Gabapentin, a prescription drug sold under different brand names, like Neurontin, Gralise, and Horizant, is an anti-epileptic medication that offers respite from seizures and neuropathic (nerve) pain. Sometimes, doctors may prescribe it for patients with migraine headaches too.
Epilepsy, migraines, and other conditions associated with nerves or neuropathic pain are caused due to wrong signaling by the brain, which manipulates your body into feeling pain, even if there’s no injury or damage. Gabapentin helps in slowing down these erroneous neurotransmissions, thereby relieving the patient’s pain sensations.
Nevertheless, Gabapentin has been reported to have several adverse effects, including swelling, back or chest pain, shortness of breath, vomiting, urinary problems, lack of concentration, and even suicidal tendencies, especially in high doses.
Even the US Food and Drug Administration (FDA) has been forced to issue a warning about antiepileptic drugs (AEDs), like Gabapentin, causing serious breathing problems among patients with respiratory comorbidities (like COPD).
Another issue with gabapentin is that it provides only temporary relief. It doesn’t address the underlying problems of these ailments.
This has prompted many to look for safer, effective, and more reliable alternatives – that some found in Cannabidiol (CBD).
While some use CBD to alleviate Gabapentin’s side-effects, while helping in the overall therapy, others have replaced Gabapentin with CBD oil.
Can CBD Effectively Treat Epilepsy & Nerve Pain?
Despite the broad-spectrum of studies conducted on cannabidiol and its benefits, CBD remains one of nature’s mysteries.
It seems to help treat and alleviate symptoms and provide relief from many kinds of health problems – when even the strongest of prescription medications fail. However, it doesn’t cause any severe side-effects, as most potent drugs do.
Moreover, studies reveal that CBD doesn’t directly bind with most of the body’s receptors – not even with the endocannabinoid receptors, as THC, CBD’s psychotropic cousin, does. However, it does seem to have a good interaction with the 5-HT1A receptor.
The 5-HT1A receptor, a subtype of serotonin or 5-hydroxytryptamine (5-HT) neuroreceptor, interacts with serotonin, the body’s happy chemical, influencing several bodily functions associated with mood, cognition, reward, learning, memory, pain sensations, etc. Its activation is linked to the body’s anxiolytic, antidepressant, and antipsychotic mechanisms.
So, can CBD help ease epilepsy seizures and nerve pain?
Several years ago, when controlled studies to test the efficacy of Epidiolex on children with epilepsy was still being planned, a 2014 review focussed on the need to take a broader look at the potential use of CBD to address epilepsy and other neuropsychiatric disorders, like anxiety, schizophrenia, addiction, and neonatal hypoxic-ischemic encephalopathy. This review was published in the medical journal Epilepsia.
Numerous other studies have been carried out on the effects of cannabidiol and medical marijuana on epilepsy and other neurological disorders. Most of these indicated that CBD could have a positive impact on treatments for epileptic seizures and neuropathic pain.
So, let’s find out what the scientific researchers have found so far…
- For the first time in 2017, an Italian researcher, Emilio Perucca, found solid evidence of purified CBD having a positive impact on patients with two rare types of epilepsy – Dravet Syndrome and Lennox-Gastaut Syndrome. In his review, published in the Journal of Epilepsy Research, he reviewed three high-quality placebo-controlled adjunctive-therapy trials of a purified CBD product in patients with Dravet syndrome and Lennox-Gastaut syndrome.
- In June 2018, the FDA approved the cannabidiol oral solution Epidiolex® for treating seizures associated with two rare and severe forms of epilepsy, Lennox-Gastaut and Dravet syndromes, in patients aged two years and older.
This was the first time that the FDA approved any cannabis-derived drug. This was also the first FDA-approved drug for the treatment of Dravet Syndrome patients.
- In May 2019, a team of researchers from Florida Agricultural and Mechanical (A&M) University College of Pharmacy and Pharmaceutical Sciences, published a paper on the ‘Treatment of Seizures Associated with Lennox-Gastaut and Dravet Syndromes…’ in the Pharmacy and Therapeutics (P&T). Their findings concluded that the FDA-approved CBD oral solution (Epidiolex ®) is indeed “a new anti-epileptic drug (AED)… the first plant-derived CBD agent…for treating severe and difficult-to-treat forms of childhood epilepsy… (that exhibits) significant reduction…in the frequency of convulsive seizures…”
- A September 2018 review, published in the Frontiers in Neurology by a team of Brazilian researchers, indicated that CBD improves seizure control in patients with treatment-resistant epilepsy. This review, which collated data from 11 studies, provides strong evidence of CBD’s potent therapeutic effects on 670 patients. This review also indicated that CBD-rich cannabis extracts are much more potent than purified CBD in treatment-resistant epilepsy.
- In an April 2019 study on the use of CBD for treatment of epilepsy, published in the Molecules journal, suggested that CBD could be used on patients, suffering from AED-resistant epilepsies.
In 2016, when California became the first American state to allow the use of medical marijuana for certain ailments, several interesting studies were conducted.
- A May 2016 review, published in the Pharmacological Research, was one of those first papers, printed in a medical journal that focused on the need for considering CBD as an alternative AED. It did, however, draw attention to the need for more preclinical and clinical studies to establish the facts.
- A 2016 study, published in the Innovations in Clinical Neuroscience, pointed towards medical marijuana’s potentials in epilepsy treatment. The researchers, however, expressed despair over the lack of sufficient research and facilities to conduct experiments owing to the legal issues surrounding marijuana.
Several more studies have been held on CBD’s efficacy in handling drug‐resistant epilepsy. This includes a March 2020 review, which established that “Cannabidiol is a multitarget drug”, which “may act on unconventional central and peripheral targets to control drug‐resistant epilepsy”.
These studies indicate that CBD does exhibit some anti-epileptic properties and could be used to control the severity and frequency of seizures, even when conventional drugs fail in their adequacy.
Meanwhile, several other researchers have shed light on CBD’s positive effects on chronic pain management.
- Ethan B Russo discussed the role that cannabinoids can play in the management of difficult-to-treat pain disorders in his paper, published in the Therapeutics and Clinical Risk Management in 2008. He suggested that cannabinoids could offer significant ‘side benefits’ beyond analgesia, including anti-emetic effects. He further inferred that CBD also inhibits cancer-induced angiogenesis.
- A February 2018 paper, published in the Canadian Family Physician magazine, also concluded that CBD could be prescribed for treating neuropathic pain, palliative cancer pain, CINV, and MS- or SCI-related spasticity in patients, where traditional medicines are not effective.
Does CBD interact with/inhibit Gabapentin in the body?
CBD is generally known to interact during the first-pass effect, i.e. metabolism by a group of liver enzymes, known as Cytochrome P450 (CYP450). Studies show CBD inhibits many, if not most, of the CYP enzymes, including CYP2C9, CYP2C19, CYP3A4, CYP2D6.
- A 2019 review, published in the Medicines, indicated that CBD alters the levels and effectiveness of certain enzymes in the body, leading to certain drugs undergoing delayed metabolism, thus increasing the risk of their retention in higher concentration and overdosing.
Nevertheless, Gabapentin is considered a better option over other AEDs, owing mainly to its lack of substantial metabolism in the human digestive system. Therefore, gabapentin doesn’t tend to interact with most other drugs and chemical substances.
- A 2011 study, published in the Journal of Medical Sciences, indicated that Gabapentin isn’t metabolized in the human body, leaving no scope for drug interaction. It enters the bloodstream by bypassing the first-pass enzyme interaction and “more than 95%” gets excreted unchanged through urine.
- Another 2017 study, published in the Journal of Experimental Pharmacology, indicated that Gabapentin only interacts with certain chemicals, like caffeine, losartan, ethacrynic acid (both anti-hypertensive drugs), phenytoin (anti-seizure medication), magnesium oxide, anti-malarial drugs, and morphine, but does not interact with cannabis or alcohol, among several other drugs and substances.
However, Gabapentin is a structural analog of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA).
- In May 2017, researchers indicated that if CBD travels to the brain through the bloodstream, it could bind with the GABAA receptors and slow down the firing frequency of neurons.
This is very similar to the route Gabapentin follows in the body, possibly suggesting that CBD could still interact with Gabapentin, despite the latter not being metabolized by the body digestive enzymes – which is how most drugs usually interact with CBD.
The Last Word
When it comes to your health, it’s always best to let your doctor have the last word.
Neuropathic pain and epilepsy are two critical disorders that need proper medical care and attention.
Studies into any possible drug interaction are inconclusive, at best. Even if CBD doesn’t interact with Gabapentin in the liver, they may still do so in the bloodstream (as discussed in the earlier section). So, mixing the two chemical compounds may not be totally safe.
Even though CBD has been proven by many researchers to be a potent and safe substance that can aid in treatment-resistant epilepsy, it is still unwise to stop taking AEDs and start on CBD oil on your own.