Cannabinoid levels description in a cohort of patients with chronic and neuropathic pain treated with Cannabis decoction: A possible role of TDM
Alessandra Manca a 1 , Cristina Valz b 1 , Francesco Chiara c , Jacopo Mula a , Alice Palermiti a , Martina Billi a , Miriam Antonucci d , Amedeo De Nicolò a , Nicola Luxardo b , Daniele Imperiale e , Flavio Vischia f , David De Cori f , Jessica Cusato a 2 , Antonio D’Avolio a 2
a
University of Turin, Department of Medical Sciences, Laboratory of Clinical Pharmacology and Pharmacogenetics. Amedeo di Savoia Hospital, Corso Svizzera 164, Turin 10149, Italy
b
SC Terapia del dolore – ASL Città di Torino, Turin 10144, Italy
c
University of Turin, Department of Clinical and Biological Sciences, Laboratory of Clinical Pharmacology San Luigi A.O.U., RegioneGonzole 10, Orbassano, Turin 10043, Italy
d
SCDU Infectious Diseases, Amedeo di Savoia Hospital, ASL Città di Torino, Turin 10149, Italy
e
Neurology Unit, Maria Vittoria Hospital, ASL Città di Torino, Turin 10144, Italy
f
Department of Mental Health – Psychiatric Unit West, Turin 10149, Italy
Affiliationer
The phytocomplex of Cannabis is made up of approximately 500 substances: terpeno-phenols metabolites, including Δ-9-tetrahydrocannabinol and cannabidiol, exhibit pharmacological activity.
Medical Cannabis has several pharmacological potential applications, in particular in the management of chronic and neuropathic pain. In the literature, a few data are available concerning cannabis pharmacokinetics, efficacy and safety.
Thus, aim of the present study was the evaluation of cannabinoid pharmacokinetics in a cohort of patients, with chronic and neuropathic pain, treated with inhaled medical cannabis and decoction, as a galenic preparation.
In this study, 67 patients were enrolled. Dried flower tops with different THC and CBD concentrations were used: Bedrocan® medical cannabis with THC level standardized at 19% and with a CBD level below 1%, Bediol® medical cannabis with THC and CBD level standardized at similar concentration of 6.5% and 8%, respectively.
Cannabis was administered as a decoction in 47 patients and inhaled in 11 patients. The blood withdrawn was obtained before the new dose administration at the steady state and metabolites plasma concentrations were measured with an UHPLC-MS/MS method.
Statistically significant differences were found in cannabinoids plasma exposure between inhaled and oral administration of medical cannabis, between male and female and cigarette smokers.
For the first time, differences in cannabinoid metabolites exposures between different galenic formulations were suggested in patients. Therapeutic drug monitoring could be useful to allow for dose adjustment, but further studies in larger cohorts of patients are required in order to confirm these data.
