Daily Dose Q&A

2026-02-27

THC, CBD and CBN can inhibit the hydroxylation of warfarin and increase the INR. Do cannabinoids affect the metabolism of heparin? Is the metabolism of direct oral anticoagulants (rivaroxaban, edoxaban, apixaban) impacted by cannabinoids?

While cannabinoids do not alter the metabolism of heparin, cannabinoids may impact the metabolism of DOACs. DOAC levels may increase, leading to an increased risk of bleeding.

Greger J, Bates V, Mechtler L, Gengo F. A Review of Cannabis and Interactions With Anticoagulant and Antiplatelet Agents. J Clin Pharmacol. 2020 Apr;60(4):432-438. doi: 10.1002/jcph.1557. Epub 2019 Nov 13. PMID: 31724188..

2026-02-26

Does marijuana use alter the sexual intercourse experience?

An online survey posed questions regarding various aspects of sexual experience and how those aspects were impacted by marijuana use. The results indicated that marijuana helped individuals relax, heightened their sensitivity to touch, and increased intensity of feelings, thus enhancing their sexual experience, while others found that marijuana interfered by making them sleepy and less focused or had no effect on their sexual experience.

Wiebe E, Just A. How Cannabis Alters Sexual Experience: A Survey of Men and Women. J Sex Med 2019;

2026-02-25

Side effects of short-term cannabinoid therapy may differ from person to person, and the same person may experience different side effects at different times. What factors influence the probability and the severity of adverse events?

Many factors influence the likelihood and the severity of adverse events, including the type of cannabinoid preparation, the mode of administration, the dose administered, the patient’s expectations, the patient's prior experience with cannabinoid-based therapies, the health of the patient, and the age of the patient. Drug–drug interactions may also lead to adverse events.

Vulfsons S, Minerbi A, Sahar T. Cannabis and Pain Treatment-A Review of the Clinical Utility and a Practical Approach in Light of Uncertainty. Rambam Maimonides Med J. 2020 Jan 30;11(1):e0002. doi: 10.5041/RMMJ.10385. PMID: 32017678; PMCID: PMC7000155.

2026-02-24

Is there a US governmental office to which patients can report any adverse effects from CBD products?

Yes, even though CBD (with the exception of Epidiolex) is not approved by the FDA, patients can report any adverse effects from CBD products to the FDA’s MedWatch program.

Joshi K. Cannabis-derived compounds: What you need to know Current Psychiatry. 2020 October;19(10):64-65 | 10.12788/cp.0050

2026-02-23

What is the clinical presentation of severe cannabis intoxication in the pediatric population?

The presentation of severe intoxication due to THC consumption in the pediatric population may include bradycardia, hypotension, convulsions, and respiratory depression that may require orotracheal intubation.

Fradera AS, Campos LS, Profumo AD et al. Accidental cannabis intoxication with an unexpected outcome. Emergencia Pediatricas. 2024; 3(2): 91-93