CBD and Aspirin
Can one take CBD with aspirin, and are there any interactions that should cause some concerns? This article aims to detail answers to those questions, as well as provide some information on the best CBD oils in the market today. Also, read on and know the different types of aspirin and how they are used to benefit particular health issues.
Is it Safe to Take CBD with Aspirin?
Both aspirin and CBD have their therapeutic advantages. However, taking CBD while on medication with aspirin is not recommended, as the combination of these drugs may result in a severe case of bleeding. Neither is it advisable to use CBD as a treatment option in place of aspirin.
Aspirin is a safe over-the-counter drug that most people have been relying on for years to treat pain, fever, and headache. When administered in low doses, it can also reduce the risks of stroke, heart attack, and pre-eclampsia in pregnant mothers.
Aspirin therapy reduces the clumping action of platelets to help prevent heart attacks. As a blood thinner, aspirin prevents the formation of blood clots, which can quickly form and block the artery. Unfortunately, this blood-thinning property of aspirin is what could also cause an increased risk of bleeding.
A study that analyzed CBD safety and side effects stated that while CBD can raise the levels of concentration of certain medications in the blood, its adverse side effects can sometimes outweigh the advantages. By accentuating aspirin's blood-thinning property, CBD can cause a surge in the level of the blood thinner, Coumadin.
Interactions Between CBD with Aspirin
There are no scientific data to establish CBD as a treatment option in the same way that people use aspirin. CBD may increase the blood-thinning properties of aspirin, or the two drugs may interact with the heart in different ways. A study shows that CBD can lower blood pressure, which could help prevent hypertensive heart disease. Meanwhile, aspirin interferes with the blood's clotting action and therefore prevents a heart attack.
The potential adverse effects of mixing CBD and aspirin are the following:
- Stomach ache
- Nose bleeds
- Intestinal bleeding
- Gastrointestinal ulcers
- Bleeding in the brain
Benefits of CBD
The endocannabinoid system (ECS) in the human body is involved in regulating a range of functions, including appetite, mood, sleep, pain, and immune system response. The body naturally produces endocannabinoids, which also act as neurotransmitters that bind to cannabinoid receptors in the nervous system.
Studies have shown that CBD can alleviate chronic pain by reducing inflammation and interacting with neurotransmitters. There have also been anecdotal reports on CBD’s efficacy in helping treat a variety of medical conditions. Among others, CBD's antioxidative and anti-inflammatory properties may help lower risk factors that can lead to heart disease, like high blood pressure.
In one research, CBD showed its therapeutic potential in pre-clinical models of metastatic breast cancer. However, the indisputable scientific evidence is for CBD's efficacy in the remedy of epilepsy syndromes like Lennox-Gastaut Syndrome (LGS) and Dravet Syndrome (DS), the symptoms of which do not typically respond to anti-seizure medications. In several studies, CBD was able to reduce the frequency of seizures substantially, and, in some cases, it was able to prevent them entirely. Recently, the U.S. Food and Drug Administration (FDA) approved Epidiolex as the first-ever cannabis-derived medicine for LGS and DS.
CBD is generally considered safe, even at high doses. However, given that cannabis regulations differ from state to state, consumers may not be getting what is stated on the product labels. The quantities tested in high-CBD products, including CBD-infused edibles and CBD-infused beverages, tend to be far below the concentrations tested experimentally.
CBD and Salicylate
Aspirin and CBD both help treat inflammation. 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.
Aspirin and CBD are both derived from plants. Medical marijuana, sometimes referred to as medical cannabis, is a term for derivatives of the Cannabis sativa plant. 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.
Salicylate, the active ingredient in aspirin, is salt derived from salicylic acid. Salicylate compounds are naturally present in some plants like white willow bark and wintergreen leaves. These compounds protect the plants are protected against insect damage and disease. Thousands of years ago, the salicylate compounds extracted from willow bark were used as a folk remedy.
Types of Aspirin and Their Uses
Baby Aspirin vs. Adult Aspirin
Low-dose aspirin has an aspirin content of 75 to 150 mg. A single pill of baby aspirin contains 81 milligrams of aspirin. It is called baby aspirin because of the small dose, but it is not safe for children. One should never give aspirin to children younger than 16 unless their doctor prescribes it.
An adult aspirin pill contains a 325-milligram dose. For individuals who have had a heart attack or have had a heart stent placed, it is crucial to take aspirin and other blood-thinning medications exactly as prescribed by a doctor.
Plain or Coated?
Enteric-coated aspirin is formulated to pass through the stomach and not dissolve until it reaches the small intestine. Hence, coated aspirins are gentler on the stomach and are appropriate for people who take aspirin daily, as well as those with a history of gastritis or ulcers. Although coated aspirins do not guarantee a decreased risk of gastrointestinal bleeding, they may be as effective as plain aspirin when taken at the time of a possible heart attack.
Why Take Aspirin Daily?
Every day, millions of Americans take aspirin to prevent another heart attack, or what doctors refer to as secondary prevention. Unless there is a particularly valid reason not to take aspirin, individuals with coronary artery disease should take an aspirin every day. Most experts recommend taking a baby aspirin daily for prevention.
To get aspirin into the bloodstream immediately, especially when the clotting process is underway, the patient should chew and swallow an uncoated 325 mg full adult-size tablet as soon as possible.
Meanwhile, if one is taking aspirin and needs to undergo a surgical procedure or dental work, he or she should inform the attending physician about the aspirin dose and frequency of intake. Otherwise, there could be complications that may arise from excessive bleeding during surgery. Also, one must not stop taking prescribed aspirin therapy unless advised by a doctor.
Drug Interactions Between Aspirin and Other Drugs
- Aspirin can severely weaken the body's ability to prevent the formation of blood clots when taken with anticoagulants (blood thinners), such as warfarin (like Coumadin) or enoxaparin (like Lovenox). This combination of blood thinners and aspirin can result in spontaneous and excessive bleeding. Thus, patients who are taking aspirin while on warfarin or enoxaparin must be carefully managed and observed by a doctor.
- Aspirin can cause a substantial rise in uric acid levels in the blood. Patients who have problems related to increased uric acid levels or gout must refrain from taking aspirin.
- Aspirin may interact with prescription drugs used to lower blood sugar levels in patients with diabetes. The interaction may lead to a severe medical condition called hypoglycemia, which is characterized by an abnormal drop in blood sugar level. Blood sugar levels should be monitored closely.
- Some NSAIDs, such as ibuprofen (like Motrin and Advil), can lower the antiplatelet effects of aspirin if taken immediately before aspirin. In this situation, aspirin becomes less effective.
- Aspirin may cause allergic reactions in some people. Symptoms, such as flushing, hives (itchy rashes), blocked and runny nose, and severe asthma may occur within an hour of taking a tablet. The aspirin allergy of people who have hives, nasal polyps, or asthma is 10 to 30% greater compared to people without these conditions.
Best CBD Oils for Cardiovascular Health
Although using CBD together with aspirin is not advisable, there are CBD oil products that may prove beneficial when used by itself or when used with other drugs that do not have the same chemical characteristics of aspirin.
The following CBD products are recommended for those who are looking to improve their general cardiovascular health.
- Full Spectrum CBD Oil by Ananda Hemp - This product contains 2000 mg of CBD in a 50ml container, which translates to a 40 mg dose of CBD per 1 ml serving. Start with 1/3 dropper under the tongue after a meal. Hold for up to a minute and then swallow with water.
- CBD Oil Tincture Drops by Bee's Knees CBD - Besides CBD oil, coconut oil is the only other ingredient in the tincture. As a carrier oil, coconut oil provides optimal bioavailability.
- All-Natural Full Spectrum CBD Tincture by Bloom Farms CBD - The tincture contains only two ingredients, organic MCT coconut oil, and hemp.
- CBD Oil Tincture by Joy Organics - Third-party lab test results are readily available on the company website. The tinctures have a shelf life of 18 months and come with 30 servings per bottle.
- CBD Tincture by Evo Hemp - Evo Hemp uses CO2 extraction in its CBD products, one of the purest and most expensive methods of extraction.
- CBD Oil Drops by Colomont Inc. - This tincture is a CBD isolate, which makes it ideal to use if one is concerned about passing a drug test.
An individual's risk for health problems may depend on several factors, including family history, age, and overall health. Thus, experts recommend a personalized approach when considering the daily intake of aspirin to prevent heart disease. Even in low doses, aspirin can cause side effects, such as vomiting, nausea, heartburn, or bleeding in the stomach.
Among its many benefits, CBD may help maintain overall heart health. However, it is not safe to take CBD while on aspirin therapy. Before taking CBD-infused products or dietary supplements, it is advisable to consult with a medical professional experienced in cannabis use, especially if the patient is treating a particular health issue.
More Information on Aspirin and Salicylate
Aspirin Use During Pregnancy
* Prospective studies of aspirin use during pregnancy have involved low doses (40-150 mg/day) rather than analgesic doses.
* Large retrospective studies of aspirin use in women during pregnancy have failed to demonstrate a teratogenic effect.
* Aspirin should be avoided during the third trimester due to possible bleeding complications and premature closure of the ductus arteriosus, which may lead to pulmonary vasculature abnormalities and pulmonary hypertension in the newborn.
* In pregnancies at risk for the development of pregnancy-induced hypertension and pre-eclampsia, and in fetuses with intrauterine growth retardation, low-dose aspirin (40-150 mg/day) may be beneficial.
* Use of low dose aspirin may reduce preeclampsia by approximately 25%, but study findings have been inconsistent.
Pregnancy-Induced Hypertension (PIH)
Imperiale and Petrulis performed a meta-analysis of six published, controlled trials (one nonrandomized, two non-placebo, three double-blind) of aspirin in PIH. They evaluated the degree of reduction in the incidence of PIH, the reduction in severe low birth weight infants, and adverse effects of low doses of aspirin during pregnancy. Of 394 women studied the relative risk of pregnancy-induced hypertension in women who took aspirin was found to be 0.35 (95% CI; 0.22-0.55).
Aspirin reduced the risk of severe low birth weight among newborns by 44% (RR 0.56; CI 0.36-0.88), and reduced the risk of caesarean section by 66% (RR 0.34; CI 0.25-0.48) overall, although the specific indications for caesarean section were generally not described. There was no effect on fetal and neonatal mortality and no maternal or neonatal adverse were associated with aspirin use.
In a randomized, double-blind, placebo-controlled trial, Sibai et al studied the effects of a daily aspirin dose of 60 mg on the incidence of pre-eclampsia in 3135 normotensive nulliparous women. Aspirin was started at 13 to 26 weeks gestation for the remainder of pregnancy.
There was no significant difference in birth weight or the incidence of fetal growth retardation, postpartum hemorrhage, or neonatal bleeding problems between groups in the 2985 women followed up. The incidence of pre-eclampsia was reduced in the treatment group (4.6% vs 6.3%), while abruptio placentae (premature separation of placenta from uterus) was increased by aspirin (11/1,570 Vs 2/1,565; p=0.01).
A multicenter study (CLASP) looked at aspirin administration for the prophylaxis of pre-eclampsia, prophylaxis and treatment of intrauterine growth retardation (IUGR), and treatment of pre-eclampsia in 9364 women. Women between 12- and 32-weeks’ gestation were randomly assigned 60 mg aspirin daily or placebo.
Aspirin was associated with a 12% reduction in the incidence of protein uric pre-eclampsia, which was not significant. There were no significant differences in the incidence of IUGR (1.4% with aspirin Vs 1.7% with placebo) or stillbirth and neonatal death (2.7% Vs 2.8%), but the likelihood of preterm delivery was significantly reduced (19.7% Vs 22.2%, p=0.003).
Aspirin was not associated with a significant increase in placental hemorrhage or in bleeding during preparation for epidural anesthesia (0.4% Vs 0.6%), but there was a slight increase in the use of blood transfusion after delivery 4.0% Vs 3.2%). Low-dose aspirin was generally safe for the fetus and newborn infant, with no evidence of an increase in bleeding.
Adverse Effects of Aspirin
Aspirin in therapeutic doses may induce hypersensitivity, asthma, urate kidney stones, chronic gastro-intestinal blood loss, tinnitus, nausea, vomiting, and Reyes syndrome.
Anticoagulants or NSAIDs - increased risk of bleeding
Methotrexate - reduced excretion
Diuretics - antagonism of spironolactone and reduced excretion acetazolamide
Corticosteroids - increased risk GI bleeding/ulceration
Antiepileptics - increased effect of phenytoin and valproate
The pharmacokinetic characteristics of salicylate taken in overdosage have important implications for the genesis and treatment of poisoning.
Salicylates are rapidly and completely absorbed from the jejunum and small bowel when administered in aqueous solutions. However, ingestion of excessive doses does not always occur in the fasting state, so absorption and the attainment of peak plasma salicylate concentrations may be delayed by the presence of food in the stomach and by prolonged gastric emptying.
It has also been suggested that salicylates cause pyloric spasm, thus delaying gastric emptying and absorption, but variability in the rates of disintegration and dissolution of different formulations are probably more important.
About 10 percent of adults who ingest overdoses show a rise in plasma salicylate concentrations after gastric lavage, almost certainly due to flushing salicylate from the stomach into the small bowel thus facilitating absorption.
Absorption of large, potentially lethal doses may be slower than therapeutic doses partly due to the inhibitory effect of aspirin on gastric emptying and the impaired dispersion of the drug in gastrointestinal fluids. In overdose, salicylate levels may rise for 12 hours or more.
When enteric-coated aspirin formulations are taken, the onset of toxic features and the attainment of peak plasma concentrations may be delayed for 12 or more hours.
Salicylates are rapidly hydrolyzed by first pass metabolism in the intestinal mucosa and liver. Acetylsalicylic acid can only be detected in the plasma for a few hours after an overdose while plasma concentrations of salicylic acid, the principal product of hydrolysis, decline slowly with a half-life of the order of 20 to 30 hours.
Kinetics in Children
Neonates absorb salicylate as rapidly as any other age group but metabolize it more slowly than young teenagers because of comparatively immature hepatic function. Renal excretion is also slower and neonates therefore attain higher plasma concentrations. Reduced plasma albumin concentrations in this age group may increase
Kinetics in the Elderly
Absorption of therapeutic doses of salicylate is not impaired in the elderly but the elimination half-life and volume of distribution may be significantly increased. These observations may be explained by impaired hepatic and renal function despite the normal results of conventional laboratory function tests.
Phil Young, BSc (Hons) Msc MRPharmS
National Poisons Information Service (Newcastle Centre)
Regional Drug & Therapeutics Centre
Newcastle upon Tyne
This monograph has been produced by staff of a National Poisons Information Service Centre in the United Kingdom. The work was commissioned and funded by the UK Departments of Health, and was designed as a source of detailed information for use by poisons information centres.
Peer review group: Directors of the UK National Poisons Information Service.