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Cheng A, Zhang S, Meng F, Xing M, Liu H, Yang G, Gao Y. Nanosuspension-Loaded Dissolving Microneedle Patches for Enhanced Transdermal Delivery of a Highly Lipophilic Cannabidiol. Int J Nanomedicine 2024; 19:4061-4079. [PMID: 38736651 PMCID: PMC11088408 DOI: 10.2147/ijn.s452207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 04/11/2024] [Indexed: 05/14/2024] Open
Abstract
Purpose Transdermal Drug Delivery System (TDDS) offers a promising alternative for delivering poorly soluble drugs, challenged by the stratum corneum's barrier effect, which restricts the pool of drug candidates suitable for TDDS. This study aims to establish a delivery platform specifically for highly lipophilic drugs requiring high doses (log P > 5, dose > 10 mg/kg/d), to improve their intradermal delivery and enhance solubility. Methods Cannabidiol (CBD, log P = 5.91) served as the model drug. A CBD nanosuspension (CBD-NS) was prepared using a bottom-up method. The particle size, polydispersity index (PDI), zeta potential, and concentration of the CBD-NS were characterized. Subsequently, CBD-NS was incorporated into dissolving microneedles (DMNs) through a one-step manufacturing process. The intradermal dissolution abilities, physicochemical properties, mechanical strength, insertion depth, and release behavior of the DMNs were evaluated. Sprague-Dawley (SD) rats were utilized to assess the efficacy of the DMN patch in treating knee synovitis and to analyze its skin permeation kinetics and pharmacokinetic performance. Results The CBD-NS, stabilized with Tween 80, exhibited a particle size of 166.83 ± 3.33 nm, a PDI of 0.21 ± 0.07, and a concentration of 46.11 ± 0.52 mg/mL. The DMN loaded with CBD-NS demonstrated favorable intradermal dissolution and mechanical properties. It effectively increased the delivery of CBD into the skin, extended the action's duration in vivo, and enhanced bioavailability. CBD-NS DMN exhibited superior therapeutic efficacy and safety in a rat model of knee synovitis, significantly inhibiting TNF-α and IL-1β compared with the methotrexate subcutaneous injection method. Conclusion NS technology effectively enhances the solubility of the poorly soluble drug CBD, while DMN facilitates penetration, extends the duration of action in vivo, and improves bioavailability. Furthermore, CBD has shown promising therapeutic outcomes in treating knee synovitis. This innovative drug delivery system is expected to offer a more efficient solution for the administration of highly lipophilic drugs akin to CBD, thereby facilitating high-dose administration.
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Affiliation(s)
- Aguo Cheng
- Key Laboratory of Photochemical Conversion and Optoelectronic Materials, Technical Institute of Physics and Chemistry of Chinese Academy of Sciences, Beijing, People’s Republic of China
- University of Chinese Academy of Sciences, Beijing, People’s Republic of China
| | - Suohui Zhang
- Key Laboratory of Photochemical Conversion and Optoelectronic Materials, Technical Institute of Physics and Chemistry of Chinese Academy of Sciences, Beijing, People’s Republic of China
- Beijing CAS Microneedle Technology Ltd, Beijing, People’s Republic of China
| | - Fanda Meng
- School of Clinical and Basic Medical Sciences, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong Province, People’s Republic of China
| | - Mengzhen Xing
- Key Laboratory of New Material Research Institute, Department of Pharmaceutical Research Institute, Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, People’s Republic of China
| | - Han Liu
- Beijing CAS Microneedle Technology Ltd, Beijing, People’s Republic of China
| | - Guozhong Yang
- Beijing CAS Microneedle Technology Ltd, Beijing, People’s Republic of China
| | - Yunhua Gao
- Key Laboratory of Photochemical Conversion and Optoelectronic Materials, Technical Institute of Physics and Chemistry of Chinese Academy of Sciences, Beijing, People’s Republic of China
- University of Chinese Academy of Sciences, Beijing, People’s Republic of China
- Beijing CAS Microneedle Technology Ltd, Beijing, People’s Republic of China
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Tarlovski S, Bar Kadmon A, Goldberg E, Segal D, Gavish D, Stepensky D. Comparative Pharmacokinetic Assessment of Innovative Sublingual, Rectal and Vaporizer Cannabis Products Versus Approved Cannabis Products in Healthy Volunteers. Cannabis Cannabinoid Res 2024. [PMID: 38656906 DOI: 10.1089/can.2023.0229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
Background: Over the last years, there is a dramatic increase in the use of medical cannabis products for an expanding range of clinical indications. The type of the drug product and its administration route affect substantially the rate and the extent of absorption of cannabinoids and the effects induced by them in the patients. The current challenge for the cannabis pharmaceutical industry is to develop formulations that allow predictable and stable absorption of cannabinoids. This article reports the results of the clinical trial that investigated the pharmacokinetics (PKs) of innovative cannabis products in healthy volunteers. Materials and Methods: This was a single-center study with a single-dose, randomized, crossover, partially blinded controlled design. Each of the 12 healthy volunteers received 8 different products, of the 10 products that were assessed in this trial: novel sublingual (SL) tablet, vaporizer, and rectal products, comparator products (Sativex® and oil-based oromucosal products), and placebo products. Serial blood samples were collected, plasma concentrations of the THC, 11-OH-THC, and CBD were quantified and subjected to noncompartmental PK analysis. Results: Novel medical cannabis products that were investigated in the study induced substantial exposure of the volunteers to the active ingredients, had more rapid absorption, and in some cases also less variable absorption of THC and CBD, in comparison with the approved comparison products. The bioavailability of the novel SL tablet-based and suppositories products was somewhat lower than that of the oromucosal products. The vaporizer provided immediate systemic absorption with highest maximal concentration. The safety profile of the novel cannabis products, namely vaporizer, SL tablets, and suppositories, was not inferior to the Sativex and oil-based oromucosal formulations. Conclusions: The novel cannabis products that were assessed in this study have PK properties that may be advantageous for management of specific medical conditions or in specific subgroups of patients that are prescribed medical cannabis.
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Affiliation(s)
| | | | | | - Dadi Segal
- Panaxia Pharmaceutical Industries Ltd., Lod, Israel
| | - Dov Gavish
- Department of Medicine, Edith Wolfson Medical Center, Holon, Israel, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - David Stepensky
- Department of Clinical Biochemistry and Pharmacology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
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O’Sullivan SE, Jensen SS, Kolli AR, Nikolajsen GN, Bruun HZ, Hoeng J. Strategies to Improve Cannabidiol Bioavailability and Drug Delivery. Pharmaceuticals (Basel) 2024; 17:244. [PMID: 38399459 PMCID: PMC10892205 DOI: 10.3390/ph17020244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/02/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
The poor physicochemical properties of cannabidiol (CBD) hamper its clinical development. The aim of this review was to examine the literature to identify novel oral products and delivery strategies for CBD, while assessing their clinical implications and translatability. Evaluation of the published literature revealed that oral CBD strategies are primarily focused on lipid-based and emulsion solutions or encapsulations, which improve the overall pharmacokinetics (PK) of CBD. Some emulsion formulations demonstrate more rapid systemic delivery. Variability in the PK effects of different oral CBD products is apparent across species. Several novel administration routes exist for CBD delivery that may offer promise for specific indications. For example, intranasal administration and inhalation allow quick delivery of CBD to the plasma and the brain, whereas transdermal and transmucosal administration routes deliver CBD systemically more slowly. There are limited but promising data on novel delivery routes such as intramuscular and subcutaneous. Very limited data show that CBD is generally well distributed across tissues and that some CBD products enable increased delivery of CBD to different brain regions. However, evidence is limited regarding whether changes in CBD PK profiles and tissue distribution equate to superior therapeutic efficacy across indications and whether specific CBD products might be suited to particular indications.
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Affiliation(s)
| | - Sanne Skov Jensen
- Fertin Pharma, Dandyvej 19, 7100 Vejle, Denmark; (S.S.J.); (G.N.N.); (H.Z.B.)
| | - Aditya Reddy Kolli
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, 2000 Neuchâtel, Switzerland;
| | | | - Heidi Ziegler Bruun
- Fertin Pharma, Dandyvej 19, 7100 Vejle, Denmark; (S.S.J.); (G.N.N.); (H.Z.B.)
| | - Julia Hoeng
- Vectura Fertin Pharma, 4058 Basel, Switzerland;
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Koch N, Jennotte O, Lechanteur A, Deville M, Charlier C, Cardot JM, Chiap P, Evrard B. An Intravenous Pharmacokinetic Study of Cannabidiol Solutions in Piglets through the Application of a Validated Ultra-High-Pressure Liquid Chromatography Coupled to Tandem Mass Spectrometry Method for the Simultaneous Quantification of CBD and Its Carboxylated Metabolite in Plasma. Pharmaceutics 2024; 16:140. [PMID: 38276510 PMCID: PMC10820640 DOI: 10.3390/pharmaceutics16010140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 01/12/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024] Open
Abstract
Cannabidiol (CBD) has multiple therapeutic benefits that need to be maximized by optimizing its bioavailability. Numerous formulations are therefore being developed and their pharmacokinetics need to be studied, requiring analytical methods and data from intravenous administration. As CBD is susceptible to hepatic metabolism, the requirement of any method is to quantify metabolites such as 7-COOH-CBD. We demonstrated that CBD and 7-COOH-CBD could be simultaneously and correctly quantified in piglet plasma by using an UHPLC-MS/MS technique. The validated method allowed for an accurate bioanalysis of an intravenously injected solution consisting of CBD-HPβCD complexes. The experimental pharmacokinetic profile of CBD showed multi-exponential decay characterized by a fast apparent distribution half-life (0.25 h) and an elimination half-life of two hours. The profile of 7-COOH-CBD was not linked with the first-pass metabolism, since 80% of the maximum metabolite concentration was reached at the first sampling time point, without any decrease during the period of study. A two-compartment model was optimal to describe the experimental CBD profile. This model allowed us to calculate macro-micro constants and volumes of distribution (Vss = 3260.35 ± 2286.66 mL) and clearance (1514.5 ± 261.16 mL·h-1), showing that CBD is rapidly distributed to peripheral tissues once injected and slowly released into the bloodstream.
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Affiliation(s)
- Nathan Koch
- Laboratory of Pharmaceutical Technology and Biopharmacy, Center for Interdisciplinary Research on Medicines (CIRM), University of Liège, 4000 Liège, Belgium; (O.J.); (A.L.); (B.E.)
| | - Olivier Jennotte
- Laboratory of Pharmaceutical Technology and Biopharmacy, Center for Interdisciplinary Research on Medicines (CIRM), University of Liège, 4000 Liège, Belgium; (O.J.); (A.L.); (B.E.)
| | - Anna Lechanteur
- Laboratory of Pharmaceutical Technology and Biopharmacy, Center for Interdisciplinary Research on Medicines (CIRM), University of Liège, 4000 Liège, Belgium; (O.J.); (A.L.); (B.E.)
| | - Marine Deville
- Department of Toxicology, Center for Interdisciplinary Research on Medicines (CIRM), Academic Hospital of Liège, 4000 Liège, Belgium; (M.D.); (C.C.); (P.C.)
| | - Corinne Charlier
- Department of Toxicology, Center for Interdisciplinary Research on Medicines (CIRM), Academic Hospital of Liège, 4000 Liège, Belgium; (M.D.); (C.C.); (P.C.)
| | | | - Patrice Chiap
- Department of Toxicology, Center for Interdisciplinary Research on Medicines (CIRM), Academic Hospital of Liège, 4000 Liège, Belgium; (M.D.); (C.C.); (P.C.)
| | - Brigitte Evrard
- Laboratory of Pharmaceutical Technology and Biopharmacy, Center for Interdisciplinary Research on Medicines (CIRM), University of Liège, 4000 Liège, Belgium; (O.J.); (A.L.); (B.E.)
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Shreiber-Livne I, Sulimani L, Shapira A, Procaccia S, Meiri D, Sosnik A. Poly(ethylene glycol)-b-poly(epsilon-caprolactone) nanoparticles as a platform for the improved oral delivery of cannabidiol. Drug Deliv Transl Res 2023; 13:3192-3203. [PMID: 37341881 DOI: 10.1007/s13346-023-01380-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2023] [Indexed: 06/22/2023]
Abstract
Cannabidiol (CBD), a non-psychoactive constituent of Cannabis, has proven neuroprotective, anti-inflammatory and antioxidant properties though his therapeutic use, especially by the oral route, is still challenged by the poor aqueous solubility that results in low oral bioavailability. In this work, we investigate the encapsulation of CBD within nanoparticles of a highly hydrophobic poly(ethylene glycol)-b-poly(epsilon-caprolactone) block copolymer produced by a simple and reproducible nanoprecipitation method. The encapsulation efficiency is ~ 100% and the CBD loading 11% w/w (high performance liquid chromatography). CBD-loaded nanoparticles show a monomodal size distribution with sizes of up to 100 nm (dynamic light scattering), a spherical morphology, and the absence of CBD crystals (high resolution-scanning electron microscopy and cryogenic-transmission electron microscopy) which is in line with a very efficient nanoencapsulation. Then, the CBD release profile from the nanoparticles is assessed under gastric- and intestine-like conditions. At pH 1.2, only 10% of the payload is released after 1 h. Conversely, at pH 6.8, a release of 80% is recorded after 2 h. Finally, the oral pharmacokinetics is investigated in rats and compared to a free CBD suspension. CBD-loaded nanoparticles lead to a statistically significant ~ 20-fold increase of the maximum drug concentration in plasma (Cmax) and a shortening of the time to the Cmax (tmax) from 4 to 0.3 h, indicating a more complete and faster absorption than in free form. Moreover, the area-under-the-curve (AUC), a measure of oral bioavailability, increased by 14 times. Overall results highlight the promise of this simple, reproducible, and scalable nanotechnology strategy to improve the oral performance of CBD with respect to common oily formulations and/or lipid-based drug delivery systems associated with systemic adverse effects.
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Affiliation(s)
- Inbar Shreiber-Livne
- Laboratory of Pharmaceutical Nanomaterials Science, Department of Materials Science and Engineering, Technion - Israel Institute of Technology, Technion City, Haifa, 320003, Israel
- Laboratory of Cancer Biology and Cannabinoid Research, Department of Biology, Technion - Israel Institute of Technology, Haifa, 3200003, Israel
- Russell Berrie Nanotechnology Institute, Technion - Israel Institute of Technology, Haifa, 3200003, Israel
| | - Liron Sulimani
- The Kleifeld Laboratory, Department of Biology, Technion - Israel Institute of Technology, Haifa, 3200003, Israel
- CannaSoul Analytics, Caesarea, 3099109, Israel
| | - Anna Shapira
- Laboratory of Cancer Biology and Cannabinoid Research, Department of Biology, Technion - Israel Institute of Technology, Haifa, 3200003, Israel
| | - Shiri Procaccia
- Laboratory of Cancer Biology and Cannabinoid Research, Department of Biology, Technion - Israel Institute of Technology, Haifa, 3200003, Israel
| | - David Meiri
- Laboratory of Cancer Biology and Cannabinoid Research, Department of Biology, Technion - Israel Institute of Technology, Haifa, 3200003, Israel.
| | - Alejandro Sosnik
- Laboratory of Pharmaceutical Nanomaterials Science, Department of Materials Science and Engineering, Technion - Israel Institute of Technology, Technion City, Haifa, 320003, Israel.
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6
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Tagen M, Klumpers LE, Peshkovsky A. Pharmacokinetics of Two Nanoemulsion Formulations of Δ 8-Tetrahydrocannabinol in Rats. AAPS PharmSciTech 2023; 24:239. [PMID: 37989959 DOI: 10.1208/s12249-023-02699-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/08/2023] [Indexed: 11/23/2023] Open
Abstract
The use of Δ8-tetrahydrocannabinol (Δ8-THC) has increased in recent years. Given that the oral absorption of cannabinoids in oil formulations is typically slow and variable, nanoemulsions may be an improved delivery vehicle. Therefore, we characterized the pharmacokinetics (PK) in Sprague-Dawley rats following the administration of three different oral formulations containing 10 mg/kg Δ8-THC: a translucent liquid nanoemulsion, a reconstituted powder nanoemulsion, and a medium chain triglyceride (MCT) oil solution for comparison. Δ8-THC was also administered intravenously at 0.6 mg/kg. Plasma samples were quantified for Δ8-THC and two metabolites, 11-hydroxy-Δ8-THC (11-OH-Δ8-THC) and 11-carboxy-Δ8-THC (COOH-Δ8-THC). Non-compartmental PK parameters were calculated, and a PK model was developed based on pooled data. Despite a smaller median droplet size of the translucent liquid nanoemulsion (26.9 nm) compared to the reconstituted powder nanoemulsion (168 nm), the PK was similar for both. The median Tmax values of Δ8-THC for the nanoemulsions (0.667 and 1 h) were significantly shorter than the median Tmax of Δ8-THC in MCT oil (6 h). This resulted in an approximately 4-fold higher Δ8-THC exposure over the first 4 h for the nanoemulsions relative to the MCT oil solution. The active 11-OH-Δ8-THC metabolite followed a similar pattern to Δ8-THC. The non-compartmental bioavailability estimates of Δ8-THC for the nanoemulsions (11-16.5%) were lower than for the MCT oil solution (>21.5%). However, a model-based analysis indicated similar bioavailability for all three oral formulations. These results demonstrate favorable absorption properties of both nanoemulsions, despite the difference in droplet sizes, compared to an MCT oil formulation.
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Affiliation(s)
| | - Linda E Klumpers
- Verdient Science LLC, Denver, Colorado, USA
- University of Vermont, Larner College of Medicine, Burlington, Vermont, USA
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7
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Johnson DA, Funnell MP, Heaney LM, Cable TG, Wheeler PC, Bailey SJ, Clifford T, James LJ. Cannabidiol Oil Ingested as Sublingual Drops or Within Gelatin Capsules Shows Similar Pharmacokinetic Profiles in Healthy Males. Cannabis Cannabinoid Res 2023. [PMID: 37733294 DOI: 10.1089/can.2023.0117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023] Open
Abstract
Introduction: Cannabidiol (CBD) is a nonintoxicating phytocannabinoid used in clinical treatments and sold widely in consumer products. CBD products may be designed for sublingual or oral delivery, but it is unclear whether either is advantageous for CBD absorption. This study compared CBD pharmacokinetics after providing CBD oil as sublingual drops and within orally ingested gelatin capsules, at a dose relevant to consumer products. Materials and Methods: Eight males completed three conditions in a participant-blinded, randomized crossover design. Participants received the following combinations of placebo and CBD-containing (69 mg/mL) hemp oil in capsules and as sublingual drops: placebo capsules/placebo drops (Placebo), CBD capsules/placebo drops (CBD-Caps), and placebo capsules/CBD drops (CBD-Drops). Blood samples, blood pressure, and subjective scales were obtained/completed hourly for 6 h and at 24 h. Discussion: Plasma CBD concentrations were not different between CBD-Caps and CBD-Drops (interaction effect p=0.76). Peak CBD concentration (28.0±15.6 vs. 24.0±22.2 ng/mL), time of peak CBD concentration (4±1 vs. 4±2 h), and area under the concentration curve (45.3±20.3 vs. 41.8±23.3 ng/mL·6 h) were not different between conditions (p≥0.25). Cardiometabolic outcomes (plasma glucose/triacylglycerol, heart rate, blood pressure), liver function (plasma alanine aminotransferase/aspartate aminotransferase), kidney function (plasma creatinine), and subjective feelings/symptoms were not different between conditions (p≥0.07). Conclusions: Plasma CBD profiles were comparable between CBD-Caps and CBD-Drops, suggesting that there were not meaningful differences in routes of CBD absorption between conditions. This implies that CBD oil delivered sublingually is swallowed before oral mucosal CBD absorption occurs, which may have implications for research design, CBD product design, and consumer product choice.
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Affiliation(s)
- Drusus A Johnson
- National Centre for Sport and Exercise Medicine, School of Sport, Health and Exercise Sciences, Loughborough University, Loughborough, Leicestershire, United Kingdom
| | - Mark P Funnell
- National Centre for Sport and Exercise Medicine, School of Sport, Health and Exercise Sciences, Loughborough University, Loughborough, Leicestershire, United Kingdom
| | - Liam M Heaney
- National Centre for Sport and Exercise Medicine, School of Sport, Health and Exercise Sciences, Loughborough University, Loughborough, Leicestershire, United Kingdom
| | - Thomas G Cable
- National Centre for Sport and Exercise Medicine, School of Sport, Health and Exercise Sciences, Loughborough University, Loughborough, Leicestershire, United Kingdom
| | - Patrick C Wheeler
- National Centre for Sport and Exercise Medicine, School of Sport, Health and Exercise Sciences, Loughborough University, Loughborough, Leicestershire, United Kingdom
| | - Stephen J Bailey
- National Centre for Sport and Exercise Medicine, School of Sport, Health and Exercise Sciences, Loughborough University, Loughborough, Leicestershire, United Kingdom
| | - Tom Clifford
- National Centre for Sport and Exercise Medicine, School of Sport, Health and Exercise Sciences, Loughborough University, Loughborough, Leicestershire, United Kingdom
| | - Lewis J James
- National Centre for Sport and Exercise Medicine, School of Sport, Health and Exercise Sciences, Loughborough University, Loughborough, Leicestershire, United Kingdom
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Moazen-Zadeh E, Chisholm A, Bachi K, Hurd YL. Pharmacokinetics of Cannabidiol: A Systematic Review and Meta-Regression Analysis. Cannabis Cannabinoid Res 2023. [PMID: 37643301 DOI: 10.1089/can.2023.0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Abstract
Background: In this review, we provide an updated assessment of available evidence on the pharmacokinetics (PK) of CBD and explore the impact of different factors on PK outcomes. Materials and Methods: This systematic review and meta-regression analysis was preregistered (PROSPERO: CRD42021269857). We systematically searched Medline, Embase, PsycInfo, and Web of Science Core Collection up to November 19, 2022. Trials of CBD in healthy adults were included if they reported at least one of the PK parameters of interest, including Tmax, Cmax, AUC0-t, AUC0-inf, and T1/2, in serum or plasma. Studies of patient populations or CBD co-administration with other medications were excluded. The National Heart, Lung, and Blood Institute's Quality Assessment Tool for Before-After Studies with no Control Group was used. Random-effects multivariable meta-regression analysis was conducted. Results: A total of 112 trial arms from 39 studies were included; 26 trial arms had a "Good" quality, 70 "Fair," and 16 "Poor." Eight arms used inhalation CBD, 29 oromucosal, 73 oral, and 2 intravenous. CBD formulations could be categorized to nanotech (n=14), oil-based (n=21), alcohol-based (n=10), water-based (n=12), Sativex (n=17), and Epidiolex® (n=22). For single-dose studies, CBD doses ranged between 2 and 100 mg in inhalation, 5-50 mg in oromucosal, and 0.42-6000 mg in oral administration. Sixty-six trial arms had only male participants or a higher number of male than female participants. The duration of the PK session was between 4 and 164 h. A higher CBD dose was associated with higher Cmax, AUC0-t, and AUC0-inf. Compared with oral administration, oromucosal administration was associated with lower Cmax, AUC0-t, and AUC0-inf. Fed status was associated with higher Cmax and AUC0-t when compared with the fasting status. A higher ratio of female participants was associated with lower Tmax in oral administration and higher Cmax. Conclusion: As expected, CBD dose, route of administration, and diet were major determinants of CBD PK with oral routes providing higher bioavailability and nanotechnology formulations a faster onset. Although CBD appeared to have a faster onset and longer duration in women, more studies are required to delineate the role of biological sex. Factors that influence CBD PK have implications for medication development and appropriate dosing in clinical practice.
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Affiliation(s)
- Ehsan Moazen-Zadeh
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Addiction Institute, Mount Sinai Behavioral Health System, New York, New York, USA
| | - Alexandra Chisholm
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Addiction Institute, Mount Sinai Behavioral Health System, New York, New York, USA
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, Addiction Institute, Mount Sinai Behavioral Health System, New York, New York, USA
| | - Keren Bachi
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Addiction Institute, Mount Sinai Behavioral Health System, New York, New York, USA
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Yasmin L Hurd
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Addiction Institute, Mount Sinai Behavioral Health System, New York, New York, USA
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, Addiction Institute, Mount Sinai Behavioral Health System, New York, New York, USA
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9
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Lazzarotto Rebelatto ER, Rauber GS, Caon T. An update of nano-based drug delivery systems for cannabinoids: Biopharmaceutical aspects & therapeutic applications. Int J Pharm 2023; 635:122727. [PMID: 36803924 DOI: 10.1016/j.ijpharm.2023.122727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 02/08/2023] [Accepted: 02/11/2023] [Indexed: 02/17/2023]
Abstract
Nanotechnology has been widely used to improve stability, efficacy, release control and biopharmaceutical aspects of natural and synthetic cannabinoids. In this review, the main types of cannabinoid-based nanoparticles (NPs) reported so far are addressed, taking into account the advantages and disadvantages of each system. Formulation, preclinical and clinical studies performed with colloidal carriers were individually analyzed. Lipid-based nanocarriers have been recognized for their high biocompatibility and ability to improve both solubility and bioavailability. Δ9-tetrahydrocannabinol-loaded lipid systems designed to treat glaucoma, for example, showed superior in vivo efficacy in comparison to market formulations. The analyzed studies have shown that product performance can be modulated by varying particle size and composition. In the case of self-nano-emulsifying drug delivery systems, the reduced particle size shortens the time to reach high plasma concentrations while the incorporation of metabolism inhibitors extends the plasma circulation time. The use of long alkyl chain lipids in NP formulations, in turn, is strategized to achieve intestinal lymphatic absorption. Polymer NPs have been prioritized when a sustained or site-specific cannabinoid release is desirable (e.g., CNS-affecting diseases/cancer). The functionalization of the surface of polymer NPs makes their action even more selective whereas surface charge modulation is highlighted to provide mucoadhesion. The present study identified promising systems for targeted applications, making the process of optimizing new formulations more effective and faster. Although NPs have shown a promising role in the treatment of several difficult-to-treat diseases, more translational studies should be performed to confirm the benefits reported here.
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Affiliation(s)
| | - Gabriela Schneider Rauber
- Department of Applied Science and Technology (DISAT), Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129 Torino, Italy
| | - Thiago Caon
- Postgraduate Program in Pharmacy (PGFAR), Federal University of Santa Catarina Trindade, Florianopolis 88040-900, Brazil.
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Moazen-Zadeh E, Chisholm A, Bachi K, Hurd YL. Pharmacokinetics of Cannabidiol: A systematic review and meta-regression analysis. medRxiv 2023:2023.02.01.23285341. [PMID: 36778355 PMCID: PMC9915832 DOI: 10.1101/2023.02.01.23285341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background In this review, we provide an updated assessment of available evidence on the pharmacokinetics (PK) of cannabidiol (CBD) and explore the impact of different factors on PK outcomes. Materials and Methods This systematic review and meta-regression analysis was pre-registered (PROSPERO: CRD42021269857). We systematically searched Medline, Embase, PsychInfo, and Web of Science Core Collection up to November 19, 2022. Trials of CBD in healthy adults were included if they reported at least one of the PK parameters of interest, including Tmax, Cmax, AUC0-t, AUC0-inf, and T 1/2 , in serum or plasma. Studies of patient populations or CBD co-administration with other medications were excluded. The National Heart, Lung, and Blood Institute's Quality Assessment Tool for Before-After Studies with no Control Group was used. Random-effects multivariable meta-regression analysis was conducted. Results A total of 112 trial arms from 39 studies were included; 26 trial arms had a "Good" quality, 70 "Fair," and 16 "Poor." Eight arms used inhalation CBD, 29 oromucosal, 73 oral, and 2 intravenous. CBD formulations could be categorized to nanotech (n=14), oil-based (n=21), alcohol-based (n=10), water-based (n=12), Sativex (n=17), and Epidiolex (n=22). For single-dose studies, CBD doses ranged between 2-100mg in inhalation, 5-50mg in oromucosal, and 0.42-6000mg in oral administration. Sixty-six trial arms had only male participants or a higher number of males than females. The duration of the PK session was between 4h-164h. A higher CBD dose was associated with higher Cmax, AUC0-t, and AUC0-inf. Compared to oral administration, oromucosal administration was associated with lower Cmax, AUC0-t, and AUC0-inf. Fed status was associated with higher Cmax and AUC0-t when compared to the fasting status. A higher ratio of female participants was associated with lower Tmax in oral administration and higher Cmax. Conclusion As expected, CBD dose, route of administration, and diet were major determinants of CBD pharmacokinetics with oral routes providing higher bioavailability and nanotechnology formulations a faster onset. Though CBD appeared to have a faster onset and longer duration in females, more studies are required to delineate the role of biological sex. Factors that influence CBD PK have implications for medication development and appropriate dosing in clinical practice.
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Vázquez‐Valadez VH, Oliva‐Arellano MV, Martínez‐Soriano PA, Hernández‐Serda MA, Velázquez‐Sánchez AM, Concepción Rodríguez‐Maciel J, Angeles E. In Silico
Predictability of Toxicity Parameters Using the OECD QSAR Toolbox of Some Components of
Cannabis sativa. ChemistrySelect 2023. [DOI: 10.1002/slct.202204079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Víctor Hugo Vázquez‐Valadez
- Laboratorio de Química Medicinal y Teórica FESC – Universidad Nacional Autónoma de México Av. 1 de Mayo S/N Cuautitlán Izcalli Estado de México México ZIP 54750
- QSAR Analytics SA de CV. Tempano 10, Colonia Atlanta, Cuautitlán Izcalli Estado de México México ZIP 54740
| | - María Virginia Oliva‐Arellano
- Laboratorio de Química Medicinal y Teórica FESC – Universidad Nacional Autónoma de México Av. 1 de Mayo S/N Cuautitlán Izcalli Estado de México México ZIP 54750
| | - Pablo Arturo Martínez‐Soriano
- Laboratorio de Química Medicinal y Teórica FESC – Universidad Nacional Autónoma de México Av. 1 de Mayo S/N Cuautitlán Izcalli Estado de México México ZIP 54750
| | - Manuel Alejandro Hernández‐Serda
- Laboratorio de Química Medicinal y Teórica FESC – Universidad Nacional Autónoma de México Av. 1 de Mayo S/N Cuautitlán Izcalli Estado de México México ZIP 54750
| | - Ana María Velázquez‐Sánchez
- Laboratorio de Química Medicinal y Teórica FESC – Universidad Nacional Autónoma de México Av. 1 de Mayo S/N Cuautitlán Izcalli Estado de México México ZIP 54750
| | - José Concepción Rodríguez‐Maciel
- Laboratorio de Fitosanidad – Entomología y Acarología Colegio de Posgraduados Km 36.5 Carretera México-Texcoco, Texcoco Estado de México México ZIP 56230
| | - Enrique Angeles
- Laboratorio de Química Medicinal y Teórica FESC – Universidad Nacional Autónoma de México Av. 1 de Mayo S/N Cuautitlán Izcalli Estado de México México ZIP 54750
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Kolesarova M, Simko P, Urbanska N, Kiskova T. Exploring the Potential of Cannabinoid Nanodelivery Systems for CNS Disorders. Pharmaceutics 2023; 15. [PMID: 36678832 DOI: 10.3390/pharmaceutics15010204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/25/2022] [Accepted: 12/28/2022] [Indexed: 01/11/2023] Open
Abstract
Cannabinoids have a major therapeutic value in a variety of disorders. The concepts of cannabinoids are difficult to develop, but they can be used and are advantageous for a number of diseases that are not sufficiently managed by existing treatments. Nanoconjugation and encapsulation techniques have been shown to be effective in improving the delivery and the therapeutic effectiveness of drugs that are poorly soluble in water. Because the bioavailability of cannabinoids is low, the challenge is to explore different administration methods to improve their effectiveness. Because cannabinoids cross the blood-brain-barrier (BBB), they modify the negative effects of inflammatory processes on the BBB and may be a key factor in the improvement of BBB function after ischemic disease or other conditions. This review discusses various types of cannabinoid administration, as well as nanotechnologies used to improve the bioavailability of these compounds in CNS diseases.
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Kwee CMB, van Gerven JMA, Bongaerts FLP, Cath DC, Jacobs G, Baas JMP, Groenink L. Cannabidiol in clinical and preclinical anxiety research. A systematic review into concentration-effect relations using the IB-de-risk tool. J Psychopharmacol 2022; 36:1299-1314. [PMID: 36239014 PMCID: PMC9716490 DOI: 10.1177/02698811221124792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Preclinical research suggests that cannabidiol (CBD) may have therapeutic potential in pathological anxiety. Dosing guidelines to inform future human studies are however lacking. AIM We aimed to predict the therapeutic window for anxiety-reducing effects of CBD in humans based on preclinical models. METHODS We conducted two systematic searches in PubMed and Embase up to August 2021, into pharmacokinetic (PK) and pharmacodynamic (PD) data of systemic CBD exposure in humans and animals, which includes anxiety-reducing and potential side effects. Risk of bias was assessed with SYRCLE's RoB tool and Cochrane RoB 2.0. A control group was an inclusion criterion in outcome studies. In human outcome studies, randomisation was required. We excluded studies that co-administered other substances. We used the IB-de-risk tool for a translational integration of outcomes. RESULTS We synthesised data from 87 studies. For most observations (70.3%), CBD had no effect on anxiety outcomes. There was no identifiable relation between anxiety outcomes and drug levels across species. In all species (humans, mice, rats), anxiety-reducing effects seemed to be clustered in certain concentration ranges, which differed between species. DISCUSSION A straightforward dosing recommendation was not possible, given variable concentration-effect relations across species, and no consistent linear effect of CBD on anxiety reduction. Currently, these results raise questions about the broad use as a drug for anxiety. Meta-analytic studies are needed to quantitatively investigate drug efficacy, including aspects of anxiety symptomatology. Acute and (sub)chronic dosing studies with integrated PK and PD outcomes are required for substantiated dose recommendations.
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Affiliation(s)
- Caroline MB Kwee
- Department of Experimental Psychology and Helmholtz Institute, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands,Altrecht Academic Anxiety Centre, Utrecht, The Netherlands,Caroline MB Kwee, Department of Experimental Psychology and Helmholtz Institute, Faculty of Social and Behavioural Sciences, Utrecht University, Heidelberglaan 1, Utrecht 3584 CS, The Netherlands.
| | | | - Fleur LP Bongaerts
- Department of Experimental Psychology and Helmholtz Institute, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands
| | - Danielle C Cath
- University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands,Department of Specialist Trainings, GGZ Drenthe, Assen, The Netherlands
| | | | - Johanna MP Baas
- Department of Experimental Psychology and Helmholtz Institute, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands
| | - Lucianne Groenink
- Department of Pharmaceutical Sciences, Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
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ALSaeedy M, Hasan A, Al-Adhreai A, Alrabie A, Qaba H, Mashrah A, Öncü-Kaya EM. An overview of liquid chromatographic methods for analyzing new generation anti-epileptic drugs. J LIQ CHROMATOGR R T 2022. [DOI: 10.1080/10826076.2022.2134146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Mohammed ALSaeedy
- Department of Chemistry, Faculty of Applied Sciences, Dhamar University, Dhamar, Yemen
- Department of Chemistry, Faculty of Sciences, Eskisehir Technical University, Eskisehir, Turkey
- Department of Chemistry, Faculty of Education-Albaydha, Albaydha University, Albaydha, Yemen
| | - Ahmed Hasan
- Department of Pharmacology, Graduation School of Health Science, Anadolu University, Eskisehir, Turkey
| | - Arwa Al-Adhreai
- Department of Chemistry, Faculty of Applied Sciences, Dhamar University, Dhamar, Yemen
- Department of Chemistry, Maulana Azad of Arts, Science and Commerce, Aurangabad, India
| | - Ali Alrabie
- Department of Chemistry, Faculty of Education-Albaydha, Albaydha University, Albaydha, Yemen
- Department of Chemistry, Maulana Azad of Arts, Science and Commerce, Aurangabad, India
| | - Hafsah Qaba
- Department of Analytical Chemistry, Graduation School of Health Sciences, Anadolu University, Eskisehir, Turkey
| | - Abdulrahman Mashrah
- Department of Food Science and Technology, Faculty of Agriculture and Food Sciences, Ibb University, Ibb, Yemen
- Department of Food Engineering, Institute of Natural Sciences-Sakarya, Sakarya University, Sakarya, Turkey
| | - Elif Mine Öncü-Kaya
- Department of Chemistry, Faculty of Sciences, Eskisehir Technical University, Eskisehir, Turkey
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Arnold JC, McCartney D, Suraev A, McGregor IS. The safety and efficacy of low oral doses of cannabidiol: An evaluation of the evidence. Clin Transl Sci 2022; 16:10-30. [PMID: 36259271 PMCID: PMC9841308 DOI: 10.1111/cts.13425] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 09/08/2022] [Accepted: 09/16/2022] [Indexed: 02/04/2023] Open
Abstract
Global interest in the non-intoxicating cannabis constituent, cannabidiol (CBD), is increasing with claims of therapeutic effects across a diversity of health conditions. At present, there is sufficient clinical trial evidence to support the use of high oral doses of CBD (e.g., 10-50 mg/kg) in treating intractable childhood epilepsies. However, a question remains as to whether "low-dose" CBD products confer any therapeutic benefits. This is an important question to answer, as low-dose CBD products are widely available in many countries, often as nutraceutical formulations. The present review therefore evaluated the efficacy and safety of low oral doses of CBD. The review includes interventional studies that measured the clinical efficacy in any health condition and/or safety and tolerability of oral CBD dosed at less than or equal to 400 mg per day in adult populations (i.e., ≥18 years of age). Studies were excluded if the product administered had a Δ9 -tetrahydrocannabinol content greater than 2.0%. Therapeutic benefits of CBD became more clearly evident at doses greater than or equal to 300 mg. Increased dosing from 60 to 400 mg/day did not appear to be associated with an increased frequency of adverse effects. At doses of 300-400 mg, there is evidence of efficacy with respect to reduced anxiety, as well as anti-addiction effects in drug-dependent individuals. More marginal and less consistent therapeutic effects on insomnia, neurological disorders, and chronic pain were also apparent. Larger more robust clinical trials are needed to confirm the therapeutic potential of lower (i.e., <300 mg/day) oral doses of CBD.
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Affiliation(s)
- Jonathon C. Arnold
- Lambert Initiative for Cannabinoid TherapeuticsThe University of SydneySydneyNew South WalesAustralia,Brain and Mind CentreThe University of SydneySydneyNew South WalesAustralia,Faculty of Medicine and Health, Discipline of Pharmacology, Sydney Pharmacy SchoolThe University of SydneySydneyNew South WalesAustralia
| | - Danielle McCartney
- Lambert Initiative for Cannabinoid TherapeuticsThe University of SydneySydneyNew South WalesAustralia,Brain and Mind CentreThe University of SydneySydneyNew South WalesAustralia,Faculty of Science, School of PsychologyThe University of SydneySydneyNew South WalesAustralia
| | - Anastasia Suraev
- Lambert Initiative for Cannabinoid TherapeuticsThe University of SydneySydneyNew South WalesAustralia,Brain and Mind CentreThe University of SydneySydneyNew South WalesAustralia,Faculty of Science, School of PsychologyThe University of SydneySydneyNew South WalesAustralia
| | - Iain S. McGregor
- Lambert Initiative for Cannabinoid TherapeuticsThe University of SydneySydneyNew South WalesAustralia,Brain and Mind CentreThe University of SydneySydneyNew South WalesAustralia,Faculty of Science, School of PsychologyThe University of SydneySydneyNew South WalesAustralia
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László S, Bátai IZ, Berkó S, Csányi E, Dombi Á, Pozsgai G, Bölcskei K, Botz L, Wagner Ö, Pintér E. Development of Capsaicin-Containing Analgesic Silicone-Based Transdermal Patches. Pharmaceuticals (Basel) 2022; 15:ph15101279. [PMID: 36297391 PMCID: PMC9611826 DOI: 10.3390/ph15101279] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/29/2022] [Accepted: 10/13/2022] [Indexed: 12/03/2022] Open
Abstract
Transdermal therapeutic systems (TTSs) enable convenient dosing in drug therapy. Modified silicone-polymer-based patches are well-controlled and cost-effective matrix diffusion systems. In the present study, we investigated the substance release properties, skin penetration, and analgesic effect of this type of TTS loaded with low-dose capsaicin. Release properties were measured in Franz diffusion cell and continuous flow-through cell approaches. Capsaicin was detected with HPLC-UV and UV spectrophotometry. Raman spectroscopy was conducted on human skin samples exposed to the TTS. A surgical incision or carrageenan injection was performed on one hind paw of male Wistar rats. TTSs were applied to the epilated dorsal skin. Patches were kept on the animals for 6 h. The thermal hyperalgesia and mechanical pain threshold of the hind paws were detected. Patches exhibited controlled, zero-order kinetic capsaicin release. According to the Raman mapping, capsaicin penetrated into the epidermis and dermis of human skin, where the target receptors are expressed. The thermal pain threshold drop of the operated rat paws was reversed by capsaicin treatment compared to that of animals treated with control patches. It was concluded that our modified silicone-polymer-based capsaicin-containing TTS is suitable for the relief of traumatic and inflammatory pain.
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Affiliation(s)
- Szabolcs László
- Department of Inorganic and Analytical Chemistry, Faculty of Chemical Technology and Biotechnology, Budapest University of Technology and Economics, Műegyetem rkp. 3, H-1111 Budapest, Hungary
- Department of Pharmacology and Pharmacotherapy, Medical School, University of Pécs, Szigeti u. 12, H-7624 Pécs, Hungary
| | - István Z. Bátai
- Department of Pharmacology and Pharmacotherapy, Medical School, University of Pécs, Szigeti u. 12, H-7624 Pécs, Hungary
- Molecular Pharmacology Research Group, Szentágothai Research Centre, University of Pécs, Ifjúság ú. 20, H-7624 Pécs, Hungary
| | - Szilvia Berkó
- Institute of Pharmaceutical Technology and Regulatory Affairs, Faculty of Pharmacy, University of Szeged, Eötvös str. 6, H-6720 Szeged, Hungary
| | - Erzsébet Csányi
- Institute of Pharmaceutical Technology and Regulatory Affairs, Faculty of Pharmacy, University of Szeged, Eötvös str. 6, H-6720 Szeged, Hungary
| | - Ágnes Dombi
- Department of Pharmacology and Pharmacotherapy, Medical School, University of Pécs, Szigeti u. 12, H-7624 Pécs, Hungary
- Molecular Pharmacology Research Group, Szentágothai Research Centre, University of Pécs, Ifjúság ú. 20, H-7624 Pécs, Hungary
| | - Gábor Pozsgai
- Department of Pharmacology and Pharmacotherapy, Medical School, University of Pécs, Szigeti u. 12, H-7624 Pécs, Hungary
- Molecular Pharmacology Research Group, Szentágothai Research Centre, University of Pécs, Ifjúság ú. 20, H-7624 Pécs, Hungary
- Correspondence: ; Tel.: +36-72-536-217
| | - Kata Bölcskei
- Department of Pharmacology and Pharmacotherapy, Medical School, University of Pécs, Szigeti u. 12, H-7624 Pécs, Hungary
- Molecular Pharmacology Research Group, Szentágothai Research Centre, University of Pécs, Ifjúság ú. 20, H-7624 Pécs, Hungary
| | - Lajos Botz
- Department of Pharmaceutics and Central Clinical Pharmacy, Faculty of Pharmacy, University of Pécs, Honvéd u. 3., H-7624 Pécs, Hungary
| | - Ödön Wagner
- Department of Inorganic and Analytical Chemistry, Faculty of Chemical Technology and Biotechnology, Budapest University of Technology and Economics, Műegyetem rkp. 3, H-1111 Budapest, Hungary
| | - Erika Pintér
- Department of Pharmacology and Pharmacotherapy, Medical School, University of Pécs, Szigeti u. 12, H-7624 Pécs, Hungary
- Molecular Pharmacology Research Group, Szentágothai Research Centre, University of Pécs, Ifjúság ú. 20, H-7624 Pécs, Hungary
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Shehata I, Hashim A, Elsaeidy A, Nair A, Urits I, Viswanath O, Kaye A, Habib M. Cannabinoids and Their Role in Chronic Pain Treatment: Current Concepts and a Comprehensive Review. Health Psychol Res 2022; 10:35848. [PMID: 36628124 PMCID: PMC9820704 DOI: 10.52965/001c.35848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 05/18/2022] [Indexed: 11/22/2022] Open
Abstract
For decades, chronic pain was managed with an almost conventional approach of using a wide range of analgesic spectrum, surgical approaches and complex interventional pain techniques to modulate or even interrupt pain pathways. These different approaches carry many pharmacological hazards together with the lack of efficacy and safety of many interventional and surgical management techniques for chronic pain have mandated searching for other effective therapies including alternative treatments. Cannabinoids are naturally occurring substances that are derived from Cannabis sativa L. The usage of cannabinoids and their related synthetic chemical compounds has emerged as a choice in the management of different chronic pain conditions is being evaluated, however, the efficacy is still not consistently established. In the present investigation, therefore, we discuss the different aspects related to cannabinoids and their implications in the management of chronic pain conditions. This review will also discuss the safety profile of the cannabinoids together with the legal considerations that hinder their use in different countries.
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Affiliation(s)
| | | | | | | | - Ivan Urits
- Louisiana State University Health Sciences Center
| | | | - Alan Kaye
- Louisiana State University Health Sciences Center
| | - Marian Habib
- Hurghada General Hospital, Department of Cardiology, Hurghada, Egypt
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18
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Alvarez JC, Pelissier AL, Mura P, Goullé JP. Le cannabidiol (CBD) : que faut-il retenir ? Toxicologie Analytique et Clinique 2022. [DOI: 10.1016/j.toxac.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Gáll Z, Kelemen K, Tolokán A, Zolcseak I, Sável I, Bod R, Ferencz E, Vancea S, Urkon M, Kolcsár M. Anticonvulsant Action and Long-Term Effects of Chronic Cannabidiol Treatment in the Rat Pentylenetetrazole-Kindling Model of Epilepsy. Biomedicines 2022; 10:1811. [PMID: 36009358 PMCID: PMC9405483 DOI: 10.3390/biomedicines10081811] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/20/2022] [Accepted: 07/26/2022] [Indexed: 11/16/2022] Open
Abstract
Cannabidiol (CBD) showed anticonvulsant action in several preclinical models and is currently approved by regulatory agencies to treat childhood epilepsy syndromes. However, CBD treatment has limited benefits, and its long-term effects on cognition are not fully understood yet. This study aimed to examine the impact of long-term CBD treatment in the pentylenetetrazole (PTZ)-kindling model of epilepsy. Adult male Wistar rats (N = 24) received PTZ (35 mg/kg intraperitoneally) every other day until two consecutive generalized seizures occurred. CBD (60 mg/kg body weight) was administered daily by the oral route until the kindled state was achieved (n = 12). To confirm that the formulation and administration techniques were not of concern, liquid chromatography–mass spectrometry was performed to test the brain penetration of the CBD formula. As a result of CBD treatment, a lower mortality rate and significantly prolonged generalized seizure latency (925.3 ± 120.0 vs. 550.1 ± 69.62 s) were observed, while the frequency and duration of generalized seizures were not influenced. The CBD-treated group showed a significant decrease in vertical exploration in the open field test and a significant decrease in the discrimination index in the novel object recognition (NOR) test (−0.01 ± 0.17 vs. 0.57 ± 0.15, p = 0.04). The observed behavioral characteristics may be connected to the decreased thickness of the stratum pyramidale or the decreased astrogliosis observed in the hippocampus. In conclusion, CBD treatment did not prevent kindling, nor did it affect seizure frequency or duration. However, it did increase the latency to the first seizure and decreased the prolonged status epilepticus-related mortality in PTZ-kindled rats. The cognitive impairment observed in the NOR test may be related to the high dose used in this study, which may warrant further investigation.
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Abstract
INTRODUCTION Oral administration of cannabinoids is a convenient route of administration in many cases. To enhance the poor and variable bioavailability of cannabinoids, selected strategies utilizing proper delivery systems have been designed. Low solubility in the GI aqueous media is the first and most critical barrier. Thereafter, cannabinoids can reach the systemic blood circulation via the portal vein that is associated with significant hepatic first pass metabolism (FPM) or bypass it via lymphatic absorption. AREAS COVERED The solubility obstacle of cannabinoids is mainly addressed with lipid-based formulations such as self-nanoemulsifying drug delivery systems (SNEDDS). Certain lipids are used to overcome the solubility issue. Surfactants and other additives in the formulation have additional impact on several barriers, including dictating the degree of lymphatic bioavailability and hepatic FPM. Gastro-retentive formulation is also plausible. EXPERT OPINION Comparison of the role of the same SNEDDS formulation, cyclosporine vs. cannabinoids, when used to elevate the oral bioavailability of different compounds, is presented. It illustrates some similarities and major mechanistic differences obtained by the same SNEDDS. Thus, the different influence over the absorption pathway illuminates the importance of understanding the absorption mechanism and its barriers to properly select appropriate strategies to achieve enhanced oral bioavailability.
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Affiliation(s)
- Ayala Bar-Hai
- Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, P.O. Box 12065, Jerusalem 91120, Israel
| | - Abraham J Domb
- Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, P.O. Box 12065, Jerusalem 91120, Israel
| | - Amnon Hoffman
- Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, P.O. Box 12065, Jerusalem 91120, Israel
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Kwee CM, Baas JM, van der Flier FE, Groenink L, Duits P, Eikelenboom M, van der Veen DC, Moerbeek M, Batelaan NM, van Balkom AJ, Cath DC. Cannabidiol enhancement of exposure therapy in treatment refractory patients with social anxiety disorder and panic disorder with agoraphobia: A randomised controlled trial. Eur Neuropsychopharmacol 2022; 59:58-67. [PMID: 35561538 DOI: 10.1016/j.euroneuro.2022.04.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/28/2022] [Accepted: 04/01/2022] [Indexed: 12/20/2022]
Abstract
Preclinical research suggests that enhancing CB1 receptor agonism may improve fear extinction. In order to translate this knowledge into a clinical application we examined whether cannabidiol (CBD), a hydrolysis inhibitor of the endogenous CB1 receptor agonist anandamide (AEA), would enhance the effects of exposure therapy in treatment refractory patients with anxiety disorders. Patients with panic disorder with agoraphobia or social anxiety disorder were recruited for a double-blind parallel randomised controlled trial at three mental health care centres in the Netherlands. Eight therapist-assisted exposure in vivo sessions (weekly, outpatient) were augmented with 300 mg oral CBD (n = 39) or placebo (n = 41). The Fear Questionnaire (FQ) was assessed at baseline, mid- and post-treatment, and at 3 and 6 months follow-up. Primary analyses were on an intent-to-treat basis. No differences were found in treatment outcome over time between CBD and placebo on FQ scores, neither across (β = 0.32, 95% CI [-0.60; 1.25]) nor within diagnosis groups (β = -0.11, 95% CI [-1.62; 1.40]). In contrast to our hypotheses, CBD augmentation did not enhance early treatment response, within-session fear extinction or extinction learning. Incidence of adverse effects was equal in the CBD (n = 4, 10.3%) and placebo condition (n = 6, 15.4%). In this first clinical trial examining CBD as an adjunctive therapy in anxiety disorders, CBD did not improve treatment outcome. Future clinical trials may investigate different dosage regimens.
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Affiliation(s)
- Caroline Mb Kwee
- Department of Experimental Psychology and Helmholtz Institute, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, the Netherlands; Altrecht Academic Anxiety Centre, Utrecht, the Netherlands.
| | - Johanna Mp Baas
- Department of Experimental Psychology and Helmholtz Institute, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, the Netherlands
| | | | - Lucianne Groenink
- Department of Pharmaceutical Sciences, Division of Pharmacology, UIPS, Utrecht University, Utrecht, the Netherlands
| | - Puck Duits
- Altrecht Academic Anxiety Centre, Utrecht, the Netherlands
| | - Merijn Eikelenboom
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Centre and GGZ inGeest, Amsterdam, the Netherlands
| | - Date C van der Veen
- University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Mirjam Moerbeek
- Department of Methodology and Statistics, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, the Netherlands
| | - Neeltje M Batelaan
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Centre and GGZ inGeest, Amsterdam, the Netherlands
| | - Anton Jlm van Balkom
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Centre and GGZ inGeest, Amsterdam, the Netherlands
| | - Danielle C Cath
- University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands; GGZ Drenthe, Department of Specialist Trainings, Assen, the Netherlands
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Baratta F, Pignata I, Ravetto Enri L, Brusa P. Cannabis for Medical Use: Analysis of Recent Clinical Trials in View of Current Legislation. Front Pharmacol 2022; 13:888903. [PMID: 35694246 PMCID: PMC9174563 DOI: 10.3389/fphar.2022.888903] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
Cannabis has long been regarded as a recreational substance in the Western world. The recent marketing authorization of some medicinal products of industrial origin and the introduction onto the market of inflorescences for medical use mean that medical doctors can now prescribe Cannabis-based medicines in those countries which allow it. Nevertheless, there is still considerable controversy on this topic in the scientific community. In particular, this controversy concerns: the plant species to be used; the pathologies that can be treated and consequently the efficacy and safety of use; the routes of administration; the methods of preparation; the type and dosage of cannabinoids to be used; and, the active molecules of interest. As such, although medical Cannabis has been historically used, the results of currently completed and internationally published studies are inconclusive and often discordant. In light of these considerations, the aim of this work is to analyse the current legislation in countries that allow the use of medical Cannabis, in relation to the impact that this legislation has had on clinical trials. First of all, a literature search has been performed (PubMed and SciFinder) on clinical trials which involved the administration of Cannabis for medical use over the last 3 years. Of the numerous studies extrapolated from the literature, only about 43 reported data on clinical trials on medical Cannabis, with these mainly being performed in Australia, Brazil, Canada, Denmark, Germany, Israel, Netherlands, Switzerland, the United Kingdom and the United States of America. Once the reference countries were identified, an evaluation of the legislation in relation to Cannabis for medical use in each was carried out via the consultation of the pertinent scientific literature, but also of official government documentation and that of local regulatory authorities. This analysis provided us with an overview of the different legislation in these countries and, consequently, allowed us to analyse, with greater awareness, the results of the clinical trials published in the last 3 years in order to obtain general interest indications in the prosecution of scientific research in this area.
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Abbotts KSS, Ewell TR, Butterklee HM, Bomar MC, Akagi N, Dooley GP, Bell C. Cannabidiol and Cannabidiol Metabolites: Pharmacokinetics, Interaction with Food, and Influence on Liver Function. Nutrients 2022; 14:2152. [PMID: 35631293 PMCID: PMC9144241 DOI: 10.3390/nu14102152] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/17/2022] [Accepted: 05/19/2022] [Indexed: 12/10/2022] Open
Abstract
Cannabidiol (CBD) is widely available and marketed as having therapeutic properties. Over-the-counter CBD is unregulated, many of the therapeutic claims lack scientific support, and controversy exists as to the safety of CBD-liver interaction. The study aims were to compare the pharmacokinetics of commercial CBD and CBD metabolites following the ingestion of five different CBD formulations, determine the influence of CBD on food induced thermogenesis, determine the influence of food on CBD pharmacokinetics, and determine the influence of CBD on markers of liver function. Fourteen males (body mass index ≥ 25 kg/m2) were studied in a placebo-controlled, randomized, crossover design. On five occasions, different CBD formulations were ingested (one per visit). On two additional occasions, CBD or placebo was ingested following a meal. CBD servings were standardized to 30 mg. Considerable pharmacokinetic variability existed between formulations; this pharmacokinetic variability transferred to several of the metabolites. CBD did not influence food induced thermogenesis but did favorably modify early insulin and triglyceride responses. Food appreciably altered the pharmacokinetics of CBD. Finally, CBD did not evoke physiologically relevant changes in markers of liver function. Collectively, these data suggest that consumers should be aware of the appreciable pharmacokinetic differences between commercial CBD formulations, CBD is unlikely to influence the caloric cost of eating but may prove to be of some benefit to initial metabolic responses, consuming CBD with food alters the dynamics of CBD metabolism and increases systemic availability, and low-dose CBD probably does not represent a risk to normal liver function.
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de Oliveira MC, Bruschi ML. Self-Emulsifying Systems for Delivery of Bioactive Compounds from Natural Origin. AAPS PharmSciTech 2022; 23:134. [PMID: 35534702 DOI: 10.1208/s12249-022-02291-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 04/24/2022] [Indexed: 12/14/2022] Open
Abstract
Nature has been used as therapeutic resources in the treatment of diseases for many years. However, some natural compounds have poor water solubility. Therefore, physicochemical strategies and technologies are necessary for development of systems for carrying these substances. The self-emulsifying drug delivery systems (SEDDS) have been used as carriers of hydrophobic compounds in order to increase the solubility and absorption, improving their bioavailability. SEDDS are constituted with a mixture of oils and surfactants which, when come into contact with an aqueous medium under mild agitation, can form emulsions. In the last years, a wide variety of self-emulsifying formulations containing bioactive compounds from natural origin has been developed. This review provides a comprehensive overview of the main excipients and natural bioactive compounds composing SEDDS. In addition, applications, new technologies and innovation are reviewed as well. Examples of self-emulsifying formulations administered in different sites are also considered for a better understanding of the use of this strategy to modify the delivery of compounds from natural origin.
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Wang C, Wang J, Sun Y, Freeman K, Mchenry MA, Wang C, Guo M. Enhanced Stability and Oral Bioavailability of Cannabidiol in Zein and Whey Protein Composite Nanoparticles by a Modified Anti-Solvent Approach. Foods 2022; 11:376. [PMID: 35159526 PMCID: PMC8833932 DOI: 10.3390/foods11030376] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 01/21/2022] [Accepted: 01/25/2022] [Indexed: 02/04/2023] Open
Abstract
Wide applications of cannabidiol (CBD) in the food and pharmaceutical industries are limited due to its low bioavailability, sensitivity to environmental pressures and low water solubility. Zein nanoparticles were stabilized by whey protein (WP) for the delivery of cannabidiol (CBD) using a modified anti-solvent approach. Particle size, surface charge, encapsulation efficiency, and re-dispersibility of nanoparticles were influenced by the zein to WP ratio. Under optimized conditions at 1:4, zein–WP nanoparticles were fabricated with CBD (200 μg/mL) and further characterized. WP absorbed on zein surface via hydrogen bond, hydrophobic forces, and electrostatic attraction. The zein–WP nanoparticles showed excellent storage stability (4 °C, dark) and effectively protected CBD degradation against heat and UV light. In vivo pharmacokinetic study demonstrated that CBD in zein–WP nanoparticles displayed 2-times and 1.75-fold enhancement in maximum concentration (C max) and the area under curve (AUC) as compared to free-form CBD. The data indicated the feasibility of developing zein–WP based nanoparticles for the encapsulation, protection, and delivery of CBD.
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26
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Lalsare S. Cannabinoids: Legal aspects, pharmacology, phytochemistry, probable targets from biological system, and therapeutic potential. Asian J Pharm Res Health Care 2022. [DOI: 10.4103/ajprhc.ajprhc_9_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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27
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De Prá MAA, Vardanega R, Loss CG. Lipid-based formulations to increase cannabidiol bioavailability: In vitro digestion tests, pre-clinical assessment and clinical trial. Int J Pharm 2021; 609:121159. [PMID: 34624443 DOI: 10.1016/j.ijpharm.2021.121159] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 09/28/2021] [Accepted: 10/03/2021] [Indexed: 12/31/2022]
Abstract
Herein, medium-chain triglycerides (MCT), glyceryl monolinoleate (GML), and a self-emulsifying drug delivery system (SEDDS) for cannabidiol (CBD) delivery were compared using in vitro and in vivo (mouse and human) studies. In vitro digestion tests showed that SEDDS yielded the highest CBD recovery in the aqueous phase (86 ± 2%), followed by GML (13 ± 2%) and MCT (5.6% ± 0.8%). In vivo tests (mouse) revealed that SEDDS promoted the highest CBD exposure, exhibiting an area under the plasma concentration-time curve (AUC0-6h) 1.48 times greater than GML and 3.97 times greater than that of the MCT formulation. A single-dose, open-label, crossover study performed in 11 volunteers showed that SEDDS increased CBD AUC0-12h by 1.12 and 1.48 times in relation to GML and MCT, respectively. The in vitro-in vivo correlation was r2 0.75 for mice and r2 0.66 for humans. The AUC correlation between mice and humans was 0.98. Collectively, these results indicate that the lipid profile substantially influences CBD delivery and highlights the potential of the SEDDS and GML formulations as candidate solutions for increasing CBD AUC and bioavailability.
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Affiliation(s)
- Manuel A A De Prá
- Entourage Phytolab, R. Tabapuã 111, 04533-010 São Paulo, SP, Brazil.
| | - Renata Vardanega
- Entourage Phytolab, R. Tabapuã 111, 04533-010 São Paulo, SP, Brazil
| | - Carla G Loss
- Entourage Phytolab, R. Tabapuã 111, 04533-010 São Paulo, SP, Brazil
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28
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Li Y, Orahoske CM, Dano R, Zhang W, Li B, Su B. Pharmacokinetic study of an anti-trypanosome agent with different formulations and administration routes in mice by HPLC-MS/MS. Biomed Chromatogr 2021; 35:e5169. [PMID: 33978959 PMCID: PMC8434948 DOI: 10.1002/bmc.5169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/08/2021] [Accepted: 05/05/2021] [Indexed: 11/06/2022]
Abstract
Previously compound 12 showed great anti-trypanosome activity without toxicity in an in vivo study. In the current study, a sensitive and rapid high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) method was developed and validated to investigate its pharmacokinetics in mouse plasma. A protein precipitation method was applied to extract the compound, and it was then separated using a Kinetex C18 column with mobile phase consisting of acetonitrile-0.1% formic acid water (50:50, v/v) at a flow rate of 300 μl/min. The analytes were detected with the multiple reaction monitoring in negative electrospray ionization source for quantitative response of the compounds. Compound 12 was detected at m/z 477.0 → 367.2, while the internal standard compound 14 was detected at m/z 499.2 → 268.2. Inter- and intra-day precision was <5.22 and 2.79% respectively, while the accuracy range was within ±9.65%. The method was successfully applied to evaluate the pharmacokinetics of compound 12 in mouse plasma with two formulations (20% Cremophor EL or sesame oil) and drug administration routes (oral and intraperitoneal injection). We observed a better drug serum concentration with the Cremophor formulation, and the two different drug administration routes did not show significant differences from the drug distribution.
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Affiliation(s)
- Yaxin Li
- Department of Chemistry, Center for Gene Regulation in Health and Disease, College of Sciences and Health Professions, Cleveland State University, 2121 Euclid Ave., Cleveland, OH, 44115, USA
| | - Cody M Orahoske
- Department of Chemistry, Center for Gene Regulation in Health and Disease, College of Sciences and Health Professions, Cleveland State University, 2121 Euclid Ave., Cleveland, OH, 44115, USA
| | - Raina Dano
- Department of Chemistry, Center for Gene Regulation in Health and Disease, College of Sciences and Health Professions, Cleveland State University, 2121 Euclid Ave., Cleveland, OH, 44115, USA
| | - Wenjing Zhang
- Department of Chemistry, Center for Gene Regulation in Health and Disease, College of Sciences and Health Professions, Cleveland State University, 2121 Euclid Ave., Cleveland, OH, 44115, USA
| | - Bibo Li
- Department of Biological, Geological, and Environmental Sciences, Center for Gene Regulation in Health and Disease, College of Sciences and Health Professions, Cleveland State University, 2121 Euclid Ave., Cleveland, OH, 44115, USA
| | - Bin Su
- Department of Chemistry, Center for Gene Regulation in Health and Disease, College of Sciences and Health Professions, Cleveland State University, 2121 Euclid Ave., Cleveland, OH, 44115, USA
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Stella B, Baratta F, Della Pepa C, Arpicco S, Gastaldi D, Dosio F. Cannabinoid Formulations and Delivery Systems: Current and Future Options to Treat Pain. Drugs 2021; 81:1513-57. [PMID: 34480749 DOI: 10.1007/s40265-021-01579-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2021] [Indexed: 12/24/2022]
Abstract
The field of Cannabis sativa L. research for medical purposes has been rapidly advancing in recent decades and a growing body of evidence suggests that phytocannabinoids are beneficial for a range of conditions. At the same time impressing development has been observed for formulations and delivery systems expanding the potential use of cannabinoids as an effective medical therapy. The objective of this review is to present the most recent results from pharmaceutical companies and research groups investigating methods to improve cannabinoid bioavailability and to clearly establish its therapeutic efficacy, dose ranges, safety and also improve the patient compliance. Particular focus is the application of cannabinoids in pain treatment, describing the principal cannabinoids employed, the most promising delivery systems for each administration routes and updating the clinical evaluations. To offer the reader a wider view, this review discusses the formulation starting from galenic preparation up to nanotechnology approaches, showing advantages, limits, requirements needed. Furthermore, the most recent clinical data and meta-analysis for cannabinoids used in different pain management are summarized, evaluating their real effectiveness, in order also to spare opioids and improve patients' quality of life. Promising evidence for pain treatments and for other important pathologies are also reviewed as likely future directions for cannabinoids formulations.
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30
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Feng W, Qin C, Cipolla E, Lee JB, Zgair A, Chu Y, Ortori CA, Stocks MJ, Constantinescu CS, Barrett DA, Fischer PM, Gershkovich P. Inclusion of Medium-Chain Triglyceride in Lipid-Based Formulation of Cannabidiol Facilitates Micellar Solubilization In Vitro, but In Vivo Performance Remains Superior with Pure Sesame Oil Vehicle. Pharmaceutics 2021; 13:1349. [PMID: 34575426 PMCID: PMC8472830 DOI: 10.3390/pharmaceutics13091349] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/21/2021] [Accepted: 08/24/2021] [Indexed: 12/13/2022] Open
Abstract
Oral sesame oil-based formulation facilitates the delivery of poorly water-soluble drug cannabidiol (CBD) to the lymphatic system and blood circulation. However, this natural oil-based formulation also leads to considerable variability in absorption of CBD. In this work, the performance of lipid-based formulations with the addition of medium-chain triglyceride (MCT) or surfactants to the sesame oil vehicle has been tested in vitro and in vivo using CBD as a model drug. The in vitro lipolysis has shown that addition of the MCT leads to a higher distribution of CBD into the micellar phase. Further addition of surfactants to MCT-containing formulations did not improve distribution of the drug into the micellar phase. In vivo, formulations containing MCT led to lower or similar concentrations of CBD in serum, lymph and MLNs, but with reduced variability. MCT improves the emulsification and micellar solubilization of CBD, but surfactants did not facilitate further the rate and extent of lipolysis. Even though addition of MCT reduces the variability, the in vivo performance for the extent of both lymphatic transport and systemic bioavailability remains superior with a pure natural oil vehicle.
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Affiliation(s)
- Wanshan Feng
- School of Pharmacy, University of Nottingham, Nottingham NG7 2RD, UK; (W.F.); (C.Q.); (E.C.); (J.B.L.); (A.Z.); (Y.C.); (C.A.O.); (M.J.S.); (D.A.B.); (P.M.F.)
| | - Chaolong Qin
- School of Pharmacy, University of Nottingham, Nottingham NG7 2RD, UK; (W.F.); (C.Q.); (E.C.); (J.B.L.); (A.Z.); (Y.C.); (C.A.O.); (M.J.S.); (D.A.B.); (P.M.F.)
| | - Elena Cipolla
- School of Pharmacy, University of Nottingham, Nottingham NG7 2RD, UK; (W.F.); (C.Q.); (E.C.); (J.B.L.); (A.Z.); (Y.C.); (C.A.O.); (M.J.S.); (D.A.B.); (P.M.F.)
- School of Pharmacy, Universita di Roma Tor Vergata, 00173 Rome, Italy
| | - Jong Bong Lee
- School of Pharmacy, University of Nottingham, Nottingham NG7 2RD, UK; (W.F.); (C.Q.); (E.C.); (J.B.L.); (A.Z.); (Y.C.); (C.A.O.); (M.J.S.); (D.A.B.); (P.M.F.)
| | - Atheer Zgair
- School of Pharmacy, University of Nottingham, Nottingham NG7 2RD, UK; (W.F.); (C.Q.); (E.C.); (J.B.L.); (A.Z.); (Y.C.); (C.A.O.); (M.J.S.); (D.A.B.); (P.M.F.)
- College of Pharmacy, University of Anbar, Ramadi 31001, Iraq
| | - Yenju Chu
- School of Pharmacy, University of Nottingham, Nottingham NG7 2RD, UK; (W.F.); (C.Q.); (E.C.); (J.B.L.); (A.Z.); (Y.C.); (C.A.O.); (M.J.S.); (D.A.B.); (P.M.F.)
- Tri-Service General Hospital, Medical Supplies and Maintenance Office, National Defense Medical Center, Taipei 114202, Taiwan
| | - Catherine A. Ortori
- School of Pharmacy, University of Nottingham, Nottingham NG7 2RD, UK; (W.F.); (C.Q.); (E.C.); (J.B.L.); (A.Z.); (Y.C.); (C.A.O.); (M.J.S.); (D.A.B.); (P.M.F.)
| | - Michael J. Stocks
- School of Pharmacy, University of Nottingham, Nottingham NG7 2RD, UK; (W.F.); (C.Q.); (E.C.); (J.B.L.); (A.Z.); (Y.C.); (C.A.O.); (M.J.S.); (D.A.B.); (P.M.F.)
| | | | - David A. Barrett
- School of Pharmacy, University of Nottingham, Nottingham NG7 2RD, UK; (W.F.); (C.Q.); (E.C.); (J.B.L.); (A.Z.); (Y.C.); (C.A.O.); (M.J.S.); (D.A.B.); (P.M.F.)
| | - Peter M. Fischer
- School of Pharmacy, University of Nottingham, Nottingham NG7 2RD, UK; (W.F.); (C.Q.); (E.C.); (J.B.L.); (A.Z.); (Y.C.); (C.A.O.); (M.J.S.); (D.A.B.); (P.M.F.)
| | - Pavel Gershkovich
- School of Pharmacy, University of Nottingham, Nottingham NG7 2RD, UK; (W.F.); (C.Q.); (E.C.); (J.B.L.); (A.Z.); (Y.C.); (C.A.O.); (M.J.S.); (D.A.B.); (P.M.F.)
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31
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Navarrete F, García-Gutiérrez MS, Gasparyan A, Austrich-Olivares A, Manzanares J. Role of Cannabidiol in the Therapeutic Intervention for Substance Use Disorders. Front Pharmacol 2021; 12:626010. [PMID: 34093179 PMCID: PMC8173061 DOI: 10.3389/fphar.2021.626010] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 05/04/2021] [Indexed: 01/04/2023] Open
Abstract
Drug treatments available for the management of substance use disorders (SUD) present multiple limitations in efficacy, lack of approved treatments or alarming relapse rates. These facts hamper the clinical outcome and the quality of life of the patients supporting the importance to develop new pharmacological agents. Lately, several reports suggest that cannabidiol (CBD) presents beneficial effects relevant for the management of neurological disorders such as epilepsy, multiple sclerosis, Parkinson’s, or Alzheimer’s diseases. Furthermore, there is a large body of evidence pointing out that CBD improves cognition, neurogenesis and presents anxiolytic, antidepressant, antipsychotic, and neuroprotective effects suggesting potential usefulness for the treatment of neuropsychiatric diseases and SUD. Here we review preclinical and clinical reports regarding the effects of CBD on the regulation of the reinforcing, motivational and withdrawal-related effects of different drugs of abuse such as alcohol, opioids (morphine, heroin), cannabinoids, nicotine, and psychostimulants (cocaine, amphetamine). Furthermore, a special section of the review is focused on the neurobiological mechanisms that might be underlying the ‘anti-addictive’ action of CBD through the regulation of dopaminergic, opioidergic, serotonergic, and endocannabinoid systems as well as hippocampal neurogenesis. The multimodal pharmacological profile described for CBD and the specific regulation of addictive behavior-related targets explains, at least in part, its therapeutic effects on the regulation of the reinforcing and motivational properties of different drugs of abuse. Moreover, the remarkable safety profile of CBD, its lack of reinforcing properties and the existence of approved medications containing this compound (Sativex®, Epidiolex®) increased the number of studies suggesting the potential of CBD as a therapeutic intervention for SUD. The rising number of publications with substantial results on the valuable therapeutic innovation of CBD for treating SUD, the undeniable need of new therapeutic agents to improve the clinical outcome of patients with SUD, and the upcoming clinical trials involving CBD endorse the relevance of this review.
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Affiliation(s)
- Francisco Navarrete
- Instituto de Neurociencias, Universidad Miguel Hernández-CSIC, San Juan de Alicante, Spain.,Red Temática de Investigación Cooperativa en Salud (RETICS), Red de Trastornos Adictivos, Instituto de Salud Carlos III, MICINN and FEDER, Madrid, Spain
| | - María Salud García-Gutiérrez
- Instituto de Neurociencias, Universidad Miguel Hernández-CSIC, San Juan de Alicante, Spain.,Red Temática de Investigación Cooperativa en Salud (RETICS), Red de Trastornos Adictivos, Instituto de Salud Carlos III, MICINN and FEDER, Madrid, Spain
| | - Ani Gasparyan
- Instituto de Neurociencias, Universidad Miguel Hernández-CSIC, San Juan de Alicante, Spain.,Red Temática de Investigación Cooperativa en Salud (RETICS), Red de Trastornos Adictivos, Instituto de Salud Carlos III, MICINN and FEDER, Madrid, Spain
| | | | - Jorge Manzanares
- Instituto de Neurociencias, Universidad Miguel Hernández-CSIC, San Juan de Alicante, Spain.,Red Temática de Investigación Cooperativa en Salud (RETICS), Red de Trastornos Adictivos, Instituto de Salud Carlos III, MICINN and FEDER, Madrid, Spain
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Williams NNB, Ewell TR, Abbotts KSS, Harms KJ, Woelfel KA, Dooley GP, Weir TL, Bell C. Comparison of Five Oral Cannabidiol Preparations in Adult Humans: Pharmacokinetics, Body Composition, and Heart Rate Variability. Pharmaceuticals (Basel) 2021; 14:35. [PMID: 33418866 DOI: 10.3390/ph14010035] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 12/28/2020] [Accepted: 01/04/2021] [Indexed: 12/19/2022] Open
Abstract
Data supporting the physiological effects of cannabidiol (CBD) ingestion in humans are conflicting. Differences between CBD preparations and bioavailability may contribute to these discrepancies. Further, an influence of body composition on CBD bioavailability is feasible, but currently undocumented. The aims of this study were to: (1) compare the pharmacokinetics of five oral CBD preparations over 4 h; (2) examine the relationship between body composition and CBD pharmacokinetics; and, (3) explore the influence of CBD on heart rate variability. In total, five preparations of CBD, standardized to 30 mg, were orally administered to 15 healthy men and women (21-62 years) in a randomized, crossover design. Prior to and 60 min following CBD ingestion, heart rate variability was determined. Body composition was assessed using dual energy X-ray absorptiometry. Peak circulating CBD concentration, time to peak concentration, and area under the curve was superior in a preparation comprising 5% CBD concentration liquid. Fat free mass was a significant predictor (R
2 = 0.365, p = 0.017) of time to peak concentration for this preparation. Several heart rate variability parameters, including peak frequency of the high frequency band, were favorably, but modestly modified following CBD ingestion. These data confirm an influence of CBD preparation and body composition on CBD bioavailability, and suggest that acute CBD ingestion may have a modest influence on autonomic regulation of heart rate.
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Morel A, Lebard P, Dereux A, Azuar J, Questel F, Bellivier F, Marie-Claire C, Fatséas M, Vorspan F, Bloch V. Clinical Trials of Cannabidiol for Substance Use Disorders: Outcome Measures, Surrogate Endpoints, and Biomarkers. Front Psychiatry 2021; 12:565617. [PMID: 33692705 PMCID: PMC7937926 DOI: 10.3389/fpsyt.2021.565617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 01/21/2021] [Indexed: 12/24/2022] Open
Abstract
Background: Cannabidiol (CBD) is a cannabinoid of potential interest for the treatment of substance use disorders. Our aim was to review the outcome measures, surrogate endpoints, and biomarkers in published and ongoing randomized clinical trials. Methods: We conducted a search in PubMed, Web of Science, PMC, PsycINFO, EMBASE, CENTRAL Cochrane Library, "clinicalTrials.gov," "clinicaltrialsregister.eu," and "anzctr.org.au" for published and ongoing studies. Inclusion criteria were randomized clinical trials (RCTs) examining the use of CBD alone or in association with other cannabinoids, in all substance use disorders. The included studies were analyzed in detail and their qualities assessed by a standardized tool (CONSORT 2010). A short description of excluded studies, consisting in controlled short-term or single administration in non-treatment-seeking drug users, is provided. Findings: The screening retrieved 207 published studies, including only 3 RCTs in cannabis use disorder. Furthermore, 12 excluded studies in cannabis, tobacco, and opioid use disorders are described. Interpretation: Primary outcomes were validated withdrawal symptoms scales and drug use reduction in the three RCTs. In the short-term or crossover studies, the outcome measures were visual analog scales for subjective states; self-rated scales for withdrawal, craving, anxiety, or psychotomimetic symptoms; and laboratory tasks of drug-induced craving, effort expenditure, attentional bias for substance, impulsivity, or anxiety to serve as surrogate endpoints for treatment efficacy. Of note, ongoing studies are now adding peripheral biomarkers of the endocannabinoid system status to predict treatment response. Conclusion: The outcome measures and biomarkers assessed in the ongoing CBD trials for substance use disorders are improving.
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Affiliation(s)
- Alix Morel
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Lariboisière-Fernand Widal, GHU NORD, Assistance Publique - Hôpitaux de Paris, 200 rue du Fg St Denis, Paris, France
| | - Pierre Lebard
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Lariboisière-Fernand Widal, GHU NORD, Assistance Publique - Hôpitaux de Paris, 200 rue du Fg St Denis, Paris, France
| | - Alexandra Dereux
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Lariboisière-Fernand Widal, GHU NORD, Assistance Publique - Hôpitaux de Paris, 200 rue du Fg St Denis, Paris, France.,INSERM UMRS1144, 4 avenue de l'Observatoire, Paris, France.,FHU NOR-SUD, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Julien Azuar
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Lariboisière-Fernand Widal, GHU NORD, Assistance Publique - Hôpitaux de Paris, 200 rue du Fg St Denis, Paris, France.,INSERM UMRS1144, 4 avenue de l'Observatoire, Paris, France.,FHU NOR-SUD, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Frank Questel
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Lariboisière-Fernand Widal, GHU NORD, Assistance Publique - Hôpitaux de Paris, 200 rue du Fg St Denis, Paris, France.,INSERM UMRS1144, 4 avenue de l'Observatoire, Paris, France.,FHU NOR-SUD, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Frank Bellivier
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Lariboisière-Fernand Widal, GHU NORD, Assistance Publique - Hôpitaux de Paris, 200 rue du Fg St Denis, Paris, France.,INSERM UMRS1144, 4 avenue de l'Observatoire, Paris, France.,FHU NOR-SUD, Assistance Publique - Hôpitaux de Paris, Paris, France.,UFR Médecine, Université de Paris, 3 rue Thomas Mann, Paris, France
| | - Cynthia Marie-Claire
- INSERM UMRS1144, 4 avenue de l'Observatoire, Paris, France.,FHU NOR-SUD, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Mélina Fatséas
- University of Bordeaux, Bordeaux, France.,CNRS-UMR 5287- Institut de Neurosciences Cognitives et Intégratives d'Aquitaine (INCIA), Bordeaux, France.,Pôle d'addictologie, CHU de Bordeaux, Hôpital Haut-Lévêque, Avenue de Magellan, Pessac, France
| | - Florence Vorspan
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Lariboisière-Fernand Widal, GHU NORD, Assistance Publique - Hôpitaux de Paris, 200 rue du Fg St Denis, Paris, France.,INSERM UMRS1144, 4 avenue de l'Observatoire, Paris, France.,FHU NOR-SUD, Assistance Publique - Hôpitaux de Paris, Paris, France.,UFR Médecine, Université de Paris, 3 rue Thomas Mann, Paris, France
| | - Vanessa Bloch
- INSERM UMRS1144, 4 avenue de l'Observatoire, Paris, France.,FHU NOR-SUD, Assistance Publique - Hôpitaux de Paris, Paris, France.,Service de Pharmacie, Hôpital Fernand Widal, GHU NORD, Assistance Publique - Hôpitaux de Paris, 200 rue du Fg St Denis, Paris, France
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Cáceres Guido P, Riva N, Caraballo R, Reyes G, Huaman M, Gutierrez R, Agostini S, Fabiana Delaven S, Pérez Montilla CA, García Bournissen F, Schaiquevich P. Pharmacokinetics of cannabidiol in children with refractory epileptic encephalopathy. Epilepsia 2020; 62:e7-e12. [PMID: 33280111 DOI: 10.1111/epi.16781] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/13/2020] [Accepted: 11/13/2020] [Indexed: 11/27/2022]
Abstract
Growing interest in the clinical use of cannabidiol (CBD) as adjuvant therapy for pediatric refractory epileptic encephalopathy emphasizes the need for drug treatment optimization. The aim of this study was to characterize the pharmacokinetics of CBD in pediatric patients with refractory epileptic encephalopathy receiving an oil-based oral solution. To evaluate CBD concentrations, six serial blood samples per patient were collected after the morning dose of CBD, at least 21 days after the beginning of treatment. Twelve patients who received a median (range) dose of 12.2 (5.3-19.4) mg/kg/d (twice daily) were included in the analysis. Median (range) CBD time to maximum plasma concentration, maximum plasma concentration, and area under the concentration versus time curve up to 6 hours after dosing were 3.2 hours (1.9-6.2), 49.6 ng/mL (14.4-302.0), and 226.3 ng ⋅ h/mL (70.5-861.3), respectively. CBD systemic exposure parameters were in the lower range of previous reports in pediatric patients receiving doses in a similar range. Most of our patients (83%) showed little CBD plasma level fluctuation during a dosing interval, comparable to that encountered after oral administration of an extended release drug delivery system. CDB administration was generally safe and well tolerated, and a novel levothyroxine-CBD interaction was recorded. Similar to other studies, large interindividual variability in CBD exposure was observed, encouraging the use of CBD therapeutic drug monitoring.
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Affiliation(s)
- Paulo Cáceres Guido
- Clinical Pharmacokinetics Unit, Pharmacy Area, Garrahan Pediatric Hospital, Buenos Aires, Argentina
| | - Natalia Riva
- Precision Medicine, Garrahan Pediatric Hospital, Buenos Aires, Argentina.,National Scientific and Technical Research Council, Buenos Aires, Argentina
| | - Roberto Caraballo
- National Scientific and Technical Research Council, Buenos Aires, Argentina.,Department of Neurology, Garrahan Pediatric Hospital, Buenos Aires, Argentina
| | - Gabriela Reyes
- Department of Neurology, Garrahan Pediatric Hospital, Buenos Aires, Argentina
| | - Marina Huaman
- Department of Neurology, Garrahan Pediatric Hospital, Buenos Aires, Argentina
| | - Robinson Gutierrez
- Department of Neurology, Garrahan Pediatric Hospital, Buenos Aires, Argentina
| | - Silvana Agostini
- Polyvalent Day Hospital, Garrahan Pediatric Hospital, Buenos Aires, Argentina
| | | | - Carlos A Pérez Montilla
- National Scientific and Technical Research Council, Buenos Aires, Argentina.,Multidisciplinary Institute for Research on Pediatric Diseases, Parasitology and Chagas Service, Buenos Aires Children's Hospital "Ricardo Gutierrez, ", Buenos Aires, Argentina
| | - Facundo García Bournissen
- National Scientific and Technical Research Council, Buenos Aires, Argentina.,Division of Paediatric Clinical Pharmacology, Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Paula Schaiquevich
- Precision Medicine, Garrahan Pediatric Hospital, Buenos Aires, Argentina.,National Scientific and Technical Research Council, Buenos Aires, Argentina
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35
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Franco V, Gershkovich P, Perucca E, Bialer M. The Interplay Between Liver First-Pass Effect and Lymphatic Absorption of Cannabidiol and Its Implications for Cannabidiol Oral Formulations. Clin Pharmacokinet 2020; 59:1493-1500. [DOI: 10.1007/s40262-020-00931-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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