epidiolex
4 interactions related to epidiolex
cbd + simvastatin
Simvastatin is heavily dependent on CYP3A4 for first-pass and systemic clearance, and CBD inhibits CYP3A4. Co-administration is expected to raise simvastatin and active-metabolite exposure, increasing the risk of muscle pain, transaminase elevation, and rare rhabdomyolysis.
cbd + clobazam
CBD strongly inhibits CYP2C19, the enzyme that clears N-desmethylclobazam (the active metabolite of clobazam). Co-administration triples plasma N-desmethylclobazam levels, causing excess sedation, ataxia, and somnolence; this is documented in the FDA-approved Epidiolex prescribing information.
cbd + valproate
Concomitant CBD (Epidiolex) and valproate use produces a significantly higher rate of ALT/AST elevations than either drug alone - up to ~17% of patients in the combination group versus ~1-2% on valproate alone in pooled Epidiolex trial data. Postmarketing reports also describe hyperammonemia in patients on the combination.
cbd + warfarin
CBD inhibits CYP2C9 (and CYP3A4), the enzymes responsible for metabolizing the more potent S-enantiomer of warfarin. Co-use raises plasma warfarin concentrations, elevates INR, and increases bleeding risk; a published case report required a roughly 30% warfarin dose reduction after the patient started CBD.