Abu-Sawwa Renad, Scutt Brielle, Park Yong
J Pediatr Pharmacol Ther. 2020;25(6):485-499. doi: 10.5863/1551-6776-25.6.485.
The first plant-derived, purified pharmaceutical-grade cannabidiol (CBD) medication, Epidiolex, was approved in the United States by the FDA on June 25, 2018. Its approval for patients ≥ 2 years of age with Dravet syndrome (DS) or Lennox-Gastaut syndrome (LGS) markedly altered the treatment of medically refractory seizures in these disorders. This state-of-the-art review will discuss the history of CBD, its current pharmacology and toxicology, evidence supporting its use in a variety of epileptic syndromes, common side effects and adverse effects, and pharmacokinetically based drug-drug interactions. Owing to the importance in considering side effects, adverse effects, and drug-drug interactions in patients with medically refractory epilepsy syndromes, this review will take a deeper look into the nuances of the above within a clinical context, as compared to the other antiepileptic medications. Furthermore, despite the limited data regarding clinically significant drug-drug interactions, potential pharmacokinetic drug-drug interactions with CBD and other antiepileptics are theorized on the basis of their metabolic pathways. The article will further elucidate future research in terms of long-term efficacy, safety, and drug interactions that is critical to addressing unanswered questions relevant to clinical practice.
首款源自植物的纯化药用级大麻二酚（CBD）药物艾必妥（Epidiolex）于2018年6月25日获美国食品药品监督管理局（FDA）批准。它被批准用于治疗2岁及以上患有德雷维特综合征（DS）或伦诺克斯-加斯东综合征（LGS）的患者，这显著改变了这些疾病中药物难治性癫痫的治疗方法。这篇前沿综述将讨论CBD的历史、其当前的药理学和毒理学、支持其在多种癫痫综合征中应用的证据、常见的副作用和不良反应，以及基于药代动力学的药物相互作用。鉴于在药物难治性癫痫综合征患者中考虑副作用、不良反应和药物相互作用的重要性，与其他抗癫痫药物相比，本综述将在临床背景下更深入地探讨上述细微差别。此外，尽管关于具有临床意义的药物相互作用的数据有限，但基于CBD和其他抗癫痫药物的代谢途径，推测了它们潜在的药代动力学药物相互作用。本文将进一步阐明在长期疗效、安全性和药物相互作用方面的未来研究，这对于解决与临床实践相关的未决问题至关重要。
