Cannabidiol May Negatively Interact With Antiepileptic Drugs
Cannabidiol, a compound of cannabis that is being investigated as a potential treatment for epilepsy, may negatively interact with commonly used antiepileptic drugs (AEDs), new research suggests.
Analysis from an ongoing, open-label compassionate-use study included 42 children and 39 adults given the cannabidiol (CBD) Epidiolex (GW Pharmaceuticals, plc) to augment their epilepsy treatment. Results from the full group showed an increasing dose of CBD was associated with significant increases in serum levels of rufinamide, topiramate, and N-desmethylclobazam and a significant decrease in clobazam.
The adult-only subgroup also showed a significant association between increasing CBD dose and increased zonisamide and eslicarbazepine serum levels.
All these serum-level changes were considered to be within the accepted therapeutic range except for N-desmethylclobazam/clobazam.
However, increasing CBD dosing was linked to changes on liver function tests for the full study population receiving concomitant valproate.
Lead author Tyler E. Gaston, MD, assistant professor of neurology at the University of Alabama at Birmingham Epilepsy Center, told Medscape Medical News that the results highlight the importance of monitoring AED levels, as well as liver tests, when treating with CBD.
Dr Tyler E. Gaston
Also, if Epidiolex goes for US Food and Drug Administration approval, “this is something that clinicians will need to know about when counseling their patients,” said Dr Gaston.
The findings were published online August 6 in Epilepsia.
As reported by Medscape Medical News, previous research suggests CBD can reduce seizures in a variety of epilepsy disorders, including Dravet syndrome and Lennox-Gastaut syndrome.
However, “to date, there are few data on CBD’s interactions with other AEDs,” write the investigators.
The University of Alabama at Birmingham’s prospective, compassionate-use study was created to assess CBD’s safety and potential as an add-on therapy for treatment-resistant epilepsy. And it includes frequent monitoring of serum AED levels in case of any drug–drug interactions.
“Given what is known about CBD’s mechanism of action and metabolism, it was suspected that other AEDs with metabolism hinging on similar enzymes would be affected,” the researchers write.
All participants began taking 5 mg/kg per day of CBD. They were instructed to split it into two doses — one in the morning and one in the evening — and to take it along with their other AEDs.
The patients attended the clinic every 2 weeks, where CBD dose adjustments were made in 5 mg/kg per day increments, based on response and tolerability, up to a maximum of 50 mg/kg per day.
At each visit, patients were also weighed and underwent neurologic examinations and laboratory testing. Each patient’s “seizure diary,” which included possible adverse effects, was also reviewed. Aspartate aminotransferase and alanine aminotransferase levels were compared with liver function test findings at baseline in those taking concomitant valproate.
For the current analysis, the investigators examined first-year data for 39 adult participants (51% women; mean age, 29.1 years) and 42 pediatric participants (48% girls; mean age, 10.4 years). The mean age at seizure onset was 7.2 and 2.4 years, respectively, and the mean number of AEDs taken at enrollment was 3.2 and 3.0, respectively.
In addition, the most common type of seizures for the adults was partial only (n = 26), followed by generalized only (n=8). For the children, generalized-only seizures were the most common (n = 28), followed by partial only (n=8).
Results from the full group showed that increasing CBD dose was significantly associated with increased levels of the following:
N-desmethylclobazam (the active metabolite of clobazam, P
Medscape Medical News © 2017 WebMD, LLC
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Cite this: Cannabidiol May Negatively Interact With Antiepileptic Drugs – Medscape – Aug 18, 2017.
Cannabidiol can change serum levels of several commonly used antiepileptic drugs in both adult and pediatric patients with epilepsy, new research suggests.
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What to try after Keppra and Lamotrigine? CBD Oil?
My son had one seizure at 17 years old. He has not been diagnosed with epilepsy, but he did have an abnormal EEG that showed “slowing” so he was put on meds. After a few months on Keppra he became very depressed and moody. We changed to Lamotrigine, and although he has been seizure free for 2+ years now, he is increasingly depressed, irritable, has mood swings, and his grades in school are going down. He was always an excellent student and happy person, and now school and life in general are a struggle for him. He doesn’t even enjoy being with friends like he used to. We tried adding an antidepressant , but he didn’t like it so he stopped after a few weeks.
His doctor said he could try going off Lamotrigine b/c he has been seizure free 2+ years, but we are nervous about more seizures starting at college, and also the side effects (depression, etc..) of stopping lamotrigine.
What meds have others tried, other than Keppra and Lamotrigine, to control seizures and help with depressive symptoms?
Has anyone gone off medication and onto CBD oil with success? Do any neurologists prescribe CBD? Our neurologist will not prescribe CBD Oil but has patients who take it. Could CBD help with lamotrigine withdrawl?
Thank you everyone for listening, any advice is appreciated.
there are about 60+ meds that
there are about 60+ meds that are created to control seizures.Now you need to relax and do some research before thinking of or wanting medications. If the neurologist wants to take your son off meds because he has gone 2 years without a seizure then you should understand that he would wean your son off meds. By weaning his off slowly then he would know what dosage he needs to be at IF YOUR SON HAD A SEIZURE. There have been many people that had epilepsy and seizures that after 2 years they were taken off all meds. There have been others (my cousin was one) that was weaned off and had one. When that happened the neurologist raised the dosage to the last dosage the person had been on that kept her from having seizures. My cousin stopped having seizures but her dosage was very low. she drove and didn’t have seizures but took her meds. I know of others that never take seizure medications. CBD oil has been used for many different things. His neurologist can give you more information on it then I can. Understand too that It is still illegal in some states.
Thank you Joe. We talked to
Thank you Joe. We talked to his doctor and the weaning off lamotrigine will take a month I guess, going down 50mg per week. I hope we can go med free now, I guess we wont really know until we try. He has had a lot of problems on the two medications, depression, lack of concentration, grades going down in college, etc.. It’s so frustrating. Thank you for responding.
no problem I had issues now
no problem I had issues now and then but I also learned how to do things that relaxed me which got rid of the stress. I tore things apart and put them back together.
Have you taken your son to an
Have you taken your son to an epileptologist and psychiatrist? Has he been seen in an epilepsy center and gotten an MRI? It seems that he is having symptoms without a clear diagnosis of epilepsy. I would want a few more medical opinions to rule out different kinds of epilepsy and more information on whether he is suffering mood swings or depression or side effects.
Sorry for typos. wrote this
Sorry for typos. wrote this fast on my phone.
I was having up to four
I was having up to four seizures a day without an success with seizure meds. I do the MAD ( modified Atkins diet, like the ketogenic diet but a lot easier) I take a high CBD oil/ low THC oil three times a day. The CBD oil didn’t work alone for me but it did take the edge off my Aura, reduced my twitching and I recovered better. The thing is once I ran out of the CBD oil but was sure I would be fine for one day without it and I was wrong! I started having seizures first thing the next day. Same with the diet and the THC. I have to be doing all three for it to work. I wish you the best for your son!
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