The Curbsiders Internal Medicine Podcast #496 Hotcakes: Cannabidiol (CBD)-induced liver injury, IV iron for HFrEF, bedtime BP meds, Carpal Tunnel Syndrome & RA, & Finerenone for HFpEF
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Aug 25, 2025 Dive into the fascinating world of CBD and its potential liver risks. Discover the latest on IV iron treatments for heart failure and the timing of blood pressure medications. Learn about the surprising links between carpal tunnel syndrome and rheumatoid arthritis. Plus, catch the buzz on the FDA's approval of finerenone for heart failure, marking a significant step in management. This engaging discussion is packed with insights that can truly inform clinical practice!
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CBD Can Cause Liver Enzyme Elevations
- A randomized trial using FDA-approved CBD at ~2.5 mg/kg/day for 28 days caused more liver enzyme elevations than placebo.
- Even healthy adults with normal baseline labs showed liver injury signals, prompting clinicians to ask about CBD use.
Ask About CBD When Checking Liver Tests
- Ask patients directly about CBD use when reviewing supplements and liver tests.
- Consider checking liver enzymes for patients using intermediate-range CBD doses.
IV Iron Trial Was Neutral For Hard HF Outcomes
- The FAIR-HF2 trial found ferric carboxymaltose did not significantly reduce cardiovascular death or HF hospitalization.
- Subgroup heterogeneity and study limitations leave uncertainty about benefit in select iron-deficient HF patients.