Does CBD Gummies Thin Your Blood

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If you have a heart condition, you should speak to your doctor before using medical marijuana. Learn how cannabis and blood thinners interact. If you've been prescribed warfarin (an anticoagulant) and are wondering if you can also take CBD oil, read this post before proceeding to know the risks of this drug interaction. The short answer is – no, in most cases cannabis and specific cannabinoids do not seem to act as strong blood thinners.

Is Marijuana a Blood Thinner?

Nearly 3 million Americans rely on blood thinners each year to prevent and control blood clots, but some people are now looking to medical marijuana as a potential replacement or supplement. The compounds found in cannabis may hold great promise for individuals with heart and blood vessel conditions, but medical experts still have some concerns.

If you still have questions after reading this post, Green Health Docs can help. We offer medical marijuana card certification in numerous states, and our licensed physicians can answer all your questions and help you to get approved. Green Health Docs has clinics located in multiple states across the country, and GHD even offers telemedicine evaluations. Contact Green Health Docs today. We are here 7 days a week to help.

What Is a Blood Thinner?

A blood thinner doesn’t actually thin your blood; it’s a substance that has anticoagulant or antiplatelet properties. These medications are designed to prevent blood clots, which is important as clots can clog arteries, prevent oxygen from reaching vital organs, and even lead to life-threatening events like a heart attack or stroke.

Anticoagulants are compounds that prevent clots from forming and prevent existing clots from getting bigger. Medicines like warfarin and heparin are examples of anticoagulants.

Antiplatelet substances prevent platelets in your blood from sticking together to form clots. Over-the-counter aspirin is an example of a medication with antiplatelet properties.

Blood thinners—whether anticoagulant or antiplatelet—are used to treat a variety of conditions that are caused, threatened, or exacerbated by blood clots. Examples include:

  • Abnormal heart arrhythmias like atrial fibrillation
  • Congenital heart disorders
  • Certain chronic blood vessel diseases
  • Ischemic heart disease
  • Heart valve replacements

In addition, if you’ve undergone a surgery that may increase your risk of clotting, your physician may recommend a blood thinner as a preventive measure.

Is Marijuana a Blood Thinner?

Marijuana has been shown to have some anticoagulant properties and may act as a natural blood thinner. Not much research has been done to examine the reasons why, but cannabinoids appear to impact the ways in which platelets clot.

As a result, some patients are turning to marijuana as a replacement for their conventional blood thinner, as marijuana doesn’t have the side effects of many pharmaceutical drugs. Even aspirin can damage the stomach if used regularly, but cannabis appears to have no such long-term effects.

Still, doctors advise caution, especially for patients with a significant heart condition. The full anticoagulant effects of marijuana are not fully understood, and some patients may benefit more than others. In addition, each strain of cannabis has a unique profile of cannabinoids and terpenes, and not all cannabis plants affect the blood in the same way.

Can Medical Marijuana Replace Your Blood Thinners?

More research is needed to determine if marijuana can safely replace blood-thinning medications. We do know that marijuana has anticoagulant properties, but it’s yet to be determined whether cannabis can prevent clotting with the same effectiveness as conventional medications.

If you want to pursue medical marijuana as a natural alternative to blood thinners, you should always do it under the supervision of a physician. Your doctor can monitor your blood pressure, platelet levels, and other vitals, and they can perform other tests to check for clotting. They might also make specific dosage recommendations and monitor the effects of different marijuana strains that you try.

Is It Safe to Use Medical Marijuana With Blood Thinners?

Blood thinners and cannabis are both well-tolerated on their own, but combining them can have unexpected outcomes. That’s why it’s so important to speak with your doctor before mixing the two.

Some medical professionals are concerned about the potential dangers of mixing pharmaceutical blood thinners with cannabis. It appears that marijuana inhibits the metabolism of the blood thinner, thereby increasing the anticoagulant effect.

While more blood-thinning might sound like a good thing, remember that a certain amount of clotting is necessary. Without it, we would bleed uncontrollably at the slightest blood vessel injury. Excessive bleeding and internal hemorrhages can result from high anticoagulant levels in the body.

A knowledgeable physician can help you to find the right dosage to stay safe. It depends on the marijuana strain and the type of blood thinner. For instance, a recent case review found that people using marijuana while on warfarin should reduce their drug intake by 30% to avoid a bleeding risk.

Is CBD Oil a Blood Thinner?

Cannabidiol (CBD) may also have blood-thinning properties, even when it’s derived from hemp instead of cannabis. This is of particular concern because CBD requires no subscription, is not subject to federal regulation, and is typically not consumed under a doctor’s supervision.

If you’re not on blood thinners, CBD won’t likely present any risk. However, once again, there is some concern for individuals who use CBD and traditional blood thinners concurrently. CBD has been shown to interact with blood-thinning agents like naproxen, ibuprofen, and warfarin. As with cannabis, CBD appears to block the drugs’ metabolism, leading to higher levels of the drug inside the body.

This seems to suggest that CBD is partly to blame for marijuana’s effect on blood thinners. CBD is one of over 100 cannabinoids found in cannabis, and it interacts with the same cannabinoid receptors as THC.

How to Consume Marijuana When You’re On Blood Thinners

The manner in which you consume marijuana—smoking vs. edibles vs. vaping, etc…—can impact your level of risk if you have a heart condition that requires blood thinners. CDC data suggests that smoking accounts for nearly 80% of adult marijuana use, but inhaling smoke into the lungs can be hazardous for someone with a heart or blood vessel condition.

Marijuana affects the cardiovascular system regardless of how it’s consumed, but smoke-free ingestion is the safest bet for someone at risk. Edibles, tinctures, and capsules are available, offering all the anticoagulant properties without the smoke inhalation. Just note that when consuming edibles, you must be very careful about your dosage. Because edibles are partially digested and metabolized by the liver, they are far more potent than smoked marijuana flower.

Making Sound Decisions Regarding Marijuana & Blood Thinners

To recap, medical marijuana has some blood-thinning properties, but it can be difficult to predict how it will fare when used alongside or in place of traditional blood thinners. If you’re thinking of using marijuana for its anticoagulant qualities:

  • Always do so under the supervision of a doctor
  • Be especially cautious if you have an existing heart condition
  • Avoid smoking if other consumption methods are available

Finally, note how marijuana affects your heart. If you notice palpitations, increased heartbeat, or other heart-related symptoms, see your doctor right away.

Green Health Docs has physicians located in states throughout the U.S. Our doctors can help you to make an informed decision as to whether medical marijuana might be right for you. Our doctors are authorized to provide medical marijuana certifications in their respective states, so you can register as a patient and discover the benefits for yourself. Depending on where you live, you might even be able to obtain your medical marijuana card online.

As long as you maintain professional supervision, follow your doctor’s advice, and watch out for any unusual symptoms, you should be able to consume safely whether you’re already on blood thinners or looking to preserve your cardiovascular health naturally.

CBD and Warfarin: Can You Safely Mix Them Together?

CBD oil is a natural remedy that contains the cannabinoid CBD extracted from the cannabis plant. It’s said to reduce inflammation, provide greater resistance to stress, and promote nerve health.

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However, CBD oil may have an adverse drug interaction with anticoagulants such as warfarin.

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

How Does CBD Affect Your Body?

Cannabidiol (CBD) is a compound that comes from the cannabis plant known for its health benefits. CBD oil can be extracted from hemp or marijuana plants. Hemp-based CBD oil is legal in all 50 states, while marijuana-derived CBD oil varies by state.

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.

Furthermore, CBD is non-psychoactive, meaning it doesn’t get you high, unlike tetrahydrocannabinol (THC), the other compound from the cannabis plant.

These are just some of the common reasons why people use CBD oil:

  • Pain relief
  • Anti-anxiety
  • Acne cure
  • Weight management
  • Brain health
  • Cardiovascular health

However, CBD is not for everyone. Some side effects have been reported in rare cases, which may include:

  • Dry mouth
  • Fatigue
  • Sedation
  • Appetite changes
  • Diarrhea

Additionally, using CBD alongside certain medications raises some questions.

How Does CBD Oil Affect Your Blood?

It has been shown that CBD itself has mild anticoagulating effects, meaning that it can act somewhat like a blood thinner. Nevertheless, more studies must be done to better understand how CBD affects your blood.

In clinical trials, case studies, and scientific research, CBD is shown to work well with the endocannabinoid system in the body.

Following the passage of the Farm Bill, scientists now have greater access to CBD and can finally study its potential as a healing agent. As a result, researchers are conducting more and more studies and clinical trials on CBD every day.

Does CBD Interact With Medications?

Various pharmaceuticals, herbal products, and health supplements can interact with CBD. As a result, the use of other drugs might need to be reduced or modified if CBD is introduced.

The main thing is to understand that some medications should not be taken together.

There are many other factors that can influence drug interactions, such as one’s health condition, the dose of a medication, and the dose of CBD. So if you’re starting a new medication, consult your doctor first before taking CBD oil.

Does CBD Interact With Warfarin?

Short answer: Yes.

Taking any kind of medication or substance requires your body to metabolize it. In the metabolic process, drugs are broken down so the body can absorb their effects.

The chemical structure of a drug determines how it’s broken down by the liver, thereby determining how quickly it leaves your system. The enzyme family called cytochrome P450 (CYP450) is responsible for converting foreign substances and making them easily excreted by the body.

The CYP450 enzyme may be slowed or accelerated by some medication or substance, including CBD.

Drug interactions occur because your body’s metabolism rate is altered during this time. This is referred to as the “grapefruit effect” due to the grapefruit’s ability to slow down the absorption of the drug by the body.

CYP450, CBD Oil, and Warfarin

CYP450 is predominantly responsible for the metabolism of warfarin. CBD inhibits this enzyme class. CBD competes with warfarin on the same metabolic pathway, according to a US National Library of Medicine study published in 2017.

CBD can cause warfarin to stay in the body for too long without being broken down when taken together. This can result in unwanted side effects such as excessive bleeding or overdose.

What Can Increase the Risk of Bleeding?

Warfarin treatment can increase your chances of bleeding during the first three months. The risk is even greater for older adults. You may also be at risk if you use other blood-thinning medications.

Genetic factors may also cause some people who take warfarin to be more prone to bleeding. Your doctor may recommend a genetic test to determine the best dose for you.

Other medical conditions that increase your risk of bleeding are:

  • Alcoholism
  • Cancer
  • History of stroke
  • Kidney problems
  • Liver disease
  • Ulcers, gastritis, and peptic disease
  • Uncontrolled blood pressure

Can You Take CBD Oil With Warfarin?

CBD oil and warfarin should not be taken together. Taking any form of CBD during your warfarin treatment should be avoided as well.

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.

Severe bleeding, headaches, swelling, or sudden pain in the extremities are some of the risks associated with warfarin.

A 2017 study published in Epilepsy & Behavior Case Reports showed that CBD increased the effects of blood-thinning drugs like warfarin by slowing down how the body metabolizes the substance. CBD may potentially increase some of the risks of warfarin by extending its duration in the body.

If you’re currently taking warfarin and want to use CBD for another condition, be sure to speak with your healthcare provider first.

Can You Take Other Blood Thinners With CBD Oil?

Drug interactions can be influenced by a number of factors, including your health, weight, and general tolerance. When CBD oil is combined with blood thinners, several considerations must be made.

Two of the remaining three oral anticoagulants approved by the FDA to treat irregular rapid heart rates are also metabolized by the CYP450 system. As a result, they will also be affected by CBD’s grapefruit effect.

Rivaroxaban and apixaban are the oral anticoagulants described.

Further, a study published in 2011 described how dabigatran (Pradaxa), another oral anticoagulant, doesn’t undergo CYP450 metabolism. A review of dabigatran suggests that the drug may have a few drug-food and drug-drug interactions. The use of dabigatran as an alternative to warfarin treatment is also being considered.

Once again, it’s advisable to consult your doctor before taking any anticoagulant together with CBD to determine safety and tolerance.

The FDA has authorized warfarin use for the following purposes:

  • Treatment of venous thrombosis, associated pulmonary embolisms, and pulmonary thrombosis.
  • Treatment of thromboembolic complications caused by cardiac valve replacement or irregular or rapid heartbeats (atrial fibrillation).
  • Identify and prevent deaths, recurrent heart attacks or myocardial infarctions (MI), and other thromboembolic events like strokes and systemic embolisms that may follow a cardiac arrest.

Can CBD Replace Warfarin?

The overall research on CBD is relatively young compared to traditional drugs. Currently, CBD has not been explicitly evaluated as a safe replacement for warfarin or any form of the anticoagulant.

Phytomedicine published a study written in 2007 that used an obese rat model to show that cannabis extracts may have anticoagulant effects. In this study, cannabinoids like cannabinol (CBN) and tetrahydrocannabinol (THC) exhibited anticoagulant properties.

According to the researchers, the cannabinoids THC and CBN from Cannabis sativa were possible treatments for thrombosis and diabetes, a condition that could lead to an irregular rise in blood clotting.

There have been limited studies to determine if CBD can act as an anticoagulant, and at this time, there is no evidence that CBD can act as an anticoagulant medication.

You should still consult a medical expert before taking CBD as a substitute for warfarin or any prescription medication. There are still many unknowns regarding CBD’s effects on the body.

What To Look For When Shopping for CBD Oil

The market for CBD oil has expanded a lot in recent years. It is available online and in stores across the country. However, not all CBD oils are created equal and there are certain things you should know before purchasing your first bottle.

CBD Concentration

Some people are not sure what CBD concentration means when buying CBD oil.

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There are many different types, and some can be much stronger than others. The concentration will depend on what you’re looking to use the CBD oil for and how often you plan on using it. The higher the concentration, the stronger the effects are likely to be.

There is also a limit to the amount of THC that can be present in a product. The percentage of THC in CBD oil should be clear on its label.

CBD Dosage

The next thing you should look at is how much CBD is in each dosage (the number of milligrams). Taking a certain amount of CBD will vary depending on the concentration as well as other factors like age or medical needs.

CBD Vendor’s Certificate of Analysis (COA)

Before buying CBD oil, it’s important to check its COA. This will not only ensure that the product is of good quality but also tell you if the vendor has been trustworthy in providing accurate information about the product.

This certificate ensures that the product is safe, and you shouldn’t have any worries about what you’re putting into your body. It lets you know that this product has been tested and meets all safety standards mandated by law.

CBD Source

When shopping for CBD oil, check the CBD’s source. If you’re in the United States, it’s best to buy CBD that uses American-grown organic hemp.

Hemp is a bioaccumulator, which means it absorbs the nutrients and elements from the soil it’s planted. These nutrients are dissolved within the plant’s cell walls and then released throughout its life cycle.

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.

Ideally, hemp should be grown in fertile soil with no harsh chemicals.

Additional Ingredients

CBD products may be formulated with beneficial ingredients like MCT oils or melatonin.

Unfortunately, CBD products can sometimes contain potentially hazardous ingredients, such as vegetable glycerin and propylene. So be aware of these substances and steer clear of CBD products containing them.

Other Products That May Interact With Warfarin

In addition to individual factors, there are several drug interactions that can change how your body reacts.

Warfarin interacts with vitamins, nutritional supplements, drugs, and food. These items may reduce the efficacy of warfarin or increase bleeding risks.

Here’s a list of common foods and drinks to avoid while taking warfarin:

  • Grapefruit or grapefruit juice
  • Cranberries or cranberry juice
  • Pomegranate or pomegranate juice
  • Garlic
  • Black licorice
  • Alcohol

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

  • Abnormal heart rhythm medications, such as amiodarone (Pacerone, Nexterone)
  • Antibiotics
  • Aspirin or products containing aspirin
  • Antacids or laxatives
  • Antifungal medications, including fluconazole (Diflucan)
  • Colds and allergy medications
  • Ibuprofen (Advil, Motrin IB, etc.)
  • Naproxen sodium (Aleve, Naprelan, etc.)
  • Product containing acetaminophen (Tylenol, etc.)

Here’s a list of common herbal or nutritional supplements to avoid while taking warfarin:

  • Vitamin E
  • Ginseng
  • Green tea
  • Dong quai (Angelica sinensis)
  • St. John’s wort
  • Coenzyme Q10 (ubiquinone)

Key Takeaways on Interactions Between CBD and Warfarin

The body absorbs CBD through the CPY450 system, which also helps your body process warfarin. Therefore, combining CBD with warfarin is not advisable.

If you insist on taking CBD together with it, warfarin may stay in your body for longer than necessary. This can lead to severe side effects such as excessive bleeding and even death from overdose.

If you’re on warfarin or about to use this medicine, be mindful of the other foods, drugs, and supplements that you should avoid as well.

CBD oil is a legal and safe drug in the United States. However, there are laws different for every state and you should make sure we check the law first before you buy CBD oil.

There are many benefits of using CBD. However, there are many fake products out there that don’t meet quality standards. To maximize its benefits and prevent any harm to your body, be sure to buy from a trusted source. You should also make sure that the product has been third-party tested.

Most importantly, it’s highly recommended to seek medical advice before using CBD products as a replacement for a prescribed drug or a nutritional supplement.

Have you tried taking CBD and warfarin together? Share your experience in the comments below to help other readers!

References:

  1. Grinspoon, P. (2019, Aug 27). Cannabidiol (CBD) — what we know and what we don’t. Retrieved from https://www.health.harvard.edu/blog/cannabidiol-cbd-what-we-know-and-what-we-dont-2018082414476. (1)
  2. Yamaori S., Koeda K., Kushihara M., Hada Y., Yamamoto I., Watanabe K. Comparison in the in vitro inhibitory effects of major phytocannabinoids and polycyclic aromatic hydrocarbons contained in marijuana smoke on cytochrome P450 2C9 activity. Drug Metab Pharmacokinet. 2012;27(3):294–300. (2)
  3. Deaton, J. G., & Nappe, T. M. (n.d.). Warfarin Toxicity. StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK431112/
  4. Doliner B, Jaller JA, Lopez AJ, Lev-Tov H. Treatments to prevent primary venous ulceration after deep venous thrombosis. J Vasc Surg Venous Lymphat Disord. 2019 Mar;7(2):260-271.e1.
  5. W., M., D., K., & M., B. (2013). Co-administration of rivaroxaban with drugs that share its elimination pathways: pharmacokinetic effects in healthy subjects. doi: 10.1111/bcp.12075.
  6. Ganetsky, M., Babu, K. M., Salhanick, S. D., Brown, R. S., & Boyer, E. W. (2011). Dabigatran: Review of Pharmacology and Management of Bleeding Complications of This Novel Oral Anticoagulant, 7(4). doi: 10.1007/s13181-011-0178-y
  7. Sharp CR, deLaforcade AM, Koenigshof AM, Lynch AM, Thomason JM. Consensus on the Rational Use of Antithrombotics in Veterinary Critical Care (CURATIVE): Domain 4-Refining and monitoring antithrombotic therapies. J Vet Emerg Crit Care (San Antonio). 2019 Jan;29(1):75-87.
  8. Badjatiya A, Rao SV. Advances in Antiplatelet and Anticoagulant Therapies for NSTE-ACS. Curr Cardiol Rep. 2019 Jan 12;21(1):3.
  9. Unger, E. F. (2015, October 16). Atrial fibrillation and new oral anticoagulant drugs. Retrieved from https://www.fda.gov/drugs/news-events-human-drugs/atrial-fibrillation-and-new-oral-anticoagulant-drugs
  10. Coetzee, C., Levendal, R. A., van de Venter, M., & Frost, C. L. (2007). Anticoagulant effects of a Cannabis extract in an obese rat model. Phytomedicine, 14(5). doi: 10.1016/j.phymed.2006.02.004
Nina Julia

Nina created CFAH.org following the birth of her second child. She was a science and math teacher for 6 years prior to becoming a parent — teaching in schools in White Plains, New York and later in Paterson, New Jersey.

Is cannabis a blood thinner?

Ever wondered how cannabinoids like THC or CBD affect your blood? It may seem like a weird question, but it is a vitally important one for anyone taking anticoagulant medications and considering using cannabis. It turns out that this issue has been under-researched and could have significant impacts on patients who may be at greater risk of heart attacks and strokes.

What is a blood thinner?

It is not uncommon for patients at a high risk of blood clots and strokes to receive medications called “anticoagulants” or “antiplatelet drugs”, often generically referred to as “blood thinners.” These drugs do exactly what you might expect – prevent blood from forming a clot. It is important to note that while clotting is good and necessary when you have a cut or injury, forming a clot inappropriately can be highly dangerous. Blood clots can greatly interrupt blood flow to the surrounding tissue, causing serious damage to important organs, and sometimes death. Some common examples of anticoagulant blood thinning medications on the market include warfarin (Coumadin), heparin, apixaban (Eliquis), and enoxaparin (Lovenox). One of the most common examples of an antiplatelet drug is aspirin.

How do blood thinners work?

Blood thinners typically act in one of two ways – as anticoagulants or antiplatelets. But before we explain how these drugs work, it is important to understand a couple of things about blood clotting in the human body.

Blood consists of several primary constituents including plasma, red blood cells, white blood cells, and platelets. Whenever we injure ourselves and break a blood vessel, causing bleeding, platelets start to attach to the damaged tissue and act as a kind of cork that plugs the hole in the blood vessel. 1

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Blood thinners disrupt the blood clotting process in one of two ways. Anticoagulants typically slow down the process of blood clotting by interrupting clotting factors, whereas antiplatelet drugs prevent platelets from coming together to form blood clots in the first place.

Typically, “blood thinners” refer to anticoagulants, though you may find the term “blood thinner” applied to either anticoagulants or antiplatelet drugs.

Does weed thin your blood?

The short answer is – no, in most cases cannabinoids do not seem to act as strong blood thinners. There are very few case studies that report anticoagulant effects in cannabis patients, and the ones that do exist involve using cannabis with traditional anticoagulant medications. 2

While the general concensus is that phytocannabinoids (derived from the cannabis plant) do not cause anticoagulations, there has been only one study that found that THC, CBD and CBN could thin the blood of obese rodents. Preclinical rodent studies are challenging to interpret, however, as the results very often don’t directly scale to the human biological system. In this study the authors speculated that cannabinoids may be inhibiting an enzyme in blood plasma called thrombin, which promotes blood clotting. Additionally, the authors noted that THC (and CBD for that matter) are known to interact with receptors known as PPARy 3 , which are highly present in blood vessels. Lastly the authors note that certain endocannabinoids like anandamide may promote clotting, but these tests were in vitro (aka in a laboratory test-tube), not in a living animal. 4

There have also been reports that synthetic cannabinoids, aka spice or K2, may cause blood thinning due to contaminants found mixed with the cannabinoids. Basically, rat poison designed to work by making rodents bleed to death is occasionally mixed with synthetic cannabinoids, either accidentally or as a cutting agent, which can cause coagulopathy (aka inappropriate clotting). In this case, hundreds of patients were seen in emergency departments in 2018 with signs of bleeding with no known cause. It was later found that many of these patients had been consuming synthetic cannabinoid products, and these products were contaminated with rat poison. This is yet another cautionary tale regarding synthetic cannabinoids and another reason why cannabis regulations allowing for safe access to cannabis are so important. 5 6

Is it safe to use THC with blood thinners?

This is a tricky one given the lack of research. In general patients taking anticoagulants often have cardiovascular issues, which can be problematic with cannabis use as THC is known to cause changes in heart rate and blood pressure. This effect is particularly strong with smoking or vaping THC products, but can also happen with edibles. So it follows that THC should likely be avoided if a patient is taking blood thinners.

If a patient is taking anticoagulants, that could indicate that their cardiovascular system may not be in the best of health to begin with. This can be problematic with cannabis use, in particular THC which is known to cause changes in heart rate and blood pressure. Generally, patients with high risks of strokes, heart attacks and other cardiovascular dysfunction are those most commonly prescribed blood thinners. Since THC carries its own risk of exacerbating cardiovascular issues in susceptible users and should likely be avoided if a patient is taking blood thinners. 7

As far as THC’s anticoagulant effects are concerned, there is very limited evidence that THC may act as an anticoagulant by inhibiting thrombin, but that evidence is in rodents and stems from only one study mentioned previously. The real concern about THC in this population is actually related to blood pressure, heart rate and heart rhythm; an older heart may be even more susceptible to these changes. 8 9

CBD and Blood Thinners

As mentioned previously, CBD is a known PPARy receptor agonist, causing vasorelaxation and lowering blood pressure. CBD is also known to interfere with the normal function of certain enzymes already inside of us, known as cytochrome P450 enzymes. These CYP450 enzymes are all over our bodies and play important roles in metabolizing food and drugs. Cannabidiol is a known inhibitor of some CYP enzymes, leading to an increased risk of pharmaceutical drug interactions. And CBD is not alone in this effect. Many other phytocannabinoids do carry this potential to interfere with liver enzymes – though all of them do so with lesser potency than CBD. In simple terms, CBD can slow the body’s ability to break down common medications – including blood thinners.

There are multiple case reports available which detail situations in which patients have experienced herb-drug or drug-drug interactions between CBD and a common anticoagulant, warfarin (Coumadin). In one instance, a 46-year-old male patient required a nearly 20% reduction in their warfarin dose after beginning Epidiolex, a pharmaceutical containing CBD isolate in a liquid solution. In another instance, a 44 year-old male patient required a 30% dose reduction in warfarin after starting to use CBD oil. There was, however, one case report where this drug interaction did not occur. 10 11 12 13 14

These drug interactions highlight some important lessons. First, it is important to recognize that pharmaceutical interactions with cannabis are very real and can be dangerous if not monitored properly – especially in the context of drugs like blood thinners. However, there is a flip side to this drug interaction issue. Oftentimes, if a patient and their physician are aware of these potential interactions, it’s possible a patient could choose to continue using anticoagulants and cannabis together. This combination would likely warrant close monitoring of the anticoagulant effects, and would certainly require increased communication between the patient and the medical provider. But if monitored properly, it’s possible that the dose of patient’s anticoagulants could be reduced, possibly reducing the risk of serious negative side effects from those medications while still deriving benefit from the cannabinoids.

Bottom line: Talk to your healthcare provider

So what does all of this mean? Is marijuana a blood thinner?

According to the miniscule amount of research that has been performed so far on this topic, it is possible that cannabinoids like THC or CBD could act as anticoagulants, and the endocannabinoid system is involved in platelet aggregation. However, it appears this effect may only be in certain contexts, for instance, in the rodent study that identified anticoagulant effects of THC, CBD and CBN, the rodents were obese rodents in a simulated Type-2 diabetes model. In that scenario, cannabinoids exhibited anticoagulant effects by inhibiting the blood clotting signaling compound thrombin. However, we do not know how that would scale up to humans with Type 2 diabetes or other conditions. 15

We do know that cannabinoids can interact negatively with blood thinning medications, either by inhibiting their breakdown and elevating their concentrations in the body or by preventing their activation. In both cases, this can be extremely dangerous for patients, as coagulation of blood is a fine balance of clotting and bleeding, and the result of managing these medications poorly can be as serious as death. This is why it is so important to talk to a healthcare professional if you plan to try using cannabis in combination with anticoagulant and antiplatelet medications. Your physician can arrange regular blood tests to monitor for interactions with other medications and take appropriate steps as needed to keep you safe.

So for now, the jury is still out. There is a tiny bit of preclinical evidence that cannabinoids may affect blood’s ability to clot, but a lot more research is still needed. However if you combine cannabis products, especially CBD, with your anticoagulant or antiplatelet medication, be sure to take extra caution to monitor the effects with your doctor.

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