Practical use of pharmaceutically purified oral cannabidiol in Dravet syndrome and Lennox-Gastaut syndrome

ABSTRACT

Introduction

Pharmaceutically purified oral cannabidiol (CBD) has been recently approved by the US Food and Drug Administration and European Medicines Agency as treatment of seizures associated with Dravet syndrome (DS) and Lennox-Gastaut syndrome (LGS), which are severe and difficult-to-treat developmental and epileptic encephalopathies with onset in early childhood.

Areas covered

This review will critically review the pharmacokinetic properties of CBD, the interactions with antiseizure and non-antiseizure medications, and the main tolerability and safety issues to provide guidance for its use in everyday practice.

Expert opinion

CBD is metabolized in the liver and can influence the activity of enzymes involved in drug metabolism. The best characterized drug-drug interaction is between CBD and clobazam. The most common adverse events include somnolence, gastrointestinal discomfort, and increase in serum transaminases. High-grade purified CBD oral solution represents an effective therapeutic option in patients with DS and LGS. The findings cannot be extrapolated to other cannabis-based products, synthetic cannabinoids for medicinal use and non-medicinal cannabis and CBD derivatives.

KEYWORDS:

• Cannabidiol
• epilepsy
• Dravet syndrome
• Lennox-Gastaut syndrome

Article highlights

• Pharmaceutically purified oral cannabidiol (CBD) is approved for treatment of seizures associated with Dravet syndrome and Lennox-Gastaut syndrome

• CBD is metabolized in the liver and can influence the activity of enzymes involved in drug metabolism

• The best characterized drug-drug interaction is between CBD and clobazam

• The most common adverse events include somnolence, gastrointestinal discomfort, and increase in serum transaminases

• The findings cannot be extrapolated to other cannabis-based products, synthetic cannabinoids for medicinal use and non-medicinal cannabis and CBD derivatives

Declaration of interest

S Lattanzi has received speaker’s or consultancy fees from Eisai, UCB Pharma, and GW Pharmaceuticals and has served on advisory board for GW Pharmaceuticals. G Zaccara has received speaker’s or consultancy fees from Eisai, GW Pharmaceuticals, UCB Pharma and Jazz Pharmaceuticals. E Russo has received speaker’s fees or funding or has participated in advisory boards for Eisai, Pfizer, GW Pharmaceuticals, UCB Pharma. AL Neve received speaker’s or consultancy fees from Eisai, Mylan, Bial, Sanofi, and UCB Pharma. P Striano has received fees and research grants from GW Pharmaceuticals, Zogenix, BioMarin, and Kolfarma. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or conflict with the subject matter or materials discussed in this manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplemental material

Supplemental data for this article can be accessed here.

Additional information

Funding

This paper was not funded.