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cbd and blood thinners

Cbd and blood thinners

Warfarin is an anticoagulant (blood thinner) medication that prevents the formation of dangerous blood clots that could lead to heart attacks or strokes. Warfarin is available under several brand names, including Coumadin and Jantoven.

Here’s a list of common drugs to avoid while taking warfarin:

Can You Take Other Blood Thinners With CBD Oil?

Can you take CBD oil with warfarin? Read on to find out.

Bioaccumulators are effective at absorbing either good or harmful elements. So you can also compromise the quality of the CBD plant if polluted soil is used.

Other Products That May Interact With Warfarin

There are several ways in which CBD affects your body. To begin with, CBD is not addictive and does not cause any withdrawal symptoms. This means taking higher doses of CBD is okay as long as you don’t exceed your daily recommended amount or take too much at once.

Cbd and blood thinners

No research has explicitly documented interactions between Xanax and CBD. Patients taking Xanax who are interested in CBD should speak to their healthcare providers for more information.

Acetaminophen and CBD both are metabolized by CYP450, which lowers the effectiveness of both chemicals as they’re processed in the body. One controversial 2019 study, conducted by the University of Arkansas on mice and published in the journal Molecules, claimed that high doses of CBD contributed to liver toxicity, which could compound acetaminophen’s liver damage potential. However, the study’s authors have been accused of cherry-picking research and designing experiments to showcase potential CBD toxicity. The one study they cited with human test subjects did not show liver toxicity from CBD.

Ibuprofen is a nonsteroidal anti-inflammatory (NSAID) medicine that reduces pain and inflammation in the body. Ibuprofen has a risk of blood-thinning and can cause dizziness, shortness of breath, and nausea.

Should I take CBD with statins?

The type, quality, and purity of CBD administered all affect how it interacts with your body and medication. The timing of when you take CBD and any other prescription drug also factors into how the two may interact in your body. And of course, every individual responds to medications differently, depending on genetics, age, weight, and other factors.

In 2017, researchers at the University of Alabama, Birmingham, conducted a study published in Epilepsy & Behavior Case Reports which showed that CBD increases the effects of drugs used for blood-thinning by slowing down how the body metabolizes warfarin and prolonging its presence in the system. By increasing the duration of warfarin’s presence in the body, CBD could potentially exacerbate some of the associated risks.

Plavix is the brand name of the drug clopidogrel, frequently prescribed for patients who have had or are likely to have a heart attack. The drug works by blocking blood platelets from forming clots in arteries near the heart.

Should I take CBD with Tylenol?

These drug classifications include a large percentage of existing prescriptions, such as benzodiazepines, antihistamines, haloperidol, antiretrovirals, statins, cyclosporine, sildenafil, warfarin, and other drugs metabolized by CYP3A4 and CYP2D6.

CBD acts on the same metabolites as grapefruit — therefore, many of the prescription drugs that carry grapefruit warning labels may have similar risks when taken with CBD. Photo by: Gina Coleman/Weedmaps

Cbd and blood thinners

With up-titration of CBD oil, a non-linear increase in the INR was noted ( Table 1 , Fig. 1 ). Warfarin dosage adjustments were made by primary care physician in effort to maintain an INR within his therapeutic range. At the most recent study visit his warfarin dose had been reduced by approximately 30%. The patient was followed clinically without bleeding complications.

The metabolism of CBD is also by way of the hepatic P450 enzyme system. To date there are seven major isoforms identified that contribute to this process: CYP1A1, CYP1A2, CYP2C9, CYP2C19, CYP2D6, CYP3A4, and CYP3A5, with CYP3A4 and CYP2C19 being the dominant contributors [9]. Five of the seven isoforms are also involved with metabolism of warfarin, including CYP2C9, which is the dominant enzyme for S-warfarin, and CYP3A4, which is the dominant enzyme for R-warfarin [7], [9]. In addition to competing for enzymes in same metabolic pathway as warfarin, CBD has been demonstrated to act as a potent competitive inhibitor of all seven of its own CYP enzymes and as such could further impair the degradation of warfarin [10], [11]. It is this combination of factors that presumably constitutes the observed rise in INR values with concomitant warfarin and CBD administration.

INR Trend over time.

Table 1

A 44-year-old Caucasian male with Marfan Syndrome, mechanical mitral valve replacement, warfarin therapy, and post-stroke epilepsy was enrolled in the University of Alabama at Birmingham open-label program for compassionate use of cannabidiol for the management of treatment-resistant epilepsy ( <"type":"clinical-trial","attrs":<"text":"NCT02700412","term_id":"NCT02700412">> NCT02700412). His seizures began at age 27 concurrent with diagnosis of stroke during the post-operative period from cardiac surgery. Despite initial control of seizures on monotherapy, events returned in 2011 prompting adjustment of anti-seizure medications and eventual consideration of epilepsy surgery. Following video EEG monitoring, he was determined to be a poor surgical candidate due to non-localized seizure onset. Additionally, the need for anticoagulation due to mechanical valve limited more invasive testing for localization of seizure focus as well as posed a challenge for completion of any surgical resection. He was subsequently referred to the UAB CBD program.

The use of cannabis products for the treatment of epilepsy and other chronic diseases is growing rapidly [1], [2]. Cannabis products include any pharmaceutical or artisanal derivatives of the cannabis plant [2]. One such agent is cannabidiol (CBD), one of the phytocannabinoids frequently used by patients with seizures. Current data regarding interactions between CBD and other pharmaceuticals are primarily limited to anti-seizure drugs [3], [4]. This case report observes a clinically significant interaction between pharmaceutical grade cannabidiol (Epidiolex®; Greenwich Biosciences, Inc.) and warfarin, one of the most widely used oral anticoagulants.

3. Discussion

Despite the emergence of novel oral anticoagulants, warfarin continues to be the most commonly used oral anticoagulant worldwide [5]. A potent inhibitor of vitamin K epoxide reductase complex, warfarin functions by disrupting the production of vitamin-K-dependent clotting factors [6]. The drug is comprised of R and S stereoisomers with S-warfarin being the more active of the two. Warfarin is metabolized via the CYP450 hepatic enzyme complex and cleared through the renal system, however each stereoisomer is metabolized differently. The S-isomer is predominantly metabolized by CYP2C9 and R-warfarin by way of CYP3A4 with lesser involvement of CYP1A1, CYP1A2, CYP2C8, CYP2C9, CYP2C18 and CYP2C19 [6]. Resultantly, factors that impact the CYP2C9 enzyme (genetic polymorphisms, other medications, etc.) alter warfarin activity [5], [7], [8]. Due to its narrow therapeutic index and variability of dosing requirements amongst individuals, frequent monitoring of the INR is required to both achieve and maintain appropriate anticoagulant effects on the blood. Drugs that compete as substrates for these cytochromes or inhibit their activity may increase warfarin plasma concentrations and INR, potentially increasing the risk of bleeding. Conversely, drugs which induce these metabolic pathways may decrease warfarin plasma concentrations and INR, potentially leading to reduced efficacy.

At the time of study enrolment, the patient was taking lamotrigine 400 mg and levetiracetam 1500 mg, both twice daily. He was also taking warfarin 7.5 mg daily with a goal International Normalized Ratio (INR) of 2–3. Prior to study entry, his INR had been stable for at least 6 months with levels ranging from 2.0 to 2.6 ( Fig. 1 ). At the initial study visit, his baseline INR was obtained and he was placed on the starting dose of CBD at 5 mg/kg/day divided twice daily. Per study protocol (www.uab.edu/cbd) CBD dose was increased in 5 mg/kg/day increments every two weeks.