How THC and CBD capsules move through the body in multiple sclerosis patients with pain | Research

The takeaway

In a substudy of 23 MS patients, oral THC and CBD capsules showed large individual variation in blood levels at steady state, but pharmacokinetic profiles were similar to those previously reported in healthy volunteers.

Neurologists prescribing cannabis-based medicines, pharmacologists, and MS treatment researchers

THC half-life 2.75 h, CBD half-life 4.95 h

What the researchers found

Among 23 MS patients taking oral THC (max 22.5 mg/day), CBD (max 45 mg/day), or combination capsules, pharmacokinetic parameters showed considerable individual variation but were comparable to previous reports from healthy controls. Simulated parameters for THC (5 mg): Cmax 1.21 ng/mL, Tmax 2.68 h, half-life 2.75 h. For CBD (10 mg): Cmax 2.67 ng/mL, Tmax 0.10 h, half-life 4.95 h.

Why it matters

Patient-level pharmacokinetic data for oral cannabis capsules in MS patients is scarce. Understanding how these medications behave in real patients, not just healthy volunteers, is important for dosing guidance.

The numbers in context

23 MS patients (17 female, mean age 52); max doses 22.5 mg THC and 45 mg CBD daily divided into 3 doses; THC half-life 2.75 h; CBD half-life 4.95 h; no effect found on pain or spasticity outcomes; considerable placebo response

How the study worked

Pharmacokinetic substudy within a randomized, double-blinded, placebo-controlled trial of 134 MS patients. Blood samples from 23 patients (4 THC, 6 CBD, 4 THC+CBD, 9 placebo) were analyzed using UHPLC-MS/MS, with computerized modeling to estimate PK parameters at probable steady state.

What this study cannot tell us

Very small substudy (23 patients, only 4 in THC group); no significant effect on pain or spasticity; substantial placebo response; maximum doses may be too low for therapeutic effect; PK parameters modeled rather than directly measured

How to read the evidence

Very small pharmacokinetic substudy within an RCT. Provides useful mechanistic data but limited by sample size.

When this study was published

2024 study

The bigger picture

The wide individual variation in how patients metabolize cannabis-based capsules highlights why standardized dosing may produce very different blood levels across patients, complicating clinical use.

Questions still open

Would higher doses produce therapeutic effects? Does the wide pharmacokinetic variation explain why some patients respond to cannabis-based medicines and others do not?

Common questions

How did oral cannabis capsules behave in MS patients?

Blood levels varied substantially between individuals, but the overall pharmacokinetic profiles were similar to what has been seen in healthy volunteers. THC peaked around 2.7 hours after dosing with a half-life of about 2.75 hours, while CBD peaked faster with a longer half-life of about 5 hours.

Did the cannabis capsules help with MS symptoms?

No significant effect was found on pain or spasticity measures, though there was a considerable placebo response. The maximum doses used (22.5 mg THC, 45 mg CBD per day) may have been too low for therapeutic effects, and the substudy was very small.

Read the original research

Pharmacokinetics and pharmacodynamics of cannabis-based medicine in a patient population included in a randomized, placebo-controlled, clinical trial.

Clinical and translational science, 17(1), e13685

View on PubMed ↗Publisher’s paper ↗

Citation

Hansen, Julie Schjødtz; Boix, Fernando; Hasselstrøm, Jørgen Bo; Sørensen, Lambert Kristiansen; Kjolby, Mads; Gustavsen, Stefan; Hansen, Rikke Middelhede; Petersen, Thor; Sellebjerg, Finn; Kasch, Helge; Rasmussen, Peter Vestergaard; Finnerup, Nanna Brix; Saedder, Eva Aggerholm; Svendsen, Kristina Bacher. (2024). Pharmacokinetics and pharmacodynamics of cannabis-based medicine in a patient population included in a randomized, placebo-controlled, clinical trial.. Clinical and translational science, 17(1), e13685. https://doi.org/10.1111/cts.13685