Cannabidiol (Medicinal cannabis)
Cannabidiol (medicinal cannabis/CBD) is an antiseizure medication that is formed of pure CBD. The psychoactive component, tetrahydrocannabinol (THC) has been removed.
Cannabidiol is usually used as an adjunctive therapy to control focal and generalised seizures in children with Dravet syndrome, Lennox Gastaut Syndrome and Tuberose Sclerosis Complex ≥ 2 years of age.
Currently, cannabidiol as Epidyolex has been approved on the PBS for children with Dravet’s syndrome and Lennox Gastaut Syndrome.
Important: Dosing guides
Initiation and escalation doses on this webpage are a guide only.
All medications must be individualised based on:
- patient age, weight, co-morbidities
- disease, seizure type, frequency, duration
- medication metabolism, interactions, side-effect profile characteristics.
Further consultation with appropriate formularies or a paediatric neurologist may be required.
Dosing
Side effects
- Sleepiness / drowsiness
- Irritability, changes in mood and behaviour including suicidality
- Fatigue / lack of energy
- Changes in appetite (increased or decreased)
- Diarrhoea and/or vomiting
- Fever
- Upper respiratory tract infection
- Drooling
- Increased seizures
- Cannabidiol may also cause side effects if it interacts with other medicines.
- Epidyolex® oral liquid contains sesame oil (avoid if allergic)
- All anti-seizure medications are potentially teratogenic and this is often dose related
Other notable side effects
- Cannabidiol can cause liver dysfunction and liver enzymes should be monitored prior to start of treatment and with titration.
Interactions
Cannabidiol may interact with other medications including antiseizure medications such as clobazam, sodium valproate and phenytoin. Cannabidiol is contraindicated in children who have raised transaminases > 3 x upper limit of normal (ULN) or bilirubin > 2 x ULN.
When discontinuing, withdraw very slowly. Sudden cessation of cannabidiol can cause seizures. The withdrawal plan is dependent on total daily dosage and duration of treatment but should be done very gradually.
Resources
This information is reviewed annually by the Sydney Children’s Hospitals Network Paediatric Epilepsy NSW working group which includes medical, nursing, and pharmacy representation.