CBD (Cannabis sativa) is a non-psychoactive component of cannabis that has long been studied for its potential to relieve pain, insomnia and anxiety. More recently it has also been used as a drug treatment against certain forms of seizures.
RCTs that compare cannabis or cannabinoids with placebo in adults for nausea and vomiting associated with chemotherapy treatments, appetite stimulation in HIV infection, chronic cancer pain relief, spasticity caused by MS, depression, sleep disorders psychosis or glaucoma treatment should be conducted.
Medicinal Uses
Cannabis or cannabinoids (including CBD) are being utilized medicinally in many states that have legalized their use, including oils, capsules and patches containing low levels of THC – the psychoactive component in marijuana – for various conditions. Studies are being done regarding their efficacy.
There is evidence that oral cannabinoids can be effective antiemetics and could potentially alleviate cancer-related anorexia-cachexia and bowel spasticity. Nabiximols is an oromucosal spray containing whole plant cannabis extract with an even ratio of THC to CBD that is currently being evaluated as an option to treat pain and spasticity associated with multiple sclerosis.
Two small studies suggest that dronabinol may help improve dystonia movement scale scores when compared with placebo, although these trials were limited by their small sample sizes and shorter duration. Unfortunately, no strong evidence is available supporting other cannabis-derived treatments for dystonia.
Safety
As an antioxidant, CBD offers protection from oxidative stress by blocking the redox reaction that produces reactive oxygen species (ROS). Furthermore, CBD may prevent pro-inflammatory metabolites from deposition and support antioxidative enzyme activity.
CBD stands out from marijuana or hemp in that it does not contain psychoactive THC compounds; thus it is legal for sale in most states. CBD products come in the form of oil-based capsules, extracts and liquid drops and even food supplements or beauty products.
Dependent upon its concentration, CBD may activate or antagonize cannabinoid receptors and interact with ionotropic and nuclear cannabinoids. Natural (+)-CBD and synthetic derivatives such as 5′-dimethylheptyl-CBD and (+)-1-COOH-5′-dimethylheptyl-CBD exhibit low CB1 affinity but high CB2 affinity; both can inhibit AEA cellular uptake via FAAH cannabinoid glucuronide reductase [120]. On the other hand, (-)-8,9-dihydro-7-hydroxy-CBD has high affinity for CB1 receptors; its anti-inflammatory effects in fibromyalgia cells via an inverted U-shaped dose-response curve mediated by TRPV1 inhibition [121].
Side Effects
CBD (cannabidiol) is an active chemical found in cannabis (Cannabis sativa) plants. It can be found in many products including dietary supplements and drugs; its presence has many health advantages; CBD is non-psychoactive unlike its psychoactive counterpart delta-9-tetrahydrocannabinol (THC), the main psychoactive component in marijuana.
Atropine has low affinity for both CB1 and CB2 receptors, yet displays significant affinity for TRPV1; according to reports it stimulates and desensitizes this human TRPV1 receptor as well as providing anti-inflammatory activity in microglia BV-2 cell lines.
Appropriate studies have yet to demonstrate geriatric-specific issues that might limit the efficacy of CBD in elderly patients; however, older individuals tend to suffer from age-related liver, kidney and heart issues which necessitate caution when prescribing to elderly individuals as dose adjustments may be required for each.
Dosage
As with other drugs, cannabidiol may interact with various medications and supplements; those taking any should discuss this use with their healthcare provider prior to commencing therapy.
CBD may increase the level or effect of certain drugs by interfering with their metabolism in the liver, potentially increasing risk for side effects and necessitating moderating therapy/monitoring closely if taken simultaneously with them. If coadministering with these medications, be cautious. If using both, follow all dosage instructions closely.
Studies conducted on humans indicate that cannabidiol may prevent or slow down the metabolic modification of reactive oxygen species (ROS) associated with oxidative stress, possibly explaining its neuroprotective and cardioprotective actions in protecting from brain injury or heart attack damage.
