CBD Effects and Side Effects

Timothy Culbert, MD, IFMCP

CBD effects and possible uses*

CBD is a non-intoxicating cannabinoid that has effects on the body and brain but does not cause the sensory and psychological effects that THC does. Scientific research to evaluate the therapeutic applications for CBD is just in its infancy. The marketing hype is definitely overselling at this point, but the science will catch up and CBD (and THC) will likely have some clear and more general applications for use with public health issues like anxiety, sleep, and pain. 

Current promising applications being investigated include (see sources near bottom of page):

• Anti-seizure
• Anxiety (with growing support for social anxiety applications)
• Chronic pain
• Sleep (with more research to support sleep issues related to anxiousness and stress)
• Inflammatory bowel diseases
• Migraines

CBD side effects*

CBD is well tolerated, even in large doses. However, CBD can cause side effects. These include: dry mouth, diarrhea, reduced appetite, drowsiness, dizziness, and fatigue. Another cause for concern is the unreliability of the purity and dosage of CBD in products. That concern highlights the importance of choosing a high quality product that undergoes rigorous third-party testing. 

CBD contraindications*

Research also suggests many side effects that occur with CBD use are likely the result of drug-to-drug interactions between CBD and other medications an individual may be taking (e.g., blood thinners). How does this work? Some medications are changed and broken down by the liver. Cannabidiol might decrease how quickly the liver breaks down some medications. In effect, using cannabidiol along with some medications that are broken down by the liver might increase the effects and/or side effects of some medications.  

This is a key reason to check with your primary doctor before starting CBD, particularly if you're on any medication or adding to another supplement or over-the-counter product that causes sleepiness. Other examples of this type of interaction can include (but are not limited to):

• Antipsychotics
• Benzodiazepines
• Opioids
• Antihistamines
• Herbal products to support sleep
• Alchohol

Additionally, there are other medication interactions with CBD that can be serious. Penn State College of Medicine has a really handy list of medications that may be impacted by altered concentration due to a combination with cannabinoids. Unfortunately, this list does not make any distinctions between CBD or THC, but it provides some guidance. Bring this list to your doctor before starting any CBD product.  

Penn State also found potentially serious interactions between prescription CBD and THC products and the following products:

• Warfarin and other blood thinners
• Amiodarone (heart medication)
• Levothyroxine (thyroid medication)
• Seizure medications (clobazam, lamotrigine, valproate)

CBD Supplements at Resilient Remedies

Sleep CBD is a blend of broad-spectrum CBD (30 mg per serving) combined with 5 mg of CBN (cannabinol) and 3 mg of melatonin. CBN is a form of phytocannabinoid shown to be more specifically helpful for sleep, and melatonin is nature’s internal timekeeper, helping set a more consistent bedtime. CBD Sleep may improve a variety of challenging sleep issues, and is especially helpful for those who have trouble falling asleep.*

Calm CBD combines 30 mg of broad-spectrum CBD with 200 mg of l-theanine, an amino acid that can also help reduce anxiety and stabilize mood. Together, they may improve stress resilience and calm anxiety without sedation. Taken at bedtime, CBD Calm may also be helpful for those who tend to wake in the middle of the night.*

Restore CBD gummies are infused with the highest quality, all-natural, US-grown hemp. Each gummy offers a precise dose of broad-spectrum CBD to support your endocannabinoid system with naturally occurring, plant-based ingredients. This synergy of multiple cannabinoids work together for the greatest impact to restore your natural resilience.*

*Note: Some of the supplements discussed in this article can cause side effects, but many people tolerate them much better than prescription medications. They are generally considered safe, however, they should not be started without your doctor’s knowledge and supervision. If you are taking medication already, be sure to talk with your doctor before adding any of these items. If you are considering going off medication, remember never to stop your medication suddenly—always consult with your doctor about how to safely taper off any psychiatric medication. See terms.

*These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.

SOURCES

1. Abrams, D. (2018). The therapeutic effects of Cannabis and cannabinoids: An update from the National Academies of Sciences, Engineering and Medicine report. European journal of internal medicine, 49, 7-11.
2. Atakan, Z. (2012). Cannabis, a complex plant: different compounds and different effects on individuals. Therapeutic advances in psychopharmacology, 2(6), 241-54. doi:10.1177/2045125312457586
3. Atalay, S., Jarocka-Karpowicz, I., & Skrzydlewska, E. (2019). Antioxidative and Anti-Inflammatory Properties of Cannabidiol. Antioxidants, 9(1), 21. https://doi.org/10.3390/antiox9010021
4. Ballard, C. R., & Junior, M. R. M. (2019). Health benefits of flavonoids. In Bioactive compounds (pp. 185-201). Woodhead Publishing.
5. Bridgeman, M. B., & Daniel T. A. (2017). Medicinal cannabis: History, pharmacology, And implications for the acute care setting. P&T: A peer-reviewed journal for formulary management, 42(3), 180-188.
6. Cox-Georgian, D., Ramadoss, N., Dona, C., & Basu, C. (2019). Therapeutic and medicinal uses of terpenes. In Medicinal Plants (pp. 333-359). Springer, Cham.
7. García-Gutiérrez, M.S., Navarrete, F., Gasparyan, A., Austrich-Olivares, A., Sala, F., & Manzanares, J. (2020). Cannabidiol: A Potential New Alternative for the Treatment of Anxiety, Depression, and Psychotic Disorders. Biomolecules, 10(11). https://doi.org/10.3390/biom10111575  
8. Kocis, P, T., & Vrana, K, E. (2020). Delta-9-Tetrahydrocannabinol and Cannabidiol Drug-Drug Interactions. Med Cannabis Cannabinoids, 3:61-73. doi:10.1159/000507998
9. Lee, C. H., & Giuliani, F. (2019). The Role of Inflammation in Depression and Fatigue. Frontiers in immunology, 10, 1696. https://doi.org/10.3389/fimmu.2019.01696
10. Leonard, B. E. (2014). Impact of inflammation on neurotransmitter changes in major depression: An insight into the action of antidepressants, Progress in Neuro-Psychopharmacology and Biological Psychiatry, 48. 261-267. https://doi.org/10.1016/j.pnpbp.2013.10.018.
11. Morales, P. et al. (2017). Molecular targets of the phytocannabinoids: A complex picture. Progress in the chemistry of organic natural products, 103, 103-131. doi:10.1007/978-3-319-45541-9_4
12. Noreen N., Muhammad, F., Akhtar, B., Azam, F., & Anwar, M. I. (2018). Is cannabidiol a promising substance for new drug development? A review of its potential therapeutic applications. Crit Rev Eukaryot Gene Expr, 28(1), 73-86. doi: 10.1615/CritRevEukaryotGeneExpr.2018021528. 
13. Sales, A. J., Crestani, C. C., Guimarães, F. S., Joca, S. (2018). Antidepressant-like effect induced by Cannabidiol is dependent on brain serotonin levels. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 86. 255-261. https://doi.org/10.1016/j.pnpbp.2018.06.002.
14. Sales, A. J., Fogaça, M. V., Sartim, A. G., et al. (2019). Cannabidiol induces rapid and sustained antidepressant-like effects through increased BDNH signaling and synaptogenesis in the prefrontal cortex. Mol Neurobiol, 56, 1070–1081. doi:10.1007/s12035-018-1143-4. 
15. Sarris, J. et al. (2020). Medicinal cannabis for psychiatric disorders: A clinically-focused systematic review. BMC Psychiatry, 20(1). doi:10.1186/s12888-019-2409-8
16. Wong, S. S., & Wilens, T. E. (2017). Medical cannabinoids in children and adolescents: a systematic review. Pediatrics, 140(5).
17.