TREATMENT OF SPASTICITY AND PAIN IN RENALLY-IMPAIRED PATIENTS
The present disclosure provides methods of treating multiple sclerosis associated spasticity or neurological pain in a patient with renal impairment by administering cannabinoids oromucosal spray.
1 . A method of treating spasticity in a patient with multiple sclerosis, and the patient has moderate or severe renal impairment, comprising orally administering to the patient a maximum of 6 sprays per day of an oromucosal spray comprising Δ-9-tetrahydrocannabinol (THC) and cannabidiol (CBD), wherein the THC and CBD are present at a weight ratio ranging from 0.5:1.5 to 1.5:0.5.
2 . A method of treating neuropathic pain in a patient with multiple sclerosis, and the patient has moderate or severe renal impairment, comprising orally administering to the patient a maximum of 6 sprays per day of an oromucosal spray comprising Δ-9-tetrahydrocannabinol (THC) and cannabidiol (CBD), wherein the THC and CBD are present at a weight ratio ranging from 0.5:1.5 to 1.5:0.5.
3 . A method of treating pain in a patient with advanced cancer, and the patient has moderate or severe renal impairment, comprising orally administering to the patient a maximum of 6 sprays per day of an oromucosal spray comprising Δ-9-tetrahydrocannabinol (THC) and cannabidiol (CBD), wherein the THC and CBD are present at a weight ratio ranging from 0.5:1.5 to 1.5:0.5.
4 . The method of claims any one of claims 1-3 , wherein the patient has severe renal impairment.
5 . The method of claim 4 , wherein the patient with severe renal impairment is administered 1 spray per day.
6 . The method of claim 4 , wherein the patient with severe renal impairment is administered 2 spray per day.
7 . The method of claim 4 , wherein the patient with severe renal impairment is administered 3 spray per day.
8 . The method of claim 4 , wherein the patient with severe renal impairment is administered 4 spray per day.
9 . The method of claim 4 , wherein the patient with severe renal impairment is administered 5 spray per day.
10 . The method of claim 4 , wherein the patient with severe renal impairment is administered 6 spray per day.
11 . The method of claims any one of claims 1-3 , wherein the patient has moderate renal impairment.
12 . The method of claim 11 , wherein the patient with moderate renal impairment is administered 1 spray per day.
13 . The method of claim 11 , wherein the patient with moderate renal impairment is administered 2 spray per day.
14 . The method of claim 11 , wherein the patient with moderate renal impairment is administered 3 spray per day.
15 . The method of claim 11 , wherein the patient with moderate renal impairment is administered 4 spray per day.
16 . The method of claim 11 , wherein the patient with moderate renal impairment is administered 5 spray per day.
17 . The method of claim 11 , wherein the patient with moderate renal impairment is administered 6 spray per day.
18 . A method of treating spasticity in patient with multiple sclerosis, and the patient has mild renal impairment, comprising orally administering to the patient a maximum of 12 sprays per day of an oromucosal spray comprising Δ-9-tetrahydrocannabinol (THC) and cannabidiol (CBD), wherein the THC and CBD are present at a weight ratio ranging from 0.5:1.5 to 1.5:0.5.
19 . A method of treating neuropathic pain in a patient with multiple sclerosis, and the patient has mild renal impairment, comprising orally administering to the patient a maximum of 12 sprays per day of an oromucosal spray comprising Δ-9-tetrahydrocannabinol (THC) and cannabidiol (CBD), wherein the THC and CBD are present at a weight ratio ranging from 0.5:1.5 to 1.5:0.5.
20 . A method of treating pain in a patient with advanced cancer, and the patient has mild renal impairment, comprising orally administering to the patient a maximum of 12 sprays per day of an oromucosal spray comprising Δ-9-tetrahydrocannabinol (THC) and cannabidiol (CBD), wherein the THC and CBD are present at a weight ratio ranging from 0.5:1.5 to 1.5:0.5.
21 . The method of any one of claims 18-20 , wherein the patient with mild renal impairment is administered 1 spray per day.
22 . The method of any one of claims 18-20 , wherein the patient with mild renal impairment is administered 2 sprays per day.
23 . The method of any one of claims 18-20 , wherein the patient with mild renal impairment is administered 3 sprays per day.
24 . The method of any one of claims 18-20 , wherein the patient with mild renal impairment is administered 4 sprays per day.
25 . The method of any one of claims 18-20 , wherein the patient with mild renal impairment is administered 5 sprays per day.
26 . The method of any one of claims 18-20 , wherein the patient with mild renal impairment is administered 6 sprays per day.
27 . The method of any one of claims 18-20 , wherein the patient with mild renal impairment is administered 7 sprays per day.
28 . The method of any one of claims 18-20 , wherein the patient with mild renal impairment is administered 8 sprays per day.
29 . The method of any one of claims 18-20 , wherein the patient with mild renal impairment is administered 9 sprays per day.
30 . The method of any one of claims 18-20 , wherein the patient with mild renal impairment is administered 10 sprays per day.
31 . The method of any one of claims 18-20 , wherein the patient with mild renal impairment is administered 11 sprays per day.
32 . The method of any one of claims 18-20 , wherein the patient with mild renal impairment is administered 12 sprays per day.
33 . The method of any one of the preceding claims , wherein the oromucosal spray delivers about 50 μL to 200 μL per spray.
34 . The method of any one of the preceding claims , wherein the oromucosal spray delivers about 100 μL per spray.
35 . The method of any one of the preceding claims , wherein the patient is administered about 2 to about 3 mg of THC and about 2 to about 3 mg of CBD per spray.
36 . The method of any one of the preceding claims , wherein the patient is administered about 2.25 to about 2.75 mg of THC and about 2.25 to about 2.75 mg of CBD per spray.
37 . The method of any one of the preceding claims , wherein the patient is administered about 2.7 mg THC and about 2.5 mg CBD per spray.
38 . The method of any one of the preceding claims , wherein the oromucosal spray comprises from 20-30 mg/mL THC and from 20-30 mg/mL CBD.
39 . The method of any one of the preceding claims , wherein the oromucosal spray comprises 22.5 to 27.5 mg/mL THC and from 22.5 to 27.5 mg/mL CBD.
40 . The method of any one of the preceding claims , wherein the oromucosal comprises about 27 mg/mL THC and about 25 mg/mL CBD.
41 . The method of any one of the preceding claims , wherein the THC and CBD are present in a weight ratio of from about 0.9:1.1 to about 1.1:0.9.
42 . The method of any one of the preceding claims , wherein the THC and CBD are present in a weight ratio of about 1.1:0.9.
43 . The method of any one of the preceding claims , wherein the oromucosal spray comprises ethanol.
44 . The method of any one of the preceding claims , wherein the oromucosal spray comprises propylene glycol.
45 . The method of any one of the preceding claims , wherein the oromucosal spray comprises peppermint oil.
46 . A method of managing spasticity in a renally impaired patient with multiple sclerosis, neuropathic pain in a renally impaired patient with multiple sclerosis, or pain in a renally impaired patient with advanced cancer, comprising:
(a) determining the patient's renal impairment status;
(b) (i) if the patient has moderate or severe renal impairment, administering a maximum of 6 sprays per day of an oromucosal comprising Δ-9-tetrahydrocannabinol (THC) and cannabidiol (CBD); or
(ii) if the patient has mild renal impairment, administering a maximum of 12 sprays per day of an oromucosal comprising Δ-9-tetrahydrocannabinol (THC) and cannabidiol (CBD),
wherein the THC and CBD are present at a weight ratio ranging from 0.5:1.5 to 1.5:0.5.
47 . The method of claim 46 , wherein the patient with mild renal impairment is administered about 2.5 mg to about 32.4 mg of THC and about 2.5 mg to about 32.4 mg of CBD per day.
48 . The method of claim 46 , wherein the patient with moderate renal impairment is administered about 2.5 mg to about 16.2 mg of THC and about 2.5 mg to about 16.2 mg of CBD per day.
49 . The method of claim 46 , wherein the patient with severe renal impairment is administered about 2.5 mg to about 16.2 mg of THC and about 2.5 mg to about 16.2 mg of CBD per day.
50 . The method of any one of claim 1, 3-18, or 21-49 , wherein the patient has moderate to severe spasticity.
51 . The method of any one of claim 1, 4-18, or 21-50 , wherein the patient is administered the oromucosal spray in combination with one or more anti-spasticity medications.
52 . The method of claim 51 , wherein the one or more anti-spasticity medications is baclofen, tizanidine, dantrolene sodium, diazepam, clonazepam, and gabapentin.
53 . The method of any one of claim 3-18 or 20-52 , wherein the patient with advanced cancer has moderate to severe pain.
54 . The method of claim 53 , wherein patient experiences moderate to severe pain during the highest tolerated of a strong opioid therapy.
55 . The method of claim 54 , wherein the strong opioid is tramadol, buprenorphine, methadone, diamorphine, fentanyl, hydromorphone, morphine, oxycodone, or pethidine.
56 . The method of any one of the preceding claims , wherein the patient is an adult.
57 . The method of claim 56 , wherein the patient is 18-65 years old.
58 . The method of anyone of the preceding claims , wherein the oromucosal spray comprises a botanical drug substance comprising THC and CBD.
59 . The method of any one of the preceding claims , wherein the oromucosal spray further comprises one or more cannabinoids in addition to THC and CBD.
60 . The method of claim 59 , wherein the one or more cannabinoids are cannabidiolic acid (CBDA), cannabidivarin (CBDV), cannabidiol-C1 (CBD-C1), cannabidiol-C4 (CBD-C4), tetrahydrocannabivarin (THCV), cannabigerol (CBG), hydroxy cannabidiol (OH-CBD), butyl-cannabidiol (CBD-C4), cannabicyclol (CBL), or a combination thereof.
61 . The method of claim any one of the preceding claims , wherein the oromucosal spray further comprises one or more terpenes.
62 . The method of any one of the preceding claims , wherein the oromucosal spray further comprises one or more sesquiterpenes.
63 . The method of claim 61 or 62 , wherein the one or more terpenes or sesquiterpenes are beta-farnesene, selina-3,7(11)-diene, guaia-3,9-diene, trans-caryophyllene, alpha-caryophyllene, trans-nerolidol, myrcene, trans-phytol, squalene, alpha-tocopherol, or a combination thereof.
64 . The method of claim of any one of the preceding claims , wherein the oromucosal spray further comprise one or more sterols.
65 . The method of claim 64 , wherein the one or more sterols are beta-sitosterol, beta-amyrin, campesterol, lupeol, or combinations thereof.
66 . The method of claim 46 , wherein the patient with mild renal impairment is administered 1, 2, 3, 4, 5 or 6 sprays per day of the oromucosal spray.
67 . The method of claim 46 , wherein the patient with moderate renal impairment is administered 1, 2, 3, 4, 5 or 6 sprays per day of the oromucosal spray.
68 . The method of claim 46 , wherein the patient with severe renal impairment is administered 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, or 12 sprays per day of the oromucosal spray.
69 . The method of any one of claims 1-10, 33-46, and 49-68 , wherein the patient with several renal impairment has end stage renal disease (ESRD).
70 . The method of claim 69 , wherein the patient with ESRD does not receive dialysis.