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Liver Damage Could Result From Mix Of CBD & Acetaminophen

Philip Ghezelbash
liver damage, hepatotoxicity, CBD, acetaminophen, APAP, enzymes, metabolic pathways, contraindication, over the counter

A new study found that CBD works in the same pathways as enzymes that lead to liver damage. Don’t combine with Tylenol.

Cannabis has long been promoted for its medicinal benefit to nearly every organ in the body. Cannabidiol (CBD) is the cannabinoid darling of the moment, with global markets saturated in CBD-infused products ranging from food to skin care. Each product is positioned as a step toward better health and wellness. Will all of this CBD consumption improve our health? Not according to a recent study that sounds the alarm on CBD contributing to liver damage!

The Liver’s Importance to Human Health

Your liver is a vital organ, playing a key role in many different metabolic processes. The liver helps to convert nutrients from food into substances that the body can utilize to supply cells. It also is crucial for filtering out harmful substances, as well as producing bile to break down fat. Moreover, the liver plays a vital role in metabolizing drugs

So many vital functions of the body rely on a healthy liver. It comes as no surprise, then, that a damaged liver can have devastating health effects. 

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Typical symptoms of liver disease can include: 

  • Jaundice (yellowing of the skin)
  • Abdominal pain
  • Swollen legs
  • Itchy skin
  • Vomiting
  • Loss of appetite
  • Chronic fatigue

Severe cases of liver damage can result in liver failure. Without a liver transplant, severe damage will lead to death. 

Can CBD Enhance Liver Damage From Acetaminophen?

Research is showing that CBD may have negative interactions with common over-the-counter medications, such as acetaminophen (Tylenol). A recent study from the University of Arkansas for Medical Science, using mice models, investigated the interaction between CBD and acetaminophen (APAP), otherwise known as paracetamol. 

Results suggest that CBD modulates the activity of the enzymes known as CYP2E1 and CYP1A2. These are two of the more common enzymes involved in the metabolism and hepatotoxicity (liver damage) of drugs like acetaminophen. The connection is especially concerning for the elderly as aging impairs drug clearance and CYP activity.

In the study, researchers injected mice with either 116 or 290 mg/kg of CBD for three days. The researchers then injected the mice with a dose of 400 mg/kg of APAP on the fourth day. 

It was found that 37 percent of the mice treated with the lower 116 mg dose of CBD died within 5 hours of receiving the follow up APAP dose. Paradoxically, no deaths were found with the mice given 290 mg/kg CBD and acetaminophen. The reason for the latter is the subject of further research, but it is possible that higher doses of CBD enlist a protective benefit for the liver. 

All CBD + APAP mice developed lethargic conditions where they demonstrated significantly decreased activity, an impaired response to external stimuli, as well as lowered total body temperature.

How does this all relate to people? We can’t be sure yet. Based on the animal models, mixing acetaminophen-based medication and CBD may be harmful to the liver within a certain dose range. 

Liver Damage From Acetaminophen

Other studies have repeatedly demonstrated APAP’s ability to damage the liver on its own. Furthermore, CBD is not the only substance that could exacerbate acetaminophen toxicity. Pre-existing liver damage, alcohol, green tea extract, and even malnutrition are all factors that can provoke more extensive liver damage when taken or occur alongside pharmaceutical consumption. 

liver, liver damage, CBD, cannabinoids, cannabis, medical cannabis, recreational cannabis, liver health, alcohol, alcohol damage, APAP, paracetamol

Should You Stop Taking CBD?

Researchers generally regard CBD on its own as very safe. While these studies on CBD and liver damage are concerning, it’s important to recognize first that CBD alone did not cause these results. The study on mice was primarily exploring CBD’s interaction with acetaminophen metabolic pathways. Interactions with other drugs is crucial to understand to enhance efficacy and patient safety. 

The CBD product used in this study was Epidiolex, and it is the only FDA-approved CBD-based medicine. As a prescribed medicine, it tends to have higher CBD concentration than store-bought CBD products. Epidiolex contains 100 mg of CBD per mL. Over-the-counter CBD products tend to contain around 25 to 50 mg of CBD per mL. 

But while CBD concentration levels may have affected the acetaminophen study, we do need more research. This study’s researchers recommended caution when taking CBD alongside potentially hepatotoxic medications without medical supervision. If you are concerned or believe you might be taking both CBD and potentially hepatotoxic medications simultaneously, you should consult your doctor. 

Other Studies Show CBD Helps Heal Liver Damage

CBD clearly doesn’t cause liver damage in and of all itself. A review of cannabis consumption in the U.S. discovered an inverse relationship between cannabis and non-alcoholic fatty liver disease (NAFLD). This could have something to do with the action of CBD on the CB2 receptor and easing inflammation involved with NAFLD. 

Research published in Frontiers in Pharmacology in 2019 exploring the therapeutic uses of cannabidiol for alcohol-induced liver damage, came to the conclusion that CBD reduces alcohol-related steatosis and fibrosis in the liver by reducing lipid accumulation, stimulating autophagy, modulating inflammation, reducing oxidative stress, and by inducing death of activated hepatic stellate cells.”

Research tells us that CBD may even reduce liver damage. But, despite the safety profile of CBD, mixing it with the wrong medication (namely acetaminophen) could compromise liver health. The best general rule? Always speak to your physician before combining medications – even when that medicine is cannabis. 

Philip Ghezelbash

Philip Ghezelbash is an ex-personal trainer with a science background who currently operates New Zealand's only health specialized writing studio. He is passionate about presenting complex science in an easy to digest manner and is a firm believer that cannabis has substantial potential to be used as a medicine for degenerative disease.

2 Comments
  • Avatar
    N.Chiarelli

    where does this article say that CBD has damaged the liver? At the higher dose the cbd has been shown to protect the liver from acetaminophen damage.

    July 16, 2019 at 4:21 am Reply
    • Jennifer Grant

      Research is showing that CBD may have negative interactions with common over-the-counter medications, such as acetaminophen (Tylenol). A recent study from the University of Arkansas for Medical Science, using mice models, investigated the interaction between CBD and acetaminophen (APAP), otherwise known as paracetamol.

      Results suggest that CBD modulates the activity of the enzymes known as CYP2E1 and CYP1A2. These are two of the more common enzymes involved in the metabolism and hepatotoxicity (liver damage) of drugs like acetaminophen. The connection is especially concerning for the elderly as aging impairs drug clearance and CYP activity.

      In the study, researchers injected mice with either 116 or 290 mg/kg of CBD for three days. The researchers then injected the mice with a dose of 400 mg/kg of APAP on the fourth day.

      It was found that 37 percent of the mice treated with the lower 116 mg dose of CBD died within 5 hours of receiving the follow up APAP dose.

      July 16, 2019 at 10:47 am Reply

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