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Cannabidiol (CBD)

By

Laura Shane-McWhorter

, PharmD, University of Utah College of Pharmacy

Reviewed/Revised Jan 2023
View PATIENT EDUCATION

Cannabidiol (CBD) is a chemical in the Cannabis sativa plant. This plant, which contains more than 80 chemicals known as cannabinoids, is also called marijuana or hemp. Two key ingredients in cannabis are CBD and tetrahydrocannabinol (THC). THC is responsible for the intoxicating effects of cannabis, and it might contribute to the plant's health benefits. Unlike THC, CBD is not intoxicating.

CBD is available in softgels, tablets, capsules, oils, gums, liquid extracts, and vape juice (for fillable electronic cigarettes). Some of these products contain CBD only, and others contain CBD in combination with other ingredients.

A 2017 study concluded that labels of many products containing CBD make inaccurate claims about the amount of CBD in the product, and CBD concentrations in the same product sometimes vary. Moreover, THC (or marijuana) was found in 21% of the products (1 References Cannabidiol (CBD) is a chemical in the Cannabis sativa plant. This plant, which contains more than 80 chemicals known as cannabinoids, is also called marijuana or hemp. Two key ingredients... read more ).

Claims

Some people use CBD to treat many other health problems, including the following:

  • Bipolar disorder

  • Pain

  • Anxiety

  • Crohn disease

  • Diabetes

  • Sleep problems

  • Multiple sclerosis

  • Symptoms of withdrawal from heroin, morphine, and other opioid drugs

Evidence

Oral CBD has been approved by the US Food and Drug Administration (FDA) for the treatment of seizures associated with two epileptic encephalopathies: Lennox-Gastaut syndrome and Dravet syndrome. These epileptic encephalopathies start in childhood and involve frequent seizures along with severe impairments in cognitive development. Two clinical studies have reported on the effectiveness of CBD in these patients and other patients with treatment-resistant epilepsies (2, 3 References Cannabidiol (CBD) is a chemical in the Cannabis sativa plant. This plant, which contains more than 80 chemicals known as cannabinoids, is also called marijuana or hemp. Two key ingredients... read more ). However, not enough research has been done on cannabinoids for other, more common forms of epilepsy to determine if they are helpful for these conditions.

A 2018 Cochrane systematic review on cannabis‐based medicines for chronic neuropathic pain in adults included 16 studies with 1750 participants (4 References Cannabidiol (CBD) is a chemical in the Cannabis sativa plant. This plant, which contains more than 80 chemicals known as cannabinoids, is also called marijuana or hemp. Two key ingredients... read more ). The analysis showed that cannabis‐based medications may increase the number of people achieving 50% or greater pain relief compared with placebo (21% versus 17%). Cannabis-based medications probably increase the number of people achieving pain relief of 30% or greater compared with placebo (39% versus 33%). The authors concluded that this small improvement in neuropathic pain might be outweighed by the potential harms.

There are numerous clinical studies regarding the uses of CBD for various symptoms and disorders summarized on the National Institutes of Health (NIH) website.

Adverse Effects

CBD can have adverse effects such as dry mouth, low blood pressure, diarrhea, decreased appetite, mood changes, light-headedness, fatigue, rash, insomnia and poor quality sleep, and sleepiness.

CBD can cause increased transaminases and liver injury.

Drug Interactions

CBD is metabolized by the cytochrome p450 (CYP) enzymes CYP3A4 and CYP2C19. Coadministration with medications that are metabolized by or inhibit CYP3A4 or CYP2C19 can increase plasma concentrations of these medications or of CBD, which may result in increasing their effects and a greater risk of adverse reactions (5 References Cannabidiol (CBD) is a chemical in the Cannabis sativa plant. This plant, which contains more than 80 chemicals known as cannabinoids, is also called marijuana or hemp. Two key ingredients... read more ).

CBD may increase the serum concentration and effects of a number of drugs including the following:

  • Antiseizure medications (eg, brivaracetam, carbamazepine, clobazam, topiramate)

  • Immunosuppressants used to prevent rejection after an organ transplant (eg, cyclosporine, tacrolimus)

  • Anticoagulants (eg, warfarin)

  • Tricyclic antidepressants

  • Proton pump inhibitors (eg, omeprazole); diarrhea may occur

  • Nicotine, prolonging duration of action of nicotine

  • Lithium, causing or increasing lithium toxicity

  • Ketamine, possibly enhancing antidepressant effects

  • Methadone

  • Levothyroxine

CBD can cause sleepiness and drowsiness, so taking both CBD and sedatives (eg, benzodiazepines, phenobarbital, morphine, alcohol) may make people too drowsy.

Information on interactions is emerging. Any medication that has a narrow therapeutic index (eg, amiodarone) warrants caution and close monitoring with CBD use due to the possibility of drug interactions.

Acetaminophen, valproic acid, and CBD can cause liver injury, so the combination of CBD and acetaminophen or valproic acid might increase the chance of liver injury.

A number of drugs, including antiseizure medications and rifampin, may lower the serum concentration of CBD.

Tricyclic antidepressants may increase serum concentrations of CBD and thus may increase adverse effects of CBD.

(See also table .)

References

  • 1. Bonn-Miller MO, Loflin MJE, Thomas BF, et al: Labeling accuracy of cannabidiol extracts sold online. JAMA 318(17):1708-1709, 2017. doi:10.1001/jama.2017.11909

  • 2. Szaflarski JP, Bebin EM, Comi AM, et al: Long-term safety and treatment effects of cannabidiol in children and adults with treatment-resistant epilepsies: Expanded access program results. Epilepsia 59(8):1540-1548, 2018. doi:10.1111/epi.14477

  • 3. Szaflarski JP, Bebin EM, Cutter G, et al: Cannabidiol improves frequency and severity of seizures and reduces adverse events in an open-label add-on prospective study. Epilepsy Behav 87:131-136, 2018. doi:10.1016/j.yebeh.2018.07.020

  • 4. Mucke M, Phillips T, Radbruch L, Petzke F, Hauser W: Cannabis-based medicines for chronic neuropathic pain in adults. Cochrane Database Syst Rev 3(3):CD012182, 2018. Published 2018 Mar 7. doi:10.1002/14651858.CD012182.pub2

  • 5. Balachandran P, Elsohly M, Hill KP: Cannabidiol interactions with medications, illicit substances, and alcohol: a comprehensive review. J Gen Intern Med 36(7):2074-2084, 2021. doi:10.1007/s11606-020-06504-8

More Information

The following English-language resource may be useful. Please note that THE MANUAL is not responsible for the content of this resource.

Drugs Mentioned In This Article

Drug Name Select Trade
Epidiolex Solution
ARYMO ER, Astramorph PF, Avinza, DepoDur, Duramorph PF, Infumorph, Kadian, MITIGO, MORPHABOND, MS Contin, MSIR, Opium Tincture, Oramorph SR, RMS, Roxanol, Roxanol-T
BRIVIACT
Carbatrol, Epitol , Equetro, Tegretol, Tegretol -XR
ONFI, Sympazan
EPRONTIA, Qudexy XR, Topamax, Topamax Sprinkle, Topiragen , Trokendi XR
Cequa, Gengraf , Neoral, Restasis, Sandimmune, SangCya, Verkazia, Vevye
ASTAGRAF XL, ENVARSUS, HECORIA, Prograf, Protopic
Coumadin, Jantoven
Prilosec, Prilosec OTC
Commit, Habitrol, Nicoderm CQ, NICOrelief , Nicorette, Nicotrol, Nicotrol NS
Eskalith, Eskalith CR, Lithobid
Ketalar
Dolophine, Methadose
Ermeza, Estre , Euthyrox, Levo-T, Levothroid, Levoxyl, Synthroid, Thyquidity, Thyro-Tabs, TIROSINT, TIROSINT-SOL, Unithroid
Luminal, Sezaby
Cordarone, Nexterone, Pacerone
7T Gummy ES, Acephen, Aceta, Actamin, Adult Pain Relief, Anacin Aspirin Free, Apra, Children's Acetaminophen, Children's Pain & Fever , Children's Pain Relief, Comtrex Sore Throat Relief, ED-APAP, ElixSure Fever/Pain, Feverall, Genapap, Genebs, Goody's Back & Body Pain, Infantaire, Infants' Acetaminophen, LIQUID PAIN RELIEF, Little Fevers, Little Remedies Infant Fever + Pain Reliever, Mapap, Mapap Arthritis Pain, Mapap Infants, Mapap Junior, M-PAP, Nortemp, Ofirmev, Pain & Fever , Pain and Fever , PAIN RELIEF , PAIN RELIEF Extra Strength, Panadol, PediaCare Children's Fever Reducer/Pain Reliever, PediaCare Children's Smooth Metls Fever Reducer/Pain Reliever, PediaCare Infant's Fever Reducer/Pain Reliever, Pediaphen, PHARBETOL, Plus PHARMA, Q-Pap, Q-Pap Extra Strength, Silapap, Triaminic Fever Reducer and Pain Reliever, Triaminic Infant Fever Reducer and Pain Reliever, Tylenol, Tylenol 8 Hour, Tylenol 8 Hour Arthritis Pain, Tylenol 8 Hour Muscle Aches & Pain, Tylenol Arthritis Pain, Tylenol Children's, Tylenol Children's Pain+Fever, Tylenol CrushableTablet, Tylenol Extra Strength, Tylenol Infants', Tylenol Infants Pain + Fever, Tylenol Junior Strength, Tylenol Pain + Fever, Tylenol Regular Strength, Tylenol Sore Throat, XS No Aspirin, XS Pain Reliever
Depacon, Depakene, Depakote, Depakote ER, Stavzor
Rifadin, Rifadin IV, Rimactane
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NOTE: This is the Professional Version. CONSUMERS: View Consumer Version
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