I am hoping to formulate the most effective and caring rescue plan for my daughter as we prepare to head to things like drop off classes and eventually school. Her current rescue is oral THC, 5 mg and rectal diastat 7.5 MG through speaking with other parents I have found that the best possible plan is a tiered approach for example; CBD /THC and then liquid oral Valium. Because of her genetic problem, she supposedly has a higher risk of status seizures. She has shown no signs of this so far, however, I am concerned that our plan should include some thing if the cannabinoids don’t work and I don’t understand about the interaction between cannabinoids and the Benzodiazepines. I have learned from other parents that liquid valium can be titrated much more gently and has a quicker recovery when needed.
Creating an effective and caring rescue plan for your daughter, especially considering her specific needs and the potential for status seizures due to her genetic condition, requires careful consideration and consultation with healthcare professionals. The approach you’re taking, based on a tiered use of CBD/THC and then potentially introducing liquid oral Valium (diazepam), is a smart way to balance efficacy with safety. Let me share the considerations regarding the interaction between cannabinoids and benzodiazepines, and the role of liquid Valium in seizure management. More of this sort of discussion can be found here: CaplanCannabis.com
Cannabinoids and Benzodiazepines Interaction
Cannabinoids, including CBD and THC, and benzodiazepines, like Valium, can affect the central nervous system in different ways. CBD has been found to have anticonvulsant properties in several studies, potentially reducing seizure frequency in certain types of epilepsy without the psychoactive effects associated with THC (Devinsky et al., 2017). THC, while also possessing anticonvulsant qualities, carries the “limitation/benefit” of psychoactive effects, which makes its use more complex, paticularly in children (Perucca, 2017).
Benzodiazepines, on the other hand, are well-established in the treatment of acute seizures and epilepy due to their fast-acting sedative and anticonvulsant effects (Trinka et al., 2015). However- important side note, although benzodiazepines are used nearly universally on a long-term basis, the research supporting their function was primarily oriented around use over brief durations only (so we don’t know as much about the consequences of long-term use). The interaction between cannabinoids and benzodiazepines is also not fully understood, but there is some evidence to suggest that CBD may enhance the efficacy of benzodiazepines by increasing their binding affinity to the GABA-A receptor, potentially allowing for lower doses of benzodiazepines to be used effectively (Gaston et al., 2017). The more we learn, the more it seems like both categories of medicines seem to interact with some of the same receptors, in terms of their efficacy with respect to seizures.
Considering Liquid Oral Valium
Liquid oral Valium can be a versatile option due to its ability to be titrated (adjusted in dosage) based on immediate needs, offering a balance between efficacy and minimizing potential side effects. Its relatively quick onset of action is beneficial in acute seizure situations, providing rapid relief when necessary. Parents and caregivers often appreciate the ability to adjust the dose to find the optimum balance between seizure control and minimizing sedation, allowing for quicker recovery post-seizure (Trinka et al., 2015).
Implementing a Tiered Approach
A tiered approach, starting with CBD/THC and escalating to liquid Valium if necessary, allows for a personalized and responsive seizure management plan. This approach takes into consideration the potential for interactions and the aim of using the minimum effective dose to manage seizures while reducing the risk of side effects.
Recommendations
Let’s talk about it in a clinical setting, to flush out the important details: Let’s connect on her cannabis, and you should also engage with your daughter’s healthcare team to develop a comprehensive and tailored rescue plan that is comfortable for everyone. Ideally, this should include detailed discussions on the use of cannabinoids, the potential introduction of liquid Valium, and how to appropriately titrate these medications in synergy.
Ongoing Monitoring: Close monitoring of her response to the rescue plan, with particular attention to any signs of increased seizure activity or adverse reactions to the medication combination, is crucial.
Emergency Protocols: Ensure that all caregivers are well-informed about the rescue plan, including when and how to administer medications under the tiered approach.
Review and Adjust as Needed: Regularly review the effectiveness of the rescue plan with your daughter’s medical team, making adjustments based on her evolving needs and any new research findings.
References:
Devinsky, O., Cross, J.H., Laux, L., et al. (2017). Trial of Cannabidiol for Drug-Resistant Seizures in the Dravet Syndrome. New England Journal of Medicine, 376(21), 2011-2020. DOI: 10.1056/NEJMoa1611618.
Perucca, E. (2017). Cannabinoids in the Treatment of Epilepsy: Hard Evidence at Last? Journal of Epilepsy Research, 7(2), 61-76. DOI: 10.14581/jer.17012.
Trinka, E., Hofler, J., Zerbs, A. (2015). Causes of status epilepticus. Epilepsia, 56(Suppl 1), 4-12. DOI: 10.1111/epi.13012.
Gaston, T.E., Bebin, E.M., Cutter, G.R., Liu, Y., Szaflarski, J.P.; UAB CBD Program (2017). Interactions between cannabidiol and commonly used antiepileptic drugs. Epilepsia, 58(9), 1586-1592. DOI: 10.1111/epi.13852.
