THC Detox Guide. How To Get Weed Out Of Your System
This article is for people who need to detox from marijuana, get a tolerance break or pass a drug test.
We’ll tell you what are the most efficient THC detox methods even if you have only 24 hours.
This article is a summary of scientific research visualized and explained in simple language.
How our body removes weed: the basics
Below is an elementary description of weed metabolism. Just to understand the process.
You can read the detailed guide about metabolism here: The Ultimate Guide to Marijuana Metabolism
The main component in marijuana responsible for the “high” effect is THC.
THC as well as its metabolites are highly lipid(fat) soluble. So they tend to “stick” to our body fat and some other tissues. About 70% of THC in the blood is taken up by fat.
After that, the THC and its metabolites are slowly released back into the blood. Then part of it sticks back to the fat again.
So they are in the equilibrium between blood and fat.
With the blood THC goes through the liver, which metabolizes THC in 2 phases:
Phase 1
- CYP2C9 enzymes metabolize THC to 11-OH-THC
- CYP2C19 and CYP3A4 enzymes metabolize 11-OH-THC to 11-COOH-THC
Again, this is an elementary description. There are many other metabolites and enzymes involved in the process. But these are the most important.
Phase 2
During this phase glucuronide molecules are added to 11-COOH-THC and 11-OH-THC, forming THC-COO-Gluc and THC-O-Gluc metabolites. This is done by UGT1A3, UGT1A9, and UGT1A10 enzymes.
These metabolites with glucuronide molecules are water-soluble, so they don’t stick to fat and can be excreted with urine and feces.
About 65% of THC metabolites are excreted with feces and only about 25% with urine.
Enterohepatic circulation and tubular reabsorption
Part of the metabolites in the intestines is reabsorbed back into the blood by enterohepatic circulation.
Part of THC metabolites is reabsorbed back into the blood from pre-urine by tubular reabsorption.
You will understand why this is very important later in the article.
Further in this article, we will use THC as the common name for THC and its metabolites.
How long does marijuana stay in your system?
Here’s the detailed post about this: How Long Does Marijuana Stay in Your System. The Ultimate Guide
In general: THC can stay in your fat tissues for months. This depends on your metabolic rate, diet, and lifestyle.
From the fat, it will be slowly released back into the blood and then into urine and feces for months.
Studies show that low levels of THC metabolites have been detected for more than 5 weeks in the urine and feces following a single dose of THC edibles.
In hair, THC can stay for years. There was a case where it was detected three years after the use of marijuana.
No THC is reabsorbed from the blood into saliva, so it will stay in your mouth until washed out, usually for several days.
Understanding the marijuana detox process
If you need a fast detox to pass a drug test, read the next part of this post.
In this part, we’ll help you to understand how marijuana detoxification works. If you want, you can skip to step-by-step instructions.
To permanently remove all of the THC from your body you need to do the following:
- Increase the release of THC from the fat cells
- Increase the metabolism rate of THC in the liver so more THC will be metabolized and excreted
- Block the enterohepatic circulation, so THC will not be reabsorbed back into the blood from the intestines, and more THC will be excreted in feces
How to increase the release of THC from the fat cells
To do this, you need to make your body burn fat. Actually, you need to do the same things that are required to lose weight. There’s a lot of information about this on the web.
Here’s the basic list of what will help. You can find detailed information following the links below:
- Add exercise to your daily routine (lifting weights, HIIT, cardio)
- Eat healthy food (protein, fat, and vegetables)
- Cut back on refined carbs
- Do intermittent fasting
- Drink more water
- Sleep at least 7 hours each day
Here are a couple of detailed guides on losing weight:
- https://www.healthline.com/nutrition/how-to-lose-weight-as-fast-as-possible
- https://www.healthline.com/nutrition/best-ways-to-burn-fat
How to increase the metabolism rate of THC in the liver
As we already mentioned – THC is metabolized in the liver in 2 phases.
So we need to increase the speed of each phase to metabolize THC faster.
Metabolization is done by enzymes. We need enzyme inducers to increase their metabolic activity.
Enzyme inducers stimulate your body to produce more of a specific enzyme. Enzyme induction takes time. It may take several days to see significant induction, and maximal induction can take over a week.
There are a lot of medications that act as enzyme inducers. Most people don’t have easy access to them, so we don’t recommend these.
At the end of the article, we’ll list the herbs that act as enzyme inducers.
The enterohepatic circulation
Skipping all those medical terms, enterohepatic circulation is the reabsorption of THC metabolites through the intestines’ walls back into the blood.
This means that even if metabolites were moved to the intestines for excretion, they could still return to your blood.
Since we need to remove all THC from our body, we need to prevent this circulation.
How to prevent THC metabolites from being reabsorbed back into the blood
Studies are showing that activated charcoal absorbs drugs in the intestines and prevents enterohepatic circulation.
For example, adsorption of 1,000 ng/mL of free or conjugated THC-COOH was complete using as little as 5 mg of activated charcoal.
The same study shows that wheat bran can also absorb THC, and the absorption increased with increasing amounts of wheat bran.
That said, activated charcoal may cause some unpleasant side effects, the most common of which are nausea and vomiting. Besides, constipation and black stools are two other commonly reported side effects.
THC Detox: instructions
Follow a healthy diet
Well, the detailed meal plan depends on your daily calorie requirements and food preferences. First, you need to calculate the number of required calories and then modify your meal plan to consume fewer calories than required.
You can find a good calorie calculator and sample meal plans here: https://www.verywellfit.com/an-example-of-a-healthy-balanced-meal-plan-2506647
Exercise
The simplest way to add exercise to your daily routine is to go for a walk for at least 60 minutes. You can also add low-intensity cardio training.
If you work out in a gym, some good examples of low-intensity cardio include:
- Walking on the treadmill or stepper machine
- Pedaling on the exercise bike
- Hitting up the rowing machine
- Swimming laps in the pool
If you enjoy outdoor exercise, you can try:
- Walking or easy hiking trails
- Jogging
- Cycling
Yoga can also be a good form of low-intensity cardio.
Remember that you also need to do it for at least 60 minutes.
This is because our body uses the energy saved as glycogen in our muscles and liver. There’s enough energy for ~45 minutes of activity.
After this energy is depleted, our body starts to get energy from the body fat.
So if you exercise for less than 45 minutes it just doesn’t make sense in terms of fat breakdown and THC detoxification.
Supplements
As we already mentioned, you should use only one of the suggested supplements. Combining different supplements can cause interactions and severe side effects.
The mentioned dosages are recommended dosages from the manufacturers. Consult your physician for medical advice before taking any of them.
- St. John’s Wort extract: 300 mg 3 times daily.
- Panax Ginseng: 500 mg twice daily.
- Ginkgo Biloba: 240 mg daily.
- Licorice root extract: 150mg twice daily
- Aspirin: 50 mg daily for 14 days
- Soymilk: 3 cups daily
Additionally, take 500mg of activated charcoal twice daily to speed the excretion of THC with feces.
The full list of supplements is included at the end of the article.
How long does it take to detox THC?
Unfortunately, there’s no way to tell the exact time it will take. This depends on many factors. But you can use this calculator to get the estimates:
[thccalc]This calculator uses a math model to simulate the human metabolism of THC. It will show how much time it will take to detox naturally.
If you follow a healthy diet and exercise regimen and use supplements, it will significantly reduce the amount of time required to detox.
The fastest way to detox for a drug test
If you need to detox fast, the situation is different. You may need to pass a drug test, and there’s not enough time to remove weed out of the system.
So you need another way. The method is called flushing or dilution.
You need to lower THC metabolites’ concentration in your urine below the detectable (“cutoff”) level.
To do this, you need fewer metabolites to be excreted in the urine.
You can achieve that by following these steps:
- Stop THC from being released from fat into the blood. So fewer metabolites will be metabolized and excreted into the urine.
- Slow the THC metabolism in the liver by blocking(inhibiting) metabolizing enzymes.
- Stop THC from being reabsorbed back into the blood from the intestines (enterohepatic circulation)
- Flush THC metabolites from the bladder, so the concentration will be below the cutoff level.
Let’s find out how we can do each of these steps.
If you need the exact instructions, click here to skip the explanations.
How to stop the fat breakdown
Again, there are a lot of studies describing how our body burns fat.
Here’s the simple explanation:
The energy is stored in our body in the form of glycogen. Glycogen is stored in the liver and muscles.
When we need energy, our body processes glycogen from the liver and muscles, but the amount of glycogen in the body is limited.
When glycogen amounts are depleted, our body begins to process fat and protein(muscle) to get energy.
So we need to make sure there’s enough glycogen in the liver and muscles for our body, so it doesn’t start the breakdown of fat.
Our body gets glycogen from processing carbohydrates.
All we need is to consume carbohydrates before the drug test. This will provide the body with glucose and stop the breakdown of fat.
We also need to consider that some carbohydrates take more time to be processed, so you need to correlate the type of carbohydrates and the time we need to pass the test.
Source: https://www.atkins-hcp.com/atkins-resources/research/how-insulin-blocks-fat-burning-1
How to slow the metabolism of THC
To do this, we need to inhibit(block) the activity of THC metabolizing enzymes. This will reduce their activity, and thus less THC will be metabolized for excretion.
As you see, this is the opposite of what we do when we need to detox.
We need to use enzyme inhibitors. An enzyme inhibitor is a molecule that binds to an enzyme and decreases its activity.
Actually, we need to decrease the activity of only one enzyme, CYP2C9. This is the enzyme responsible for metabolizing THC into metabolites that are excreted in the urine.
The good thing is that inhibition is basically instant.
Here’s the list of CYP2C9 inhibitors:
- Ginger ( https://pubmed.ncbi.nlm.nih.gov/23770984/ )
- Devil’s claw (https://pubmed.ncbi.nlm.nih.gov/15384148/ )
- Echinacea ( https://pubmed.ncbi.nlm.nih.gov/15992226/ )
- Garlic (https://pubmed.ncbi.nlm.nih.gov/15992226/)
- Ginseng (https://pubmed.ncbi.nlm.nih.gov/15133536/ )
- Grapefruit juice (https://pubmed.ncbi.nlm.nih.gov/17995595/ )
- Green Tea (https://pubmed.ncbi.nlm.nih.gov/27518169/ )
- Kava (https://pubmed.ncbi.nlm.nih.gov/12386118/ )
- Saw Palmetto (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4464477/ )
The research found that seventeen oils had the potential to be potent inhibitors of CYP2C9. Those oils were:
bergamot, cardamom, carrot seed, cinnamon leaf, citronella, clary sage, clove bud, elemi, eugenol, geranium bourbon, ginger, neroli, oregano Vulgare, and vanilla absolute.
Many other herbs can inhibit these enzymes, but the above are the most popular.
How to stop THC from being reabsorbed back into the blood from the intestines.
As we previously said, activated charcoal or wheat bran can block enterohepatic circulation. But since this is a fast detox, you need to use the increased dosage.
How to flush THC metabolites from the bladder
At this step, we already reduced the number of THC metabolites entering the bladder. Still, some metabolites were already excreted there.
So we need to flush them out to reduce their concentration in the urine. This can be done by drinking more water and urinating several times.
The problem here is that when we drink more water, our urine becomes pale and “diluted.” The other components of urine are also flushed out.
The lab will check the urine for the specific gravity, creatinine levels, and color. If any of these parameters are out of normal range – your urine will be rejected as diluted. And you’ll need to retake the test.
How to restore creatinine levels in the urine
Creatinine is a by-product of muscle metabolism that is excreted into your urine. Urine creatinine is typically used to measure kidney function, but it is also a way that drug testing companies measure whether you have excessively diluted urine.
The DOT and SAMHSA guidelines (which many drug testing labs follow) have a cutoff of 20 mg/dL for urine creatinine. If your value is below this, your sample may be rejected.
Creatine (note the spelling difference with creatinine) is the precursor to creatinine, and it is available as a dietary supplement.
To restore creatinine levels you need to take a creatine ethyl ester supplement as it quickly raises creatinine in the urine. Creatine ethyl ester is more effective than creatine monohydrate.
You can use creatine monohydrate too, but it will take more time to absorb.
How to restore specific gravity of the urine
The lab technician can run a specific gravity test to see if your urine is overly diluted. Specific gravity is a measure of your urine density, determined by the concentration of solutes in your urine. Any molecule that is dissolved in your urine will increase its specific gravity.
When you drink a lot of water, the specific gravity decreases, and your urine will be rejected.
To restore specific gravity, you should drink an electrolyte solution. By consuming extra electrolytes, your kidneys will excrete these with the excess fluid and keep your urine’s specific gravity in the normal range.
How to restore the color of the urine
The first thing a lab tech will do upon collecting the sample is a visual inspection. A very clear-looking specimen may arouse suspicion and trigger additional testing.
You can take vitamin B2 to restore the color of the urine. Vitamin B2 (also called riboflavin) is water-soluble and excreted by your kidneys. You should take it 3 hours before the test.
The fastest way to detox for a drug test: step by step instructions
- The night before the test, eat carbohydrate-rich food. This is what is called carbohydrate loading. Foods with low glycemic indices are better for carbo-loading due to their minimal effect on glucose levels. Low glycemic foods include vegetables, whole-wheat pasta, and grains.
- 4 hours before the test, take 5 grams of activated charcoal. This will break the enterohepatic circulation of THC metabolites.
- Take 10 g of creatine ethyl ester 3 hours before the test. This will restore the creatinine level.
- Take 300 mg of vitamin B2 3 hours before the test. This will restore the color of the urine.
- Consume the electrolyte solution with grapefruit juice 0.5 – 1L per hour starting 3 hours before the test. The juice will inhibit THC metabolism, and electrolytes will restore specific gravity.
How long weed it detectable by drug tests
Drug tests look for THC metabolites in saliva, blood, urine, and hair, depending on the drug test type.
Each drug test has the “cutoff level” – the minimal detectable concentration of metabolites in the sample. If the concentration is above the cutoff level – you’ll fail the drug test.
How long can drug tests detect the time marijuana depends on a person’s lifestyle, diet, and metabolism rate.
Here are the average values:
- Blood: 7 days
- Urine: 30 days
- Hair: months and years. This depends on how frequently you cut your hair.
- Saliva: 3 days
Home remedies for THC detox
Several popular remedies are told to help detox from marijuana. Since we already know what happens with marijuana in our bodies, we will find out if these remedies work or not.
We’ll split all the remedies into 3 groups: drinks, pills, and herbs, and analyze remedies within each group.
Let’s analyze how each of these remedies affects fat breakdown, metabolizing enzymes, and enterohepatic circulation.
PRMNT – means that the remedy is effective for the permanent detoxification from marijuana.
FLUSH – means that the remedy is effective for the same-day flushing method.
ENZ – shows how the remedy affects the activity of drug-metabolizing enzymes.
FAT – shows how the remedy affects the breakdown of fat.
“Up arrow” means the increase. “Down arrow” means the decrease.
Herbs for THC detox
Herb | PRMT | FLUSH | ENZ | FAT |
---|---|---|---|---|
St. Johns Wort | ||||
Panax ginseng | ||||
Ginko Biloba | ||||
Euphorbiae Pekinensis | ||||
Licorice | ||||
Echinacea | ||||
Garlic | ||||
Ginger | ||||
Green Vegetables | ||||
Goldenseal |
St. John’s Wort
This is the most famous herb for inducing enzymes responsible for phase 1 of THC metabolism. It is well researched, and several studies confirm its properties.
This research shows that St John’s Wort induces CYP3A4 enzymes.
“St. John’s Wort Affects cytochrome P450 isoforms increasing metabolic activity CYP3A4 and CYP2C9.”
Source: https://www.ctsi.ucla.edu/education/files/view/training/docs/McKeeverCS.pdf
“St. John’s wort affects the pharmacokinetics of several drugs by inducing CYP isozymes, such as CYP3A4, CYP2C19, CYP2C9”.
Source: https://pubmed.ncbi.nlm.nih.gov/18205997/
Panax Ginseng
There was a study with 12 people involved. They 500mg of Panax Ginseng twice daily for 28 days. The results showed that Panax ginseng induced CYP3A activity in the liver and possibly the gastrointestinal tract.
Ginkgo Biloba
The study with 14 people showed that the Ginkgo Biloba extract moderately induces the CYP2C19 enzyme. But this only occurred at the highest recommended dose of 240mg/day.
Another study showed that the G. Biloba Extract at 100-2,500 ng/ml significantly induced the activity and expression of CYP3A.
Euphorbiae Pekinensis
In this study’s results, both Euphorbiae Pekinensis Radix and Glycyrrhizae Radix showed induction of the CYP2C9 enzyme.
Licorice
Sixteen adult males were enrolled in a two-phase, randomized study. In each phase, the volunteers received a placebo or glycyrrhizin(the primary ingredient of licorice) for 14 days.
They took 150mg glycyrrhizin salt tablets at 7 a.m. and another at 7 p.m. for 14 days.
The results showed the modest induction of the CYP3A enzyme.
Echinacea
In this study, echinacea showed the ability to inhibit the CYP3A4 enzyme, which is one of the main enzymes responsible for THC removal. So it can be used for the same-day flushing method.
Garlic
In this study, garlic extract inhibited the activity of the CYP2C9 enzyme by 90% after four days.
So consuming garlic will slow THC metabolism.
Ginger
This study was designed to explore the potential effects of ginger components.
All three ginger components reduced the CYP2C9 activity and moderately reduced CYP2C19 and CYP3A4 activity. These are the three major enzymes in THC metabolism.
Green Vegetables
Green vegetables include kale, spinach, collards, swiss chards, and a few others.
These vegetables have fat-burning properties, such as being low in calories and carbohydrates and loaded with fiber.
Eating green vegetables helps you to increase the volume of your meals without increasing the calories.
Studies show that meals and diets with a low energy density make people eat fewer calories overall.
Green vegetables are also incredibly nutritious and very high in many vitamins, antioxidants, and minerals, including calcium, which has been shown to aid fat burning in some studies.
Goldenseal
Studies show that extracts of Goldenseal (Hydrastis Canadensis) inhibited the CYP2C9 and CYP3A4 enzymes.
The main component of Goldenseal is berberine. Some researches show that taking berberine can reduce weight in obese people.
These effects are opposite to each other. The weight loss effect is good for detoxing, and enzyme inhibition is bad for it.
But since promoting weight loss/fat breakdown takes time and enzyme inhibition is almost instant. Goldenseal can be used for fast detox.
Verdict: can be used in the fast detox method.
THC Detox Drinks
Drink | PRMNT | FLUSH | ENZ | FAT |
---|---|---|---|---|
Cranberry Juice | ||||
Grapefruit juice | ||||
Lemon Juice | ||||
Pomegranate juice | ||||
Pickle juice | ||||
Gatorade | ||||
Kool-Aid | ||||
Pedialyte | ||||
Soymilk | ||||
Green tea | ||||
Apple Cider Vinegar | ||||
Water |
Cranberry juice
Cranberry juice is rich in flavonoids, which are known to inhibit the CYP2C9 enzyme.
However, another study shows that daily ingestion of cranberry juice does not inhibit CYP2C9, CYP1A2, or CYP3A4.
So, we have a contradiction here.
Another study shows that cranberry decreases diet-induced weight gain and visceral obesity.
This means that cranberry juice can prevent you from gaining more weight. It doesn’t mean that it will help you to break down the fat you already have.
Cranberry juice from the grocery stores contains sugar\fructose, so it will stop the breakdown of fat.
Cranberry can help in flushing, but only as any other drink. No need to spend extra money on buying it.
Pummelo and grapefruit juice
This study has shown that grapefruit and pummelo juices are potent inhibitors of CYP3A4 and CYP2C9 enzymes.
So you should avoid grapefruit juice during THC detox but you can use it in the flushing method to prevent THC from getting into the urine.
Lemon juice
Lemon juice, similar to grapefruit juice, inhibits the CYP3A4 enzyme by almost 60%.
Pomegranate juice
This juice acts as a CYP3A4 and CYP2C9 inhibitor so it can be used as an alternative to other juices in the flushing method.
Gatorade, Kool-Aid, Pedialyte
All these drinks are electrolyte drinks that contain vitamins and minerals required to restore the specific gravity of the urine. So it’s recommended to drink these during the flushing methods.
Another positive effect of these drinks is that they contain sugar, so they’ll also stop the breakdown of body fat and excretion of THC into the blood.
Soymilk
In this study, soymilk, and miso significantly induced CYP3A4 enzyme activity.
Green tea
There’s a study showing that green tea inhibits the CYP2C9 enzyme so it can be useful for the fast detox protocol.
Another study showed that green tea induced a small, statistically non-significant weight loss in overweight or obese adults. Because the amount of weight loss is small, it is not likely to be clinically important. Green tea had no significant effect on the maintenance of weight loss.
Green tea is a diuretic, so it will help to urinate frequently, which is good for flushing the metabolites out of the bladder.
So it can help to pass a drug test. It can be used for detox along with enzyme inducers only.
Apple Cider Vinegar and Pickle Juice
Vinegar doesn’t affect THC metabolizing enzymes and enterohepatic circulation.
However, there’s interesting research. During the 12-week treatment period, the subjects in 3 groups took 500 ml daily of a beverage containing either 15 ml of vinegar, 30 ml of vinegar, or 0 ml of vinegar.
Bodyweight, BMI, and visceral fat were significantly lower in both vinegar intake groups than in the placebo group.
So, this study shows that daily intake of vinegar can increase body fat breakdown.
Vinegar can help with detoxification from marijuana by increasing the breakdown of fat cells.
Pickle juice contains vinegar, so the effects are the same.
Water
Consuming more water is an efficient way to burn more body fat and increase the metabolism of THC.
In an eight-week study published in 2013, 50 girls with excess weight drank about two cups of water half an hour before breakfast, lunch, and dinner without any additional dietary changes.
They lost weight and saw reductions in body mass index and body composition scores.
Drinking water increases the number of calories you burn, which is known as resting energy expenditure.
In adults, resting energy expenditure has been shown to increase by 24–30% within 10 minutes of drinking water. This lasts at least 60 minutes.
Several other studies have monitored overweight people who drank 1-1.5 liters (34–50 oz) of water daily for a few weeks. They found a significant reduction in weight, body mass index (BMI), waist circumference, and body fat.
THC detox pills
Here’s the list of pills that will help you to get marijuana out of your system or pass a drug test.
Aspirin
In the study aspirin, 50 mg daily, was given for 7 and 14 days to 18 males volunteers.
Both 7-day and 14-day low-dose of aspirin-induced the activities of CYP2C19.
CYP3A activity increased moderately but significantly by both 7-day and 14-day aspirin treatment.
There was a study with 100 urine specimens tested. That study showed that urine with aspirin metabolites had a false negative on immunoassay drug tests.
Although direct addition of Aspirin to urine specimens did not produce the same results.
This study confirms that taking Aspirin several hours before the test can cause a false negative. But you must remember that the results are not guaranteed!
So Aspirin can be used in permanent detoxification and in flushing methods.
Niacin
Niacin only affects the CYP2D6 enzyme, but this enzyme doesn’t take part in the metabolism of THC.
However, Several studies show that niacin blocks the breakdown of fats in adipose tissue.
So it can be used as an additional remedy to pass a drug test to temporarily block the fat breakdown.
Unfortunately, there are severe side effects and dangers of using niacin.
It can cause liver problems, stomach ulcers, changes in glucose levels, muscle damage, low blood pressure, heart rhythm changes, and other issues.
Taking niacin also might worsen allergies, gallbladder disease, and symptoms of certain thyroid disorders.
You can block the breakdown of fat by eating carbohydrates the day before or eating chocolate bars several hours before the test. Using niacin is not worth the health risks.
Water pills / diuretics: Midol, Lasix, Furosemide
Diuretics make you urinate frequently and thus help in flushing THC out of your bladder in the flushing method. However the same effect can be achieved just by drinking water, so you don’t need to take diuretics.
These pills can cause dehydration and health damage, so we don’t recommend using them.
Laxatives
Laxatives can help you to remove THC from the intestines more quickly. So less THC will be reabsorbed into the blood through enterohepatic circulation.
This will only help if you are trying to detox from marijuana completely. However, there are potential side effects, so you need to consult your doctor before using them.
Vitamin C
In 2005 Ottawa Health Research Institute published a study in which 14 adults took 500mg of vitamin C daily for two weeks.
The results showed that the activity of the CYP3A4 enzyme was increased by 21%. CYP3A4 is one of the main enzymes responsible for metabolizing THC before excretion.
So this study confirms that taking vitamin C can speed up the detoxification from THC.
Activated charcoal pills
Studies are showing that activated charcoal absorbs drugs in the intestines and prevents enterohepatic circulation.
For example, adsorption of 1,000 ng/mL of free or conjugated THC-COOH was complete using as little as 5 mg of activated charcoal.
That said, activated charcoal may cause some unpleasant side effects, the most common of which are nausea and vomiting. Besides, constipation and black stools are two other commonly reported side effects.