Cannabidiol (CBD) is a chemical found in the Cannabis sativa plant, also known as hemp or cannabis. In the United States, one type of CBD is approved as a seizure medication.

The Cannabis sativa plant contains over 80 chemicals known as cannabinoids. The most well-known component of cannabis is delta-9-tetrahydrocannabinol (THC). However, CBD is derived from hemp, a strain of the Cannabis sativa plant that contains only trace amounts of THC. CBD appears to have effects on some brain chemicals, but these are distinct from THC's effects.

CBD in a prescription form is used to treat seizure disorders (epilepsy). CBD is also used to treat anxiety, pain, dystonia, Parkinson's disease, Crohn's disease, and many other conditions, but there is no good scientific evidence to support these claims.

In 2018, legislation made it legal to sell hemp and hemp products in the United States. However, this does not imply that all CBD products derived from hemp are legal. CBD cannot be legally included in foods or dietary supplements because it is a prescription drug. CBD is only permitted in "cosmetic" products. However, CBD products labelled as dietary supplements are still available on the market. The amount of CBD in these products is not always the same as stated on the label.

What are the benefits and effectiveness?

Epileptic seizures (epilepsy)

The US FDA has approved a specific prescription product (Epidiolex, GW Pharmaceuticals) to treat seizures caused by Dravet syndrome, Lennox-Gastaut syndrome, or tuberous sclerosis complex. It is unknown whether other forms of CBD can help with seizures. For the time being, stick with the prescription product.

There is interest in using CBD for a variety of other purposes, but there isn't enough reliable data to say whether it would be beneficial in these cases.

MS (Multiple Sclerosis) (MS)

A prescription-only nasal spray containing both 9-delta-tetrahydrocannabinol (THC) and cannabidiol (Sativex, GW Pharmaceuticals) has been shown to be effective in improving pain, muscle tightness, and urination frequency in people with MS. Outside of the United States, this product is used in over 25 countries. However, there is inconclusive evidence on the efficacy of cannabidiol for symptoms of multiple sclerosis when used alone. Some preliminary research suggests that using a cannabidiol spray under the tongue may improve pain and muscle tightness in MS patients, but not muscle spasms, tiredness, bladder control, mobility, or well-being and quality of life.

Side-Effects

CBD is possibly safe to take in appropriate doses when taken orally. Doses of up to 200 mg per day have been safely used for up to 13 weeks. A specific prescription CBD product (Epidiolex) has been sed at higher doses and for longer durations under the supervision of a healthcare provider.

Side-effects of CBD include dry mouth, low blood pressure, lightheadedness, and drowsiness. High doses of the prescription form of CBD, Epidiolex, have also been linked to liver damage.

When applied to the skin: There is insufficient reliable information to determine whether CBD is safe or what the potential side effects are.

Warnings and Special Precautions

Pregnancy and breast-feeding

Taking CBD while pregnant or breast-feeding may be dangerous. CBD products may contain other ingredients that are harmful to a foetus or infant. To be on the safe side, avoid using.

Children

It is possible that taking a specific prescription CBD product (Epidiolex) by mouth in doses of up to 25 mg/kg daily is safe for children. This product is approved for use in children over the age of one who have certain conditions. It is unclear whether other CBD products are safe for children.

Liver Disease

People with liver disease may need to take lower doses of CBD.

Parkinson's disease

Some preliminary research suggests that high doses of CBD may exacerbate muscle movement and tremors in some people with Parkinson's disease.

What about interactions?

Interaction Level: Moderate

Use this combination with caution.

Medications that have been altered by the liver (Cytochrome P450 1A1 (CYP1A1) substrates) interact with CANNABIDIOL (CBD)

The liver changes and breaks down some medications. CBD may affect how quickly the liver degrades these medications. This may alter the effectiveness and side effects of these medications.

Medications that have been altered by the liver (Cytochrome P450 1A2 (CYP1A2) substrates) interact with CANNABIDIOL (CBD)

The liver changes and breaks down some medications. CBD may affect how quickly the liver degrades these medications. This may alter the effectiveness and side effects of these medications.

Medications that have been altered by the liver (Cytochrome P450 1B1 (CYP1B1) substrates) interact with CANNABIDIOL (CBD)

The liver changes and breaks down some medications. CBD may affect how quickly the liver degrades these medications. This may alter the effectiveness and side effects of these medications.

Medications that have been altered by the liver (Cytochrome P450 2A6 (CYP2A6) substrates) interact with CANNABIDIOL (CBD)

The liver changes and breaks down some medications. CBD may affect how quickly the liver degrades these medications. This may alter the effectiveness and side effects of these medications.

Medications that have been altered by the liver (Cytochrome P450 2B6 (CYP2B6) substrates) interact with CANNABIDIOL (CBD)

The liver changes and breaks down some medications. CBD may affect how quickly the liver degrades these medications. This may alter the effectiveness and side effects of these medications.

Medications that have been altered by the liver (Cytochrome P450 2C19 (CYP2C19) substrates) interact with CANNABIDIOL (CBD)

The liver changes and breaks down some medications. CBD may affect how quickly the liver degrades these medications. This may alter the effectiveness and side effects of these medications.

Medications that have been altered by the liver (Cytochrome P450 2C9 (CYP2C9) substrates) interact with CANNABIDIOL (CBD)

The liver changes and breaks down some medications. CBD may affect how quickly the liver degrades these medications. This may alter the effectiveness and side effects of these medications.

Drugs that are altered by the liver (Cytochrome P450 2D6 (CYP2D6) substrates) interact with CANNABIDIOL (CBD)

The liver changes and breaks down some medications. CBD may affect how quickly the liver degrades these medications. This may alter the effectiveness and side effects of these medications.

Medications that have been altered by the liver (Cytochrome P450 3A4 (CYP3A4) substrates) interact with CANNABIDIOL (CBD)

The liver changes and breaks down some medications. CBD may affect how quickly the liver degrades these medications. This may alter the effectiveness and side effects of these medications.

CANNABIDIOL interacts with sedative medications (CNS depressants) (CBD)

CBD may cause drowsiness and slow breathing. Sedative medications can also cause sleepiness and slowed breathing. Taking CBD with sedative medications may result in breathing problems and/or excessive sleepiness.

CANNABIDIOL interacts with Clobazam (Onfi) (CBD)

The liver changes and breaks down clobazam. CBD may slow the rate at which the liver degrades clobazam. Clobazam's effects and side effects may be exacerbated as a result.

CANNABIDIOL interacts with eslicarbazepine (Aptiom) (CBD)

The body changes and breaks down eslicarbazepine. CBD may slow the rate at which the body breaks down eslicarbazepine. This may cause a slight increase in eslicarbazepine levels in the body.

CANNABIDIOL interacts with rufinamide (Banzel) (CBD)

The body changes and breaks down rufinamide. CBD may slow the rate at which the body degrades rufinamide. This may cause a slight increase in rufinamide levels in the body.

CANNABIDIOL interacts with topiramate (Topamax) (CBD)

The body changes and breaks down topiramate. CBD may slow the rate at which the body breaks down topiramate. This may cause a slight increase in topiramate levels in the body.

CANNABIDIOL interacts with valproate (CBD)

Valproic acid can harm the liver. Cannabidiol combined with valproic acid may increase the risk of liver injury. CBD and/or valproic acid may need to be discontinued, or the dose reduced.

Zonisamide binds to CANNABIDIOL (CBD)

The body changes and breaks down zonisamide. CBD may slow the rate at which the body degrades zonisamide. This may cause a slight increase in zonisamide levels in the body.

Medications that have been altered by the liver (Cytochrome P450 2C8 (CYP2C8) substrates) interact with CANNABIDIOL (CBD)

The liver changes and breaks down some medications. CBD may affect how quickly the liver degrades these medications. This may alter the effectiveness and side effects of these medications.

Medications that have been altered by the liver (glucuronidated drugs) interact with CANNABIDIOL (CBD)

The liver changes and breaks down some medications. CBD may affect how quickly the liver degrades these medications. This may alter the effectiveness and side effects of these medications.

Medications that cause the liver to break down other medications (Cytochrome P450 2C19 (CYP2C19) inducers) interact with CANNABIDIOL (CBD)

The liver changes and breaks down CBD. Some drugs accelerate the rate at which the liver changes and breaks down CBD. This could alter CBD's effects and side effects.

Medications that cause the liver to break down other medications (Cytochrome P450 3A4 (CYP3A4) inducers) interact with CANNABIDIOL (CBD)

The liver changes and breaks down CBD. Some drugs accelerate the rate at which the liver changes and breaks down CBD. This could alter CBD's effects and side effects.

CANNABIDIOL interacts with medications that inhibit the breakdown of other medications by the liver (Cytochrome P450 2C19 (CYP2C19) inhibitors) (CBD)

The liver changes and breaks down CBD. Some drugs slow down the rate at which the liver changes and breaks down CBD. This could alter CBD's effects and side effects.

CANNABIDIOL interacts with medications that inhibit the breakdown of other medications in the liver (Cytochrome P450 3A4 (CYP3A4) inhibitors) (CBD)

The liver changes and breaks down CBD. Some drugs slow down the rate at which the liver changes and breaks down CBD. This could alter CBD's effects and side effects.

CANNABIDIOL interacts with Brivaracetam (Briviact) (CBD)

Brivaracetam is altered and degraded by the body. CBD may slow the rate at which the body degrades brivaracetam. This may raise brivaracetam levels in the body.

CANNABIDIOL interacts with Everolimus (Zostress) (CBD)

The body changes and degrades everolimus. CBD may slow the rate at which the body degrades everolimus. This could raise the body's levels of everolimus.

Tacrolimus (Prograf) has an interaction with CANNABIDIOL (CBD)

Tacrolimus is altered and degraded by the body. CBD may slow the rate at which the body breaks down tacrolimus. This could raise tacrolimus levels in the body.

CANNABIDIOL interacts with methadone (dolophine) (CBD)

Methadone is degraded by the liver. CBD may slow the rate at which the liver degrades methadone. Taking cannabidiol alongside methadone may increase its effects and side effects.

Tegretol (carbamazepine) interacts with CANNABIDIOL (CBD)

The body changes and breaks down carbamazepine. CBD may slow the rate at which the body breaks down carbamazepine. This could raise carbamazepine levels in the body and exacerbate its side effects.

Sirolimus (Rapamune) has an interaction with CANNABIDIOL (CBD)

The body changes and breaks down sirolimus. CBD may slow the rate at which the body breaks down sirolimus. This could raise sirolimus levels in the body.

CANNABIDIOL interacts with stiripentol (Diacomit) (CBD)

The body changes and breaks down stiripentol. CBD may slow the rate at which the body degrades stiripentol. Stiripentol levels in the body may rise as a result, as may its side effects.

CANNABIDIOL interacts with lithium (CBD)

Taking higher doses of CBD may raise lithium levels. This raises the possibility of lithium toxicity.

CANNABIDIOL interacts with Warfarin (CBD)

CBD may cause warfarin levels to rise, increasing the risk of bleeding. CBD and/or warfarin may need to be discontinued, or the dose reduced.

Tamoxifen (Soltamox) has an interaction with CANNABIDIOL (CBD)

The body changes and breaks down tamoxifen. CBD may influence how quickly the body degrades tamoxifen. This could have an effect on tamoxifen levels in the body.

CANNABIDIOL interacts with caffeine (CBD)

The body changes and breaks down caffeine. CBD may slow the rate at which the body breaks down caffeine. Caffeine levels in the body may rise as a result of this.

CANNABIDIOL interacts with Citalopram (Celexa) (CBD)

The body changes and breaks down citalopram. CBD may slow the rate at which the body degrades citalopram. This could raise citalopram levels in the body and exacerbate its side effects.

Medications that have been altered by the liver (Cytochrome P450 2E1 (CYP2E1) substrates) interact with CANNABIDIOL (CBD)

The liver changes and breaks down some medications. CBD may affect how quickly the liver degrades these medications. This may alter the effectiveness and side effects of these medications.

Dosing

Adults have most commonly used CBD in doses of 200 mg or less per day. Speak with a healthcare provider to determine the best dose for a specific condition.

Speak with a healthcare provider for more information on using prescription CBD, such as Epidiolex.