Drug reference

Cannabidiol

Antiepileptic · Anticonvulsant

Also known as CBD

AntiepilepticAnticonvulsant

CDSCO approved

EXCRETION

—

not curated

INTERACTIONS

9 major

SEVERE in our sources

PREGNANCY

—

not curated

Top interactionssee all 9 →

BuprenorphineSevereDatabaseDDInter
DextropropoxypheneSevereDatabaseDDInter
LeflunomideSevereDatabaseDDInter
LevacetylmethadolSevereDatabaseDDInter

Mechanism

Cannabidiol acts as an anticonvulsant, providing a clinical consequence of treating seizures associated with Dravet and Lennox-Gastaut syndromes. The provided textbook excerpts do not detail its specific molecular target or the pathway affected to achieve this effect.

Indications

Seizures associated with Dravet syndromeSeizures associated with Lennox-Gastaut syndromeReducing craving in chronic alcoholism (off-label)medication-resistant seizures in Dravet syndromemedication-resistant seizures in Lennox-Gastaut syndromemedication-resistant seizures in tuberous sclerosis complexAnticonvulsant (FDA-approved)Potential treatment of OUD

Dosing

Adult: Start at 2.5 mg/kg/dose PO BID for 1 week, dosage may be increased to a maintenance dose of 5 mg/kg/dose PO BID. Dose may be further increased after 1 week if needed and tolerated at weekly increments of 2.5 mg/kg/dose BID (5 mg/kg/24 hr). Those requiring a more rapid titration from 10 mg/kg/24 hr to 20 mg/kg/24 hr may be titrated no more frequently than Q48 hr.
Pediatric: Child ≥2 yr: Start at 2.5 mg/kg/dose PO BID for 1 week, dosage may be increased to a maintenance dose of 5 mg/kg/dose PO BID. Dose may be further increased after 1 week if needed and tolerated at weekly increments of 2.5 mg/kg/dose BID (5 mg/kg/24 hr). Those requiring a more rapid titration from 10 mg/kg/24 hr to 20 mg/kg/24 hr may be titrated no more frequently than Q48 hr.
Hepatic adjustment: Child-Pugh Category B (moderate): Initial PO Dose 1.25 mg/kg/dose BID, Maintenance PO Dose 2.5 mg/kg/dose BID, Maximum PO Dose 5 mg/kg/dose BID. Child-Pugh Category C (severe): Initial PO Dose 0.5 mg/kg/dose BID, Maintenance PO Dose 1 mg/kg/dose BID, Maximum PO Dose 2 mg/kg/dose BID.
Max dose: 20 mg/kg/24 hr

Pharmacokinetics

Peak effect

3 to 5 hours after oral administration

Half-life

14–30+ h (long and variable, increases with chronic dosing)

Bioavailability

low and variable orally, enhanced 3- to 15-fold by concomitant fatty food consumption

Protein binding

>94%

Metabolism

primarily metabolized by hydroxylation of the C7 methyl group by CYP2C19, followed by oxidation to the C7 carboxylic acid by CYP3A4. The C7 hydroxyl metabolite (7-OH-CBD) appears to retain antiepileptic activity.

Excretion

metabolites are subject to phase II glucuronidation, primarily at the phenolic oxygen. CBD metabolites are excreted mostly via the feces with small amounts via urine.

Side effects

Common

SomnolenceDecreased appetiteDiarrheaElevated transaminase (dose related or with concomitant valproic acid and clobazam use)FatigueMalaiseAstheniaRashInsomniaSleep disorderelevated hepatic transaminases (dose-related, >10% of patients had >3x upper limit of normal ALT at 10-25 mg/kg/day)

Serious