Authors :
Presenting Author: Nikol Agadzhanian, MSc – Yale University, Yale School of Medicine
Jayanth Tallapalli, – Yale University
Rohith Nelakurthi, MD – Yale
Zhou Xin, PhD – Yale University
Aline Herlopian, MD – Yale
Ilisa Nussbaum, MPH, RDN CD-N – Yale Univeristy
Rationale:
Epidiolex®, a purified, oil-based cannabidiol (CBD) formulation, is approved for treating seizures associated with specific epilepsy syndromes. Its lipid-rich excipient raises questions about potential effects on patient lipid profiles. Understanding this impact is critical for informing clinical management, including the potential need for lipid monitoring before and during treatment.
Methods:
We identified 600 patients receiving CBD therapy at the Yale Comprehensive Epilepsy Center (2018-2025). A preliminary retrospective analysis was conducted on a subset of 21 patients prescribed Epidiolex® who had at least three serological lipid measurements (either 2 pre-/1 post- or 1 pre-/2 post-CBD initiation). The lipid panel included low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c), triglycerides (TG), and total cholesterol (TC). Primary endpoints were changes in lipid parameters. Secondary endpoints included BMI changes. Pre-treatment baseline values were compared to the most recent post-treatment values using paired t-tests and a mixed-effects model controlling for weight and within-patient clustering. Patients were stratified by daily dose and treatment duration.
Results:
Analysis of 21 patients revealed significant alterations in the lipid profile. HDL-c increased by 7.64 mg/dL (14%, p=0.003), LDL-c increased by 13.41 mg/dL (12%, p=0.016), and TC increased by 17.61 mg/dL (9%, p=0.005). TG changes were not significant (+8.55 mg/dL, p=0.456). A dose-response analysis showed a significant association between CBD dose and increases in both HDL-c (0.80 mg/dL per 100mg CBD, p=0.003) and TC (1.96 mg/dL per 100mg CBD, p=0.005). Weight changes exhibited a biphasic, dose-dependent pattern, with medium doses (400-800mg) associated with weight gain and high doses ( >800mg) with weight loss. No cardiovascular events were reported during the follow-up period.
Conclusions:
This preliminary analysis suggests that CBD therapy may be associated with dose-dependent alterations in lipid profiles and complex weight changes. These potential effects warrant further investigation to determine their clinical significance. Analysis of the larger, ongoing cohort is necessary to validate these findings. If confirmed, these results would support implementing pre- and post-treatment lipid screening to guide patient management.
eed for individualized lipid monitoring in patients on chronic CBD therapy, with consideration of dose optimization based on lipid response patterns. Further prospective studies with larger cohorts and cardiovascular outcome measures are warranted to fully characterize the long-term metabolic implications of therapeutic CBD use.
Funding: Jazz Pharmaceuticals Investigator-Initiated Award