Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/658—Medicinal preparations containing organic active ingredients o-phenolic cannabinoids, e.g. cannabidiol, cannabigerolic acid, cannabichromene or tetrahydrocannabinol
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/335—Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin
  • A61K31/35—Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin having six-membered rings with one oxygen as the only ring hetero atom
  • A61K31/352—Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin having six-membered rings with one oxygen as the only ring hetero atom condensed with carbocyclic rings, e.g. methantheline 
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/045—Hydroxy compounds, e.g. alcohols; Salts thereof, e.g. alcoholates
  • A61K31/05—Phenols
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K36/00—Medicinal preparations of undetermined constitution containing material from algae, lichens, fungi or plants, or derivatives thereof, e.g. traditional herbal medicines
  • A61K36/18—Magnoliophyta (angiosperms)
  • A61K36/185—Magnoliopsida (dicotyledons)
  • A61K36/348—Cannabaceae
  • A61K36/3482—Cannabis
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
  • A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
  • A61K47/44—Oils, fats or waxes according to two or more groups of A61K47/02-A61K47/42; Natural or modified natural oils, fats or waxes, e.g. castor oil, polyethoxylated castor oil, montan wax, lignite, shellac, rosin, beeswax or lanolin
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/0012—Galenical forms characterised by the site of application
  • A61K9/0053—Mouth and digestive tract, i.e. intraoral and peroral administration
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/0012—Galenical forms characterised by the site of application
  • A61K9/007—Pulmonary tract; Aromatherapy
  • A61K9/0073—Sprays or powders for inhalation; Aerolised or nebulised preparations generated by other means than thermal energy
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P25/00—Drugs for disorders of the nervous system
  • A61P25/08—Antiepileptics; Anticonvulsants
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K2121/00—Preparations for use in therapy
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K2300/00—Mixtures or combinations of active ingredients, wherein at least one active ingredient is fully defined in groups A61K31/00 - A61K41/00

Definitions

• the present disclosure relates to novel compositions of matter, including oral solutions, comprising cannabinoids THC and CBD.
• the present disclosure further relates to novel methods of use of compositions comprising THC and CBD.
• the primary active ingredients in cannabis, THC and CBD, are 21 -carbon
• terpenophenolic compounds These two compounds were isolated from the Cannabis plant approximately 60 years ago, and their structures and chemical properties have been well characterized (Gaoni and Mechoulam, 1964). There have been extensive reviews on the pharmacology and potential therapeutic potential of THC and CBD (Kreitzer and Stella, 2009; Pertwee et al., 2010).
• THC and CBD are generally thought to exert their actions via the endocannabinoid system, although CBD's mechanism of action may include receptors and pathways outside this system (extensively reviewed by Pertwee et al, 2010).
• the primary cannabinoid receptors include CBl, with a neuromodulatory role and CB2, with an immunomodulatory role (GW Pharma, 2015).
• CB 1 receptors Within the brain, the distribution of CB 1 receptors is heterogeneous, accounting for several well- documented pharmacological properties of CBl receptor agonists, such as phytocannabinoids.
• CBD while considered part of the cannabinoid family due to its chemical structure, does not appear to have a great affinity for either of the cannabinoid receptors (Pacher et al, 2006).
• the lack of interaction with the CBl receptor is thought to explain the well-established safety profile of CBD and lack of psychotropic effect relative to THC.
• compositions of matter comprising the cannabinoids CBD and THC in certain relative ratios may have particular utility, for instance in the treatment or prevention of certain diseases, conditions, or symptoms.
• the composition comprises the cannabinoids CBD and THC.
• the cannabinoids CBD and THC are present in specific relative ratios.
• the relative ratio of CBD to THC in the novel composition is at least 20: 1 CBD:THC, preferably 25: 1 CBD:THC, more preferably 30: 1 CBD:THC, even more preferably 40: 1 CBD: THC, or most preferably 50: 1 CBD: THC.
• the cannabinoids CBD and THC may be present in a medicament or pharmaceutical composition.
• the medicament or pharmaceutical preparation comprises the cannabinoids CBD and THC.
• the cannabinoids CBD and THC are present in certain relative ratios.
• the relative ratio of CBD to THC in the novel composition is at least 20: 1 CBD:THC, preferably 25: 1 CBD: THC, more preferably 30: 1 CBD: THC, even more preferably 40: 1 CBD: THC, or most preferably 50: 1 CBD:THC.
• the medicament or pharmaceutical composition may further comprise other excipients, carriers, stabilizers, and the like.
• the medicament or pharmaceutical composition further comprises one or more excipients.
• the one or more excipients comprises a carrier substance.
• the carrier substance may be an oil or lipid based substance.
• the carrier may be grapeseed oil, coconut oil, medium chain triglycerides (MCT), sesame oil, or similar substance.
• the cannabinoids CBD and THC are formulated in carrier to specific concentrations, and with certain relative ratios.
• the cannabinoids are formulated to a concentration of lOOmg/mL of CBD and 2mg/mL THC in carrier substance.
• the carrier is grapeseed oil.
• the disease, condition, or symptom may include, but is not limited to: seizure disorders such as epilepsy, treatment-resistant epilepsy, Dravet Syndrome, Lennox-Gastaut Syndrome; spasticity disorders such as multiple sclerosis; neurodegenerative disorders such as Parkinson's Disease, Alzheimer's Disease, Huntington's Disease or amyloid lateral sclerosis (ALS); proliferative diseases such as cancer; dermatological conditions such as psoriasis; mental health conditions such as post-traumatic stress disorder (PTSD), insomnia, anxiety, depression, or schizophrenia; respiratory diseases such as chronic obstructive pulmonary disorder (COPD).
• seizure disorders such as epilepsy, treatment-resistant epilepsy, Dravet Syndrome, Lennox-Gastaut Syndrome
• spasticity disorders such as multiple sclerosis
• neurodegenerative disorders such as Parkinson's Disease, Alzheimer's Disease, Huntington's Disease or amyloid lateral sclerosis (ALS); proliferative diseases such as cancer
• dermatological conditions such as ps
• CBD cannabidiol
• THC delta-9-tetrahydrocannabinol
• CBD cannabidiol
• THC delta-9-tetrahydrocannabinol
• the CBD: THC ratio is from about 45 : 1 to about 55: 1. In some embodiments of any of the aspects, the CBD:THC ratio is about 50: 1. In some
• the CBD: THC ratio is 50: 1.
• the CBD and THC are formulated in grape seed oil. In some embodiments of any of the aspects, the CBD and THC are obtained from
• the CBD and THC are provided at concentrations of about 100 mg/mL and 2 mg/mL respectively.
• the composition further comprises one or more pharmaceutically acceptable carriers or excipients.
• described herein is a method of treating pediatric epilepsy in a subject in need thereof, the method comprising administering a composition described herein to the subject.
• the composition is administered twice daily.
• the composition is administered orally.
• the composition is administered by inhalation.
• the subject is administered the composition of any of claims 1-8 at a dosage of from about 1 mg/kg/day of CBD to about 18 mg/kg/day of CBD. In some embodiments of any of the aspects, the subject is administered the composition of any of claims 1-8 at a dosage of from about 5 mg/kg/day of CBD to about 18 mg/kg/day of CBD. In some embodiments of any of the aspects, the subject is administered the composition of any of claims 1-8 at a dosage of from about 7 mg/kg/day of CBD to about 16 mg/kg/day of CBD.
• the subject is administered the composition of any of claims 1-8 at a dosage of from 2 mg/kg/day of CBD to 16 mg/kg/day of CBD. In some embodiments of any of the aspects, the subject is administered the composition of any of claims 1-8 at an increasing dosage of the composition, wherein the increase is about 2 mg/kg/day of CBD every 7 days.
• the maximal dose is from about 13 mg/kg/day of CBD to about 14.5 mg/kg/day of CBD. In some embodiments of any of the aspects, the maximal dose is about 16 mg/kg/day of CBD.
• the subject is administered at least one further concomitant antiepileptic drug (AED).
• AED antiepileptic drug
• the treatment reduces the frequency or severity of seizures.
• the term 'cannabis' means a genus of flowering plants that includes three putative species, Cannabis sativa, Cannabis indica, and Cannabis ruderalis.
• the term cannabis may also refer to plant material derived or extracted from the cannabis plant, for instance the leaves, stem, seeds, flowering bodies, or other portions of the plant.
• 'cannabinoid' or 'cannabinoids' means a class of chemical compounds which include the phytocannabinoids (oxygen -containing C21 aromatic hydrocarbon compounds found in the cannabis plant), and chemical compounds which mimic the actions of phytocannabinoids or have a similar structure (e.g. endocannabinoids, found in the nervous and immune systems of animals and that activate cannabinoid receptors).
• Phytocannabinoids are known to occur in significant quantities in the cannabis plant, and may include, but are not limited to tetrahydrocannabinol (THC), cannabidiol (CBD), cannabinol (CBN), and cannabigerol (CBG).
• the term 'THC means tetrahydrocannabinol and may include different isoforms and variants, such as delta-9 -Tetrahydrocannabinol (A9-THC) and delta-8-tetrahydrocannabinol ( ⁇ 8- THC).
• the term 'CBD' means cannabidiol, a cannabinoid often found in cannabis, and having a CAS registry number 13956-29-1. Cannabidiol is known to have many beneficial medicinal qualities, as described elsewhere in this application. In some embodiments, the cannabinoid has the structure of Formula I.
• the term 'therapeutically effective amount' means a dosage of sufficient quantity to exert a therapeutic effect, to alleviate a symptom, to prevent the onset or progression of a disease, or to cause effective treatment of a disease.
• a therapeutically effective amount may be determined, for instance, by a dose escalation study, or dose titration.
• the term 'medicament' means a pharmaceutical composition comprising active and inactive ingredients in sufficient quantities to exert a medically beneficial effect.
• a medicament may comprise a therapeutically effective amount of active ingredients.
• a medicament may further comprise additional excipients, additives, stabilizers, carriers, or other compounds to improve the formulation, stability, bioavailability, pharmacokinetics, pharmacodynamics, or other properties of the medicament.
• the medicament of the present disclosure comprises therapeutically effective amounts of the cannabinoids THC and CBD in certain relative ratios.
• CBD is the predominant cannabinoid, with relatively lower amounts of THC.
• the CBD to THC ratio is greater than 20 to 1.
• the CBD to THC ratio is greater than 25 to 1.
• the CBD to THC ratio is greater than 30 to 1. In other embodiments, the CBD to THC ratio is greater than 40 to 1. In other embodiments, the CBD to THC ratio is greater than 50 to 1.
• the medicament of the present disclosure comprises a nonpolar carrier oil such as grapeseed oil, coconut oil, medium chain triglycerides (MCT), sesame oil, or another carrier oil. In certain embodiments of the disclosure, the carrier oil is grapeseed oil. In certain embodiments of the disclosure, the medicament of the present disclosure comprises CBD in a concentration of lOOmg/mL and THC in a concentration of 2mg/mL in grapeseed oil.
• Pharmaceutically acceptable carriers and diluents include saline, aqueous buffer solutions, solvents and/or dispersion media.
• the use of such carriers and diluents is well known in the art.
• Some non-limiting examples of materials which can serve as pharmaceutically-acceptable carriers include: (1) sugars, such as lactose, glucose and sucrose; (2) starches, such as corn starch and potato starch; (3) cellulose, and its derivatives, such as sodium carboxymethyl cellulose, methylcellulose, ethyl cellulose, microcrystalline cellulose and cellulose acetate; (4) powdered tragacanth; (5) malt; (6) gelatin; (7) lubricating agents, such as magnesium stearate, sodium lauryl sulfate and talc; (8) excipients, such as cocoa butter and suppository waxes; (9) oils, such as peanut oil, cottonseed oil, safflower oil, sesame oil, olive oil, corn oil and soybean oil;
• wetting agents, coloring agents, release agents, coating agents, sweetening agents, flavoring agents, perfuming agents, preservative and antioxidants can also be present in the formulation.
• excipient e.g., pharmaceutically acceptable carrier or the like are used interchangeably herein.
• CBD cannabidiol
• THC delta-9-tetrahydrocannabinol
• the ratio of CBD:THC can be, e.g., from about 40: 1 to about 60: 1, from about 45 : 1 to about 55: 1, from about 48: 1 to about 52: 1, from 40: 1 to 60: 1, from 45 : 1 to 55 : 1, from 48: 1 to 52: 1, about 50: 1, or 50: 1.
• compositions described herein can be pharmaceutical compositions comprising CBD and THC in the specified ratios and further comprising one or more pharmaceutically acceptable carriers or excipients.
• Compositions comprising the ratios of CBD and THC described herein provide the surprising effect of reducing seizure frequency and/or severity in pediatric epileptic patients with a low incidence of side effects, e.g., increases in blood pressure, dizziness, , irritability, ataxia, blurred vision, diplopia vision, rashes, motor incoordination / falls, gastrointestinal (anorexia, loss of appetite, nausea, vomiting, and weight loss), aggression, hostility, irritability, anger, and homicidal ideation / threats, which are observed with prior art formulations.
• compositions described herein comprise CBD and THC, which can be obtained from cannabis, e.g., Cannabis sativa L.
• the CBD and THC can be isolated and/or extracted from cannabis by methods known in the art and formulated by any method known in the art.
• the CBD and THC are formulated in oil, e.g., a plant/vegetable oil, grape seed oil.
• compositions described herein can be plant extracts, e.g., whole plant extracts. In some embodiments of any of the aspects, the compositions described herein can be purified compositions.
• the composition described herein comprises CBD and THC at concentrations of from about 80 mg/mL to about 120 mg/mL and from about 1 mg/mL to about 4 mg/mL, respectively; from about 90 mg/mL to about 110 mg/mL and from about 1.5 mg/mL to about 3 mg/mL, respectively; from about 96 mg/mL to about 104 mg/mL and from about 1.75 mg/mL to about 2.5 mg/mL, respectively; from 80 mg/mL to 120 mg/mL and from 1 mg/mL to 4 mg/mL, respectively; from 90 mg/mL to 110 mg/mL and from 1.5 mg/mL to 3 mg/mL, respectively; from 96 mg/mL to 104 mg/mL and from 1.75 mg/mL to 2.5 mg/mL, respectively; about 100 mg/mL and about 2 mg/mL respectively; or 100 mg/mL and 2 mg/mL respectively.
• active pharmaceutical ingredients may be found in concentrations that vary from the labelled assay specification.
• the active ingredients in the medicaments of the present disclosure may thus be expected to vary between at least 80% to 120% of the specified concentration.
• the active ingredients in the medicaments of the present disclosure may be expected to vary between at least 90% to 110% of the specified concentration.
• described herein is a method of treating pediatric epilepsy in a subject in need thereof, the method comprising administering a composition as described herein to the subject, e.g., a composition comprising cannabidiol (CBD) and delta-9- tetrahydrocannabinol (THC) at a ratio of from about 40: 1 to about 60: 1.
• CBD cannabidiol
• THC delta-9- tetrahydrocannabinol
• the methods described herein reduce the frequency and/or severity of seizures.
• the methods described herein comprise administering an amount and/or number of doses of the described compositions which are effective to reduce the frequency and/or severity of seizures with a low incidence of side effects.
• the methods described herein relate to treating a subject having or diagnosed as having epilepsy (e.g., pediatric epilepsy) with a composition described herein.
• Subjects having pediatric epilepsy can be identified by a physician using current methods of diagnosing pediatric epilepsy.
• Symptoms and/or complications of pediatric epilepsy which characterize these conditions and aid in diagnosis are well known in the art and include but are not limited to, staring, seizures, tremors, stiffening of the body, loss of consciousness, breathing problems, lack of response to noise, apparent confusion, extreme sleepiness and irritability upon waking, head nodding, vomiting, changes in vision in speech, and periods of rapid blinking.
• Tests that may aid in a diagnosis of, e.g. epilepsy include, but are not limited to, blood tests,
• EEG electroencephalogram
• CT computed tomography
• MRI magnetic resonance imaging
• PET magnetic resonance imaging
• a family history of epilepsy, or exposure to risk factors for pediatric epilepsy e.g. head injury, brain tumor, trauma, stroke, or certain metabolic problems
• the subject is a pediatric subject.
• a "subject in need" of treatment for a particular condition can be a subject having that condition, diagnosed as having that condition, or at risk of developing that condition.
• administering refers to the placement of a compound as disclosed herein into a subject by a method or route which results in at least partial delivery of the agent at a desired site.
• Pharmaceutical compositions comprising the compounds disclosed herein can be administered by any appropriate route which results in an effective treatment in the subject.
• compositions described herein can be administered orally, e.g., as discrete dosage forms, such as, but not limited to, tablets (including without limitation scored or coated tablets), pills, caplets, capsules, chewable tablets, powder packets, cachets, troches, wafers, aerosol sprays, or liquids, such as but not limited to, syrups, elixirs, solutions or suspensions in an aqueous liquid, a non-aqueous liquid, an oil-in-water emulsion, or a water-in-oil emulsion.
• Such compositions contain a predetermined amount of the pharmaceutically acceptable salt of the disclosed compounds, and may be prepared by methods of pharmacy well known to those skilled in the art. See generally, Remington: The Science and Practice of Pharmacy, 21st Ed., Lippincott, Williams, and Wilkins, Philadelphia PA. (2005).
• compositions described herein can be administered by inhalation, e.g., as a vapor or aerosol formulation or by nebulization.
• a composition described herein can be provided in solution or suspension may be packaged in a pressurized aerosol container together with suitable propellants, for example, hydrocarbon propellants like propane, butane, or isobutane with conventional adjuvants.
• suitable propellants for example, hydrocarbon propellants like propane, butane, or isobutane with conventional adjuvants.
• a composition described herein can also be administered in a non-pressurized form such as in a nebulizer or atomizer.
• a composition can also be administered directly to the airways in the form of a dry powder, e.g., by use with an inhaler.
• Aerosols for the delivery to the respiratory tract are known in the art. See for example, Adjei, A. and Garren, J. Pharm. Res., 1 : 565-569 (1990); Zanen, P. and Lamm, J.-W. J. Int. J. Pharm., 114: 111-115 (1995); Gonda, I. "Aerosols for delivery of therapeutic and diagnostic agents to the respiratory tract," in Critical Reviews in Therapeutic Drug Carrier Systems, 6:273-313 (1990); Anderson et al., Am. Rev. Respir.
• the dosage of a composition as described herein can be determined by a physician and adjusted, as necessary, to suit observed effects of the treatment. With respect to duration and frequency of treatment, it is typical for skilled clinicians to monitor subjects in order to determine when the treatment is providing therapeutic benefit, and to determine whether to increase or decrease dosage, increase or decrease administration frequency, discontinue treatment, resume treatment, or make other alterations to the treatment regimen.
• the dosing schedule can vary from once a week to twice daily depending on a number of clinical factors, such as the subject's sensitivity to the therapy.
• the desired dose or amount of activation can be administered at one time or divided into subdoses, e.g., 2-4 subdoses and administered over a period of time, e.g., at appropriate intervals through the day or other appropriate schedule.
• administration can be chronic, e.g., one or more doses and/or treatments daily over a period of weeks or months .
• a composition described herein can be administered over a period of time, such as over a 5 minute, 10 minute, 15 minute, 20 minute, or 25 minute period.
• Examples of dosing and/or treatment schedules can include weekly, every other day, daily, twice daily, thrice daily, or more frequent administration.
• the compositions described herein are administered daily. In some embodiments of any of the aspects, the compositions described herein are administered twice daily.
• the daily dosage of the compositions described herein is from about 1 mg/kg/day of CBD to about 18 mg/kg/day of CBD. In some embodiments of any of the aspects, the daily dosage of the compositions described herein is from 1 mg/kg/day of CBD to 18 mg/kg/day of CBD. In some embodiments of any of the aspects, the daily dosage of the compositions described herein is from about 5 mg/kg/day of CBD to about 18 mg/kg/day of CBD. In some embodiments of any of the aspects, the daily dosage of the compositions described herein is from 5 mg/kg/day of CBD to 18 mg/kg/day of CBD.
• the daily dosage of the compositions described herein is from about 7 mg/kg/day of CBD to about 18 mg/kg/day of CBD. In some embodiments of any of the aspects, the daily dosage of the compositions described herein is from 7 mg/kg/day of CBD to 18 mg/kg/day of CBD.
• the daily dosage of the compositions described herein is from about 2 mg/kg/day of CBD to about 16 mg/kg/day of CBD. In some embodiments of any of the aspects, the daily dosage of the compositions described herein is from 2 mg/kg/day of CBD to 16 mg/kg/day of CBD.
• the dosage of the composition administered to the subject increases over time, e.g., from a dose of about 1 mg/kg/day of CBD to about 3 mg/kg/day of CBD to a maximal dose. In some embodiments of any of the aspects, the dosage of the composition administered to the subject increases overtime, e.g., from a dose of 1 mg/kg/day of CBD to 3 mg/kg/day of CBD to a maximal dose. In some embodiments of any of the aspects, the dosage is increased at a rate of about 2 mg/kg/day of CBD every 7 days. In some embodiments of any of the aspects, the dosage is increased at a rate of 2 mg/kg/day of CBD every 7 days.
• the maximal dosage of the compositions described herein is from about 11 mg/kg/day of CBD to about 18 mg/kg/day of CBD. In some embodiments of any of the aspects, the maximal dosage of the compositions described herein is from 11 mg/kg/day of CBD to 18 mg/kg/day of CBD. In some embodiments of any of the aspects, the daily dosage of the compositions described herein is from about 13 mg/kg/day of CBD to about 14.5 mg/kg/day of CBD. In some embodiments of any of the aspects, the daily dosage of the compositions described herein is from 13 mg/kg/day of CBD to 14.5 mg/kg/day of CBD. In some embodiments of any of the aspects, the maximal dosage of the compositions described herein is about 16 mg/kg/day of CBD. In some embodiments of any of the aspects, the maximal dosage of the compositions described herein is 16 mg/kg/day of CBD.
• the dosage ranges for the administration of the compositions described herein, according to the methods described herein depend upon, for example, the form of the composition, its potency, and the extent to which symptoms, markers, or indicators of a condition described herein are desired to be reduced, for example the percentage reduction desired for seizure frequency or severity.
• the dosage should not be so large as to cause adverse side effects, as described elsewhere herein.
• the dosage will vary with the age, condition, and sex of the patient and can be determined by one of skill in the art.
• the dosage can also be adjusted by the individual physician in the event of any complication.
• compositions described in e.g. the treatment of a condition described herein, or to induce a response as described herein (e.g. reduction in seizures) can be determined by the skilled clinician.
• a treatment is considered "effective treatment," as the term is used herein, if one or more of the signs or symptoms of a condition described herein are altered in a beneficial manner, other clinically accepted symptoms are improved, or even ameliorated, or a desired response is induced e.g., by at least 10% following treatment according to the methods described herein.
• Efficacy can be assessed, for example, by measuring a marker, indicator, symptom, and/or the incidence of a condition treated according to the methods described herein or any other measurable parameter appropriate, e.g. seizure frequency or the markers described in the Examples herein. Efficacy can also be measured by a failure of an individual to worsen as assessed by hospitalization, or need for medical interventions (i.e., progression of the disease is halted). Methods of measuring these indicators are known to those of skill in the art and/or are described herein.
• Treatment includes any treatment of a disease in an individual or an animal (some non- limiting examples include a human or an animal) and includes: (1) inhibiting the disease, e.g., preventing a worsening of symptoms (e.g. pain or inflammation); or (2) relieving the severity of the disease, e.g., causing regression of symptoms.
• An effective amount for the treatment of a disease means that amount which, when administered to a subject in need thereof, is sufficient to result in effective treatment as that term is defined herein, for that disease.
• the subject can be receiving and/or administered additional therapies and/or therapeutic agents.
• the subject is administered at least one further antiepileptic drug (AED), e.g., concurrently, concomitantly, previously, or subsequently.
• AED antiepileptic drug
• Antiepipleptic drugs or anticonvulsants are known in the art and can include, without limitation, Acetazolamide, Carbamazepine, Clobazam, Clonazepam, Eslicarbazepine acetate, Ethosuximide, Gabapentin, Lacosamide, Lamotrigine, Levetiracetam, Nitrazepam, Oxcarbazepine, Perampanel, Piracetam, Phenobarbital, Phenytoin, Pregabalin, Primidone, Rufinamide, Sodium valproate, Stiripentol, Tiagabine, Topiramate, Vigabatrin, and Zonisamide.
• novel compositions of matter comprising cannabinoids CBD and THC in certain relative ratios.
• novel compositions of matter comprising CBD and THC in certain relative ratios.
• the CBD to THC ratio is at least 20 to 1.
• the CBD to THC ratio is at least 25: 1.
• the CBD to THC ratio is at least 30 to 1.
• the CBD to THC ratio is at least 40 to 1.
• the CBD to THC ratio is at least 50 to 1.
• the present disclosure provides novel medicaments, or pharmaceutical compositions that are beneficial for the treatment or prevention of a disease or condition, or for the alleviation of symptoms of a disease or condition.
• the medicament comprises THC and CBD in certain relative ratios.
• the CBD to THC ratio is at least 20 to 1.
• the CBD to THC ratio is at least 25 to 1.
• the CBD to THC ratio is at least 30 to 1.
• the CBD to THC ratio is at least 40 to 1.
• the CBD to THC ratio is at least 50 to 1.
• the present disclosure also provides novel methods of treatment using the disclosed novel compositions of the present disclosure.
• a method of treatment or prevention of disease comprising administering a therapeutically effective amount of a medicament comprising CBD and THC in certain relative ratios.
• the CBD to THC ratio is at least 20 to 1.
• the CBD to THC ratio is at least 25: 1.
• the CBD to THC ratio is at least 30 to 1.
• the CBD to THC ratio is at least 40 to 1.
• the CBD to THC ratio is at least 50 to 1.
• the disease or condition may be, but is not limited to: seizure disorders such as epilepsy, treatment-resistant epilepsy, Dravet Syndrom, Lennox-Gestaut Syndrome; spasticity disorders such as multiple sclerosis; neurodegenerative disorders such as Parkinson's Disease, Alzheimer's Disease, Huntington's Disease or amyloid lateral sclerosis (ALS); proliferative diseases such as cancer; dermatological conditions such as psoriasis; mental health conditions such as posttraumatic stress disorder (PTSD), insomnia, anxiety, depression, or schizophrenia; respiratory diseases such as chronic obstructive pulmonary disorder (COPD).
• seizure disorders such as epilepsy, treatment-resistant epilepsy, Dravet Syndrom, Lennox-Gestaut Syndrome
• spasticity disorders such as multiple sclerosis
• neurodegenerative disorders such as Parkinson's Disease, Alzheimer's Disease, Huntington's Disease or amyloid lateral sclerosis (ALS); proliferative diseases such as cancer
• dermatological conditions such as psori
• Tilray Cannabis Extract - Active Substance standardized to 100 mg/mL CBD; 2 mg/mL THC as an oral solution
• the overall manufacturing process involves the cultivation of Cannabis sativa L. as the starting material for the production of the Drug Product.
• the cannabis is then subjected to a crude extraction process to produce the Crude Extract.
• the final step in the process is the formulation of the Crude Extract into Drug Product by dissolving in a suitable excipient.
• Cannabis sativa L. strains are grown indoors in a facility established with optimized environmental conditions that are controlled and monitored to assure the production of cannabis to the highest standards of chemical content and microbial purity. The material is milled before extraction to maximize extraction efficiency and is then subjected to a fluid extraction process.
• Milled cannabis is stored in approximately 1 kg quantities in heat sealed polyethylene bags. Labelled storage is room temperature. Material older than six months is subjected to reanalysis prior to being released for extraction.
• Crude extraction involves a proprietary fluid based extraction. Extraction materials comply with USP/EP requirements.
• Crude extract is stored in 1L Type III amber glass bottles with a polypropylene cap.
• Labelled storage is refrigeration. Material older than three months is subjected to reanalysis prior to being released for purification.
• the crude extract is further processed to isolate purified cannabidiol (CBD) and delta-9- tetrahydrocannabinol (THC).
• CBD cannabidiol
• THC delta-9- tetrahydrocannabinol
• TN-501G Drug Product is formulated in grapeseed oil. In-process confirmation of potency is followed by final filling into 25 ml HDPE bottles.
• Dravet syndrome is a devastating syndrome which causes medication resistant epilepsy associated with significant cognitive morbidity and frequent seizures.
• UDEP Epilepsy Patient
• the risk of SUDEP in treatment resistant epilepsy is 1 in 150.
• VNS Vagal Nerve Stimulator
• Tilray TIL-TC 150 is formulated with THC and CBD in grape seed oil at strengths of 2 mg/ml and 100 mg/ml, respectively.
• the product is formulated with standard pharmaceutical excipients .
• the active ingredients in TIL- TC 150 Oil are THC and CBD, present in a 1 : 50 ratio . These active ingredients are derived from Cannabis sativa L. strains produced by Tilray, a federally-licensed producer and distributor of medical cannabis under Health Canada's Marijuana for Medical Purposes Regulations.
• CBD is highly lipid soluble and is a potent inhibitor of CYP2B6, CYP2C8, CYP2C9, CYP2C 19, and CYP3A4. The effects of other concomitant drug levels metabolized by these enzyme systems are not known. CBD is excreted in the urine and feces . The plasma peaks vary significantly between individuals but are typically between 1 to 2 hours . The CBD levels are detected up to 8 hours post administration.
• Cannabinoids are thought to lead to increases in systolic BP over time and decreases in diastolic BP with noted heart rate increase . However, these effects are likely due to elevated THC content and many of the adverse effects are considered in keeping with the psychoactive THC effects . Mixtures of
• cannabinoids are less psychoactive than pure THC . Therefore, a mixture of other cannabinoids (terpenoids, etc.) may also reduce any potential psychoactive issues .
• Gastrointestinal anorexia, loss of appetite, nausea, vomiting, and weight loss
• the low level of these gastrointestinal effects is due to the carrier oil, regardless such side effects are rare with the compositions described herein.
• Psychiatric and behavioural adverse reactions such as aggression, hostility, irritability, anger, and homicidal ideation / threats .
• compositions described herein provide an optimal CBD dose while lowering the THC dose, resulting in superior performance as compared to prior art formulations .
• the dosing titration protocol of up to 16 mg/kg/day of CBD is to reduce the frequency of side effects reported in a patient population.
• Safety and tolerability reviews were conducted by regular clinical evaluations at baseline, every 2 weeks for the first month, monthly for 4 months (to interim outcome stage) then once every 3 months thereafter (for those choosing to continue therapy) .
• CBD were started at 2mg/kg/day CBD and titrated slowly by 2mg/kg/day CBD every 7 days until 16mg/kg/day CBD is reached (or maximal tolerated dose clinically) .
• Patients were also assessed for concomitant AED levels at baseline and maximal tolerated CBD dose . These concomitant AEDs can be adjusted as necessary based on the level and signs/symptoms of toxicity or decline in seizure control.
• Dosing safety was measured by blood work evaluation of renal, hematologic and hepatic function and of AED levels, by parent/caregiver report, by physician assessment, and by assessing caregiver reported tolerability and the Pediatric Epilepsy Side Effects Questionnaire (PESQ) .
• PESQ Pediatric Epilepsy Side Effects Questionnaire
• Efficacy can be assessed by assessing changes from baseline in: seizure frequency using a parent-reported diary; the frequency of use of rescue
• Seizure frequency measurements can also include a 24-hour ambulatory EEG study which measures the percentage change in electrographic seizure frequency and the percentage change in interictal activity (e .g., using spike detection software) .
• Week 8 can be the last increase if the participant increases by this schedule .
• the maximal dose is 16/mg/kg/day CBD .
• Participants can be taking concomitant AED, perhaps 1 -4 AEDs . In addition, they may have a VNS device inserted or be on the ketogenic diet. [0091] It is contemplated that treatment according to the methods described herein reduce seizure frequency due to the addition of a high CBD low THC plant extract option to the patient's current AED regimen.
• compositions described herein can be administered orally.
• a reference to "A and/or B", when used in conjunction with open-ended language such as “comprising” can refer, in one embodiment, to A only (optionally including elements other than B); in another embodiment, to B only (optionally including elements other than A); in yet another embodiment, to both A and B (optionally including other elements); etc.
• the phrase "at least one,” in reference to a list of one or more elements, should be understood to mean at least one element selected from any one or more of the elements in the list of elements, but not necessarily including at least one of each and every element specifically listed within the list of elements and not excluding any combinations of elements in the list of elements.
• This definition also allows that elements may optionally be present other than the elements specifically identified within the list of elements to which the phrase "at least one" refers, whether related or unrelated to those elements specifically identified.
• At least one of A and B can refer, in one embodiment, to at least one, optionally including more than one, A, with no B present (and optionally including elements other than B); in another embodiment, to at least one, optionally including more than one, B, with no A present (and optionally including elements other than A); in yet another embodiment, to at least one, optionally including more than one, A, and at least one, optionally including more than one, B (and optionally including other elements); etc.

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