(PDF LINK) jamainternal_florian_2025_oi_250038_1756399031.24166
JAMA Intern Med. 2025; 185(9):1070-1078. 10.1001/jamainternmed.2025.2366
Key Points:
Question What are the effects of daily cannabidiol (CBD) use in healthy adults at doses representative of consumer use on liver safety and endocrine hormone levels?
Meaning These results document hepatic transaminase elevations and eosinophilia in healthy adults exposed to CBD doses representative of consumer use of unregulated CBD products.
In “Cannabidiol and Liver Enzyme Level Elevations in Healthy Adults: A Randomized Clinical Trial” (JAMA Intern Med. 2025;185[9]:1070-1078, doi:10.1001/jamainternmed.2025.2366), investigators enrolled 201 healthy adults (median age ~ 36 years) and randomized them to either purified CBD at 5 mg/kg/day (given twice daily) or placebo for 28 days, monitoring weekly liver enzymes and endocrine markers. They observed that 8 participants (5.6 %) in the CBD arm—but none in the placebo arm—developed ALT or AST elevations exceeding 3× the upper limit of normal, and 7 met pre-specified withdrawal criteria for potential drug-induced liver injury, although none developed symptoms or bilirubin abnormalities and all enzyme elevations reversed after discontinuation. The authors conclude that even doses of CBD representative of consumer use may pose a nontrivial risk of asymptomatic transaminase elevations, warranting closer safety monitoring and further study of long‐term hepatic effects.
As a physician, these findings raise concern: the fact that ~1 in 20 healthy adult users had notable enzyme elevations—even in the absence of overt liver injury—suggests that CBD ingestion is not entirely benign to hepatic metabolism, and clinicians should be vigilant about checking liver function in frequent users. It is important to note, however, that this study was conducted in healthy adult volunteers—not older adults or patients on other medications (many of which may interact via cytochrome P450 pathways)—so the risk in those populations (with polypharmacy or preexisting hepatic stress) could very well be higher than seen here.
Deep Thoughts,
Justin B Boge DO, MHA, MS