CBD for older people: precautions and gaps in the studies

With age, people take more medicines, the organs that clear them sometimes slow down, and side effects are felt more. France's Haute Autorité de santé has devoted a programme to safer prescribing for older people. It points out that appropriate care avoids most medicine-related harm.

The only CBD-based medicine follows the same logic. Published by the European Medicines Agency, the summary of product characteristics for Epidyolex asks for careful dose selection in older patients, starting with the lowest dose. It gives as reasons the more frequent liver, kidney or heart impairment at that age, other illnesses and treatments taken at the same time.

The broadest synthesis is a 2021 meta-analysis in PLOS Medicine pooling 46 controlled trials of natural or synthetic cannabinoids in 6,216 adults, with an average age of 58.6. Four of these trials tested CBD alone, and in them the authors found no more adverse events than with placebo and no serious treatment-related adverse event.

The participants' age is the problem. Only four trials recruited people aged 65 and over, 68 participants with an average age of 72.4, and just one targeted people aged 75 and over. The authors acknowledge that tolerability could differ after 65 or 75.

The Epidyolex file shows the same gap. Its trials had too few patients over 55 to compare their response with that of younger ones. How the body handles CBD was not studied beyond age 74.

CBD slows down several of the enzymes that clear medicines. In healthy volunteers taking CBD at Epidyolex doses, the level of a metabolite of clobazam, an antiepileptic, rose 3 to 4 fold, and that of everolimus, an immunosuppressant, 2.5 fold. One published case reports a sharp rise in INR, the clotting marker, in a patient taking warfarin. These measurements are detailed in our article on the grapefruit effect of CBD.

These figures concern high doses, around 1,000 mg a day; nothing has been measured at the doses of products sold to the public. Hence the caveat from EFSA: when it set a provisional level of 2 mg a day for a 70 kg adult on 9 February 2026, it stated that safety is not established for people on medication. The UK Food Standards Agency advises them against CBD. Our article on how much CBD per day compares these benchmarks.

In the controlled trials of Epidyolex, drowsiness or sedation affected 29% of patients on CBD, mostly at the start of treatment. The rate reached 43% among those also taking clobazam. According to the product summary, alcohol and other nervous system depressants can strengthen this effect. In an older person, unusual drowsiness also brings a risk of falling.

The liver is the second point. CBD can raise liver enzymes (the transaminases), more so at higher doses. The same document reports, in a study outside epilepsy, two older patients whose markers rose and then returned to normal once CBD was stopped.

A CBD product can contain traces of THC, which is easy to forget. According to France's drug policy agency, MILDECA, they can pass into saliva and make a roadside test positive; our article on CBD and driving sets out the penalties.

The framework changed in 2026. On 20 May, the Ministry of Agriculture restated that foods containing CBD, supplements included, are not authorised and must be withdrawn from sale. What remains on sale, CBD cosmetics among them, is listed in our overview of CBD regulation in 2026. A cosmetic may claim no effect on a disease: MILDECA states that therapeutic claims are banned under criminal penalties. What a label must show is described in our guide to assessing a CBD cream or balm.

An illness is a matter for the medical route. France's medical cannabis experiment ended on 31 December 2024; according to the ANSM, a transition phase allows patients already enrolled to continue their treatment. Our article on medical cannabis in 2026 follows how the texts evolve, and our guide to choosing CBD explains how to read a lab report.

Before you talk to the pharmacist, write down all your medicines, including those taken without a prescription. Add the product you are considering with its CBD content, and any history of liver disease or falls.