cannabidiol (Epidiolex, Zygel, ZYN002, CBD)
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Introduction
Component of marijuana; constituent of Sativex. Reduces certain unwanted side effects of tetrahydrocannabinol while adding to the analgesic activity.
Indications
- efficacy for Dravet syndrome & Lennox-Gastaut syndrome[4]
- 50% reduction in seizures in patients with Lennox- Gastaut syndrome[6]
- in Dravet syndrome, 5% of patients become convulsive seizure-free with cannabidiol vs 0% with placebo[7]
- FDA advisory panel recommends approval[9]
- may diminish seizure severity in refractory epilepsy[5]
- add-on treatment promising for children with developmental & epileptic encephalopathies (phase 2 trial)[15]
- heroin use disorder
- appears to improve pain, sleep, & anxiety disorders
* FDA-approved for treatment of Lennox-Gastaut syndrome & Dravet syndrome &[11]
Dosage
Adverse effects
- diarrhea, vomiting
- fatigue, pyrexia, somnolence
- abnormal liver-function tests[7]
- may not adversely affect driving if tetrahydrocannabinol is not a component[14]
Drug interactions
- potent inhibitor of cyt P450s CYP2C19 & CYP3A4
- relatively weak inhibitor of CYP1A2, CYP2C9, & CYP2D6
- interacts with anticonvulsants clobazam, topiramate, rufinamide, & zonisamide & eslicarbazepine in adults[3]
Laboratory
Notes
other common self-directed uses
- psychiatric disorders (64%)
- musculoskeletal disorders (26%)
- sleep disorders (15%)
- neurological disorders (7%)
- mental health (30%)
- mental acuity, psychosocial stress management[13]
- emotional exhaustion & burnout among frontline health care professionals working with COVID-19 patients[16]
More general terms
Component of
References
- ↑ Prescriber's Letter 12(6):32 2005 New Drug: Sativex (Delta-9-tetrahydrocannabinol and Cannabidiol) Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=210605&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ Wikipedia: Cannabidiol https://en.wikipedia.org/wiki/Cannabidiol
- ↑ 3.0 3.1 Fiore K Cannabidiol Interacts with Multiple Epilepsy Drugs. MedPage Today. December 05, 2016 http://www.medpagetoday.com/MeetingCoverage/AES/61860
- ↑ 4.0 4.1 Fiore K. Cannabidiol Works in Dravet, Lennox-Gastaut. MedPage Today. Dec 6, 2016 http://www.medpagetoday.com/MeetingCoverage/AES/61866
- ↑ 5.0 5.1 Fiore K. Cannabidiol May Cut Seizure Severity in Refractory Epilepsy. MedPage Today. Dec 6, 2016 http://www.medpagetoday.com/MeetingCoverage/AES/61888
- ↑ 6.0 6.1 Bachert A Cannabidiol Cuts Seizures in LGS Patients - Decreased appetite, sleepiness most common side effects. MedPage Today. April 18, 2017 https://www.medpagetoday.com/MeetingCoverage/AAN/64620
Patel A, et al Cannabidiol (CBD) significantly reduces drop seizure frequency in Lennox-Gastaut syndrome (LGS): results of a dose-ranging, multi-center, randomized, double-blind, placebo-controlled trial (GWPCARE3) American Academy of Neurology (AAN) 2017 - ↑ 7.0 7.1 7.2 Devinsky O, Cross JH, Laux L et al Trial of Cannabidiol for Drug-Resistant Seizures in the Dravet Syndrome. N Engl J Med 2017; 376:2011-2020. May 25, 2017 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28538134 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1611618
Berkovic SF Cannabinoids for Epilepsy - Real Data, at Last N Engl J Med 2017; 376:2075-2076. May 25, 2017 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28538129 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMe1702205 - ↑ 8.0 8.1 Stockings E, Zagic D, Campbell G et al Evidence for cannabis and cannabinoids for epilepsy: a systematic review of controlled and observational evidence. J Neurol, Neurosurg, & Psychiatry. March 2018 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29511052 <Internet> http://jnnp.bmj.com/content/early/2018/02/05/jnnp-2017-317168
- ↑ 9.0 9.1 NEJM JWatch Editors FDA Advisers Recommend Approval of Cannabis-Based Drug for Seizures. Physician's First Watch, April 20, 2018 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org
Joseph A Panel recommends FDA approval of epilepsy drug derived from marijuana. STAT. April 19, 2018 https://www.statnews.com/2018/04/19/fda-epilepsy-drug-marijuana/
FDA Briefing Document Peripheral and Central Nervous System Drugs Advisory Committee Meeting. April 19, 2018 https://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/PeripheralandCentralNervousSystemDrugsAdvisoryCommittee/UCM604736.pdf - ↑ 10.0 10.1 Devinsky O, Patel AD, Cross JH et al Effect of Cannabidiol on Drop Seizures in the Lennox-Gastaut Syndrome. N Engl J Med 2018; 378:1888-1897. May 17, 2018 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29768152 https://www.nejm.org/doi/full/10.1056/NEJMoa1714631
- ↑ 11.0 11.1 Brauser D FDA Approves First Cannabis Drug for Rare Forms of Epilepsy. Medscape - Jun 25, 2018. https://www.medscape.com/viewarticle/898510
- ↑ Hurd YL, Spriggs S, Alishayev J et al Cannabidiol for the Reduction of Cue-Induced Craving and Anxiety in Drug-Abstinent Individuals With Heroin Use Disorder: A Double-Blind Randomized Placebo-Controlled Trial. Am J Psychiatr. May 21, 2019 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31109198 https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2019.18101191
- ↑ 13.0 13.1 Leas EC et al. Self-reported cannabidiol (CBD) use for conditions with proven therapies. JAMA Netw Open 2020 Oct 1; 3:e2020977 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33057645 PMCID: PMC7563067 Free PMC article https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2771735
- ↑ 14.0 14.1 George J Does Cannabidiol Impair Driving? - Driving tests suggest no, unless THC is added to the mix. MedPage Today December 1, 2020 https://www.medpagetoday.com/neurology/generalneurology/89956
Arkell TR, Vinckenbosch F, Kevin RC et al Effect of Cannabidiol and delta-9-Tetrahydrocannabinol on Driving Performance. A Randomized Clinical Trial. JAMA. 2020;324(21):2177-2186. Dec 1 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33258890 PMCID: PMC7709000 Free PMC article https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2020.21218 - ↑ 15.0 15.1 George J CBD Gel Cuts Seizures in Pediatric Patients - Transdermal cannabidiol shows promise in developmental and epileptic encephalopathies. https://www.medpagetoday.com/meetingcoverage/aes/90107
Scheffer I, et al ZYN002 Cannabidiol Transdermal Gel in Children and Adolescents With Developmental and Epileptic Encephalopathies: An Open-Label Clinical Trial. American Epilepsy Society (AES) 2020; Abstract 983 - ↑ 16.0 16.1 Crippa JAS, Zuardi AW, Guimaraes FS et al Efficacy and Safety of Cannabidiol Plus Standard Care vs Standard Care Alone for the Treatment of Emotional Exhaustion and Burnout Among Frontline Health Care Workers During the COVID-19 Pandemic. A Randomized Clinical Trial. JAMA Netw Open. 2021;4(8):e2120603. August 13. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34387679 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2782994
- ↑ Scherer L OTC Cannabidiol Products Tied to Improved Pain, Sleep, Anxiety. Medscape. Jan 24, 2022 https://www.medscape.com/viewarticle/967088