Bhanga

Safety, contraindications and cautions

Compiled from published regulatory and institutional sources, listed against each statement. This is a reference summary, not advice about your own use. Ayurvedic preparations are dispensed by qualified practitioners, and anyone taking prescribed medication should raise an interaction with the prescriber rather than act on a page.

Contraindications

• Major Populations untested for this preparation: pregnancy, breastfeeding, and organ dysfunction — The only clinical study of a named Bhanga preparation excluded these groups from the outset, so its safety observations say nothing about them. Verbatim exclusion criteria: 'Patients suffering from systemic diseases such as uncontrolled hypertension/diabetes, cardiac/pulmonary/hepatic or renal dysfunctions, HIV/VDRL, pregnant or breast-feeding women, patients with inability to comprehend and complete proposed course of intervention were excluded.' Inclusion was limited to patients 'between age 18 to 70 years' with clinically diagnosed cancer, so no age group outside 18-70 was studied either. The trial also states: 'Precautions had been taken while prescribing TD for Pitta predominant Prakriti (constitution) patients and those who were reported to have chronic addiction(s) of any form.' This entry records untested populations and the trial's own precautions; it is not a contraindication that the trial itself states. For pregnancy and breastfeeding the separate class-level FDA and LactMed entries below give the positive advice to avoid.Tavhare SD, Acharya R, Reddy RG, Dhiman KS. Management of chronic pain with Jalaprakshalana (water-wash) Shodhita (processed) Bhanga (Cannabis sativa L.) in cancer patients with deprived quality of life: An open-label single arm clinical trial. Ayu. 2019 Jan-Mar;40(1):34-43. PMCID PMC6891996, PMID 31831967, doi:10.4103/ayu.AYU_43_19
• Major Unprocessed (Ashodhita) Bhanga, and excessive use — The trial report states: 'If used in Ashodhita (Unprocessed) form, may cause Madakari (Intoxicant) effects hence, Ayurveda classics have advised Shodhana (Purifying process) of Bhanga before its therapeutic use.' The Sodhana review's Bhanga entry states: 'Its excessive use causes dyspepsia, cough, impotence, melancholy, dropsy, restlessness, and insanity.' Both are classical and ethnopharmacological attributions carried by the two sources; neither source reports chemical, animal or clinical data behind them, and neither quantifies what counts as excessive use. The review also shows that Bhanga is not one standardised product: it names Shodhana methods different from the water-wash used in the trial, namely that Bhanga 'is boiled with Babbula Tvak kvatha for 3 h and the powder obtained is triturated with Godugdha' and that toxic effects 'can also be reduced by triturating with Babbula Tvak kvatha and frying the powder obtained in Cow Ghee'. No source located reports how much cannabinoid any of these methods removes, so no claim of detoxification is made here.Tavhare SD, Acharya R, Reddy RG, Dhiman KS. Management of chronic pain with Jalaprakshalana (water-wash) Shodhita (processed) Bhanga (Cannabis sativa L.) in cancer patients with deprived quality of life: An open-label single arm clinical trial. Ayu. 2019 Jan-Mar;40(1):34-43. PMCID PMC6891996, PMID 31831967, doi:10.4103/ayu.AYU_43_19Maurya SK, Seth A, Laloo D, et al. Sodhana: An Ayurvedic process for detoxification and modification of therapeutic activities of poisonous medicinal plants. Anc Sci Life. 2015 Apr-Jun;34(4):188-197. PMCID PMC4535066, doi:10.4103/0257-7941.160862
• Do not useclass-level Pregnancy — FDA states: 'FDA strongly advises against the use of cannabidiol (CBD), tetrahydrocannabinol (THC), and marijuana in any form during pregnancy or while breastfeeding.' FDA also states the limitation that 'There is no comprehensive research studying the effects of CBD on the developing fetus, pregnant mother, or breastfed baby.'; absence of documented harm from a given exposure is therefore not evidence of safety.What You Should Know About Using Cannabis, Including CBD, When Pregnant or Breastfeeding, FDA Consumer Update
• Do not useclass-level Breastfeeding — FDA advises against use while breastfeeding and states that 'breastmilk can contain THC for up to six days after use.' LactMed gives a longer range from the published literature: 'The duration of detection of THC in milk has ranged from 6 days to greater than 6 weeks in various studies.' LactMed records that 'In general, professional guidelines recommend that cannabis use should be avoided by nursing mothers, and nursing mothers should be informed of possible adverse effects on infant development from exposure to cannabis compounds in breastmilk.' LactMed also states the countervailing context that 'Because of insufficient long-term data on the outcome of infants exposed to cannabis via breastmilk, health professionals' opinions on the acceptability of breastfeeding by cannabis-using mothers varies.'What You Should Know About Using Cannabis, Including CBD, When Pregnant or Breastfeeding, FDA Consumer UpdateCannabis, Drugs and Lactation Database (LactMed), NCBI Bookshelf NBK501587, record updated 2026 Aug 15
• Do not useclass-level Psychiatric illness or predisposition to psychosis — MSK's professional Contraindications section states: 'Cannabis products should not be used by patients with psychiatric, cardiovascular, renal, or hepatic illnesses'. MSK's patient-facing warning repeats it: 'Don't take cannabis products if: ... You have psychiatric illnesses that affect mood, thinking, and behavior. Cannabis may make these conditions worse.' NCCIH states: 'The use of cannabis, especially frequent use, has been linked to a higher risk of developing schizophrenia or other psychoses (severe mental illnesses) in people who are predisposed to these illnesses.'Cannabis, Memorial Sloan Kettering About HerbsCannabis (Marijuana) and Cannabinoids: What You Need To Know, NCCIH
• Do not useclass-level Liver disease or hepatic impairment — MSK's professional Contraindications section names hepatic illness: 'Cannabis products should not be used by patients with psychiatric, cardiovascular, renal, or hepatic illnesses'. MSK's patient-facing warning: 'You have kidney, heart, or liver disease. Cannabis may make these worse.' A substance-specific hepatic hazard stands alongside this rather than being folded into a general organ-disease entry: NCCIH states 'CBD use has been associated with liver injury, male reproductive harm, and interactions with other drugs', and that 'diarrhea, sleepiness, abnormalities on tests of liver function, and drug interactions, appear to be due to CBD itself rather than contaminants in CBD products; these effects were observed in some of the people who participated in studies of Epidiolex before its approval as a drug'. FDA likewise lists, among risks of CBD 'Based on clinical studies in humans', 'liver toxicity (damage)'. Those hepatic findings are about CBD, so they bear on cannabis products in which CBD is present; no cited source reports a hepatic finding for the Bhanga preparation, and the only clinical study of that preparation reports no laboratory results. No source cited here states a contraindication to concurrent hepatotoxic drugs, and none is asserted.Cannabis, Memorial Sloan Kettering About HerbsCannabis (Marijuana) and Cannabinoids: What You Need To Know, NCCIHWhat You Should Know About Using Cannabis, Including CBD, When Pregnant or Breastfeeding, FDA Consumer Update
• Do not useclass-level Heart disease and cardiovascular illness — MSK's professional Contraindications section names cardiovascular illness: 'Cannabis products should not be used by patients with psychiatric, cardiovascular, renal, or hepatic illnesses'. MSK's patient-facing warning: 'You have kidney, heart, or liver disease. Cannabis may make these worse.' MSK's Adverse Reactions section additionally records, with no route restriction, that 'Cannabis use has been associated with increased risk of rare, but life-threatening cardiac dysrhythmia ... as well as both acute coronary syndrome and chronic cardiovascular disease'. See the cardiac adverse-effect entry below for MSK's separate inhalation-attributed list and for why this warning is not narrowed to inhalation.Cannabis, Memorial Sloan Kettering About Herbs
• Do not useclass-level Kidney disease and renal illness — MSK's professional Contraindications section names renal illness: 'Cannabis products should not be used by patients with psychiatric, cardiovascular, renal, or hepatic illnesses'. MSK's patient-facing warning: 'You have kidney, heart, or liver disease. Cannabis may make these worse.'Cannabis, Memorial Sloan Kettering About Herbs
• Do not useclass-level Children, including accidental ingestion of an oral preparation stored in the home — This is the hazard matched to the route by which Bhanga is taken. NCCIH states: 'There have been many reports of unintentional consumption of cannabis or its products by children, leading to illnesses severe enough to require emergency room treatment or admission to a hospital. Among a group of people who became ill after accidental exposure to candies containing THC, the children generally had more severe symptoms than the adults and needed to stay in the hospital longer.' NCCIH gives no number of cases and does not name the products involved. MSK's separate paediatric warning concerns a drug interaction rather than accidental exposure: 'Don't give cannabis products to children with epilepsy who are on clobazam (Onfi). Cannabis can increase its side effects'. The only clinical study of the Bhanga preparation enrolled adults aged 18 to 70 only, so it provides no paediatric safety data of any kind.Cannabis (Marijuana) and Cannabinoids: What You Need To Know, NCCIHCannabis, Memorial Sloan Kettering About HerbsTavhare SD, Acharya R, Reddy RG, Dhiman KS. Management of chronic pain with Jalaprakshalana (water-wash) Shodhita (processed) Bhanga (Cannabis sativa L.) in cancer patients with deprived quality of life: An open-label single arm clinical trial. Ayu. 2019 Jan-Mar;40(1):34-43. PMCID PMC6891996, PMID 31831967, doi:10.4103/ayu.AYU_43_19
• Majorclass-level Adolescent use and use during brain development — NCCIH states: 'Adolescents using cannabis are four to seven times more likely than adults to develop cannabis use disorder.' MSK states: 'Long-term cannabis use was shown to be detrimental to functional connectivity in the developing brain'. MSK gives no definition of long-term use with this statement.Cannabis (Marijuana) and Cannabinoids: What You Need To Know, NCCIHCannabis, Memorial Sloan Kettering About Herbs
• Majorclass-level Older adults — NCCIH states: 'Cannabis use is associated with an increased risk of injury among older adults.' NCCIH gives no effect size, no age threshold and no injury type with this statement. Read alongside NCCIH's orthostatic hypotension statement and MSK's drowsiness, loss of balance and confusion, this is a fall and injury hazard.Cannabis (Marijuana) and Cannabinoids: What You Need To Know, NCCIHCannabis, Memorial Sloan Kettering About Herbs
• Majorclass-level Driving or operating machinery — NCCIH states: 'The use of cannabis has been linked to an increased risk of motor vehicle crashes.' MSK's professional short-term adverse effects include drowsiness, somnolence, disorientation, confusion and loss of balance, and MSK's patient-facing side-effect list includes drowsiness, trouble focusing and hallucinations.Cannabis (Marijuana) and Cannabinoids: What You Need To Know, NCCIHCannabis, Memorial Sloan Kettering About Herbs
• Majorclass-level Perioperative period, including elective surgery — MSK's Adverse Reactions section states: 'Perioperative morbidity: A large retrospective analysis found cannabis abuse to be associated with increased perioperative morbidity among elective spine surgery patients'. MSK's exposure term is 'cannabis abuse', the study is retrospective and the surgical population is elective spine surgery specifically; MSK reports no sample size, no effect size and no adjustment, and does not extend the finding to other operations. It is carried here because a surgical hazard cannot be raised by a cited source and then dropped, not because it has been shown for other surgery.Cannabis, Memorial Sloan Kettering About Herbs

Interactions with medicines

• Major Warfarin and other anticoagulants — MSK: 'Warfarin: THC and CBD both elevate international normalized ratio (INR) levels'. MSK's patient-facing warning places it on a do-not-take footing: do not take cannabis products if 'You're taking warfarin (Jantoven or Coumadin) or other blood thinners. Cannabis can increase your risk of bleeding.' Severity basis, stated here so the grading can be checked: every interaction that MSK itself places in its patient-facing 'Don't take cannabis products if' list is graded major in this record.Cannabis, Memorial Sloan Kettering About Herbs
• Major Sedatives and hypnotics, including lorazepam, diazepam and zolpidem — MSK: 'Sedatives or hypnotics: Sedation and significant pharmacodynamic interactions when taken with cannabis via potentiation of central effects'. MSK's patient-facing do-not-take list names lorazepam (Ativan), diazepam (Valium) and zolpidem (Ambien): 'Taking these medications and cannabis can increase drowsiness.' Severity basis: MSK's do-not-take list.Cannabis, Memorial Sloan Kettering About Herbs
• Major Nivolumab and related immune checkpoint inhibitors — MSK: 'Immunotherapy (nivolumab): Combined use with cannabis was associated with a reduction in treatment response rates in patients with advanced melanoma, non-small-cell lung cancer, and renal clear cell carcinoma (observational study)'. MSK reports elsewhere on the same page that in that study 'Progression-free survival and overall survival remained unaffected', which is carried here so the finding is not overstated. MSK's patient-facing do-not-take list: 'You're taking nivolumab (Opdivo). Cannabis can lower the response to this medication in patients with advanced melanoma, non-small-cell lung cancer, and renal clear cell carcinoma.' The named cancers describe the populations studied; no therapeutic role for cannabis in any of them is stated or implied by this record. Severity basis: MSK's do-not-take list.Cannabis, Memorial Sloan Kettering About Herbs
• Major Fluoxetine — MSK: 'Fluoxetine: Case reports of mania resulting from co-administration of cannabis'. MSK's patient-facing do-not-take list pairs fluoxetine with disulfiram: 'You're taking fluoxetine (Prozac) or disulfiram (Antabuse). Taking cannabis with these medications can cause confusion, elevated mood, inflated self-esteem, decreased need for sleep, racing thoughts, and trouble focusing.' MSK separately documents, in its Adverse Reactions section, 'Serotonin syndrome: In a male, with a diagnosis of bipolar disorder managed with fluoxetine, melatonin, and lithium, following use of THC vape pen'; that case involved three concurrent psychotropic drugs and a THC vape pen, so cannabis is one of several exposures and the route was inhalation. Severity basis: MSK's do-not-take list, reinforced by that serotonin syndrome case.Cannabis, Memorial Sloan Kettering About Herbs
• Major Disulfiram — MSK: 'Disulfiram: Delirium and hypomania resulting from co-administration with cannabis'. MSK's patient-facing do-not-take list: 'You're taking fluoxetine (Prozac) or disulfiram (Antabuse). Taking cannabis with these medications can cause confusion, elevated mood, inflated self-esteem, decreased need for sleep, racing thoughts, and trouble focusing.' Severity basis: MSK's do-not-take list.Cannabis, Memorial Sloan Kettering About Herbs
• Major Clobazam, particularly in children with epilepsy — MSK: 'Clobazam: CBD increased clobazam levels in epileptic children'. MSK's patient-facing do-not-take instruction: 'Don't give cannabis products to children with epilepsy who are on clobazam (Onfi). Cannabis can increase its side effects'. Severity basis: MSK's do-not-take instruction. MSK attributes the level rise to CBD.Cannabis, Memorial Sloan Kettering About Herbs
• Major Amphetamines, cocaine, atropine and other sympathomimetic agents — MSK: 'Amphetamines, cocaine, atropine and sympathomimetic agents: Cardiotoxicity may occur with cannabis via additive hypertension and tachycardia'. MSK's patient-facing do-not-take list names them individually and adds pseudoephedrine, epinephrine and dobutamine: 'You're on amphetamines (Adzenys XR-ODT, Evekeo ODT). Heart damage may occur with cannabis'; 'You're taking atropine (Atropen). Taking this medication and cannabis can cause heart damage.'; 'You're on cocaine. Heart damage may occur with cannabis'; 'You're taking pseudoephedrine (such as Sudafed), epinephrine (such as Auvi-Q) or the prescription drug dobutamine (Dobutamine). Taking these medications and cannabis can cause heart damage.' Severity basis: MSK's do-not-take list.Cannabis, Memorial Sloan Kettering About Herbs
• Major Cyclosporine and mycophenolate mofetil in transplant recipients — MSK: 'Cyclosporine and mycophenolate mofetil: In a patient with end-stage kidney disease with a kidney transplantation, after adding CBD for pain. A drop in the levels of cyclosporine and mycophenolate mofetil levels was observed, thought to be via induction of CYP 3A4 and inhibition of hepatic esterase'. MSK adds: 'CBD was later discontinued.' Severity basis, and the reason this departs from the do-not-take rule used above: MSK does not list this in its patient-facing do-not-take list, but a fall in transplant immunosuppressant levels carries graft-rejection risk, so it is graded major on the clinical consequence. The limitations are that this is a single patient, that MSK attributes the exposure to CBD rather than to whole cannabis, that the mechanism is given as a supposition ('thought to be'), and that MSK reports no clinical outcome for the graft.Cannabis, Memorial Sloan Kettering About Herbs
• Moderate Buprenorphine — MSK: 'Buprenorphine: A retrospective study found that cannabis use decreased the formation of norbuprenorphine and elevated buprenorphine and norbuprenorphine levels in liver healthy individuals on opioid maintenance therapy substituted with buprenorphine. This interaction may lead to increased or altered opioid activity and risk of intoxication'. Severity basis: not in MSK's do-not-take list; a retrospective pharmacokinetic finding in liver-healthy individuals, with the clinical consequence stated by MSK as a possibility ('may lead to').Cannabis, Memorial Sloan Kettering About Herbs
• Moderate Citalopram and escitalopram — MSK: 'Citalopram/Escitalopram: CBD significantly elevated citalopram plasma concentrations in patients taking citalopram or escitalopram. But it is unclear whether this also increased SSRI-mediated adverse effects'. Severity basis: not in MSK's do-not-take list, and MSK itself states the clinical consequence is unclear.Cannabis, Memorial Sloan Kettering About Herbs
• Moderate Oxazepam and other UGT-glucuronidated drugs — MSK: 'Oxazepam: A study done in human microsomes found a strong inhibitory effect of major cannabinoids on the UGT-mediated glucuronidation of R,S-oxazepam metabolism'. MSK adds: 'Clinical relevance has yet to be determined.' Severity basis: not in MSK's do-not-take list; a human-microsome in vitro finding with clinical relevance undetermined by MSK's own statement, so no clinical magnitude is asserted here. It is carried rather than dropped because oxazepam is also a sedative, and MSK grades sedatives and hypnotics as do-not-take on a separate pharmacodynamic basis.Cannabis, Memorial Sloan Kettering About Herbs
• Moderate P-glycoprotein substrates — MSK: 'P-glycoprotein substrates: CBD inhibits P-glycoprotein and may influence metabolism of certain drugs'. MSK adds: 'Clinical relevance is not known.' Severity basis: not in MSK's do-not-take list, and MSK states the clinical relevance is not known; no magnitude is asserted here, and MSK names no specific substrate drug.Cannabis, Memorial Sloan Kettering About Herbs
• Moderate CYP2C19 and CYP2C9 substrates — MSK: 'Cytochrome P450 substrates: In vitro, CBD strongly inhibits CYP2C19 and CYP2C9. Clinical relevance is not known.' This is an in vitro finding for CBD; MSK states the clinical magnitude is not established, and this record does not assert one. Severity basis: not in MSK's do-not-take list; in vitro only.Cannabis, Memorial Sloan Kettering About Herbs
• Moderate CYP1A2 substrates — MSK: 'Cytochrome P450 substrates: Smoking cannabis induces CYP1A2, with additive effects when smoked together with tobacco, and can affect the intracellular concentration of drugs metabolized by this enzyme'. MSK attributes this induction to smoking; it does not report it for oral cannabis, and this record does not extend it to the oral route by which Bhanga is taken. Severity basis: not in MSK's do-not-take list, and route-limited by MSK's own wording.Cannabis, Memorial Sloan Kettering About Herbs

Reported adverse effects

• Adverse events reported in the only clinical study of the Bhanga preparation (1 of 37 enrolled patients (one reported burning sensation and was dropped from the trial); the article otherwise states no adverse drug reactions were noted among the 24 completers over 4 weeks) — The trial's own reporting is internally inconsistent and both parts are carried. Its adverse-reaction section states: 'No ADR were noted during the trial period. No withdrawal symptoms were noted after completion of trial.' The same paragraph then states: 'Patients (n=1) who reported burning sensation after TD administration were dropped out from trial.' The abstract's conclusion is that the preparation at that dose 'does not cause any major adverse effect and withdrawal symptoms during trial period'. Its earlier account of the dropouts gives different reasons and does not mention the burning sensation: 'Total 37 (100%) patients were enrolled in trial out of which 24 (64.86%) have completed treatment while 13 (35.14%) patients dropped out due to reasons such as conventional therapy settings and inconvenience in long distance travelling to reach trial center.' What this can and cannot support: an absence of recorded adverse drug reactions in 24 people who completed 4 weeks of an open-label, uncontrolled, single-centre trial is a very small negative. It cannot exclude uncommon harms, harms beyond 4 weeks, harms in the excluded groups, or harms in the 13 patients who did not complete. Pre- and post-treatment blood, urine, biochemistry and ECG investigations are described in the methods as done 'to check the safety aspects after 1 month of administration of trial drug', but no laboratory or ECG result is reported anywhere in the article, so this record cannot report that organ-function testing was normal.Tavhare SD, Acharya R, Reddy RG, Dhiman KS. Management of chronic pain with Jalaprakshalana (water-wash) Shodhita (processed) Bhanga (Cannabis sativa L.) in cancer patients with deprived quality of life: An open-label single arm clinical trial. Ayu. 2019 Jan-Mar;40(1):34-43. PMCID PMC6891996, PMID 31831967, doi:10.4103/ayu.AYU_43_19
• Short-term effects (No frequency, incidence or denominator is stated by MSK for any item in either list) — MSK's professional Adverse Reactions section: 'Short-term adverse effects following use of medical cannabinoids include dizziness, dry mouth, nausea, fatigue, somnolence, euphoria, vomiting, disorientation, drowsiness, confusion, loss of balance, and hallucination'. MSK's separate patient-facing section, 'What are the side effects?', gives an overlapping but not identical list: 'Drowsiness ... Restlessness ... Anxiety (strong feelings of worry or fear); Paranoia (intense thoughts or feelings that someone might try to harm you); Hallucinations ... Feeling hungry; Short-term memory loss; Euphoria ...; Trouble focusing; Changes in your blood pressure; Faster heart rate; Confusion; Nausea ...; Vomiting ...; Flushing ...; Depression ...; Insomnia'. Setting the two lists side by side: drowsiness, hallucinations, euphoria, confusion, nausea and vomiting appear in both; restlessness, anxiety, paranoia, feeling hungry, short-term memory loss, trouble focusing, changes in blood pressure, faster heart rate, flushing, depression and insomnia appear only in the patient-facing list; dizziness, dry mouth, fatigue, somnolence, disorientation and loss of balance appear only in the professional list. MSK does not label the patient-facing list as acute-use effects, and this record does not characterise it as one; MSK's heading is simply 'Side effects of taking cannabis products may include'. Anxiety also appears separately in MSK's withdrawal syndrome entry below.Cannabis, Memorial Sloan Kettering About Herbs
• Addiction and cannabis use disorder (NCCIH: adolescents are four to seven times more likely than adults to develop cannabis use disorder; no absolute incidence is given by either source, and MSK lists 'Risk of addiction' with no frequency) — NCCIH: 'Some people who use cannabis develop cannabis use disorder, which has symptoms such as craving, withdrawal, lack of control, and negative effects on personal and professional responsibilities. Adolescents using cannabis are four to seven times more likely than adults to develop cannabis use disorder.' MSK's Adverse Reactions list includes 'Risk of addiction'. MSK's clinical summary adds that non-medical use is associated with 'high risk of addiction, especially when used from an early age' and with 'dependence'. The Bhanga trial reported no withdrawal symptoms after 4 weeks in 24 completers; that is a 4-week observation in a small uncontrolled sample and is not evidence that the preparation does not cause dependence with longer use.Cannabis (Marijuana) and Cannabinoids: What You Need To Know, NCCIHCannabis, Memorial Sloan Kettering About HerbsTavhare SD, Acharya R, Reddy RG, Dhiman KS. Management of chronic pain with Jalaprakshalana (water-wash) Shodhita (processed) Bhanga (Cannabis sativa L.) in cancer patients with deprived quality of life: An open-label single arm clinical trial. Ayu. 2019 Jan-Mar;40(1):34-43. PMCID PMC6891996, PMID 31831967, doi:10.4103/ayu.AYU_43_19
• Withdrawal syndrome and psychotic episodes upon cessation (No frequency stated by the source) — MSK: 'Withdrawal syndrome (irritability, sleeping difficulties, dysphoria, craving, and anxiety) and psychotic episodes upon cessation.' MSK attributes the psychotic episodes to cessation, not to ongoing use. MSK's clinical summary adds that withdrawal 'makes cessation tough, eventually leading to relapse'.Cannabis, Memorial Sloan Kettering About Herbs
• Serotonin syndrome (One case, reported by MSK) — MSK: 'Serotonin syndrome: In a male, with a diagnosis of bipolar disorder managed with fluoxetine, melatonin, and lithium, following use of THC vape pen'. Limitations carried with it: a single case, in a patient on three concurrent psychotropic drugs, with the cannabis exposure by THC vape pen rather than by ingestion. MSK gives no age, no dose and no outcome.Cannabis, Memorial Sloan Kettering About Herbs
• Catatonia requiring electroconvulsive therapy (No frequency stated by the source; MSK cites three references for this item) — MSK: 'Catatonia: Associated with cannabis use necessitating electroconvulsive therapy (ECT)'.Cannabis, Memorial Sloan Kettering About Herbs
• Acute toxic hippocampal encephalopathy (One case, reported by MSK) — MSK: 'Acute toxic hippocampal encephalopathy: In a male, associated with cannabis use'. MSK gives no age, no dose, no route and no outcome, and states the relationship as an association in one case.Cannabis, Memorial Sloan Kettering About Herbs
• Cardiac and cerebrovascular events: myocardial infarction, sudden cardiac death, cardiomyopathy, stroke, transient ischemic attack, cannabis arteritis, life-threatening dysrhythmia, acute coronary syndrome and chronic cardiovascular disease (MSK describes the dysrhythmia as 'rare, but life-threatening'; no incidence figure is given for any item) — MSK states two things separately. Route-attributed: 'Inhalation is associated with myocardial infarction, sudden cardiac death, cardiomyopathy, stroke, transient ischemic attack, and cannabis arteritis'. Not route-attributed: 'Cannabis use has been associated with increased risk of rare, but life-threatening cardiac dysrhythmia ... as well as both acute coronary syndrome and chronic cardiovascular disease'. MSK reports no comparison of routes and no finding that oral use is free of the inhalation-associated events, so the inhalation attribution is recorded as the source's wording and is not used to narrow the cardiac warning. The Bhanga preparation is given orally in capsules, and the cardiac contraindication above applies to that route.Cannabis, Memorial Sloan Kettering About HerbsTavhare SD, Acharya R, Reddy RG, Dhiman KS. Management of chronic pain with Jalaprakshalana (water-wash) Shodhita (processed) Bhanga (Cannabis sativa L.) in cancer patients with deprived quality of life: An open-label single arm clinical trial. Ayu. 2019 Jan-Mar;40(1):34-43. PMCID PMC6891996, PMID 31831967, doi:10.4103/ayu.AYU_43_19
• Non-ischaemic cardiomyopathy with cardioembolism, radial artery thrombosis and gangrene requiring amputation (One case, reported by MSK) — MSK, quoted in full: 'Non-ischaemic cardiomyopathy and cardioembolism: In a recreational cannabis + tobacco smoker. He also developed gangrene in his left forearm as a result of left radial artery thrombosis. The patient was managed in the line of decompensated heart failure, with the right-hand gangrene requiring amputation'. Two limitations are carried. The patient was a cannabis and tobacco smoker, so the exposure is confounded by tobacco and the route was inhalation. MSK's own text is internally inconsistent about which limb was affected, naming the left forearm and left radial artery and then the right hand as the site requiring amputation; the wording is reproduced as written and is not reconciled here.Cannabis, Memorial Sloan Kettering About Herbs
• Cannabis hyperemesis syndrome, and recurrent severe vomiting (MSK: cyclic attacks of nausea and vomiting in chronic cannabinoid users, attributed to two deaths) — MSK: 'Cannabis hyperemesis syndrome (CHS), characterized by cyclic attacks of nausea and vomiting in chronic cannabinoid users, has been attributed to two deaths. In another case series, four patients were reported to experience relief from CHS following administration of benzodiazepines.' The second sentence is MSK's own follow-on and is carried so the entry is not truncated; it concerns management of the syndrome and is not an efficacy statement about cannabis. NCCIH does not name the syndrome; it states separately: 'Some long-term users of high doses of cannabis have developed a condition involving recurrent severe vomiting.' NCCIH does not define high dose or long-term.Cannabis, Memorial Sloan Kettering About HerbsCannabis (Marijuana) and Cannabinoids: What You Need To Know, NCCIH
• Chronic bronchitis in regular users, and pneumothorax (No frequency stated by the source; MSK's bronchitis item is a comparison of regular users with non-users) — MSK: 'Chronic bronchitis in regular users of cannabis products compared to non-users'; 'Pneumothorax: Associated with cannabis use'. MSK does not state a route for either item. Both are respiratory events that in practice attach to smoked use, but MSK does not say so and this record does not add a route attribution the source does not make.Cannabis, Memorial Sloan Kettering About Herbs
• Memory effects and effects on the developing brain (No frequency stated by the source) — MSK's patient-facing side-effect list includes 'Short-term memory loss', MSK states 'Cannabis use was also reported to elevate the risk of creating false memories', and 'Long-term cannabis use was shown to be detrimental to functional connectivity in the developing brain'. MSK's statements about cognitive impairment, psychosis and suicidal ideation belong to SYNTHETIC cannabinoid drugs, which MSK says 'cause more serious adverse effects compared to natural cannabis'; those must not be carried to Cannabis sativa herb, and are not carried here.Cannabis, Memorial Sloan Kettering About Herbs
• Orthostatic hypotension with risk of fainting and falls (No frequency stated by the source) — NCCIH: 'Marijuana may cause orthostatic hypotension (head rush or dizziness on standing up), possibly raising danger from fainting and falls.'Cannabis (Marijuana) and Cannabinoids: What You Need To Know, NCCIH
• CBD-specific effects: decreased alertness, mood changes, decreased appetite, diarrhoea, liver injury, extreme sleepiness and male reproductive harm (No frequency stated by either source; NCCIH states the liver-function and related effects 'were observed in some of the people who participated in studies of Epidiolex before its approval as a drug') — NCCIH: 'CBD may have side effects, including decreases in alertness, changes in mood, decreased appetite, and gastrointestinal symptoms such as diarrhea. CBD may also produce psychotic effects or cognitive impairment in people who also regularly use THC. In addition, CBD use has been associated with liver injury, male reproductive harm, and interactions with other drugs.' NCCIH adds that 'Some side effects, such as diarrhea, sleepiness, abnormalities on tests of liver function, and drug interactions, appear to be due to CBD itself rather than contaminants in CBD products; these effects were observed in some of the people who participated in studies of Epidiolex before its approval as a drug'. FDA lists, 'Based on clinical studies in humans', risks that 'can include the following: liver toxicity (damage), extreme sleepiness, harmful interactions with other drugs'. These are findings about CBD; no cited source reports the cannabidiol content of the Bhanga preparation, and this record does not estimate one.Cannabis (Marijuana) and Cannabinoids: What You Need To Know, NCCIHWhat You Should Know About Using Cannabis, Including CBD, When Pregnant or Breastfeeding, FDA Consumer Update
• Product contamination and label inaccuracy (No frequency or proportion of products is stated by either source) — NCCIH: 'There have been reports of contamination of cannabis/cannabinoid products with microorganisms, pesticides, or other substances.' NCCIH separately: 'Some cannabis/cannabinoid products contain amounts of cannabinoids that differ substantially from what's stated on their labels.' NCCIH on CBD specifically: 'over-the-counter CBD products may contain more or less CBD than stated on their labels, and because of less rigorous regulatory oversight than prescription drugs, they may also contain contaminants, such as THC.' FDA: 'We have also heard reports of CBD potentially containing other contaminants (e.g., pesticides, heavy metals, bacteria, and fungus); we are investigating this.' FDA's wording is that it has heard reports and is investigating, not that contamination has been confirmed at any rate. No cited source reports an elemental or microbiological analysis of the Bhanga preparation, and none is claimed here. LactMed adds, for street sources, 'the possibility of other harmful contaminants in street drugs'.Cannabis (Marijuana) and Cannabinoids: What You Need To Know, NCCIHWhat You Should Know About Using Cannabis, Including CBD, When Pregnant or Breastfeeding, FDA Consumer UpdateCannabis, Drugs and Lactation Database (LactMed), NCBI Bookshelf NBK501587, record updated 2026 Aug 15
• Serious lung injury linked to THC-containing vaping products (NCCIH: 'many of the reported cases'; no number is given) — NCCIH: 'The FDA has warned the public not to use vaping products that contain THC. Products of this type have been implicated in many of the reported cases of serious lung injuries linked to vaping.' Carried for completeness because it appears in the safety list this record draws from, and marked route-specific: it concerns vaping products, not an ingested leaf powder, and is not evidence about oral Bhanga.Cannabis (Marijuana) and Cannabinoids: What You Need To Know, NCCIH
• Effects in the breastfed infant (One matched cohort of 68 exposed and 68 control infants, plus individual case reports; no incidence rate is given) — These are separate bodies of evidence, not one study. Cohort: 68 infants whose mothers reported smoking marijuana during breastfeeding were compared with 68 matched control infants; the duration of breastfeeding varied, but the majority were breastfed for 3 months and received less than 16 fluid ounces of formula daily. LactMed's finding in full: 'Motor development of the marijuana-exposed infants was slightly reduced in a dose-dependent (i.e., number of reported joints per week) manner at 1 year of age, especially among those who reported smoking marijuana on more than 15 days per month during the first month of lactation. No effect was found on mental development.' The dose metric is reported joints per week and the heavier-use subgroup is defined by the first month of lactation. A smaller earlier study is carried alongside it so the cohort is not presented alone: of 27 mothers who reported smoking marijuana during breastfeeding, six of their infants were compared at 1 year with infants of mothers who did not smoke during pregnancy or breastfeeding, and 'No differences were found in growth, or on mental and motor development.' Case reports: 'A 6-month-old infant was exclusively breastfed by a mother who was a chronic cannabis user. She presented to the emergency department with somnolence after falling off a couch and developing seizure-like activity and minimally responsive dilated pupils. Laboratory values and a head CT scan were normal except for carboxy-THC found in urine and blood. The infant returned to baseline in 72 hours.' A 9-month-old girl was hospitalised for a first tonic-clonic seizure with THC and metabolites in her blood, her mother having smoked about 5 cannabis resin joints daily since the child was 4 months old, sometimes just before breastfeeding; LactMed's own caveat is carried: 'The infant's symptoms were probably caused by cannabis, but direct exposure to cannabis smoke and diazepam and tobacco use could have contributed.' Route-matched to an ingested preparation: 'The infant of a woman who used cannabis edibles for anxiety during pregnancy and during breastfeeding had several episodes of apnea. At 1 week of age while undergoing treatment for a urinary tract infection, the infant required intubation because of apneic episodes. At 5 weeks of age, the mother noticed the infant was having irregular breathing and apneic episodes and took the infant to the hospital. There the infant was having more apneic episodes and had urine positive for THC, although the mother reported not using cannabis for the prior 3 days.' That infant was also exposed in utero and was being treated for infection, so the exposure is not isolated.Cannabis, Drugs and Lactation Database (LactMed), NCBI Bookshelf NBK501587, record updated 2026 Aug 15
• Possible increased risk of autism spectrum disorder after postnatal cannabis use (A large registry study in Australia and New Zealand; LactMed gives no sample size and no effect size) — LactMed, with its caveat attached in the same breath: 'A large registry study in Australia and New Zealand suggested that postnatal use of cannabis may increase the risk of autism spectrum disorder, with male infants affected to a greater extent than female infants. However, no information on the breastfeeding status of the mothers was presented.' Because breastfeeding status was not reported, this study does not establish that the exposure route was breastmilk. It is carried, with that caveat, rather than dropped.Cannabis, Drugs and Lactation Database (LactMed), NCBI Bookshelf NBK501587, record updated 2026 Aug 15
• Changes in breastmilk composition and milk supply (One preliminary study of secretory IgA in 14 women, two studies of milk lipid content, and survey data on breastfeeding duration) — LactMed's summary: 'One preliminary study found a decrease in secretory IgA (sIgA) levels in the milk of cannabis users. Two studies found decreases in the lipid content of milk, but they had opposite findings on the effects on protein and carbohydrate content. The clinical relevance of these changes is questionable.' That final sentence is LactMed's own and is carried with the findings. The sIgA result is qualified further in LactMed's detailed section: among 14 women who used cannabis postpartum by inhalation, 'The milk of cannabis users had lower levels of sIgA relative to non-users; however, when adjusted for BMI, there was no difference in sIgA levels between the groups.' On supply, LactMed states: 'Cannabis can affect serum prolactin variably and it might decrease milk supply and the duration of lactation.' In the same 14-woman study, 'Cannabis-using mothers reported lower levels of milk production in the first, second, fourth, and sixth weeks postpartum, compared to non-users.' A Colorado cross-sectional survey found both prenatal and postnatal cannabis use associated with shorter breastfeeding duration, with 58% of women reporting postpartum cannabis use breastfeeding for 9 or more weeks compared with 79% of women who did not, a statistically significant difference. The countervailing evidence is carried too: in an online survey of 1516 mothers who used cannabis during lactation, 'Most mothers (85.8%) reported no changes in their milk supply when using cannabis compared to when they were not using it', and a separate biorepository comparison of 165 exposed and 472 unexposed samples found higher protein and carbohydrate levels in the exposed milk with fat and energy content not significantly different between the groups. LactMed also notes a confounder for the shorter-duration findings: in a 4969-woman database study, marijuana users were more likely to smoke cigarettes, and 'Tobacco smoking is known to decrease the duration of breastfeeding, so the effect of marijuana is not clear.'Cannabis, Drugs and Lactation Database (LactMed), NCBI Bookshelf NBK501587, record updated 2026 Aug 15

Dose and duration limits

Human oral dose, from the only clinical study of a named Bhanga preparation. No animal dose is reported or substituted anywhere in this field. The trial administered Jalaprakshalana (water-wash) Shodhita Bhanga as a leaf powder in size 0 capsules, 250 mg three times a day at 9 am, 3 pm and 9 pm, orally, with 50 ml of cow's milk mixed with 4 g of crystal sugar as an adjuvant, for 4 weeks, in adults aged 18 to 70 with cancer. That is 750 mg of powder per day. The trial states its basis for the unit dose: 'Recommended dose of water-wash processed cannabis leaves as per Ayurvedic pharmacopoeia of India is 250 mg'. That sentence is the trial's citation of the Ayurvedic Pharmacopoeia of India; the pharmacopoeial text itself could not be read on a permitted host on 2026-09-11, because pharmacopoeia.gov.in and www.pharmacopoeia.gov.in did not resolve (DNS NXDOMAIN, curl exit code 6), so the API figure is reported here only as quoted by the trial and not as verified against the monograph. What this dose is and is not: it is the amount given in one open-label, single-arm, uncontrolled 4-week study in which 37 patients enrolled and 24 completed. It is not a maximum, not a ceiling, not a tested-safe dose and not a dose for any group the trial excluded (pregnant or breastfeeding women, people with uncontrolled hypertension or diabetes, cardiac, pulmonary, hepatic or renal dysfunction, HIV/VDRL, and anyone outside 18-70). No cited source states a maximum daily quantity, a maximum duration, or a cumulative limit for Bhanga, and none states a dose for cannabis generally: the MSKCC About Herbs cannabis page has a 'Dosage' heading whose content is marked 'OneMSK Only' and carries no public text, and the NCCIH, FDA and LactMed pages state no dose. The dose above is specific to the water-wash Shodhita form; no source located gives a dose for Bhanga processed by the other Shodhana methods described in the Sodhana review, or for unprocessed Bhanga. Regulatory status: this record states INSUFFICIENT DATA on the Indian regulatory position of Bhanga. Two Ministry of Ayush documents were requested directly on 2026-09-11 and returned no content (https://ayush.gov.in/resources/pdf/quality_standards/Drugs-and-Cosmetics-Act-Rules.pdf returned HTTP 404; https://www.ayush.gov.in/docs/guideline_safety_toxicity.pdf returned HTTP 403), so the gazetted Schedule E(1) text could not be read on a permitted host, and no claim about Schedule E(1), Rule 161(2) or prescription-only status is made here. This is a statement about what could and could not be retrieved in this session, not a finding that no such rule exists. The trial notes for context that its drug was procured 'after taking due approval of the state excise authority' and that the study was registered as CTRI/2016/02/006658. Because no ceiling is established, the psychiatric, cardiac, renal, hepatic, respiratory, paediatric-ingestion and dependence hazards recorded above apply to internal use at any quantity.Tavhare SD, Acharya R, Reddy RG, Dhiman KS. Management of chronic pain with Jalaprakshalana (water-wash) Shodhita (processed) Bhanga (Cannabis sativa L.) in cancer patients with deprived quality of life: An open-label single arm clinical trial. Ayu. 2019 Jan-Mar;40(1):34-43. PMCID PMC6891996, PMID 31831967, doi:10.4103/ayu.AYU_43_19Maurya SK, Seth A, Laloo D, et al. Sodhana: An Ayurvedic process for detoxification and modification of therapeutic activities of poisonous medicinal plants. Anc Sci Life. 2015 Apr-Jun;34(4):188-197. PMCID PMC4535066, doi:10.4103/0257-7941.160862Cannabis, Memorial Sloan Kettering About Herbs

Quoted in the units the source uses. Nothing here is converted.

Every statement above was checked by four independent reviewers, each looking for a different kind of error, and published only if the source could be confirmed to say it. How safety data is verified.