Critical considerations before using CBD
Cannabidiol, or CBD, has surged in popularity, with products ranging from oils and gummies to lotions and vapes readily available to consumers. While often marketed as a natural remedy for a variety of ailments, it is critical to recognize that not all CBD is created equal, and it is not safe for everyone. The FDA has only approved one prescription drug containing purified CBD (Epidiolex) for specific seizure disorders, and the over-the-counter market is largely unregulated. This lack of oversight means product purity, dosage, and safety are often uncertain, making it even more important for certain individuals to be cautious. Before considering CBD, it is vital to understand the documented risks and contraindications, especially for vulnerable populations or those with underlying health issues.
Who should stay away from CBD?
Pregnant or breastfeeding individuals
One of the most strongly advised groups to avoid CBD is pregnant or breastfeeding individuals. The U.S. Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC) have issued strong warnings against using CBD, THC, or marijuana during pregnancy or lactation. There is no comprehensive research on the effects of CBD on a developing fetus or breastfed baby.
- Potential risks: Animal studies have shown high doses of CBD can cause reproductive problems in male fetuses and low birth weight in infants.
- Transference: Cannabinoids can transfer to babies through breast milk, and the effects on an infant's developing brain are unknown.
- Contaminants: Due to the unregulated market, there is a risk that CBD products could contain harmful contaminants, such as heavy metals, pesticides, or unlisted THC, which can also be harmful.
People with liver disease
CBD is primarily metabolized by the liver, and data from clinical trials for the prescription product Epidiolex showed that high doses can lead to elevated liver enzymes, a sign of potential liver damage. This risk is heightened when CBD is combined with other medications that affect the liver, such as valproate. For individuals with pre-existing liver conditions, CBD use could worsen their condition or interfere with their medications. The FDA has identified the potential for liver injury as a serious risk associated with CBD use.
Individuals taking certain medications
The most widespread risk associated with non-prescription CBD use is its potential for significant drug interactions. CBD is a strong inhibitor of the cytochrome P450 (CYP450) enzyme system in the liver, which is responsible for metabolizing many prescription drugs. By interfering with these enzymes, CBD can either increase or decrease the concentration of other drugs in the bloodstream, leading to either an increase in adverse effects or a loss of effectiveness.
Common medication interactions:
- Blood Thinners: CBD can increase the blood-thinning effects of drugs like warfarin (Coumadin) by inhibiting the CYP enzymes that metabolize it, significantly raising the risk of bleeding.
- Anti-Seizure Medications: While prescription CBD treats certain seizure disorders, it can interact with other anti-epileptic drugs like clobazam, lamotrigine, and valproate, altering their levels and potentially increasing side effects.
- Immunosuppressants: Drugs used after organ transplants, such as tacrolimus, can have their levels dangerously altered by CBD, requiring close monitoring.
- Antidepressants: Certain antidepressants, like citalopram, can interact with CBD, potentially leading to increased side effects.
- Statins: CBD may interact with cholesterol-lowering statin drugs like atorvastatin, increasing the risk of side effects like muscle pain.
Children and adolescents
Aside from the FDA-approved Epidiolex for specific seizure disorders under strict medical supervision, experts strongly advise against giving children CBD. The long-term effects of CBD on a child's developing brain are largely unknown and under-researched. Concerns include potential impacts on brain development, unreliable dosing in unregulated products, and the risk of contamination with THC.
People with glaucoma
Some research suggests that CBD might increase the pressure inside the eyes, which could be harmful for individuals with glaucoma. Patients with eye conditions should consult a healthcare provider before using CBD.
Elderly individuals
Older adults may have a heightened risk of experiencing CBD side effects, such as dizziness, fatigue, and potential drug interactions, especially if they have age-related changes in liver function or are on multiple medications.
People with low blood pressure
CBD has been known to lower blood pressure. Individuals who already have low blood pressure should be especially cautious, as it could cause further drops in their blood pressure.
Comparison of CBD products: OTC vs. FDA-approved
It is crucial to understand the fundamental differences between the regulated, prescription CBD drug Epidiolex and the vast majority of over-the-counter (OTC) CBD products. The distinctions highlight why medical supervision is so important.
| Feature | FDA-Approved Epidiolex | Over-the-Counter CBD Products |
|---|---|---|
| Regulation | FDA-regulated prescription drug. | Largely unregulated; sold as supplements or food additives. |
| Purity | Purified, pharmaceutical-grade CBD. | Purity can vary; potential for contaminants like heavy metals, pesticides, or unlisted THC. |
| Dosage | Standardized, precise dosages determined by clinical trials. | Non-standardized; actual CBD content may differ from the label. |
| Therapeutic Use | Approved for specific, severe seizure disorders (Lennox-Gastaut and Dravet syndromes) under medical supervision. | Marketed with unproven claims for a wide range of conditions (e.g., anxiety, pain, sleep). |
| Monitoring | Requires regular blood tests to monitor for liver function and other side effects. | No required medical monitoring; users are on their own to identify potential harm. |
| Drug Interactions | Identified and managed under close medical supervision. | Potential for significant and unmonitored drug interactions. |
Navigating safety in an unregulated market
Given the significant risks for certain individuals and the inconsistent quality of products in the unregulated CBD market, consumer vigilance is paramount. Before purchasing any CBD product, research the company thoroughly. Reputable brands will often provide a certificate of analysis (COA) from an independent third-party lab. This document should verify the product's cannabinoid content, including its CBD and THC levels, and confirm it has been tested for contaminants. If a company claims to do its own internal analysis, it is best to avoid them. For conditions requiring treatment, sticking to evidence-based, proven medications under a doctor's care is the safest approach.
Conclusion: Always consult your doctor
For many, CBD may seem like a harmless, natural alternative for common issues like anxiety or pain. However, as the evidence shows, the risks are substantial for certain populations, and the unregulated market poses significant challenges for everyone. The interactions with common prescription medications, the potential for liver damage, and the unknown effects on pregnant women, children, and older adults are serious reasons for caution. Regardless of your health status, the most responsible approach is to always have a thorough discussion with a healthcare provider before starting any new supplement, including CBD. Your doctor can assess your personal risk factors, review your current medications, and help you make an informed, safe decision.
