Probable Interaction Between Warfarin and Inhaled and Oral Administration of Cannabis

Hsu, Amy P.; Painter, Nathan A.

doi:10.1177/0897190019854958

Cited by 25 publications

(41 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Most recently, a case report by Hsu and Painter described a 35‐year‐old man on long‐term warfarin therapy with an INR target of 2.0‐3.0 . The patient had been stable on warfarin 10 mg daily for the past 8 years.…”

Section: Resultsmentioning

confidence: 99%

A Review of Cannabis and Interactions With Anticoagulant and Antiplatelet Agents

Gréger

Bates

Mechtler

et al. 2019

The Journal of Clinical Pharma

View full text Add to dashboard Cite

Legalization of medical cannabis has occurred in 33 states and the District of Columbia, and recreational use has increased exponentially since 2013. As a result, it is important to understand how cannabis interacts with other drugs and has potential risks for patients on concomitant medications. Components of medical cannabis can inhibit or compete for several cytochrome P450 (CYP) hepatic isoenzymes, UDP‐glucuronosyltransferases, and P‐glycoprotein. These enzymes and transporters are involved in the metabolism and absorption of numerous medications, including anticoagulants (ACs) and antiplatelet agents (APs), potentially causing harmful drug‐drug interactions. ACs and/or APs are often prescribed to high‐risk patients with cardiac conditions, a history of myocardial infarction, or stroke. Cannabis may cause these medications to be less efficacious and put patients at risk for recurrent cardiovascular and cerebrovascular events. Several case reports show cannabis may inhibit the metabolism of warfarin because of CYP2C9 interactions, resulting in increased plasma concentrations, increased international normalized ratio, and risk of bleeding. Cannabidiol inhibits CYP2C19, an isoenzyme responsible for the transformation of clopidogrel to its active thiol metabolite. This interaction could lead to subtherapeutic levels of active metabolite and possibly increased stroke risk. Within this review, a total of 665 articles were screened from PubMed and EMBASE. Four case reports, 1 in vitro study, and 1 pharmacokinetic article were found to be of relevance. This review serves to examine reported and potential cannabis interactions with APs/ACs to help inform patients and health care providers of possible risks and knowledge gaps.

show abstract

Section: Resultsmentioning

confidence: 99%

A Review of Cannabis and Interactions With Anticoagulant and Antiplatelet Agents

Gréger

Bates

Mechtler

et al. 2019

The Journal of Clinical Pharma

View full text Add to dashboard Cite

show abstract

“…Schools of pharmacy should consider adding information within standing courses where appropriate that include high‐impact learning practices, such as case studies that include patients that are currently using cannabis alongside other pharmaceuticals 22 . Furthermore, interactions with prescribed medications should be covered, for example highlighting case studies such as the interaction between warfarin and cannabis 23,24 . In a recent study showing that pharmacy students who attended a brief two‐hour lecture on CBD were more confident on the topic, the authors recommended that formal lectures be incorporated into the curriculum 25 …”

Section: Discussionmentioning

confidence: 99%

Cannabis education in United States Pharmacy Colleges and Schools

Kruger

Krüger

Bednarczyk

et al. 2021

J Am Coll Clin Pharm

View full text Add to dashboard Cite

IntroductionGiven the rapid change in legal status and rise in cannabis use within the United States (U.S.), pharmacists will increasingly require competence in issues related to cannabis, especially for medical use. Pharmacy students and professionals in other health fields report low levels of cannabis knowledge, and medical cannabis users report that their knowledge is mostly from their own experiences and the internet. Several pharmacy organizations have advocated for pharmacists' education on therapeutic and legal issues related to medical cannabis.ObjectivesTo determine the extent to which cannabis and its medical use are covered in the educational curricula of U.S. schools and colleges of pharmacy, plans for future coverage of medical cannabis, and differences by the state‐level legal status of cannabis.MethodsPharmacy schools and colleges located within the U.S. were identified via the Accreditation Council for Pharmacy Education website. A 19‐item survey was developed by researchers with experience in curriculum development and pharmaceutical issues related to cannabis. One individual from each school provided detailed information on the inclusion of medical cannabis/marijuana topics in their Doctor of Pharmacy program.ResultsTwo‐thirds (67%) of programs responded to the survey. Most programs (85.4%) had content on medical cannabis available in their curriculum, 53.1% in their required curriculum, 65.6% in their elective curriculum, and 33.0% in both their required and elective curricula. A small proportion (16.7%) had a stand‐alone medical cannabis elective course. Stand‐alone electives had the most comprehensive coverage of cannabis topics. General required and elective courses had minor differences in comprehensiveness.ConclusionResults demonstrate a moderately rapid expansion in cannabis coverage in pharmacy curricula, although coverage of cannabis topics is rarely comprehensive. Additional efforts are needed to integrate cannabis into coursework and experiential learning experiences.

show abstract

“…Due to the high therapeutic index of acutely administered glucocorticoids, this drug interaction may be tolerated. The situation is, however, entirely different for the antithrombin warfarin, the plasma level of which is also increased by CBD [183,186]. In this case, the interaction may lead to life-threatening bleeding.…”

Section: Opportunities Challenges and Pitfalls Of Cannabidiol Use Asmentioning

confidence: 98%

Opportunities, Challenges and Pitfalls of Using Cannabidiol as an Adjuvant Drug in COVID-19

Malinowska

Baranowska-Kuczko

Kicman

et al. 2021

IJMS

View full text Add to dashboard Cite

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may lead to coronavirus disease 2019 (COVID-19) which, in turn, may be associated with multiple organ dysfunction. In this review, we present advantages and disadvantages of cannabidiol (CBD), a non-intoxicating phytocannabinoid from the cannabis plant, as a potential agent for the treatment of COVID-19. CBD has been shown to downregulate proteins responsible for viral entry and to inhibit SARS-CoV-2 replication. Preclinical studies have demonstrated its effectiveness against diseases of the respiratory system as well as its cardioprotective, nephroprotective, hepatoprotective, neuroprotective and anti-convulsant properties, that is, effects that may be beneficial for COVID-19. Only the latter two properties have been demonstrated in clinical studies, which also revealed anxiolytic and antinociceptive effects of CBD (given alone or together with Δ9-tetrahydrocannabinol), which may be important for an adjuvant treatment to improve the quality of life in patients with COVID-19 and to limit post-traumatic stress symptoms. However, one should be aware of side effects of CBD (which are rarely serious), drug interactions (also extending to drugs acting against COVID-19) and the proper route of its administration (vaping may be dangerous). Clearly, further clinical studies are necessary to prove the suitability of CBD for the treatment of COVID-19.

show abstract

Probable Interaction Between Warfarin and Inhaled and Oral Administration of Cannabis

Cited by 25 publications

References 12 publications

A Review of Cannabis and Interactions With Anticoagulant and Antiplatelet Agents

A Review of Cannabis and Interactions With Anticoagulant and Antiplatelet Agents

Cannabis education in United States Pharmacy Colleges and Schools

Opportunities, Challenges and Pitfalls of Using Cannabidiol as an Adjuvant Drug in COVID-19

Contact Info

Product

Resources

About