Clinically Significant Drug-Drug Interaction Between Methadone and Cannabidiol

The use of cannabidiol products in pediatric patients is becoming more frequent because of the increased ease of accessibility. This case report illustrates the potential for cannabidiol to interact with stable medication regimens. A 13-year-old girl with metastatic cancer and chronic pain presented...

Full description

Saved in:
Bibliographic Details
Published in:Pediatrics (Evanston) 2020-06, Vol.145 (6), p.e20193256
Main Authors: Madden, Kevin, Tanco, Kimberson, Bruera, Eduardo
Format: Article
Language:English
Subjects:
Cannabidiol
Cannabinoids
Chronic pain
Clinical significance
Drug interaction
Fatigue
Metastases
Methadone
Pediatrics
Sleep and wakefulness
Citations: Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:The use of cannabidiol products in pediatric patients is becoming more frequent because of the increased ease of accessibility. This case report illustrates the potential for cannabidiol to interact with stable medication regimens. A 13-year-old girl with metastatic cancer and chronic pain presented with increased sleepiness and fatigue. She had been started on 7.5 mg of methadone by mouth twice daily 4 months earlier. Unbeknownst to her physicians, her parents had commenced her on cannabidiol and subsequently increased the dose leading up to her presentation, thinking it would result in tumor shrinkage. The initial serum methadone level was 271 ng/mL, which decreased to 125 ng/mL 14 days after discontinuing cannabidiol. The reduced serum methadone level coincided with improved sleepiness and fatigue. Cannabidiol inhibits CYP3A4 and CYP2C19, both of which are involved in the metabolism of methadone. Pediatricians should be aware of this potential interaction and inquire if their patients are receiving cannabidiol.
ISSN:0031-4005
1098-4275
DOI:10.1542/peds.2019-3256