Cannabis in liver disorders: a friend or a foe?
Abstract
The recent legalization of recreational marijuana use in some parts of the world, the discovery of new indications for the clinical application of cannabis, and the acceptance of the use of cannabis in practice has been paralleled by extensive research on the active components of cannabis and the endocannabinoid system within the human body. In this review, we evaluate the available evidence on cannabis and its constituents and the application of this evidence in clinical practice, focusing particularly on the liver and liver diseases. Constituents of cannabis, such as cannabidiol and Δ 9-tetrahydrocannabinol, have shown anti-inflammatory, antioxidant, and hepatoprotective effects both in in vitro and clinical studies, and appear to have potential in the symptom management and treatment of various liver diseases that were previously considered difficult to manage conservatively. In addition, the manipulation of the inherent endocannabinoid response system has found favor in many clinical fields and has generated considerable research and clinical interest. Moreover, evidence with regard to the adverse effects of marijuana use in liver diseases is weak, which has led to raise a question on the prior rules, with regard to a denial of liver transplantation to marijuana users. All in all, the recent trends in research, clinical experiences, as well as the legislature, has opened up new avenues towards the widespread clinical application of cannabis and its derivatives as well as modifiers of the components of the endocannabinoid system. More research is required to fully exploit these new evidences.
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The CBD can be associated with transaminitis, which is typically dose-related and more common at very high doses (800 mg/day).
“The CBD can be associated with transaminitis, which is typically dose-related and more common at very high doses (800 mg/day).”
From Clinical Practice Guidelines for Cannabis and Cannabinoid-Based Medicines in the Management of Chronic Pain and Co-Occurring Conditions (2024) · cites this paper as [127]
Transaminitis typically improves by lowering the dose of CBD.
“Transaminitis typically improves by lowering the dose of CBD.”
From Clinical Practice Guidelines for Cannabis and Cannabinoid-Based Medicines in the Management of Chronic Pain and Co-Occurring Conditions (2024) · cites this paper as [127]
Cites
Ror2 signaling regulates Golgi structure and transport through IFT20 for tumor invasiveness
Nishita, M., Park, S.-Y., Nishio, T., Kamizaki, K., Wang, Z., Tamada, K., Takumi, T., Hashimoto, R., Otani, H., Pazour, G. J., et al. (2017) · Scientific Reports · doi:10.1038/s41598-016-0028-x · Cited by 15,947 · see citing works
Osei‐Hyiaman, D., DePetrillo, M. A., Pacher, P., Liu, J., Radaeva, S., Bátkai, S., Harvey-White, J. D., Mackie, K., Offertáler, L., Wang, L., et al. (2005) · Journal of Clinical Investigation · doi:10.1172/jci23057 · Cited by 1,103 · see citing works
Endocannabinoid signaling at the periphery: 50 years after THC
Maccarrone, M., Bab, I., Bı́ró, T., Cabral, G. A., Dey, S. K., Marzo, V. D., Konje, J. C., Kunos, G., Mechoulam, R., Pacher, P., et al. (2015) · Trends in Pharmacological Sciences · doi:10.1016/j.tips.2015.02.008 · Cited by 648 · see citing works
Medical Marijuana for Treatment of Chronic Pain and Other Medical and Psychiatric Problems
Hill, K. P. (2015) · JAMA · doi:10.1001/jama.2015.6199 · Cited by 508 · see citing works
Cerdá, M., Wall, M. M., Keyes, K. M., Galea, S., & Hasin, D. S. (2011) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2011.06.011 · Cited by 490 · see citing works
Azofeifa, A., Mattson, M. E., Schauer, G. L., McAfee, T. A., Grant, A. M., & Lyerla, R. (2016) · MMWR Surveillance Summaries · doi:10.15585/mmwr.ss6511a1 · Cited by 461 · see citing works
Circulating Endocannabinoids: From Whence Do They Come and Where are They Going?
Hillard, C. J. (2017) · Neuropsychopharmacology · doi:10.1038/npp.2017.130 · Cited by 449 · see citing works
Daily Cannabis Smoking as a Risk Factor for Progression of Fibrosis in Chronic Hepatitis C *
Hézode, C., Roudot‐Thoraval, F., NGUYEN, S. V., Grenard, P., Julien, B., Zafrani, E., Pawlotsky, J., Dhumeaux, D., Lotersztajn, S., & Mallat, A. (2005) · Hepatology · doi:10.1002/hep.20733 · Cited by 292 · see citing works
Vara‐Ciruelos, D., Salazar‐Roa, M., Olea‐Herrero, N., Guzmán, M., Velasco, G., & Díaz‐Laviada, I. (2011) · Cell Death and Differentiation · doi:10.1038/cdd.2011.32 · Cited by 268 · see citing works
Booz, G. W. (2011) · Free Radical Biology and Medicine · doi:10.1016/j.freeradbiomed.2011.01.007 · Cited by 246 · see citing works
Role of cannabis in cardiovascular disorders
Goyal, H., Awad, H. H., & Ghali, J. K. (2017) · Journal of Thoracic Disease · doi:10.21037/jtd.2017.06.104 · Cited by 228 · see citing works
Self-citationDisease Progression in Chronic Hepatitis C: Modifiable and Nonmodifiable Factors
Missiha, S. B., Ostrowski, M., & Heathcote, E. J. (2008) · Gastroenterology · doi:10.1053/j.gastro.2008.02.069 · Cited by 227 · see citing works
PETROCELLIS, L. D., & Marzo, V. D. (2009) · Journal of Neuroimmune Pharmacology · doi:10.1007/s11481-009-9177-z · Cited by 216 · see citing works
Daily Cannabis Use: A Novel Risk Factor of Steatosis Severity in Patients With Chronic Hepatitis C
Hézode, C., Zafrani, É. S., Roudot‐Thoraval, F., Costentin, C. E., Hessami, A., Bouvier‐Alias, M., Medkour, F., Pawlotsky, J., Lotersztajn, S., & Mallat, A. (2007) · Gastroenterology · doi:10.1053/j.gastro.2007.11.039 · Cited by 186 · see citing works
Obesity and Cannabis Use: Results From 2 Representative National Surveys
Strat, Y. L., & Foll, B. L. (2011) · American Journal of Epidemiology · doi:10.1093/aje/kwr200 · Cited by 169 · see citing works
Established and potential therapeutic applications of cannabinoids in oncology
Walsh, D., Nelson, K. A., & Mahmoud, F. A. (2003) · Supportive Care in Cancer · doi:10.1007/s00520-002-0387-7 · Cited by 164 · see citing works
Prevalence of marijuana use at college entry and risk factors for initiation during freshman year
Suerken, C. K., Reboussin, B. A., Sutfin, E. L., Wagoner, K. G., Spangler, J. G., & Wolfson, M. (2013) · Addictive Behaviors · doi:10.1016/j.addbeh.2013.10.018 · Cited by 153 · see citing works
Rajavashisth, T. B., Shaheen, M. A., Norris, K. C., Pan, D., Sinha, S. K., Ortega, J. P. M., & Friedman, T. C. (2012) · BMJ Open · doi:10.1136/bmjopen-2011-000494 · Cited by 141 · see citing works
Influence of Cannabis Use on Severity of Hepatitis C Disease
Ishida, J. H., Peters, M. G., Jin, C., Louie, K., Tan, V., Bacchetti, P., & Terrault, N. A. (2008) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2007.10.021 · Cited by 136 · see citing works
Wang, Y., Mukhopadhyay, P., Cao, Z., Wang, H., Feng, D., Haskó, G., Mechoulam, R., Gao, B., & Pacher, P. (2017) · Scientific Reports · doi:10.1038/s41598-017-10924-8 · Cited by 123 · see citing works
Magen, I., Avraham, Y., Ackerman, Z., Vorobiev, L., Mechoulam, R., & Berry, E. (2010) · British Journal of Pharmacology · doi:10.1111/j.1476-5381.2009.00589.x · Cited by 121 · see citing works
Role of cannabis in digestive disorders
Goyal, H., Singla, U., Gupta, U., & May, E. (2016) · European Journal of Gastroenterology & Hepatology · doi:10.1097/meg.0000000000000779 · Cited by 118 · see citing works
Self-citationCannabidiol ameliorates cognitive and motor impairments in mice with bile duct ligation
Magen, I., Avraham, Y., Ackerman, Z., Vorobiev, L., Mechoulam, R., & Berry, E. M. (2009) · Journal of Hepatology · doi:10.1016/j.jhep.2009.04.021 · Cited by 111 · see citing works
Lim, M. P., Devi, L. A., & Rozenfeld, R. (2011) · Cell Death and Disease · doi:10.1038/cddis.2011.52 · Cited by 107 · see citing works
Avraham, Y., Grigoriadis, N. K., Poutahidis, T., Vorobiev, L., Magen, I., Ilan, Y., Mechoulam, R., & Berry, E. (2010) · British Journal of Pharmacology · doi:10.1111/j.1476-5381.2010.01179.x · Cited by 93 · see citing works
Medical Marijuana Use in Oncology
Wilkie, G., Sakr, B. J., & Rizack, T. (2016) · JAMA Oncology · doi:10.1001/jamaoncol.2016.0155 · Cited by 93 · see citing works
Adejumo, A., Alliu, S., Ajayi, T. O., Adejumo, K. L., Adegbala, O. M., Onyeakusi, N. E., Akinjero, A., Durojaiye, M., & Bukong, T. N. (2017) · PLoS ONE · doi:10.1371/journal.pone.0176416 · Cited by 77 · see citing works
Marijuana Use in Potential Liver Transplant Candidates
Ranney, D. N., Acker, W. B., Al‐Holou, S. N., Ehrlichman, L. K., Lee, D. S., Lewin, S. A., Nguyen, C., Peterson, S. F., Sell, K., Kubus, J. J., et al. (2008) · American Journal of Transplantation · doi:10.1111/j.1600-6143.2008.02468.x · Cited by 73 · see citing works
Role of Cannabinoids in the Development of Fatty Liver (Steatosis)
Purohit, V., Rapaka, R. S., & Shurtleff, D. (2010) · The AAPS Journal · doi:10.1208/s12248-010-9178-0 · Cited by 69 · see citing works
Brunet, L., Moodie, E. E. M., Rollet, K., Cooper, C., Walmsley, S. L., Potter, M., Klein, M. B., & for the Canadian Co-infection Cohort Investigators (2013) · Clinical Infectious Diseases · doi:10.1093/cid/cit378 · Cited by 67 · see citing works
Critical appraisal of the potential use of cannabinoids in cancer management
Rosengren, R. J., & Cridge, B. J. (2013) · Cancer Management and Research · doi:10.2147/cmar.s36105 · Cited by 66 · see citing works
Zhu, J., Chen, P.-Y., Frankel, M., Selby, R. R., & Fong, T. (2017) · Transplantation · doi:10.1097/tp.0000000000001969 · Cited by 65 · see citing works
Possible hepatotoxicity of chronic marijuana usage
Borini, P., Guimarães, R. C., & Borini, S. B. (2004) · Sao Paulo Medical Journal · doi:10.1590/s1516-31802004000300007 · Cited by 63 · see citing works
Endocannabinoids and Liver Disease. IV. Endocannabinoid involvement in obesity and hepatic steatosis
Kunos, G., & Osei‐Hyiaman, D. (2008) · American Journal of Physiology-Gastrointestinal and Liver Physiology · doi:10.1152/ajpgi.00057.2008 · Cited by 61 · see citing works
Role of cannabinoids in chronic liver diseases
Parfieniuk‐Kowerda, A., & Flisiak, R. (2008) · World Journal of Gastroenterology · doi:10.3748/wjg.14.6109 · Cited by 60 · see citing works
Marijuana Use and Organ Transplantation: a Review and Implications for Clinical Practice
Rai, H. S., & Winder, G. S. (2017) · Current Psychiatry Reports · doi:10.1007/s11920-017-0843-1 · Cited by 58 · see citing works
Review article: the endocannabinoid system in liver disease, a potential therapeutic target
Basu, P. P., Aloysius, M. M., Shah, N. J., & Brown, R. S. (2014) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.12673 · Cited by 48 · see citing works
Self-citationCannabis use is associated with reduced prevalence of progressive stages of alcoholic liver disease
Adejumo, A., Ajayi, T. O., Adegbala, O. M., Adejumo, K. L., Alliu, S., Akinjero, A., Onyeakusi, N. E., Ojelabi, O., & Bukong, T. N. (2018) · Liver International · doi:10.1111/liv.13696 · Cited by 47 · see citing works
Patsenker, E., Sachse, P., Chicca, A., Gachet, M. S., Schneider, V., Mattsson, J., Lanz, C., Worni, M., Gottardi, A. D., Semmo, M., et al. (2015) · International Journal of Molecular Sciences · doi:10.3390/ijms16047057 · Cited by 44 · see citing works
Larrain, S., & Rinella, M. E. (2012) · Clinics in Liver Disease · doi:10.1016/j.cld.2012.05.009 · Cited by 40 · see citing works
Ultra Low Dose Delta 9-Tetrahydrocannabinol Protects Mouse Liver from Ischemia Reperfusion Injury
Hochhauser, E., Lahat, E., Sultan, M., et al. (2015) · Cellular Physiology and Biochemistry · doi:10.1159/000430165 · Cited by 39 · see citing works
Therapeutic potential of cannabidiol against ischemia/reperfusion liver injury in rats
Fouad, A. A., & Jresat, I. (2011) · European Journal of Pharmacology · doi:10.1016/j.ejphar.2011.08.048 · Cited by 38 · see citing works
Endocannabinoids and liver disease – review
Gabbay, E., Avraham, Y., Ilan, Y., Israeli, E., & Berry, E. M. (2005) · Liver International · doi:10.1111/j.1478-3231.2005.01180.x · Cited by 38 · see citing works
Polysubstance abuse in liver transplant patients and its impact on survival outcome.
Nickels, M. W., Jain, A., Sharma, R. K., et al. (2007) · PubMed · Cited by 37 · see citing works
SPICE/K2 Synthetic Marijuana-Induced Toxic Hepatitis Treated with N-Acetylcysteine
Culpepper-Morgan, J. A. (2014) · American Journal of Case Reports · doi:10.12659/ajcr.891399 · Cited by 33 · see citing works
Gubatan, J. M. B., Staller, K. D., Barshop, K., & Kuo, B. (2016) · Digestive Diseases and Sciences · doi:10.1007/s10620-016-4090-9 · Cited by 30 · see citing works
Nordmann, S., Vilotitch, A., Roux, P., Esterle, L., Spire, B., Marcellin, F., Salmon, D., Dabis, F., Chas, J., Rey, D., et al. (2017) · Journal of Viral Hepatitis · doi:10.1111/jvh.12797 · Cited by 27 · see citing works
Cannabinoid modulation of perivascular sympathetic and sensory neurotransmission.
Ralevic, V., & Kendall, D. (2009) · Current Vascular Pharmacology · doi:10.2174/157016109787354114 · Cited by 24 · see citing works
Protective effect of cannabidiol against cadmium hepatotoxicity in rats
Fouad, A. A., Al-Mulhim, A. S., & Gomaa, W. M. (2013) · Journal of Trace Elements in Medicine and Biology · doi:10.1016/j.jtemb.2013.07.001 · Cited by 23 · see citing works
Severity and outcomes of acute alcoholic pancreatitis in cannabis users
Goyal, H., Guerreso, K., Smith, K. E. R., Harper, K., Patel, S. N., Patel, A. S., & Parikh, P. (2017) · Translational Gastroenterology and Hepatology · doi:10.21037/tgh.2017.06.03 · Cited by 22 · see citing works
Self-citationRecreational Drugs: a New Health Hazard for Patients with Concomitant Chronic Liver Diseases
Tarantino, G., Citro, V., & Finelli, C. (2014) · Journal of Gastrointestinal and Liver Diseases · doi:10.15403/jgld-1283 · Cited by 18 · see citing works
The endocannabinoid system in chronic liver disease
Zamora‐Valdés, D., Ponciano‐Rodríguez, G., Chávez-Tapia, N. C., & Méndez‐Sánchez, N. (2005) · Annals of Hepatology · doi:10.1016/s1665-2681(19)32047-2 · Cited by 17 · see citing works
Potential Role of CB2 Receptors in Cannabis Smokers With Chronic Hepatitis C *
Schwabe, R. F., & Siegmund, S. V. (2005) · Hepatology · doi:10.1002/hep.20895 · Cited by 15 · see citing works
The acute effect of cannabis on plasma, liver and brain ammonia dynamics, a translational study
Abulseoud, O. A., Zuccoli, M. L., Zhang, L., Barnes, A. J., Huestis, M. A., & Lin, D. (2017) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2017.03.006 · Cited by 14 · see citing works
Effect of (-)-∆9-tetrahydrocannabinoid on the hepatic redox state of mice
Pinto, C., Moura, E., Serrão, P., et al. (2010) · Brazilian Journal of Medical and Biological Research · doi:10.1590/s0100-879x2010007500015 · Cited by 9 · see citing works
Swarnalatha, G., Pai, S. G., Ram, R., & Dakshinamurty, K. (2013) · Indian Journal of Nephrology · doi:10.4103/0971-4065.116335 · Cited by 8 · see citing works
Endocannabinoids, CB1 Receptors, and Liver Disease: Hitting More Than One Bird With the Same Stone
Kunos, G., & Gao, B. (2008) · Gastroenterology · doi:10.1053/j.gastro.2007.12.017 · Cited by 8 · see citing works
Fielding, C. M., & Angulo, P. (2014) · Medical Principles and Practice · doi:10.1159/000360401 · Cited by 7 · see citing works
A case of reversible drug‐induced liver failure
Ansari, M. J. U., ARSHED, S. K., Islam, M. A., Sen, S., & Yousif, A. M. (2017) · Clinical Case Reports · doi:10.1002/ccr3.1030 · Cited by 7 · see citing works
Protopopescu, C., Santos, M. E. S. B., Sogni, P., et al. (2018) · Journal of Hepatology · doi:10.1016/s0168-8278(18)30501-4 · Cited by 5 · see citing works
Marcellin, F., Fontaine, H., Serfaty, L., Sogni, P., & Carrieri, P. (2018) · Expert Review of Anti-infective Therapy · doi:10.1080/14787210.2018.1473764 · Cited by 4 · see citing works
Self-medication of achalasia with cannabis, complicated by a cannabis use disorder
Luquiens, A. (2015) · World Journal of Gastroenterology · doi:10.3748/wjg.v21.i20.6381 · Cited by 3 · see citing works
High Hope for Medical Marijuana in Digestive Disorders
Isfort, R. W., & Gerich, M. E. (2016) · The American Journal of Gastroenterology · doi:10.1038/ajg.2016.3 · Cited by 2 · see citing works
Endocannabinoids and non-alcoholic steatohepatitis
Helmy, A. (2006) · Saudi Journal of Gastroenterology · doi:10.4103/1319-3767.27744 · Cited by 1 · see citing works
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Bell, A. D., MacCallum, C., Margolese, S., Walsh, Z., Wright, P., Daeninck, P. J., Mandarino, E., Lacasse, G., Kaur Deol, J., de Freitas, L., et al. (2024) · Cannabis & Cannabinoid Research · doi:10.1089/can.2021.0156 · Cited by 78 · see citing works
“127,128 Additional safety concerns The CBM use is typically not recommended for children and youth.”
BackgroundAndrews, C. N., Devlin, S. M., Le Foll, B., Fischer, B., Tse, F., Storr, M., & Congly, S. E. (2019) · Journal of the Canadian Association of Gastroenterology · doi:10.1093/jcag/gwy064 · Cited by 25 · see citing works
- Authors
- Goyal, H., Rahman, M. R., Perisetti, A., Shah, N., & Chhabra, R.
- Affiliations
- Mercer University (US)
- Texas Tech University (US)
- University of Arkansas for Medical Sciences (US)
- University of Louisville (US)
- Saint Luke's Hospital (US)
- Corresponding author
- Goyal, Hemant
- Venue
- European Journal of Gastroenterology & Hepatology
- Published
- 2018-11
- Volume
- 30
- Issue
- 11
- Pages
- 1283-1290
- ISSN
- 0954-691X (ISSN-L)
- OpenAlex
- W2888820089
- Cited by
- 33
- References
- 64
- Citations by year
- 2025: 1 · 2024: 3 · 2023: 2 · 2022: 6 · 2021: 6 · 2020: 8 · 2019: 5 · 2018: 2
- FWCI
- 0.61
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Journal of Gastroenterology & Hepatology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Cannabis and Cannabinoid Research
- Health Sciences › Medicine › Hepatology › Hepatitis C virus research
- Health Sciences › Medicine › Complementary and alternative medicine › Nigella sativa pharmacological applications
- Keywords
- cannabis, liver disease, endocannabinoid system, cannabidiol, tetrahydrocannabinol, hepatoprotection, anti-inflammatory activity, antioxidant activity, liver transplantation, cannabis use, recreational cannabis legalization, symptom management
- MeSH terms
- Animals, Cannabinoids, Marijuana Abuse, Humans, Liver, Liver Diseases, Marijuana Smoking, Prognosis, Risk Factors, Signal Transduction, Endocannabinoids, Medical Marijuana
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