Drug-Drug Interaction Between Cannabidiol, Cyclosporine, and Mycophenolate Mofetil: A Case Report

•Chronic pain treatment in patients with end-stage kidney disease is complex and still a challenging task in clinical practice.•The benefit of using cannabidiol in the treatment of chronic pain has been reported recently.•Cannabidiol is metabolized by cytochrome P450 and UDP-glucuronosyltransferase enzymes, and it can also act either as an inhibitor or an inducer of these enzymes.•Cannabidiol was also found to be a potent inhibitor of carboxylesterases in vitro.•This case report shows cannabidiol's impact on cyclosporine and mycophenolate mofetil metabolism in a patient with end-stage kidney disease with kidney transplantation. [Display omitted] Kidney transplantation remains the optimal therapy for many patients with end-stage kidney disease (ESKD). Chronic pain is one of the most common and distressing symptoms among patients with ESKD, and its treatment is a complex and challenging task to accomplish. The benefits of cannabidiol (CBD) in chronic pain treatment have been reported recently. Cannabidiol is metabolized by cytochrome P450, mainly CYP3A4 and CYP2C19, and can also undergo direct conjugation via UDP-glucuronosyltransferase enzymes, with a growing body of evidence suggesting it is also a potent inhibitor or inducer of these pathways. Cannabidiol was also found to be a potent inhibitor of carboxylesterases in vitro. Because cytochrome P450 enzymes and carboxylesterases are also responsible for the clearance and activation of immunosuppressants, respectively, drug-drug interactions are likely to occur. Here, we report a pharmacokinetic drug interaction between CBD and cyclosporine and mycophenolate mofetil in a patient with ESKD with a kidney transplantation. It is thus crucial to take into account these interactions and monitor drug levels to avoid drug toxicity or a lack of efficacy. This study is in accordance with the guidelines of the Declaration of Helsinki and the Declaration of Istanbul.