Cannabidiol (CBD)
Mechanism
- Cannabis use disorder1
- Psychosis3
- Anxiety3
- Insomnia (possible)4
Features
Dosing
300-600 mg qhs for most uses. 150 mg for insomnia.
INTERACTIONS: Raises med levels as a strong inhibitor at multiple CYP enzymes (CYP-2D6, 2C9, 3A4, 2C19, 1A2, 2B6, 3A, 2E1, 2C8). The interaction is potentially serious with clonidine, tricyclics (amitriptyline, desipramine, imipramine, nortriptyline), carbamazepine, phenobarbital, valproate, fentanyl, levothyroxine, theophylline, warfarin, propofol, sirolimus, everolimus, and tacrolimus.
Management
This “healthier”strain of cannabis is #1 for cannabis use disorder, but questionable in anxiety, insomnia, and psychosis (where it has a mix of positive and negative studies. It is also expensive, but if a low dose helps patients get off cannabis that is great (even though only 300-600 mg worked in trials, $80/month).
TOLERABILITY: Sedation, appetite decrease.
RISKS: Drug interactions, elevated LFTs.
EMR Text
Cannabis Use Disorder
Cannabidiol (CBD) recommended based on a randomized controlled trial in cannabis use disorder.
Cannabidiol side effects, including elevated LFTs, reviewed with patient.
Anxiety
Cannabidiol (CBD) recommended based on randomized controlled trials in DSM anxiety disorders (Gundugurti PR et al, Asian J Psychiatr. 2024;97:104073).
Cannabidiol side effects, including elevated LFTs, reviewed with patient.
Psychosis
Cannabidiol (CBD) recommended based on a randomized controlled trials where it reduced psychotic symptoms (McGuire P et al, Am J Psychiatry. 2018;175(3):225-231).
Cannabidiol side effects, including elevated LFTs, reviewed with patient.