University of Cambridge School of Clinical Medicine, Box 111, Cambridge Biomedical Campus, Cambridge, CB2 0SP, UK.
Department of Paediatric Neurology, Cambridge University Hospitals NHS Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK.
Seizure. 2021 Mar;86:189-196. doi: 10.1016/j.seizure.2020.09.010. Epub 2020 Oct 3.
Cannabidiol is efficacious as an adjunctive treatment in children with epilepsy associated with Dravet and Lennox-Gastaut syndromes. As its role is currently adjunctive, we reviewed the interactions of cannabidiol with other antiseizure medications (ASMs).
A search of Cochrane, Pubmed and Embase databases from January 2015 to April 2020 was performed. All original research papers discussing interactions between cannabidiol and ASMs were included. Bibliographies of review articles were searched to identify further papers. Adverse events and side effects were excluded.
Cannabidiol interacts with ASMs through both pharmacokinetic and pharmacodynamic mechanisms. Thirty studies were identified (eighteen observational cohort studies, two randomised-control trials, three case reports/series, three animal studies, two briefing reports, an analysis of cohort data and a clinical trial simulation). There is potential for pharmacokinetic interactions between CBD and brivaracetam, clobazam, eslicarbazepine, lacosamide, gabapentin, oxcarbazepine, phenobarbital, potassium bromide, pregabalin, rufinamide, sirolimus/everolimus, stiripentol, tiagabine, topiramate and zonisamide. Pharmacodynamic interactions were identified for clobazam, valproate and levetiracetam. An animal study identified that the brain concentration of ASMs may be altered while the serum concentration remains the same.
Pharmacokinetic and pharmacodynamic interactions exist between cannabidiol and ASMs. The cytochrome p450 system in particular has been implicated in pharmacokinetic interactions, although not exclusively. The existing literature is limited for some ASMs by studies having relatively small cohorts. As increasing numbers of patients use cannabidiol, specialists need to monitor closely for interactions clinically and with blood levels when required.
在患有德拉维特综合征和 Lennox-Gastaut 综合征相关癫痫的儿童中，大麻二酚作为辅助治疗是有效的。由于其作用目前是辅助性的，我们回顾了大麻二酚与其他抗癫痫药物（ASM）的相互作用。
对 Cochrane、Pubmed 和 Embase 数据库进行了 2015 年 1 月至 2020 年 4 月的检索。纳入了所有讨论大麻二酚与 ASM 相互作用的原始研究论文。检索综述文章的参考文献以确定其他论文。排除了不良反应和副作用。
大麻二酚通过药代动力学和药效学机制与 ASM 相互作用。确定了 30 项研究（18 项观察性队列研究、2 项随机对照试验、3 项病例报告/系列、3 项动物研究、2 项简报报告、一项队列数据分析和一项临床试验模拟）。CBD 与布瓦西坦、氯巴占、依佐加滨、拉科酰胺、加巴喷丁、奥卡西平、苯巴比妥、溴化钾、普瑞巴林、鲁非尼胺、西罗莫司/依维莫司、司替戊醇、噻加宾、托吡酯和佐米曲普坦之间可能存在药代动力学相互作用。氯巴占、丙戊酸和左乙拉西坦存在药效学相互作用。一项动物研究发现，尽管血清浓度保持不变，但 ASM 的脑浓度可能会发生变化。
大麻二酚与 ASM 之间存在药代动力学和药效学相互作用。细胞色素 P450 系统尤其与药代动力学相互作用有关，但并非排他性的。对于一些 ASM，由于研究的队列相对较小，现有文献有限。随着越来越多的患者使用大麻二酚，专家需要密切监测临床相互作用，并在需要时监测血药浓度。
