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Interaction between warfarin and cannabis.

Per Damkier1,2, Dorte Lassen3, Mette Marie Hougaard Christensen1,2,4

  • 1Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark.

Basic & Clinical Pharmacology & Toxicology
|October 17, 2018
PubMed
Summary
This summary is machine-generated.

Delta-9-tetrahydrocannabinol (THC) in cannabis may interact with warfarin, increasing the risk of bleeding. Patients on warfarin should be cautious about cannabis use due to potential drug interactions.

Keywords:
MiniReviewcannabiscase reportdrug-drug interactionwarfarin

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Area of Science:

  • Pharmacology
  • Drug Metabolism
  • Cannabinoid Research

Background:

  • Delta-9-tetrahydrocannabinol (THC), the primary psychoactive component of cannabis, is known to interact with drug-metabolizing enzymes.
  • Cytochrome P450 enzymes, particularly CYP2C9, play a crucial role in the metabolism of many medications.
  • Warfarin, a common anticoagulant, is a substrate of CYP2C9 and has a narrow therapeutic window, making it susceptible to drug-drug interactions.

Observation:

  • A case report details a patient on warfarin therapy experiencing elevated International Normalized Ratio (INR) levels after recreational cannabis use.
  • Literature review identified studies indicating THC's inhibitory effect on CYP2C9-mediated warfarin metabolism.
  • Additional case reports show significant INR increases and bleeding events associated with marijuana use, and dose adjustments needed for warfarin when co-administered with cannabidiol.

Findings:

  • In vitro studies demonstrate that THC inhibits the metabolism of warfarin by CYP2C9.
  • Cannabis use, including marijuana and cannabidiol, appears to increase INR values in patients treated with warfarin.
  • Sparse but consistent data suggest a potential drug-drug interaction between cannabinoids and warfarin.

Implications:

  • Patients prescribed warfarin should be informed about the potential risks associated with concurrent cannabis use.
  • Healthcare providers should consider cannabinoid use when monitoring INR levels and adjusting warfarin dosage.
  • Further research is warranted to elucidate the mechanisms and clinical significance of this drug interaction.