Epidiolex (cannabidiol) is a prescription drug that’s used to manage seizures caused by certain conditions. This drug can interact with alcohol, other medications, and some supplements. For example, Epidiolex can interact with alprazolam (Xanax).
Epidiolex is used in adults and certain children to manage seizures caused by any of the following conditions:
- Lennox-Gastaut syndrome (a severe type of epilepsy)
- Dravet syndrome
- tuberous sclerosis complex
Epidiolex comes as a liquid solution that you swallow. It contains the active ingredient* cannabidiol (CBD).
An interaction can occur because one substance causes another substance to have a different effect than expected. Interactions can also occur if you have certain health conditions.
Keep reading to learn about the possible interactions of Epidiolex. And for more information about the drug, including details about its uses, see this article.
* An active ingredient is what makes a drug work.
Certain health conditions or other factors could raise your risk of harm if you take Epidiolex. In such cases, your doctor may not prescribe Epidiolex for you. These are known as contraindications. Epidiolex has one contraindication, which is described below.
If you’ve had an allergic reaction. If you’ve had an allergic reaction to Epidiolex or any of its ingredients, your doctor likely won’t prescribe Epidiolex. This is because taking the drug could cause another allergic reaction. You can ask your doctor about other treatments that may be better options for you.
Epidiolex interacts with alcohol. Your doctor may recommend that you avoid drinking alcohol during your Epidiolex treatment.
When taken on its own, Epidiolex can cause sleepiness. Consuming alcohol while taking Epidiolex raises your risk of this side effect even more. It also raises the risk of sleepiness being more severe.
Sleepiness caused by Epidiolex can carry over to the next day, and it may affect your balance and coordination. Combining alcohol and Epidiolex can also make it dangerous to drive or operate machinery the next day.
If you drink alcohol, talk with your doctor about how much (if any) may be safe to drink during your Epidiolex treatment.
Before you start using Epidiolex, tell your doctor and pharmacist about any prescription, over-the-counter, or other drugs you take. Sharing this information with them may help prevent possible interactions. (To learn whether Epidiolex interacts with supplements, herbs, and vitamins, see the “Are there other interactions with Epidiolex?” section below.)
If you have questions about drug interactions that may affect you, talk with your doctor or pharmacist.
The table below lists drugs that may interact with Epidiolex. Keep in mind that this table does not include all drugs that may interact with Epidiolex. For more information about some of these interactions, see the “Drug interactions explained” section below.
| Drug type or drug name | Drug examples | What can happen |
| valproic acid and drugs similar to it | • divalproex sodium (Depakote) • valproic acid | can increase the risk of side effects of Epidiolex and valproic acid drugs |
| drugs that speed up the activity of certain enzymes in your body | • the antibiotic rifampin (Rimactane) • the antiepileptic drugs phenytoin (Dilantin) and carbamazepine (Tegretol, others) | can make Epidiolex less effective |
| drugs affected by certain proteins in your body | • bupropion (Wellbutrin XL/SR) • lamotrigine (Lamictal) • lorazepam (Ativan) | can increase the risk of side effects from these other drugs |
Learn more about certain drug interactions that can occur with Epidiolex.
Interaction with valproic acid and drugs similar to it
Epidiolex interacts with valproic acid and drugs similar to it. These medications are prescribed to manage seizures in certain situations. They’re also prescribed off-label to treat other conditions, including certain mental health conditions. (With off-label use, doctors prescribe a drug for a purpose other than what it’s approved for.)
Examples of valproic acid and similar medications include:
- divalproex sodium (Depakote)
- valproic acid
What could happen
Both Epidiolex and valproic acid drugs can cause liver problems, including liver damage and an increase in liver enzyme levels. Combining these medications raises the risk of these side effects.
What you can do
If your doctor determines you’ll take Epidiolex with a valproic acid drug, they’ll closely monitor your liver function during treatment. This includes using blood tests to check your liver enzyme levels. If these tests show that you have a problem with your liver, your doctor may either:
- adjust your dosage of Epidiolex or the valproic acid drug
- have you stop taking Epidiolex or the valproic acid drug
Interaction with drugs that affect certain enzymes in your body
Epidiolex interacts with medications that increase the activity of specific enzymes (proteins) in your body called CYP3A4 and CYP2C19.
Examples of drugs that increase the activity of these enzymes include:
- the antibiotic rifampin (Rimactane)
- the seizure drugs phenytoin (Dilantin) and carbamazepine (Tegretol, others)
What could happen
If you take Epidiolex with a drug that increases the activity of the CYP3A4 or CYP2C19 enzymes, Epidiolex may be less effective.
When you take a dose of Epidiolex, CYP3A4 and CYP2C19 enzymes in your body break down the drug and help remove it from your system. Taking certain drugs increases the level of these enzymes in your body. This means your body will break down Epidiolex faster, and there may not be enough of the drug in your system for it to work properly.
What you can do
Before you start taking Epidiolex, tell your doctor and pharmacist about all medications you take. They can check to see whether any interact with Epidiolex. Your doctor may decide to increase your Epidiolex dosage if you need to take it with a drug that causes the interaction described above.
Interaction with drugs affected by certain proteins in your body
Epidiolex interacts with drugs that are affected by certain proteins in your body.
Examples of these medications include:
- bupropion (Wellbutrin XL, Wellbutrin SR)
- lamotrigine (Lamictal)
- clobazam (Onfi, Sympazan)
- digoxin (Lanoxin)
- the organ transplant drugs sirolimus (Rapamune, others), tacrolimus (Astagraf XL, Prograf), and everolimus (Afinitor, Zortress)
What could happen
Your body uses special proteins to transport and break down certain drugs after you take a dose.
Epidiolex can lower the amount of certain proteins in your body or slow down their activity. This can increase your risk of side effects from other drugs that rely on one or more of these proteins.
What you can do
Before you start taking Epidiolex, talk with your doctor and pharmacist about all medications you take. They can check to see whether any have this specific interaction with Epidiolex. If you need to take another drug with Epidiolex that could cause this interaction, your doctor may decrease your dosage of the other drug.
Epidiolex may have other interactions. They could occur with supplements, foods, vaccines, or even lab tests. See below for details. Note that the information below does not include all other possible interactions with Epidiolex.
Does Epidiolex interact with supplements?
Before you start taking Epidiolex, talk with your doctor and pharmacist about any supplements, herbs, and vitamins you take. Sharing this information with them may help you avoid possible interactions.
If you have questions about interactions that may affect you, talk with your doctor or pharmacist.
Epidiolex interactions with herbs
Epidiolex can interact with the herb St. John’s wort, which some people use to help relieve symptoms of depression or other conditions.
St. John’s wort can increase the activity of an enzyme (protein) called CYP3A4. This can cause your body to break down Epidiolex too quickly, which may make Epidiolex less effective. (To learn more about Epidiolex and CYP3A4, see the “Drug interactions explained” section above.)
If you take St. John’s wort, tell your doctor before you begin taking Epidiolex. Your doctor may recommend that you stop taking St. John’s wort during your Epidiolex treatment. Or they may increase your Epidiolex dosage and closely monitor how well the drug is working for you.
Epidiolex and vitamins
There are currently no reports of Epidiolex interacting with vitamins. But this doesn’t mean that vitamin interactions won’t be recognized in the future.
For this reason, it’s still important to check with your doctor or pharmacist before taking any of these products while taking Epidiolex.
Does Epidiolex interact with food?
Epidiolex interacts with grapefruit and grapefruit juice.
Grapefruit and grapefruit juice can block the activity of the CYP3A4 enzyme. This can cause Epidiolex levels to build up in your body, which raises your risk of side effects from the drug.
Due to this interaction, your doctor may recommend that you do not consume grapefruit or grapefruit juice during your Epidiolex treatment.
Does Epidiolex interact with vaccines?
Epidiolex isn’t known to interact with any vaccines.
Talk with your doctor or pharmacist if you have questions about receiving any vaccines while taking Epidiolex.
Does Epidiolex interact with lab tests?
Epidiolex isn’t known to interact with any lab tests.
If you have questions about having lab work done while taking Epidiolex, talk with your doctor or pharmacist.
Does Epidiolex interact with cannabis or CBD?Cannabis (commonly called marijuana) and cannabis products, such as cannabidiol (CBD), have been specifically reported to interact with Epidiolex.
Because Epidiolex contains cannabidiol (CBD) as its active ingredient, combining Epidiolex with cannabis or cannabis products may increase your risk of certain side effects. Examples of these side effects include diarrhea, upset stomach, and drowsiness.
Before you start treatment with Epidiolex, tell your doctor and pharmacist if you use cannabis. By sharing this information with them, you may help prevent possible interactions.
Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.
Certain medical conditions or other health factors may raise the risk of interactions with Epidiolex. Before using Epidiolex, talk with your doctor about your health history. They’ll determine whether Epidiolex is right for you.
Health conditions or other factors that might interact with Epidiolex include:
Mental health conditions, including depression. Drugs used for epilepsy, including Epidiolex, can increase the risk of suicidal thoughts and behaviors. You may have a higher risk of these side effects if you take Epidiolex and have an existing mental health condition, such as depression. Your doctor can help determine whether Epidiolex is safe for you to take based on your mental health history.
Liver problem or condition. In rare cases, taking Epidiolex can cause liver-related side effects. You may have a higher risk of these side effects if you already have a liver condition, such as liver cirrhosis (scarring).
Substance use disorder. Epidiolex contains cannabidiol (CBD) as its active ingredient. CBD is a component of cannabis (commonly called marijuana). In studies, cannabidiol hasn’t been shown to cause addiction. Still, let your doctor know if you have a substance use disorder (such as alcohol use disorder) before you start taking Epidiolex. Your doctor can help determine whether it’s safe for you to take Epidiolex.
Pregnancy. It’s not known whether it’s safe to take Epidiolex while pregnant. If you’re pregnant or planning a pregnancy, talk with your doctor before taking Epidiolex.
If you take Epidiolex during pregnancy, consider joining the North American Antiepileptic Drug Pregnancy Registry. A pregnancy registry collects information about the effects of a drug when taken during pregnancy. To learn more or sign up, visit the registry website or call 888-233-2334.
Breastfeeding. It’s not known whether it’s safe to breastfeed while taking Epidiolex. If you’re currently breastfeeding or planning to do so, talk with your doctor about whether Epidiolex is right for you.
Allergic reaction. If you’ve had an allergic reaction to Epidiolex or any of its ingredients, your doctor will likely not prescribe Epidiolex. This is because taking the drug could cause another allergic reaction. You can ask your doctor about other treatments that may be better choices for you.
Taking certain steps can help you avoid interactions with Epidiolex. Before starting treatment, talk with your doctor and pharmacist. Things to discuss with them include:
- Whether you drink alcohol or use cannabis.
- Other medications you take, as well as any vitamins, supplements, and herbs. Your doctor or pharmacist can help you fill out a
medication list . - What to do if you start taking a new drug during your Epidiolex treatment.
It’s also important to understand Epidiolex’s
If you have trouble reading or understanding this information, your doctor or pharmacist can help.
Taking Epidiolex exactly as prescribed can also help prevent interactions.
If you still have questions about Epidiolex and its possible interactions, talk with your doctor.
Questions you may want to ask your doctor include:
- Do other drugs that may treat my condition have similar interactions as Epidiolex?
- If Epidiolex interacts with a health condition I have, could I still take the drug?
- Will my Epidiolex dosage affect my risk of interactions?
To learn more about Epidiolex, see these articles:
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Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.