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Cannabidiol Interacts with Multiple Epilepsy Drugs

— Four agents in addition to clobazam identified in open-label study

by Kristina Fiore, Associate Editor, MedPage Today December 5, 2016

HOUSTON — Cannabidiol is likely to interact with more anti-epileptic agents than just clobazam, researchers reported here.

In an open-label study of 81 adult and pediatric patients, the cannabis derivative also showed drug-drug interactions with topiramate and rufinamide, Tyler Gaston, MD, of the University of Alabama at Birmingham, and colleagues reported at the American Epilepsy Society meeting here.

Cannabidiol appeared to interact with zonisamide and eslicarbazepine as well, but only in adults, the researchers reported.

“With marijuana, the general idea is that it’s a safe product, and while that may be true, I think there are some caveats to that and I think that physicians need to be monitoring and managing this,” Gaston told MedPage Today.

The cannabidiol-clobazam interaction has been well established, particularly with the active metabolite N-desmethylclobazam, the researchers said. However, there are no published human data on cannabidiol’s potential interactions with other anti-epileptic drugs.

So Gaston and colleagues monitored patients who were enrolled in a state-based compassionate use study of cannabidiol for those who were refractory to at least four other anti-epileptic drugs. Over a year of monitoring, they collected data on 81 patients: 39 adults and 42 children.

Cannabidiol dosing was weight-based, starting at at 5 mg/kg per day, split into twice-daily dosing.

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Four agents in addition to clobazam identified in open-label study

New Study Finds CBD Interacts with Antiepileptic Drugs

Scientists continue to learn more about cannabidiol (CBD) and how it can potentially be beneficial for the treatment of epilepsy and seizure disorders. Findings in a new study published in Epilepsia may give neurologists and epilepsy patients a better idea on how best to incorporate the non-psychoactive compound into treatment regimens when taking other antiepileptic drugs.

CBD is a natural, non-psychoactive cannabinoid found in cannabis plants like hemp. Studies on CBD’s efficacy for treating epilepsy have been promising and as a result patients are increasingly using the compound for seizure management. The research on CBD interactions is needed, as it’s not uncommon for some epilepsy patients to take CBD with more traditional anticonvulsant drugs.

“With any new potential seizure medication, it is important to know if drug interactions exist and if there are labs that should be monitored while taking a specific medication,” said the study’s lead author, Tyler Gaston, MD.

In this recent open label study on both children and adults diagnosed with difficult-to-control epilepsy disorders, researchers from the University of Alabama at Birmingham found evidence that CBD does alter the blood levels of commonly used antiepileptic medications.

The study’s participants – 39 adults and 42 children – were treated with CBD and their respective prescribed anticonvulsant medication. Their blood levels of antiepileptic drugs were monitored to see if they were altered at all from CBD.

Gaston and his colleagues found that CBD did cause there to be significant changes in levels of traditional anti-epilepsy drugs. In adult and children participants, the drugs clobazam, topiramate, and refunamide were significantly higher when taking CBD. In adults only, levels of zonisamide and eslicarbazepine were found to be at elevated levels.

None except for clobazam reached outside of the normally accepted range. The adults given clobazam and CBD reportedly experienced sedation more frequently than when taking clobazam alone.

“Our study shows that CBD, just like other antiepileptic drugs, has interactions with other seizure drugs that patients and providers need to be aware of,” said Gaston.

The findings can help physicians to more accurately adjust the doses of antiepilepsy medications they prescribe to patients that are also taking CBD. They also suggest that epilepsy patients taking CBD may be able to reduce their intake of traditional antiseizure drugs.

The researchers did acknowledge that more research on CBD drug interactions is needed.

“While the interaction between CBD and clobazam has been established in the literature, there are currently no published human data on CBD’s potential interactions with other seizure medications,” said Gaston. “However, given the open label and naturalistic follow-up design of this study, our findings will need to be confirmed under controlled conditions.”

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Findings in a new study may give neurologists a better idea on how best to incorporate CBD in epilepsy treatment regimens. ]]>