Your Good Health: CBD oil risky for anyone on heart medication
January 3, 2019 06:02 AM
Dear Dr. Roach: I am a 49-year-old woman who had a massive heart attack in April of this year. My father died of a massive heart attack at 49 when I was three. I have four stents in three arteries and am on Brilinta, low-dose aspirin, blood-pressure medication, etc.
I have had essential tremor for all of my life, first noticing the tremors in middle school. The tremor is in my hands, making writing nearly impossible, and I have head bobs. I have an internal tremor that never stops.
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A previous practitioner prescribed a month’s trial of beta blockers several years ago. I noticed no relief with the tremor, but was physically ill for the first 30 minutes of the morning in the first two weeks of the trial. Recently, while doing some research, I found an online blog regarding essential tremor and CBD oil. Nearly all of the bloggers found some level of relief using this treatment.
If I choose to try CBD oil to assist with my tremor, is there a risk of it interfering with my heart and blood-pressure medications?
Cannabidiol, or CBD, is a nonpsychoactive substance found in cannabis, as opposed to tetrahydrocannabinol, or THC, the best-known psychoactive component.
CBD is typically sold as an oil, and has been receiving press as a potential treatment for a wide variety of medical issues. Many or most of these claims have no data to support them. Anecdotal reports, such as most blogs, are neither reliable nor scientific (and may or may not be true).
There is also an issue with proving the dosage and purity of products said to contain CBD.
However, in the case of essential tremor, there is some evidence: Studies in mice have shown benefit with CBD, although a single case report showed effectiveness of THC but not CBD in essential tremor.
The issue of drug interactions is a significant one. CBD inhibits two powerful pathways the body uses to detoxify drugs, the CPY3A4 and CYP2D6 systems. This is a serious issue for you. Ticagrelor (Brilinta), an anticoagulant, is metabolized by CYP3A4, as are some of the statin drugs usually prescribed to people with heart blockages.
The effect of the anticoagulant could be much higher than expected, leading to bleeding risk. Other commonly used heart medications are metabolized by CYP2D6, and the effect on these medications is unpredictable.
I can’t recommend CBD products given the medications you are taking, but would suggest you consider alternative treatments.
You might have read about deep brain stimulation and ultrasound, two powerful and effective treatments for people whose symptoms have not responded to standard treatments.
Dear Dr. Roach: This question is for my husband. How safe is drinking tea while on warfarin?
He has his INR checked monthly, and for the most part, it stays between 2 and 3.
He watches his vitamin K intake regularly. He has read conflicting stories about how tea interacts with warfarin by making INR levels high.
Tea comes in two major types: black tea, which is fermented, and green tea, which is not. Black tea has no known interactions with warfarin (Coumadin). Green tea contains small amounts of vitamin K, which could make the INR lower and the warfarin less effective. However, the effect is likely to be small. Further, if he drinks a consistent amount per day, his dose can be adjusted to reflect his vitamin K intake.
Dear Dr. Roach: I am a 49-year-old woman who had a massive heart attack in April of this year. My father died of a massive heart attack at 49 when I was three. I have four stents in three arteries . . .
CBD Oil and Heart Failure
Could CBD oil ease your heart failure symptoms or help you manage your condition? This herbal supplement is sold over the counter and may be marketed with various health claims, but heart experts arenвЂ™t so sure itвЂ™s worthwhile or even safe if you have heart failure.
вЂњHeart failure patients should know that while CBD has been touted as a wonder compound and seems to be in almost everything these days, it has never been shown to have any significant cardiovascular benefits in human studies,вЂќ says Scott Lundgren, DO, a transplant cardiologist at Nebraska Medicine in Omaha.
What Is CBD Oil?
CBD oil contains cannabidiol, an herbal liquid supplement made from the cannabis plant. It doesnвЂ™t have the same effect on the brain as THC, another compound found in cannabis that gives you a вЂњhighвЂќ when smoked or eaten, says Larry Allen, MD, associate division head for clinical affairs in cardiology at University of Colorado Anschutz Medical Campus.
вЂњThere are no known cardiovascular benefits for cannabis or cannabidiol, and there may even be some adverse effects, so people should not take these products and think that it will have positive effects on their cardiovascular health,вЂќ says Allen, whoвЂ™s also co-author of the American Heart AssociationвЂ™s statement on all cannabis products.
In 2018, the FDA approved the first oral, purified CBD drug, Epidiolex, to treat seizures in two rare forms of epilepsy. Two synthetic versions of cannabidiol were later approved: dronabinol (Marinol, Syndros) for treatment of nausea during cancer chemotherapy and nabilone (Cesamet) to treat weight loss associated with AIDS.
Some of CBDвЂ™s proven benefits in other health conditions may be intriguing to people living with heart failure, Allen says.
вЂњDoes it stimulate your appetite? Yes. Do people gain weight if they take it? Possibly true. Patients with severe heart failure do have cachexia,вЂќ or severe weight loss and muscle wasting, he says. вЂњOne could argue that people with nausea, lack of appetite, or who are losing weight could think CBD would help them. People with heart failure have a fair amount of discomfort, including edema [swelling] and somatic or pain-related issues, so you could think CBD has a role.вЂќ
But there isnвЂ™t really any evidence to prove that it will relieve heart failure symptoms or be safe to use if you have heart failure, he adds.
What We Know About CBD
Some research suggests that CBD oil may improve some heart-related symptoms:
- A very small study conducted in 2017 in England found that CBD improved resting blood pressure and blood pressure spikes related to stress in people without heart conditions.
- Various studies in animals have shown that CBD could improve vasorelaxation, or opening of arteries for better blood flow, as well as reduce inflammation. A small clinical trial from Mexico studying CBD in people with heart failure hasnвЂ™t reported any results yet.
- A large study of more than 161,000 people hospitalized for heart failure who had used marijuana found that they had, on average, a lower risk of death and shorter hospital stays. But this doesnвЂ™t necessarily mean CBD oil would have the same benefit.
ItвЂ™s illegal in the U.S. to market CBD by adding it to any food or calling it a dietary supplement. Also, although the FDA has approved a few CBD drugs to treat certain diseases, donвЂ™t expect CBD sold over the counter to be safe or beneficial for heart failure, Lundgren says.
вЂњCBD oil may not have the same properties, and it can actually cause gastrointestinal distress like diarrhea or cause decreased appetite. CBD products can include unknown ingredients and may not be accurately labeled,вЂќ he says.
When you use CBD oil, your liver breaks it down. During this process, it could interfere with your medications for heart failure or other heart conditions. вЂњCBD has known interactions with warfarin, certain statins, calcium channel blockers, beta-blockers, and nitrates. Just because a supplement is вЂnaturalвЂ™ doesnвЂ™t mean that it is safe,вЂќ Lundgren says.
CBD May Have Health Risks
CBD oil must be studied in randomized clinical trials on people, not animals, before it can be considered safe or effective for heart failure, Lundgren says. Until that happens, he advises against buying or using CBD. вЂњThere is some evidence that CBD can cause liver injury as well as lead to male infertility issues. When consumed with alcohol, individuals may experience increased drowsiness, which can lead to household injuries.вЂќ
If you have heart failure, you might feel like youвЂ™re taking control of your own care by trying herbal treatments that donвЂ™t require a prescription. To be safe, talk to your cardiologist first: Ask questions about CBD oil and make decisions together about using this or any other supplement, Allen says.
вЂњCBD products cost money and can distract you from taking prescribed treatments for heart failure that are evidence-based. They could do indirect harm to people with heart failure. . We already have a half-dozen treatments for heart failure symptoms and to help you live longer.вЂќ
Larry Allen, MD, MHS, University of Colorado Anschutz Medical Campus.
Scott Lundgren, DO, Nebraska Medicine.
FDA: вЂњWhat You Need to Know (And What WeвЂ™re Working to Find Out) About Products Containing Cannabis or Cannabis-derived Compounds, Including CBD,вЂќ вЂњFDA Approves First Drug Comprised of an Active Ingredient Derived from Marijuana to Treat Rare, Severe Forms of Epilepsy,вЂќ вЂњFDA and Cannabis: Research and Drug Approval Process.вЂќ
JCI Insight: вЂњA single dose of cannabidiol reduces blood pressure in healthy volunteers in a randomized crossover study.вЂќ
Oxidative Medicine and Cellular Longevity: вЂњTherapeutic Applications of Cannabinoids in Cardiomyopathy and Heart Failure.вЂќ
Cannabis and Cannabinoid Research: вЂњAn Update on Safety and Side Effects of Cannabidiol: A Review of Clinical Data and Relevant Animal Studies.вЂќ
ClinicalTrials.gov: вЂњCannabidiol in Patients With Heart Failure in AHA/ACC Stages A-C (CAPITAL-AC).вЂќ NCT03634189.
Journal of Cardiac Failure: вЂњMarijuana Use is Associated with Better Hospital Outcome in Patients with Acute Heart Failure: A Propensity Match Analysis from National Inpatient Database.вЂќ
CBD oil is made from cannabis plants but wonвЂ™t make you high. Still, this natural supplement could interact with some heart medicines. Find out what you need to know before you try CBD oil for heart failure.