CBD Gummies And Warfarin

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Taking warfarin with CBD can make warfarin stay in the body for too long without being broken down. This may have detrimental effects like overdose. Learn more. Warfarin is an anticoagulant that helps to prevent blood clot formation and is used to treat deep vein thrombosis WebMD provides information about interactions between Coumadin and antipsychotics-sibutramine.

CBD and Warfarin – August 2022

Warfarin (brand names: Coumadin, Jantoven) is an oral anticoagulant or blood thinner that is primarily used to help prevent and treat blood clots. It can also be administered to treat blood clots arising from certain heart conditions, heart attack, or open-heart surgery (4 ) .

Warfarin is metabolized by Cytochrome P450, also known as CYP450. It is a class of liver enzymes that play an essential role in the metabolism of warfarin and other medications before the drugs are cleared through the renal system (5 ) .

CYP450 includes CYP3A4, CYP1A1, CYP2C8, CYP1A2, CYP2C18, CYP219, and CYP2C69, which predominantly metabolize warfarin (6 ) .

Consequently, medications, treatments, and other factors that affect the CYP269 enzyme can also alter the effects of warfarin in the body (7 ) .

Like warfarin, CBD is metabolized through the hepatic P450 enzyme system. Both CBD and warfarin share similar proteins during their respective metabolism processes.

CBD is metabolized by the body through CYP1A1, CYP1A2, CYP2C19, CYP3A4, CYP2D6, CYP269, and CYP3A5, five of which are active enzymes that act on warfarin.

A 2017 study facilitated by the U.S. National Library of Medicine National Institutes of Health explained that CBD competes in a similar metabolic pathway with that of warfarin (8 ) .

CBD also acted as a powerful inhibitor of CYP3A4 enzymes, which can diminish the degradation of warfarin (9 ) . This is also known as the “grapefruit effect” as the grapefruit juice can also slow down the body’s absorption of warfarin (10 ) .

As such, taking warfarin together with CBD can make warfarin stay in the body for too long without being broken down. This may have detrimental effects such as bleeding, or worse, overdose (11 ) .

This is why regular measurement of a user’s international normalized ratio (INR) is necessary, more so when warfarin is taken with CBD. It ensures that the blood levels remain within a narrow range to avoid the side effects brought by warfarin.

Mayo Clinic presented a number of warfarin side effects that require immediate medical attention (12 ) :

  • Excessive bleeding, including heavy menstrual bleeding, nosebleed, and internal hemorrhage
  • Bloody or black stool
  • Brown or red urine
  • Reduced urine output
  • Bruises that appear even without suffering from any injury
  • Chronic pain in the stomach
  • Vomiting of blood
  • Changes in the vision
  • Unusual weakness, tiredness, or dizziness
  • Joint pain, swelling or discomfort, especially after experiencing an injury
  • Stupor

Other less serious side effects of warfarin are:

  • Bleeding between menstruation period
  • Gum bleeding after brushing the teeth
  • Vomiting, diarrhea, or being unable to eat for 24 hours or more
  • Fever

In rare cases, warfarin can also cause necrosis or death of skin tissue. Any changes in skin temperature or color, as well as severe pain on the skin, warrant prompt medical care. Be on the lookout for blotchy, net-like spots on the skin, too.

Pain in the toes, especially when they turn dark or purple in color, signifies a severe health problem.

Patients who intend to use CBD with warfarin must seek the advice of a licensed medical professional first to ensure that the drug interactions will be beneficial to their health.

Can Another Oral Anticoagulant Be a Substitute for Warfarin so CBD Oil Can Be Taken?

Among the remaining three oral anticoagulants approved by the FDA to treat irregular rapid heart rate, two are also metabolized by the CYP450 system. Thus, they can also be subjected to the grapefruit effect of CBD (13 ) .

These oral anticoagulants are rivaroxaban and apixaban (14 ) .

Meanwhile, a 2011 review explained that another approved oral anticoagulant, dabigatran (Pradaxa), does not undergo metabolism through CYP450. According to the review, dabigatran has shown a few drug-food and drug-drug interactions. Medical professionals are also considering dabigatran as a substitute for warfarin therapy (15 ) .

However, it is still best to schedule a consultation with a health professional before taking any anticoagulant along with CBD to ascertain safety and body tolerance.

The U.S. Food and Drug Administration or FDA has authorized the use of warfarin for the following purposes:

  • Treat clots that form in the vein (venous thrombosis) and associated pulmonary embolisms or blood clot in the lungs (16 )
  • Treat thromboembolic complications caused by cardiac valve replacement or irregular or rapid heart rate (atrial fibrillation) (17 )
  • Reduce the risk of death, recurrent heart attack or myocardial infarction (MI) and other thromboembolic events such as stroke and systemic embolism that may occur after a cardiac arrest (18 )

Can CBD Replace Warfarin?

There is no specific study or case report that directly expounds on CBD as a safe substitute for warfarin or any anticoagulants.

One study used an obese rat model to describe how cannabis extract could possibly contain anticoagulant effects is that of a 2007 study written in the journal Phytomedicine (19 ) .

The study showed that cannabinoids such as cannabinol (CBN) and tetrahydrocannabinol (THC) demonstrated anticoagulant activity (20 ) .

Thus, the authors suggested that Cannabis sativa and the cannabinoids THC and CBN can be potentially used to treat thrombosis and type 2 diabetes, a kind of ailment which could cause an irregular increase of blood clotting (21 ) .

Since there are limited studies on whether CBD can act as an anticoagulant, it is still best to ask a medical expert before considering CBD as a replacement for a prescription drug, and there is currently no evidence to suggest that CBD could be anticoagulant medications.

What to Look for in a CBD Product

There are several things to keep in mind before purchasing CBD products, the first of which is seeking a doctor’s approval. Once it is done, consider these action steps prior to buying any CBD product.

  1. Check the laws in the area where the product will be bought and consumed. In the United States, there are jurisdictions that have specific restrictions regarding the allowable THC content in CBD products.
  2. Take time to read reviews before buying from an online store. When buying from a clinic or a physical store, make sure that it is an authorized CBD seller by the government. Remember to purchase from reliable and legitimate brands only.
  3. Examine the additional ingredients. Some products include beneficial ingredients like MCT oils or melatonin. However, there are also CBD products that contain potentially dangerous ingredients such as vegetable glycerin and propylene.
  4. Determine the right dosage. CBD intake may be low dose or higher depending on the user’s condition.
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It is advisable to talk to a trusted and experienced medical professional who has deep knowledge about CBD to minimize probable risks and avoid side effects, especially because CBD has other verified drug interactions, too.

Studies show that aside from warfarin, CBD also inhibits the metabolism of other drugs, including clobazam, an anti-epileptic medicine (22 ) .

The grapefruit effect also applies to certain kinds of benzodiazepines, a class of prescribed medications for anxiety. Some of the benzodiazepines that are metabolized by the CYP450 system are alprazolam (Xanax), brotizolam, triazolam, and midazolam (23 ) .

An author and professor of medicine at Harvard Medical School, Peter Grinspoon, MD, warns the public through a Harvard Health article that CBD can cause nausea, irritability, and fatigue (24 ) .

In addition, Brent A. Bauer, M.D., medical editor of Mayo Clinic Book of Alternative Medicine , also explained that other side effects of CBD include diarrhea, reduced appetite, dry mouth, fatigue, and drowsiness (25 ) .

What food, supplements, and drugs interact with warfarin?

Warfarin, like other medications, can interact with vitamins, nutritional supplements, drugs, and food. The interaction might lessen the efficacy of warfarin or increase the risk of bleeding.

Aside from grapefruit, some of the typical food and drinks that can interact with warfarin are:

  • Garlic
  • Alcohol
  • Cranberry juice or cranberries
  • Pomegranate
  • Black licorice

Common herbal or nutritional supplements that might interact with warfarin include:

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

Some of the common drugs that have been identified to have warfarin interaction include:

  • Laxatives or antacids
  • Aspirin or any product that has aspirin
  • Antifungal medications like fluconazole (Diflucan)
  • Acetaminophen or any product that has acetaminophen
  • Several antibiotics
  • Allergy or cold medicines
  • Naproxen sodium (Naprelan, Aleve) or ibuprofen (Motrin IB, Advil)
  • Medications used to treat abnormal heart rhythms (Nexterone, Pacerone)

Some of the medical conditions that can also increase the risk of bleeding are:

  • Uncontrolled blood pressure
  • Stomach ulcer, peptic disease or gastritis
  • Cancer
  • Alcoholism
  • Kidney ailments
  • Liver disease
  • Increased risk of falling
  • Stroke history

The presence of the following ailments may affect the usage of warfarin:

  • Catheter insertion
  • Congestive heart failure
  • Anemia
  • Diabetes
  • Kidney disease
  • Blood disease called Polycythemia vera
  • Deficiency in Protein C
  • Thrombocytopenia (heparin-induced)
  • Bowel problems or stomach ache including bleeding
  • Inflammation of blood vessel (vasculitis)
  • Spinal anesthesia
  • Intestinal or stomach ulcer
  • Threatened miscarriage (patients who have this condition are strictly discouraged from taking warfarin)
  • Deficiency in Vitamin K
  • Malnutrition
  • Fats in the stool or steatorrhea
  • Diarrhea
  • Trauma

How to Minimize the Risk of Bleeding while Taking Warfarin

There are action steps that can be taken to lower the risk of bleeding while undergoing warfarin treatment:

  • Inform the attending physician of all the medications and supplements that a patient is taking. Doing so can help the doctor evaluate if further testing or dosage adjustment is needed, or if a new drug might alter the effect of the warfarin treatment.
  • Be cautious of injury, especially from falling. As much as possible, abstain from participating in contact sports that may cause bruising or physical damage. Report any chronic pain in case an injury occurred.
  • Keep away from sharp objects to avoid being cut.
  • Refrain from nose-picking and, if needed, gently blow the nose.
  • If a patient who is having warfarin treatment undergo surgeries or even minor procedures like dental cleanings or vaccinations, tell the assigned health care provider about it to ensure proper and safe medical attention.
  • Use a soft-bristled toothbrush, electric razor, and waxed dental floss for hygiene and grooming. Ask the physician for a safer way to clean the gums and teeth.
  • In case of emergency, it will be helpful if a patient has a card or note that says he is having warfarin treatment (and other medications, if any) so the medical providers can take the right course of action.

Understanding the Role of Vitamin K with Warfarin Treatment

Vitamin K is a nutrient that can lessen the effectiveness of warfarin. However, it is vital for the heart and bones. Consistency in Vitamin K intake is necessary when taking warfarin. A sudden increase in Vitamin K consumption can significantly increase clotting risk.

The recommended Vitamin K intake level for adult men and women is 120 micrograms (mcg) and 90 mcg, respectively.

Food and drinks that are rich in Vitamin K include:

  • Spinach
  • Kale
  • Collards
  • Chard
  • Mustard greens
  • Turnip greens
  • Broccoli
  • Asparagus
  • Plums
  • Asparagus
  • Rhubarb
  • Green tea
  • Brussels sprouts
  • Certain oils extracted from vegetables such as soybean oil and canola oil

Before making any changes in the diet, it is encouraged to consult a physician for proper guidance.

Conclusion

Cannabidiol or CBD is one of the chemical compounds found in the cannabis plant. It is a non-psychoactive substance, which means it will not make a person “high”. The body reacts to cannabinoids through the receptors in the endocannabinoid system.

Since CBD is absorbed by the body through the CPY450 system, which is also responsible for the metabolism of warfarin in the body, it is not recommended to take CBD and warfarin together. Doing so may cause the warfarin to stay longer in the body than necessary and may lead to harmful effects such as excessive bleeding and overdose.

Expert medical advice is highly encouraged before consuming CBD products either as a replacement for a prescribed drug or a nutritional supplement.

Yamaori S., Ebisawa J., Okushima Y., Yamamoto I., Watanabe K. Potent inhibition of human cytochrome P450 3A isoforms by cannabidiol: role of phenolic hydroxyl groups in the resorcinol moiety. Life Sci. 2011;88(15–16):730–736
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.
Deaton, J. G., & Nappe, T. M. (n.d.). Warfarin Toxicity. StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK431112/
Mayo Clinic. (2020, February 1) Warfarin (Oral Route) Retrieved from: https://www.mayoclinic.org/drugs-supplements/warfarin-oral-route/description/drg-20070945
Lynch T, Price A. The Effect of Cytochrome P450 Metabolism on Drug Response, Interactions, and Adverse Effects. Am Fam Physician. 2007 Aug 1;76(3):391-396. Retrieved from https://www.aafp.org/afp/2007/0801/p391.html
Coumadin Product Data- FDA. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5789126/
Johnson J.A. Clinical pharmacogenetics implementation consortium (CPIC) guideline for pharmacogenetics-guided warfarin dosing: 2017 update. Clin Pharmacol Ther. 2017 (n/a-n/a); Whirl-Carrillo M., EMM, Hebert J.M., Gong L., Sangkuhl K., Thorn C.F. Pharmacogenomics knowledge for personalized medicine. Clin Pharmacol Ther. 2012;92(4):414–417; Wadelius M., Chen L.Y., Downes K., Ghori J., Hunt S., Eriksson N. Common VKORC1 and GGCX polymorphisms associated with warfarin dose. J Pharm. 2005;5(4):262–270. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5789126/
Yamaori and Koeda, op. cit.
Yamaori and Okushima, op. cit.
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 .
Deaton, J. G., & Nappe, T. M. (n.d.). Warfarin Toxicity. StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK431112/
Mayo Clinic. Warfarin Side Effects: Watch for Interactions. Retrieved from https://www.mayoclinic.org/diseases-conditions/deep-vein-thrombosis/in-depth/warfarin-side-effects/art-20047592
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.
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.
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
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.
Badjatiya A, Rao SV. Advances in Antiplatelet and Anticoagulant Therapies for NSTE-ACS. Curr Cardiol Rep. 2019 Jan 12;21(1):3.
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
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
Anderson, L. L., Absalom, N. L., Abelev, S. V., Low, I. K., Doohan, P. T., Martin, L. J., … Arnold, J. C. (2019). Coadministered cannabidiol and clobazam: Preclinical evidence for both pharmacodynamic and pharmacokinetic interactions. Epilepsia, 60(11). doi: 10.1111/epi.16355.
Otani, K. Cytochrome P450 3A4 and Benzodiazepines. Seishin Shinkeigaku Zasshi. 2003;105(5):631-42. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/12875231
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 .
Bauer, B. A. (n.d.). What are the benefits of CBD — and is it safe to use? Retrieved from https://www.mayoclinic.org/healthy-lifestyle/consumer-health/expert-answers/is-cbd-safe-and-effective/faq-20446700

Table of Contents

  • Does CBD interact with warfarin?
  • Can CBD Be Taken with Warfarin?
  • Can Another Oral Anticoagulant Be a Substitute for Warfarin so CBD Oil Can Be Taken?
  • Can CBD Replace Warfarin?
  • What to Look for in a CBD Product
  • What food, supplements, and drugs interact with warfarin?
  • How to Minimize the Risk of Bleeding while Taking Warfarin
  • Understanding the Role of Vitamin K with Warfarin Treatment
  • Conclusion
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Dr. Aaron Wiegmann, BS, FL, MD, MS

Aaron Wiegmann, BS, FL, MD, MS is a general surgeon and scientist currently training to become a plastic and reconstructive surgeon. He practices in Chicago, where he was born and raised. He has several peer-reviewed publications (mostly on surgical outcomes).

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Can you consume CBD gummies along with Warfarin?

Warfarin is an anticoagulant that helps to prevent blood clot formation. It is mainly used to treat deep vein thrombosis, myocardial infarction, pulmonary embolism, etc.

On the other hand, CBD is present in marijuana and hemp plants to help treat insomnia, inflammation, anxiety, and more. Since Warfarin is a blood thinner, one of the most commonly asked questions is if it can be mixed with Sunday Scaries CBD gummies . We will discuss it thoroughly in the coming sections.

What is the impact of CBD on the body?

Many people use CBD oil because of the benefits that it has to offer. CBD is obtained from cannabis plants and can have numerous positive impacts on the body. Hemp-based oil has been legalized in many places. Nonetheless, the legality of marijuana-based CBD oil will vary significantly .

Contrary to popular belief, CBD isn’t addictive. Therefore, it can have different impacts on the body. CBD will not get you high and isn’t psychoactive. Nonetheless, CBD does the following benefits:

  • Treats acne
  • Weight management
  • Brain health
  • Relieves pain
  • Healthy for the cardiovascular system
Will CBD gummies interact with medicines?

There are numerous health supplements and herbal products that can interact with CBD. While you start using CBD gummies, you need to understand if they will interact with medicines. As a result, when you introduce CBD to your body, you will need to reduce the use of other drugs.

You should know that not every medicine can be taken together. Therefore, it is advisable to consult professionals before starting the use. The influence of drug interactions will have an essential role in determining if you should be using or not. Furthermore, it would help to consider the dose of medicine, your health condition, and CBD dosage . Talk to your doctor whenever you start using CBD gummies or any medicine.

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Will CBD gummies interact with Warfarin?

Yes. Therefore, it is advisable not to consume CBD gummies with warfarin. The interaction will vary depending on the dosage of consumption. Since it can pose a high risk, you shouldn’t start usage unless you’re advised. The combination will have a slow impact on the body.

It will break down and eliminate warfarin from the body. As a result, your body will increase serum levels. If the serum concentration in your body increases, you will likely experience some side effects. These side effects require immediate medical conditions, or they can cause internal bleeding.

How do CBD gummies interact with Warfarin?

The CBD interaction with Warfarin usually happens in two ways. These include:

This condition happens when two medicines will require the same enzyme for metabolism. As a result, both will start competing against each other to get the enzyme. The metabolic inhibitor will lead to slower elimination. As a result, it will slow down the metabolism of both drugs.

The metabolism of Warfarin happens through CYP459 enzymes. However, the CYP2C19 and CYP3A4 enzymes play a significant part, whereas those with lesser impact include CYP2D6, CYP3A5, and CYP1A22.

These enzymes play an essential role in the metabolism of CBD as well. Therefore, when these two medicines are taken together, CBD gummies overpowers Warfarin. As a result, the body may notice the excessive accumulation of Warfarin, which may eventually lead to various side effects, mainly headache and bruising.

While the previous impact slows down, it can also lead to an increased effect that can be dangerous. This condition occurs because two drugs will have the same impact on the body. If these two medicines are used together, they will act upon the same receptor, causing directional impact.

Since CBD gummies are overpowering, it will take over Warfarin, thereby ensuring the latter’s accumulation in the body. When Warfarin stays in your body for a long time, it will become potent, increasing the risk of side effects.

Should you take CBD gummies with Warfarin?

No. As suggested above, CBD gummies and Warfarin can pave the way for a host of side effects. Over-accumulation of Warfarin in the body will cause most of the side effects. As a result, the process of blood clotting will become slow. Therefore, people will be prone to bleeding easily, increasing the risk of bruising and internal bleeding. Many people may also experience hemorrhage, even due to minor injuries.

Medical professionals recommend never to take these two medicines together. You should see a doctor before you start using CBD gummies with Warfarin. The same may be followed when using any other blood-thinning medicine. It is often advisable to start with a minimal dosage of CBD gummies.

Can CBD gummies replace Warfarin?

While CBD gummies are more potent than Warfarin, it shouldn’t be an efficient replacement. Every medicine works differently and can help treat different conditions. CBD as a base will often have an anticoagulant impact, and the anticoagulant impact due to CBD gummies is weaker than that of Warfarin. Furthermore, Warfarin is a prescription drug. Therefore, people can’t use CBD gummies as an alternative unless advised.

What increases the risk of internal bleeding?

However, the treatment of Warfarin can increase the risk of internal bleeding in the initial stages. However, the impact will be severely high for older adults, and it will have the same impact on various blood-thinning medicines.

Common conditions that may contribute to the increased risk of bleeding due to Warfarin usage include kidney problems, alcoholism, liver disease, stroke, blood pressure, gastritis, ulcer, and peptic disorders. Genetic factors are also an important point to consider. The doctor will be able to recommend genetic tests that can eventually help you understand what the best Warfarin dosage is.

Conclusion

If you plan to use CBD gummies and Warfarin together, you need to be familiar with the side effects. Our body will absorb CBD with the help of CPY450, which also impacts the absorption of Warfarin. Many times consistent usage can also increase the risk of fatality.

Before using any product, you must seek medical advice. The cbd cherry gummies can prove to be highly beneficial. However, it is always advisable to be familiar with the dosage quantity. Furthermore, it is advisable to go for only the tested products.

Warfarin/Cannabinoids Interactions

This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.

Medical warning:

Moderate. These medicines may cause some risk when taken together. Contact your healthcare professional (e.g. doctor or pharmacist) for more information.

How the interaction occurs:

Products that contain active ingredients from cannabis such as THC or CBD may slow down how quickly your body processes warfarin.

What might happen:

You may experience an increased chance for bleeding including bleeding from your gums, nosebleeds, unusual bruising, or dark stools.

What you should do about this interaction:

Make sure your healthcare professionals (e.g. doctor or pharmacist) know that you are taking dronabinol, using cannabis products such as CBD oil, or using marijuana. You may need to have your bleeding tests (e.g. INR) checked more often, especially when you first start taking these products, if the dose changes, or if you increase or decrease use of cannabis products and marijuana. If you have any signs of bleeding, such as bleeding from your gums, nosebleeds, unusual bruising, or dark stools, contact your doctor right away.Your healthcare professionals may already be aware of this interaction and may be monitoring you for it. Do not start, stop, or change the dosage of any medicine before checking with them first.

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