Treatment with CBD

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The pharmacokinetics of CBD

The pharmaco-kinetics of CBD

What you eat influences how you react to CBD (the parmacokinetics of CBD). This clinical trial assessed the effect of high-fat and low-fat meals, whole milk, and alcohol on CBD blood levels. We discuss the following:

Pharmacokinetics vs pharmacodynamics of CBD

Pharmacokinetics is the process of what happens to a bioactive substance when it enters the body. It describes the fate of the substance, in this case CBD, from the moment of administration to the point of leaving the body. As such, pharmacokinetics of CBD is how the body influences the fate of CBD in the body. On the other hand, pharmacodynamics of CBD is how CBD influences the fate of the body when it takes CBD.

  • Pharmacokinetics: how the concentration of CBD changes in the blood over time
  • Pharmacodynamics: how the concentration of CBD influences its effect on the body

The pharmacokinetics of CBD is important to know to be able to assess proper dosing, benefits, and side effects of CBD. This is especially important, because certain foods might influence CBD pharmacokinetics.

Watch this 4:32 minute video by HEAT Inc: “Pharmacokinetics What the Body Does to a Drug”
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A randomized clinical trial to assess the pharmacokinetics of CBD

Scientist were interested in finding out how low-fat vs high-fat meal types, the consumption of whole milk, and drinking alcohol would influence the pharmacokinetics of CBD, in comparison to fasting. To find this out, they conducted a randomized, open label (participants knew what they were getting), crossover clinical study.

Study participants were 30 healthy volunteers, who fasted overnight, and then received a single dose of 750 mg Epidiolex (FDA approved purified CBD medication). Then they fasted again for another 4 hours, although they could drink some water. After fasting, they randomly received:

  1. CBD but no food
  2. High-fat breakfast: bacon or cheese with fried eggs, fried potatoes, two slices of bread with margarine, and one glass of milk. Then 30 minutes later they got CBD.
  3. Low-fat breakfast: a lot like the breakfast above, but instead of fried eggs and bacon they got marmalade and a bit of ham or chicken breast, and instead of milk they drank tea, coffee, or water. Then 30 minutes later they got CBD.
  4. They got CBD then drank two cups (500 mL) of milk.
  5. They got CBD then had an alcoholic drink.

Assessing CBD in the blood and adverse effects

Nurses draw some venous blood from the participants 16 times during the study period, and laboratory technicians analyzed the concentration of CBD in the blood. In addition, the scientists checked a number of vital signs and performed numerous physical examinations and evaluations to register any adverse events.

Even though almost all participants (90%) reported some adverse effects, these effects were only mild. Just two participants reported moderate adverse effects, and both were in the group where they drank alcohol after taking CBD. These side effects were:

  • Headache (especially if they had alcohol)
  • Sleepiness
  • Diarrhea
  • Some of those who drank alcohol felt dizzy, while none of those who did not have alcohol felt dizzy
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How food influences the pharmacokinetics of CBD

The researchers found that compared to those who fasted the whole time, those who had the high-fat meal had the highest blood concentrations of CBD, followed by the low-fat meal, whole milk, and (to a lesser extent) alcohol. The effect of the low-fat meal was similar to the effect of drinking milk. As such, having eaten and drunk anything before taking CBD increased blood CBD levels.

This showed that there was significant food effect for CBD and its metabolites, especially with high-fat meals.

Watch this 4:12 minute video by Ted-Ed: “How does your body process medicine?”

Reference

Crockett J, Critchley D, Tayo B, Berwaerts J, Morrison G. A phase 1, randomized, pharmacokinetic trial of the effect of different meal compositions, whole milk, and alcohol on cannabidiol exposure and safety in healthy subjects. Epilepsia. 2020 Feb;61(2):267-277.

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