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Clinically Significant Drug-Drug Interaction Between Methadone and Cannabidiol
Kevin Madden1, Kimberson Tanco2, Eduardo Bruera2
1Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas kmadden@mdanderson.org.
Pediatrics
|May 24, 2020
Summary
Cannabidiol (CBD) use in children may affect medication levels. A case report highlights CBD
Area of Science:
- Pharmacology
- Pediatric Oncology
- Clinical Toxicology
Background:
- Increasing accessibility of cannabidiol (CBD) products has led to their more frequent use in pediatric patients.
- This case report focuses on a pediatric patient with metastatic cancer and chronic pain on a stable medication regimen.
Observation:
- A 13-year-old girl experienced increased sleepiness and fatigue after her parents administered cannabidiol (CBD) to her.
- She was concurrently receiving methadone for chronic pain, and the CBD dosage was increased by her parents.
- Physicians were initially unaware of the CBD use and its potential impact on her treatment.
Findings:
- Serum methadone levels decreased significantly (from 271 ng/mL to 125 ng/mL) within 14 days of discontinuing cannabidiol (CBD).
- The reduction in methadone levels correlated with the resolution of the patient's sleepiness and fatigue.
- Cannabidiol (CBD) is known to inhibit CYP3A4 and CYP2C19 enzymes, which are critical for methadone metabolism.
Implications:
- This case highlights a potential drug interaction between cannabidiol (CBD) and methadone in pediatric patients.
- Pediatricians should proactively inquire about cannabidiol (CBD) use in patients, especially those on medications metabolized by CYP3A4 or CYP2C19.
- Awareness of this interaction is crucial for maintaining therapeutic drug levels and patient safety in pediatric care.
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