Food effects on the formulation, dosing, and administration of cannabidiol (CBD) in humans: A systematic review of clinical studies

Cannabidiol (CBD), a non-psychotropic phytocannabinoid from the Cannabis plant, is increasingly being pursued as a treatment for differing ailments. The bioavailability and pharmacokinetics of CBD are not well understood, and proper dosing schemes have not been adequately developed for its clinical use. CBD is a lipophilic molecule and exhibits low water solubility, so its formulation expectedly impacts its gastrointestinal absorption and subsequent blood plasma concentrations. In this review article, the food effects on CBD pharmacokinetics were analyzed. Clinical trials focusing on the performance of Epidiolex, the FDA-approved CBD formulation, were found in several databases and systematically analyzed in terms of administration method, dosing schedules, and patient characteristics. 44 data sets from clinical trials were found to be useful in the quantitative analysis. Following the normalization of all the pharmacokinetic data sets by dose and patient weight, CBD exhibited a much greater bioavailability in fed patients. For Epidiolex, administration in the fed state led to lower interindividual variability and more predictable pharmacokinetics. Considering all the different oral formulations of CBD, further analysis points to the main excipient of oral CBD formulations (refined sesame seed oil) as a major contributor to the dose-dependent variations in CBD pharmacokinetics, especially affecting the fasted state. We discuss the implications of these results on the downstream pharmacodynamics of endocannabinoid receptor modulation and its broad physiological implications.

Automated summary

CBD is increasingly being sought after as a treatment for various ailments, but its bioavailability and pharmacokinetics are not well understood, and proper dosing schemes have not been adequately developed for clinical use. Research has shown that CBD has higher bioavailability when taken with food, and the administration of Epidiolex in the fed state leads to lower interindividual variability in pharmacokinetics. The main excipient in oral CBD formulations, refined sesame seed oil, is a major contributor to the dose-dependent variations in CBD pharmacokinetics.