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The future is uncertain, At the border, they fought bloody battles again and again for me and for our territory.

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In that case, it s up gummy to me to make the final decision, In the case of a small difference in votes, the representative of the royal family, Augs, has the final decision. The Sen Lan family and the Potter family have been fighting for many years, and the power in their hands can be said to be half a catty. gummies

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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.

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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.

Conclusions

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.

Learn more with CBD training academy

When: 2 hours/On-Demand
Who: Siyavash (Sia) Fooladian, MD, MPH
What:

  • What’s the endocannabinoid system & how it works
  • The critical importance of drug interactions
  • Results of drug interactions including kidney failure, gastrointestinal bleeding, liver dysfunction & more
  • Drugs to avoid when taking CBD
  • The way to optimize health via the merging of Eastern and Western modalities

“Dr Fooladian cuts to the chase about how to avoid dangerous drug interactions & complications” -Jack

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