Does CBD interact with Aspirin?, CBDGroup.cz Despite CBD’s potential therapeutic benefits, taking it together with aspirin has its risks and is not recommended. Learn more.
Does CBD interact with Aspirin?
Information about the risks and possible interactions between CBD and aspirin.
Cannabidiol, or CBD, is a non-psychoactive cannabinoid derived from the Cannabis sativa plant that is commonly used to manage chronic pain and inflammation.
Aspirin (acetylsalicylic acid) is another common painkiller that can be bought over the counter at pharmacies.
Despite similar effects, the level of risk of interaction between the two substances is minimal.
Does CBD interact with Aspirin?
CBD is unlikely to interact with low doses of Aspirin.
However, at higher doses or with long-term use, CBD could theoretically increase serum levels of Aspirin over time – leading to potential side effects.
Both CBD and Aspirin are considered blood thinners and analgesics. It is possible that this combination could lead to an increase in side effects associated with these effects – including bruising, blood loss or liver damage.
In practice, however, none of these side effects have been reported, and people who take both dietary supplements daily rarely, if ever, experience any significant side effects.
Is it safe to take CBD and Aspirin together?
In most cases, it is safe to take CBD together with low doses of Aspirin. If you have been prescribed a high-potency Aspirin or are taking Aspirin daily to manage your risk of heart disease, it is a good idea to check with your doctor before starting CBD.
Although CBD is unlikely to interact directly with Aspirin, it may be contraindicated in some types of heart disease.
Is CBD a suitable alternative to aspirin?
CBD is widely used for several benefits, the main ones being pain relief and anxiety management.
For mild to moderate pain and inflammation, CBD may be a viable and potentially even more effective option than Aspirin.
For use as a blood thinner, CBD is not comparable to Aspirin and is not considered a viable alternative.
What is Aspirin?
Aspirin and its generic ingredient acetylsalicylic acid (ASA). It is a drug commonly used to treat pain, inflammation and fever. It is classified as a non-steroidal anti-inflammatory drug – NSAID for short.
It is widely prescribed to patients with heart disorders such as heart attack, heart failure or cardiac arrest as a blood thinner to prevent possible blood clots and subsequent heart damage.
Aspirin is readily available in pharmacies and no prescription is needed to purchase it from these pharmacies. The drug is manufactured by different pharmaceutical companies and is therefore available under different brand names such as Bayer, Easprin, Ecotrin and Ecoprin.
Aspirin has a half-life of either 2 hours to 3 hours or 15 hours to 30 hours depending on the dose, with the former being the half-life of 100 mg or less of Aspirin. The drug is excreted predominantly in the urine, almost 80%, with the remainder excreted in faeces and sweat.
Aspirin (Acetylsalicylic acid)
Aspirin, Aspro Clear, Bayer, Disprin, Easprin, Ecotrin, Ecoprin, Entercote
Non-Steroidal Anti-inflammatory Drug (NSAID)
Liver (CYP2C19 and CYP3A)
Interaction with CBD
Agonistic (Increased effects)
Risk of Interaction
What does Aspirin do?
Aspirin is used to treat a range of medical conditions that present with symptoms such as fever, pain and inflammation. It is one of the most commonly prescribed drugs in cardiology clinics because its ability to thin the blood is crucial for patients who have recently had a heart attack or stroke.
Aspirin’s mechanism of action involves the irreversible inhibition of the enzyme cyclooxygenase, or COX, which is key to the synthesis and distribution of prostaglandins and thromboxane in the body.
There are two different types of cyclooxygenases in the human body, namely COX1 and COX2 enzymes, the former being responsible for the production of thromboxane, a hormone responsible for vasoconstriction and platelet aggregation in blood vessels.
COX1 is irreversibly inhibited by Aspirin, while the activity of COX2, the enzyme responsible for the production of prostaglandin hormone, which induces the release of pro-inflammatory cytokines, is modified by the drug.
The modification of COX2 activity leads to the conversion of the enzyme’s ability to produce prostaglandins into the production of the enzyme lipoxygenase, which helps with the metabolism of various polyunsaturated fats in the human body.
Aspirin’s inhibitory effect on the COX1 enzyme helps the drug to manage bleeding because the irreversible inhibition of thromboxane A2 in platelets inhibits platelet aggregation for 7 to 8 days, which is the lifespan of an affected platelet. This mechanism is responsible for prescribing Aspirin to patients with a history of heart attack, stroke, transient ischemic attack, and unstable angina to help prevent recurrence of these medical emergencies.
Prostaglandins play a large role in transmitting information from the brain to various parts of the body suffering from pain and inflammation. They are also known to have an effect on the regulation of the hypothalamic heat centre and therefore alter body temperature and disrupt the body’s thermal homeostasis.
Inhibition of these prostaglandins by inhibiting an enzyme required for their synthesis is essential for pain and inflammation management in the body. Aspirin can manage and treat fever-like symptoms by inhibiting these hormones and inducing proper body temperature regulation.
The irreversible inhibition of local hormones in the body and possibly platelet aggregation is what sets Aspirin apart from other NSAIDs such as Ibuprofen and Diclofenac, as these are reversible inhibitors.
Side effects of Aspirin
Aspirin is a widely available, over-the-counter medication that is taken by almost all age groups. However, it is essential to keep in mind the fact that there are several side effects of this medication that need to be taken into account.
The use of Aspirin is contraindicated in pregnancy, especially after the 20th week of pregnancy, as it can lead to kidney disorders in the fetus due to decreased amniotic fluid levels.
In addition, its use is not recommended in children with flu or colds as it can lead to the development of a near fatal, progressive brain disease known as Reye’s syndrome. The use of this product is contraindicated in patients treated with warfarin or in patients with disorders affecting the lining of the stomach, such as peptic ulcers and gastritis. The preparation must not be taken with alcohol.
Common side effects of Aspirin include:
- Skin rash.
- Stomach and intestinal ulcers
- Abdominal pain
- Abdominal cramps
- Abdominal discomfort
Aspirin should not be taken with a history of gastrointestinal disorders, without the advice of a healthcare professional.
More serious side effects of Aspirin include:
- Retinal vein occlusion
- Cerebral microhemorrhage
- Reye’s syndrome
- Bleeding in the gastrointestinal tract
Types of drug interactions with CBD
Cannabidiol, or CBD, has several benefits that can be attributed to its growing popularity, however, it can cause serious complications when it interacts with other drugs.
CBD can interact with other medications and cause either increased or decreased effects of the main drug.
These interactions can be of either low, moderate or severe clinical significance, with low interactions requiring no form of caution, moderate interactions to be avoided unless medically necessary and severe interactions to be avoided at all costs.
Based on the effect of CBD on the parent drug, CBD-drug interactions can be divided into three types:
1. Agonist interactions
CBD enhances the effect of the drug by exerting the same effects. This is common with drugs that have similar analgesic, sedative, anxiolytic, or anti-inflammatory effects.
2. Antagonistic interaction
CBD reduces the effect of the drug by either removing the drug from the system more quickly or inhibiting its effects. This is common with drugs with effects that are opposite to those of CBD – for example, stimulants, emetics or low blood pressure medications.
3. Metabolic competition
CBD blocks or competes with drug metabolism in the liver. This can cause an increase in the concentration of both substances in the bloodstream, which can lead to side effects.
This interaction is most concerning for drugs taken daily as it can cause levels to rise to dangerous levels over time.
Key Finding: Can CBD and Aspirin be taken together?
CBD and Aspirin have similar effects for managing pain and inflammation. There is some slight risk of interaction between these substances, but only when taken in high doses or over long periods of time.
Most people find greater pain relief when taking both Aspirin and CBD together.
Atalay, S., Jarocka-Karpowicz, I., & Skrzydlewska, E. (2020). Antioxidative and anti-inflammatory properties of cannabidiol. Antioxidants, 9(1), 21.
Pellati, F., Borgonetti, V., Brighenti, V., Biagi, M., Benvenuti, S., & Corsi, L. (2018). Cannabis sativa L. and nonpsychoactive cannabinoids: their chemistry and role against oxidative stress, inflammation, and cancer. BioMed research international, 2018.
Sofia, R. D., Vassar, H. B., & Knobloch, L. C. (1975). Comparative analgesic activity of various naturally occurring cannabinoids in mice and rats. Psychopharmacology, 40(4), 285-295.
CBD and Aspirin – August 2022
Aspirin is typically used by a person to relieve minor pain and aches or to reduce fever. Veterinarians also often prescribe aspirin for dogs that are suffering from musculoskeletal or osteoarthritis inflammation.
But can people take aspirin and use CBD at the same time?
The cytochrome P450 enzyme system, which is found within the liver, is responsible for metabolizing (breaking down) potentially toxic compounds, including over 60% percent of any drugs consumed (5 ) .
Certain substances can affect processing times within this system, making drugs metabolize faster or slower than they would on their own.
Cannabidiol can inhibit the cytochrome P450 system’s ability to metabolize certain drugs, leading to an overall increase in processing times (6 ) .
In a study published by the American Society for Clinical Pharmacology and Therapeutics, researchers illustrated the effect of low-dose aspirin administration on the activity of cytochrome P450 (CYP) in healthy human subjects (7 ) .
Researchers of the said study found that the effects of aspirin on the CYP450 system of enzymes depend on the specific type of enzyme under the CYP450 family of enzymes.
Given that the specific effects of combining CBD with aspirin have not been established in any scientific study, using the two substances together is not recommended.
Can Another Antiplatelet Be a Substitute for Aspirin So CBD Oil Can Be Taken ?
Ticlopidine (marketed as Ticlid), an effective inhibitor of platelet formation, is indicated for patients who cannot take aspirin or in whom aspirin has not worked to prevent a thrombotic stroke (8 ) .
A thrombotic stroke is one that is caused by thrombosis, the formation or presence of a blood clot within a blood vessel.
However, ticlopidine inhibits multiple CYP450 types of enzymes, as data from a study published in the British Journal of Clinical Pharmacology showed (9 ) .
According to the research findings, the plasma concentrations and/or toxicity of drugs whose elimination pathways involve the different types of CYP450 enzymes increased when ticlopidine is concomitantly administered.
Thus, ticlopidine may also interact with CBD in the same way that aspirin does.
Given that the specific effects of combining CBD with aspirin have not been established with scientific evidence, using ticlopidine is also not recommended to use with CBD.
It is interesting to note, however, that bleeding time was significantly prolonged by aspirin alone and by ticlopidine alone.
However, the most significant prolongation was produced by aspirin plus ticlopidine, according to results of a study published by the American Heart Association (10 ) .
The results of the study also demonstrated that the combination of aspirin and ticlopidine is a potent antiplatelet strategy.
Can CBD replace Aspirin?
There is no scientific data to establish CBD as a treatment option in the same way that people use aspirin. The two drugs may interact with the heart in different ways.
An article on aspirin risks and benefits by Mark Fendrick, M.D., published by the University of Michigan Institute for Healthcare Policy and Innovation.
In the said article, Fendrick says that aspirin interferes with the blood’s clotting action and reduces the clumping action of platelets, possibly preventing a heart attack (11 ) .
Still, he cautions that it is not advisable to take aspirin tablets, hoping to prevent a heart attack, without a doctor’s supervision .
Is CBD a safer alternative to aspirin in preventing heart attack?
Data from a 2012 study published in the British Journal of Clinical Pharmacology showed that CBD influenced platelet formation, which could support the ability of CBD to delay or prevent the development of cardiovascular disorders (12 ) .
However, the study was done on animal subjects. Whether the responses to CBD would translate into the human cardiovascular system remains to be established.
In another study , which was first published by JCI Insight in 2017, results showed that CBD could lower blood pressure, which could help prevent hypertensive heart disease (13 ) .
The study was done on healthy volunteers, however. The researchers noted that further research is required to establish whether CBD has a role in the treatment of cardiovascular disorders.
New Guidelines for Aspirin Use
According to an October 2019 article published by the American College of Physicians, recent research based on a 2017 National Health Interview Survey has found that, in certain groups of people, there are few advantages and a higher risk of bleeding from daily aspirin use (14 ) .
In response to the results of the survey, the American Heart Association and American College of Cardiology updated their guidelines in March of 2019.
The two agencies no longer recommend aspirin for the prevention of cardiovascular disease in adults aged 70 and above or for those with a higher risk of bleeding, like those with stomach (peptic) ulcers.
Thus, medical experts advise that people speak with their health care providers before taking aspirin daily.
Two Types of Blood Thinners: Which Type is Aspirin?
There are two primary types of blood thinners. Anticoagulants, like heparin or warfarin (Coumadin), slow down the aggregation or formation of clots.
On the other hand, antiplatelet drugs, like aspirin, inhibit blood cells (platelets) from clumping together to form a clot (15 ) .
Aspirin as Nonsteroidal Anti-Inflammatory Drug (NSAID)
Nonsteroidal anti-inflammatory drugs (NSAIDs) reduce fever and inflammation and relieve pain. Examples of NSAIDs include aspirin, ibuprofen, and naproxen.
Aspirin, unlike other NSAIDs, can help certain people lower their risk of a heart attack or stroke. However, taking aspirin is not recommended for everyone as the antiplatelet can cause severe bleeding, according to an article published by the University of Michigan Health System (UMHS) (16 ) .
The article says that people who are over 65 years old or who have existing kidney, heart, liver, stomach, or intestinal disease are at increased risk for complications .
How NSAIDs Work
NSAIDs work by blocking enzymes called COX-1 and COX-2. These enzymes produce prostaglandins, a group of compounds made by the cells in the body (17 ) .
Prostaglandins made by COX-1 enzymes actuate platelets and protect the lining of stomach and intestines. Prostaglandins produced by COX-2 enzymes are generated in response to injury or infection, controlling inflammation.
Most NSAIDs work non-selectively on both enzymes. However, this lack of selectivity becomes an issue given that pain and inflammation relief from NSAIDs come from blocking COX-2. When COX-1 is also blocked, unwanted adverse side effects emerge.
Aspirin, an NSAID, functions by blocking the production of prostaglandins, the on-off switch in cells that control pain and inflammation. Thus, aspirin prevents mild inflammation and pain (18 ) .
“To the consumer, aspirin is almost a miracle drug,” says Nimita Thekkepat, assistant professor of pharmacy at St. Louis College of Pharmacy. “It helps inflammation, fever, and it can save your life from a heart attack.”
However, while aspirin blocks the type of prostaglandins that trigger pain or lead to clotting and narrowing of the blood vessels and inflammation, the drug also blocks a different kind of prostaglandins that protect the stomach lining.
Aspirin belongs to a group of nonsteroidal anti-inflammatory drugs, or NSAIDs, that include ibuprofen (Motrin, Advil), naproxen (Aleve) and ketoprofen (Orudis).
Among these NSAIDs, aspirin induces the most irritation and the most toxic (painkiller) to the stomach, says Dr Richard Brasington, head of the Division of Rheumatology at Washington University School of Medicine.
Medical experts, like Brasington, warn against taking a variety of nonsteroidal anti-inflammatory drugs at the same time as they neutralize each other, making neither drugs perform well. The remedy is to wait several hours after taking one medicine before taking the next.
Blood Thinners and NSAIDs, A Bad Mix
NSAIDs impact the way platelets work and could impede with healthy blood clotting, which could increase the risk of bleeding, especially in the digestive tract, says cardiologist Dr Deepak L. Bhatt, a Harvard Medical School professor, in an article published by Harvard Health (19 ) .
Bhatt also adds that taking NSAIDs together with blood thinners raises the bleeding risk even more.
Medical marijuana, sometimes referred to as medical cannabis, is a term for derivatives of the Cannabis sativa plant (20 ) .
CBD (cannabidiol) and THC (tetrahydrocannabinol) are common cannabinoids that are natural constituents of cannabis plants, which include marijuana and hemp. Thus, CBD can either be a hemp or cannabis extract.
Marijuana contains much more THC than hemp, while hemp contains excellent quantities of CBD. THC induces a euphoric high, while CBD helps promote relaxation and calmness.
In a study published in the Cerebrum Journal, researchers explained that the endocannabinoid system (ECS), which is comprised of cannabinoid receptors, endocannabinoid molecules, and their metabolic enzymes, is crucial in maintaining homeostasis, or balance, amongst physiological functions (21 ) .
CBD Oil or Hemp Oil?
The term “hemp oil” is sometimes used to refer to the CBD-rich product extracted from the hemp plant’s flowers and leaves, which is essentially CBD oil. However, the term is also used to refer to hemp seed oil that contains no CBD.
Although hemp seed oil is not CBD oil, which is extracted from the flowers and leaves of the plant, note that oil pressed from hemp seed does not contain CBD, THC, and plant cannabinoids (22 ) .
CBD oil is available in different varieties, such as full-spectrum (oil derived from the whole plant), THC-free distillate, and CBD isolates.
Cannabis and Aspirin
In a 2013 study published in the Rambam Maimonides Medical Journal, it was shown that the ECS is involved in numerous body functions, including the modulation of pain and inflammation (23 ) .
In a 2008 study published in the Journal of Therapeutics and Clinical Risk Management , author Ethan Russo found that Tetrahydrocannabinol (THC) has twenty times the anti-inflammatory potency of aspirin (24 ) .
Results from his research also suggest that cannflavin A, a flavone unique to cannabis, inhibits PGE-2 thirty times more potently than aspirin, although further examinations are needed (25 ) .
PGE-2 (Prostaglandin E2) is a bioactive lipid that elicits a wide range of biological effects associated with cancer and inflammation (26 ) .
Flavones are a sub-group of flavonoids shown to exhibit anti-inflammatory, antidiabetic, anticancer, anti-thrombogenic (prevents blood clot), and neuroprotective activities through different mechanisms of action outside a living organism and in animal models (27 ) .
Cannabidiol and CYP2D6
Cannabidiol, a major phytocannabinoid, is a potent atypical inhibitor for CYP2D6, according to a study published in the Drug Metabolism and Disposition Journal (28 ) .
Phytocannabinoids are cannabinoids that occur naturally in the cannabis plant. Cannabinoids are closely-related compounds naturally found in cannabis, like CBD and THC.
In the said study, the researchers investigated the inhibitory impacts of the primary phytocannabinoids on the activity of human CYP2D6. The results indicated that CBD caused directly blocked CYP2D6 potency.
Drug to Drug Interactions
In a 2016 study published in the Epilepsia Journal , the authors found that repeated administration of CBD may induce CYP2B enzymes in animal subjects, which may have implications for people with epilepsy as antiepileptic drugs (AEDs), such as valproate and clobazam, are metabolized via these enzymes (29 ) .
Still, the antiepileptic mechanisms of CBD have not been known. The researchers noted that there is a lack of data from longitudinal double-blind, randomized, controlled studies on the efficacy of pure CBD for any disorder.
Recently, the U.S. Food and Drug Administration (FDA) approved Epidiolex as the first-ever cannabis-derived medicine for Lennox-Gastaut Syndrome (LGS) and Dravet Syndrome (DS), the symptoms of which do not typically respond to anti-seizure medications (30 ) .
While CBD is the active ingredient in Epidiolex, it also contains inactive ingredients that include dehydrated alcohol, sesame seed oil, strawberry flavor, and sucralose (31 ) .
Aspirin and Beta Blockers
Aspirin blunts the vasodilation (widening of blood vessels) caused by both angiotensin-converting enzyme (ACE) inhibitors and beta blockers in hypertensive patients and in patients with heart failure. This conclusion was derived from a study that was published in the Journal of the American College of Cardiology (32 ) .
The specific mechanisms that cause this interaction are unknown, and further studies are needed. Until conclusive evidence is available, it is not advisable to use aspirin in conjunction with beta blockers.
Aspirin and Warfarin
A 2017 study published in the Cannabis and Cannabinoid Research Journal analyzed CBD safety and side effects (33 ) .
Researchers of the said study noted that while CBD can raise the levels of concentration of certain medications in the blood, its adverse side effects can sometimes outweigh the advantages.
Based on the results of the study, the authors indicated that CBD could cause a surge in the level of the anticoagulant (blood thinner), warfarin (Coumadin), by accentuating aspirin’s blood-thinning property.
Aspirin is part of a group of painkillers and fever reducers called non-steroidal anti-inflammatory drugs (NSAIDs).
Meanwhile, CBD’s broad utility for pain relief may be partly explained by its anti-inflammatory effects.
CBD’s antioxidative and anti-inflammatory properties may help lower risk factors that can lead to heart disease, like high blood pressure , as a 2017 study suggests (34 ) .
Still, despite CBD’s potential therapeutic benefits, taking it together with aspirin is not recommended . Neither is it advised to use CBD products in any form (gummies, tincture, vape, or topical) with other antiplatelet prescription drugs. Although using aspirin and CBD may each have its advantages, it also comes with risks. As studies mentioned above demonstrate, the risks may outweigh the health benefits.