Drug-Drug Interactions Between Cannabidiol and Lithium

Rani K Singh; Brittany Dillon; David A Tatum; Katherine C Van Poppel; Daniel J Bonthius

doi:10.1177/2329048X20947896

Drug-Drug Interactions Between Cannabidiol and Lithium

Child Neurol Open. 2020 Aug 13:7:2329048X20947896. doi: 10.1177/2329048X20947896. eCollection 2020 Jan-Dec.

Authors

Rani K Singh¹, Brittany Dillon¹, David A Tatum², Katherine C Van Poppel¹, Daniel J Bonthius¹

Affiliations

¹ Division of Pediatric Neurology, Department of Pediatrics, Atrium Health/Levine Children's Hospital, Concord, NC, USA.
² Child and Adolescent Psychiatry, Atrium Health/Levine Children's Hospital, Charlotte, NC, USA.

Abstract

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.

Keywords: antiepileptic drugs; antiseizure drugs; autism; behavior; epilepsy; pediatric.

Publication types

Case Reports