Abstract:
BACKGROUND:The mechanistic target of rapamycin inhibitors everolimus and sirolimus have activity against multiple manifestations of tuberous sclerosis complex and are approved to treat astrocytomas, angiomyolipomas, lymphangioleiomyomatosis, and epilepsy. Cannabidiol is a novel antiepileptic medication. There is lack of information regarding drug-drug interactions between mechanistic target of rapamycin inhibitors and cannabidiol in clinical practice. METHODS:We reviewed patients with tuberous sclerosis complex who were treated with a mechanistic target of rapamycin inhibitor (everolimus, sirolimus) and cannabidiol. Clinical information, mechanistic target of rapamycin inhibitor and cannabidiol dosing, concomitant antiepileptic drugs, as well as laboratory and adverse events were reviewed before and after initiation of cannabidiol. RESULTS:A total of 25 patients were treated with cannabidiol and a mechanistic target of rapamycin inhibitor (18 everolimus, seven sirolimus). All mechanistic target of rapamycin inhibitor levels were drawn as troughs. Levels were significantly higher in 76% patients after cannabidiol treatment (P = 0.0003). Median change from baseline was +9.8 ng/mL for everolimus and +5.1 ng/mL for sirolimus. Adverse events occurred in 40%, with diarrhea being the most frequent adverse event occurring in three patients. No severe adverse events occurred during the treatment period. CONCLUSIONS:Cannabidiol resulted in increased serum levels of everolimus and/or sirolimus. Some patients experienced doubling or tripling of their mechanistic target of rapamycin inhibitor trough following the addition of cannabidiol. In some cases, this resulted in clinical toxicity, as well as laboratory abnormalities. Awareness of this interaction can lead clinicians to evaluate serum levels and other safety laboratory studies more closely, and thereby avoid potentially significant adverse effects. In patients known to be prone to mechanistic target of rapamycin inhibitor toxicity, preemptive reduction in dose may be warranted upon initiation of cannabidiol.
journal_name
Pediatr Neuroljournal_title
Pediatric neurologyauthors
Ebrahimi-Fakhari D,Agricola KD,Tudor C,Krueger D,Franz DNdoi
10.1016/j.pediatrneurol.2019.11.017subject
Has Abstractpub_date
2020-04-01 00:00:00pages
59-61eissn
0887-8994issn
1873-5150pii
S0887-8994(19)30955-5journal_volume
105pub_type
杂志文章abstract:OBJECTIVE:We present a child with Rasmussen encephalitis and highlight the pitfalls of diagnosis when magnetic resonance imaging (MRI) is negative for atrophy. We review the literature regarding this issue, introduce the FreeSurfer software as a potential means of noninvasive diagnosis, and discuss methods for prompt a...
journal_title:Pediatric neurology
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journal_title:Pediatric neurology
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journal_title:Pediatric neurology
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journal_title:Pediatric neurology
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journal_title:Pediatric neurology
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journal_title:Pediatric neurology
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journal_title:Pediatric neurology
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journal_title:Pediatric neurology
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journal_title:Pediatric neurology
pub_type: 临床试验,杂志文章
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pub_type: 临床试验,杂志文章,随机对照试验
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journal_title:Pediatric neurology
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journal_title:Pediatric neurology
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更新日期:2005-08-01 00:00:00
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journal_title:Pediatric neurology
pub_type: 杂志文章,评审
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更新日期:2015-06-01 00:00:00
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journal_title:Pediatric neurology
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更新日期:2014-08-01 00:00:00
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journal_title:Pediatric neurology
pub_type: 杂志文章
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更新日期:2001-11-01 00:00:00
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journal_title:Pediatric neurology
pub_type: 杂志文章,评审
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