Does CBD have contraindications?

Cannabidiol (CBD), recognized as the most widely used non-psychoactive cannabinoid in the world, stands out for its positive properties in the treatment of various diseases. Currently, there is a wide range of studies that support its efficacy; however, what is less talked about is its contraindications, i.e. the circumstances for which it is not indicated to use CBD products.

In this Cannactiva blog post, we will see in which situations the use of CBD may be contraindicated.

What are the contraindications of CBD?

Like any substance, cannabidiol should be used appropriately, when certain situations for which it is contraindicated are not present, to avoid unwanted adverse effects.

The main contraindications of CBD are:

Drug Interactions

CBD can interfere with several drugs by affecting a group of liver enzymes known as cytochrome P450. This means that it could change the way these drugs act in the body, increasing or decreasing their effects, and potentially causing adverse effects due to these interactions.

CBD can modify the efficacy of some drugs, so it is crucial to consult a physician if you are taking other medications along with CBD to make sure there are no unsafe interactions between them.

Specifically, CBD is processed in the liver by a group of liver enzymes known as cytochrome P450. Since many drugs and compounds such as CBD use the same P450 enzymes for their metabolism, both substances “compete” and therefore CBD could modify the efficacy of drugs such as anticoagulants, antidepressants, antiepileptics and many more (4).

For more details on possible drug interactions, visit our blog on CBD and drugs: What are the interactions?

Pregnancy, lactation and children

The effects of CBD on fetal development and newborns are not yet fully understood, but given the influence of the endocannabinoid system (ECS) in pregnancy, it is advisable to avoid CBD consumption during this stage.

There is a possibility that CBD may affect the permeability of the placental barrier (5), affecting the exchange of nutrients and chemicals between mother and fetus. It can also be excreted through breast milk, so its use is not recommended during lactation (6).

In children and adolescents, the use of CBD without professional advice is contraindicated. The endocannabinoid system is crucial in brain development, and the introduction of CBD can have unpredictable effects on development.

It is worth mentioning that the endocannabinoid system of children presents structural differences with respect to that of adults, so the dose must be adjusted differently, and the effects of cannabinoids may manifest differently from what has been observed in clinical studies in adults.

In addition, it is essential to keep CBD products out of the reach of children to prevent possible intoxication (especially jelly beans).

Mental Health Disorders

Some progress has been made in the study of CBD and mental disorders. So far, it seems that CBD can be an ally in the treatment of brain chemistry dysfunctions (8), such as schizophrenia or bipolar disorder (9).

However, it has been suggested that CBD may be unpredictable in its effects on mental health conditions and more research is needed to understand in detail the effects of CBD on psychiatric symptoms and medications.

Although it has also become a very popular solution for anxiety and depression, in case of mental health disorders it is always advisable to seek medical advice and supervision, in order to obtain the necessary professional advice.

Liver Disease

Both cannabinoids of plant origin (phytocannabinoids) and those of synthetic origin need to be metabolized in the liver to exert their effects and be eliminated from the body.

Because CBD is processed in the liver, the use of cannabidiol without professional advice is contraindicated in the presence of liver disease.

At high doses, CBD may affect liver function and increase liver enzymes, indicating hepatic stress (1, 2, 3). In addition, in people with liver disease, CBD may aggravate liver dysfunction.

This does not mean that CBD is harmful to the liver, but in the case of liver disease, when the organ is not functioning properly, taking CBD can produce adverse effects. In healthy people, CBD does not necessarily cause these problems, although there are cases of hepatic alterations when used in high doses.

In addition, the chances of adverse effects are multiplied when combining CBD and alcohol.

In healthy individuals using cannabidiol, it is recommended to monitor liver function under the guidance of a health care professional, especially if CBD is taken in high doses or for a prolonged period of time.

For more information on studies related to CBD and the liver, see the effects of CBD on the liver.

Heart disease

CBD can cause fluctuations in heart rate and blood pressure (7), which, although it does so in a subtle or subclinical manner, can affect people with heart conditions.

People with heart disease, especially those taking medications such as beta-blockers, should consult with their physician before taking CBD. Beta-blocking drugs or beta-blockers aim to make blood flow easily through the arteries by lowering blood pressure to slow the work of the heart, and cannabidiol could enhance these effects.

Adverse effects of CBD

The consumption of CBD can lead to infrequent and generally mild side effects, such as changes in appetite, dizziness, diarrhea, fatigue and, rarely, dry mouth. These effects vary between individuals and may depend on the amount being used.

The optimal CBD dosage varies from person to person, and can be difficult to determine on your own. Remember that people may respond differently to CBD. What works for one person may not work for another, and there may be individual reactions that contraindicate the use of CBD for one person. A professional can guide you in that regard, and help you find the right dose of CBD for your needs.

Learn more about the side effects of CBD.

Conclusion

It is crucial to approach the benefits of CBD with caution, especially in people with specific medical conditions that could lead to adverse effects. Many of the contraindications of CBD can be avoided with proper management.

If you have a diagnosed disorder or disease, you should consult with a medical specialist before using CBD. On the other hand, the quality and dosage of CBD products vary considerably. Low quality products may not contain the advertised amount of CBD or include impurities, complicating disease management and increasing the risk of contraindications.

Over-the-counter CBD products, such as those from Cannactiva, are not intended to treat or prevent disease.

Consult a healthcare professional for personalized advice, especially when other medications are being used.

Note: This is an informational article and is not intended to prevent, diagnose or treat any disease. Its contents may complement, but should never replace, any diagnosis or treatment of any disease or symptom. Cannactiva products are not medicines and are intended for external use. Cannactiva is not responsible for the misuse of this information. Please note that new scientific evidence may become available since the date of publication. Therefore, consult your doctor before using CBD.

References

1. Devinsky, O., Patel, A. D., Cross, J. H., Villanueva, V., Wirrell, E. C., Privitera, M., Greenwood, S. M., Roberts, C., Checketts, D., VanLandingham, K. E., Zuberi, S. M., & GWPCARE3 Study Group (2018). Effect of Cannabidiol on Drop Seizures in the Lennox-Gastaut Syndrome. The New England journal of medicine, 378(20), 1888-1897. https://doi.org/10.1056/NEJMoa1714631
2. Devinsky, O., Patel, A. D., Thiele, E. A., Wong, M. H., Appleton, R., Harden, C. L., Greenwood, S., Morrison, G., Sommerville, K., & GWPCARE1 Part A Study Group (2018). Randomized, dose-ranging safety trial of cannabidiol in Dravet syndrome. Neurology, 90(14), e1204-e1211.
3. 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.
4. Zendulka, O., Dovrtělová, G., Nosková, K., Turjap, M., Šulcová, A., Hanuš, L., & Juřica, J. (2016). Cannabinoids and Cytochrome P450 Interactions. Current drug metabolism, 17(3), 206-226.
5. Feinshtein, V., Erez, O., Ben-Zvi, Z., Eshkoli, T., Sheizaf, B., Sheiner, E., & Holcberg, G. (2013). Cannabidiol enhances xenobiotic permeability through the human placental barrier by direct inhibition of breast cancer resistance protein: an ex vivo study. American journal of obstetrics and gynecology, 209(6), 573.e1-573.e15.
6. Joseph, P., & Vettraino, I. M. (2020). Cannabis in Pregnancy and Lactation – A Review. Missouri medicine, 117(5), 400-405.
7. Jadoon, K. A., Tan, G. D., & O’Sullivan, S. E. (2017). A single dose of cannabidiol reduces blood pressure in healthy volunteers in a randomized crossover study. JCI insight, 2(12), e93760.
8. Pinto, J. V., Saraf, G., Frysch, C., Vigo, D., Keramatian, K., Chakrabarty, T., Lam, R. W., Kauer-Sant’Anna, M., & Yatham, L. N. (2020). Cannabidiol as a Treatment for Mood Disorders: A Systematic Review. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 65(4), 213-227.
9. Boggs, D. L., Surti, T., Gupta, A., Gupta, S., Niciu, M., Pittman, B., Schnakenberg Martin, A. M., Thurnauer, H., Davies, A., D’Souza, D. C., & Ranganathan, M. (2018). The effects of cannabidiol (CBD) on cognition and symptoms in outpatients with chronic schizophrenia a randomized placebo controlled trial. Psychopharmacology, 235(7), 1923-1932.