Implications of Cannabidiol in Pharmacogenomic-Based Drug Interactions with CYP2C19 Substrates

Abstract

This is a patient case exploring the importance of evaluating herbal and dietary supplements and how they may impact drug-drug and drug-gene implications based on pharmacogenomics test results. Even though herbal supplements are considered natural by many patients, which is often the reason for starting them, herbal supplements may still be metabolized by the same pathways as other medications, potentially contributing to drug-drug, drug-herb, and drug-gene interactions, and therefore, potentially impacting a patient’s response to medications.

Hyponatremic Cognitive Dysfunction Resulting from Drug-Drug-Gene Interaction between Sertraline and Cannabidiol in an Intermediate CYP2C19 Metabolizer Patient

“…This case report provides an example of possible CBD-induced phenoconversion of CYP2C19 resulting in increased exposure to sertraline and subsequent hyponatremia. [17][18] Sertraline and CYP2C19 One of sertraline's primary metabolites observed in vitro and in vivo is N-desmethylsertraline, an N-demethylation product generated largely by CYP2C19. [1][2][19][20] The CYP2C19 gene is highly polymorphic -to date, there are 39 known allele variants.…”

“…This case report provides an example of possible CBD-induced phenoconversion of CYP2C19 resulting in increased exposure to sertraline and subsequent hyponatremia. [ 17 - 18 ]…”