Liver safety: research and patient questions

While adjunctive transdermal cannabidiol (ZYN002) at doses of 195 mg or 390 mg daily did not demonstrate statistically significant superiority over placebo in reducing focal seizure frequency over 12 weeks, it exhibited an excellent safety and tolerability profile with minimal gastrointestinal or hepatic adverse events. The favorable long-term tolerability and signals of seizure reduction in the open-label extension suggest that future clinical trials evaluating higher doses of transdermal cannabidiol in adult focal epilepsy are warranted.

While purified CBD is generally well-tolerated in clinical trials, the widespread availability of unregulated CBD-infused foods presents safety risks due to unpredictable dosing, lack of extract standardization, and pronounced increases in bioavailability when consumed with dietary fats. Integrative clinicians should counsel patients on the variability and lack of federal safety oversight in commercial CBD food products, keeping potential drug-drug interactions and elevated liver enzyme risks in mind.