WebMD provides information about interactions between Coumadin and antipsychotics-sibutramine. Contributor: Dr. Augustine Provencio, MD, ABFP TEST Xarelto Pill Box CBD and Xarelto explained. The anticoagulant Xarelto can treat clotting disorders,
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.
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.
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.
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
- 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.