Cannabis FAQ

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Individuals can develop a tolerance to CBD, thereby requiring a higher dose as time goes on. As such, withdrawal symptoms may be present if the individual stops after regular and prolonged use. Withdrawal symptoms have mostly been described with THC however, not CBD.

Studies describing transdermal effect of CBD showed variable plasma concentrations. Of note, transdermal patches of CBD usually contain a solvent that increases absorption. No studies describing the systemic absorption of CBD ointment were found, however.

CBD is a potential inhibitor of CYP3A4 and could possibly increase plasma concentration of rivoroxaban. The studies evaluating the interaction profile of CBD used high doses of CBD, and therefore it could be difficult to compare with the doses he would potentially be receiving. Not enough data is available to exclude the possibility of an interaction between Rivaroxaban and CBD. Warfarin would be an option to allow monitoring.

While the data of pain management in fibromyalgia is limited, there was one study showing that 18mg CBD VAPORIZED was well tolerated and produced pain relief.

After review of the patient’s health problems, she is at an extremely high risk of thrombosis. Suggest therefore to continue apixaban and to inform the hematologist by phone that she is starting CBD. Due to potential drug-drug interaction between apixaban and CBD, suggest asking the hematologist to change to warfarin as that would allow monitoring of the patient’s anticoagulation.