CBD Oil

Is CBD Oil Safe? Drug Interactions & Side Effects

Scientists have shown that CBD has a rather wide safety range. It has not been shown to cause intoxication or have any effects on blood pressure, heart rate, or body temperature like it's cousin THC.

Is CBD Safe?

CBD is generally regarded as safe, well-tolerated, and non-addictive by the medical community and the World Health Organization 1 Cannabidiol Critical Review Report World Health Organization. (2018). Cannabidiol Critical Review Report. Retrieved from: https://www.who.int/medicines/access/controlled-substances/CannabidiolCriticalReview.pdf World Health Organization. . Various studies have found that there are no serious CBD side effects – even at doses as high as 1500 mg per day 2 Safety and side effects of cannabidiol, a Cannabis sativa constituent Bergamaschi, M. M., Queiroz, R. H., Zuardi, A. W., & Crippa, J. A. (2011). Safety and side effects of cannabidiol, a Cannabis sativa constituent. Current drug safety, 6(4), 237–249. Bergamaschi, M. M., Queiroz, R. H., Zuardi, A. W., & Crippa, J. A. . Note that such high doses are not necessary for improving your wellbeing.  

 

Despite its safe reputation, CBD is not side-effect free. It has been documented to interact with certain medications and have a few uncommon, minor side effects. Furthermore, when discussing how safe CBD truly is, it is important to note that substantial long-term data is not yet available. Epidiolex, an FDA-approved CBD prescription drug, gives us the best data currently available on CBD safety. 

 

So, yes, CBD is generally safe. However, in the absence of substantial long-term data, the FDA and Health Canada advise cation and encourage consulting with your doctor before medicating with CBD products 3,4 What to Know About Products Containing Cannabis and CBD U.S. Food & Drug Administration. (2020). What to Know About Products Containing Cannabis and CBD. Retrieved from: https://www.fda.gov/consumers/consumer-updates/what-you-need-know-and-what-were-working-find-out-about-products-containing-cannabis-or-cannabis U.S. Food & Drug Administration .

 

CBD Side Effects

The Epidiolex trials have reported a range of undesirable CBD side effects. The most common side effects of CBD included tiredness, diarrhoea, and reproduced appetite 5,6 An Update on Safety and Side Effects of Cannabidiol: A Review of Clinical Data and Relevant Animal Studies Iffland, K., & Grotenhermen, F. (2017). An Update on Safety and Side Effects of Cannabidiol: A Review of Clinical Data and Relevant Animal Studies. Cannabis and cannabinoid research, 2(1), 139–154. Iffland, K., & Grotenhermen, F.  while the less common side effects included irritability, agitation, or poor sleep. 

 

In all these cases, however, the side effects observed were mild, occurred infrequently, and appeared to be correlated with using CBD in high doses. The higher the dose, the more likely you are to experience side effects. 

 

As with any drug, CBD affects each body differently. So, while CBD oil is non-intoxicating, it is advisable to avoid driving or operating heavy machinery until you know how CBD oil affects you, interacts with your body, and the duration of CBD effects. And although not considered to be a common allergenic, the possibility of an allergic reaction to CBD or some of its components like terpenes still exists.

Long-term Effects of CBD

The long-term effects of CBD are still being studied, and it is not yet known if long, repeated exposure to CBD causes harm. As a result, the dosage and frequency at which this harm occurs are also unknown. These unknowns are why the FDA and Health Canada recommend caution when taking CBD. 

 

In some of the animal studies completed to date, mice were given ultra-high doses of CBD, the equivalent of or higher than the maximum recommended human dose. Some liver injury and reproductive toxicity were noted 3,7 What to Know About Products Containing Cannabis and CBD U.S. Food & Drug Administration. (2020). What to Know About Products Containing Cannabis and CBD. Retrieved from: https://www.fda.gov/consumers/consumer-updates/what-you-need-know-and-what-were-working-find-out-about-products-containing-cannabis-or-cannabis U.S. Food & Drug Administration . When tested in humans, however, only the evidence for liver injury has been reported. 

 

The FDA trials for Epidiolex reported that “13% 6 Epidiolex 6. GW Pharmaceuticals, Inc. (2018). Epidiolex GW Pharmaceuticals, Inc. . This suggests potential liver damage caused by CBD or by its interaction with anti-seizure medications. 

 

Since there is potential for liver injury, CBD doses should be lower in people with known liver conditions. And in this case, your doctor should monitor your liver enzymes and check for potential medication interactions before and during a CBD regimen. 

 

The good news is that the trials found the damage to be mostly reversible. Two-thirds of patients reported a substantial decrease in adverse effects when intake of CBD or interacting medication was decreased or stopped altogether. In case you don’t already know, the liver is a regenerative organ, meaning that it can restore and rebuild after damage has been inflicted.

 

It should be noted that these studies tested adverse effects at higher doses than what consumers should be using. However, it is prudent that a CBD user remains aware of these potential CBD side effects and that you seek medical advice if experiencing any. 

Different glass bottles with CBD OIL, THC tincture and cannabis leaves on yellow background.

When to avoid CBD

The FDA has determined that the benefits of Epidiolex (CBD oil) outweigh the risks in a specific set of people, mostly children. However, until the long-term CBD oil side effects are better understood in populations such as the elderly, children, adolescents, and pregnant or lactating women, the FDA recommends exercising caution when these special populations use CBD. 

 

Since there is evidence of fetal harm in mice with ultra-high doses of CBD, it is not recommended for pregnant or lactating women 8 Cannabidiol Adverse Effects and Toxicity Huestis, M. A., Solimini, R., Pichini, S., Pacifici, R., Carlier, J., & Busardò, F. P. (2019). Cannabidiol Adverse Effects and Toxicity. Current neuropharmacology, 17(10), 974–989. Huestis, M. A., Solimini, R., Pichini, S., Pacifici, R., Carlier, J., & Busardò, F. P. . Although the effect of CBD on growing fetuses, children, and adolescents remains unclear, there may be unknown developmental risks. The Epidiolex trials were centered on childhood seizures and have shown that it is safe for children over the age of 2 years. Children under the age of 2 should probably not use CBD oil. As usual, you should always consult a pediatrician before giving a child CBD for any reason. 

 

CBD Drug Interactions

CBD can interact with numerous medications, and this is because it is processed by some critical liver enzymes. CBD can interact with enzymes that are responsible for handling almost 30% of all medications 9 Medical Cannabis Adverse Effects & Drug Interactions DOH DCRx. (2015). Medical Cannabis Adverse Effects & Drug Interactions. [PowerPoint Slides]. Retrieved from: https://dchealth.dc.gov/dcrx DOH DCRx . Elderly persons are more at risk for these medication interactions and should use low doses of CBD.

Below is a sample – but not exhaustive – list of medication classes that CBD has been known to interact with. The most notable ones are blood thinners like Warfarin, anti-seizure medications, opioids, and antidepressants.

  • Blood thinners like Warfarin
  • Anti-seizure medications (Clobazam and Valproate)
  • Antidepressants (SSRIs, tricyclic antidepressants)
  • Antipsychotics (haloperidol)
  • Antibiotics (macrolides)
  • Calcium channel blockers and beta-blockers
  • Benzodiazepines
  • Cyclosporine
  • Sildenafil (and other PDE5 inhibitors)
  • Antihistamines
  • HIV medications (antiretrovirals)
  • Some statins (Atorvastatin and simvastatin)
  • Opioids (codeine and oxycodone)

The list of medications above does not mean that CBD shouldn’t be taken at all if you are on them – it could just mean that you need to have a lower dose of CBD oil. You may also wish to ask your doctor about reducing or consolidating the medications you’re currently on to minimize the risk of interactions with CBD.

CBD Withdrawal

CBD is recognized as a non-addictive substance by many studies and the WHO 1 Cannabidiol Critical Review Report World Health Organization. (2018). Cannabidiol Critical Review Report. Retrieved from: https://www.who.int/medicines/access/controlled-substances/CannabidiolCriticalReview.pdf World Health Organization. . The FDA trials for Epidiolex (98% CBD oil) included a human dependence study. 1500mg per day of CBD did not produce signs or symptoms of withdrawal over a six week period after stopping CBD 6 Epidiolex 6. GW Pharmaceuticals, Inc. (2018). Epidiolex GW Pharmaceuticals, Inc. . CBD withdrawal, if existent, is probably very mild and likely poses no serious health effects.

Glass bottles with CBD oil, THC tincture and hemp leaves on green background.

Taking CBD Safely

CBD may produce mild side effects that are correlated with taking higher doses. Therefore, you should start low with your CBD dosage (10-15mg) and gradually upping your intake over some time until desired effects are achieved. If you have CBD side effects, try reducing your CBD dose by 10-15mg until they disappear. Determining your starting and maintenance doses should be done in consultation with a physician that is familiar with your medical history, as well as the set of symptoms you seek to remedy

Sources
  1. World Health Organization. (2018). Cannabidiol Critical Review Report. Retrieved from: https://www.who.int/medicines/access/controlled-substances/CannabidiolCriticalReview.pdf
  2. Bergamaschi, M. M., Queiroz, R. H., Zuardi, A. W., & Crippa, J. A. (2011). Safety and side effects of cannabidiol, a Cannabis sativa constituent. Current drug safety, 6(4), 237–249.
  3. U.S. Food & Drug Administration. (2020). What to Know About Products Containing Cannabis and CBD. Retrieved from: https://www.fda.gov/consumers/consumer-updates/what-you-need-know-and-what-were-working-find-out-about-products-containing-cannabis-or-cannabis
  4. Health Canada. (2019). Cannabidiol (CBD). Retrieved from https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/about/cannabidiol.html
  5. Iffland, K., & Grotenhermen, F. (2017). An Update on Safety and Side Effects of Cannabidiol: A Review of Clinical Data and Relevant Animal Studies. Cannabis and cannabinoid research, 2(1), 139–154.
  6. 6. GW Pharmaceuticals, Inc. (2018). Epidiolex
  7. Ewing, L. E., Skinner, C. M., Quick, C. M., Kennon-McGill, S., McGill, M. R., Walker, L. A., ElSohly, M. A., Gurley, B. J., & Koturbash, I. (2019). Hepatotoxicity of a Cannabidiol-Rich Cannabis Extract in the Mouse Model. Molecules (Basel, Switzerland), 24(9), 1694.
  8. Huestis, M. A., Solimini, R., Pichini, S., Pacifici, R., Carlier, J., & Busardò, F. P. (2019). Cannabidiol Adverse Effects and Toxicity. Current neuropharmacology, 17(10), 974–989.
  9. DOH DCRx. (2015). Medical Cannabis Adverse Effects & Drug Interactions. [PowerPoint Slides]. Retrieved from: https://dchealth.dc.gov/dcrx

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