Category: Toxicology
Keywords: cannabinoids, liver enzymes, toxicology (PubMed Search)
Posted: 1/20/2026 by Lena Carleton, MD
(Updated: 1/26/2026)
Click here to contact Lena Carleton, MD
Consumer use of cannabidiol (CBD) products for medicinal and recreational purposes has increased in recent years. Regulatory barriers have limited randomized controlled trials examining the clinical and physiologic effects of cannabinoids in humans. This study aimed to evaluate the impact of daily cannabidiol oil use on liver enzymes and endocrine hormones in healthy adults.
In this double-blind, randomized, placebo-controlled study conducted at a clinical pharmacology unit in Wisconsin, 201 healthy adults were randomized to receive either oral CBD (2.5 mg/kg twice daily) or placebo. Laboratory testing was performed weekly.
Among participants receiving CBD (n = 151), 8 developed AST and ALT elevations greater than three times the upper limit of normal; 7 of these also had eosinophilia. No participants in the placebo group (n = 50) developed similar transaminase elevations. There were no significant differences between groups in measured endocrine hormones, including total testosterone, inhibin B, thyroid-stimulating hormone, total triiodothyronine, and free thyroxine.
Limitations included a modest sample size, unequal group sizes, and a relatively short duration of exposure and follow-up.
Key Takeaway: CBD use may be associated with elevations in AST and ALT. However, evidence remains limited, and abnormal liver enzymes should still prompt evaluation for alternative etiologies.
Florian J, Salcedo P, Burkhart K, et al. 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
