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Product Review: CBD & Hemp SupplementsInitial Posting: 2/8/18

Sections: Jump to a section by clicking on its name.What It IsWhat It DoesQuality Concerns and What CL TestedWhat CL Found & Top Picks

CBD for PeopleCBD for Pets

Test Results By ProductWhat to Look for When Buying and UsingConcerns and CautionsFull Ingredients by ProductHow Products Were Evaluated

Summary:What is it? CBD (cannabidiol) is a compound derived from hemp and marketed as a supplementdespite the U.S. FDA's position that CBD is not a dietary supplement.

Does it work? CBD has been shown to reduce the frequency of certain types of seizures, andpreliminary evidence suggests it may also help with anxiety, schizophrenia, and other conditions.However, all of these effects have involved large doses of CBD — hundreds of milligrams per day,which is more than in many marketed CBD supplements and products (See What It Is and What ItDoes).

What did CL Find? ConsumerLab found the dose of CBD per suggested serving ranged 10foldfrom 2.2 mg to 22.3 mg, and the cost to obtain 10 mg of CBD from each product ranged over 5foldfrom 80 cents to $4.54. (See What CL Found and use the Results table to compare the amounts ofCBD and other cannabinoids in products).

Top Picks — ConsumerLab selected a Top Pick for People and a Top Pick for Pets based on topquality and value.

What to look for? If you seek CBD, look for products that list the amount of CBD per serving. If aproduct lists only "cannabinoids" it may contain some CBD but you won't know how much.Products may still have significant amounts of CBD if they list "hemp extract" as an ingredient, butdon't expect much CBD if "hemp oil" is the only ingredient. (See ConsumerTips)

How much to take? Most of the research with CBD has involved high doses (several hundredmilligrams daily). However, many CBD products on the market are lower dose and it is not clear ifthis dosing is effective. (See ConsumerTips: Dosage)

Other Concerns: Highdose CBD can cause a range of side effects (particularly gastrointestinal)and affect certain medications. For details, see Concerns and Cautions.

What It Is: Cannabidiol (CBD) and its precursor compound CBDa are dominant "cannabinoid" compounds found inhemp and cannabis (a hemp plant also known as marijuana). Unlike tetrahydrocannabinol (THC), which isanother cannabinoid compound, CBD is not believed to be a psychoactive compound affecting perceptionand behavior.

What It Does: NOTE: The effects described below are based on daily doses of hundreds of milligrams of CBD. Many CBDproducts on the market contain much lower amounts (providing tens of milligrams or less per day), and it isnot known if these low doses are as effective as higher doses.

Much of the research with CBD has focused on the reduction of certain types of seizures. A placebocontrolled clinical trial found a high daily dose of CBD (20 mg per kg of body weight, i.e., hundreds ofmilligrams) to reduce the frequency of convulsions in a rare form of epilepsy known as Dravet syndromein children and young adults, although it was also associated with a higher rate of adverse effects includingdiarrhea, vomiting, fatigue, pyrexia, somnolence, and abnormal results on liverfunction tests (Devinsky, NewEng J Med 2017). Similarly, the same high daily dose reduced the number of drop seizures among peoplewith treatmentresistant LennoxGastaut syndrome in a 3month study. Seizures per month decreased 44%with CBD compared to 22% with placebo; however, again, those taking CBD also had a higher rate ofadverse effects including diarrhea, somnolence, fever, decreased appetite, and vomiting (Thiele, Lancet2018).

A preliminary trial found modest, doserelated improvements in symptoms of dystonia (involuntary musclecontractions) in five individuals taking between 100 mg and 600 mg per day of cannabidiol, however, therewas a worsening of tremor and the ability to initiate movement in two of the individuals who also hadParkinson's disease (Consroe, Int J Neurosci 1986).

A study of highdose CBD (1,000 mg per day) among adults with schizophrenia found that adding CBDrather than placebo to existing treatments for six weeks reduced psychotic symptoms and caused a trend,although not statistically significant, toward improved performance on cognitive tasks. In this study, CBD wasgiven in two divided doses (morning and evening) and was well tolerated with no increase in adverse effects(McGuire, Am J Psy 2017).

Although laboratory studies and studies in animals suggest CBD may help reduce anxiety, there are only afew studies investigating these effects in people. For example, a small study in young healthy men found thata single, 400 mg dose of CBD taken as a capsule reduced selfreported anxiety (but also increased feelingsof mental sedation), one hour after ingestion, compared to placebo (Crippa, Neuropsychopharmacology2004). A study that found CBD reduced anxiety with social speaking utilized a single dose of 600 mg of CBDgiven 90 minutes before speaking (Bergamaschi, Neuropsychopharm 2011) and a similar study showedreduced anxiety using a dose of 300 mg (Zuardi, J Psychopharmacol 1993). In a 10 year old girl with anxietyand sleep disorders due to post traumatic stress disorder caused by sexual abuse, 25 mg of CBD taken atbedtime, and 6 mg to 12 mg of CBD sublingual spray taken as needed throughout the day for 5 monthsimproved her anxiety and sleep to the extent that they were no longer classified as disorders (Shannon, PermJ 2016). Although no side effects were observed, it is important to note that there is concern thatcannabinoids may affect brain development in children (See Concerns and Cautions).

A very small study among 15 men and women with a history of insomnia found that 160 mg of cannabidioltaken as a capsule 30 minutes before bedtime for one week significantly increased selfreported duration ofsleep compared to placebo. Ten participants reported sleeping more than 7 hours after taking this dose ofCBD, but when the same participants took a placebo, only six reported getting more than 7 hours of sleep.However, there was no decrease in the amount of time it took to fall asleep. Lower doses of CBD (40 mg and80 mg) did not increase sleep time or reduce the amount of time it took to fall asleep (Carlini, J ClinPharmacol 1981). None of the participants reported increased difficulty in waking or feeling sleepy uponawakening, compared to placebo.

Although there is some preliminary evidence that THC and, possibly other cannabinoids could potentiallyhelp to reduce interocular (eye) pressure in people with glaucoma, one study found that, four hours afteringestion, a single, sublingual dose of CBD (which also contained about 1 mg of THC) had no effect oninterocular pressure, while a 40 mg dose of CBD (containing about 2 mg of THC) temporarily increasedinterocular pressure (Tomida, J Glaucoma 2006; Health Canada 2013). There do not appear to be longerterm studies, or studies investigating the effects of cannabidiol alone for glaucoma.

One study found that an oral spray containing THC and CBD reduced pain in people with rheumatoid arthritis(Blake, Rheumatology (Oxford) 2006); however, a review of four short term clinical studies (including thisone) investigating the effects of cannabinoids for the treatment of rheumatic diseases, including fibromyalgiasyndrome, back pain, osteoarthritis and rheumatoid arthritis, concluded that there is "currentlyinsufficient evidence to recommend cannabinoid treatments for management of rheumatic diseases pendingfurther study." (Fitzcharles, Schmerz 2016). There do not appear to be any studies on the use of CBD alonefor reducing pain in these conditions.

A few studies suggest that a combination of THC and CBD may be helpful for cancerrelated pain; however,there do not appear to be studies on the effects of CBD alone for cancerrelated pain (Blake, Ann Palliat Med2017). (For more information about cannabinoids and cancer treatment, see the National Cancer Institute'swebpage about this topic.)

Creams, gels and lotions containing CBD are often promoted to treat pain, such as muscle or joint pain.CBD appears to be better absorbed through the skin than THC (Huestis, Chem Biodivers 2007) and there issome evidence that in animals, creams and gels containing CBD may help reduce inflammation in conditionssuch as arthritis and multiple sclerosis (Hammell, Eur J Pain 2016; Giacoppo, Daru 2015). However, thereare no studies on the effects of topical CBD creams, gels or lotions in people.

Legality, Quality Concerns, and What CL Tested For: Legality Although CBD is not psychoactive, it is not permitted to be sold as an ingredient in dietary supplements in theU.S., as the FDA considers it an investigational new drug. (Note: If an ingredient is marketed as asupplement prior to the FDA authorizing its investigation as a drug, it may continue to be marketed as asupplement, but this was not the case with CBD, according to the FDA). Two conditions for which CBD hasbeen or is being investigated as a new drug are cancer pain and, as noted above, Dravet syndrome (view alist here of completed, ongoing, and planned studies with cannabidiol). In Canada, cannabidiol is a controlledsubstance.

Products on the Market Despite the fact that CBD cannot be legally sold in the U.S. as a dietary supplement, many CBD products areavailable. Although it does not appear that individuals have been prosecuted for purchasing these productsfor their own use, the U.S. FDA has issued many warning letters to companies selling products claiming tocontain CBD and/or promoting such products as treatments.

The FDA also published the amounts of CBD, THC and other cannabis compounds it found in products ittested in 2015 and 2016 (click here and select the year to view). Most products contained very smallconcentrations of CBD — similar to what is normally found in hemp oil (about 0.0025% CBD) while otherscontained very large concentrations (25% to 35% CBD) yielding doses similar to those used in clinical trials(typically 200 mg or more per day). Many of the tested products did not contain the levels of CBD theyclaimed. The FDA cautions that "Consumers should beware purchasing and using any such products."

The reason why hemp oils would not be expected to contain much CBD is that hemp oil is typically madefrom hemp seeds, which contain little CBD (although some CBD may contaminate the surface of the seeds).In fact, ConsumerLab.com has tested hempseed oils as part of its review of seed oil supplements(sources of omega3 and omega6 fatty acids) and found those products to contain well under 1 mg ofCBD per serving. CBD is principally found in the flowers and, to a lesser extent, the upper leaves of the hempplant. A "CBD oil" product is typically an oil, such as from hemp seed or other sources, to which a CBDextract (from hemp flowers) has been added (Mead, Epilepsy & Behavior 2017).

At least one seller of CBD supplements to the public, PlusCBD LTD, appears to claim that is not illegal to sellthese products if they are derived from "industrial" or "agricultural" hemp. Industrial hemp is typically a largerplant with more stalk and less leaves and flowers than that used to produce marijuana or CBD for medicaluse. It is grown for its fiber (for textiles) and seeds (as food and oil), which would be very low in THC (lessthan 0.3%) and CBD. It is true that the U.S. Drug Enforcement Agency (DEA) has stated that CBD in traceamounts from cannabis stalk or seeds is not a controlled substance, in contrast to CBD derived from

cannabis flower which is a controlled substance despite the compound being the same. However, this doesnot seem to override the FDA's position that CBD cannot be sold as dietary supplement. It would also seemdifficult to obtain large quantities of CBD from industrial hemp or cannabis stalk.

Many states now have medical marijuana laws that permit products with high CBD content to be sold byapproved dispensaries and used by residents for medical purposes recommended by a healthcare provider.In addition, several states without medical marijuana laws allow products that are high in CBD (e.g., at least5%, 10%, or 15% CBD) and low in THC (typically less than 0.3%) to be used for specific medical purposes(typically intractable epilepsy) as approved or recommended by a healthcare professional (See list of stateson ProCon.org). However, these state laws do not make the general sale of such products legal, and somespecifically require that the products be purchased outofstate.

What CL Tested For Considering the enormous variation that has been shown in the amounts of CBD in marketed products andthe fact that many don't accurately disclose their CBD content, as noted above, ConsumerLab.compurchased a sampling of popular products labeled to contain CBD, cannabinoids (other than THC), and/orhemp extracts and tested them to determine the amounts of CBD and other cannabinoids they contained,comparing these amounts to label expectations. Products were also tested for contamination with lead,cadmium and arsenic. See How Products Were Evaluated for more details.

Products were compared on their label accuracy, quality, and cost. Due to the FDA's position that CBD is aninvestigational drug that cannot be sold as a supplement and CL's requirement that a CL "Approved" productmeet FDA labeling requirements, products were not rated as Approved or Not Approved.

What CL Found: CBD was found in every product and none was contaminated with heavy metals nor contained significantamounts of THC. However, the dose of CBD per suggested serving ranged 10fold from 2.2 mg to 22.3 mg,and the cost to obtain 10 mg of CBD ranged over 5fold from 80 cents to $4.54 (as shown in the graphbelow). Among the liquid (oil) products, the concentration of CBD ranged from 0.8% to as much as 4.8% byweight, and among capsules containing powders it ranged from 1.3% to 2.3%. More details are found in theResults table further below.

From among products that passed all of the laboratory tests, CL identified its Top Picks, representing acombination of best value and best quality, described below.

CBD/Hemp Extracts for People Top Pick: Bluebird Botanicals Hemp Classic 6x Concentrated provided CBD at one of the lowest costs(82 cents per 10 mg) and had by far the highest concentration of CBD (4.8% of the oil is CBD, compared to0.8% to 1.7% for other oils). It also contained a small amount of other cannabinoids, as one would expectfrom hemp extract. The suggested serving on the label is 15 drops (found to provide 22.3 mg of CBD and 1.1 mg of other cannabinoids, costing $1.83), and the label suggests taking that dose twice or more per day.

A close second for Top Pick is Elixinol Natural Drops Hemp Oil + Coconut Extract, which is slightly lessexpensive than Bluebird to get CBD (80 cents per 10 mg). However, it does not contain other cannabinoidsbecause it is not made from a hemp extract, but contains hemp oil plus added CBD. It does, however, state aspecific amount of CBD on its label — 5 mg per ½ dropperful, and it contained a bit more than that — wefound 6.2 mg. Interestingly, SOL CBD Pure Hemp Extract appears to be very similar to Elixinol, listing theexact same ingredients, but it costs twice as much as Elixinol and its name does not seem particularlyappropriate since it was not found to contain other cannabinoids expected in a hemp extract.

Most products were predominately, if not exclusively, CBD, with only small amounts of other cannabinoids.The only product with a much higher amount of other cannabinoids was Endoca Raw Hemp Oil, which hadalmost equal amounts of CBD (5.5 mg) and CBDa (4.9 mg) per capsule.

Getting a higher dose: Be aware that none of the products provide the high doses of CBD typically used inclinical trials, and the benefit of these lower doses is not clear. If you are seeking higher strengths of CBD,i.e., such as 50 mg or more per dose, there are products on the market that claim such amounts, but they donot always contain what they claim. The FDA's tests in 2015 showed that products such as Hemp Honey21% Cannabidiol Oil, 21% CBD Hemp Oil Treatment, 26% Hemp Oil Treatment, and UltraCBD contained littleto no CBD. However, the FDA did identify several products in 2016 that contained the high concentrationslisted on their labels such as Herbal Renewals 25% CBD Hemp Oil Gold Label, US Hemp Wholesale 25%CBD Hemp Oil Supplement Gold Label, Endoca Hemp Oil 15% CBD (1500 mg), and iHempCBD FilteredCBD Hemp Oil 35.51% (click here and select the year to view).

These higherdose products tend to be very expensive. For example, Endoca's 1500 CBD mg (30 capsules,each with 50 mg of CBD), is $156 compared to its 300 mg CBD which is $31.[Note: The 300 mg CBD productis different from the Endoca 300 mg CBD + CBDa product tested in this Review.] The cost to get CBD fromeach of these products, assuming they contain what they claim, comes out about the same $1 per 10 mg,which is about 20 cents more than from the best priced products in this Review. You can see, though, that ifyou want a daily dose of, say, 500 mg of CBD, it could easily cost $40 to $50 per day.

CBD/Hemp Extracts for Pets Top Pick: CW [Charlotte's Web] Paws MCT Oil provided CBD at a much lower cost than CannaPet: 10 mgof CBD costs $1.14 from CW but a whopping $4.54 from CannaPet. CW is bottled oil, while CannaPet is apowderfilled capsule. Interestingly, CW's product for people, CW Everyday Plus, is essentially the same oilas CW Paws: both were found in testing by ConsumerLab to provide about 16 mg of CBD per milliliter (ml) (2dropperfuls of Everyday or 1 dropperful of Paws, which has a larger dropper), but this dose cost $2.47 fromEveryDay Plus versus $1.87 from CW Paws. The only significant difference is that Everyday Plus has mintchocolate flavoring.

An even lower cost option than CW Paws MCT Oil, would be one of the product marketed for use by people,such as Bluebird, Elixinol, and Plus +CBDOil.

Test Results by Product: The table below lists test results and information for nine products containing CBD grouped first by those for

people and then by those for pets. Products are shown alphabetically within each category.ConsumerLab.com selected all of these products based on reader suggestions and popularity in themarketplace.

Also shown below for each product is the claimed type and amount of hemp ingredient and cannabinoids perserving or unit, the serving size recommended on the label, the amount of CBD and other cannabinoidsfound, dietary designations if claimed on the label (i.e. Kosher, NonGMO) and ingredient and costcomparisons. Check marks in the table indicate that a product passed ConsumerLab.com's quality criteria forthat attribute (see Passing Score). The full list of ingredients is available for each product by clicking on theword "Ingredients" in the first column.

RESULTS OF CONSUMERLAB.COM TESTING OF CBD OIL PRODUCTS Click on beneath a product name to find a vendor that sells it.

Product Name, AmountListed of Hemp Oil/Extractper Unit, and SuggestedDaily Serving on Label

Click on "Ingredients" forFull Listing

ClaimedAmount ofHemp

Oil/Extract PerServing

ClaimedAmount of

CannabinoidsPer Serving

TEST RESULTS

(See How Products Were Evaluated)

Cost ForSuggestedServing On

Label

[Cost Per 10 mgCannabidiol(CBD) Found]

Other NotableFeatures2

Price Paid

Contained LabeledAmount of

Cannabinoids1 perserving

(% CBD of oil or

powder)

Did Not ExceedContaminationLimit for Lead,Cadmium and

Arsenic

Did Not ExceedLimit for THC

Bluebird BotanicalsHemp Classic 6 xConcentrated,1,500+ mg (hempextract and hempoil; 15 drops [0.5 mL], twiceor more per day3)

Dist. by Bluebird Botanicals Ingredients

Amounts of hempextract andorganic virginhemp seed oilnot listed

25 mg fullspectrumcannabinoids

Bottled oil

Found: CBD: 22.3 mg per 15

drops Other cannabinoids: 1.1

mg per 15 drops

4.8% of oil is CBD

Highest concentrationof CBD

$1.83

[$0.82] Low cost for

CBD

$109.80/1 fl. oz.[30 ml] bottle(approx. 60servings)

CW™ [Charlotte'sWeb] Everyday Plus Infused Oil MintChocolate (28 mghemp extract per 2full droppers [1 mL]; 2 fulldroppers, twice daily)

Mfd. by CW Hemp Ingredients

28 mg hemp extract (above groundplant parts)

Amounts ofcannabinoids notlisted

Bottled oil

Found: CBD: 16.1 mg per 2 full

droppers Other cannabinoids:

none

1.7% of oil is CBD

$2.47

[$1.54]

Vegan

$74.24/1 fl. oz.[30 ml] bottle(approx. 30servings)

Elixinol™ Natural DropsHemp Oil + Coconut Extractwith Naturally Occurring CBD

16.7 mg hemp oil (seedsand stalks)

Found:

$0.50

[$0.80]

(16.7 mg hemp oilper ½ dropper [0.5mL]; ½ dropper,twice daily)

Dist. by Elixinol LLC Ingredients

5 mg CBD

Bottled oil

CBD: 6.2 mg per ½dropper

Other cannabinoids:none

1.3% of oil is CBD

Lowest cost forCBD

$29.99/1 fl. oz.[30 ml] bottle(approx. 60servings)

Endoca Raw HempOil (hemp oil andCBD + CBDa; nosuggested servingor daily servingsize4)

Dist. by Endoca Ingredients

Amount of hempoil not listed

10 mg5 CBD + CBDa

Oil inmedium/largecapsule

Found: CBD: 5.5 mg per capsule Other cannabinoids: 4.9

mg per capsule (4.9 mg CBDa)

1.1% of oil is CBD

$1.035

[$1.88]

Omega3 (40mg), omega6(133.3 mg),vitamin E

(266.67 mcg)

Vegan

$31.00/30capsules

Plus +CBD OilCapsules 10 mgCBD (125 mg hempoil per capsule; 1capsule, once daily)

Dist. by CV Sciences, Inc. Ingredients

125 mg driedhemp oil (aboveground plantparts) containing10 mg CBD

Powder in largecapsule

Found: CBD: 9.8 mg per capsule Other cannabinoids: 1.2

mg per capsule

2.3% of powder is CBD

$1.00

[$1.02]

$29.95/30capsules

PrimeMyBody NanoEnhanced Hemp Oil(24 mg hemp extractper 4 pumps [2 mL];1 to 4 pumps [0.5 to2 mL], once or more daily6)

Dist. by PrimeMyBody Ingredients

24 mg hemp extract(stems andstalks) containing16 mgphytocannabinoiddiols

Bottled oil

Found: CBD: 16.2 mg per 4

pumps Other cannabinoids:

none

0.8% of oil is CBD

$4.76

[$2.94]

Gluten free

$119.00/1.7 fl.oz. [50 ml] bottle(approx. 25servings)

SOL CBD PureHemp Extract (16.7mg hemp oil per ½dropper [0.5 mL]; ½dropper, twice daily)

Dist. by Halcyon Botanicals Ingredients

16.7 mg hemp oil (seedsand stalks)

5 mg CBD

Bottled Oil

Found: CBD: 5.2 mg per ½

dropper Other cannabinoids:

none

1.1% of oil is CBD

$1.03

[$1.99]

$124.00/2 fl. oz.[60 ml] (two pack

of 1 ouncebottles) (approx.120 servings)

Pet Products

CannaPet®Advanced (organichemp flour; 1capsule, once or

Amount oforganic hempflour not listed

Found: CBD: 2 mg per capsule Other cannabinoids: 0.2

mg per capsule

$1.00

[$4.54]

twice daily7)

Dist. by CannaPet® Ingredients

Amounts ofcannabinoids notlisted

Powder inmedium/largecapsule

1.3% of powder is CBD

$29.99/30capsules

CW™ [Charlotte'sWeb] Paws MCT Oil(25 mg hemp extractper 1 full dropper [1ml]; ¼ to 1 fulldropper [0.25 mL to 1 mL];twice daily)

Mfd. by CW Hemp Ingredients

25 mg hemp CO2extract

Amounts ofcannabinoids notlisted

Bottled oil

Found: CBD: 16.4 mg per full

dropper Other cannabinoids:

none

1.7% of oil is CBD

$1.87

[$1.14]

$187.10/3.38 fl.oz. [100 ml]

bottle (approx.100 servings)

Tested through CL's Quality Certification Program prior to, or after initial posting of this Product Review.

1 Variation permitted of up to 25% more and 10% less than listed amount. 2 Not tested but claimed on label. 3 Label states "Take one or more servings by mouth, twice per day, or as directed by a medical professional." 4 There are no listed serving size and daily serving size. 5 Based on taking 1 capsule per serving. 6 Label states "Take 14 pumps by mouth, holding for 30 second before swallowing. Best taken on an empty stomach 10 minutesbefore meals." 7 Label states "Dogs Under 20lbs (9 kg): 1 capsule 2x/daily. Cats Under 20lbs (9 kg): 1 capsule daily."

##TABLE_UNLESS_TEXT##

Copyright ConsumerLab.com, LLC, 2018. All rights reserved. Not to be reproduced, excerpted, or cited in any fashion without theexpress written permission of ConsumerLab.com LLC.

ConsumerTips:

What to Look for When Buying and Using: Read Labels Carefully As noted earlier, hemp oil would not be expected to contain much CBD, while hemp extract or products thatspecifically list CBD as an ingredient would be expected to contain CBD. Ideally, look for a product that liststhe amount of CBD per serving (not just per entire bottle). If a product lists "cannabinoids" it may containsome CBD but you won't know how much.

Dosing Most of the research with CBD has involved high doses (several hundred milligrams daily). This is muchmore than you'll typically get from products being sold on the market. Here's what's been shown to work inpreliminary clinical studies, as discussed in more detail in the What It Does section:

Anxiety (relating to public speaking): 300 mg to 600 mg of CBD dailyInsomnia: 160 mg of CBD 30 minutes before bedtime to increase sleep time (but will not decrease theamount of time it takes to fall asleep)

Reduction in seizures: 20 mg of CBD per kilogram of body weight daily (e.g., for a 70 kg adult, thiswould be 1,400 mg of CBD)Schizophrenia: 1,000 mg of CBD daily

Concerns and Cautions: CBD can cause side effects and interact with certain medications and conditions, although these effects havetypically been reported only with very high daily intake, i.e., hundreds of milligrams daily.

High daily doses of CBD (20 mg per kg of body weight, i.e., hundreds of milligrams) may causedecreased appetite, diarrhea, vomiting, fatigue, fever, somnolence, and abnormal results onliverfunction tests (Devinsky, New Eng J Med 2017; Thiele, Lancet 2018).CBD at a dose of 300 mg has been shown to worsen symptoms of Parkinson's disease (Consroe,Int J Neurosci, 1986).CBD should be used with caution with sedative and sleepinducing medications, as it may enhancetheir effects.CBD can increase blood serum levels of antiepleptic drugs (Gaston, Epilepsia 2017). CBD mayincrease the bloodthinning effects of warfarin (Coumadin, Jantoven) likely because CBD competesfor the same liver enzymes that break down warfarin and other drugs. This was observed in a man withpoststroke epilepsy taking warfarin: His INR (a measure of how long it takes blood to clot) beganincreasing several weeks after starting CBD (Epidiolex, Greenwich Biosciences, Inc.) for his seizures.His CBD dosing started with several hundred milligrams daily and increased to over 1,000 mg, at whichpoint his warfarin dose had been reduced by approximately 30% (Grayson, Epilepsy Behav Case Rep2017).A small study in healthy men found that a single dose (400 mg) of antifungal drug ketoconazole(Nizoral, Xolegel, Extina) increased blood levels of CBD, while a single dose (600 mg) of the antibioticrifampicin (Rifadin) decreased blood levels of CBD (Stott, Springerplus 2013).CBD can inhibit the liver enzyme CYP2D6, theoretically increasing blood levels of drugs metabolizedwith this enzyme, such as the proton pump inhibitor drug omeprazole (Zegerid, Prilosec OTC) and theantipsychotic drug risperidone (Risperdal) (Iffland, Cannabis Cannabinoid Res 2017).The American Academy of Pediatrics has not endorsed Cannabis and cannabinoid use because ofconcerns about brain development (National Cancer Institute 2017).

Information on this site is provided for informational purposes only. It is not an endorsement of anyproduct nor is it meant to substitute for the advice provided by physicians or other healthcareprofessionals. The information contained herein should not be used for diagnosing or treating ahealth problem or disease. Consumers should inform their healthcare providers of the dietarysupplements they take.

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