CBD Oil And Lamotrigine

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In our latest question and answer, the pharmacist discusses the use of CBD with Lamictal and Prilosec. My son had one seizure at 17 years old. He has not been diagnosed with epilepsy, but he did have an abnormal EEG that showed "slowing" so he was put on meds. After a few months on Keppra he became very depressed and moody. We changed to Lamotrigine, and although he has been seizure free for 2+ years now, he is increasingly depressed, irritable, has mood swings, and his grades

Cannabidiol (CBD) With Prilosec And Lamictal

In our latest question and answer, the pharmacist discusses the use of CBD with Lamictal and Prilosec.

Mazy asked

I read your article about possible drug interactions with CBD oil. I’m still confused. I take 50 mg of CBD oil per day in addition to 40mg of Prilosec once a day and 100mg of Lamictal twice per day. It appears to me after reading your article that the Prilosec increases the amount of CBD in my bloodstream but it inhibits the amount of Lamictal in my bloodstream. Is that correct?

At a glance

  • Based on the known metabolism of CBD (cannabidiol), Prilosec (omeprazole) and Lamictal (lamotrigine), there are several potential interactions to be concerned with. CBD may increase blood concentrations of both Prilosec and Lamictal due to enzyme inhibition, but more studies are needed to confirm this.

Answer

Thank you for reading one of our articles regarding CBD (cannabidiol) interactions. I am more than happy to elaborate on any specific drug interaction you are concerned with.

Based on your question, you are concerned with the use of two drugs with CBD, Prilosec (omeprazole) and Lamictal (lamotrigine), so I will cover both of those for you.

Before discussing those two drugs, it is important to point out that drug interaction studies concerning CBD are lacking. Most potential interactions with CBD are based simply on what we know about its metabolism and the metabolism of other drugs.

Very few studies exist that explore CBD interactions with specific drugs. Currently, the most well-documented interactions are with certain anticonvulsants, like Onfi (clobazam) [1] , valproate, Topamax (topiramate) and Zonegran (zonisamide) [2] .

Having said that, let’s take a look at Prilosec and Lamictal.

CBD With Prilosec

Prilosec (omeprazole) is a PPI (proton pump inhibitor) that is used not only to help relieve the symptoms of heartburn but also to treat GERD, ulcers and a variety of excess acid-related disorders. [3]

Prilosec has been well studied in regard to its metabolism and potential drug interactions. One of the most commonly known interactions clinicians in all areas of practice are aware of is between Prilosec and Plavix (clopidogrel), an antiplatelet medication. [4]

Prilosec is known to inhibit at least two metabolizing enzymes: [5]

This is important since metabolizing enzyme inhibition is the most common mechanism behind drug interactions. [6]

If you take Prilosec in addition to a drug that is metabolized via CYP2C19 or CYP2C8, their blood concentrations could potentially be increased, which could increase the risk of dose-related side effects since they won’t be metabolized as efficiently.

CBD (cannabidiol) is metabolized by a variety of enzymes, most notably CYP3A4 and CYP2C19. [7]

Theoretically, Prilosec, being an inhibitor of CYP2C19, could potentially increase CBD concentrations. The prescribing information for Epidiolex, a prescription CBD product, discusses this: [8]

“EPIDIOLEX is metabolized by CYP3A4 and CYP2C19. Therefore, coadministration with a moderate or strong inhibitor of CYP3A4 or CYP2C19 will increase cannabidiol plasma concentrations, which may result in a greater risk of adverse reactions [see Clinical Pharmacology (12.3)]. Consider a reduction in EPIDIOLEX dosage when coadministered with a moderate or strong inhibitor of CYP3A4 or CYP2C19.” Epidioloex Prescribing Information

Interestingly enough, there has been at least one study that reported that Prilosec did not affect CBD concentrations, even though, in theory, we could expect one: [9]

“. the moderate CYP2C19 inhibitor omeprazole [Prilosec], a proton-pump inhibitor used to treat gastroesophageal reflux disease, did not significantly alter the pharmacokinetics of CBD.” Cannabis Cannabinoid Res. 2016; 1(1): 90–101

Clearly, more studies are needed to see if there truly is an interaction between CBD and Prilosec and whether or not it is clinically significant. Based on the information that is currently available, it doesn’t appear to be overly concerning.

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CBD With Lamictal

Clinical studies for cannabidiol show that it can inhibit an enzyme known as UGT2B7 (UDP-Glucuronosyltransferase-2B7). [10] [11]

Lamictal is predominately metabolized by this enzyme. Therefore, there is the potential that CBD could increase concentrations of Lamictal (due to inhibition of its metabolism), increasing the risk of side effects. [12]

Like the potential interaction with CYP2C19 substrate drugs, the prescribing information for Epidiolex (the prescription CBD product) states the following regarding UGT2B7:

Community Forum Archive

My son had one seizure at 17 years old. He has not been diagnosed with epilepsy, but he did have an abnormal EEG that showed “slowing” so he was put on meds. After a few months on Keppra he became very depressed and moody. We changed to Lamotrigine, and although he has been seizure free for 2+ years now, he is increasingly depressed, irritable, has mood swings, and his grades in school are going down. He was always an excellent student and happy person, and now school and life in general are a struggle for him. He doesn’t even enjoy being with friends like he used to. We tried adding an antidepressant , but he didn’t like it so he stopped after a few weeks. His doctor said he could try going off Lamotrigine b/c he has been seizure free 2+ years, but we are nervous about more seizures starting at college, and also the side effects (depression, etc..) of stopping lamotrigine. What meds have others tried, other than Keppra and Lamotrigine, to control seizures and help with depressive symptoms? Has anyone gone off medication and onto CBD oil with success? Do any neurologists prescribe CBD? Our neurologist will not prescribe CBD Oil but has patients who take it. Could CBD help with lamotrigine withdrawl? Thank you everyone for listening, any advice is appreciated.

Comments

there are about 60+ meds that
Submitted by just_joe on Tue, 2017-10-24 – 17:03

there are about 60+ meds that are created to control seizures.Now you need to relax and do some research before thinking of or wanting medications. If the neurologist wants to take your son off meds because he has gone 2 years without a seizure then you should understand that he would wean your son off meds. By weaning his off slowly then he would know what dosage he needs to be at IF YOUR SON HAD A SEIZURE. There have been many people that had epilepsy and seizures that after 2 years they were taken off all meds. There have been others (my cousin was one) that was weaned off and had one. When that happened the neurologist raised the dosage to the last dosage the person had been on that kept her from having seizures. My cousin stopped having seizures but her dosage was very low. she drove and didn’t have seizures but took her meds. I know of others that never take seizure medications. CBD oil has been used for many different things. His neurologist can give you more information on it then I can. Understand too that It is still illegal in some states.

there are about 60+ meds that are created to control seizures.Now you need to relax and do some research before thinking of or wanting medications. If the neurologist wants to take your son off meds because he has gone 2 years without a seizure then you should understand that he would wean your son off meds. By weaning his off slowly then he would know what dosage he needs to be at IF YOUR SON HAD A SEIZURE. There have been many people that had epilepsy and seizures that after 2 years they were taken off all meds. There have been others (my cousin was one) that was weaned off and had one. When that happened the neurologist raised the dosage to the last dosage the person had been on that kept her from having seizures. My cousin stopped having seizures but her dosage was very low. she drove and didn’t have seizures but took her meds. I know of others that never take seizure medications. CBD oil has been used for many different things. His neurologist can give you more information on it then I can. Understand too that It is still illegal in some states.

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there are about 60+ meds that are created to control seizures.Now you need to relax and do some research before thinking of or wanting medications. If the neurologist wants to take your son off meds because he has gone 2 years without a seizure then you should understand that he would wean your son off meds. By weaning his off slowly then he would know what dosage he needs to be at IF YOUR SON HAD A SEIZURE. There have been many people that had epilepsy and seizures that after 2 years they were taken off all meds. There have been others (my cousin was one) that was weaned off and had one. When that happened the neurologist raised the dosage to the last dosage the person had been on that kept her from having seizures. My cousin stopped having seizures but her dosage was very low. she drove and didn’t have seizures but took her meds. I know of others that never take seizure medications. CBD oil has been used for many different things. His neurologist can give you more information on it then I can. Understand too that It is still illegal in some states.

Thank you Joe. We talked to
Submitted by ChicagoMom on Wed, 2017-10-25 – 11:09

Thank you Joe. We talked to his doctor and the weaning off lamotrigine will take a month I guess, going down 50mg per week. I hope we can go med free now, I guess we wont really know until we try. He has had a lot of problems on the two medications, depression, lack of concentration, grades going down in college, etc.. It’s so frustrating. Thank you for responding.

Thank you Joe. We talked to his doctor and the weaning off lamotrigine will take a month I guess, going down 50mg per week. I hope we can go med free now, I guess we wont really know until we try. He has had a lot of problems on the two medications, depression, lack of concentration, grades going down in college, etc.. It’s so frustrating. Thank you for responding.

Thank you Joe. We talked to his doctor and the weaning off lamotrigine will take a month I guess, going down 50mg per week. I hope we can go med free now, I guess we wont really know until we try. He has had a lot of problems on the two medications, depression, lack of concentration, grades going down in college, etc.. It’s so frustrating. Thank you for responding.

no problem I had issues now
Submitted by just_joe on Thu, 2017-10-26 – 17:04

no problem I had issues now and then but I also learned how to do things that relaxed me which got rid of the stress. I tore things apart and put them back together.

no problem I had issues now and then but I also learned how to do things that relaxed me which got rid of the stress. I tore things apart and put them back together.

no problem I had issues now and then but I also learned how to do things that relaxed me which got rid of the stress. I tore things apart and put them back together.

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Have you taken your son to an
Submitted by RTLEmum on Tue, 2017-10-31 – 14:16

Have you taken your son to an epileptologist and psychiatrist? Has he been seen in an epilepsy center and gotten an MRI? It seems that he is having symptoms without a clear diagnosis of epilepsy. I would want a few more medical opinions to rule out different kinds of epilepsy and more information on whether he is suffering mood swings or depression or side effects.

Have you taken your son to an epileptologist and psychiatrist? Has he been seen in an epilepsy center and gotten an MRI? It seems that he is having symptoms without a clear diagnosis of epilepsy. I would want a few more medical opinions to rule out different kinds of epilepsy and more information on whether he is suffering mood swings or depression or side effects.

Have you taken your son to an epileptologist and psychiatrist? Has he been seen in an epilepsy center and gotten an MRI? It seems that he is having symptoms without a clear diagnosis of epilepsy. I would want a few more medical opinions to rule out different kinds of epilepsy and more information on whether he is suffering mood swings or depression or side effects.

Sorry for typos. wrote this
Submitted by Concerned Mom_5a1c0f14ce9d4 on Mon, 2017-11-27 – 08:14

Sorry for typos. wrote this fast on my phone.

I was having up to four
Submitted by LaGallina on Fri, 2017-12-29 – 18:22

I was having up to four seizures a day without an success with seizure meds. I do the MAD ( modified Atkins diet, like the ketogenic diet but a lot easier) I take a high CBD oil/ low THC oil three times a day. The CBD oil didn’t work alone for me but it did take the edge off my Aura, reduced my twitching and I recovered better. The thing is once I ran out of the CBD oil but was sure I would be fine for one day without it and I was wrong! I started having seizures first thing the next day. Same with the diet and the THC. I have to be doing all three for it to work. I wish you the best for your son!

I was having up to four seizures a day without an success with seizure meds. I do the MAD ( modified Atkins diet, like the ketogenic diet but a lot easier) I take a high CBD oil/ low THC oil three times a day. The CBD oil didn’t work alone for me but it did take the edge off my Aura, reduced my twitching and I recovered better. The thing is once I ran out of the CBD oil but was sure I would be fine for one day without it and I was wrong! I started having seizures first thing the next day. Same with the diet and the THC. I have to be doing all three for it to work. I wish you the best for your son!

I was having up to four seizures a day without an success with seizure meds. I do the MAD ( modified Atkins diet, like the ketogenic diet but a lot easier) I take a high CBD oil/ low THC oil three times a day. The CBD oil didn’t work alone for me but it did take the edge off my Aura, reduced my twitching and I recovered better. The thing is once I ran out of the CBD oil but was sure I would be fine for one day without it and I was wrong! I started having seizures first thing the next day. Same with the diet and the THC. I have to be doing all three for it to work. I wish you the best for your son!

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