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2022-09-23
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Copyright (c) 2022 Jade Nanan, Sheena Crosby, Michael J. Schuh
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright of content published in INNOVATIONS in pharmacy belongs to the author(s).
Hyponatremic Cognitive Dysfunction Resulting from Drug-Drug-Gene Interaction between Sertraline and Cannabidiol in an Intermediate CYP2C19 Metabolizer Patient
Jade Nanan
Mayo Clinic Florida
Sheena Crosby
Mayo Clinic Florida
Michael J. Schuh
Mayo School of Health Related Sciences
DOI: https://doi.org/10.24926/iip.v13i3.4890
Keywords: CYP2C19, Hyponatremia, Drug-drug-gene interaction, pharmacogenomics, cannabidiol, PGx
Abstract
Background: Pharmacogenomics (PGx) can provide more precision in determining causation of adverse drug reactions (ADRs) from drug-drug-gene interaction clinical application.
Case Summary: Patient was an intermediate CYP2C19 metabolizer on stable therapy taking a low but therapeutic dose of sertraline for depression and anxiety over a period of 20 years. The patient then became hyponatremic and cognitively impaired after addition of cannabidiol (CBD) to this sertraline regimen. The proposed mechanism was drug-drug-gene interaction of CBD further inhibiting the CYP2C19 metabolism of sertraline and increasing drug exposure to produce moderate to severe hyponatremia and subsequent cognitive dysfunction.
Practice Implications: Pharmacogenomics (PGx) testing may assist in etiology of patient symptoms from adverse drug reactions (ADRs) or drug-drug interactions by combining these with detection and application of drug-gene interactions. This case shows inhibition of CYP2C19 by CBD to further increase sertraline exposure, producing hyponatremia and subsequent cognitive dysfunction through CYP2C19 phenoconversion by CBD.
