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Palmieri B, Vadalà M. Oral THC: CBD cannabis extract in main symptoms of Alzheimer disease: agitation and weight loss. Clin Ter 2023; 174:53-60. [PMID: 36655645 DOI: 10.7417/ct.2023.5009] [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] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Objectives Ten million new cases of dementia are recorded annually worldwide, with agitation and idiopathic weight loss being the most common symptoms. Several pharmacological therapies have emerged in recent years, but the clinical use of cannabis extracts in older patients with AD is constantly growing. This retrospective, analytical, observational, spontaneous trial aimed to enhance the clinical action of THC: CBD cannabis extract administration in AD patients with severe symptoms such as agitation, weight loss, cognitive impairment, and sleep disturbance. Methods Thirty patients (9 men and 21 women) diagnosed with mild, moderate, or severe AD, aged 65-90 years, appealing to our Second Opinion Medical Consultation (Modena, Italy), were enrolled and required to use oil-diluted cannabis extract, Bedrocan® (22% THC, 0.5% CBD, Olive Oil 50 ml), twice a day for 12 weeks. The efficacy of cannabinoid therapy was evaluated at baseline and 12 weeks after therapy, employing three self-administered questionnaires completed by the parents of the enrolled patients: NPI-Q, CMAI, and MMSE. Key findings The NPI-Q demonstrated a reduction (p<0.0001) in agitation, apathy, irritability, sleep disturbances, and eating disturbances, consequently improving caregiver distress. Levels of physically and verbally aggressive behaviours, measured using the CMAI questionnaire, were lower (p<0.0001) in all patients. The MMSSE questionnaire confirmed a significant decrease (p<0.0001) in cognitive impairment in 45% of the patients. Conclusion Our anecdotical, spontaneous, and observational study demonstrated the efficacy and safety of oil-diluted cannabis extract in patients with AD. The limitations of our study are: 1) small patient cohort, 2) absence of control group, 3) self-administered questionnaires that are the most practical but not objective instruments to assess the neurologic functions of AD patients.
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Affiliation(s)
- B Palmieri
- Second Opinion Medical Network, Modena (MO), Italy
- Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia, Modena (MO), Italy
| | - M Vadalà
- Second Opinion Medical Network, Modena (MO), Italy
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Palmieri B, Vadalà M. Oral THC: CBD cannabis extract in main symptoms of Alzheimer disease: agitation and weight loss. Clin Ter 2023; 174:53-60. [PMID: 36655645 DOI: 10.7417/ct.2023.2497] [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] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Objectives Ten million new cases of dementia are recorded annually worldwide, with agitation and idiopathic weight loss being the most common symptoms. Several pharmacological therapies have emerged in recent years, but the clinical use of cannabis extracts in older patients with AD is constantly growing. This retrospective, analytical, observational, spontaneous trial aimed to enhance the clinical action of THC: CBD cannabis extract administration in AD patients with severe symptoms such as agitation, weight loss, cognitive impairment, and sleep disturbance. Methods Thirty patients (9 men and 21 women) diagnosed with mild, moderate, or severe AD, aged 65-90 years, appealing to our Second Opinion Medical Consultation (Modena, Italy), were enrolled and required to use oil-diluted cannabis extract, Bedrocan® (22% THC, 0.5% CBD, Olive Oil 50 ml), twice a day for 12 weeks. The efficacy of cannabinoid therapy was evaluated at baseline and 12 weeks after therapy, employing three self-administered questionnaires completed by the parents of the enrolled patients: NPI-Q, CMAI, and MMSE. Key findings The NPI-Q demonstrated a reduction (p<0.0001) in agitation, apathy, irritability, sleep disturbances, and eating disturbances, consequently improving caregiver distress. Levels of physically and verbally aggressive behaviours, measured using the CMAI questionnaire, were lower (p<0.0001) in all patients. The MMSSE questionnaire confirmed a significant decrease (p<0.0001) in cognitive impairment in 45% of the patients. Conclusion Our anecdotical, spontaneous, and observational study demonstrated the efficacy and safety of oil-diluted cannabis extract in patients with AD. The limitations of our study are: 1) small patient cohort, 2) absence of control group, 3) self-administered questionnaires that are the most practical but not objective instruments to assess the neurologic functions of AD patients.
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Affiliation(s)
- B Palmieri
- Second Opinion Medical Network, Modena (MO), Italy
- Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia, Modena (MO), Italy
| | - M Vadalà
- Second Opinion Medical Network, Modena (MO), Italy
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Bettiol A, Lombardi N, Crescioli G, Maggini V, Gallo E, Mugelli A, Firenzuoli F, Baronti R, Vannacci A. Galenic Preparations of Therapeutic Cannabis sativa Differ in Cannabinoids Concentration: A Quantitative Analysis of Variability and Possible Clinical Implications. Front Pharmacol 2019; 9:1543. [PMID: 30705629 PMCID: PMC6344428 DOI: 10.3389/fphar.2018.01543] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 11/09/2018] [Accepted: 12/18/2018] [Indexed: 01/02/2023] Open
Abstract
Introduction: Magistral preparations of therapeutic cannabis are extracted from standardized products imported from Holland or from the Florence Military Pharmaceutical Chemical Works, but extraction protocols differ among galenic laboratories. This study assessed the inter-laboratory variability in concentrations of cannabidiol (CBD), cannabinol (CBN), tetrahydrocannabinol (THC), and tetrahydrocannabinolic acid (THCA) among different magistral oil preparations. Methods: 219 samples of Bediol, Bedrobinol, Bedrolite or FM-2 70 or 100 mg/ml in oil were collected from 3 laboratories. Concentrations of CBD, CBN, THC, and THCA were quantified by high-pressure liquid chromatography; inter-laboratories variability was assessed using the Kruskal–Wallis test. Results: A significant variability in CBD and THC concentrations was found for Bediol 70 mg/ml samples from 2 laboratories [for CBD: median 5.4 (range 4.8–6.6) vs. 6.1 (4.9–7.2) mg/ml, p = 0.033; for THC: 3.6 (3.1–3.9) vs. 4.0 (2.6–5.1) mg/ml, p = 0.020]. As for Bediol 100 mg/ml, a significant variability emerged in THC concentrations among the three considered laboratories [5.7 (-) vs. 4.2 (1.5–4.8) vs. 5.2 (4.2–6.9), p = 0.030]. No significant inter-laboratory variability emerged for Bedrocan and Bedrolite. Concentrations of CBD, CBN, and THC were <LOQ in all Bedrocan samples, and CBN and THCA were <LOQ in all Bedrolite samples. As for FM-2, a significant inter-laboratories variability was found for CBD concentrations. Conclusion: Quantitative variability of cannabinoids in magistral preparations might impact on the efficacy and safety of therapeutic cannabis. A standardized protocol is needed to guarantee a homogeneous product and patients’ therapeutic continuity.
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Affiliation(s)
- Alessandra Bettiol
- Section of Pharmacology and Toxicology, Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy.,Tuscan Regional Centre of Pharmacovigilance and Phytovigilance, Florence, Italy
| | - Niccolò Lombardi
- Section of Pharmacology and Toxicology, Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy.,Tuscan Regional Centre of Pharmacovigilance and Phytovigilance, Florence, Italy
| | - Giada Crescioli
- Section of Pharmacology and Toxicology, Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy.,Tuscan Regional Centre of Pharmacovigilance and Phytovigilance, Florence, Italy
| | - Valentina Maggini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Center for Integrative Medicine, Careggi University Hospital, University of Florence, Florence, Italy
| | - Eugenia Gallo
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Center for Integrative Medicine, Careggi University Hospital, University of Florence, Florence, Italy
| | - Alessandro Mugelli
- Section of Pharmacology and Toxicology, Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy.,Tuscan Regional Centre of Pharmacovigilance and Phytovigilance, Florence, Italy
| | - Fabio Firenzuoli
- Center for Integrative Medicine, Careggi University Hospital, University of Florence, Florence, Italy
| | - Roberto Baronti
- Clinical Toxicology Laboratory, Local Health Service, Florence, Italy
| | - Alfredo Vannacci
- Section of Pharmacology and Toxicology, Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy.,Tuscan Regional Centre of Pharmacovigilance and Phytovigilance, Florence, Italy
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Łebkowska-Wieruszewska B, Stefanelli F, Chericoni S, Owen H, Poapolathep A, Lisowski A, Giorgi M. Pharmacokinetics of Bedrocan®, a cannabis oil extract, in fasting and fed dogs: An explorative study. Res Vet Sci 2019; 123:26-8. [PMID: 30580232 DOI: 10.1016/j.rvsc.2018.12.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/24/2018] [Accepted: 12/13/2018] [Indexed: 11/22/2022]
Abstract
The aim of this study was to explore the pharmacokinetics of the two main active compounds (THC and CBD) contained in the cannabis oil extract Bedrocan® in fasting and fed dogs. Bedrocan® (20% delta-9-tetrahydrocannabinol [THC] and 0.5% cannabidiol [CBD]) was administered at 1.5 and 0.037 mg/kg THC and CBD, respectively in fasted and fed dogs according to a 2 × 2 cross over study design. The quantification of the two active ingredients was performed by LC/MS. No detectable concentrations of CDB were found at any collection time. THC was quantifiable from 0.5 to 10 h, although there was large inter-subject variability. Fed dogs showed a longer absorption phase (Tmax 5 vs 1.25 h) and lower maximal blood concentration (7.1 vs 24 ng/mL) compared with the fasted group. A larger AUC was found in the fasted group; the relative oral bioavailability in fed animals was 48.22%.
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Carcieri C, Tomasello C, Simiele M, De Nicolò A, Avataneo V, Canzoneri L, Cusato J, Di Perri G, D'Avolio A. Cannabinoids concentration variability in cannabis olive oil galenic preparations. ACTA ACUST UNITED AC 2017; 70:143-149. [PMID: 29057480 DOI: 10.1111/jphp.12845] [Citation(s) in RCA: 42] [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: 07/03/2017] [Accepted: 08/26/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Knowledge of the exact concentration of active compounds in galenic preparations is crucial to be able to ensure their quality and to properly administer the prescribed dose. Currently, the need for titration of extracts is still debated. Considering this, together with the absence of a standard preparation method, the aim of this study was to evaluate cannabinoids concentrations variability in galenic olive oil extracts, to evaluate the interlot and interlaboratory variability in the extraction yield and in the preparation composition. METHODS Two hundred and one extracts (123 (61.2%) from Bedrocan® , 54 (26.9%) from Bediol® , 11 (5.5%) from Bedrolite® , and 13 (6.5%) from mixed preparations) were analysed by liquid chromatography coupled with tandem mass spectrometry, quantifying cannabinoids (THC, CBD, THCA, CBDA and CBN) concentrations. KEY FINDINGS The RSD% of THC and CBD concentrations resulted higher than 50%. Specifically for Bedrocan® , Bediol® , Bedrolite® (5 g/50 ml), these were THC 82%, THC 53% and CBD 91%, THC 58% and CBD 59%, respectively. The median extraction yields were greater than 75% for all preparations. CONCLUSIONS Our results highlighted a wide variability in THC and CBD concentrations that justify the need for titration and opens further questions about other pharmaceutical preparations without regulatory indication for this procedure.
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Affiliation(s)
- Chiara Carcieri
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, University of Turin, Turin, Italy.,Unit of Infectious Diseases, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Cristina Tomasello
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, University of Turin, Turin, Italy.,Hospital Pharmacy, Maria Vittoria Hospital, ASL CITTA' DI TORINO, Turin, Italy
| | - Marco Simiele
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, University of Turin, Turin, Italy.,CoQua Lab s.r.l, Academic Spin-off of University of Turin, Turin, Italy
| | - Amedeo De Nicolò
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Valeria Avataneo
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Luca Canzoneri
- Pain Management Center, San Luigi Hospital, Orbassano, Turin, Italy
| | - Jessica Cusato
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Giovanni Di Perri
- Unit of Infectious Diseases, Department of Medical Sciences, University of Turin, Turin, Italy.,CoQua Lab s.r.l, Academic Spin-off of University of Turin, Turin, Italy
| | - Antonio D'Avolio
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, University of Turin, Turin, Italy.,CoQua Lab s.r.l, Academic Spin-off of University of Turin, Turin, Italy
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