Methods and compositions for treating cannabis use disorder and mitigating cannabinoid withdrawal
The present invention provides methods of treating cannabis withdrawal syndrome and other cannabis related conditions, including cannabis use disorder, in a subject, comprising administering to the subject in need thereof an effective amount of a cannabinoid or an effective amount of a cannabinoid and an effective amount of a second active agent, such as gabapentin or a gabapentin analog.
1. A method of treating cannabis withdrawal syndrome, comprising administering to a patient in need thereof about 6 mg of nabilone and a therapeutically effective amount of gabapentin on a daily basis, wherein the amount of gabapentin administered is about 100-800 mg per day.
2. The method of claim 1 , wherein the amount of gabapentin administered is about 300-600 mg per day.
3. The method of claim 1 , wherein the treatment results in a reduction in cannabis withdrawal syndrome symptoms as measured by evening cortisol levels, sleep, weight loss, standing heart rate, craving or withdrawal scoring based on the results of one or more questionnaires administered to the subject, withdrawal symptoms based on observations of a health care provider, and combinations thereof.
4. The method of claim 1 , wherein the reduction in symptoms occurs within a time frame following administration of nabilone and gabapentin selected from the group consisting of about 36 hours, about 24 hours, about 18 hours, about 12 hours, about 10 hours, about 8 hours, about 6 hours, and about 4 hours or less.
5. The method of claim 1 , wherein the daily dose is administered for at least 3 days.
6. The method of claim 1 , wherein the daily dose of nabilone and gabapentin is administered twice daily.
7. The method of claim 1 , wherein the daily dose of nabilone and gabapentin is administered once daily.
8. The method of claim 1 , wherein the daily dose of nabilone is reduced by at least 15% every 3 or 4 days.
9. The method of claim 1 , wherein the daily doses of nabilone and gabapentin are adjusted according to the following schedule:
Dose
Nabilone (mg)
Gabapentin (mg)
1
6
300
2
5
600
3
4
900
4
3
900
5
2
900
6
1
900
7
0.5
1200
8
0.25
900
9
0
900
10
0
900 or 600
11
0
300
wherein each dose is administered for one or more days.
10. The method of claim 1 , wherein the treatment results in a reduction in cannabis withdrawal syndrome symptoms as measured by a CWS score, wherein the daily dose of nabilone and/or gabapentin is adjusted in a manner that maintains a CWS score to within about 150% of a CWS score that is achieved about 24 hrs after the first dose of nabilone and gabapentin is administered.
11. The method of claim 1 , wherein the treatment results in a reduction in cannabis withdrawal syndrome symptoms as measured by evening cortisol levels, wherein the daily dose of nabilone and/or gabapentin is adjusted in a manner that limits any increase in evening cortisol levels to no more than 120% of cortisol levels that are achieved at or within about 24 hrs after the first dose of nabilone and gabapentin is administered.
12. The method of claim 1 , wherein the treatment results in a reduction in cannabis withdrawal syndrome symptoms as measured by standing heart rate, wherein the daily dose of nabilone and/or gabapentin is adjusted in a manner that limits any increase in standing heart rate to no more than 5% of the standing heart rate measured about 24 hrs after the first dose of nabilone and gabapentin is administered.
13. The method of claim 1 , wherein the treatment results in a reduction in cannabis withdrawal syndrome symptoms as measured by appetite and body weight, wherein the daily dose of nabilone and/or gabapentin is adjusted in a manner that limits any weight loss to no more than 1 kg (2.2 lbs) or less of the subject's weight measured about 24 hrs after the first dose of nabilone and gabapentin is administered.
14. The method of claim 1 , wherein the reduction in cannabis withdrawal syndrome symptoms comprises a reduction in craving sensations.
15. The method of claim 1 , wherein the reduction in cannabis withdrawal syndrome symptoms comprises a reduction in sleep disturbance and/or an improvement in sleep quality.
16. The method of claim 1 , wherein the treatment results in a reduction in cannabis withdrawal syndrome symptoms as measured by one or more assessment tool selected from the group consisting of WBS score, WBS 6 question subscale score, CWS 6 question subscale score, the Craving subscale, PGI-S, PGI bothersomeness or CGI, wherein the daily dose of nabilone and gabapentin is adjusted in a manner that maintains a withdrawal score on the selected assessment tool to within 150% of the score that is achieved about 24 hours after the first dose of nabilone and gabapentin is administered.
17. The method of claim 1 , wherein the treatment results in a reduction in cannabis withdrawal syndrome symptoms as measured by one or more assessment tool selected from the group consisting of WBS score, WBS 6 question subscale score, CWS 6 question subscale score, the Craving subscale, PGI-S scale, PGI bothersomeness scale or CGI scale, wherein the daily dose of nabilone and gabapentin is adjusted in a manner that maintains a withdrawal score on the selected assessment tool as selective from the group consisting of, a score of 40 or less on the CWS, a score of 25 or less on the CWS 6 question subscale, a score of 20 or less on the WBS, a score of 4 or less on WBS 6 question subscale, a score of 2 or less on the Craving subscale, a score of 1.5 or less on the PGI-S scale, a score of 1.0 or less on the PGI bothersomeness scale or a score of 1.5 or less on the CGI.
18. A method of treating cannabis withdrawal syndrome, comprising administering on a daily basis to a patient in need thereof nabilone in an amount sufficient to achieve a mean AUC 0-24 range of 23100-47250 pg-hr/mL and gabapentin in an amount sufficient to achieve a mean AUC 0-24 range of 17500-97875 pg-hr/mL.
19. The method of claim 18 , wherein nabilone is administered in an amount sufficient on a daily basis to achieve a mean AUC 0-24 range of 26400-43750 pg-hr/mL and gabapentin is administered in an amount sufficient on a daily basis to achieve a mean AUC 0-24 range of 20000-90625 pg-hr/mL.
20. The method of claim 18 , wherein the amount of gabapentin administered is about 200-750 mg per day.
21. The method of claim 18 , wherein the amount of nabilone administered is 3-7 mg per day.
22. A kit comprising:
a. a plurality of daily doses of nabilone;
b. a plurality of daily doses of gabapentin; and
c. optionally a dosing schedule for administering the nabilone and gabapentin,
wherein the kit contains daily doses of nabilone and gabapentin sufficient to provide daily doses for a period of time selected from the group consisting of 30 to 60 days, 21 to 42 days, and about 4 weeks or 1 month.
23. The kit of claim 22 , comprising initial daily doses of nabilone of 6 mg.
24. The kit of claim 22 , comprising initial daily doses of gabapentin of 300-600 mg.
25. The kit of claim 22 , wherein the plurality of daily doses of nabilone comprises daily doses of nabilone selected from 0.25 mg, 0.5 mg, 1 mg, 1.5 mg, 2 mg, 2.5 mg, 3 mg, 3.5 mg, 4 mg, 4.5 mg, 5 mg, 5.5 mg, 6 mg and combinations thereof.
26. The kit of claim 22 , wherein the plurality of daily doses of gabapentin comprises daily doses of gabapentin selected from 200 mg, 300 mg, 400 mg, 500 mg, 600 mg, 700 mg, 800 mg, 900 mg 1000 mg, 1100 mg, 1200 mg, 1300 mg, 1400 mg, 1500 mg and combinations thereof.
27. The kit of claim 22 , wherein the daily doses for one week are presented on a solid substrate.
28. The kit of claim 27 , wherein the solid substrate is a blister pack.
29. The kit of claim 22 , further comprising one or more cannabis withdrawal syndrome symptom questionnaires.
30. The kit of claim 22 , wherein the kit contains daily doses of nabilone and gabapentin sufficient to provide daily doses for 30 to 60 days.
31. The kit of claim 22 , wherein the kit contains daily doses of nabilone and gabapentin sufficient to provide daily doses for 21 to 42 days.
32. The kit of claim 22 , wherein the kit contains daily doses sufficient to provide daily doses for about 4 weeks or 1 month.
33. The method of claim 1 , wherein the amount of gabapentin administered is about 200 to 300 mg per day.
34. A method of treating cannabis withdrawal syndrome, comprising administering to a patient in need thereof therapeutically effective daily doses of nabilone and gabapentin, wherein the nabilone daily dose is from 5 to 7 mg per day and the gabapentin daily dose is from 50 to 700 mg per day and wherein the daily doses are administered for a period of time of between two to seven days.
35. The method of claim 34 , wherein subsequent daily doses of nabilone and gabapentin are administered for a second period of time, wherein the nabilone daily dose is from 4 to 6 mg per day and the gabapentin daily dose is from 300 to 1000 mg per day and wherein the daily doses are administered for a second period of time of between two to seven days.
36. The method of claim 35 , wherein subsequent daily doses of nabilone and gabapentin are administered for a third period of time, wherein the nabilone daily dose is from 3 to 5 mg per day and the gabapentin daily dose is from 300 to 1200 mg per day and wherein the daily doses are administered for a third period of time of between two to seven days.
37. The method of claim 36 , wherein subsequent daily doses of nabilone and gabapentin are administered for a fourth period of time, wherein the nabilone daily dose is from 2 to 4 mg per day and the gabapentin daily dose is from 300 to 1200 mg per day and wherein the daily doses are administered for a fourth period of time of between two to seven days.
38. The method of claim 37 , wherein subsequent doses of nabilone and gabapentin are administered for a fifth period of time, wherein the nabilone daily dose is from 1 to 3 mg per day and the gabapentin daily dose is from 300 to 1200 mg per day and wherein the daily doses are administered for a fifth period of time of between two to seven days.
39. The method of claim 38 , wherein subsequent doses of nabilone and gabapentin are administered for a sixth period of time, wherein the nabilone daily dose is from 0.5 to 2 mg per day and the gabapentin daily dose is from 300 to 1200 mg per day and wherein the daily doses are administered for a sixth period of time of between two to seven days.
40. The method of claim 39 , wherein subsequent doses of nabilone and gabapentin are administered for a seventh period of time, wherein the nabilone daily dose is from 0.25 to 1 mg per day and the gabapentin daily dose is from 300 to 1000 mg per day and wherein the daily doses are administered for a seventh period of time of between two to seven days.
41. The method of claim 40 , wherein subsequent doses of nabilone and gabapentin are administered for a eighth period of time, wherein the nabilone daily dose is from 0.0 to 0.5 mg per day and the gabapentin daily dose is from 300 to 1000 mg per day and wherein the daily doses are administered for a eighth period of time of between two to seven days.