Singh Rani K, Dillon Brittany, Tatum David A, Van Poppel Katherine C, Bonthius Daniel J
Division of Pediatric Neurology, Department of Pediatrics, Atrium Health/Levine Children's Hospital, Concord, NC, USA.
Child and Adolescent Psychiatry, Atrium Health/Levine Children's Hospital, Charlotte, NC, USA.
Child Neurol Open. 2020 Aug 13;7:2329048X20947896. doi: 10.1177/2329048X20947896. eCollection 2020 Jan-Dec.
Epidiolex (Cannabidiol- CBD) is approved for epilepsy associated with Dravet syndrome (DS) and Lennox-Gastaut syndrome (LGS) in patients over 2 years of age. Common side effects include somnolence and diarrhea. Recent studies have demonstrated interactions between cannabidiol and several other antiseizure medications. However, little is known regarding interactions between cannabidiol and other classes of medications. We discuss an autistic patient with LGS and significant psychiatric comorbidities who was being treated with multiple antiseizure and psychiatric medications, including lithium, when CBD was added to his medical regimen. Several weeks after initiating CBD therapy, he developed hypersomnolence, ataxia and decreased oral intake and was found to have lithium toxicity. Lithium was discontinued and his symptoms resolved. He remains on CBD and 2 other antiseizure medications, seizure-free with improved behavior. We review mechanisms of action and pharmacokinetics of CBD and discuss possible explanations for lithium toxicity in this patient.
Epidiolex（大麻二酚 - CBD）被批准用于治疗2岁以上患有德雷维特综合征（DS）和伦诺克斯 - 加斯托综合征（LGS）相关的癫痫。常见副作用包括嗜睡和腹泻。最近的研究表明大麻二酚与其他几种抗癫痫药物之间存在相互作用。然而，关于大麻二酚与其他类药物之间的相互作用知之甚少。我们讨论了一名患有LGS且有严重精神疾病合并症的自闭症患者，他正在接受多种抗癫痫和精神药物治疗，包括锂盐，此时在他的治疗方案中添加了CBD。开始CBD治疗几周后，他出现了过度嗜睡、共济失调和口服摄入量减少的情况，并被发现有锂中毒。停用锂盐后他的症状得到缓解。他继续使用CBD和另外两种抗癫痫药物，癫痫未发作且行为有所改善。我们回顾了CBD的作用机制和药代动力学，并讨论了该患者锂中毒的可能原因。
