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Cannabidiol

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Cannabidiol
Clinical data
AHFS/Drugs.comInternational Drug Names
ATC code
  • None
Legal status
Legal status
  • Not Ranked (US)

Schedule II (Can)

(THC - Schedule/Level I; THC and CBD two main chemicals in cannabis)
Pharmacokinetic data
Bioavailability13-19% (oral),[1] 11-45% (mean 31%; inhaled)[2]
Elimination half-life9 h[1]
Identifiers
  • 2-[(1R,6R)-6-isopropenyl-3-methylcyclohex-2-en-1-yl]-5-pentylbenzene-1,3-diol
CAS Number
PubChem CID
ChemSpider
UNII
CompTox Dashboard (EPA)
ECHA InfoCard100.215.986 Edit this at Wikidata
Chemical and physical data
FormulaC21H30O2
Molar mass314.4636 g·mol−1
3D model (JSmol)
Melting point66 °C (151 °F)
Boiling point180 °C (356 °F)
(range: 160–180 °C)[3]
  • Oc1c(c(O)cc(c1)CCCCC)[C@@H]2\C=C(/CC[C@H]2\C(=C)C)C
  • InChI=1S/C21H30O2/c1-5-6-7-8-16-12-19(22)21(20(23)13-16)18-11-15(4)9-10-17(18)14(2)3/h9,12-13,17-18,22-23H,2,5-8,10-11H2,1,3-4H3/t17-,18+/m0/s1 checkY
  • Key:ZTGXAWYVTLUPDT-ZWKOTPCHSA-N checkY
  (verify)

Cannabidiol (CBD) is one of at least 85 cannabinoids found in cannabis.[4] It is a major constituent of the plant, second to tetrahydrocannabinol (THC), and represents up to 40% in its extracts.[5] Compared with THC, cannabidiol is psychoactive but not intoxicating, and is considered to have a wider scope of medical applications than THC,[6] including to epilepsy,[7] multiple sclerosis spasms,[8] anxiety disorders, bipolar disorder,[6] schizophrenia,[9] nausea, convulsion and inflammation, as well as inhibiting cancer cell growth.[10] There is some preclinical evidence from studies in animals that suggests CBD may modestly reduce the clearance of THC from the body by interfering with its metabolism.[11][12][13] Cannabidiol has displayed sedative effects in animal tests.[14] Other research indicates that CBD increases alertness.[15] CBD has been shown to reduce growth of aggressive human breast cancer cells in vitro, and to reduce their invasiveness.[16]

Clinical applications

The bud of a Cannabis sativa flower coated with trichomes, which contain more CBD than any other part of the plant.[citation needed]

Antimicrobial actions

CBD has been shown to inhibit methicillin-resistant staphylococcus aureus (MRSA) in vitro.[17] CBD, along with the cannabis terpenoid pinene, is effective against MRSA, and may exhibit antiseptic effects against Propionibacterium acnes, the key pathogen in acne. CBD absorbed transcutaneously may also attenuate the increased sebum production at the root of acne.[18]

Neurological effects

A 2010 study found that strains of cannabis containing higher concentrations of cannabidiol did not produce short-term memory impairment vs. strains with similar concentrations of THC, but lower concentrations of CBD.[19] The researchers attributed this attenuation of memory effects to CBD's role as a CB1 antagonist.[20] CBD also appears to protect against 'binge' alcohol induced neurodegeneration.[21][22]

There have been numerous case reports and one small clinical trial documenting the ability of CBD to reduce seizure frequency in epilepsy including in treatment-refractory cases of childhood epilepsy syndromes (for example dravet syndrome).[23][24][25]

Cannabidiol's strong antioxidant properties have been shown to play a role in the compound's neuroprotective and anti-ischemic effects.[10]

Cannabidiol has proven effective in treating an often drug-induced set of neurological movement disorders known as dystonia.[26] In one study, five out of five participants showed noted improvement in their dystonic symptoms by 20-50%.[26][27][27]

Parkinson's disease
In 1985, a single case study suggested that CBD may be effective in the management of levodopa-induced dyskinesia in a Parkinson's disease patient.[28] A small open-label clinical trial demonstrated therapeutic benefit of cannabidiol in Parkinson's disease psychosis.[29] This condition is often particularly problematic to treat seeing how Parkinson's disease involves the gradual destruction of the dopaminergic cells of the nigrostriatal pathway and most antipsychotics (with the exception of clozapine and quetiapine) significantly inhibit nigrostriatal dopamine activity (although this is not their intended action as it is the mesolimbic dopamine pathway they are intended to inhibit).[30]

Psychotropic effects

A 2008 study published in the British Journal of Psychiatry showed significant differences in the Oxford-Liverpool Inventory of Feelings and Experiences scores among three groups: the first consisted of non-cannabis users, the second consisted of users with THC detected, and the third consisted of users with both THC and CBD detected. The THC-only group scored significantly higher for unusual experiences than the THC-and-CBD group, whereas the THC-and-CBD group had significantly lower introvertive anhedonia scores than the THC-only group and the non-cannabis user group. This research indicates that CBD acts as an anti-psychotic and may counteract the potential psychotomimetic effects of THC on individuals with latent schizophrenia.[31]

Recent studies have shown cannabidiol to be as effective as atypical antipsychotics in treating schizophrenia.[9] Studies have shown CBD may reduce schizophrenic symptoms due to its apparent ability to stabilize disrupted or disabled NMDA receptor pathways in the brain, which are shared and sometimes contested by norepinephrine and GABA.[9][32] Leweke et al. performed a double blind, 4 week, explorative controlled clinical trial to compare the effects of purified cannabidiol and the atypical antipsychotic amisulpride on improving the symptoms of schizophrenia in 42 patients with acute paranoid schizophrenia. Both treatments were associated with a significant decrease of psychotic symptoms after 2 and 4 weeks as assessed by Brief Psychiatric Rating Scale and Positive and Negative Syndrome Scale. While there was no statistical difference between the two treatment groups, cannabidiol induced significantly fewer side effects (extrapyramidal symptoms, increase in prolactin, weight gain) when compared to amisulpride.[33]

Studies have shown cannabidiol decreases activity of the limbic system[34] and decreases social isolation induced by THC.[35] Cannabidiol has also been shown to reduce anxiety in social anxiety disorder.[36][37] Although in rats chronic cannabidiol administration was recently found to produce anxiogenic-like effects, hence indicating that, prolonged treatment with cannabidiol might incite anxiogenic effects.[38]

Cannabidiol has demonstrated antidepressant-like effects in animal models of depression.[39][40][41]

Cancer research

In November 2007, researchers at the California Pacific Medical Center reported that CBD shows promise for controlling the spread of metastatic breast cancer. In vitro CBD down-regulates, or "turns off", the activity of ID1, the gene responsible for tumor metastasis[16] in breast and other types of cancers, including the particularly aggressive triple negative breast cancer.[16][42][43] The researchers in September 2012 said they hope to start human trials soon.[44]

Cannabidiol has been shown to inhibit cancer cell growth with low potency in non-cancer cells. Although the inhibitory mechanism is not yet fully understood, Ligresti et al. suggest that "cannabidiol exerts its effects on these cells through a combination of mechanisms that include either direct or indirect activation of CB2 and TRPV1 receptors, and induction of oxidative stress, all contributing to induce apoptosis."[43]

Non-intoxicating cannabinoids, including cannabidiol (CBD) and other more pronounced CB2 agonists such as cannabinol (CBN, an immunosuppressant), are now seen as promising targets for anti-tumor drugs since they experimentally reduce the size of in-vivo xenografts, for example gliomas. Combinations of submaximal THC doses and CBD have both been successfully applied to greatly increase in-vitro efficacy of temozolomide in glioblastoma multiforme cell lines. CBD likely exerts its effects through the induction of apoptosis by Reactive oxygen species.[45] Non-psychoactive cannabinoids can be administered at much higher doses without the well-known side effects that are sometimes associated with the drop-out rate in trials involving psychoactive cannabinoids.

A team of researchers from the University of California at Irvine proposed in February 2013 that CBD's anti-malignant effect by way of apoptosis may be due to its potential action on "mutant p53 proteins in cancer cells," due to cannabidiol's chemo-physical similarity to stictic acid, a promising anti-cancer compound found in some species of lichens that acts on the aforementioned proteins. The University biologists, chemists and computer scientists "identified an elusive pocket on the surface of the p53 protein that can be targeted by cancer-fighting drugs".[46][47]

Dravet syndrome

Dravet syndrome is a rare form of epilepsy that is resistant to most anti-epileptic medications. In the October 2013 edition of The Nation, CBD was touted as the "single compound in cannabis [that] may revolutionize modern medicine". The article went on to say that "nothing else is able to help treatment-resistant epileptic children with Dravet syndrome and related disorders."[48]

The 2013 CNN documentary Weed: Dr. Sanjay Gupta Reports featured a medical marijuana strain called Charlotte's Web, which contains virtually no THC and a high percentage of CBD (0.76% THC and 17.61% CBD) that was being used successfully to treat a 5-year-old Colorado medical marijuana patient who suffers with Dravet syndrome.[49] In 2010, a Modesto, California father reported that he had experienced success treating his son's case of Dravet Syndrome with a CBD-rich cannabis tincture. His 5-year-old son went from a daily dose of 22 pharmaceutical pills down to four, began eating solid food, and experiencing fewer and less intense seizures since beginning treatment with CBD.[50] Before using the tincture, the boy experienced seizures "24 hours a day lasting an hour and a half", but since the first day the high-CBD tincture was administered, he has been seizure-free.[51]

CBD-enhanced cannabis

Decades ago, growers in the US bred CBD almost entirely out of cannabis plants because their customers preferred varietals that were more mind-altering due to a higher THC, lower CBD content.[50] To meet the demands of medical cannabis patients, growers are developing more CBD-rich strains.[52]

In November 2012, an Israeli medical cannabis facility announced a new strain of the plant which has only cannabidiol as an active ingredient, and virtually no THC, providing some of the medicinal benefits of cannabis without the euphoria.[53][54] The researchers said the cannabis plant, enriched with CBD, "can be used for treating diseases like rheumatoid arthritis, colitis, liver inflammation, heart disease and diabetes". Research on CBD enhanced cannabis began in 2009, resulting in Avidekel, a cannabis strain that contains 15.8% CBD and less than 1% THC. Raphael Mechoulam, leading cannabinoid researcher, noted "It is possible that (Avidekel's) CBD to THC ratio is the highest among medical marijuana companies in the world, but the industry is not very organized, so one cannot keep exact track of what each company is doing".[55]

Pharmacology

Pharmacodynamics

Cannabidiol has a very low affinity for CB1 and CB2 receptors but acts as an indirect antagonist of their agonists.[10][56] While one would assume that this would cause cannabidiol to reduce the effects of THC, it may potentiate THC's effects by increasing CB1 receptor density or through another CB1-related mechanism.[57] It is also an inverse agonist of CB2 receptors.[10][56] Recently, it was found to be an antagonist at the putative new cannabinoid receptor, GPR55, a GPCR expressed in the caudate nucleus and putamen.[58] Cannabidiol has also been shown to act as a 5-HT1A receptor agonist,[59] an action which is involved in its antidepressant,[39][60] anxiolytic,[60][61] and neuroprotective[62][63] effects. Cannabidiol is an allosteric modulator of μ and δ-opioid receptors.[64] Cannabidiol's pharmacologial effects have also been attributed to PPAR-γ receptor agonism and intracellular calcium release.[65]

Pharmacokinetic interactions

There is some preclinical evidence to suggest that cannabidiol may reduce THC clearance, modestly increasing THC's plasma concentrations resulting in a greater amount of THC available to receptors, increasing the effect of THC in a dose-dependent manner.[11][12][13] Despite this the available evidence in humans suggests no significant effect of CBD on THC plasma levels.[66]

Pharmaceutical preparations

A CBD extract made from industrial hemp was introduced to the US market in 2012. Because the FDA considers cannabinoids derived from hemp to be "food-based" products, no legal restrictions exist.[67]

Nabiximols (USAN, trade name Sativex) is an aerosolized mist for oral administration containing a near 1:1 ratio of CBD and THC. The drug was approved by Canadian authorities in 2005 to alleviate pain associated with multiple sclerosis.[68][69][70]

Isomerism

Cannabidiol numbering
Cannabidiol numbering
7 double bond isomers and their 30 stereoisomers
Formal numbering Terpenoid numbering Number of stereoisomers Natural occurrence Convention on Psychotropic Substances Schedule Structure
Short name Chiral centers Full name Short name Chiral centers
Δ5-cannabidiol 1 and 3 2-(6-isopropenyl-3-methyl-5-cyclohexen-1-yl)-5-pentyl-1,3-benzenediol Δ4-cannabidiol 1 and 3 4 No unscheduled
Δ4-cannabidiol 1, 3 and 6 2-(6-isopropenyl-3-methyl-4-cyclohexen-1-yl)-5-pentyl-1,3-benzenediol Δ5-cannabidiol 1, 3 and 4 8 No unscheduled
Δ3-cannabidiol 1 and 6 2-(6-isopropenyl-3-methyl-3-cyclohexen-1-yl)-5-pentyl-1,3-benzenediol Δ6-cannabidiol 3 and 4 4 ? unscheduled
Δ3,7-cannabidiol 1 and 6 2-(6-isopropenyl-3-methylenecyclohex-1-yl)-5-pentyl-1,3-benzenediol Δ1,7-cannabidiol 3 and 4 4 No unscheduled
Δ2-cannabidiol 1 and 6 2-(6-isopropenyl-3-methyl-2-cyclohexen-1-yl)-5-pentyl-1,3-benzenediol Δ1-cannabidiol 3 and 4 4 Yes unscheduled
Δ1-cannabidiol 3 and 6 2-(6-isopropenyl-3-methyl-1-cyclohexen-1-yl)-5-pentyl-1,3-benzenediol Δ2-cannabidiol 1 and 4 4 No unscheduled
Δ6-cannabidiol 3 2-(6-isopropenyl-3-methyl-6-cyclohexen-1-yl)-5-pentyl-1,3-benzenediol Δ3-cannabidiol 1 2 No unscheduled

Based on: Nagaraja, Kodihalli Nanjappa, Synthesis of delta-3-cannabidiol and the derived rigid analogs, Arizona University 1987.

See also: Tetrahydrocannabinol#Isomerism, Abnormal cannabidiol.

Chemistry

Cannabidiol is insoluble in water but soluble in organic solvents, such as pentane. At room temperature it is a colorless crystalline solid.[71] In strongly basic medium and the presence of air it is oxidized to a quinone.[72] Under acidic conditions it cyclizes to THC.[73] The synthesis of cannabidiol has been accomplished by several research groups.[74][75][76]

Biosynthesis

Cannabis produces CBD-carboxylic acid through the same metabolic pathway as THC, until the last step, where CBDA synthase performs catalysis instead of THCA synthase.[77]

Natural occurrence

Cannabis indica may have a CBD:THC ratio 3–5 times that of Cannabis sativa.

Cannabidiol is not scheduled by the Convention on Psychotropic Substances.

Cannabidiol is a Schedule II drug in Canada.[78]

The legal status of cannabidiol in United States is unclear. In Schedule I[79][80] there is a broad category called "Tetrahydrocannabinols", although cannabidiol is not chemically a tetrahydrocannabinol. Cannabidiol has DEA statistical number 7372,[81].

References

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