Interactions between cannabidiol and commonly used antiepileptic drugs
To identify potential pharmacokinetic interactions between the pharmaceutical formulation of cannabidiol (CBD; Epidiolex) and the commonly used antiepileptic drugs (AEDs) through an open‐label safety study. Serum levels were monitored to identify interactions between CBD and AEDs.
In 39 adults and 42 children, CBD dose was started at 5 mg/kg/day and increased every 2 weeks by 5 mg/kg/day up to a maximum of 50 mg/kg/day. Serum AED levels were obtained at baseline prior to CBD initiation and at most study visits. AED doses were adjusted if it was determined that a clinical symptom or laboratory result was related to a potential interaction. The Mixed Procedure was used to determine if there was a significant change in the serum level of each of the 19 AEDs with increasing CBD dose. AEDs with interactions seen in initial analysis were plotted for mean change in serum level over time. Subanalyses were performed to determine if the frequency of sedation in participants was related to the mean serum N‐desmethylclobazam level, and if aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were different in participants taking concomitant valproate.
Increases in topiramate, rufinamide, and N‐desmethylclobazam and decrease in clobazam (all p < 0.01) serum levels were seen with increasing CBD dose. Increases in serum levels of zonisamide (p = 0.02) and eslicarbazepine (p = 0.04) with increasing CBD dose were seen in adults. Except for clobazam and desmethylclobazam, all noted mean level changes were within the accepted therapeutic range. Sedation was more frequent with higher N‐desmethylclobazam levels in adults (p = 0.02), and AST/ALT levels were significantly higher in participants taking concomitant valproate (p < 0.01).
Significantly changed serum levels of clobazam, rufinamide, topiramate, zonisamide, and eslicarbazepine were seen. Abnormal liver function test results were noted in participants taking concomitant valproate. This study emphasizes the importance of monitoring serum AED levels and LFTs during treatment with CBD.
CBD Medical Interactions. What’s safe?
As CBD becomes more popular in the healthcare industry, you should be informed on CBD medical interactions and other safety concerns.
Because cannabidiol, or CBD as it’s called for short, has anti-inflammatory and pain-relieving properties, many healthcare professionals are beginning to offer their patients products with this particular ingredient as a way to help relieve or resolve a variety of different issues.
However, because CBD comes from the cannabis plant often brings up a number of safety-related questions. Being knowledgeable about the safety-related issues of CBD can help you better inform your patients.
Will CBD products make my patients high?
If you’re concerned about CBD making your patients feel the high commonly associated with marijuana use, don’t be says Anthony Franciosi. Franciosi is a “ganja-preneur” and founder of the Honest Marijuana Company, a company which utilizes all-natural cultivation methods to produce organic and eco-conscious cannabis products, even packaging them in earth-friendly recyclable tin cans.
“CBD doesn’t seem to make people mind-alteringly high,” Franciosi explains, “because it has very little effect on the CB1 receptors in the brain that regulate learning, coordination, sleep, pain and CB2 receptors in the immune system.”
Thus, patients exposed to CBD in health-related products such as oils, lotions, and creams, don’t have to worry about this type of effect.
Will CBD products make my patients sleepy?
Another well-known side effect of cannabis is how it relaxes the user, potentially causing some concern that patients using CBD products will notice this same impact, rendering them unable to live an active life during its use.
Rachna Patel is a medical marijuana doctor based out of Walnut Creek, California and she says that this isn’t an issue. Specifically, Patel says that, when it comes to topicals containing CBD, they “tend to not cause the same side effects as medical marijuana products that are inhaled, ingested, or used sublingually, like the high or drowsiness.”
Therefore, your patients can use these types of products without fear of any type of tiredness or lethargy as a result.
What about drug interactions?
Drug interaction is a huge issue as combining two or more substances that shouldn’t be taken at the same time can sometimes result in unintended side effects. For example, it can “make your drug less effective, cause unexpected side effects, or increase the action of a particular drug,” says the U.S. Food and Drug Administration. In some cases, it can even be deadly.
CBD is known to reduce the levels of Lamotrigine and enhance the effects of Clobazam so be sure to check with your patients what medications they are taking before recommending CBD products.
When is CBD potentially unsafe for patients?
Patel does advise that there are a couple of instances in which CBD should not be used for patient care. An allergy to CBD is one of them.
“I generally suggest that patients check the ingredients on the label to ensure that they are not allergic to any of the ingredients listed. Also, topicals based in an alcohol can exacerbate certain skin conditions like psoriasis, for instance.”
How do I find the safest CBD products possible?
Gunhee Park, founder of Ministry of Hemp, warns that there are currently no quality measures in place when it comes to CBD products. “As of now, it’s really up to individual companies to police themselves and operate transparently,” he says. That being said, there are still some steps you can take to ensure that you offer your patients the safest CBD products possible.
For starters, pay attention to the origin of the oils, says Park. “The main reason why hemp’s cultivation environment is so important,” he explains, “is because of hemp’s properties of absorbing contaminants from the soil while it grows. So if the soil it was grown on is not good, clean soil, then that plant might contain high levels of lead or mercury.”
Park also suggests that you “always request third party lab results on the products. These lab results should test for potency, pesticides, residual solvents, and mycotoxins of the CBD hemp oil.” According to Park, obtaining these third-party results “are the only way to ensure a clean or safe product.”
Additionally, when it comes to CBD topicals, Park says that it’s important to take the time to check the label to ensure that it has a transdermal delivery system. This includes looking for keywords like “nano technology, encapsulation, or micellization of CBD. This shows that their solution can carry CBD through the dermal layers.”