Eliquis is one of the most prescribed blood thinners on the market today. But is it safe to use cannabis alongside this drug? Learn the risks, benefits, and possible side effects of taking CBD oil while on blood thinner medication. Eliquis is the brand name of the medication apixaban. It is an anticoagulant medication used to prevent blood clots that could cause a heart attack,
CBD Gummies And Eliquis
Many HelloMD readers are curious about how marijuana interacts with a new type of blood thinner called Eliquis. Here’s what research reveals about the way these two substances work with each other, and whether it’s wise to use cannabis while taking this type of blood thinning drug.
More than three million Americans take Eliquis (apixaban), a blood thinning medication prescribed for treating blood clots and preventing clotting in people with conditions like atrial fibrillation and peripheral artery disease. Eliquis is one of the most prescribed blood thinners on the market today, so many people taking it are also taking other medications and supplements, including cannabis. But is it safe to use cannabis with Eliquis? Read on to learn more.
What is Eliquis?
Eliquis is one of several drugs used to inhibit proteins that cause blood to clot. While clotting is a vital process for closing wounds and protecting them, blood clots that form in the veins and arteries can cause strokes, circulation problems and even death. The “blood thinner” classification also includes older drugs like warfarin (coumadin) and heparin, but they target different factors that affect clotting.
Like warfarin and heparin, Eliquis is used to prevent blood clots from forming in a variety of conditions, including the following:
- Deep vein thrombosis, which can cause clotting in the legs and other parts of the body
- Atrial fibrillation, a condition in which the heart beats irregularly
- Peripheral artery disease, which causes poor blood circulation in the limbs
Eliquis has a number of side effects, mainly excessive bruising and the risk of serious bleeding due to the blood’s inability to clot. That’s why users are told to avoid situations that could cause bruising or bleeding, like working with sharp utensils or playing contact sports.
The risk of bleeding while taking Eliquis increases when it’s used with a long list of other common medications including aspirin, non-steroidal anti-inflammatories (NSAIDs) and herbal supplements including St. John’s Wort. These medications can either cause bleeding on their own, like aspirin, or affect the way the body processes Eliquis. And while research is limited, some studies suggest that cannabis compounds like THC and CBD might have similar effects, especially when used in large amounts.
How Does Cannabis Interact with Eliquis?
Eliquis belongs to a new category of blood thinners called Factor Xa inhibitors. These medications are considered safer and more effective than older anticoagulants like warfarin and heparin. Eliquis blocks Factor Xa, which produces the clotting protein thrombin, while warfarin and similar drugs are vitamin K antagonists, which means that they block Vitamin K’s ability to release clotting proteins. Warfarin and other vitamin K antagonists require regular INR (international normalized ratio) testing to check for blood levels of the drug, but Eliquis doesn’t require regular INR tests.
Because we’re talking about a relatively new drug, much of the research on the interactions between cannabis and blood thinners has focused on warfarin. But although Eliquis and warfarin target different clotting factors in the blood, they’re metabolized by the liver on the same pathways. That gives researchers some insight into the potential effects of cannabis on Eliquis.
The Science of Blood Thinners
The liver metabolizes drugs and other external toxins through a set of enzymes called cytochrome p450, or CYP450. 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.
Within the CYP450 system, specific enzyme groups act on these chemicals to make them available to the body. But when these substances compete for space on the same pathways, they can either boost the activity of enzymes in that pathway, so that chemicals are metabolized quickly, or inhibit it, which slows processing and intensifies the effects of a drug or other substance.
THC and CBD, the most prevalent compounds in cannabis, are processed by the same CYP450 enzyme pathways as Eliquis, warfarin and other blood thinners. This means that cannabis products can affect the way these drugs are metabolized and made available to the body.
Cannabis May Affect How the Drug is Metabolized
Recent research on the effects of cannabis on anticoagulant drugs indicates that cannabis inhibits the activity of the relevant CYP450 enzymes, so that they’re less efficient at metabolizing the drugs. When that happens, blood levels of the drug will rise and its effects on the body are magnified. One study found that high doses of CBD can inhibit the processing of warfarin on shared CYP450 pathways. For one test subject, that led to markedly elevated levels of warfarin, which could cause serious side effects.
Although research on the effects of cannabis specifically on Eliquis are limited, the same CYP450 pathways are involved. So, when Eliquis is taken concurrently with CBD and/or THC, blood levels of Eliquis could potentially rise. And when Eliquis levels rise excessively, blood clotting may be compromised. That could cause outcomes ranging from frequent bloody noses all the way on up to a potentially fatal event, such as a hemorrhagic stroke or heart attack.
Should You Take Cannabis with Eliquis?
With a few exceptions involving very large amounts of CBD and other cannabis products, there has been no reporting of clinical cases of excess anticoagulation due to cannabis use while on Eliquis. Along with that, patients using cannabis in relatively low amounts while taking anticoagulants don’t report any clinically significant effects.
But a highly elevated Eliquis level can lead to serious consequences, so it’s important to discuss using cannabis with your prescribing physician prior to usage, and it goes without saying that it’s imperative you follow their recommendations for staying safe while using Eliquis.
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.
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 Eliquis
Eliquis is the brand name of the medication apixaban. It is an anticoagulant medication used to prevent blood clots that could cause a heart attack, stroke, or pulmonary embolism. Patients taking this medication may be interested in taking CBD for other health conditions but should proceed with caution because its potential interactions with CBD.
If you are considering using CBD for any condition, do your homework before purchasing. You can find an array of products on Amazon and other websites, and not all products contain the same mixture of ingredients.
Check out our review of the Best All-Purpose CBD Gummies you can find on the internet, including many Amazon products.
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CBD and Eliquis
Taking CBD and Eliquis together may increase the blood levels of Eliquis, but we do not know this for sure. There are no studies that have tested drug interactions in people who are taking both at the same time. However, indirect research shows there may be an interaction. The body breaks down Eliquis mostly by using the enzymes CYP3A4 and P-GP. Studies have shown that CBD can inhibit both CYP3A4 and P-GP in humans. Since these are the enzymes that remove Eliquis from the body, taking CBD at the time may increase the levels of Eliquis in the blood.
A drug interaction that increases Eliquis levels can be dangerous. Increased levels of Eliquis can cause uncontrolled bleeding including bleeding in the brain, spine, eye, joints, abdomen or inside the pericardium — the sac that surrounds the heart. Unlike other anticoagulants, there is no easy way to reverse high levels of Eliquis. Andexanet Alfa can reverse Eliquis overdose, but it is only used in hospitals and is very expensive.
Do not, under any circumstances, start to take CBD if you are on a regimen of Eliquis without the knowledge and consent of your doctor. The risk is too great.
Why is Taking Eliquis and CBD Together a Risk?
Adding CBD along with Eliquis can be risky because of interactions between CBD and liver enzymes. These enzymes are what metabolizes Eliquis and many other prescription medications. Let’s explore how Eliquis is metabolized and how CBD can play a role.
What is the First Pass Effect?
When you take Eliquis by mouth, it first enters the stomach before making its way to the body’s circulation. However, before entering the bloodstream it passes through the liver via the hepatic portal vein. Enzymes in the liver begin to break down the Eliquis, which is the body’s natural defense against toxins.
While passing through the liver, Eliquis is broken down into inactive metabolites. Usually, only a small fraction of what is swallowed actually makes it into your bloodstream. This process is called the First Pass Effect. When taken by mouth, about 50% of the dose ends up in the bloodstream.
The primary enzymes responsible for breaking down Eliquis and other medications that have entered the liver are cytochromes P450 (CYP). They are present in many different kinds of organisms and over 50,000 of them have been identified. Different medications are broken down by different CYPs inside the liver. More than 60% of medications are metabolized by P450 enzymes. Eliquis is primarily broken down by CYP3A4 and P-GP.
Grapefruit and P450 Enzymes
You might have taken Eliquis, or another medication, and noticed in the package insert that you should not eat grapefruit or drink grapefruit juice while taking that medication. That’s because ingesting grapefruit inhibits CYP3A4, a P450 enzyme. That means more of it enters your systemic bloodstream than would happen otherwise. In theory, CBD can do the same thing as grapefruit.
Eliquis is labeled with a warning that you should not consume grapefruit or grapefruit juice while taking the medication.
What Do CBD and Grapefruit Have in Common?
Just like grapefruit, some cannabinoids (like CBD) inhibit P450 enzymes. Specifically, CBD greatly inhibits the actions of the CYP3A subfamily of enzymes.
This means that any drug that carries a warning about interactions with grapefruit is of even more concern when mixing with CBD. Since the research on CBD is still in its infancy, medical labeling has not caught up to the current research. Therefore, drugs like Eliquis may lack important drug interaction labeling. This lack of labeling also means that most doctors have no idea about this interaction.
It is up to patients to be their own advocates in this case. Read medication labels carefully, research possible interactions, ask a pharmacist whether or not medications interact with CBD. If they do, proceed with caution.
CBD and the First Pass Effect
In 2011, a study on the effects of several cannabinoids found that CBD strongly inhibited the actions of CYP3A4 enzymes. The researchers could not pinpoint the exact mechanism but postulated that “CBD may bind to the catalytic sites of these CYP3A isoforms.” The catalytic site is where the enzyme attaches to a molecule and carries out its chemical reaction. In other words, CBD “saturates” these enzymes so they cannot do their normal work on Eliquis.
If the CBD binds to that site, it blocks the enzyme from being able to break down Eliquis. So, CBD doesn’t stop the production of the enzymes that cells have already made but blocks the already made enzymes from working on Eliquis. Therefore, more of the drug passes unchanged through the liver and into the bloodstream. This could mean that a dangerous overdose could occur if someone took CBD and a medication that is normally broken down by CYP450 enzymes, like Eliquis.
Can You Safely Take a Medication with a Grapefruit Warning and CBD?
Theoretically, yes. However, this should be done very cautiously and under the very strict supervision of a doctor. Many doctors may not be familiar with CBD and how it affects things like medication metabolism. More than likely, you would need to get routine blood work done to check your blood serum levels for your medication to make sure that you are within therapeutic ranges. Note that routine tests for the blood levels are not commonly available and may be very expensive. Your doctor is more likely to ask you to stop taking CBD or switch your Eliquis to a drug that requires more monitoring, like warfarin.
CBD really is an amazing, natural compound that can be beneficial for some health conditions. However, along with its healing properties, it does have other effects on the body that should be weighed carefully. Its ability to inhibit liver enzymes that metabolize medications could make some medications less effective and increase the concentration of others. Talk to your doctor, and consider the risks versus the benefits of any medication or supplement, including CBD.
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