Xarelto And CBD Oil


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Xarelto And CBD Oil Hi there! The cytochrome p450 system accounts for 70 to 80 percent of the enzymes involved in drug clearance, making it the most important system for drug metabolism. Both Learn the risks, benefits, and possible side effects of taking CBD oil while on blood thinner medication. Contributor: Dr. Augustine Provencio, MD, ABFP TEST Xarelto Pill Box CBD and Xarelto explained. The anticoagulant Xarelto can treat clotting disorders,

Xarelto And CBD Oil

Hi there!
The cytochrome p450 system accounts for 70 to 80 percent of the enzymes involved in drug clearance, making it the most important system for drug metabolism. Both THC and CBD are competitive inhibitors of three different enzymes in the cytochrome p450 system, two of which are involved in the metabolism of Xarelto (rivaroxaban). This means that CBD and THC are competing for the same receptors as is Xarelto. So when Xarelto is taken concurrently with CBD and/or THC, Xarelto levels could possibly rise. When Xarelto levels rise excessively, blood clotting may become compromised, leading to signs ranging from frequent bloody noses, all the way on up to a potentially fatal event, such as a hemorrhagic stroke or heart attack.

A case report published in 2009 described a patient who was on coumadin (Warfarin) —the most commonly prescribed blood thinner— therapy for eleven years. He was admitted to the hospital for a severe gastrointestinal bleed when he confessed to consuming much more cannabis than was typical for him; his INR was 10.41 (therapeutic range is usually between 2 and 3); after inpatient treatment, his INR normalized; then, fifteen days after being discharged, he was readmitted with an INR of 11.55; after he quit using cannabis, his INR remained between 1.08 and 4.40 and he suffered no further complications.

Another case report suggested that extremely high doses of CBD can lead to markedly elevated coumadin levels. Enrolled in a clinical trial evaluating CBD as a potential treatment for epilepsy, the test subject was given extremely high doses of CBD. He was first given doses averaging 265mg, which resulted in a slightly elevated coumadin level; at doses averaging 528mg, the coumadin levels were markedly elevated; after reducing the coumadin dose, INR results normalized. Relevantly, very few patients, if any, would ever take as much CBD.

However, as previously mentioned, a highly elevated Xarelto level can lead to serious, even fatal, consequences. And because the effects of cannabis on Xarelto levels have yet to be sufficiently studied, you should discuss the matter with your prescribing physician and monitor your INR results with extra vigilance.

You’re very welcome Colly. CBD and Xarelto would still compete for the same p450 isoenzymes. However, because CBD has low affinity to those isoenzyes, it would take much more than 40mg to affect coagulation. Your anesthesiologist will make sure coagulation isn’t compromised with a blood test prior to surgery. Best of luck!

Blood Thinners and CBD Oil Interaction

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.

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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.

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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 Xarelto

CBD and Xarelto explained. The anticoagulant Xarelto can treat clotting disorders, which are diseases of the blood. If you take Xarelto and are interested in CBD for health benefits, speak with your doctor first.

CBD is sometimes taken to treat pain or inflammation and may sound like a safer option than prescription medications. But is it safe to combine the two?

Is it Safe to Mix CBD and Xarelto?

It is not safe to combine CBD and Xarelto because CBD changes the way your body metabolizes certain drugs. Some research has shown that CBD affects metabolic enzymes that break down Xarelto. Discuss your plan with your healthcare team before making any medication changes.

What is Xarelto?

Xarelto (Rivaroxaban) is a prescription anticoagulant. It can treat or prevent the formation of blood clots. If clots form in the cardiovascular system, they can become lodged in critical organs. A clot lodged in the veins of the lungs is called a pulmonary embolism, and one stuck in the veins of the legs or arms is called a deep vein thrombosis.

Xarelto can also prevent blood clots after surgery or in those have atrial fibrillation, an irregular heart rhythm.

Why Could it Be Unsafe to Mix CBD and Xarelto?

CBD changes how your body breaks down drugs, which can lead to higher levels of Xarelto in the bloodstream. When your body breaks down drugs more slowly than usual, it is similar to taking more Xarelto than prescribed.

Cytochrome P450 Enzymes

Enzymes are unique proteins that carry out roles in the cells. They can speed up chemical reactions, or they can help to break down waste products, drugs, or medications.

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CBD affects a family of metabolic enzymes called cytochrome P450 (CYP450). There are over 50,000 different kinds of CYP450 enzymes, which all break down different things.

Metabolic enzymes are found in tissues all over your body, but this article will focus on the ones found in your gut and liver. CYP450 enzymes break down about 60% of prescription drugs.

Drug Metabolism Basics

When you take a medication by mouth, it travels to the stomach and then the small intestine. CYP450 enzymes in the small intestine may start breaking down the drug before it enters the bloodstream. Most drugs are mostly intact by the time they enter circulation.

One in the bloodstream, Xarelto is first transported to the liver through the hepatic portal vein. The liver has a high concentration of CYP450 enzymes, which break down a larger portion of Xarelto than those in the small intestine.

After passing through the liver, the remaining medication circulates to the rest of the body. After reaching various parts of your body, Xarelto flows through the blood and into the liver again. This process repeats until the drug is eliminated.

The First Pass Effect and Bioavailability

When you swallow a medication, only a percentage reaches your bloodstream. Some drug is broken down by the liver, and this is called the first-pass effect.

The percentage of drug that reaches the bloodstream after the first-pass effect is called bioavailability. If a drug has a bioavailability of 90%, that means 10% of the drug is lost, and 90% makes it into your systemic bloodstream. Bioavailability varies from drug to drug.

Xarelto has a bioavailability of roughly 60% to 100%, depending on the dose and if you take it with food.

Grapefruit and the First Pass Effect

You may have noticed a warning on some medications that reads, “Avoid eating grapefruit or drinking grapefruit juice while taking this medication.” Drugs carry this warning because grapefruit can affect CYP450 enzymes.

Certain compounds in grapefruit can bind to and shut down CYP450 enzymes. When these enzymes are shut down, the drug stays in the bloodstream for longer than usual. Therefore, grapefruit can increase the level of certain drugs to dangerously high amounts.

The compounds in grapefruit can interact with drugs for a long time. They can permanently shut down certain CYP450 enzymes, sometimes as long as 72 hours.

CBD and the First Pass Effect

Just like grapefruit, CBD changes how fast your body breaks down drugs. A study found that CBD is a powerful inhibitor of the CYP450 enzymes CYP3A4 and CYP3A5. Both of these enzymes play a role in breaking down Xarelto.

When CBD inhibits CYP3A4 and CYP3A5, Xarelto stays in the body for longer. Higher levels of Xarelto can lead to side effects, including higher rates of minor and major bleeding events.

Speak with your doctor or pharmacist before taking CBD, especially if you are taking Xarelto.

Increased Side Effects

If higher than normal amounts of Xarelto are in the body, you could be at a higher risk for unwanted side effects.

Side effects of too much Xarelto may include:

  • Bleeding in the abdomen
  • Bleeding in the brain
  • Bleeding in the lungs
  • Hemorrhagic stroke
  • Liver damage
  • Pain
  • Reduced clotting capabilities
  • Stomach upset
  • Unexplained bruising

Some of these side effects can be life-threatening or even fatal.


It is probably unsafe to combine CBD and Xarelto. CBD changes how fast the body removes Xarelto and causes higher doses in the bloodstream.

Higher levels of Xarelto can increase the rate of dangerous side effects. Some of the side effects of Xarelto can be serious or even fatal. For this reason, CBD should not be combined with Xarelto without the knowledge, consent, and supervision of your healthcare team.

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