El uso Medicinal del Cannabis

La planta de cannabis se utilizó por miles de años en distintas culturas alrededor del mundo para distintos fines, entre ellos, la medicina. La planta posee distintos principios activos, denominados Cannabinoides. Estos Cannabinoides, en un número de más de 60, tienen distintas funciones, algunas descubiertas, y en su mayoría sin tener en claro aún cual es propósito. Estos Cannabinoides, por estar dentro de la planta se denominan Fitocannabinoides.

El cuerpo humano posee, en la superficie de muchos tipos de células de nuestro organismo, sitios específicos donde se acoplan estos  principios activos de la planta, los fitocannabinoides. Los más comunes, y de cuales se tiene mayor información son el THC, el CBD, CBG, CBN y algunos más. Los receptores de estos cannabinoides son denominados CB1 y CB2, encontrándose distribuidos por todo el cuerpo.El cuerpo humano también produce moléculas similares a las de la planta de cannabis, llamados endocannabinoides (endo=adentro). 

Los cannabinoides tienen muchas propiedades medicinales, y esto permite que algunas dolencias y patologías puedan ser tratadas con cannabis, tales como cáncer, epilepsia, glaucoma, esclerosis múltiple, fibromialgia, dolor crónico, etc.

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CANNABINOIDS AND EPILEPSY - FEBRERO 2018

Cannabinoids and Epilepsy

 

1. 
An interaction between warfarin and cannabidiol, a case report.

Grayson L(1), Vines B(1), Nichol K(2), Szaflarski JP(1); UAB CBD Program.

Author information: 
(1)University of Alabama at Birmingham, United States.
(2)Greenwich Biosciences, United States.

•An interaction between warfarin and cannabidiol is described•The mechanisms of
cannabidiol and warfarin metabolism are reviewed•Mechanism of the interaction is 
proposed•INR should be monitored in patients when cannabinoids are introduced.



2.
Cannabinoids in the Treatment of Epilepsy: Hard Evidence at Last?

Perucca E(1)(2).

Author information: 
(1)Division of Clinical and Experimental Pharmacology, Department of Internal
Medicine and Therapeutics, University of Pavia, Pavia, Italy.
(2)C. Mondino National Neurological Institute, Pavia, Italy.

The interest in cannabis-based products for the treatment of refractory epilepsy 
has skyrocketed in recent years. Marijuana and other cannabis products with high 
content in Δ(9) - tetrahydrocannabinol (THC), utilized primarily for recreational
purposes, are generally unsuitable for this indication, primarily because THC is 
associated with many undesired effects. Compared with THC, cannabidiol (CBD)
shows a better defined anticonvulsant profile in animal models and is largely
devoid of adverse psychoactive effects and abuse liability. Over the years, this 
has led to an increasing use of CBD-enriched extracts in seizure disorders,
particularly in children. Although improvement in seizure control and other
benefits on sleep and behavior have been often reported, interpretation of the
data is made difficult by the uncontrolled nature of these observations. Evidence
concerning the potential anti-seizure efficacy of cannabinoids reached a turning 
point in the last 12 months, with the completion of three high-quality
placebo-controlled adjunctive-therapy trials of a purified CBD product in
patients with Dravet syndrome and Lennox-Gastaut syndrome. In these studies, CBD 
was found to be superior to placebo in reducing the frequency of convulsive
(tonic-clonic, tonic, clonic, and atonic) seizures in patients with Dravet
syndrome, and the frequency of drop seizures in patients with Lennox-Gastaut
syndrome. For the first time, there is now class 1 evidence that adjunctive use
of CBD improves seizure control in patients with specific epilepsy syndromes.
Based on currently available information, however, it is unclear whether the
improved seizure control described in these trials was related to a direct action
of CBD, or was mediated by drug interactions with concomitant medications,
particularly a marked increased in plasma levels of N-desmethylclobazam, the
active metabolite of clobazam. Clarification of the relative contribution of CBD 
to improved seizure outcome requires re-assessment of trial data for the subgroup
of patients not comedicated with clobazam, or the conduction of further studies
controlling for the confounding effect of this interaction.

3.
Arvanil, olvanil, AM 1172 and LY 2183240 (various cannabinoid CB1 receptor
agonists) increase the threshold for maximal electroshock-induced seizures in
mice.

Tutka P(1), Wlaź A(2), Florek-Łuszczki M(3), Kołodziejczyk P(4),
Bartusik-Aebisher D(5), Łuszczki JJ(6).

Author information: 
(1)Department of Experimental and Clinical Pharmacology, Faculty of Medicine,
University of Rzeszów, Rzeszów, Poland; Centre for Innovative Research in Medical
and Natural Sciences', Faculty of Medicine, University of Rzeszów, Rzeszów,
Poland. Electronic address: Esta dirección de correo electrónico está siendo protegida contra los robots de spam. Necesita tener JavaScript habilitado para poder verlo..
(2)Department of Pathophysiology, Medical University of Lublin, Lublin, Poland.
(3)Department of Gerontology, Institute of Rural Health, Lublin, Poland.
(4)Department of Experimental and Clinical Pharmacology, Faculty of Medicine,
University of Rzeszów, Rzeszów, Poland; Centre for Innovative Research in Medical
and Natural Sciences', Faculty of Medicine, University of Rzeszów, Rzeszów,
Poland.
(5)Department of Experimental and Clinical Pharmacology, Faculty of Medicine,
University of Rzeszów, Rzeszów, Poland.
(6)Department of Pathophysiology, Medical University of Lublin, Lublin, Poland;
Isobolographic Analysis Laboratory, Institute of Rural Health, Lublin, Poland.

BACKGROUND: Recent evidence reveals therapeutic potential for cannabinoids to
reduce seizure frequency, severity and duration. Animal models are useful tools
to determine the potential antiseizure or antiepileptic effects of cannabinoids. 
The objective of this study was evaluation of the effect of arvanil, olvanil, AM 
1172 and LY 2183240, the compounds interacted with endocannabinoid and/or
endovanilloid systems, on convulsions in the commonly used model of convulsions
in mice.
METHODS: Arvanil and olvanil were injected intraperitoneally (ip) 30 min and AM
1172 and LY 2183240 were administered ip 60 min before the maximal electroshock
seizure threshold (MEST) test. The criterion for convulsant activity was tonic
hindlimb extension.
RESULTS: Arvanil, olvanil, AM 1172 and LY 2183240 dose-dependently increased the 
electroconvulsive threshold in mice. The TID20 (threshold increasing dose 20)
values for arvanil, olvanil, AM 1172 and LY 2183240 were 0.9, 2.18, 2.48 and
3.56 mg kg-1, respectively, and the TID50 (threshold increasing dose 50) values
were 1.88, 6.45, 6.29 and 10.04 mg kg-1, respectively.
CONCLUSION: This study identified anticonvulsant effects of arvanil, olvanil, AM 
1172 and LY 2183240. The order of the magnitude of the anticonvulsant effects of 
the examined compounds was following: arvanil > olvanil > AM 1172 > LY 2183240.

Copyright © 2017 Institute of Pharmacology, Polish Academy of Sciences. Published
by Elsevier Urban & Partner Sp. z o.o. All rights reserved.


4.
The therapeutic effects of Cannabis and cannabinoids: An update from the National
Academies of Sciences, Engineering and Medicine report.

Abrams DI(1).

Author information: 
(1)Hematology-Oncology, Zuckerberg San Francisco General Hospital, Professor of
Clinical Medicine, University of California San Francisco Ward 84, 995 Potrero
Avenue, San Francisco, CA 94110, USA. Electronic address: Esta dirección de correo electrónico está siendo protegida contra los robots de spam. Necesita tener JavaScript habilitado para poder verlo..

The National Academies of Sciences, Engineering and Medicine conducted a rapid
turn-around comprehensive review of recent medical literature on The Health
Effects of Cannabis and Cannabinoids. The 16-member committee adopted the key
features of a systematic review process, conducting an extensive search of
relevant databases and considered 10,000 recent abstracts to determine their
relevance. Primacy was given to recently published systematic reviews and primary
research that studied one of the committee's 11 prioritized health endpoints-
therapeutic effects; cancer incidence; cardiometabolic risk; respiratory disease;
immune function; injury and death; prenatal, perinatal and postnatal outcomes;
psychosocial outcomes; mental health; problem Cannabis use; and Cannabis use and 
abuse of other substances. The committee developed standard language to
categorize the weight of evidence regarding whether Cannabis or cannabinoids use 
for therapeutic purposes are an effective or ineffective treatment for the
prioritized health endpoints of interest. In the Therapeutics chapter reviewed
here, the report concluded that there was conclusive or substantial evidence that
Cannabis or cannabinoids are effective for the treatment of pain in adults;
chemotherapy-induced nausea and vomiting and spasticity associated with multiple 
sclerosis. Moderate evidence was found for secondary sleep disturbances. The
evidence supporting improvement in appetite, Tourette syndrome, anxiety,
posttraumatic stress disorder, cancer, irritable bowel syndrome, epilepsy and a
variety of neurodegenerative disorders was described as limited, insufficient or 
absent. A chapter of the NASEM report enumerated multiple barriers to conducting 
research on Cannabis in the US that may explain the paucity of positive
therapeutic benefits in the published literature to date.

Copyright © 2018 European Federation of Internal Medicine. Published by Elsevier 
B.V. All rights reserved.



5.
Practical considerations in medical cannabis administration and dosing.

MacCallum CA(1), Russo EB(2).

Author information: 
(1)Faculty of Medicine, University of British Columbia, BC, Canada. Electronic
address: Esta dirección de correo electrónico está siendo protegida contra los robots de spam. Necesita tener JavaScript habilitado para poder verlo..
(2)International Cannabis and Cannabinoids Institute, Prague, Czech Republic.
Electronic address: Esta dirección de correo electrónico está siendo protegida contra los robots de spam. Necesita tener JavaScript habilitado para poder verlo..

Cannabis has been employed medicinally throughout history, but its recent legal
prohibition, biochemical complexity and variability, quality control issues,
previous dearth of appropriately powered randomised controlled trials, and lack
of pertinent education have conspired to leave clinicians in the dark as to how
to advise patients pursuing such treatment. With the advent of pharmaceutical
cannabis-based medicines (Sativex/nabiximols and Epidiolex), and liberalisation
of access in certain nations, this ignorance of cannabis pharmacology and
therapeutics has become untenable. In this article, the authors endeavour to
present concise data on cannabis pharmacology related to tetrahydrocannabinol
(THC), cannabidiol (CBD) et al., methods of administration (smoking,
vaporisation, oral), and dosing recommendations. Adverse events of cannabis
medicine pertain primarily to THC, whose total daily dose-equivalent should
generally be limited to 30mg/day or less, preferably in conjunction with CBD, to 
avoid psychoactive sequelae and development of tolerance. CBD, in contrast to
THC, is less potent, and may require much higher doses for its adjunctive
benefits on pain, inflammation, and attenuation of THC-associated anxiety and
tachycardia. Dose initiation should commence at modest levels, and titration of
any cannabis preparation should be undertaken slowly over a period of as much as 
two weeks. Suggestions are offered on cannabis-drug interactions, patient
monitoring, and standards of care, while special cases for cannabis therapeutics 
are addressed: epilepsy, cancer palliation and primary treatment, chronic pain,
use in the elderly, Parkinson disease, paediatrics, with concomitant opioids, and
in relation to driving and hazardous activities.

Copyright © 2018. Published by Elsevier B.V.