Although CBD oil is legal in most U.S. states and is widely accessible to purchase it’s important to understand the potential risks and dangers of CBD Oil. Can CBD Oil Cause Nosebleeds PEOPLE’S PHARMACY PRESCRIPTIONS AND HOME REMEDIES Old-time trick useful in stopping nosebleeds and Teresa Graedon King Features Syndicate Q: I am a Vaping has become an increasingly popular alternative to smoking in recent years. We present a rare and unusual case of upper airway bleeding caused by inhalation of a cannabidiol (CBD) oil-based vape due to a chemical burn. There are no case reports of this injury in the literature, and we discuss …
Understanding the Risks of CBD Oil
CBD is short for cannabidiol, a chemical which is extracted from the hemp plant and then diluted with a carrier oil like coconut or hemp seed oil. While both CBD and marijuana are derived from the cannabis plant, CBD does not contain enough tetrahydrocannabinol (THC) to produce mind-altering effects. Hemp contains 0.3% or less THC, while marijuana contains higher than 0.3% THC.
CBD interacts with the body’s endocannabinoid system (ECS), which helps regulate the immune system, appetite, sleep, mood, digestion, inflammation, pain, motor control, temperature regulation, reproduction, and memory.
The FDA and CBD oil
Although CBD oil is legal in most states within the U.S. and can be purchased at your local drug/health food stores, smoke shops, and gas stations, only one CBD product has been reviewed by the Food and Drug Administration (FDA) for safety. That drug, Epidiolex, is a purified form of CBD that was approved by the FDA in 2018 for the treatment of certain seizure disorders. During their review of Epidiolex, the FDA did identify an increased risk of liver injury from the product but determined the risk could be managed provided the drug was taken under medical supervision.
Other than Epidiolex, the FDA warns that no CBD products have undergone a strict evaluation process to determine if they are “safe and effective to treat a particular disease, what the proper dosage is, how they could interact with other drugs or foods, or whether they have dangerous side effects or other safety concerns.”
The FDA also warns that testing of some CBD products has revealed the presence of contaminants like pesticides and heavy metals, and that some did not contain the levels of CBD claimed.
It is illegal for companies to promote their CBD products as a cure, treatment, or prevention of any specific disease or condition. Companies that make such claims are sent a warning letter from the FDA.
Why do people use CBD oil?
Although there have yet to be any large-scale human studies on CBD, there is scientific evidence that the oil may relieve pain, reduce anxiety and depression, reduce side-effects of cancer treatment, reduce epileptic seizures, and lower blood pressure, as well as deliver anti-inflammatory and other beneficial effects.
The Mayo Clinic reports that while CBD is usually well-tolerated, it can cause such side effects as dry mouth, diarrhea, reduced appetite, drowsiness and fatigue. Some users have also reported experiencing nausea and irritability.
Potential risks with CBD oil
Harvard Health Publishing says two of the biggest concerns with CBD use are:
- CBD can increase the levels of other medications in the body the same way grapefruit juice does.
- CBD is sold as a supplement and not required to undergo the same stringent testing as FDA-approved medications.
Agreeing with the FDA, Harvard warns the lack of regulation means consumers can’t be certain what is contained in the product and whether the dose is accurately stated.
While some CBD providers submit their products for independent lab testing, other providers do not and have no verifiable way of proving what is contained within their oil. Since the industry is largely unregulated currently, consumers often have little insight into what the products contain unless they are able to access the results.
And because a large segment of the U.S. population takes one or more prescribed and/or over the counter medications while also taking CBD oil, many are at increased risk of a dangerous interaction. A study published in JAMA Internal Medicine found that due to concurrent use of prescription medications and dietary supplements in 2011, “15% of older adults [are] potentially at risk for a major drug-drug interaction.” This estimated risk had increased from 8.4% in 2005.
Drug interactions not only impact the efficacy of a medication, but they can also cause harmful side effects. Many drugs and toxins are broken down in the body by a vital enzyme called CYP3A4, mostly found in the liver, allowing them to be eliminated by the body. Grapefruit has been found to interfere with the metabolization process, allowing the drug to build up in the body, which can be dangerous.
CBD appears to have a similar effect, which is quite concerning, as approximately 60% of medications on the market interact with CYP3A4 enzymes. Check the FDA website for information about which drugs don’t interact well with grapefruit. And always consult your healthcare provider, prior to using CBD, for medical advice specific to your needs.
Risks of CBD when used with other medications
Research indicates that CBD can interact with medications including:
- Blood Thinners: A study published in the journal Epilepsy and Behavior Case Reportsfound a “clinically significant interaction between pharmaceutical grade cannabidiol (Epidiolex®) and warfarin, one of the most widely used oral anticoagulants.” If CBD disrupts the metabolization of a blood thinner like warfarin, the build-up of drug levels in the body could result in dangerous bleeding. It’s important that patients prescribed Epidiolex are carefully monitored by health professionals.
- Epilepsy Drugs: Even though the FDA approved the CBD drug Epidiolex to treat certain forms of epileptic seizures, incorrect doses can result in more aggressive seizures. This drug should only be used under close medical supervision.
- Chemotherapy Drugs: As with most drugs, chemo drugs are manufactured considering the likely rate of metabolization. If CBD slows down that rate, concentrations of the drug can build up in the body which could result in toxicity.
Other research has also linked CBD to interactions with:
- Antidepressants and Anti-anxiety Medications
- Cold or Flu Medications
- Blood Pressure Medications (Beta Blockers)
Always consult a doctor if you’re taking any of the medications above to understand their interaction risks.
The FDA continues to advise the public to be cautious about using CBD until more scientific research supports its efficacy and safety.
Turning Point of Tampa’s goal is to always provide a safe environment and a solid foundation in 12-Step recovery, in tandem with quality individual therapy and groups. We have been offering Licensed Residential Treatment for Addiction, Eating Disorders and Dual Diagnosis in Tampa since 1987. If you need help or know someone who does, please contact our admissions department at 813-882-3003, 800-397-3006 or [email protected]
Can CBD Oil Cause Nosebleeds
PEOPLE’S PHARMACY PRESCRIPTIONS AND HOME REMEDIES
Old-time trick useful
in stopping nosebleeds
and Teresa Graedon
King Features Syndicate
Q: I am a teacher, and students in my room get frequent nosebleeds. Our school nurse drops her keys down the backs of these students, and it works perfectly! I have even done it in the classroom to avoid disruptions. It has worked every time.
A: Thank you for the reminder. Putting cold keys against the back of the neck is an old-time remedy to stop a nosebleed. We’ve heard from many teachers that they have used this trick. Here is what another reader had to say:
“I have suffered from nosebleeds since I was 4 years old. Dry air or blowing too hard would trigger one.
“I read that car keys down the neck would stop bleeding. I tried it this morning, actually. I blew my nose and immediately noticed blood. I quickly grabbed a bunch of keys and tapped them on my neck for about two minutes. Within one minute, there was no more bleeding. I suffer from very bad nosebleeds, so this information is VERY helpful.”
As far as we can tell, there are no clinical trials involving keys or other cold objects on the back of the neck for nosebleeds. Some people use a package of frozen peas or ice.
Q: My doctor prescribed 800 mg of ibuprofen a couple of times a day for the pain and inflammation of a severely twisted knee. When I took my blood pressure a few weeks later, it was 180/96. That’s much higher than my usual 124/76.
That scared me, so I searched your website for answers. I discovered that ibuprofen can raise blood pressure. What else can I use for the pain?
A: Ask your doctor whether topical NSAIDs like diclofenac gel would help your pain without causing hypertension. You will need to monitor your blood pressure even with a drug like Voltaren gel.
Other options that should not raise your blood pressure include anti-inflammatory herbs such as ashwagandha, boswellia, ginger and turmeric. Bromelain derived from pineapple and Knox gelatin also might be beneficial. You can learn more about them in our online resource, “Alternatives for Arthritis.”
Q: I’m a female distance runner. About 15 years ago, I had knee pain. An MRI showed a torn meniscus. I limped out of the doctor’s office after he gave me alternatives that included surgery, a shot of hyaluronic acid and physical therapy. I selected the PT, which I still do on my own.
My knee pain resolved but recurred with less intensity when I started training for a marathon. My husband brought home some CBD cream, a nonhallucinogenic form of cannabis ointment.
I did not believe it would do a thing, but it definitely does. I’ve gained back some speed and now consistently run, hike and bike pain-free.
A: Cannabidiol (CBD) is, as you suggest, derived from cannabis. This is a compound that does not have psychoactive properties. It has been used to control seizures. The Food and Drug Administration recently approved a highly purified form as the brand-name epilepsy medicine Epidiolex.
Researchers have been examining the use of CBD for pain, with some promising results in dogs with arthritis (Frontiers in Veterinary Science, July 23, 2018). We have heard from other readers that CBD oil can be helpful in managing pain, but there are few well-controlled clinical trials to support this approach. We’re glad you have gotten such benefit and look forward to more research.
In their column, Joe and Teresa Graedon answer letters from readers. Send questions to them via www .peoplespharmacy.com.
Oropharyngeal Bleeding Due to Cannabidiol Oil Vape Use
Vaping has become an increasingly popular alternative to smoking in recent years. We present a rare and unusual case of upper airway bleeding caused by inhalation of a cannabidiol (CBD) oil-based vape due to a chemical burn. There are no case reports of this injury in the literature, and we discuss the clinical presentation, diagnosis and our management of this potentially life-threatening injury. A 27-year-old man presented to the accident and emergency department after using a CBD oil vape. After one inhalation of the CBD oil vape, the patient experienced immediate onset pain in the oropharynx, dyspnoea, expectoration of blood and hoarseness. The patient had used a CBD oil vape four hours earlier that evening for the first time, which was procured from an unregulated online source. The patient was referred to the Ear, Nose and Throat (ENT) team where the examination of oropharynx identified a posterior pharyngeal bleeding point. Flexible nasal endoscopy was undertaken showing profound erythema and inflammation throughout the oropharynx and posterior pharyngeal wall. The mucous membranes had been detached leaving an exposed bleeding submucosa. The patient was commenced on three cycles of back-to-back adrenaline nebulisers (1:1000 adrenaline in 5ml of 0.9% NaCl), 6.6mg dexamethasone intravenously and hydrogen peroxide gargles (5ml of 3% hydrogen peroxide in 10ml of water) three times a day. There were early involvement and review of the airway by the anaesthetic and intensive care teams, which was deemed safe at the time. A plan was made for a definitive airway if bleeding reoccurred. Upper airway bleeding can present as a rare form of vape-induced injury and should be considered part of the differential diagnosis particularly in those using CBD oil vapes. History taking is pertinent and patients should be questioned on the specific vape liquids used. Airway stabilisation is the priority with early involvement of the multi-disciplinary team including anaesthetists, intensive care specialists and ENT surgeons.
Keywords: bleeding; emergency medicine; ent; oral injury; oropharynx; otolaryngology; smoking; vape.
Copyright © 2021, Pankhania et al.
Conflict of interest statement
The authors have declared that no competing interests exist.
Leas EC, Moy N, McMenamin SB, Shi Y, Benmarhnia T, Stone MD, Trinidad DR, White M. Leas EC, et al. Int J Environ Res Public Health. 2021 Jun 22;18(13):6719. doi: 10.3390/ijerph18136719. Int J Environ Res Public Health. 2021. PMID: 34206501 Free PMC article.
Berg CJ, Getachew B, Pulvers K, Sussman S, Wagener TL, Meyers C, Park A, Dorvil S, Patterson A, Weber A, Hayes RB, Barker DC, Henriksen L. Berg CJ, et al. Prev Med Rep. 2020 Sep 12;20:101208. doi: 10.1016/j.pmedr.2020.101208. eCollection 2020 Dec. Prev Med Rep. 2020. PMID: 32995147 Free PMC article.
Shoemaker K, Thompson CS, Sawant R, Thiel G. Shoemaker K, et al. BMJ Case Rep. 2019 Jan 20;12(1):e228377. doi: 10.1136/bcr-2018-228377. BMJ Case Rep. 2019. PMID: 30665932 Free PMC article.
Tunkel DE, Anne S, Payne SC, Ishman SL, Rosenfeld RM, Abramson PJ, Alikhaani JD, Benoit MM, Bercovitz RS, Brown MD, Chernobilsky B, Feldstein DA, Hackell JM, Holbrook EH, Holdsworth SM, Lin KW, Lind MM, Poetker DM, Riley CA, Schneider JS, Seidman MD, Vadlamudi V, Valdez TA, Nnacheta LC, Monjur TM. Tunkel DE, et al. Otolaryngol Head Neck Surg. 2020 Jan;162(1):8-25. doi: 10.1177/0194599819889955. Otolaryngol Head Neck Surg. 2020. PMID: 31910122 Review.
Watt BE, Proudfoot AT, Vale JA. Watt BE, et al. Toxicol Rev. 2004;23(1):51-7. doi: 10.2165/00139709-200423010-00006. Toxicol Rev. 2004. PMID: 15298493 Review.