epidiolex
4 interactions related to epidiolex
cbd + simvastatin
Simvastatin is cleared mainly by the liver enzyme CYP3A4, and CBD inhibits that same enzyme. Combining them is expected to raise simvastatin exposure, which could increase the risk of muscle pain and, rarely, more serious muscle injury. This is a predicted, mechanism-based interaction rather than one confirmed by a direct human study.
cbd + clobazam
CBD inhibits CYP2C19, the enzyme that clears N-desmethylclobazam, the active metabolite of clobazam. Taking the two together raises N-desmethylclobazam levels substantially, increasing sedation, drowsiness, drooling, and unsteadiness. This interaction is documented in the FDA-approved Epidiolex prescribing information and in clinical studies in children with epilepsy.
cbd + valproate
Taking CBD (including prescription Epidiolex and over-the-counter products) together with valproate raises the chance of liver enzyme elevations well above either drug alone, and the combination has been linked to high blood ammonia that can cause confusion or worsening seizures even when liver tests look only mildly abnormal. This pairing should be managed by the prescribing neurologist with baseline and follow-up liver testing.
cbd + warfarin
CBD inhibits the liver enzymes (notably CYP2C9, and also CYP3A4) that clear warfarin, especially its more potent S-enantiomer. Adding CBD to a stable warfarin regimen can slow warfarin breakdown, raise its blood level, push the INR upward, and increase bleeding risk. A published case report described a patient who needed a meaningful warfarin dose reduction after starting CBD.