Your blood clots when you cut your finger, slowing the bleeding and helping it heal. However, blood clots formed inside a vein can cause serious medical conditions, restricting blood flow. Many cardiovascular conditions are treated with anticoagulants, medications prescribed to “thin” the blood and make it less likely to clot.
If you use CBD, is it safe to use Eliquis or any other blood thinner?
While the best answer can come from your doctor, the research does not currently support the combined use of CBD and blood thinner medications like Eliquis without consulting a physician first.
Millions of people use CBD to treat specific conditions or for general wellness. Eliquis and other anti-clotting medications are also commonly prescribed but can cause concerns over drug interactions. Weighing CBD product growth and Eliquis’ possible side effects when used with other medicines, is it safe to use cannabidiol with prescribed Eliquis or other anticoagulants?
What is Eliquis?
Eliquis is a prescription anticoagulant that prevents excessive blood clotting. It’s primarily prescribed to avoid blood clots in certain cardiovascular conditions, which can lead to strokes.
Cardiovascular diseases are common, especially among adults. A subject-reported survey by the CDC shows that about 5.5% of Americans over 18 have at least one condition affecting their heart or blood vessels.
Both deep vein thrombosis and atrial fibrillation are heart conditions often treated with Eliquis or another blood thinner. Both conditions increase the patient’s susceptibility to strokes.
Deep vein thrombosis (DVT) can occur at any age. A clot forms within the vein, often in the lower legs, thigh, or pelvis, causing local discomfort, pain, and swelling. If this clot moves through the vein or artery, it can lodge in the lung or brain, causing severe complications or even death.
Another cardiac condition, atrial fibrillation (AFib) or an irregular heartbeat, has become more common in older adults. High blood pressure, another aging factor, accounts for about 1 in 5 cases of AFib. Cannabidiol (CBD), the non-psychoactive form of cannabis, can lower blood pressure for some users.
Over 3 million people in the USA use Eliquis, ranking it 48th among prescribed medicines. It’s primarily prescribed to prevent the formation of blood clots, especially critical for those at risk for certain cardiovascular events.
Commonly known as the generic apixaban, Eliquis reduces the risk of stroke in AFib, treats deep vein thrombosis or pulmonary embolism, and prevents post-surgical clotting issues following hip or knee replacement surgery.
Eliquis is classified as a direct factor Xa inhibitor. Eliquis reduces blood's ability to clot, controlled by factor Xa. Factor Xa (FXa–pronounced factor ten A) is an enzyme, part of a series of chemical reactions that help create a clot. It triggers the conversion of a protein called prothrombin to thrombin. In turn, thrombin converts a blood protein called fibrinogen into fibrin, which forms a sticky web to trap blood cells and create a clot. Eliquis inhibits or prevents this by stopping this cascade of clotting started by Factor Xa.1
Eliquis is a safe and effective drug used worldwide. Still, it may cause side effects, which may include but aren’t limited to:
- Anemia (low red blood cell counts)
- Bleeding
- Bruising
- Nausea
- Low blood pressure
- Nose bleeds
- Blood in urine
- Abnormal liver tests
- Skin rash.
Eliquis Drug Interactions With CBD
CBD use has risen in popularity due to reports by consumers and early clinical research that points to its potential for pain, insomnia, anxiety, and other symptom relief.2 However, CBD can interfere with or change how certain medicines work. Blood thinners like Eliquis have a change in effectiveness when combined with CBD.
Many commonly prescribed drugs are broken down in the liver by enzymes. CBD can interfere with these enzymes, allowing too much or too little of the medication to be absorbed by the body.
Eliquis, an FXa inhibitor drug and acts as an anticoagulant to the blood, preventing clots and their severe effects. In the liver, the CYP450 enzyme group helps metabolize many drugs, including FXa inhibitors like blood thinners. In this group, one enzyme, CYP3A4/5, is most active in converting the FXa inhibitor, Eliquis, to its active form in the body.1 Any drug that interferes with this action can change the plasma concentration of the beneficial blood thinner, possibly making the blood too thin and leading to unwanted bleeding. Eliquis drug interactions include nonsteroidal anti-inflammatory drugs (NSAIDs), other blood thinners, and Paxlovid (a COVID-19 drug).
Here’s the problem; CBD and Eliquis are both metabolized by the CYP450 enzyme channel. In CBD’s case, it is metabolized primarily through the CYP3A4 and the CYP2C19 enzymes, but also the CPY2C9 enzyme.3 CBD is a potent inhibitor of the CYP3A4 enzymes, which metabolize Eliquis. Thus, like Warfarin, rather than being immediately absorbed and put into use, Eliquis may remain in the system longer, possibly thinning the blood too much.4
Although there are risks in combining CBD and Eliquis, the positive effects of CBD may play a role in managing other aspects of cardiovascular diseases. Many individuals recognize CBD to work to relieve inflammation, pain, and anxiety, but research is ongoing.
Following surgery, some patients have post-operative pain, where the pain-relieving properties of CBD can provide well-tolerated relief. People living with arthritis often use CBD products to manage daily joint pain. For Eliquis patients experiencing post-operative pain and inflammation, CBD may provide some relief.
Cardiovascular conditions, which often require the use of an anticoagulant like Eliquis, can be a source of considerable anxiety for patients. The potential anti-anxiety effect of CBD may help manage this, improving the quality of life.5
It’s crucial to consult with a healthcare provider before combining CBD with any medication.
Adding CBD to any cardiovascular treatment regimen should always be confirmed and approved by your healthcare provider.
Is CBD a Blood Thinner?
Although clinical research is underway, scientists don’t have a conclusive answer if CBD is a blood thinner. The anti-inflammatory effects of CBD are well documented. Although CBD’s relaxation of blood vessels lowers blood pressure by improving blood flow, it may not change the fluidity of the blood itself.6
Another study found that the cannabinoids THC and CBN both lessen blood coagulation in the body. Specifically, researchers found that THC reduced platelet aggregation, which is the clumping together of white blood cells to form a clot.7 While CBD alone may not have blood thinning effects, it indicates that the cannabinoids in full-spectrum CBD products may have an anti-coagulation impact.
CBD and Blood Thinners: Is It a Problem?
Eliquis and its generic apixaban are commonly prescribed for cardiovascular conditions, which may benefit from a blood thinner. But it isn’t the only prescription available.
Warfarin, sold under the brand name of Coumadin or Jantoven, is the original breakthrough prescription anticoagulant. Despite the emergence of newer anticoagulants on the market, Warfarin is still the most common blood thinner on the market today.
Like Eliquis, Warfarin is also used to prevent blood clots and reduce the risk of strokes. It is also commonly prescribed for conditions like atrial fibrillation(AFib) and the prevention of deep vein thrombosis (DVT) and pulmonary embolism (PE).
But warfarin approaches these problems in a different way from Eliquis.
Eliquis and warfarin metabolize in the liver but compete for enzymes. Whereas Eliquis is a factor Xa inhibitor, Warfarin is metabolized via the CYP450 enzymes and works by inhibiting the formation of vitamin K-dependent clotting factors. Warfarin is metabolized via the enzyme CYP2C9, so any other medication that also uses that enzyme for metabolization can interfere with it.8
Here’s the issue. The P450 enzyme group, including CYP2C9, also metabolizes CBD. CBD and warfarin compete for the same enzyme in order to be metabolized, and CBD is a potent inhibitor of the CYP2C9 enzymes, which causes the blood-thinning mechanism of Warfarin to increase, making the blood too thin.3
Unlike Eliquis, Warfarin requires regular testing of the international normalized ratio (INR), which tests the clotting rate. If this ratio is elevated, the blood is clotting too slowly, risking excessive bleeding. If it is too low, the chance of a clot forming is increased.
Since CBD and blood thinners compete for similar metabolism routes, there is a concern about the interaction between these two medications. Research concludes that CBD oil can interact with blood thinners and should be used only with medical supervision.
Safety Tips For Using CBD and Eliquis
It is best to speak with your doctor before taking CBD with Eliquis. It is generally not recommended to take CBD with Eliquis or other blood thinners due to the dual effect on CYP enzymes. Both substances can alter the clotting mechanism, and their use can cause unwanted interactions. Here is what current research and expert recommendations say about safely using Eliquis and CBD together:
- Tell your doctor about your CBD use. CBD can have mild to severe interactions with medications, including blood thinners.
- Be aware of potential side effects. Monitor for signs such as excess bleeding from a cut, bleeding gums, or blood in urine or stools.
- If your doctor requests, stay on top of regular monitoring and testing for INR (International Normalized Ratio) to ensure your drug’s effectiveness and that it’s within therapeutic range.
- Don’t change your dosage of Eliquis or CBD without conferring with your doctor.
CBD can stay in your system for 2 to 5 days for occasional users and up to 15 days for regular users. This duration can vary based on several factors, including the dosage, frequency of use, method of consumption, body weight, and metabolism.9
Both CBD and Eliquis have specific half-lives – the time it takes for half of the medication to be eliminated from the body. Eliquis has a half-life of 12 hours, and CBD’s can be 18 hours or more. Using CBD simultaneously with a blood thinner should be initiated by a physician.
Two case studies illustrate the need for careful monitoring. A 46-year-old male, on warfarin for deep vein thrombosis (DVT), began taking prescription CBD (Epidiolex®) for epilepsy seizures. In the initial titration or adjustment of dosing, INR testing showed he needed a 20% reduction in warfarin to keep his INR in range after beginning CBD therapy.
In a separate case study, another patient taking CBD for seizures had a significant change in the INR testing. His elevated levels required the reduction of warfarin by 30% to achieve a safe INR reading.10
In both cases, careful monitoring and consultation with medical providers allowed a cautious continuation of CBD therapy.
If you are taking CBD or have been prescribed Epidiolex, follow the dosing instructions provided by your physician or on the packaging. Follow any suggested testing schedule and keep medical providers informed if you notice any changes in bleeding.
Can CBD Replace Eliquis?
Research suggests that cannabis, and specifically the cannabinoids THC and CBN, may have anticoagulant properties.4 However, there is no current research showing CBD can replace Eliquis as a blood thinner for preventing blood clots. More research is needed to determine efficacy, safety, and appropriate dosing.
It's crucial to approach the idea of replacing or reducing the dose of a well-established medication like Eliquis with caution. The dosing and its effects may require blood tests to be sure the anticoagulant works as needed. Before making any changes to medication regimens, especially with anticoagulants, it's imperative to consult with a healthcare professional. The potential interactions, side effects, and the specific needs of the individual patient must be considered.
What Anti-Inflammatory Can I Take With Eliquis?
Think before you pop an Advil for pain. Not all medications are safe to take with Eliquis. Eliquis’ anticoagulant properties reduce the risk of blood clots and stroke. When combined with other medicines, supplements, or over-the-counter anti-inflammatories, it can increase the risk of bleeding. If you are taking Eliquis, check with your doctor before adding any new medication for a complete review of possible restrictions.
Inflammation occurs when the immune system’s white blood cells rush to the site of injury or invasion by bacteria or viruses. To reduce the resulting redness, heat, swelling, or pain from inflammation, people often reach for NSAIDs (non-steroidal anti-inflammatory drugs), like ibuprofen, aspirin, or naproxen. NSAID medicines must be avoided while on Eliquis, since each can heighten the risk of bleeding. What anti-inflammatory can I take with Eliquis? Tylenol is okay to use. It’s not an NSAID medication and can be used with Eliquis.
Popping a pill to reduce inflammation isn’t the only way.
A natural dietary approach can reduce inflammation, improve symptoms, and reduce the risk of many diseases, including heart disease. Simple dietary changes, modeled on the Mediterranean diet, can lower the impact of inflammation.
An anti-inflammatory diet for heart health focuses on fresh fruits and vegetables, whole grains, and lean proteins like fish and poultry while limiting red meat and saturated fats. Olive oil is a star ingredient, providing heart-healthy monounsaturated fats. Nuts, seeds, and legumes are included for added protein and fiber. This diet promotes cardiovascular wellness thanks to its mix of nutrients, antioxidants, and minimally processed foods.
What you don’t eat is important too! Optimal cardiac care takes a pass on foods like refined carbohydrates (like sugar, white bread, or pastries), fried foods, sodas, red meat, processed meat, margarine, shortening, and lard.
Although some herbs and vitamins give an extra boost to anti-inflammatory benefits, when you use Eliquis or other blood thinners, supplements may trigger problems. Popular supplements, like omega-3 fatty acids, St. John’s wort, turmeric, ginger, or vitamin K, may interfere with or are also blood thinners and thus risky to take with Eliquis or other blood-thinner medications. Always check with your doctor before adding supplements, herbs, or vitamins to your routine.
References
- Byon W, Garonzik S, Boyd RA, Frost CE. Apixaban: A Clinical Pharmacokinetic and Pharmacodynamic Review. Clinical Pharmacokinetics. 2019;58(10):1265-1279. doi:https://doi.org/10.1007/s40262-019-00775-z
↩︎ - Rapin L, Gamaoun R, El Hage C, Arboleda MF, Prosk E. Cannabidiol use and effectiveness: real-world evidence from a Canadian medical cannabis clinic. J Cannabis Res. 2021;3(1):19. Published 2021 Jun 23. doi:10.1186/s42238-021-00078-w
↩︎ - Brown JD, Winterstein AG. Potential Adverse Drug Events and Drug–Drug Interactions with Medical and Consumer Cannabidiol (CBD) Use. Journal of Clinical Medicine. 2019;8(7):989. doi:https://doi.org/10.3390/jcm8070989
↩︎ - Damkier P, Lassen D, Christensen MMH, Madsen KG, Hellfritzsch M, Pottegård A. Interaction between warfarin and cannabis. Basic & Clinical Pharmacology & Toxicology. 2019;124(1):28-31. doi:https://doi.org/10.1111/bcpt.13152
↩︎ - García-Gutiérrez MS, Navarrete F, Gasparyan A, Austrich-Olivares A, Sala F, Manzanares J. Cannabidiol: A Potential New Alternative for the Treatment of Anxiety, Depression, and Psychotic Disorders. Biomolecules. 2020; 10(11):1575. https://doi.org/10.3390/biom10111575
↩︎ - Jadoon KA, Tan GD, O'Sullivan SE. A single dose of cannabidiol reduces blood pressure in healthy volunteers in a randomized crossover study. JCI Insight. 2017;2(12):e93760. Published 2017 Jun 15. doi:10.1172/jci.insight.93760
↩︎ - Coetzee C, Levendal RA ., van de Venter M, Frost CL. Anticoagulant effects of a Cannabis extract in an obese rat model. Phytomedicine. 2007;14(5):333-337. doi:https://doi.org/10.1016/j.phymed.2006.02.004
↩︎ - Grayson L, Vines B, Nichol K, Szaflarski JP; UAB CBD Program. An interaction between warfarin and cannabidiol, a case report. Epilepsy Behav Case Rep. 2017;9:10-11. Published 2017 Oct 12. doi:10.1016/j.ebcr.2017.10.001
↩︎ - Lucas CJ, Galettis P, Schneider J. The pharmacokinetics and the pharmacodynamics of cannabinoids. British Journal of Clinical Pharmacology. 2018;84(11):2477-2482. doi:https://doi.org/10.1111/bcp.13710
↩︎ - Cortopassi J. Warfarin dose adjustment required after cannabidiol initiation and titration. Am J Health Syst Pharm. 2020;77(22):1846-1851. doi:10.1093/ajhp/zxaa268
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The information in this article and any included images or charts are for educational purposes only. This information is neither a substitute for, nor does it replace, professional legal advice or medical advice, diagnosis, or treatment. If you have any concerns or questions about laws, regulations, or your health, you should always consult with an attorney, physician or other licensed professional.
