CBD Did Not Interfere With Diazepam Nasal Spray for Seizure Emergencies in Epilepsy Patients | Research

The takeaway

In a phase 3 safety study of 163 epilepsy patients, concomitant CBD use did not worsen the safety or effectiveness of diazepam nasal spray for seizure clusters, with patients on purified CBD actually showing the lowest rates of drug-attributed adverse events.

Epilepsy patients using both CBD and rescue medications, neurologists, pharmacists.

Purified CBD users had the lowest rate of diazepam-attributed adverse events (13%)

What the researchers found

Of 163 patients, 73% received no CBD, 14.1% received purified CBD (Epidiolex), and 12.9% received other CBD. While overall adverse event rates were higher in CBD users (90.9% vs 79.0%), the lowest rate of events attributed specifically to diazepam nasal spray was in the purified CBD group (13.0%). Use of second diazepam doses (effectiveness proxy) was lowest in the purified CBD group (8.2%) compared to no-CBD (11.6%) and other-CBD (20.3%).

Why it matters

Many epilepsy patients take both CBD products and rescue benzodiazepines. This study provides reassurance that CBD does not interfere with the safety or effectiveness of diazepam nasal spray, an important practical finding for clinical management.

The numbers in context

163 patients. No CBD: 73%. Purified CBD: 14.1%. Other CBD: 12.9%. Drug-attributed adverse events: purified CBD 13.0%, no CBD group higher. Second diazepam dose use: purified CBD 8.2%, no CBD 11.6%, other CBD 20.3%.

How the study worked

Post hoc analysis of a phase 3, 12-month safety study of diazepam nasal spray in patients aged 6-65 with seizure clusters. Concomitant CBD use recorded. Age- and weight-based diazepam dosing.

What this study cannot tell us

Post hoc analysis, not pre-specified. Small CBD subgroups. Patients on purified CBD tended to have more severe epilepsy syndromes. Cannot distinguish CBD effects from underlying disease severity differences. Other-CBD products were uncharacterized.

How to read the evidence

Post hoc analysis of a phase 3 study with small CBD subgroups, providing safety reassurance but not definitive drug interaction data.

When this study was published

Published 2023.

The bigger picture

Drug interactions are a major concern in epilepsy management, where patients often take multiple medications. The finding that purified CBD may actually enhance diazepam nasal spray effectiveness (lower second-dose use) is intriguing and consistent with known CBD-clobazam interactions that can boost benzodiazepine levels.

Questions still open

Does CBD enhance diazepam effectiveness through pharmacokinetic interaction?
Should epilepsy patients on CBD adjust their rescue benzodiazepine doses?

Common questions

Can you take CBD with seizure rescue medications?

This study found CBD did not interfere with diazepam nasal spray safety or effectiveness. Patients on purified CBD actually needed second doses less often.

Does CBD interact with benzodiazepines?

While CBD can interact with benzodiazepines through liver enzymes, this study found no negative safety signals when CBD was used alongside diazepam nasal spray for seizure emergencies.

Read the original research

Concomitant cannabidiol does not impact safety and effectiveness of diazepam nasal spray for seizure clusters: Post hoc analysis of a phase 3 safety study.

Epilepsy & behavior : E&B, 144, 109248

View on PubMed ↗Publisher’s paper ↗

Citation

Peters, Jurriaan M; Puri, Vinay; Segal, Eric; Misra, Sunita N; Rabinowicz, Adrian L; Carrazana, Enrique. (2023). Concomitant cannabidiol does not impact safety and effectiveness of diazepam nasal spray for seizure clusters: Post hoc analysis of a phase 3 safety study.. Epilepsy & behavior : E&B, 144, 109248. https://doi.org/10.1016/j.yebeh.2023.109248