Review maps drug interactions between antiepileptic medications and cannabinoids
Cannabinoid-AED combinations can enhance seizure protection but also increase side effects, with CBD clinical trials showing 14-35% dropout rates and common side effects of diarrhea, somnolence, and poor appetite.
Quick Facts
What This Study Found
In animal models, WIN 55,212-2 (CB1/CB2 agonist) potentiated anticonvulsant activity of various AEDs but caused profound neurotoxicity when combined with conventional AEDs. ACEA (selective CB1 agonist) enhanced phenobarbital and levetiracetam without adverse effects or pharmacokinetic interactions. Clinical CBD add-on therapy reduced seizure frequency with retention rates of 14-24% at 12 weeks to 1 year, reaching 35% at 2 years.
Key Numbers
Clinical CBD retention rate: 14-24% (12 weeks to 1 year), 35% at 2 years. Most common AEs: diarrhea, somnolence, poor appetite. ACEA enhanced phenobarbital and levetiracetam without pharmacokinetic interactions in mice.
How They Did This
Literature review of PubMed through December 2018, covering both experimental (animal model) and clinical data on AED-cannabinoid interactions.
Why This Research Matters
Most epilepsy patients on CBD are taking multiple other medications. Understanding which combinations are safe and effective is critical for clinical practice, especially as CBD use in epilepsy grows rapidly.
The Bigger Picture
The distinction between CB1/CB2 non-selective agonists (toxic combinations) and selective CB1 agonists (clean combinations with certain AEDs) has practical implications for developing safer cannabinoid-AED combinations.
What This Study Doesn't Tell Us
Animal interaction data may not translate directly to humans. Clinical retention rates reflect a mix of efficacy and tolerability. Limited pharmacokinetic interaction data in humans.
Questions This Raises
- ?Which specific AED-CBD combinations have the best efficacy-safety profile?
- ?Can selective CB1 agonists be developed for clinical use in epilepsy?
Trust & Context
- Key Stat:
- 14-35% retention rate for CBD add-on
- Evidence Grade:
- Moderate: comprehensive review of both experimental and clinical data.
- Study Age:
- Published in 2019.
- Original Title:
- Drug-drug interactions between antiepileptics and cannabinoids.
- Published In:
- Expert opinion on drug metabolism & toxicology, 15(5), 407-415 (2019)
- Authors:
- Miziak, Barbara, Walczak, Aleksandra, Szponar, Jarosław(2), Pluta, Ryszard, Czuczwar, Stanisław J
- Database ID:
- RTHC-02186
Evidence Hierarchy
Summarizes existing research on a topic.
What do these levels mean? →Frequently Asked Questions
Does CBD interact with seizure medications?
Yes, CBD can enhance the effects of certain AEDs. Clinical trials show common interactions include increased somnolence and diarrhea, with dropout rates of 14-35% over time.
Are some cannabinoid-AED combinations safer?
Animal studies suggest selective CB1 agonists (like ACEA) can enhance certain AEDs without the neurotoxic effects seen with non-selective cannabinoid agonists.
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Cite This Study
https://rethinkthc.com/research/RTHC-02186APA
Miziak, Barbara; Walczak, Aleksandra; Szponar, Jarosław; Pluta, Ryszard; Czuczwar, Stanisław J. (2019). Drug-drug interactions between antiepileptics and cannabinoids.. Expert opinion on drug metabolism & toxicology, 15(5), 407-415. https://doi.org/10.1080/17425255.2019.1605355
MLA
Miziak, Barbara, et al. "Drug-drug interactions between antiepileptics and cannabinoids.." Expert opinion on drug metabolism & toxicology, 2019. https://doi.org/10.1080/17425255.2019.1605355
RethinkTHC
RethinkTHC Research Database. "Drug-drug interactions between antiepileptics and cannabinoi..." RTHC-02186. Retrieved from https://rethinkthc.com/research/miziak-2019-drugdrug-interactions-between-antiepileptics
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.