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Highly Active RRMS – Alemtuzumab — SCE Neurology MCQ

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HardMultiple Sclerosis & CNS InflammationHighly Active RRMS – AlemtuzumabSCE Neurology

A patient taking stable cannabidiol begins a ketogenic diet and develops dose-related somnolence after taking each dose with the high-fat breakfast. What is the most appropriate interpretation and adjustment?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — High-fat food increases cannabidiol exposure; standardise every dose consistently with or without food

Explanation lettering: D = shown as B · E = shown as C · B = shown as D · C = shown as E

D is correct: food, especially a high-fat meal, materially increases cannabidiol exposure; dosing should therefore remain consistent in relation to meals, including a ketogenic diet. A reverses the direction of the food effect. B wrongly attributes the meal-dependent change solely to clobazam. C deliberately maximises pharmacokinetic variability. E uses food as an unvalidated rescue-dose strategy. Consistency matters because a diet change can alter exposure without any prescribed-dose change.

Reference: Epidyolex 100 mg/mL oral solution SmPC: https://www.medicines.org.uk/emc/product/10781/smpc