cbd oil and warfarin

Blood Thinners and CBD Oil Interaction

Blood Thinners and CBD Oil Interaction

CBD oil is showing signs of being an effective anticoagulant, but is it safe to combine with traditional blood thinners?

CBD oil is making headlines for its use in treating hypertension and heart disease, so naturally, if you suffer from a hemostasis disorder, you may be wondering if CBD could be of any help in treating your condition.

Although CBD oil has been shown to be relatively safe, it should be used cautiously with some blood thinning medications, including one of the most commonly prescribed anticoagulants.

If you are considering combining CBD oil and blood thinners, or simply want to discover if it’s a safe option, here is everything you need to know.

Effects of CBD on Blood Clotting

The effects that CBD oil has on blood clotting are not well understood, but it is thought that a few factors come into play. First, is CBD oil’s impact on blood flow.

CBD oil can aid the circulatory system by dilating blood vessels. This allows the blood to flow quicker, and in turn, can make the occurrence of blood clots less likely. A 2017 study found that just a single dose of CBD significantly reduced the blood pressure of subjects at rest and in stressful situations.

Broad- or full-spectrum CBD oil in particular may be a useful tool in preventing thrombosis, or the formation of blood clots. A study on the anticoagulant effects of cannabis found the cannabinoids (tetrahydrocannabinol) THC and cannabinol (CBN) to be effective anti-thrombotics, doubling the amount of time it took for blood clots to form in obese and lean rat test subjects compared to the control group.

Both CBN and THC are present in full-spectrum CBD oil, which contains all of the hemp plant’s cannabinoids and terpenes. Full-spectrum CBD oils will typically have 0.3% THC or less, which is in line with federal regulations. If you’d rather not have THC in your CBD product, but still are after the anticoagulant effects of CBN and CBD, a broad-spectrum CBD oil is the way to go. Broad-spectrum CBD products contain all the cannabinoids and terpenes of the hemp plant except THC. If you aren’t sure whether you’d like a full- or broad-spectrum product, a good place to start is researching your state’s laws on cannabis, THC, and CBD.

Interactions Between CBD and Blood Thinners

Although CBD oil has been found to be generally well-tolerated and free from side-effects, it can interact negatively with some pharmaceuticals. Often referred to as the ‘grapefruit effect,’ CBD oil is one of a number of natural substances that can slow down the system the body uses to process toxins.

This system is known as the cytochrome P-450 enzyme system, and is made up of liver enzymes that break down certain medications into smaller parts so your body can more easily process them. When the P-450 enzyme system is inhibited by a compound like CBD, other medications typically broken down by those liver enzymes remain in the system for longer than is desired, making it more likely that you will experience the side effects of that unprocessed medication.

As you’ll see in the table below, not all pharmaceuticals are processed by the cytochrome P-450 enzyme system. So while you may need to take care when combining CBD oil with a blood thinner like Warfarin, for example, users of Heparin face fewer risks.

Ultimately, it’s important to consult with your doctor before using CBD oil if you take any blood thinning medication. This will allow your doctor to make adjustments to your medication, taking into account any changes that CBD oil may have in its processing time.

As a starting point, here is a list of some of the most commonly prescribed blood thinners and what we currently know about their interaction with CBD oil.

Anticoagulant Type Brand Name Common Drug Side Effects Possible Side Effects of Combining Medication + CBD Oil
Rivaroxaban Xarelto Prolonged bleeding; bruising easily; nosebleeds; bleeding gums Rivaroxaban may remain in the system longer and increase the likelihood you’ll experience its side effects
Dabigatran Pradaxa Prolonged bleeding; bruising easily; nosebleeds; bleeding gums No known interaction
Apixaban Eliquis Prolonged bleeding; bruising easily; nosebleeds; bleeding gums Combine with caution; apixaban may remain in the system longer and make side effects more likely
Edoxaban Lixiana Prolonged bleeding; bruising easily; skin rash; reduced liver function; anemia No known interaction
Warfarin Coumadin; Jantoven Unusual bruising; bleeding gums; nosebleeds; prolonged bleeding Combine with caution; Warfarin may remain in the system longer and side effects could become more likely
Heparin Various Prolonged bleeding; bruising easily; nosebleeds; bleeding gums; skin irritation; allergic reaction No known interaction

How to Safely Take CBD and Blood Thinners Together

When combining CBD oil and blood thinners, there are a variety of factors that come into play. Your health, weight, and general tolerance can all influence how likely you are to experience interactions. Because there are so many variables to consider, you should first speak to your doctor about the possibility of adding CBD oil to your medication regimen. Together you can create a plan to ensure there is minimal disruption to your system.

In order to further minimize the risks of an adverse reaction between CBD oil and your anticoagulant, it’s suggested that you start with a lower dose than what is recommended for your chosen CBD product, and slowly increase the dosage over time if needed. This not only allows you to build a tolerance to CBD oil, but it also provides your doctor with the time and flexibility to decrease the dosage of your blood thinners if required.

Safest CBD Oils to Take with Blood Thinners

With so many varieties of CBD oil available to you, how do you know where to start? If you’re looking for a safe CBD oil to combine with blood thinners, or are turning to CBD oil as a preventative measure against blood clots, there are a few things to consider to ensure you’re making the smartest and safest purchase possible.

First, choose your CBD delivery method. You can buy CBD oil in a wide number of forms including capsules, vapes, edibles, and drops. While vaping CBD will deliver the fastest results, drops are more discreet with longer-lasting effects, and capsules offer a user-friendly, familiar option for people who are new to CBD. When deciding on a method it is worth noting that any format that’s processed through the digestive system will take longer to show effects and as such may lose some of its potency.

After you have chosen the preferred method for your CBD delivery, look for a high quality CBD product that has been organically grown, sustainably sourced, and third-party lab tested. Reading the lab reports, also called Certificates of Analysis, will ensure the product you purchase is in fact the safest CBD oil to take with blood thinners. A Certificate of Analysis should tell you if the CBD product you’ve contains herbicides, pesticides, heavy metals, or chemical additives.

When you have your CBD oil product, figuring out your ideal dosage is the last step to making sure you’re using CBD safely. The safest way to take CBD oil with blood thinners is to start with a small dose and increase gradually over a period of time if needed. For additional personal guidance on CBD dosage, consider speaking with a naturopathic doctor who specializes in using CBD oil to treat medical conditions.

If you’ve spoken to your physician and are ready to choose a CBD oil, check out the Best CBD Oil Products to Buy.

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Is It Time to Add Cannabinoids to the ASRA Anticoagulation Guidelines for Pain Procedures?

Cannabis has been used for both recreational and medical purposes for several centuries. Hashish, which is a form of cannabis, was found in Egyptian mummies. 1 Cannabis was prohibited in the United States in 1937 and remained relatively unpopular until the 1960s, when its use became in demand among adolescents and young adults. 2 Use of cannabis has continued to increase since then, especially after 2007. From 2007–2014, reported use increased from 5.8% to 8.4 %. Declining prices, change in public perception, and the awareness of medical cannabis may have contributed to this trend. 3

Some studies suggest that CBD is effective for treating neuropathic pain, yet research is still ongoing to determine its efficacy in chronic pain conditions and to elucidate any side effects or hazards associated with its use.

Currently, cannabis is the most popular illicit drug in the United States. A recent survey indicated that recreational use of marijuana remains the most popular indication (89.5%). Marijuana for combined recreational and medical use is also popular (36.1%), followed by medical use alone (10.5%). 4

Cannabis produces a variety of compounds known as cannabinoids that have not been detected in other plants. Some cannabinoids can be activated to produce the two most well-known cannabinoids: tetrahydrocannabinol (THC) and cannabidiol (CBD).

Use of cannabinoids is also rising because of their increased availability in stores and online. CBD can be found in retailers in all 50 states and in more than 40 countries; however, legislation regulating their use varies between states. CBD oil is made from high CBD and low THC hemp, which makes it different from other medical marijuana products that usually have high concentrations of THC. Treating chronic pain and other medical conditions with THC and CBD oil specifically represents one of the hottest and most controversial topics in the medical field.

The therapeutic effect on chronic pain is thought to be produced by modulation of signal transduction pathways in addition to interactions with the endocannabinoid and serotonin systems. Some studies suggest that CBD is effective for treating neuropathic pain, yet research is still ongoing to determine its efficacy in chronic pain conditions and to elucidate any side effects or hazards associated with its use.

Regardless of whether it is efficacious, many patients with chronic pain who are undergoing interventional pain procedures will be using these products. Physicians must understand the effects of cannabinoids, including CBD, on anticoagulation. Does it place patients at increased risk for bleeding?

Blood coagulation studies indicate that organic cannabis extract and the major cannabinoids, THC and cannabinol (CBN), show considerable antithrombotic activity in vitro. In addition, CBD showed mild anticoagulating effects. Furthermore, the authors demonstrated that 50% clotting times in obese and lean rats treated with cannabis extracts were 1.5- to 2.0-fold greater than their controls (rats not treated with cannabis extracts). The authors also suggested that cannabis may be used in the setting of hypercoagulable states as may exist in patients with diabetes type 2. 5 In other studies, CBD oil was found to affect platelets and anticoagulants by suppressing their production and thereby potentially increasing bleeding tendencies. 6

In addition, CBD can interact with warfarin and increase the risk of bleeding complications. CBD is metabolized through the hepatic P450 enzyme system, which warfarin also uses. Both share the same isoforms in their metabolism (CBD acts on CYP1A1, CYP1A2, CYP2C9, CYP2C19, CYP2D6, CYP3A4, and CYP3A5 and warfarin acts on five of them). CBD can competitively compete with the metabolism of warfarin by occupying the same isoforms, thereby decreasing the degradation of warfarin. Patients on warfarin who will be using cannabis should have their international normalized ratio monitored to detect any interaction between both drugs. 7–10

The problem is even bigger with synthetic cannabis. Synthetic cannabis is a mixture of different plant materials that have been combined with cannabinoids produced in the laboratory. Stores sell the drug under different names such as spice, K2, and fake weed. Synthetic cannabis is not legally regulated, and users should exercise caution when considering whether to use those compounds. For example, an individual in Maryland experienced fatal bleeding after the use of synthetic cannabis which was thought to be laced with brodifacoum (rat poison). 11 Dozens of similar cases were identified in Illinois. 12 Brodifacoum blocks the effects of vitamin K, leading to bleeding. Similar cases were identified in other states and the number of fatalities is rising. 13

Cannabinoids can potentially increase bleeding tendencies through various mechanisms. We need to educate patients who are being considered for interventional pain procedures about this risk. In addition, ASRA should consider adding official recommendations to its guidelines for interventional pain and spine procedures for patients using cannabinoids to better guide physicians in their practices.

Is It Time to Add Cannabinoids to the ASRA Anticoagulation Guidelines for Pain Procedures? Cannabis has been used for both recreational and medical purposes for several centuries. Hashish, which ]]>