but this is not proven.

Rifampin

The antibiotic medication rifampin, which is used to treat tuberculosis and Legionnaires’ disease,can boost the activity of cytochrome P450 enzymes. This means that rifampinmay speed up the breakdown of THC, reducing the levels of that substance in the body, according to the Pharmacy Times.

Diabetes medications

Marijuana may affect people’s blood-sugar levels, according to the Mayo Clinic. Indeed, some studies have found that marijuana users are less resistant to the effects of insulin, the hormone that helps blood sugar get inside cells, which could mean that their systems are better able to control their blood sugar levels.

But on the flip side, other studies have found that marijuana users are at increased risk of developing prediabetes, a condition in which people have elevated blood sugar levels.

People who take marijuana with drugs for diabetes should be monitored closely, and adjustments to their medications may be necessary, the Mayo Clinic said.

Research on marijuana’s potential drug interactions is limited, but here’s what is known.