The Rise of CBD and the Importance of Safe Usage
Cannabidiol, or CBD, has seen a massive surge in popularity, with U.S. sales jumping from $108 million in 2014 to $1.9 billion in 2022 [1.10.4]. Found in everything from oils to lotions, CBD gummies are a particularly popular choice for those seeking relief from pain, anxiety, and insomnia [1.10.3]. However, the widespread availability of these products raises significant safety questions. The U.S. Food and Drug Administration (FDA) does not regulate the safety and purity of most CBD products as they are sold as supplements [1.4.3]. This lack of regulation can lead to inconsistencies in potency and potential contamination with THC, pesticides, or heavy metals [1.5.4]. Given these concerns and the known physiological effects of CBD, it's vital to identify which populations should exercise caution or avoid these products altogether.
Individuals Who Must Avoid CBD Gummies
Certain groups are strongly advised against using CBD due to a lack of safety data and the potential for serious health complications.
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Pregnant and Breastfeeding Individuals: The FDA and CDC strongly advise against the use of CBD in any form during pregnancy or while breastfeeding [1.5.2, 1.5.4]. Animal studies have shown that high doses of CBD can cause problems with the reproductive systems of male fetuses [1.5.2]. It is also known that CBD can be transferred through breast milk, and its effects on a developing infant are unknown [1.5.5]. The "pump and dump" method is not effective, as CBD can be stored in fat tissue and released over time [1.5.3].
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People with Liver Disease: CBD has the potential to cause liver injury [1.4.4]. Studies on the FDA-approved CBD drug Epidiolex revealed that some users experienced elevated liver enzymes, a marker of liver stress or damage [1.4.3, 1.6.2]. Individuals with pre-existing liver conditions may be at a higher risk and may need to use lower doses under strict medical supervision, if at all [1.2.5]. A 2025 study in JAMA Internal Medicine found that even at consumer doses, 5% of healthy participants showed significant elevation of a liver enzyme marker [1.6.4].
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Children: Aside from the FDA-approved prescription drug Epidiolex, used for specific seizure disorders in children aged one and older, the safety of other CBD products for children is unclear [1.2.5]. Due to the lack of regulation and unknown long-term effects on development, it is wise to keep all non-prescription CBD products away from children [1.2.5].
Individuals Who Should Exercise Extreme Caution
For some people, CBD is not absolutely contraindicated but poses significant risks that require a conversation with a healthcare provider before use.
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People Taking Other Medications: This is one of the most significant risk categories. CBD can interfere with a large family of liver enzymes called CYP450, which are responsible for metabolizing a high percentage of prescription drugs [1.2.4]. This interaction can either increase a drug's concentration in the blood, leading to heightened side effects and toxicity, or decrease its effectiveness [1.2.4]. A general rule of thumb is if your medication has a "grapefruit warning," you should not use CBD without consulting a doctor, as they both inhibit the same enzymes [1.2.3, 1.4.3].
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Individuals with Low Blood Pressure (Hypotension): CBD has been shown to lower blood pressure [1.7.3]. For those who already have low blood pressure, taking CBD could cause it to drop to unsafe levels, leading to dizziness, lightheadedness, and fainting [1.7.1, 1.7.2]. Combining CBD with blood pressure medications can also amplify this effect [1.7.1].
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People with Parkinson's Disease: The evidence here is conflicting. While some studies explore benefits for non-motor symptoms, some early research suggests that taking high doses of CBD might worsen muscle movement and tremors for some people with Parkinson's disease [1.9.2]. The Parkinson's Foundation does not endorse its use but advises caution due to side effects like dizziness, balance problems, and impaired thinking [1.9.1].
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Individuals with Glaucoma: While cannabis (specifically THC) has been known to temporarily lower intraocular pressure (IOP), CBD may have the opposite effect. A 2018 study found that CBD actually increased eye pressure in mice by 18% [1.8.1, 1.8.2]. For this reason, the American Academy of Ophthalmology warns against using CBD for glaucoma, as it could worsen the condition [1.8.3].
Potential Side Effects and Quality Concerns
Even for those not in a high-risk group, CBD is not without side effects. Common ones include drowsiness, diarrhea, decreased appetite, dry mouth, and irritability [1.4.5]. The unregulated market also means you cannot be sure the product you're buying contains the amount of CBD advertised or if it's free from contaminants [1.4.3]. A study of 84 CBD products bought online found that over a quarter contained less CBD than labeled, and 18 of them contained THC [1.4.5]. Always look for products with a Certificate of Analysis (COA) from a third-party lab to verify purity and potency.
CBD Drug Interaction Comparison Table
| Medication Class | Examples | Potential Interaction with CBD |
|---|---|---|
| Blood Thinners | Warfarin (Coumadin), Clopidogrel | CBD can increase the levels of these drugs, raising the risk of bleeding [1.2.5, 1.3.2]. |
| Heart Rhythm Medications | Amiodarone | CBD can alter the metabolism of these drugs, potentially leading to serious side effects [1.2.2, 1.3.3]. |
| Antidepressants (SSRIs & Tricyclics) | Fluoxetine (Prozac), Sertraline (Zoloft), Amitriptyline | CBD may increase serum concentrations and side effects like drowsiness [1.2.4, 1.3.5]. |
| Benzodiazepines | Alprazolam (Xanax), Diazepam (Valium) | Combined use can significantly increase sedation, dizziness, and confusion [1.3.2]. |
| Anti-Seizure Medications | Clobazam, Valproate | CBD can significantly alter the blood levels of these drugs, requiring dose adjustments under medical supervision [1.2.5, 1.3.4]. |
| Immunosuppressants | Cyclosporine, Tacrolimus | CBD can increase levels of these drugs, risking toxicity [1.3.1, 1.3.4]. |
| Hypothyroid Medication | Levothyroxine | Combining with CBD can alter hormone medication metabolism, potentially impacting effectiveness [1.3.2]. |
Conclusion: The Primacy of Medical Consultation
While CBD gummies offer potential benefits for many, they are not a one-size-fits-all remedy. For significant portions of the population, they pose real and serious health risks. The potential for harmful drug interactions, negative effects on pre-existing conditions like liver disease and glaucoma, and the unknown consequences for pregnant or breastfeeding individuals make it imperative to approach CBD with caution. The most critical step before trying any CBD product is to have an open and honest conversation with a qualified healthcare provider. They can assess your personal health history, review your current medications, and provide guidance on whether CBD is a safe option for you.
For more information on drug interactions, one authoritative source is the National Institutes of Health (NIH): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8298645/
