Dietary fats and pharmaceutical lipid excipients increase systemic exposure to orally administered cannabis and cannabis-based medicines

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“Cannabis sativa, commonly called hemp, has thousands of years-long history of medical use. Cannabis extracts were widely used in Europe and North America for their therapeutic value as sedatives, hypnotics, analgesics, muscle relaxants, and anticonvulsant agents. However, cannabis was removed from British and American Pharmacopoeias in 20th century, partially due to politic bias. Although prohibited, many patients were nevertheless self-medicating to obtain therapeutic benefits from cannabis for various conditions, including AIDS wasting syndrome, multiple sclerosis (MS) and spinal injuries. More recently, a growing interest in the therapeutic effects of cannabis has developed following the isolation of cannabinoids, the principal chemical compounds of cannabis, as well as the discovery of endocannabinoids and their cognate receptors in humans. These advances supported legalisation and wide-spread use of cannabis for therapeutic purposes in many countries.

There has been an escalating interest in the medicinal use of Cannabis sativa in recent years. Cannabis is often administered orally with fat-containing foods, or in lipid-based pharmaceutical preparations. However, the impact of lipids on the exposure of patients to cannabis components has not been explored. Therefore, the aim of this study is to elucidate the effect of oral co-administration of lipids on the exposure to two main active cannabinoids, Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD). In this study, oral co-administration of lipids enhanced the systemic exposure of rats to THC and CBD by 2.5-fold and 3-fold, respectively, compared to lipid-free formulations. In vitro lipolysis was conducted to explore the effect of lipids on the intestinal solubilisation of cannabinoids. More than 30% of THC and CBD were distributed into micellar fraction following lipolysis, suggesting that at least one-third of the administered dose will be available for absorption following co-administration with lipids. Both cannabinoids showed very high affinity for artificial CM-like particles, as well as for rat and human CM, suggesting high potential for intestinal lymphatic transport. Moreover, comparable affinity of cannabinoids for rat and human CM suggests that similar increased exposure effects may be expected in humans. In conclusion, co-administration of dietary lipids or pharmaceutical lipid excipients has the potential to substantially increase the exposure to orally administered cannabis and cannabis-based medicines. The increase in patient exposure to cannabinoids is of high clinical importance as it could affect the therapeutic effect, but also toxicity, of orally administered cannabis or cannabis-based medicines.”

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5009397/

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Cannabinoids in bipolar affective disorder: a review and discussion of their therapeutic potential.

“Bipolar affective disorder is often poorly controlled by prescribed drugs.

Cannabis use is common in patients with this disorder and anecdotal reports suggest that some patients take it to alleviate symptoms of both mania and depression.

We undertook a literature review of cannabis use by patients with bipolar disorder and of the neuropharmacological properties of cannabinoids suggesting possible therapeutic effects in this condition.

No systematic studies of cannabinoids in bipolar disorder were found to exist, although some patients claim that cannabis relieves symptoms of mania and/or depression.

The cannabinoids Delta(9)-tetrahydrocannabinol (THC) and cannabidiol (CBD) may exert sedative, hypnotic, anxiolytic, antidepressant, antipsychotic and anticonvulsant effects.

Pure synthetic cannabinoids, such as dronabinol and nabilone and specific plant extracts containing THC, CBD, or a mixture of the two in known concentrations, are available and can be delivered sublingually.

Controlled trials of these cannabinoids as adjunctive medication in bipolar disorder are now indicated.”

http://www.ncbi.nlm.nih.gov/pubmed/15888515

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Benefits of Cannabis Terpenes: Ocimene, Terpinolene, and Guaiol

Leafly

“Terpenes are a group of fragrant essential oils – secreted alongside cannabinoids like THC and CBD – that contribute to the complex aroma of cannabis. They are also generally responsible for many of the distinguishing characteristics of different strains, and this discovery has led to a sharp increase in interest among researchers, producers, and consumers alike.

Though cannabis contains up to 200 different terpenes, there are about 10 primary terpenes and 20 secondary terpenes that occur in significant concentrations. We’d like to introduce you to the potential health benefits of three of those terpenes: ocimene, terpinolene, and guaiol.

Ocimene is an isomeric hydrocarbon found in a wide variety of fruits and plants. It is recognized by its sweet, fragrant, herbaceous, and woodsy aromas, which feature prominently in several perfumes, and which help plants defend themselves in their natural environment. Ocimene occurs naturally in botanicals as diverse as mint, parsley, pepper, basil, mangoes, orchids, kumquats, and of course cannabis.

Ocimene’s potential medical benefits include:

  • Antiviral
  • Antifungal
  • Antiseptic
  • Decongestant
  • Antibacterial

Cannabis strains that can test high in ocimene include Golden Goat, Strawberry Cough,Chernobyl, and Space Queen. At Tilray, strains currently displaying high concentrations of ocimene include OG Kush, Elwyn, and Lemon Sour Diesel.

Terpinolene is another isomeric hydrocarbon, characterized by a fresh, piney, floral, herbal, and occasionally citrusy aroma and flavor. It is found in a variety of other pleasantly fragrant plants including nutmeg, tea tree, conifers, apples, cumin, and lilacs, and is sometimes used in soaps, perfumes, and lotions.

Terpinolene’s potential medical benefits include:

  • Anticancer
  • Antioxidant
  • Sedative
  • Antibacterial
  • Antifungal

Terpinolene is found most commonly in sativa-dominant strains; a few that frequently exhibit high concentrations of this terpene include Jack Herer and its derivatives, such as Pineapple Jack, J1, and Super Jack. At Tilray, strains currently possessing higher than average concentrations of terpinolene include Lemon Sour Diesel, Afghani, and Jean Guy.

Guaiol is not an oil but a sesquiterpenoid alcohol, and is also found in cypress pine and guaiacum. It has been used for centuries as a treatment for diverse ailments ranging from coughs to constipation to arthritis. It is also an effective insect repellent and insecticide.

Guaiol’s potential medical properties include:

  • Antimicrobial
  • Anti-inflammatory

Strains that can test high in guaiol include Chocolope, Liberty Haze, and Blue Kush. At Tilray, strains currently exhibiting relatively high concentrations of guaiol include Barbara Bud, Jean

https://www.leafly.com/news/cannabis-101/benefits-of-cannabis-terpenes-ocimene-terpinolene-and-guaiol

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Cannabidiol in medicine: a review of its therapeutic potential in CNS disorders.

“Cannabidiol (CBD) is the main non-psychotropic component of the glandular hairs of Cannabis sativa.

It displays a plethora of actions including anticonvulsive, sedative, hypnotic, antipsychotic, antiinflammatory and neuroprotective properties.

However, it is well established that CBD produces its biological effects without exerting significant intrinsic activity upon cannabinoid receptors.

For this reason, CBD lacks the unwanted psychotropic effects characteristic of marijuana derivatives, so representing one of the bioactive constituents of Cannabis sativa with the highest potential for therapeutic use.

The present review reports the pharmacological profile of CBD and summarizes results from preclinical and clinical studies utilizing CBD, alone or in combination with other phytocannabinoids, for the treatment of a number of CNS disorders.”

http://www.ncbi.nlm.nih.gov/pubmed/18844286

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Memory-rescuing effects of cannabidiol in an animal model of cognitive impairment relevant to neurodegenerative disorders.

“Cannabidiol, the main nonpsychotropic constituent of Cannabis sativa, possesses a large number of pharmacological effects including anticonvulsive, sedative, hypnotic, anxiolytic, antipsychotic, anti-inflammatory, and neuroprotective, as demonstrated in clinical and preclinical studies.

 Many neurodegenerative disorders involve cognitive deficits, and this has led to interest in whether cannabidiol could be useful in the treatment of memory impairment associated to these diseases…

We used an animal model of cognitive impairment induced by iron overload in order to test the effects of cannabidiol in memory-impaired rats…

RESULTS:

A single acute injection of cannabidiol at the highest dose was able to recover memory in iron-treated rats. Chronic cannabidiol improved recognition memory in iron-treated rats. Acute or chronic cannabidiol does not affect memory in control rats.

CONCLUSIONS:

The present findings provide evidence suggesting the potential use of cannabidiol for the treatment of cognitive decline associated with neurodegenerative disorders.

 Further studies, including clinical trials, are warranted to determine the usefulness of cannabidiol in humans suffering from neurodegenerative disorders.”

http://www.ncbi.nlm.nih.gov/pubmed/21870037

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Pharmacological Evaluation of Cannabinoid Receptor Ligands in a Mouse Model of Anxiety: Further Evidence for an Anxiolytic Role for Endogenous Cannabinoid Signaling

“Extracts of Cannabis sativa have been used for their calming and sedative effects for centuries. Recent developments in drug discovery have suggested that modulation of neuronal endogenous cannabinoid signaling systems could represent a novel approach to the treatment of anxiety-related disorders while minimizing the adverse effects of direct acting cannabinoid receptor agonists. In this study, we evaluated the effects of direct cannabinoid receptor agonists and antagonists and endocannabinoid-modulating drugs on anxiety-like behavior in mice using the elevated-plus maze.

These data indicate that activation of CB1 cannabinoid receptors reduces anxiety-like behaviors in mice and further support an anxiolytic role for endogenous cannabinoid signaling. These results suggest that pharmacological modulation of this system could represent a new approach to the treatment of anxiety-related psychiatric disorders.

Marijuana is widely used throughout the world for recreational and therapeutic purposes. A common reason given for continued marijuana use in certain populations is reduction in anxiety and relaxation; however, adverse reactions, including heightened anxiety and panic, are common and widely cited reasons for discontinuation of marijuana use. The adverse effects of marijuana are more pronounced during novel or stressful environmental conditions, after consumption of large doses of cannabis, and in naive users…”

http://jpet.aspetjournals.org/content/318/1/304.long

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Cannabidiol in vivo blunts beta-amyloid induced neuroinflammation by suppressing IL-1beta and iNOS expression.

“Pharmacological inhibition of beta-amyloid (Aβ) induced reactive gliosis may represent a novel rationale to develop drugs able to blunt neuronal damage and slow the course of Alzheimer’s disease (AD). Cannabidiol (CBD), the main non-psychotropic natural cannabinoid, exerts in vitro a combination of neuroprotective effects in different models of Aβ neurotoxicity. The present study, performed in a mouse model of AD-related neuroinflammation, was aimed at confirming in vivo the previously reported antiinflammatory properties of CBD.

Cannabidiol (CBD), the main non-psychotropic component of the glandular hairs of Cannabis sativa, exhibits a plethora of actions including anti-convulsive, sedative, hypnotic, anti-psychotic, anti-nausea, anti-inflammatory and anti-hyperalgesic properties. CBD has been proved to exert in vitro a combination of neuroprotective effects in Aβ-induced neurotoxicity, including anti-oxidant and anti-apoptotic effects, tau protein hyperphosphorylation inhibition through the Wnt pathway, and marked decrease of inducible nitric oxide synthase (iNOS) protein expression and nitrite production in Aβ-challenged differentiated rat neuronal cells.

In spite of the large amount of data describing the significant neuroprotective and anti-inflammatory properties of CBD in vitro, to date no evidence has been provided showing similar effects in vivo. To achieve this, the present study investigated the potential anti-inflammatory effect of CBD in a mouse model of AD-related neuroinflammation induced by the intrahippocampal injection of the human Aβ (1–42) fragment.

The results of the present study confirm in vivo anti-inflammatory actions of CBD, emphasizing the importance of this compound as a novel promising pharmacological tool capable of attenuating Aβ evoked neuroinflammatory responses.

 …on the basis of the present results, CBD, a drug well tolerated in humans, may be regarded as an attractive medical alternative for the treatment of AD, because of its lack of psychoactive and cognitive effects.”

Read more: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2189818/

 

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Cannabis and Autism: Patient Study

“This morning a mother by the name of Anne brought her 21 year old autistic son to my Irvine office to be evaluated for treatment with cannabis.   He suffers from sever autism; very agitated, violent, and is unable to speak at all.  He requires 24/7 supervised care which his parents assume.   Anne described never having any total relief from the stress of taking care of him.

Anne told me she had tried everything to limit her son’s agitation.   She routinely has to give him ativan (benzodiazepine) and he takes risperidone daily which is an anti-psychotic.

In my office he was extremely agitated, was continuously banging the desk, jumping up and down and a few times even tried to hit his mother.  I could see the desperation on her face as she said “we have tried everything and need your help.”

I went on to explain that although the lack of clinical trials with cannabis and autism that many parents have successfully used it to help their children.   Personally I think the benefits clearly outweigh the risks in treating his sever agitation.   Cannabis is an excellent sedative and tends to even out patients moods.  It seems to modify the extreme highs and lows of both depression and anxiety.

Our goal is for the patient to start with some tinctures or edibles as he is not able to vaporize.   If we can get him sleeping and calm throughout the day not only will be able to function better but Anne and her husband can get some rest and relief.  We often forget about the toll that autism can take on parents and siblings.

I am confident that this is the right direction for Anne and her son.

Stay tuned for updates on patient K and her mother Anne.

If you would like more information about cannabis and autism please feel free to contact my office at 877-721-0047 or visit my website at www.mcsocal.com

I look forward to speaking with you.

respectfully,

Dr. Sean Breen

Medical Director, Medical Cannabis of Southern California”

http://www.mcsocal.com/blog/cannabis-and-autism-patient-study

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Would some cannabinoids ameliorate symptoms of autism?

“Cannabidiol (CBD) is a major nonpsychotropic constituent of cannabis sativa, which unlike the other major constituent delta9-tetrahydrocannabinol (delta9-THC), is virtually inactive at both of its central nervous system receptors. In one study, cell-based calcium mobilization and electrophysiological assays were used to identify and characterize several novel cannabinoid TRPV2 agonists in cultured rat dorsal root ganglion neurons. Among these, CBD was found to be the most robust and potent, followed by delta9-THC and cannabinol. Those cannabinoids may, accordingly, possess the ability, due to their action as TRPV2 agonists, to increase the release of both oxytocin and vasopressin enhancing the stimulation of oxytocin receptor and V1a receptors at the same time. CBD displays a plethora of other actions including anticonvulsive, sedative, hypnotic, antipsychotic, anti-inflammatory and neuroprotective properties. CBD and delta9-THC are components of drugs commercialized, in certain countries, as treatments for neuropathic pain, overactive bladder, and spasticity in patients suffering from multiple sclerosis. Thus, despite their action on oxytocin and vasopressin release, CBD and delta9-THC may help in improving symptoms of ASD by their sedative, antipsychotic, anticonvulsant and tranquilizing effects. In addition, the cannabinoid system has already been shown to be implicated in social behavior in rats.
 
The administration of cannabinoids for children and adolescents suffering from ASD is a controversial legal and ethical issue. Instead, those cannabinoids may be tested when administered to animals presenting autistic symptoms. Animal models of autistic symptoms exist especially in rodents that have their oxytocin and/or vasopressin function impaired such as mice or rats lacking the oxytocin or vasopressin gene or one of their receptors]. Whenever cannabinoids were found efficient in animal models of autism, the rationale supporting their efficacy may outweigh their legal and ethical adversities, when administered to children in the setting of randomized controlled studies.”
 
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