title: Clinical experiences with cannabinoids in spasticity management in multiple sclerosis.
abstract: BACKGROUND
  Spasticity is a common symptom among patients with multiple sclerosis (MS). This study aims to assess the effectiveness and safety of the combination of delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) in clinical practice for the treatment of spasticity in MS.
  
  
  METHODS
  Retrospective observational study with patients treated with inhaled THC/CBD between April 2008 and March 2012. Descriptive patient and treatment variables were collected. Therapeutic response was evaluated based on the doctor's analysis and overall impression.
  
  
  RESULTS
  Of the 56 patients who started treatment with THC/CBD, 6 were excluded because of missing data. We evaluated 50 patients (42% male) with a median age 47.8 years (25.6-76.8); 38% were diagnosed with primary progressive MS, 44% with secondary progressive MS, and 18% with relapsing-remitting MS. The reason for prescribing the drug was spasticity (44%), pain (10%), or both (46%). Treatment was discontinued in 16 patients because of ineffectiveness (7 patients), withdrawal (4), and adverse effects (5). The median exposure time in patients whose treatment was discontinued was 30 days vs 174 days in those whose treatment continued at the end of the study. THC/CBD was effective in 80% of patients at a median dose of 5 (2-10) inhalations/day. The adverse event profile consisted of dizziness (11 patients), somnolence (6), muscle weakness (7), oral discomfort (2), diarrhoea (3), dry mouth (2), blurred vision (2), agitation (1), nausea (1), and paranoid ideation (1).
  
  
  CONCLUSIONS
  THC/CBD appears to be a good alternative to standard treatment as it improves refractory spasticity in MS and has an acceptable toxicity profile.
authors.affiliation: Servicio de Farmacia, Hospital Universitario y Politécnico La Fe, Valencia, España. Electronic address: lorente_lau@gva.es.
authors.forename: L
authors.initials: L
authors.lastname: Lorente Fernández
authors.affiliation: Servicio de Farmacia, Hospital Universitario y Politécnico La Fe, Valencia, España.
authors.forename: E
authors.initials: E
authors.lastname: Monte Boquet
authors.affiliation: Servicio de Neurología, Hospital Universitario y Politécnico La Fe, Valencia, España.
authors.forename: F
authors.initials: F
authors.lastname: Pérez-Miralles
authors.affiliation: Servicio de Farmacia, Hospital Universitario y Politécnico La Fe, Valencia, España.
authors.forename: I
authors.initials: I
authors.lastname: Gil Gómez
authors.affiliation: Servicio de Neurología, Hospital Universitario y Politécnico La Fe, Valencia, España.
authors.forename: M
authors.initials: M
authors.lastname: Escutia Roig
authors.affiliation: Servicio de Neurología, Hospital Universitario y Politécnico La Fe, Valencia, España.
authors.forename: I
authors.initials: I
authors.lastname: Boscá Blasco
authors.affiliation: Servicio de Farmacia, Hospital Universitario y Politécnico La Fe, Valencia, España.
authors.forename: J L
authors.initials: JL
authors.lastname: Poveda Andrés
authors.affiliation: Servicio de Neurología, Hospital Universitario y Politécnico La Fe, Valencia, España.
authors.forename: B
authors.initials: B
authors.lastname: Casanova-Estruch
mesh_terms: D000328:Adult; D000368:Aged; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D002185:Cannabidiol / Q000009:adverse effects / Q000627:therapeutic use*; D013759:Dronabinol / Q000009:adverse effects / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications; D009128:Muscle Spasticity / Q000188:drug therapy* / Q000209:etiology; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D018712:Analgesics, Non-Narcotic; D002185:Cannabidiol; D013759:Dronabinol
keywords: Cannabidiol; Cannabinoides; Cannabinoids; Delta-9-tetrahidrocannabinol; Delta-9-tetrahydrocannabinol; Efectividad; Effectiveness; Esclerosis múltiple; Espasticidad; Multiple sclerosis; Spasticity