A Review of Cannabis and Interactions With Anticoagulant and Antiplatelet Agents

@article{Greger2019ARO,
  title={A Review of Cannabis and Interactions With Anticoagulant and Antiplatelet Agents},
  author={J. Greger and Vernice Bates and Laszlo L. Mechtler and Francis M. Gengo},
  journal={The Journal of Clinical Pharmacology},
  year={2019},
  volume={60}
}
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… 

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References

SHOWING 1-10 OF 44 REFERENCES

Interaction between warfarin and cannabis

A case report of a 27-year-old man treated with warfarin due to mechanical heart valve replacement who presented with elevated international normalized ratio (INR) value ( INR = 4.6) following recreational cannabis use is described.

The pharmacokinetics and the pharmacodynamics of cannabinoids.

The limited availability of applicable pharmacokinetic and pharmacodynamic information highlights the need to initiate prescribing cannabis medicines using a 'start low and go slow' approach, carefully observing the patient for desired and adverse effects.

Medicinal Cannabis—Potential Drug Interactions

In general, cannabinoids are usually well tolerated, but bidirectional effects may be expected with concomitant administered agents via affected membrane transporters and metabolizing enzymes, especially for the elderly and people with chronic diseases or kidney and liver conditions.

Probable Interaction Between Warfarin and Inhaled and Oral Administration of Cannabis

There are no previous reports of interactions between edible cannabis and warfarin, with very few case reports describing the interaction with other forms of cannabis, but close monitoring of INR in patients with concomitant cannabis is recommended for proper warfar in management.

Evaluating the Effect of Six Proton Pump Inhibitors on the Antiplatelet Effects of Clopidogrel.

The Potential for Pharmacokinetic Interactions Between Cannabis Products and Conventional Medications.

This review aims to identify drug-metabolizing enzymes and drug transporters that are affected by concurrent cannabis use and, conversely, those co-prescribed medications that may alter the exposure to one or more cannabinoids.

New Direct Oral Anticoagulants (DOAC) and Their Use Today

The properties of oral administration, simple dosing without monitoring, a short half-life allowing for the possibility of uncomplicated switching or bridging, and proven safety overwhelm the disadvantages, making them an attractive option for short- or long-term anticoagulation.

Novel antiplatelet agents in acute coronary syndrome

The novel oral P2Y purinoceptor 12 (P2Y12)-receptor inhibitors prasugrel and ticagrelor were approved by the FDA for clinical use in 2009 and 2011 and have a faster-acting, more-potent, and more-predictable antiplatelet effect than clopidogrel.

Cannabinoids and Cytochrome P450 Interactions.

The interplay of central cannabinoid receptors with numerous nervous systems, resulting in a hormone-mediated signal towards nuclear receptors in hepatocytes is hypothesized.