Lately I've been thinking about the pharmacodynamics of our psychocannabinoids,CannabidiolKnown CBD. starts with aLetters from Chinese doctorsTo the authors of a recent study that found CBD to be effective in treating seizures in children with the rare disease Dravet syndrome. HowOne of the first doctors to write this article(Even earlierthis is the editorial), the comment got me thinking and ultimately raised concerns about the interaction of clopidogrel and CBD.
Asian doctors say study results could be inflated by participants' useworstThey suggest that CBD's metabolic interaction with clobazam causes the drug to accumulate its active metabolite N-desmethylclobazam, which also blocks seizures. It was concluded that if CBD did not have antiepileptic (AED) properties, it would reduce seizures in patients already taking clobazam. Others are not physically affected.
Brief Introduction of Cytochrome P450
Cytochrome P450 is a superfamily of proteins responsible for metabolic reactions in the body, allowing our bodies to manipulate molecules and create new ones for use or disposal. Some of these are responsible for breaking down drugs in the body and are found in the liver, the organ responsible for breaking down unwanted chemical by-products and excreting them in bile and stool.
Some of these cytochrome p450 proteins act as enzymes (molecules that speed up chemical reactions in our body) that are responsible for certain drugs. The most common of these is certainly CYP3A4, which metabolizes most of the drugs we take. The second most common drug metabolizer is CYP2D6, but it is not closely related to cannabis.CYP2C19However, it is the enzyme responsible for the breakdown of N-desmethylclobazam and the theoretical interaction of clopidogrel and CBD discussed below.
Clopidogrel and CYP2C19 activity
Clopidogrel (Plavix®) is a commonly prescribed medication for patients who have had a myocardial infarction (MI; also known as a heart attack) or who have had a stent placed to prevent such a catastrophe. It works by preventing platelets from activating and solidifying the protruding metals of arteries or immature stents. Its effectiveness in preventing heart attacks has earned clopidogrel its place in the cardiac pharmacopoeia.
Clopidogrel is a prodrug - a drug that does not work until it is metabolized to the active form. thisRequires activation by CYP2C19Function. Inhibitors of this enzymeIts activation can be prevented by denying its purposeReduce cardiovascular events. Another common medication known to have this effect is the antacid omeprazole (Prilosec®).studythey confirmedPatients with CYP2C19 mutationloss of function mutationbenefit lessStart with clopidogrel, that isgrowth momentumTest patients for genetic susceptibility to clopidogrel before starting clopidogrel.
Theoretical Interaction of Clopidogrel and CBD
If omeprazole causesConcerns about reduced effectiveness of clopidogrel, then cannabidiol should also be thoroughly investigated. It has a combined inhibitory effect on CYP2C19, the enzyme that converts clopidogrel into its physiologically active metabolites. marijuanaincreased incidence of myocardial infarctionin patients immediately after use. While this may be partly due to increased myocardial oxygen demand, another possibility is that patients taking Plavix® experienced a decrease in the active metabolite produced by CYP2C19.Half-life 0.5-1.0 hoursThis interaction of clopidogrel and CBD should be evaluated in cohort studies as soon as possible.People's lives may depend on it.
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- Doctor Roman
Video recording of the interaction of clopidogrel with CBD:
Hello. What's going on? I'm Dr. Roman from Nature's Way Medicine®.
I want to touch on a possible interaction between CBD and Clopidogrel (aka Plavix®). CBD has been shown to inhibit an enzyme called CYP2C19 - I think that's it, check it out - which is responsible for activating clopidogrel. Clopidogrel is currently a prodrug. So when you take it it has no effect on the body unless of course it's metabolized by CYP 2C 19 - you try to remember - it becomes an active chemical that does - in this particular case - the platelets float in our blood, trying to clot where it needs to to prevent (you know) bleeding.
That's why we give Plavix® to people who have had a heart attack or who have had a heart stent implanted to stop platelet aggregation or clotting. Thrombosis in the heart or coronary arteries (sorry) can... I mean life threatening, luckily we've improved our cardiovascular medications and one of them is clopidogrel. So when a person has a stent placed in their heart, the exposed metal (or the metal that releases the drug) reaches into the bloodstream.
Bare metal braces are just that: they're just metal. They are pushed into the arteries around the heart and open, allowing blood to flow back to areas once blocked by atherosclerotic plaque. That's why we take statins. Everyone loves statins! Other stents have drug-eluting coatings or layers, in fact the drugs are designed to prevent the body from attacking them, attacking the metal and consuming it as a foreign body. Because of this, metal stents are exposed to the bloodstream for a long time and we need Plavix for at least another three years, preferably three years after the stent is placed in a way that avoids the drugs (I could be wrong). . But bare metal stents are quickly worn away through the body, covered with epithelial or endothelial linings, like the inside of our blood vessels, and over time create a continuum of light to the outside of the stent, essentially making the stent part of the holder.
Other drugs have now been shown to have this effect on clopidogrel. For example, omeprazole is an antacid (trade name Prilosec®). The drug has been shown to reduce the activity of clopidogrel by inhibiting the CYP2C19 enzyme.
Wouldn't it have the same effect if CBD also inhibited this enzyme? Wouldn't this also prevent any benefit from starting Plavix as it would prevent its activation in our body?
If true, anyone purchasing CBD nationwide would be at risk of stent thrombosis, re-infarction, and myocardial infarction (or "heart attack") due to Plavix's waning effects.
I believe a cohort study with the data we have is enough to determine if this is true. Let's take a look and share with other doctors or on your Facebook page or Twitter account. Post it on the forum or dig. And yes, let others know, because I have not heard anyone else talk about this possibility, and many of us living in the US and around the world rely on it.
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