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CBD oil has been making headlines for potentially being able to treat 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 some commonly prescribed anticoagulants.
If you are considering combining CBD oil and blood thinners, or simply want to explore if it’s a safe option, here is everything you need to know.
Effects of CBD on Blood Clotting
The effects of CBD oil on blood clotting are not well understood, but it is thought that a few factors may be involved. 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 both at rest and in stressful situations.
Broad spectrum CBD, 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, along with all the other cannabinoids and terpenes present in cannabis. CBD oil derived from the industrial or agricultural hemp variety of the cannabis plant contains less than 0.3% THC, which is in line with federal regulations.
If you’d rather not have any THC in your CBD product, but still want the anticoagulant effects of CBN and CBD, a broad spectrum CBD oil would be ideal. 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, as well as seeking advice from a medical professional.
Interactions Between CBD and Blood Thinners
Although CBD oil has been found to be generally well-tolerated and without any significant side effects in studies , it can interact negatively with some medications. Often referred to as the ‘grapefruit effect,’ CBD oil is one of a number of natural substances that can slow down systems the body uses to metabolize and break down toxins.
One of the main metabolic systems in the body is the cytochrome P-450 enzyme system , which is made up of liver enzymes that break down certain drugs in the body, with removal of potentially harmful byproducts. If the P-450 enzyme system is inhibited by a compound like CBD, medications typically broken down by the liver enzymes remain in the system for longer than desirable, making it more likely you will experience side effects from the 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 taking CBD oil with a blood thinner like warfarin, for example, people taking heparin face fewer risks.
Ultimately, it’s important to consult with a doctor before using CBD oil if you take any blood thinning medication. Your doctor will make adjustments to your medication, taking into account any effects that CBD oil may have in any potential interactions with it.
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 possible drug-drug 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 also provides your doctor with the time and flexibility to monitor changes and decrease the dosage of your blood thinners if necessary.
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 choice possible.
First, choose your CBD delivery method. You can buy CBD oil in a wide variety 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 your preferred method for CBD administration, look for a high quality CBD product that has been organically grown, sustainably sourced, and third-party lab tested. Reading the lab reports (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 have contains herbicides, pesticides, heavy metals, or chemical additives.
When you have your CBD oil product, figuring out your ideal dosage is the final 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 gradually increase it over a period of time if needed. For additional 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 .
CBD and other medications: Proceed with caution
Products containing cannabidiol (CBD) seem to be all the rage these days, promising relief from a wide range of maladies, from insomnia and hot flashes to chronic pain and seizures. Some of these claims have merit to them, while some of them are just hype. But it won’t hurt to try, right? Well, not so fast. CBD is a biologically active compound, and as such, it may also have unintended consequences. These include known side effects of CBD, but also unintended interactions with supplements, herbal products, and over-the-counter (OTC) and prescription medications.
Doubling up on side effects
While generally considered safe, CBD may cause drowsiness, lightheadedness, nausea, diarrhea, dry mouth, and, in rare instances, damage to the liver. Taking CBD with other medications that have similar side effects may increase the risk of unwanted symptoms or toxicity. In other words, taking CBD at the same time with OTC or prescription medications and substances that cause sleepiness, such as opioids, benzodiazepines (such as Xanax or Ativan), antipsychotics, antidepressants, antihistamines (such as Benadryl), or alcohol may lead to increased sleepiness, fatigue, and possibly accidental falls and accidents when driving. Increased sedation and tiredness may also happen when using certain herbal supplements, such as kava, melatonin, and St. John’s wort. Taking CBD with stimulants (such as Adderall) may lead to decreased appetite, while taking it with the diabetes drug metformin or certain heartburn drugs (such as Prilosec) may increase the risk of diarrhea.
CBD can alter the effects of other drugs
Many drugs are broken down by enzymes in the liver, and CBD may compete for or interfere with these enzymes, leading to too much or not enough of the drug in the body, called altered concentration. The altered concentration, in turn, may lead to the medication not working, or an increased risk of side effects. Such drug interactions are usually hard to predict but can cause unpleasant and sometimes serious problems.
Researchers from Penn State College of Medicine evaluated existing information on five prescription CBD and delta-9-tetrahydrocannabinol (THC) cannabinoid medications: antinausea medications used during cancer treatment (Marinol, Syndros, Cesamet); a medication used primarily for muscle spasms in multiple sclerosis (Sativex, which is not currently available in the US, but available in other countries); and an antiseizure medication (Epidiolex). Overall, the researchers identified 139 medications that may be affected by cannabinoids. This list was further narrowed to 57 medications, for which altered concentration can be dangerous. The list contains a variety of drugs from heart medications to antibiotics, although not all the drugs on the list may be affected by CBD-only products (some are only affected by THC). Potentially serious drug interactions with CBD included
- a common blood thinner, warfarin
- a heart rhythm medication, amiodarone
- a thyroid medication, levothyroxine
- several medications for seizure, including clobazam, lamotrigine, and valproate.
The researchers further warned that while the list may be used as a starting point to identify potential drug interactions with marijuana or CBD oil, plant-derived cannabinoid products may deliver highly variable cannabinoid concentrations (unlike the FDA-regulated prescription cannabinoid medications previously mentioned), and may contain many other compounds that can increase the risk of unintended drug interactions.
Does the form of CBD matter?
Absolutely. Inhaled CBD gets into the blood the fastest, reaching high concentration within 30 minutes and increasing the risk of acute side effects. Edibles require longer time to absorb and are less likely to produce a high concentration peak, although they may eventually reach high enough levels to cause an issue or interact with other medications. Topical formulations, such as creams and lotions, may not absorb and get into the blood in sufficient amount to interact with other medications, although there is very little information on how much of CBD gets into the blood eventually. All of this is further complicated by the fact that none of these products are regulated or checked for purity, concentration, or safety.
The bottom line: Talk to your doctor or pharmacist if using or considering CBD
CBD has the potential to interact with many other products, including over-the-counter medications, herbal products, and prescription medications. Some medications should never be taken with CBD; the use of other medications may need to be modified or reduced to prevent serious issues. The consequences of drug interactions also depend on many other factors, including the dose of CBD, the dose of another medication, and a person’s underlying health condition. Older adults are more susceptible to drug interactions because they often take multiple medications, and because of age-related physiological changes that affect how our bodies process medications.
People considering or taking CBD products should always mention their use to their doctor, particularly if they are taking other medications or have underlying medical conditions, such as liver disease, kidney disease, epilepsy, heart issues, a weakened immune system, or are on medications that can weaken the immune system (such as cancer medications). A pharmacist is a great resource to help you learn about a potential interaction with a supplement, an herbal product (many of which have their own drug interactions), or an over-the-counter or prescription medication. Don’t assume that just because something is natural, it is safe and trying it won’t hurt. It very well might.